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  1. Current trends in highly active anti-retroviral therapy in an anti-retroviral therapy centre attached to a remote government medical college of Maharashtra, India: a retrospective study

    OpenAIRE

    Pravin S. Rathod; Praveenkumar T Patil; Rekha P. Lohar; A.W. Patil

    2016-01-01

    Background: Highly active anti-retroviral therapy (HAART) became the keystone of national AIDS program. There is lack of awareness and inadequate training about drug safety monitoring among health care professionals in India. Hence, the present study was carried out to study current trends in HAART and pattern of associated adverse drug reactions. Methods: A retrospective observational study was conducted at an anti-retroviral therapy (ART) Centre. A total of 151 HIV/AIDS Patients (old and...

  2. Interferons and interferon (IFN)-inducible protein 10 during highly active anti-retroviral therapy (HAART)-possible immunosuppressive role of IFN-alpha in HIV infection

    DEFF Research Database (Denmark)

    Stylianou, E; Aukrust, P; Bendtzen, K;

    2000-01-01

    Interferons play an important, but incompletely understood role in HIV-related disease. We investigated the effect of HAART on plasma levels of IFN-alpha, IFN-gamma, neopterin and interferon-inducible protein 10 (IP-10) in 41 HIV-infected patients during 78 weeks of therapy. At baseline HIV-infec...... seemed not to involve enhanced lymphocyte apoptosis. Our findings suggest a pathogenic role of IFN-alpha in HIV infection, which may be a potential target for immunomodulating therapy in combination with HAART.......Interferons play an important, but incompletely understood role in HIV-related disease. We investigated the effect of HAART on plasma levels of IFN-alpha, IFN-gamma, neopterin and interferon-inducible protein 10 (IP-10) in 41 HIV-infected patients during 78 weeks of therapy. At baseline HIV...... treatment failure and even high baseline levels of IFN-alpha appeared to predict immunological relapse. Furthermore, we found a markedly suppressive effect of exogenously added IFN-alpha on phytohaemagglutinin-stimulated lymphocyte proliferation in both patients and controls, and this suppressive effect...

  3. Interferons and interferon (IFN)-inducible protein 10 during highly active anti-retroviral therapy (HAART)-possible immunosuppressive role of IFN-alpha in HIV infection

    DEFF Research Database (Denmark)

    Stylianou, E; Aukrust, P; Bendtzen, K;

    2000-01-01

    Interferons play an important, but incompletely understood role in HIV-related disease. We investigated the effect of HAART on plasma levels of IFN-alpha, IFN-gamma, neopterin and interferon-inducible protein 10 (IP-10) in 41 HIV-infected patients during 78 weeks of therapy. At baseline HIV......-infected patients had raised levels of both IP-10 and IFN-alpha compared with healthy controls (n = 19), with particularly high levels in advanced disease. HAART induced a marked decrease in levels of both IFN-alpha, neopterin and IP-10, though not to normal concentrations. In contrast, IFN-gamma levels were low...... throughout the study, and not different from controls. While neopterin and IP-10 remained significantly decreased compared with baseline levels throughout the study, IFN-alpha levels returned to baseline at the end of the study. Persistently high IP-10 and IFN-alpha levels were associated with immunological...

  4. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania.

    NARCIS (Netherlands)

    Hamza, O.; Matee, M.I.N.; Simon, E.N.; Kikwilu, E.; Moshi, M.J.; Mugusi, F.; Mikx, F.H.M.; Verweij, P.E.; Ven, A.J.A.M. van der

    2006-01-01

    ABSTRACT: BACKGROUND: The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+

  5. Ophthalmic manifestations of HIV in the highly active anti-retroviral therapy era.

    Science.gov (United States)

    Mowatt, L

    2013-01-01

    HIV-related eye disease can be classified as retinal HIV microangiopathy, opportunistic infections, neuro-ophthalmic manifestations and unusual malignancies. There is a 52-100% lifetime accumulative risk of HIV patients developing eye problems. Seventy-seven per cent of patients with ocular manifestations of HIV had CD4 counts 100 cells/μL for a minimum of three months. Despite HAART, patients with a CD4 count PORN), less commonly toxoplasmosis, pneumocystis and cryptococcus. Malignancies associated with HIV include Kaposi's sarcoma and conjunctival squamous cell carcinoma. Cranial nerve palsies, optic disc swelling and atrophy are characteristic neuro-ophthalmic features. They usually occur secondary to meningitis/encephalitis (from cryptococcus and tuberculosis). With the advent of HAART, new complications have developed in CMV retinitis: immune recovery uveitis (IRU) and cystoid macula oedema (CMO). Immune recovery uveitis occurs in 71% of patients if HAART is started before the induction of the anti-CMV treatment. However, this is reduced to 31% if HAART is started after the induction treatment. Molluscum contagiosum and Kaposi's sarcoma can spontaneously resolve on HAART. Highly active anti-retroviral therapy has reduced the frequencies of opportunistic infections and improved the remission duration in HIV patients. PMID:24756590

  6. Analysis of HIV- type 1 protease and reverse transcriptase in Brazilian children failing highly active antiretroviral therapy (HAART Análise da protease e transcriptase reversa do HIV-1 em crianças com falha terapêutica em uso de terapia anti-retroviral altamente eficaz (HAART

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    Daisy Maria Machado

    2005-02-01

    Full Text Available The aim of this study was to evaluate the genotypic resistance profiles of HIV-1 in children failing highly active antiretroviral therapy (HAART. Forty-one children (median age = 67 months receiving HAART were submitted to genotypic testing when virological failure was detected. cDNA was extracted from PBMCs and amplified by nested PCR for the reverse transcriptase and protease regions of the pol gene. Drug resistance genotypes were determined from DNA sequencing. According to the genotypic analysis, 12/36 (33.3% and 6/36 (16.6% children showed resistance and possible resistance, respectively, to ZDV; 5/36 (14% and 4/36 (11.1%, respectively, showed resistance and possible resistance to ddI; 4/36 (11.1% showed resistance to 3TC and D4T; and 3/36 (8.3% showed resistance to Abacavir. A high percentage (54% of children exhibited mutations conferring resistance to NNRTI class drugs. Respective rates of resistance and possible resistance to PIs were: RTV (12.2%, 7.3%; APV (2.4%, 12.1%; SQV(0%, 12.1%; IDV (14.6%, 4.9%, NFV (22%, 4.9%, LPV/RTV (2.4%, 12.1%. Overall, 37/41 (90% children exhibited virus with mutations related to drug resistance, while 9% exhibited resistance to all three antiretroviral drug classes.O objetivo deste estudo foi avaliar o perfil de resistência genotípica do HIV-1 em crianças com falha terapêutica ao tratamento anti-retroviral (HAART. Quarenta e uma crianças (idade mediana = 67 meses em uso de HAART foram submetidas ao teste de genotipagem no momento da detecção de falha ao tratamento. Foi realizada extração de cDNA de células periféricas mononucleares e amplificação do mesmo (regiões da transcriptase reversa e protease do gene pol através de PCR-nested. O perfil genotípico foi determinado através do seqüenciamnto de nucleotídeos. De acordo com a análise genotípica, 12/36 (33,3% e 6/36 (16,6% crianças apresentaram, respectivamente, resistência e possível resistência ao AZT; 5/36 (14% e 4/36 (11

  7. Inhibition of CYP2B6 by Medicinal Plant Extracts: Implication for Use of Efavirenz and Nevirapine-Based Highly Active Anti-Retroviral Therapy (HAART in Resource-Limited Settings

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    Nicholas E. Thomford

    2016-02-01

    Full Text Available Highly active antiretroviral therapy (HAART has greatly improved health parameters of HIV infected individuals. However, there are several challenges associated with the chronic nature of HAART administration. For populations in health transition, dual use of medicinal plant extracts and conventional medicine poses a significant challenge. There is need to evaluate interactions between commonly used medicinal plant extracts and antiretroviral drugs used against HIV/AIDS. Efavirenz (EFV and nevirapine (NVP are the major components of HAART both metabolized by CYP2B6, an enzyme that can potentially be inhibited or induced by compounds found in medicinal plant extracts. The purpose of this study was to evaluate the effects of extracts of selected commonly used medicinal plants on CYP2B6 enzyme activity. Recombinant human CYP2B6 was used to evaluate inhibition, allowing the assessment of herb-drug interactions (HDI of medicinal plants Hyptis suaveolens, Myrothamnus flabellifolius, Launaea taraxacifolia, Boerhavia diffusa and Newbouldia laevis. The potential of these medicinal extracts to cause HDI was ranked accordingly for reversible inhibition and also classified as potential time-dependent inhibitor (TDI candidates. The most potent inhibitor for CYP2B6 was Hyptis suaveolens extract (IC50 = 19.09 ± 1.16 µg/mL, followed by Myrothamnus flabellifolius extract (IC50 = 23.66 ± 4.86 µg/mL, Launaea taraxacifolia extract (IC50 = 33.87 ± 1.54 µg/mL, and Boerhavia diffusa extract (IC50 = 34.93 ± 1.06 µg/mL. Newbouldia laevis extract, however, exhibited weak inhibitory effects (IC50 = 100 ± 8.71 µg/mL on CYP2B6. Launaea taraxacifolia exhibited a TDI (3.17 effect on CYP2B6 and showed a high concentration of known CYP450 inhibitory phenolic compounds, chlorogenic acid and caffeic acid. The implication for these observations is that drugs that are metabolized by CYP2B6 when co-administered with these herbal medicines and when adequate amounts of the

  8. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy

    International Nuclear Information System (INIS)

    AIM: To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS: In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV 'viral load'. Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients--severe enough to produce tracheal compression in two patients (one of whom had stridor)--and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION: These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started

  9. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy

    Energy Technology Data Exchange (ETDEWEB)

    Buckingham, S.J.; Haddow, L.J.; Shaw, P.J.; Miller, R.F. E-mail: rmiller@gum.ucl.ac.uk

    2004-06-01

    AIM: To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS: In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV 'viral load'. Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients--severe enough to produce tracheal compression in two patients (one of whom had stridor)--and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION: These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started.

  10. Clients’ Satisfaction with Anti Retroviral Therapy Services at Hamidia Hospital Bhopal

    OpenAIRE

    Bhagat Vimal Kishor, Pal D K, Lodha Rama S, Bankwar Vishal

    2011-01-01

    Background: The HIV/AIDS pandemic is a major public health problem with an estimated 33.33 million people living with the virus globally. Free antiretroviral treatment was initiated in India 2004. Patients’ satisfaction is one of the commonly used outcome measures of patient care. Objective: To assess the satisfaction of people living with HIV/AIDS with services provided at anti retroviral therapy Centre Hamidia Hospital Bhopal. Material and Methods: A hospital based cross-sectional study was...

  11. Dental Caries Prevalence in Human Immunodeficiencyb Virus Infected Patients Receiving Highly Active Anti-Retroviral Therapy in Kermanshah, Iran

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    Loghman Rezaei-Soufi

    2014-03-01

    Full Text Available Objective: Introduction of new approaches for the treatment of human immunodeficiency virus (HIV infection such as anti-retroviral medicines has resulted in an increase in the life expectancy of HIV patient. Evaluating the dental health status as a part of their general health care is needed in order to improve the quality of life in these patients. The aim of this study was to compare the root and crown caries rate in HIV patients receiving highly active antiretroviral therapy (HAART with that rate in HIV patients without treatment option. Materials and Methods: This cross sectional study consisting of 100 individuals of both genders with human immunodeficiency virus were divided into two groups: i. group 1 (treatment group including 50 patients with acquired immunodeficiency syndrome (AIDS receiving HAART and ii. group 2 (control group including 50 HIV infected patients not receiving HAART. Dental examinations were done by a dentist under suitable light using periodontal probe. For each participant, numbers of decay (D, missed (M, filled (F, Decayed missed and filled teeth (DMFT, decay surface (Ds, missed surface (Ms, filled surface (Fs, Decayed missed and filled surfaces (DMFS, and tooth and root caries were recorded. Data were analyzed using Chi-square test and independent t test using SPSS 13.0, while p-value of <0.05 was considered statistically significant in all analysis. Results: The mean and standard deviation (SD of decayed, missed and filled teeth of those who were on highly active antiretroviral therapy was 6.86 ± 3.57, 6.39 ± 6.06 and 1.89 ± 1.93, respectively. There was no significant difference between these values regarding to the treatment of patients. The mean and standard deviation of DMFT, DMFS and the number of decayed root surfaces were 15.14 ± 6.09, 56.79 ± 28.56, and 4.96 ± 2.89 in patients treated by anti-retroviral medicine which were not significantly different compared to those without this treatment

  12. Crystalluria in HIV/AIDS patients on highly active anti-retroviral therapy in the Kumasi metropolis; a cross sectional study

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    Richard K. D. Ephraim

    2014-01-01

    Full Text Available Background: Crystalluria is associated with some highly active anti-retroviral therapies (HAART′s used in the management of HIV/AIDS. Aims: This study used light microscopy to establish the prevalence of crystalluria among HIV/AIDS patients on HAART and identified the routine crystals present in their urine. Materials and Methods: In this simple randomised cross-sectional study, 200 HIV/AIDS participants, comprising 150 on HAART and 50 HAART-naοve were recruited from the HIV clinic at the Komfo Anokye Teaching Hospital (KATH. Urine and blood samples were collected, for urinalysis and the determination of the CD4 count, respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of the participants. Results: The prevalence of crystalluria was higher among HIV-infected persons on HAART than those not on HAART (6.7% vs 4%; P = 0.733. Calcium oxalate and triple phosphate crystals were the crystal types present in their urine (3.5% and 2.5%, respectively and was present only in HIV subjects on first line of treatment (without protease inhibitors. Participants aged between 40-50 years and those with hypersthenuria and acidic urine had the highest amount of crystalluria (41.6%, 83.3%, and 58.3%, respectively. Conclusion: HAART is associated with crystalluria in HIV patients. Light microscopy will be of disgnostic value in resource limited settings.

  13. An audit on virological efficacy of anti-retroviral therapy in a specialist infectious disease clinic.

    LENUS (Irish Health Repository)

    Reyad, A

    2009-06-01

    We have assessed the efficacy of anti retroviral therapy (ART) using undetectable viral load (VL) (<50 RNA copies\\/ml) as a marker of virological success, in patients who have Human Immunodeficiency Virus (HIV) attending the Department of Infectious Disease. A cross-sectional review of patients\\' case notes was used to obtain their demographics and treatment details. 79% (253) of the hospital case notes of clinic population was available for analysis, which represents 90% of those receiving ART in the clinic. 166\\/253 of the cohort were receiving treatment at the time of this study and 95% (157\\/166) of these were on treatment for greater than 6 months. The total virological success rate is 93%, which is comparable to other centres and are as good as those from published clinical trials. 56% of those on therapy who have virological failure were Intravenous Drug Users (IVDUs). Case by case investigation for those with treatment failure is warranted.

  14. Helminthic Infections Rates and Malaria in HIV-Infected Pregnant Women on Anti-Retroviral Therapy in Rwanda

    OpenAIRE

    Emil Ivan; Nigel J Crowther; Eugene Mutimura; Lawrence Obado Osuwat; Saskia Janssen; Grobusch, Martin P.

    2013-01-01

    BACKGROUND: Within sub-Saharan Africa, helminth and malaria infections cause considerable morbidity in HIV-positive pregnant women and their offspring. Helminth infections are also associated with a higher risk of mother-to-child HIV transmission. The aim of this study was to determine the prevalence of, and the protective and risk factors for helminth and malaria infections in pregnant HIV-positive Rwandan women receiving anti-retroviral therapy (ART). METHODOLOGY AND PRINCIPLE FINDINGS: Pre...

  15. Metabolic changes associated with antiretroviral therapy in HIV-positive patients Alteraciones metabólicas asociadas a la terapia anti-retroviral en pacientes HIV-positivos Alterações metabólicas associadas à terapia anti-retroviral em pacientes HIV-positivos

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    Sabrina Esteves de Matos Almeida

    2009-04-01

    Full Text Available OBJECTIVE: To evaluate metabolic changes associated with highly active antiretroviral therapy (HAART in HIV-positive patients, and to identify risk factors associated. METHODS: Retrospective study that included 110 HIV-positive patients who where on HAART in the city of Porto Alegre (Southern Brazil between January 2003 and March 2004. Data on demographic variables, cigarette smoking, diabetes mellitus, cholesterol and triglyceride levels, stage of HIV infection, antiretroviral therapy and HCV coinfection were collected. General linear models procedure for repeated measures was used to test the interaction between HAART and HCV coinfection or protease inhibitor treatment. RESULTS: Total cholesterol, triglycerides, and glucose levels significantly increased after receiving HAART (pOBJETIVO: Evaluar las alteraciones metabólicas asociadas a la terapia anti-retroviral potente en pacientes HIV-positivos e identificar factores de riesgo asociados. MÉTODOS: Estudio retrospectivo con 110 pacientes HIV-positivos que estaban en terapia anti-retroviral potente (HAART en la ciudad de Porto Alegre (Sur de Brasil, entre enero de 2003 y marzo de 2004. Los datos colectados incluyen variables demográficas, tabaquismo, diabetes mellitas, niveles de colesterol y triglicéridos, fase de la infección viral, terapia anti-retroviral y co-infección con hepatitis C. El análisis multivariado para medidas repetidas (General Linear Model procedure for Repeated Measures fue utilizada para analizar la interacción entre el efecto de uso de HAART y el uso de inhibidores de proteasa o co-infección por hepatitis C. RESULTADOS: Fueron observados aumentos significativos en los niveles de colesterol total, triglicéridos y glucosa posterior al tratamiento con HAART (pOBJETIVO: Avaliar as alterações metabólicas associadas à terapia anti-retroviral potente em pacientes HIV-positivos e identificar fatores de risco associados. MÉTODOS: Estudo retrospectivo com 110

  16. Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia

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    Robberstad Bjarne

    2009-07-01

    Full Text Available Abstract Background As the resource implications of expanding anti-retroviral therapy (ART are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. Objective To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART. Findings ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

  17. Supporting children to adhere to anti-retroviral therapy in urban Malawi: multi method insights

    OpenAIRE

    Phiri Sam; Chiunguzeni Darles; Nyirenda Jean; Makwiza Ireen; Weigel Ralf; Theobald Sally

    2009-01-01

    Abstract Background Ensuring good adherence is critical to the success of anti-retroviral treatment (ART). However, in resource-poor contexts, where paediatric HIV burden is high there has been limited progress in developing or adapting tools to support adherence for HIV-infected children on ART and their caregivers. We conducted formative research to assess children's adherence and to explore the knowledge, perceptions and attitudes of caregivers towards children's treatment. Methods All chi...

  18. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy

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    Nosakhare J Iduoriyekemwen

    2013-01-01

    Full Text Available Access to highly active anti-retroviral therapy (HAART has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV; thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child′s urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR. Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR <60 mL/min/1.73 m 2 . Of the 99 children recruited, 60 were males and 39 were females. The mean age of the children was 6.6 ± 3.5 years. All the children were on HAART and 85% had acquired the HIV infection by vertical transmission. The overall prevalence of renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%; 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1% with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 . Renal disease was found to be significantly associated with advanced stage of HIV infection (P < 0.049. Our study showed that t he prevalence of renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection.

  19. Adesão à terapêutica anti-retroviral por indivíduos com HIV/AIDS assistidos em uma instituição do interior paulista Adhesión a la terapéutica anti-retroviral por los individuos con VIH/SIDA de uno servicio del interior paulista Adhesion to anti-retroviral therapy by individuals with HIV/AIDS attended at an institution in the interior of São Paulo

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    Elucir Gir

    2005-10-01

    -retrovirales desde hace en promedio 5 años. La cantidad diaria de comprimidos anti-retrovirales varió de 3 a 24. Como principales dificultades de la adhesión mencionaron: sabor, tamaño, cantidad, olor de los comprimidos (40,0%; efectos colaterales (14,4%; factores psicológicos (13,7%; diferentes horarios de medicación (10,8%. Cuanto a las facilidades, el 26,2% relató horarios coincidentes de los comprimidos; el 16,4% ninguna facilidad y el 16,0% ingestión condicionada a algún hábito. Esos datos requieren de la enfermería mayor vigilancia supervisada, acciones educativas e intervenciones.Inadequate adherence to highly active anti-retroviral therapy (HAART provokes important secondary effects in people living with aids. The objective was to identify the factors that make HAART adherence easy or difficult, according to aids patients attended at a university hospital in the state of São Paulo, Brazil. We interviewed 200 diagnosed aids patients using HAART for at least 6 months. Patients were interviewed individually, using a semi-structured design. Qualitative and quantitative analysis was used. 59% of the participants were men; average age was 38.2 years; 51% did not finish basic education; 50.5% did not perform any remunerated work. Patients had been using anti-retroviral agents for an average time of 5 years. The number of anti-retroviral pills ranged from 3 to 24. The main difficulties mentioned for adherence were: taste, size, number, smell of pills (40.0%; intense collateral effects (14.4%; psychological factors (13.7%; different times to take the pills (10.8%. Patients mentioned the following facilitators: coincidence of times to take the drugs (26.2%, no facility (16.4%, and administration associated to some habit (16.0%. The nursing group needs to reinforce supervised surveillance, educational and intervention actions.

  20. Cancellers - Exploring the Possibility of Receptor Decoy Traps As a Superior Anti-Retroviral Strategy.

    Science.gov (United States)

    Jeremiah, Sundararaj Stanley; Ohba, Kenji; Yamamoto, Naoki

    2016-01-01

    The global Human Immunodeficiency Virus (HIV) pandemic is still spreading due to the lack of ideal anti-retroviral measures and their availability. Till date, all attempts to produce an efficient vaccine have ended with unsatisfactory results. The highly active anti-retroviral therapy (HAART) is the only effective weapon currently available and is widely being used for curtailing the HIV pandemic. However, the HAART is also expected to fail in the near future due to the emergence and dissemination of antiviral resistance. This review sheds light on the reasons for the failure of the conventional anti-viral measures against HIV and the novel anti-retroviral strategies currently being developed. The various principles to be considered for the success of a novel anti-retroviral strategy are elaborately emphasized and an innovative concept is proposed on these lines. The proposed concept intends to use receptor decoy traps (RDT) called cancellers which are erythrocytes expressing the HIV entry receptors on their surface. If successfully developed, the cancellers would be capable of active targeting of the free HIV particles leading to the trapping of the viruses within the canceller, resulting in the neutralization of infectivity of the trapped virus. The possible ways of translating this concept into reality and the probable hurdles that can be encountered in the process are subsequently discussed. Also, the scope of cancellers in therapeutic and/or preventive strategies against HIV infection is envisaged upon their successful development. PMID:25882216

  1. In vivo mitochondrial function in HIV-infected persons treated with contemporary anti-retroviral therapy: a magnetic resonance spectroscopy study.

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    Brendan A I Payne

    Full Text Available Modern anti-retroviral therapy is highly effective at suppressing viral replication and restoring immune function in HIV-infected persons. However, such individuals show reduced physiological performance and increased frailty compared with age-matched uninfected persons. Contemporary anti-retroviral therapy is thought to be largely free from neuromuscular complications, whereas several anti-retroviral drugs previously in common usage have been associated with mitochondrial toxicity. It has recently been established that patients with prior exposure to such drugs exhibit irreversible cellular and molecular mitochondrial defects. However the functional significance of such damage remains unknown. Here we use phosphorus magnetic resonance spectroscopy ((31P-MRS to measure in vivo muscle mitochondrial oxidative function, in patients treated with contemporary anti-retroviral therapy, and compare with biopsy findings (cytochrome c oxidase (COX histochemistry. We show that dynamic oxidative function (post-exertional ATP (adenosine triphosphate resynthesis was largely maintained in the face of mild to moderate COX defects (affecting up to ∼10% of fibers: τ½ ADP (half-life of adenosine diphosphate clearance, HIV-infected 22.1±9.9 s, HIV-uninfected 18.8±4.4 s, p = 0.09. In contrast, HIV-infected patients had a significant derangement of resting state ATP metabolism compared with controls: ADP/ATP ratio, HIV-infected 1.24±0.08×10(-3, HIV-uninfected 1.16±0.05×10(-3, p = 0.001. These observations are broadly reassuring in that they suggest that in vivo mitochondrial function in patients on contemporary anti-retroviral therapy is largely maintained at the whole organ level, despite histochemical (COX defects within individual cells. Basal energy requirements may nevertheless be increased.

  2. Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy

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    Foster Nicola

    2012-09-01

    Full Text Available Abstract Background A scarcity of human resources for health has been identified as one of the primary constraints to the scale-up of the provision of Anti-Retroviral Treatment (ART. In South Africa there is a particularly severe lack of pharmacists. The study aims to compare two task-shifting approaches to the dispensing of ART: Indirectly Supervised Pharmacist’s Assistants (ISPA and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. Methods A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted. Results The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. Conclusions While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

  3. Current trends in highly active anti-retroviral therapy in an anti-retroviral therapy centre attached to a remote government medical college of Maharashtra, India: a retrospective study

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    Pravin S. Rathod

    2016-06-01

    Conclusions: The prescribing pattern of HAART regimens was in accordance with national guidelines for antiretroviral therapy. We recommend a pharmacovigilance system for sustainable management of ADRs in HIV/AIDS patients as we found under reporting of ADRs. [Int J Basic Clin Pharmacol 2016; 5(3.000: 1011-1016

  4. Supporting children to adhere to anti-retroviral therapy in urban Malawi: multi method insights

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    Phiri Sam

    2009-07-01

    Full Text Available Abstract Background Ensuring good adherence is critical to the success of anti-retroviral treatment (ART. However, in resource-poor contexts, where paediatric HIV burden is high there has been limited progress in developing or adapting tools to support adherence for HIV-infected children on ART and their caregivers. We conducted formative research to assess children's adherence and to explore the knowledge, perceptions and attitudes of caregivers towards children's treatment. Methods All children starting ART between September 2002 and January 2004 (when ART was at cost in Malawi were observed for at least 6 months on ART. Their adherence was assessed quantitatively by asking caregivers of children about missed ART doses during the previous 3 days at monthly visits. Attendance to clinic appointments was also monitored. In June and July 2004, four focus group discussions, each with 6 to 8 caregivers, and 5 critical incident narratives were conducted to provide complementary contextual data on caregivers' experiences on the challenges to and opportunities of paediatric ART adherence. Results We followed prospectively 47 children who started ART between 8 months and 12 years of age over a median time on ART of 33 weeks (2–91 weeks. 72% (34/47 never missed a single dose according to caregivers' report and 82% (327/401 of clinic visits were either as scheduled, or before or within 1 week after the scheduled appointment. Caregivers were generally knowledgeable about ART and motivated to support children to adhere to treatment despite facing multiple challenges. Caregivers were particularly motivated by seeing children begin to get better; but faced challenges in meeting the costs of medicine and transport, waiting times in clinic, stock outs and remembering to support children to adhere in the face of multiple responsibilities. Conclusion In the era of rapid scale-up of treatment for children there is need for holistic support strategies that focus

  5. Increased levels of regulatory T cells (T(regs)) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive T(regs)

    DEFF Research Database (Denmark)

    Kolte, L; Gaardbo, J C; Skogstrand, K;

    2008-01-01

    Summary This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores...... if naive T(regs) may represent recent thymic emigrant T(regs). HIV-infected patients treated with HAART with a median of 1 and 5 years were compared with healthy controls. Percentages of T(regs) (CD3(+)CD4(+)CD25(+)CD127(low)), naive T(regs) (CD3(+)CD4(+)CD25(+)CD45RA(+)) and activation markers (CD38......(+)human leucocyte antigen D-related) were determined by flow cytometry. Forkhead box P3 mRNA expression and T cell receptor excision circles (T(REC)) content in CD4(+) cells were determined by polymerase chain reaction and cytokines analysed with Luminex technology. Levels of T(regs) were significantly...

  6. Increased levels of regulatory T cells (Tregs) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive Tregs

    DEFF Research Database (Denmark)

    Kolte, L.; Gaardbo, J.C.; Skogstrand, K.;

    2009-01-01

    This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores if naive...... T(regs) may represent recent thymic emigrant T(regs). HIV-infected patients treated with HAART with a median of 1 and 5 years were compared with healthy controls. Percentages of T(regs) (CD3(+)CD4(+)CD25(+)CD127(low)), naive T(regs) (CD3(+)CD4(+)CD25(+)CD45RA(+)) and activation markers (CD38(+)human...... leucocyte antigen D-related) were determined by flow cytometry. Forkhead box P3 mRNA expression and T cell receptor excision circles (T(REC)) content in CD4(+) cells were determined by polymerase chain reaction and cytokines analysed with Luminex technology. Levels of T(regs) were significantly higher in...

  7. Predictors of mortality among HIV-infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

    Institute of Scientific and Technical Information of China (English)

    Ananya Bhowmik; Subhasis Bhandari; Rajyasree De; Subhasish Kamal Guha

    2012-01-01

    Objective: To assess early mortality and identify its predictors among the ART naive HIV-infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres.Methods: A retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality. Results: The mortality rate at one year was estimated to be 7.66 (95% CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95% CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μL were two times (OR 2.2;95% CI: 1.1-4.4) at risk of death compared to higher CD4 counts. Conclusions: Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.

  8. Assessment of factors influencing adherence to anti-retroviral therapy for human immunodeficiency virus positive mothers and their infected children

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    Arun Kumar De

    2012-01-01

    Full Text Available Background and Objectives: Mothers and children are biologically related and dependent. They should be considered as a single unit which is very important regarding adherence to anti-retroviral therapy (ART. Very high levels of adherence are required for effective ART. We therefore carried out this study to examine the adherence levels and different factors associated with adherence among human immunodeficiency virus (HIV-positive mothers and their HIV-positive children receiving ART. Design and Setting: A hospital-based cross-sectional study. Materials and Methods: Ninety-four HIV-positive mothers and their 94 HIV-positive children under ART attending the ART center of a tertiary care hospital were recruited in this study. Consenting mothers were asked to complete the "Case Study Form" containing socio-demographic and care-giving details. Mothers were also asked to complete the Beck′s depression inventory, State trait anxiety inventory, and Ways of coping inventory. Adherence was assessed using pill count. Criteria for good and poor adherence were defined. Current CD4 counts were retrieved from the hospital record. Results: Fifty-six percent of respondent mothers and 65.8% of respondent children showed good adherence to ART. Different factors were associated with poor adherence in both mothers and their children. Conclusion: Adherence of HIV-positive mothers and their HIV-positive children to ART is influenced by multiple factors and identification of these factors is necessary to get complete adherence to ART. There is statistically significant relationship between maternal and pediatric adherence to ART.

  9. Impaired phagocytosis among patients infected by the human immunodeficiency virus: implication for a role of highly active anti-retroviral therapy

    Science.gov (United States)

    Michailidis, C; Giannopoulos, G; Vigklis, V; Armenis, K; Tsakris, A; Gargalianos, P

    2012-01-01

    In patients with human immunodeficiency virus (HIV) infection, neutrophil and monocyte functions, including phagocytosis, are impaired. The purpose of this study was to investigate changes of phagocytic function and respiratory burst occurring over the course of patients infected by the HIV-1 virus. Treatment-naive patients (group B), patients receiving highly active anti-retroviral treatment (HAART) (group C) and patients in which HAART has failed (group D) were studied and compared with healthy volunteers (group A). Phagocytosis and oxidative burst were evaluated using commercially available kits. Results clearly denote a significant decrease of the phagocytic function of both cell types of groups B and C compared with group A. Among group C patients, those in the upper quartile of CD4 increase had higher oxidative burst compared with patients of the other quartiles. In addition, comparisons clearly showed a lower degree of phagocytic function and of oxidative burst of both monocytes and neutrophils of group D compared with group B. Finally, it was found that monocyte and neutrophil function was correlated inversely to the change in viral load, i.e. the greater the decrease of viral load, the better the phagocytic and oxidative activity. Innate immunity defects appear to be present in HIV-positive patients, regarding phagocytic activity and oxidative burst of monocytes and neutrophils. These defects are greatly influenced by the level of treatment efficacy, with emphasis on CD4 cell counts and viral load. PMID:22288593

  10. Retention of HIV-Infected Children in the First 12 Months of Anti-Retroviral Therapy and Predictors of Attrition in Resource Limited Settings: A Systematic Review

    OpenAIRE

    Abuogi, Lisa L.; Smith, Christiana; Elizabeth J. McFarland

    2016-01-01

    Current UNAIDS goals aimed to end the AIDS epidemic set out to ensure that 90% of all people living with HIV know their status, 90% initiate and continue life-long anti-retroviral therapy (ART), and 90% achieve viral load suppression. In 2014 there were an estimated 2.6 million children under 15 years of age living with HIV, of which only one-third were receiving ART. Little literature exists describing retention of HIV-infected children in the first year on ART. We conducted a systematic sea...

  11. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

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    Andrea J Curtis

    Full Text Available OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART in resource limited settings (RLS. DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41. OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4. The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4. During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years and children aged 5-14 years (25.76 and oral candidiasis was the most common in children <5 years (25.79. Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001. Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly

  12. Improved outcomes from HIV/TB co-infection in Singapore following a switch to earlier anti-retroviral therapy

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    Barnaby Young

    2014-11-01

    Full Text Available Introduction: Recent clinical trials have provided clear evidence to support early anti-retroviral therapy (ART in patients with HIV/TB co-infection and low CD4 counts. We investigated how this has changed treatment and outcomes in Singapore. Materials and Methods: A retrospective review was performed with inpatient and outpatient records for all subjects diagnosed with HIV/TB co-infection from 2006 to 2011 attending the Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore. Data for subjects with a presenting CD4<200 cell/mm3 were extracted and split into two groups, “Delayed”: ART more than 8/52 after starting TB treatment, and “Early”: ART within 8/52 of starting TB treatment. Results: One hundred thirty-four out of 180 subjects in the database met the inclusion criteria for this study, 89 in the delayed group and 45 in the early. No statistically significant differences in baseline demographics between the two groups were identified. Both groups presented with markedly low CD4 counts, with overall 60% <50cells/mm3. Median CD4 counts were lower in the delayed ART group (37 vs 50, p=0.015. Prevalence of other opportunistic infections at TB diagnosis was not significantly different (20%, but TB in the early ART group was more likely to include extra-pulmonary disease (46% vs 57%, p=0.038. Four cases were culture negative, 2 multi-drug resistant and 10 (7.8% were isoniazid mono-resistant. There was a significant trend to earlier ART with more recent TB diagnosis (p<0.001. In the first 365 days after TB diagnosis, 11 deaths occurred in the delayed ART group, and 0 in the early (p=0.033. A Kaplan-Meier time-to-event analysis demonstrated a clear separation in the frequency of death or opportunistic infections at eight weeks (Figure 1, p<0.001. Immune reconstitution disease was significantly more likely in the early ART group, but did not result in death (9% vs 38%, p<0.001. Treatment interruptions due to adverse drug events (ADE

  13. Outcome of surgery in post-cytomegalovirus retinal detachment: Experience before and in the era of highly active anti-retroviral therapy in Indian eyes

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    Ramandeep Singh

    2013-01-01

    Full Text Available Purpose: To evaluate the outcome of surgery for cytomegalovirus associated retinal detachment (CMVRD in human immunodeficiency virus (HIV-infected patients in pre-highly active antiretroviral therapy (HAART and HAART era in Indian eyes. Materials and Methods: Retrospective, we reviewed medical records of all consecutive HIV patients, who underwent surgical repair for CMVRD from July 1998 to June 2011. We divided patients into two groups, i.e. group 1, pre HAART era and group 2, HAART era. We compared two groups for various parameters like visual outcome, surgical success, additional procedures, follow-up, etc., Results: Twenty-eight eyes of 26 patients were included; 12 eyes of the 11 patients in group 1 and 16 eyes of the 15 patients in group 2. Significant visual acuity improvement was seen in both groups. Complete anatomic success was seen in 11 eyes in group 1 and 15 eyes in group 2. One additional procedure in group 1 and 29 additional procedures were done in group 2. A mean follow-up was 16 months in group 1 and 41 months in group 2. Conclusion: There was no difference in outcome in pre-HAART and HAART group, except for longer follow-up and additional surgical procedures in HAART group.

  14. Effect of Micronutrient and Probiotic Fortified Yogurt on Immune-Function of Anti-Retroviral Therapy Naive HIV Patients  

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    J. Dik F. Habbema

    2011-10-01

    Full Text Available Background: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving the immune-function of HIV patients. Objective: Assess the impact of micronutrient supplemented probiotic yogurt on the immune function of HIV patients. Design: We performed a randomized, double blind, controlled trial with CD4 count as primary outcome among HIV patients naïve to anti-retroviral treatment. Secondary outcomes included hematological parameters, incidence of diarrhea and clinical symptoms. A total of 112 HIV patients were randomized to receive a micronutrient fortified yogurt with (n = 55 or without additional probiotic Lactobacillus rhamnosus GR-1 (n = 57 for four weeks. Results: An average decline in CD4 count of −70 cells/μL (95% CI: −154 to −15 was observed in the micronutrient, probiotic group versus a decrease of −63 cells/μL (95% CI: −157 to −30 in the micronutrient control group (p = 0.9. Additional probiotic supplementation was well tolerated and not associated with adverse events. No difference between groups was detected in incidence of diarrhea or clinical symptoms. An improvement of hemoglobin levels was observed for all subjects, based upon a mean difference from baseline of 1.4 g/L (SD = 6 (p = 0.02. Conclusion: The addition of probiotics to a micronutrient fortified yogurt was well tolerated by HIV patients but was not associated with a further increase in CD4 count after one month.

  15. Effects of PPARγ and RBP4 gene variants on metabolic syndrome in HIV-infected patients with anti-retroviral therapy.

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    Yuan-Pin Hung

    Full Text Available BACKGROUND: PPARγ and RBP4 are known to regulate lipid and glucose metabolism and insulin resistance. The influences of PPARγ (C1431T and Pro12Ala and RBP4 (-803GA polymorphisms on metabolic syndrome in HIV-infected patients receiving anti-retroviral therapy were examined in this study. MATERIALS AND METHODS: A cross-sectional study of HIV-1 infected adults with antiretroviral therapy for more than one year in the National Cheng Kung University Hospital was conducted. The gene polymorphisms were determined by quantitative PCR. RESULTS: Ninety-one patients were included in the study. Eighty-two (90.1% patients were males with a mean age of 44.4 years. For the C1431T polymorphism in PPARγ, while patients with the T allele (48.4% had trends toward lower rate of hypertriglyceridemia, the borderline significance together with insignificant power did not support the protective effect of the T allele against development of hypertriglyceridemia. For the Pro12Ala polymorphism in PPARγ, although patients with the Pro/Ala genotype (8.8% had a higher level of serum LDL (138.0 vs. 111.5 mg/dl, P = 0.04 and trends toward higher rates of hypercholesterolemia and serum LDL>110 mg/dl, these variables were found to be independent of the Pro/Ala genotype in the multivariate analysis. For the -803GA polymorphism in RBP4, patients with the A allele (23.1% more often had insulin resistance (HOMA>3.8; 33.3 vs. 8.7%, P = 0.01 and more often received anti-hypoglycemic drugs (14.3 vs. 1.4%, P = 0.04. The detrimental effect of the A allele in RBP4 -803GA polymorphism on development of insulin resistance was supported by the multivariate analysis adjusting for covariates. CONCLUSION: The impacts of PPARγ C1431T and Pro12Ala polymorphisms on metabolism in HIV-infected patients are not significant. RBP4 -803GA polymorphism has increased risk of insulin resistance in HIV-infected patients with anti-retroviral therapy.

  16. Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

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    Theodoridou Maria

    2010-12-01

    Full Text Available Abstract Background The psychosocial development of pediatric HIV patients has not been extensively evaluated. The study objectives were to evaluate whether emotional and social functions are differentially associated with HIV-related complications. Methods A matched case-control study design was conducted. The case group (n = 20 consisted of vertically infected children with HIV (aged 3-18 years receiving HAART in Greece. Each case was matched with two randomly selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to evaluate emotional adjustment and social skills. The Fisher's exact test, student's t-test, and Wilcoxon rank sum test were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups. Results HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging abnormalities with respect to either age at HAART initiation (p = 0.306 or months of HAART treatment (p = 0.964. While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027 and Practical (p = 0.042 Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both Abnormal Emotional Symptoms (p = 0.047 and Hyperactivity scores (p = 0.0009. In contrast, HIV patients with neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033. Conclusions HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with respect to their emotional and activity spheres

  17. Retention of HIV-Infected Children in the First 12 Months of Anti-Retroviral Therapy and Predictors of Attrition in Resource Limited Settings: A Systematic Review

    Science.gov (United States)

    Smith, Christiana; McFarland, Elizabeth J.

    2016-01-01

    Current UNAIDS goals aimed to end the AIDS epidemic set out to ensure that 90% of all people living with HIV know their status, 90% initiate and continue life-long anti-retroviral therapy (ART), and 90% achieve viral load suppression. In 2014 there were an estimated 2.6 million children under 15 years of age living with HIV, of which only one-third were receiving ART. Little literature exists describing retention of HIV-infected children in the first year on ART. We conducted a systematic search for English language publications reporting on retention of children with median age at ART initiation less than ten years in resource limited settings. The proportion of children retained in care on ART and predictors of attrition were identified. Twelve studies documented retention at one year ranging from 71–95% amongst 31877 African children. Among the 5558 children not retained, 4082 (73%) were reported as lost to follow up (LFU) and 1476 (27%) were confirmed to have died. No studies confirmed the outcomes of children LFU. Predictors of attrition included younger age, shorter duration of time on ART, and severe immunosuppression. In conclusion, significant attrition occurs in children in the first 12 months after ART initiation, the majority attributed to LFU, although true outcomes of children labeled as LFU are unknown. Focused efforts to ensure retention and minimize early mortality are needed as universal ART for children is scaled up. PMID:27280404

  18. Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: emerging lessons from Cote d'Ivoire.

    Science.gov (United States)

    Holmes, Kathleen; Winskell, Kate; Hennink, Monique; Chidiac, Sybil

    2011-01-01

    The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Cote d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth. PMID:20936558

  19. Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia

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    Robberstad Bjarne

    2009-04-01

    Full Text Available Abstract Background Little is known about the costs of HIV care in Ethiopia. Objective To estimate the average per person year (PPY cost of care for HIV patients with and without anti-retroviral therapy (ART in a district hospital. Methods Data on costs and utilization of HIV-related services were taken from Arba Minch Hospital (AMH in southern Ethiopia. Mean annual outpatient and inpatient costs and corresponding 95% confidence intervals (CI were calculated. We adopted a district hospital perspective and focused on hospital costs. Findings PPY average (95% CI costs under ART were US$235.44 (US$218.11–252.78 and US$29.44 (US$24.30–34.58 for outpatient and inpatient care, respectively. Estimates for the non-ART condition were US$38.12 (US$34.36–41.88 and US$80.88 (US$63.66–98.11 for outpatient and inpatient care, respectively. The major cost driver under the ART scheme was cost of ART drugs, whereas it was inpatient care and treatment in the non-ART scheme. Conclusion The cost profile of ART at a district hospital level may be useful in the planning and budgeting of implementing ART programs in Ethiopia. Further studies that focus on patient costs are warranted to capture all patterns of service use and relevant costs. Economic evaluations combining cost estimates with clinical outcomes would be useful for ranking of ART services.

  20. Fatores de risco para a não adesão ao tratamento com terapia antiretroviral altamente eficaz Factores de riesgo para la no-adherencia al tratamiento con terapia anti-retroviral altamente eficiente Risk factors for non-compliance to treatment with highly effective antiretroviral therapy

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    Maria Rosa Ceccato Colombrini

    2008-09-01

    Full Text Available O estudo objetivou: mensurar a prevalência de não-adesão à terapia anti-retroviral altamente eficaz (HAART em pacientes com AIDS; identificar se alguns fatores relacionados na literatura estavam associados com a não-adesão; estabelecer o valor preditivo dos fatores associados à não-adesão à HAART. Foi realizado um estudo analítico de prevalência (N=60. Foram considerados os três dias anteriores à entrevista e os pacientes classificados como aderentes quando ingeriam 95% ou mais do total de comprimidos prescritos por dia. A adesão foi de 73,3%. A análise de regressão logística multivariada indicou que indivíduos da raça negra apresentaram 6,48 vezes mais risco de não-adesão; aqueles que apresentaram ausência de efeito colateral tiveram um risco 7,6 vezes maior, e a cada comprimido ingerido o risco foi de 1,12. A adesão observada foi maior que a encontrada na literatura. Os fatores sociodemográficos e culturais podem interferir na adesão à HAART.Objetivo del estudio: medir la prevalencia por falta de seguimiento al tratamiento anti-retroviral altamente eficaz (HAART en pacientes con SIDA; identificar si algunos factores relacionados en la bibliografía se encuentran asociados con la falta de seguimiento; establecer el valor preditivo de los factores asociados con la falta de seguimiento al HAART. Para lo cual fue realizado un estudio analitico de prevalencia (N=60, considerándose los tres días anteriores a la entrevista, donde aquellos pacientes con ingesta del 95% o más del total de comprimidos prescritos por día eran clasificados como seguidores del tratamiento. El seguimiento fue de 73,3%. El análisis de regresion logística multi-variable mostró que sujetos de raza negra presentaron 6,48 veces mayor riesgo de no continuar con el tratamiento; aquellos individuos sin efectos colaterales tuvieron un riesgo 7,6 veces mayor, asimismo, cada comprimido ingerido produjo un riesgo de 1,12. El seguimiento observado fue

  1. Rinossinusites em crianças infectadas pelo HIV sob terapia anti-retroviral Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy

    OpenAIRE

    Carlos Diógenes Pinheiro Neto; Raimar Weber; Bernardo Cunha Araújo-Filho; Ivan Dieb Miziara

    2009-01-01

    A associação dos inibidores de protease (IP) à terapia anti-retroviral provocou mudanças importantes na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto desta associação na prevalência de rinossinusite (RS) e na contagem sérica de linfócitos CD4 em crianças infectadas pelo HIV. CASUÍSTICA E MÉTODOS: A forma de estudo foi cross-sectional com 471 crianças infectadas pelo HIV. Em 1996, inibidores de protease foram liberados para terapia anti-retroviral. Dest...

  2. Abordagem metabólica e nutricional da lipodistrofia em uso da terapia anti-retroviral Metabolic and nutritional approach of lipodystrophy in the use of antiretroviral therapy

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    Claudia Daniele Tavares Dutra

    2008-08-01

    Full Text Available A terapia anti-retroviral altamente ativa, usada contra o Vírus da Imunodeficiência Humana, vem possibilitando a melhora do quadro clínico-laboratorial de portadores da Síndrome da Imunodeficiência Adquirida. Contudo, alterações metabólicas e complicações morfológicas, associadas ao uso da terapia, vêm sendo investigadas. A utilização prolongada desta terapia tem um impacto importante sobre o estado nutricional dos pacientes. Antes da sua utilização, a perda de peso e a desnutrição, conseqüências das infecções oportunistas, eram os maiores problemas nutricionais. Atualmente, o foco principal das discussões têm sido as complicações metabólicas e morfológicas, dentre elas a lipodistrofia, com a dislipidemia, a resistência à insulina, a osteopenia, e a distribuição alterada da gordura corporal, aumentando assim os riscos de doenças cardiovasculares. A nutrição desempenha um papel fundamental no suporte da saúde desses pacientes, integrando as equipes multiprofissionais, promovendo a melhora da adesão à terapia anti-retroviral e do prognóstico da doença. No entanto, para que se tenha mais conhecimento sobre a terapia, as proporções de seus efeitos adversos, e o perfil nutricional desses pacientes, a curto e a longo prazos, é de suma importância que se estude mais sobre este assunto, a fim de permitir perspectivas de um regime terapêutico mais seguro dentro de seus alcances metodológicos, proporcionando uma melhor qualidade de vida aos pacientes.The highly active antiretroviral therapy used against Human Immunodeficiency Virus provides an improvement in laboratory and clinical findings of patients with Acquired Immunodeficiency Syndrome. However, metabolic and morphologic disturbances associated with the therapy are being investigated. The drawn out use of these therapy has an important impact on the nutritional status of the patients. Before the use of this therapy, weight loss and malnutrition caused by

  3. Increased levels of regulatory T cells (Tregs) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive Tregs

    DEFF Research Database (Denmark)

    Kolte, L.; Gaardbo, J.C.; Skogstrand, Kristin;

    2008-01-01

    Summary This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores...... if naive T(regs) may represent recent thymic emigrant T(regs). HIV-infected patients treated with HAART with a median of 1 and 5 years were compared with healthy controls. Percentages of T(regs) (CD3(+)CD4(+)CD25(+)CD127(low)), naive T(regs) (CD3(+)CD4(+)CD25(+)CD45RA(+)) and activation markers (CD38......(+)human leucocyte antigen D-related) were determined by flow cytometry. Forkhead box P3 mRNA expression and T cell receptor excision circles (T(REC)) content in CD4(+) cells were determined by polymerase chain reaction and cytokines analysed with Luminex technology. Levels of T(regs) were significantly...

  4. Rinossinusites em crianças infectadas pelo HIV sob terapia anti-retroviral Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy

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    Carlos Diógenes Pinheiro Neto

    2009-02-01

    Full Text Available A associação dos inibidores de protease (IP à terapia anti-retroviral provocou mudanças importantes na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto desta associação na prevalência de rinossinusite (RS e na contagem sérica de linfócitos CD4 em crianças infectadas pelo HIV. CASUÍSTICA E MÉTODOS: A forma de estudo foi cross-sectional com 471 crianças infectadas pelo HIV. Em 1996, inibidores de protease foram liberados para terapia anti-retroviral. Desta forma, dois grupos de crianças foram formados: as que não fizeram uso de IP e as que fizeram uso desta droga após 1996. A prevalência de RS e a contagem sérica de linfócitos CD4 foram comparadas entre estes grupos. RESULTADOS: 14,4% das crianças infectadas pelo HIV apresentaram RS. A RS crônica foi mais prevalente que a RS aguda em ambos os grupos. Crianças menores de 6 anos tratadas com a associação de IP apresentaram maior prevalência de RS aguda. A associação de IP esteve associada à maior contagem de linfócitos CD4 séricos com menor prevalência de RS crônica. CONCLUSÕES: A terapia com IP esteve associada ao aumento na contagem de linfócitos CD4. Crianças abaixo dos 6 anos em uso de IP apresentaram menor tendência à cronificação da doença.The association of protease inhibitors (PI to antiretroviral therapy has generated sensible changes in morbidity and mortality of HIV-infected patients. AIM: Aims at evaluating the impact of this association on the prevalence of rhinosinusitis (RS and CD4+ lymphocyte count in HIV-infected children. METHODS: Retrospective cross-sectional study of the medical charts of 471 HIV-infected children. In 1996, protease inhibitors were approved for use as an association drug in antiretroviral therapy. Children were divided into two groups: one which did not receive PI and another which received PI after 1996. The prevalence of RS and CD4+ lymphocyte counts were compared between these groups

  5. The factors that influence adherence of pregnant women with HIV/AIDS to anti-retroviral therapy

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    Valéria Lima de Barros

    2011-12-01

    Full Text Available Objective: To learn the experiences of pregnant women with HIV/AIDS in relation to adherence to antiretroviral therapy in two public hospitals of reference for HIV/AIDS in Fortaleza-CE, Brazil. Methods: A descriptive study conducted with 24 pregnant women who were in prenatal care and use of antiretroviral therapy. Sociodemographic and obstetric data and information regarding the experience with antiretroviral therapy adherence were collected from July to September 2009, through a semi-structured interview. Results: Womenhad a mean age of 29, low income, low education and a stable partner. It was found that some factors affect pregnant women adherence to antiretroviral therapy. Among these, stand out not accepting the diagnosis and the absence of signs and symptoms of AIDS. However,the fear of transmitting the virus to the baby acted as a stimulus for pregnant women adhere to treatment. Conclusion: The non-acceptance of diagnosis and the absence of signs and symptoms of AIDS negatively affect pregnant women adherence to antiretroviral treatment. On the other hand, the fear that the child be born with the virus and the desire to continue to live are stimuli to adherence.

  6. Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4(+) T-cell Count and Diarrhea in HIV Patients.

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    Khalil, Shehla; Mirdha, Bijay Ranjan; Sinha, Sanjeev; Panda, Ashutosh; Singh, Yogita; Joseph, Anju; Deb, Manorama

    2015-12-01

    Intestinal parasitic infections are one of the major causes of diarrhea in human immunodeficiency virus (HIV) seropositive individuals. Antiretroviral therapy has markedly reduced the incidence of many opportunistic infections, but parasite-related diarrhea still remains frequent and often underestimated especially in developing countries. The present hospital-based study was conducted to determine the spectrum of intestinal parasitosis in adult HIV/AIDS (acquired immunodeficiency syndrome) patients with or without diarrhea with the levels of CD4(+) T-cell counts. A total of 400 individuals were enrolled and were screened for intestinal parasitosis. Of these study population, 200 were HIV seropositives, and the remaining 200 were HIV uninfected individuals with or without diarrhea. Intestinal parasites were identified by using microscopy as well as PCR assay. A total of 130 (32.5%) out of 400 patients were positive for any kinds of intestinal parasites. The cumulative number of parasite positive patients was 152 due to multiple infections. A significant association of Cryptosporidium (P<0.001) was detected among individuals with CD4(+) T-cell counts less than 200 cells/μl.

  7. Acceptance of Anti-Retroviral Therapy among Patients Infected with HIV and Tuberculosis in Rural Malawi Is Low and Associated with Cost of Transport

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    Rony Zachariah; Anthony David Harries; Marcel Manzi; Patrick Gomani; Roger Teck; Mit Phillips; Peter Firmenich

    2006-01-01

    BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB) patients systematically offered anti-retroviral treatment (ART) in a district hospital in rural Malawi in order to a) determine the acceptance of ART b) conduct a geographic mapping of those placed on ART and c) examine the association between "cost of transport" and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period...

  8. Who has access to counseling and testing and anti-retroviral therapy in Malawi – an equity analysis

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    Banda Talumba

    2009-05-01

    Full Text Available Abstract Background The HIV and AIDS epidemic in Malawi poses multiple challenges from an equity perspective. It is estimated that 12% of Malawians are living with HIV or AIDS among the 15-49 age group. This paper synthesises available information to bring an equity lens on Counselling and Testing (CT and Antiretroviral Therapy (ART policy, practice and provision in Malawi. Methods A synthesis of a wide range of published and unpublished reports and studies using a variety of methodological approaches was undertaken. The analysis and recommendations were developed, through consultation with key stakeholders in Malawi. Findings At the policy level Malawi is unique in having an equity in access to ART policy, and equity considerations are also included in key CT documents. The number of people accessing CT has increased considerably from 149,540 in 2002 to 482,364 in 2005. There is urban bias in provision of CT and more women than men access CT. ART has been provided free since June 2004 and scale up of ART provision is gathering pace. By end December 2006, there were 85,168 patients who had ever started on ART in both the public and private health sector, 39% of the patients were male while 61% were female. The majority of patients were adults, and 7% were children, aged 14 years or below. Despite free ART services, patients, especially poor rural patients face significant barriers in access and adherence to services. There are missed opportunities in strengthening integration between CT and ART and TB, Sexually Transmitted Infections (STI and maternal health services. Conclusion To promote equitable access for CT and ART in Malawi there is need to further invest in human resources for health, and seize opportunities to integrate CT and ART services with tuberculosis, sexually transmitted infections and maternal health services. This should not only promote access to services but also ensure that resources available for CT and ART strengthen

  9. Retinal arterioles narrow with increasing duration of anti-retroviral therapy in HIV infection: a novel estimator of vascular risk in HIV?

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    Sophia Pathai

    Full Text Available OBJECTIVES: HIV infection is associated with an increased risk of age-related morbidity mediated by immune dysfunction, atherosclerosis and inflammation. Changes in retinal vessel calibre may reflect cumulative structural damage arising from these mechanisms. The relationship of retinal vessel calibre with clinical and demographic characteristics was investigated in a population of HIV-infected individuals in South Africa. METHODS: Case-control study of 491 adults ≥30 years, composed of 242 HIV-infected adults and 249 age- and gender-matched HIV-negative controls. Retinal vessel calibre was measured using computer-assisted techniques to determine mean arteriolar and venular diameters of each eye. RESULTS: The median age was 40 years (IQR: 35-48 years. Among HIV-infected adults, 87.1% were receiving highly active antiretroviral therapy (HAART (median duration, 58 months, their median CD4 count was 468 cells/µL, and 84.3% had undetectable plasma viral load. Unadjusted mean retinal arteriolar diameters were 163.67±17.69 µm in cases and 161.34±17.38 µm in controls (p = 0.15. Unadjusted mean venular diameters were 267.77±18.21 µm in cases and 270.81±18.98 µm in controls (p = 0.07. Age modified the effect of retinal arteriolar and venular diameters in relation to HIV status, with a tendency towards narrower retinal diameters in HIV cases but not in controls. Among cases, retinal arteriolar diameters narrowed with increasing duration of HAART, independently of age (167.83 µm 6 years, p-trend = 0.02, and with a HIV viral load >10,000 copies/mL while on HAART (p = 0.05. HIV-related venular changes were not detected. CONCLUSIONS: Narrowing of retinal arteriolar diameters is associated with HAART duration and viral load, and may reflect heightened inflammatory and pro-atherogenic states of the systemic vasculature. Measurement of retinal vascular calibre could be an innovative non-invasive method of estimating vascular risk in HIV

  10. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy

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    Bacha Tigist

    2012-08-01

    to have treatment failure retrospectively by the authors based on their records. Hence, they were not detected and these patients were not offered second line ARTs. Conclusions Having chronic malnutrition, low CD4 at base line, chronic diarrhea after initiation of first line ART, substitution of ART drugs and age less than 3 years old were found to be independent predictors of first line ART failure in children. Most of the first line ART failure cases were not detected early and those that were detected were not switched to second line drugs in a timely fashion. Children with the above risk factors should be closely monitored for a timely switch to second line highly active anti-retroviral therapy.

  11. Estudo da síndrome da ceratoconjuntivite seca de pacientes soropositivos para o vírus da imunodeficiência adquirida humana tipo 1 e com síndrome da imunodeficiência adquirida, em uso ou não de terapia anti-retroviral combinada (HAART

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    Rodrigues Márcia Lopes

    2004-01-01

    Full Text Available OBJETIVOS: Verificar a presença de olho seco e de alterações no epitélio conjuntival em pacientes com sorologia positiva para o HIV-1 e com AIDS; relacionar as eventuais alterações com as características e com outras condições oculares e sistêmicas dos pacientes; estudar a influência da terapia anti-retroviral combinada na ceratoconjuntivite seca (KCS, nos pacientes com AIDS. MÉTODOS: Foram estudados pacientes com confirmação laboratorial da infecção pelo HIV, divididos em 2 grupos: I. HIV+ (sem diagnóstico clínico e com contagem de CD4+ acima de 200 células/mm³ e II. pacientes com AIDS (contagem de CD4+ abaixo de 200 células e/ou manifestação clínica. Foram estudadas alterações oculares, dados laboratoriais, análise do filme lacrimal e estudo da citologia de impressão conjuntival. Método estatístico: qui-quadrado. RESULTADOS: Incluídos 43 pacientes do grupo I e 77 do grupo II. Após a introdução do HAART houve queda significativa das manifestações oculares internas; entretanto, o mesmo não ocorreu com as externas. Dos pacientes que apresentaram quadro clínico de olho seco, 65,1% eram do sexo masculino. As alterações do teste de Schirmer e tempo de ruptura do filme lacrimal não estiveram relacionados com a gravidade da doença pelo HIV e nem com a contagem de CD4+.Todos os pacientes com alterações na citologia de impressão apresentavam KCS e 88,8% pertenciam ao grupo II. Observou-se aumento da freqüência dessas alterações nos pacientes com tempo de doença superior a 4 anos. CONCLUSÃO: O decréscimo da produção lacrimal não esteve relacionado com a gravidade da infecção pelo HIV e a introdução do HAART não interferiu na freqüência da síndrome de olho seco nos pacientes HIV positivos.

  12. Acceptance of Anti-Retroviral Therapy among Patients Infected with HIV and Tuberculosis in Rural Malawi Is Low and Associated with Cost of Transport

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    Zachariah, Rony; Harries, Anthony David; Manzi, Marcel; Gomani, Patrick; Teck, Roger; Phillips, Mit; Firmenich, Peter

    2006-01-01

    Background A study was conducted among newly registered HIV-positive tuberculosis (TB) patients systematically offered anti-retroviral treatment (ART) in a district hospital in rural Malawi in order to a) determine the acceptance of ART b) conduct a geographic mapping of those placed on ART and c) examine the association between “cost of transport” and ART acceptance. Methodology/Principal Findings A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78%) underwent HIV-testing of whom 770 (77%) were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135) were considered eligible for ART of whom only 101(13.6%) accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (X2 for trend = 25.4, P<0.001). Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW) or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0–8.1, P<0.001). Conclusions/Significance ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel. PMID:17205125

  13. Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport.

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    Rony Zachariah

    Full Text Available BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB patients systematically offered anti-retroviral treatment (ART in a district hospital in rural Malawi in order to a determine the acceptance of ART b conduct a geographic mapping of those placed on ART and c examine the association between "cost of transport" and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78% underwent HIV-testing of whom 770 (77% were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135 were considered eligible for ART of whom only 101(13.6% accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (chi(2 for trend = 25.4, P<0.001. Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0-8.1, P<0.001. CONCLUSIONS/SIGNIFICANCE: ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel.

  14. Premature and accelerated ageing: HIV or HAART?

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    Reuben Luke Smith

    2013-01-01

    Full Text Available Highly Active Anti-Retroviral Therapy (HAART has significantly increased life expectancy of the HIV-positive population. Nevertheless, the average lifespan of HIV patients remains shorter compared to uninfected individuals. Immunosenescence, a current explanation for this difference invokes heavily on viral stimulus despite HAART efficiency in viral suppression. We propose here that the premature and accelerated ageing of HIV patients can also be caused by adverse effects of antiretroviral drugs, specifically those that affect the mitochondria. The Nucleoside Reverse Transcriptase Inhibitor (NRTI antiretroviral drug class for instance, is known to cause depletion of mitochondrial DNA via inhibition of the mitochondrial specific DNA polymerase-ƴ. Besides NRTIs, other antiretroviral drug classes such as Protease Inhibitors also cause severe mitochondrial damage by increasing oxidative stress and diminishing mitochondrial function. We also discuss important areas for future research and argue in favour of the use of C. elegans as a novel model system for studying these effects.

  15. Adesão e não-adesão à terapia anti-retroviral: as duas faces de uma mesma vivência Adhesión y no adhesión a la terapia antiretroviral: las dos caras de una misma vivencia Adhesion and non adhesion to anti-retroviral therapy: the two faces of a same experience

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    Ana Lúcia Cardoso Nogueira da Silva

    2009-04-01

    Full Text Available O objetivo do estudo foi compreender, a partir da perspectiva de portadores e familiares, os aspectos que influenciam na adesão à terapêutica anti-retroviral. Trata-se de um estudo descritivo, de natureza qualitativa, desenvolvido no período de junho de 2006 a julho de 2007, junto a 10 indivíduos portadores do HIV/Aids, acompanhados pelo Serviço de Atendimento Especializado em Aids de Campo Mourão - PR e seus familiares. Constituem fatores facilitadores da adesão: adoção de estratégias para lembrar horários e mascarar o gosto do medicamento, ausência de efeitos colaterais, número reduzido de medicamentos a serem ingeridos e capacidade para reconhecê-los, lembrança dos sintomas da doença e o apoio da rede social. A ausência destes fatores pode culminar na não-adesão.El objetivo del estudio fue comprender, a partir de la perspectiva de portadores y familiares, los aspectos que influyen en la adhesión a la terapéutica antiretroviral. Se trata de un estudio descriptivo, de naturaleza cualitativa, desarrollado en el período de junio de 2006 a julio de 2007, junto a 10 individuos portadores del VIH/SIDA, acompañados por el Servicio de Atención Especializado en SIDA de Campo Mourão - PR y sus familiares. Constituyen factores que facilitan la adhesión: adopción de estrategias para recordar horarios y enmascarar el sabor del medicamento, ausencia de efectos colaterales, número reducido de medicamentos a ser ingeridos y capacidad para reconocerlos, recuerdo de los síntomas de la enfermedad y el apoyo de la red social. La ausencia de estos factores puede culminar en la no-adhesión.The objective of the study was to understand, from the perspective of HIV bearers and family, the aspects that influence in the adhesion to the antiretroviral therapy. It is a descriptive study, of qualitative nature, carried out from June 2006 to July 2007, with 10 HIV/Aids positive individuals, attended at the Service of Specialized Care on Aids

  16. The factors that influence adherence of pregnant women with HIV/AIDS to anti-retroviral therapy - doi:10.5020/18061230.2011.p396

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    Valéria Lima de Barros

    2012-01-01

    Full Text Available Objective: To learn the experiences of pregnant women with HIV/AIDS in relation to adherence to antiretroviral therapy in two public hospitals of reference for HIV/AIDS in Fortaleza-CE, Brazil. Methods: A descriptive study conducted with 24 pregnant women who were in prenatal care and use of antiretroviral therapy. Sociodemographic and obstetric data and information regarding the experience with antiretroviral therapy adherence were collected from July to September 2009, through a semi-structured interview. Results: Women had a mean age of 29, low income, low education and a stable partner. It was found that some factors affect pregnant women adherence to antiretroviral therapy. Among these, stand out not accepting the diagnosis and the absence of signs and symptoms of AIDS. However, the fear of transmitting the virus to the baby acted as a stimulus for pregnant women adhere to treatment. Conclusion: The non-acceptance of diagnosis and the absence of signs and symptoms of AIDS negatively affect pregnant women adherence to antiretroviral treatment. On the other hand, the fear that the child be born with the virus and the desire to continue to live are stimuli to adherence.

  17. Associated oral lesions in human immunodefeciency virus infected children of age 1 to 14 years in anti retroviral therapy centers in Tamil Nadu

    OpenAIRE

    R Krishna Kumar; G Mohan; N Venugopal Reddy; V Arun Prasad Rao; M Shameer; Ananthi Christopher

    2013-01-01

    Aim: To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV) infected children of age 1 to 14 years in Anti Retro viral therapy (ART) centres in Tamil Nadu. Materials and Methods: A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ...

  18. Associated oral lesions in human immunodefeciency virus infected children of age 1 to 14 years in anti retroviral therapy centers in Tamil Nadu

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    R Krishna Kumar

    2013-01-01

    Full Text Available Aim: To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV infected children of age 1 to 14 years in Anti Retro viral therapy (ART centres in Tamil Nadu. Materials and Methods: A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ART centers in Villupuram, Vellore and HIV Homes in Thiruvannamalai, Trichy and Salem in Tamil Nadu towns. Statistical Analysis: Statistical Package for Social Science for Windows (version 11 code: 3000135939012345. Result: Of the total 326 children, 201 (61.65% had oral lesions. (68 [20.86%] with Oral Candidiasis [OC], 54 [16.56%] with Angular Cheilitis, 27 [8.28%] with Necrotizing Ulcerative Gingivitis [NUG], 25 [7.66%] with Necrotizing Ulcerative Periodontitis [NUP], 18 [5.53%] with Linear Gingival Erythema [LGE] and 9 [2.76%] with Apthous Ulcer. Conclusion Among the oral lesions in HIV infected children, OC 20.86% was the predominant oral lesion followed by Angular Chelitis 16.56%, NUG 8.28%, NUP 7.66%, LGE5.53% and Apthous Ulcer 2.76%.

  19. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study.

    Science.gov (United States)

    Tumwine, Christopher; Neema, Stella; Wagner, Glenn

    2012-01-01

    In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy-ART) to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their "already healed" peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, "taking care of other illness", and reducing worries. When high religiosity among people living with HIV (PHAs) becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.

  20. Impact of HIV Infection and Anti-Retroviral Therapy on the Immune Profile of and Microbial Translocation in HIV-Infected Children in Vietnam

    Science.gov (United States)

    Bi, Xiuqiong; Ishizaki, Azumi; Nguyen, Lam Van; Matsuda, Kazunori; Pham, Hung Viet; Phan, Chung Thi Thu; Ogata, Kiyohito; Giang, Thuy Thi Thanh; Phung, Thuy Thi Bich; Nguyen, Tuyen Thi; Tokoro, Masaharu; Pham, An Nhat; Khu, Dung Thi Khanh; Ichimura, Hiroshi

    2016-01-01

    CD4+ T-lymphocyte destruction, microbial translocation, and systemic immune activation are the main mechanisms of the pathogenesis of human immunodeficiency virus type 1 (HIV) infection. To investigate the impact of HIV infection and antiretroviral therapy (ART) on the immune profile of and microbial translocation in HIV-infected children, 60 HIV vertically infected children (31 without ART: HIV(+) and 29 with ART: ART(+)) and 20 HIV-uninfected children (HIV(−)) aged 2–12 years were recruited in Vietnam, and their blood samples were immunologically and bacteriologically analyzed. Among the HIV(+) children, the total CD4+-cell and their subset (type 1 helper T-cell (Th1)/Th2/Th17) counts were inversely correlated with age (all p HIV(−) children by the age of 2 years; the CD4/CD8 ratio was inversely correlated with the plasma HIV RNA load and CD8+-cell activation status. Among the ART(+) children, the total CD4+-cell and Th2/Th17/Treg-subset counts and the CD4/CD8 ratio gradually increased, with estimated ART periods of normalization being 4.8–8.3 years, whereas Th1 counts and the CD8+-cell activation status normalized within 1 year of ART initiation. sCD14 levels remained high even after ART initiation. The detection frequency of bacterial 16S/23S ribosomal DNA/RNA in blood did not differ between HIV-infected and -uninfected children. Thus, in children, HIV infection caused a rapid decrease in Treg counts and the early activation of CD8+ cells and monocytes, and ART induced rapid Th1 recovery and early CD8+-cell activation normalization but had little effect on monocyte activation. The CD4/CD8 ratio could therefore be an additional marker for ART monitoring. PMID:27490536

  1. Impact of HIV Infection and Anti-Retroviral Therapy on the Immune Profile of and Microbial Translocation in HIV-Infected Children in Vietnam.

    Science.gov (United States)

    Bi, Xiuqiong; Ishizaki, Azumi; Nguyen, Lam Van; Matsuda, Kazunori; Pham, Hung Viet; Phan, Chung Thi Thu; Ogata, Kiyohito; Giang, Thuy Thi Thanh; Phung, Thuy Thi Bich; Nguyen, Tuyen Thi; Tokoro, Masaharu; Pham, An Nhat; Khu, Dung Thi Khanh; Ichimura, Hiroshi

    2016-01-01

    CD4⁺ T-lymphocyte destruction, microbial translocation, and systemic immune activation are the main mechanisms of the pathogenesis of human immunodeficiency virus type 1 (HIV) infection. To investigate the impact of HIV infection and antiretroviral therapy (ART) on the immune profile of and microbial translocation in HIV-infected children, 60 HIV vertically infected children (31 without ART: HIV(+) and 29 with ART: ART(+)) and 20 HIV-uninfected children (HIV(-)) aged 2-12 years were recruited in Vietnam, and their blood samples were immunologically and bacteriologically analyzed. Among the HIV(+) children, the total CD4⁺-cell and their subset (type 1 helper T-cell (Th1)/Th2/Th17) counts were inversely correlated with age (all p HIV(-) children by the age of 2 years; the CD4/CD8 ratio was inversely correlated with the plasma HIV RNA load and CD8⁺-cell activation status. Among the ART(+) children, the total CD4⁺-cell and Th2/Th17/Treg-subset counts and the CD4/CD8 ratio gradually increased, with estimated ART periods of normalization being 4.8-8.3 years, whereas Th1 counts and the CD8⁺-cell activation status normalized within 1 year of ART initiation. sCD14 levels remained high even after ART initiation. The detection frequency of bacterial 16S/23S ribosomal DNA/RNA in blood did not differ between HIV-infected and -uninfected children. Thus, in children, HIV infection caused a rapid decrease in Treg counts and the early activation of CD8⁺ cells and monocytes, and ART induced rapid Th1 recovery and early CD8⁺-cell activation normalization but had little effect on monocyte activation. The CD4/CD8 ratio could therefore be an additional marker for ART monitoring. PMID:27490536

  2. HIV associated neurocognitive disorders (HAND in Malawian adults and effect on adherence to combination anti-retroviral therapy: a cross sectional study.

    Directory of Open Access Journals (Sweden)

    Christine M Kelly

    Full Text Available Little is known about the prevalence and burden of HIV associated neurocognitive disorder (HAND among patients on combination antiretroviral therapy (cART in sub-Saharan Africa. We estimated the prevalence of HAND in adult Malawians on cART and investigated the relationship between HAND and adherence to cART.HIV positive adults in Blantyre, Malawi underwent a full medical history, neurocognitive test battery, depression score, Karnofsky Performance Score and adherence assessment. The Frascati criteria were used to diagnose HAND and the Global Deficit Score (GDS was also assessed. Blood was drawn for CD4 count and plasma nevirapine and efavirenz concentrations. HIV negative adults were recruited from the HIV testing clinic to provide normative scores for the neurocognitive battery.One hundred and six HIV positive patients, with median (range age 39 (18-71 years, 73% female and median (range CD4 count 323.5 (68-1039 cells/µl were studied. Symptomatic neurocognitive impairment was present in 15% (12% mild neurocognitive disorder [MND], 3% HIV associated dementia [HAD]. A further 55% fulfilled Frascati criteria for asymptomatic neurocognitive impairment (ANI; however factors other than neurocognitive impairment could have confounded this estimate. Neither the symptomatic (MND and HAD nor asymptomatic (ANI forms of HAND were associated with subtherapeutic nevirapine/efavirenz concentrations, adjusted odds ratio 1.44 (CI. 0.234, 8.798; p = 0.696 and aOR 0.577 (CI. 0.09, 3.605; p = 0.556 respectively. All patients with subtherapeutic nevirapine/efavirenz levels had a GDS of less than 0.6, consistent with normal neurocognition.Fifteen percent of adult Malawians on cART had a diagnosis of MND or HAD. Subtherapeutic drug concentrations were found exclusively in patients with normal neurocognitive function suggesting HAND did not affect cART adherence. Further study of HAND requires more robust locally derived normative neurocognitive values and

  3. Impact of HIV Infection and Anti-Retroviral Therapy on the Immune Profile of and Microbial Translocation in HIV-Infected Children in Vietnam

    Science.gov (United States)

    Bi, Xiuqiong; Ishizaki, Azumi; Nguyen, Lam Van; Matsuda, Kazunori; Pham, Hung Viet; Phan, Chung Thi Thu; Ogata, Kiyohito; Giang, Thuy Thi Thanh; Phung, Thuy Thi Bich; Nguyen, Tuyen Thi; Tokoro, Masaharu; Pham, An Nhat; Khu, Dung Thi Khanh; Ichimura, Hiroshi

    2016-01-01

    CD4+ T-lymphocyte destruction, microbial translocation, and systemic immune activation are the main mechanisms of the pathogenesis of human immunodeficiency virus type 1 (HIV) infection. To investigate the impact of HIV infection and antiretroviral therapy (ART) on the immune profile of and microbial translocation in HIV-infected children, 60 HIV vertically infected children (31 without ART: HIV(+) and 29 with ART: ART(+)) and 20 HIV-uninfected children (HIV(−)) aged 2–12 years were recruited in Vietnam, and their blood samples were immunologically and bacteriologically analyzed. Among the HIV(+) children, the total CD4+-cell and their subset (type 1 helper T-cell (Th1)/Th2/Th17) counts were inversely correlated with age (all p < 0.05), whereas regulatory T-cell (Treg) counts and CD4/CD8 ratios had become lower, and the CD38+HLA (human leukocyte antigen)-DR+CD8+- (activated CD8+) cell percentage and plasma soluble CD14 (sCD14, a monocyte activation marker) levels had become higher than those of HIV(−) children by the age of 2 years; the CD4/CD8 ratio was inversely correlated with the plasma HIV RNA load and CD8+-cell activation status. Among the ART(+) children, the total CD4+-cell and Th2/Th17/Treg-subset counts and the CD4/CD8 ratio gradually increased, with estimated ART periods of normalization being 4.8–8.3 years, whereas Th1 counts and the CD8+-cell activation status normalized within 1 year of ART initiation. sCD14 levels remained high even after ART initiation. The detection frequency of bacterial 16S/23S ribosomal DNA/RNA in blood did not differ between HIV-infected and -uninfected children. Thus, in children, HIV infection caused a rapid decrease in Treg counts and the early activation of CD8+ cells and monocytes, and ART induced rapid Th1 recovery and early CD8+-cell activation normalization but had little effect on monocyte activation. The CD4/CD8 ratio could therefore be an additional marker for ART monitoring. PMID:27490536

  4. Genotypic alteration of HAART-persistent HIV-1 reservoirs in vivo

    International Nuclear Information System (INIS)

    Three HIV-1-infected individuals, on virally-suppressive highly active anti-retroviral therapy (HAART), were treated in vivo with anti-retroviral inhibitor intensification and cell stimulatory therapies in attempting to eradicate latent viral reservoirs. Afterwards, the patients ceased all anti-retroviral drugs. Sequences of the V3 region of HIV-1 envelope protein (ENV) from patient peripheral blood mononuclear cell (PBMC) proviral DNA, patient blood plasma viral RNA and virion-associated RNA from viruses amplified by patient cell co-culture, were obtained before, during, and certain times after the clinical regimen. As anticipated, the V3 loop sequencing results indicate diversity in viral strain complexity among the individual patients. However, the detection of unique V3 ENV signature sequences or V3 signatures of low frequency, relative to those observed prior to therapy, indicate that the expression of specific viruses, or viruses of low abundance, can be induced through stimulation in vivo. Furthermore, this stimulation or general immune activation therapy (IAT) approach, consisting of administration of the anti-T-cell receptor antibody, OKT3, and IL-2 in vivo, appeared to have subsequently altered the genotype of the persistent viral reservoir in peripheral blood cells for two of the three patients

  5. Genetic variation of the HIV-1 integrase region in newly diagnosed anti-retroviral drug-naïve patients with HIV/AIDS in Korea.

    Science.gov (United States)

    Kim, J-Y; Kim, E-J; Choi, J-Y; Kwon, O-K; Kim, G J; Choi, S Y; Kim, S S

    2011-08-01

    The survival time of HIV/AIDS patients in Korea has increased since HAART (highly active anti-retroviral therapy) was introduced. However, the occurrence of drug-resistant strains requires new anti-retroviral drugs, one of which, an integrase inhibitor (INI), was approved by the US Food and Drug Administration (FDA) in 2007. INIs have been used for therapy in many countries and are about to be employed in Korea. Therefore, it is important to identify basic mutant variants prior to the introduction of INIs in order to estimate their efficacy. To monitor potential drug-resistant INI mutations in Korean HIV/AIDS patients, the polymorphism of the int gene was investigated together with the pol gene using a genotypic assay for 75 randomly selected Korean HIV-1 patients newly diagnosed in 2007. The drug-resistant mutation sequences were analysed using the Stanford HIV DB and the International AIDS Society resistance testing-USA panel (IAS-USA). Seventy strains of Korean subtype B were compared with foreign subtype-B strains, and there were no significantly different variants of the int gene region in the study population. Major mutation sites in the integrase (E92Q, F121Y, G140A/S, Y143C/R, Q148H/R/K and N155H) were not detected, and only a few minor mutation sites (L74M, V151I, E157Q, V165I, I203M, S230N and D232N) were identified in 21 strains (28%). Resistance due to mutations in the pol gene was observed in a single strain (1.3%) resistant to protease inhibitors (PIs) and in four strains (5.3%) resistant to reverse transcriptase inhibitors (RTIs). In summary, this demonstrates that INIs will be susceptible to drug naïve HIV/AIDS patients in Korea. PMID:20946407

  6. Genetic variation of the HIV-1 integrase region in newly diagnosed anti-retroviral drug-naïve patients with HIV/AIDS in Korea.

    Science.gov (United States)

    Kim, J-Y; Kim, E-J; Choi, J-Y; Kwon, O-K; Kim, G J; Choi, S Y; Kim, S S

    2011-08-01

    The survival time of HIV/AIDS patients in Korea has increased since HAART (highly active anti-retroviral therapy) was introduced. However, the occurrence of drug-resistant strains requires new anti-retroviral drugs, one of which, an integrase inhibitor (INI), was approved by the US Food and Drug Administration (FDA) in 2007. INIs have been used for therapy in many countries and are about to be employed in Korea. Therefore, it is important to identify basic mutant variants prior to the introduction of INIs in order to estimate their efficacy. To monitor potential drug-resistant INI mutations in Korean HIV/AIDS patients, the polymorphism of the int gene was investigated together with the pol gene using a genotypic assay for 75 randomly selected Korean HIV-1 patients newly diagnosed in 2007. The drug-resistant mutation sequences were analysed using the Stanford HIV DB and the International AIDS Society resistance testing-USA panel (IAS-USA). Seventy strains of Korean subtype B were compared with foreign subtype-B strains, and there were no significantly different variants of the int gene region in the study population. Major mutation sites in the integrase (E92Q, F121Y, G140A/S, Y143C/R, Q148H/R/K and N155H) were not detected, and only a few minor mutation sites (L74M, V151I, E157Q, V165I, I203M, S230N and D232N) were identified in 21 strains (28%). Resistance due to mutations in the pol gene was observed in a single strain (1.3%) resistant to protease inhibitors (PIs) and in four strains (5.3%) resistant to reverse transcriptase inhibitors (RTIs). In summary, this demonstrates that INIs will be susceptible to drug naïve HIV/AIDS patients in Korea.

  7. Impacto da Haart na prevalência de otite média crônica em crianças brasileiras infectadas pelo HIV Haart impact on prevalence of chronic otitis media in Brazilian HIV-infected children

    OpenAIRE

    Raimar Weber; Carlos Diógenes Pinheiro Neto; Ivan Dieb Miziara; Bernardo Cunha Araújo Filho

    2006-01-01

    O advento de novas drogas anti-retrovirais como os inibidores de protease provocou mudanças sensíveis na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto das novas drogas anti-retrovirais (Highly Active Anti-retroviral Therapy - HAART) na prevalência de otite média crônica em população pediátrica infectada pelo HIV. MÉTODOS: Analisamos os prontuários de 471 crianças com idade entre zero e 12 anos e 11 meses portadoras de HIV atendidas no ambulatório de AI...

  8. 复方新诺明预防治疗对艾滋病患者生存状况的影响%Effect of co-trimoxazole prophylaxis used for AIDS patients under anti-retroviral therapy

    Institute of Scientific and Technical Information of China (English)

    杨文杰; 梁妍; 李洁; 马彦民; 李宁; 孙定勇; 王哲

    2014-01-01

    Objective To analyze the situation of survival among AIDS patients under co-trimoxazole prophylaxis as initial anti-retroviral therapy(ART),in Henan province during 2007-2011. Methods Information on AIDS patients receiving initial ART during 2007-2011 was collected from the Chinese HIV/AIDS Integrated Control System. Kaplan-Meier estimation was used to generate survival curves,and Cox proportional hazard regression model was used to determine associated factors of survival status. According to the previous CTX use before ART,the subjects were divided into 3 groups including who had never taken CTX,who had taken CTX and still taking now,who had taken CTX and not current taking. Results A total of 13 103 eligible AIDS patients were identified. 1 702 patients died within 6 years after the initiation of ART,with the mortality as 4.46/100 person year. Among the 455 patients who died within 3 months and 970 died within 12 months,the mortality rates were 14.15/100 person year and 7.78/100 person year,respectively. The Kaplan-Meier survival curves showed that the survival time and mortality of the patients who had taken CTX was longer AND lower than those patients who had never taken CTX when starting the ART program. Results from the log-rank test showed that the difference of two groups was statistically significant during 12 months after the ART(log-rank=5.15,P=0.02). After controlling for other variables,results from multivariable analysis of COX model showed that factors as age,gender,marital status,perion between confirmed diagnosis and receiving the ART,baseline CD4+T cells count,clinical stage,initial therapy schedule,date when starting the ART,number of symptoms at baseline,use of CTX before starting the ART and ART being skipped in the last seven days etc,were associated with the time of survival in patients after the initiation of ART. Patients who had been taking CTX at ART initiation were at lower risk of death (adjusted HR=0.71,95%CI:0.63-0.80;P=0

  9. Regulatory T cells in human immunodeficiency virus-infected patients are elevated and independent of immunological and virological status, as well as initiation of highly active anti-retroviral therapy

    DEFF Research Database (Denmark)

    Gaardbo, J.C.; Nielsen, S.D.; Vedel, S.J.;

    2008-01-01

    Infection with human immunodeficiency virus (HIV) causes a dysregulation of the immune system. This is caused by HIV-specific as well as non-specific mechanisms and has not been explained fully. In particular, knowledge is lacking about the potential role of host-mediated immunosuppressive mechan...... found to be independent of both immunological and virological status, indicating that initiation of HAART has minor effects on the T(reg) level in HIV-infected patients....

  10. 人类免疫缺陷病毒感染者混合感染丙型和乙型肝炎病毒后对高效抗逆转录病毒治疗疗效的影响%The influence of human immunodeficiency virus co-infection with hepatitis C virus and hepatitis B virus on the efficacy of high active anti-retroviral therapy

    Institute of Scientific and Technical Information of China (English)

    李晓菲; 阚全程; 何云; 余祖江; 李志勤; 梁红霞

    2010-01-01

    Objective To evaluate the impact of HIV co-infection with HCV or HBV on the efficacy of highly active anti-retroviral therapy (HARRT). Methods The patients were divided into three groups: HIV + HBV + HCV co-infection group ( 23 patients), HIV + HCV co-infection group ( 166 patients), and HIV-only group (178 patients). HIV RNA, HCV RNA or HBV DNA were detected by real time PCR before treatment and 1,3,6,9 and 12 monthes after treatment, meanwhile the counts of CD4+ T lymphocyte and liver function including ALT, AST and TBil were tested. Results During one-year HAART, HIV RNA of HIV-only group, HIV + HBV + HCV co-infection group and HIV + HCV co-infection group decreased significantly from (6.78 ± 1.08), (6.23 ± 1.34), (6.54 ± 1.23) lg copies/ml to (0.53 ±0.15), (0.67 ±0.16),(0.43 ±0.11 ) lg copies/ml respectively (P<.001 ). And CD4+ T lymphocyte counts of the three groups elevated significantly from ( 197 ± 127), (184 ± 113), (213 ± 143) cells/μl to (382 ±74), (383 ±70),(378 ±76) cells/μl respectively (P <0.001 ). However there were no differences among the three groups in HIV RNA and CD4+ T lymphocyte counts. There were no differences in liver functions including ALT,AST and TBil among the three groups. Conclusiom HIV co-infected with HBV and/or HCV does not impact on the efficacy of HAART. What more, HAART does not impact HCV replication.%目的 观察HIV感染者合并HCV和HBV感染后对高效抗逆转录病毒治疗(HAART)疗效的影响.方法 对某地区HIV、HCV共感染患者166例(HIV+HCV组),HIV、HCV和HBV混合感染患者23例(H1V+HCV+HBV组)及单纯HIV感染者178例,给予1年的HAART治疗,观察3组患者病毒学反应、免疫学反应和肝功能动态变化.以流式细胞仪检测外周血CD4+T淋巴细胞;实时PCR定量检测HCV、HIV和HBV病毒载量.结果 单纯HIV感染组、HIV+HCV+HBV组和HIV+HCV组经HAART 1年后,HIV病毒载量分别由治疗前(6.78±1.08)、(6.23±1.34)、(6.54±1.23)lg拷贝/ml下降至(0

  11. Long-term effectiveness of highly active antiretroviral therapy (HAART) in perinatally HIV-infected children in Denmark

    DEFF Research Database (Denmark)

    Bracher, Linda; Valerius, Niels Henrik; Rosenfeldt, Vibeke;

    2007-01-01

    children treated with HAART. Initial HAART included 2 nucleoside reverse-transcriptase inhibitors in combination with either a protease inhibitor (n =38) or a non-nucleoside reverse-transcriptase inhibitor (n =12). 19 (39%) patients were previously treated with mono- or dual therapy. Baseline...

  12. AIDS-Related Non-Hodgkin's Lymphoma in the Era of Highly Active Antiretroviral Therapy

    OpenAIRE

    Prakash Vishnu; Aboulafia, David M.

    2012-01-01

    In economically developed countries, AIDS-related lymphoma (ARL) accounts for a large proportion of malignances in HIV-infected individuals. Since the introduction of highly active anti-retroviral therapy (HAART) in 1996, epidemiology and prognosis of ARL have changed. While there is a slight increase in the incidence of Hodgkin’s lymphoma in HIV-infected individuals, use of HAART has contributed to a decline in the incidence of non-Hodgkin’s lymphoma (NHL) and also a decrease in the overall ...

  13. Início da terapia anti-retroviral em estágio avançado de imunodeficiência entre indivíduos portadores de HIV/AIDS em Belo Horizonte, Minas Gerais, Brasil Initiation of antiretroviral therapy in HIV-infected patients with severe immunodeficiency in Belo Horizonte, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    José Roberto Maggi Fernandes

    2009-06-01

    Full Text Available O objetivo deste trabalho foi verificar a proporção de início tardio da terapia anti-retroviral (TARV e seus fatores associados. Estudo de corte transversal com pacientes de dois serviços públicos de referência (n = 310 em Belo Horizonte, Minas Gerais, Brasil. Atraso no início da TARV foi definido como ter contagem de linfócitos T CD4+ The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm³ or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9%, had no health insurance (76.1%, and started ART less than 120 days after the first medical visit (75.2%. The proportion of delayed ART initiation was 68.4%. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.

  14. A Comparison of the Diabetes Risk Score in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART and HAART-Naive Patients at the Limbe Regional Hospital, Cameroon.

    Directory of Open Access Journals (Sweden)

    Christian Akem Dimala

    Full Text Available Highly active antiretroviral therapy (HAART has been associated with dysglycaemia. However, there is scarce data on the risk of developing diabetes mellitus (DM in HIV/AIDS patients in Africa.Primarily to quantify and compare the risk of having diabetes mellitus in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to determine if there is an association between HAART and increased DM risk.A cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and gender to 100 HAART-naïve patients. The Diabetes Risk Score (DRS was calculated using a clinically validated model based on routinely recorded primary care parameters. A DRS ≥ 7% was considered as indicative of an increased risk of developing DM.The median DRS was significantly higher in patients on HAART (2.30% than in HAART-naïve patients (1.62%, p = 0.002. The prevalence of the increased DM risk (DRS ≥ 7% was significantly higher in patients on HAART, 31% (95% CI: 22.13-41.03 than in HAART-naïve patients, 17% (95% CI: 10.23-25.82, p = 0.020. HAART was significantly associated with an increased DM risk, the odds ratio of the HAART group compared to the HAART-naïve group was 2.19 (95% CI: 1.12-4.30, p = 0.020. However, no association was found after adjusting for BMI-defined overweight, hypertension, age, sex, family history of DM and smoking (Odds ratio = 1.22, 95% CI: 0.42-3.59, p = 0.708. Higher BMI and hypertension accounted for the increased risk of DM in patients on HAART. Also, more than 82% of the participants were receiving or had ever used Zidovudine based HAART regimens.HIV/AIDS patients on HAART could be at a greater risk of having DM than HAART-naïve patients as a result of the effect of HAART on risk factors of DM such as BMI and blood pressure.

  15. Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales Sindrome da lipodistrofia associada com a terapia anti-retroviral em portadores do HIV: considerações para os aspectos psicossociais

    Directory of Open Access Journals (Sweden)

    Ana Paula Morais Fernandes

    2007-10-01

    son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.

  16. Impacto da terapia anti-retroviral na magnitude da epidemia do HIV/AIDS no Brasil: diversos cenários Impact of antiretroviral therapy on the magnitude of the HIV/AIDS epidemic in Brazil: various scenarios

    Directory of Open Access Journals (Sweden)

    Maria Tereza S. Barbosa

    2003-04-01

    Full Text Available Neste trabalho, utilizaram-se os algoritmos EM e EMS aplicados ao método do Cálculo Retroativo para estimar a magnitude da epidemia do HIV no Brasil. Fazendo-se suposições a respeito do comportamento dos infectados, em relação à utilização da terapia combinada das drogas anti-retrovirais, construíram-se cinco cenários para a epidemia brasileira. O objetivo foi o de ilustrar os impactos que a utilização da terapia combinada das drogas anti-retrovirais possam estar tendo ou possam vir a ter na incubação do vírus e, por conseguinte, nas avaliações da epidemia realizadas a partir dos casos de Aids notificados.We applied the back-calculation method to estimate the magnitude of the HIV epidemic in Brazil, using the EM and EMS algorithms. Under certain assumptions regarding the behavior of infected patients towards combined antiretroviral therapy, we discuss five different scenarios applied to the Brazilian epidemic. Our objective was to illustrate the impact of combined antiretroviral treatment on the incubation period and thus on estimates of the size of the HIV-infected population, based on reported AIDS cases.

  17. [Rapid development of anemia in a HIV-positive patient with alpha-thalassemia after zidovudine therapy].

    Science.gov (United States)

    Altinbaş, Akif; Ozkaya, Gülşen; Büyükaşik, Yahya; Unal, Serhat

    2007-07-01

    Anemia, which may develop due to direct effect of the virus or indirect effect of zidovudine a widely used antiviral agent for the treatment, is not an uncommon complication in human immundeficiency virus (HIV) infections. In this report, a 26 years old male HIV positive patient who developed rapid anemia in the HAART (Highly active anti-retroviral therapy) protocol including zidovudine, was presented. The patient has been followed since May 2003 without anti-retroviral therapy. He was diagnosed as alpha-thalassemia trait, because of the low mean red blood cell volume (MCV), high red blood cell count and living in an Mediterranian country. However, no treatment for thalassemia had been given in this period, since the other laboratory findings [hemoglobin, hematocrit, red cell distribution width index (RDWI), iron and iron binding capacity, transferrin saturation and ferritin levels] were normal. During the follow-up of patient, HAART protocol with zidovudine, lamivudine and indinavir, was started depending on the findings of low CD4+ T-cell count (443/mm3) and high HIV serum load (1,330,000 copies/ml). In the second month of the therapy the hemoglobin level decreased to 12.9 gr/dL, and then to 9.9 gr/dL in the fourth month, while it was 14.5 gr/dL before anti-retroviral therapy. Although the patient had no hemolysis findings, and his serum folic acid level was normal, folbiol treatment was initiated with the possibility of the presence of folic acid deficiency at cellular level. Anemia resolved with folic acid replacement without discontinuation of zidovudine or a reduction in dosage. It was thought that the presence of alpha-thalassemia co-morbidity has facilitated the development of anti-retroviral-induced anemia in this patient. As a result, it is concluded that thalassemia should be considered in the differential diagnosis of anemia in HIV positive patients, especially for the ones from Mediterranian countries.

  18. Prevalence of depressive symptoms amongst highly active antiretroviral therapy (HAART patients in AIDSRelief Uganda

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    Constance Shumba

    2013-11-01

    Full Text Available There is limited data on the prevalence of depression in HIV and AIDS patients in Sub- Saharan Africa and little resources have been allocated to address this issue. Depression affects patient adherence to treatment and predisposes patients to resistance which poses a public health threat. It also affects quality of life and productivity of patients. From August 2008 to March 2009, 731 patient adherence surveys were administered to assess disease, treatment knowledge and services received. The primary variable of interest was patients’ level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion and was categorized as no depressive symptoms (score 0, low depressive symptoms (score 1-2, moderate depressive symptoms (score 3-4 and high depressive symptoms (score 5-10. Majority of the patients on highly active antiretroviral therapy (HAART (59% were found to have depressive symptoms and this was more among women than men (66% vs 43%. There was some association of depressive symptoms with non-disclosure (70% of those who had not disclosed had depressive symptoms compared to 53% among those who had disclosed. There is a high prevalence of depressive symptoms among adult patients on HAART. There is need for in-depth evaluation to find out the root causes of depressive symptoms among HAART patients in AIDSRelief clinics. There is need to integrate mental health management in HIV care and treatment as well as training the existing health workers on mental health management.

  19. Tratamiento antirretroviral en pacientes con sida y micobacteriosis Anti-retroviral treatment in patients with AIDS and mycobacterial diseases

    Directory of Open Access Journals (Sweden)

    Marcelo E. Corti

    2005-08-01

    Full Text Available La tuberculosis y otras micobacteriosis constituyen asociaciones o coinfecciones frecuentes en pacientes con sida y se asocian con una elevada mortalidad. En esta revisión se actualizan los tratamientos de las principales enfermedades micobacterianas asociadas al sida (tuberculosis y micobacteriosis por Mycobacterium avium, con especial énfasis en las interacciones farmacológicas entre antimicobacterianos, principalmente rifampicina y claritromicina, y fármacos antirretrovirales. Se analizan los esquemas de tratamiento, su duración, la quimioprofilaxis primaria y secundaria y el momento óptimo de iniciación del tratamiento antirretroviral. Finalmente se describe el síndrome inflamatorio de reconstitución inmune y su tratamiento.Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease, under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.

  20. Access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region 2002-2006

    DEFF Research Database (Denmark)

    Stengaard, Annemarie Rinder; Lazarus, Jeff; Donoghoe, Martin C;

    2009-01-01

    assessed by comparing the percentage of reported HIV cases with the percentage of HAART recipients in women at the end of 2002 and 2006 and in children at the end of 2004 and 2006. Findings. Overall, the data suggest that there is equivalence of access to antiretroviral therapy by gender and age in Europe...

  1. SERUM LIPID PROFILE AND TRANSAMINASES LEVELS IN HIV PATIENTS ON HAART WITH ADIPOSE TISSUE ALTERATIONS

    Directory of Open Access Journals (Sweden)

    Vijay

    2016-02-01

    Full Text Available BACKGROUND HIV patients receiving highly active Anti-Retroviral Therapy (HAART usually suffer from side effects like hepatitis, neurological problems, abnormal fat distribution etc. Among these, the most physical, mental and cosmetically disturbing side effect is adipose tissue alterations (ATA, also called as lipodystrophy, which is abnormal fat deposition (Lipohypertrophy and/or fat atrophy (Lipoatrophy. AIM Several studies have shown dyslipidemia in patients on HAART, but there are very few studies on the lipid profile changes in patients on ART with ATA. Hence a study was conducted to assess the serum lipid profile and transaminases activity in patients on ART with ATA and also to evaluate whether lipid profile parameters can predict ATA changes in HIV patients on HAART. METHOD Randomly selected HIV positive patients, who were attending ART centre, were included in the study. Twenty five of these patients in whom HAART was yet to be started were considered as Control group, 25 patients on HAART for more than 12 months but without ATA as ART group and 23 patients on HAART with ATA as ATA group. Lipid profile and serum transaminases in all the groups were assayed by standard methods. RESULTS Serum cholesterol and LDL were significantly increased in ART group and ATA group when compared to control group, but there was no significant difference in lipid profile parameters between ART group and ATA group. Serum AST and ALT levels were significantly increased (p<0.02 in ATA group when compared to ART group. Buffalo hump was seen only in females in our study. Lipoatrophy (facial and limbs and central obesity was seen in males. CONCLUSION There was no significant change in lipid profile parameters in ATA group when compared with ART group. Hence lipid profile parameters are not good predictors of ATA changes in HIV patients on HAART. Significant increase in transaminase levels suggests increased hepatotoxity in ATA patients due to HAART drugs. There

  2. The influence of HAART on the efficacy and safety of pegylated interferon and ribavirin therapy for the treatment of chronic HCV infection in HIV-positive individuals

    Directory of Open Access Journals (Sweden)

    Vogel M

    2010-03-01

    Full Text Available Abstract Objective This study was performed to investigate the impact of HAART versus no HAART and nucleoside free versus nucleoside containing HAART on the efficacy and safety of pegylated interferon and ribavirin therapy for the treatment of chronic HCV infection in HIV/HCV co-infected patients. In addition a control group of HCV mono-infected patients undergoing anti-HCV therapy was evaluated. Methods Multicenter, partially randomized, controlled clinical trial. HIV-negative and -positive patients with chronic HCV infection were treated with pegylated interferon alfa-2a and ribavirin (800 - 1200 mg/day for 24 - 48 weeks in one of four treatment arms: HIV-negative (A, HIV-positive without HAART (B and HIV-positive on HAART (C. Patients within arm C were randomized to receive open label either a nucleoside containing (C1 or a nucleoside free HAART (C2. Results 168 patients were available for analysis. By intent-to-treat analysis similar sustained virological response rates (SVR, negative HCV-RNA 24 weeks after the end of therapy were observed comparing HIV-negative and -positive patients (54% vs. 54%, p = 1.000. Among HIV-positive patients SVR rates were similar between patients off and on HAART (57% vs. 52%, p = 0.708. Higher SVR rates were observed in patients on a nucleoside free HAART compared to patients on a nucleoside containing HAART, though confounding could not be ruled out and in the intent-to-treat analysis the difference was not statistically significant (64% vs. 46%, p = 0.209. Conclusions Similar response rates for HCV therapy can be achieved in HIV-positive and -negative patients. Patients on nucleoside free HAART reached at least equal rates of sustained virological response compared to patients on standard HAART.

  3. Effects of Hormonal Contraception on Anti-Retroviral Drug Metabolism, Pharmacokinetics and Pharmacodynamics

    OpenAIRE

    THURMAN, Andrea Ries; Anderson, Sharon; Doncel, Gustavo F.

    2014-01-01

    Among women, human immunodeficiency virus type 1 (HIV-1) infection is most prevalent in those of reproductive age. These women are also at risk of unintended or mistimed pregnancies. Hormonal contraceptives (HCs) are one of the most commonly used methods of family planning world-wide. Therefore concurrent use of HC among women on anti-retroviral medications (ARVs) is increasingly common. ARVs are being investigated and have been approved for pre-exposure prophylaxis (PrEP), and therefore drug...

  4. Effects of highly active antiretroviral therapy (HAART) on psychomotor performance in children with HIV disease

    NARCIS (Netherlands)

    S. Koekkoek; L. Eggermont; L. de Sonneville; T. Jupimai; S. Wicharuk; W. Apateerapong; T. Chuenyam; J. Lange; F. Wit; C. Pancharoen; P. Phanuphak; J. Ananworanich

    2006-01-01

    Objective This study assesses the effects of HAART on psychomotor performance of symptomatic HIV-infected children. It is one of the first studies to look at neurobehavioral functioning in children infected with HIV in resource-limited countries. Design A longitudinal pilot study of vertically HIV-i

  5. [Pontine reversible leucopathy in an AIDS patient associated with highly active antiretroviral therapy (HAART): Report of one case].

    Science.gov (United States)

    Cartier, Luis; Matamala, José Manuel; Yáñez, Alonso

    2016-05-01

    Posterior reversible encephalopathy (PRES) is a condition characterized by T2 and FLAIR hyperintensities in magnetic resonance imaging (MRI) studies, localized preferentially in the occipital-parietal white matter regions. Pathological MRI images located in midbrain, pons, medulla and spinal cord, that could be asymptomatic, were recently included in this entity. These images are interpreted as vasogenic edema, which is caused by arterial hypertension or eclampsia, neurotoxicity related to immunosuppressive agents or chemotherapy, among other causes. We report a 25 years old asymptomatic male with AIDS, with normal blood pressure who after initiating highly active antiretroviral therapy (HAART) reported vertigo. The MRI showed a central pontine T2 hyperintensity with diffusion restriction, which was interpreted as a central pontine myelinolysis (CPM), but the lack of motor symptoms made improbable a real demyelination of the pons. The follow-up MRI revealed complete regression of the images. To our knowledge, this case could be the second report of a reversible leucopathy of the pons in a patient with AIDS, were the MRI images also simulated a CPM. This report extends the knowledge around the variability of the pathogenic interpretation of CPM images and their association with HAART. PMID:27552021

  6. Liver Enzymes Abnormalities among Highly Active Antiretroviral Therapy Experienced and HAART Naïve HIV-1 Infected Patients at Debre Tabor Hospital, North West Ethiopia: A Comparative Cross-Sectional Study

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    Melashu Balew Shiferaw

    2016-01-01

    Full Text Available Liver disease has emerged as the most common non-AIDS-related cause of death in HIV patients. However, there is limited data regarding this condition including our setting in Ethiopia. Hence, liver enzyme abnormalities among highly active antiretroviral therapy (HAART experienced and HAART naïve patients were assessed in this study. A total of 164 HAART experienced and 164 HAART naïve patients were studied. Blood specimen was collected to determine alanine aminotransferase (ALT and aspartate aminotransferase (AST, CD4 count, and viral hepatitis. The prevalence of liver enzyme abnormality was 20.1% and 22.0% among HAART experienced and HAART naïve patients, respectively. The HAART experienced patients had higher mean ALT than HAART naïve patients (P=0.002. Viral hepatitis (AOR = 6.02; 95% CI = 1.87–19.39, opportunistic infections (AOR = 2.91; 95% CI = 1.04–8.19, current CD4 count <200 cells/mm3 (AOR = 2.16; 95% CI = 1.06–4.39, and male sex (AOR = 1.83; 95% CI = 1.001–3.33 were associated with elevated ALT and/or AST. In conclusion, liver enzyme abnormalities were high in both HAART experienced and HAART naïve HIV-1 infected patients. Hence, monitoring and management of liver enzyme abnormalities in HIV-1 infected patients are important in our setting.

  7. Highly Active Antiretroviral Therapy (HAART)-Related Hypertriglyceridemia Is Associated With Failure of Recovery of CD14lowCD16+ Monocyte Subsets in AIDS Patients

    OpenAIRE

    Han, Junyan; Zhao, Hongxin; Ma, Yaluan; Zhou, Haiwei; Hao, Yu; Li, Yanmei; Song, Chuan; Han, Ning; Liu, Xiangyi; Zeng, Hui; QIN, MINGZHAO

    2015-01-01

    Abstract As cellular reservoirs, CD16+ monocyte subsets play important roles in the progression of HIV infection. Previous studies have shown that highly active antiretroviral therapy (HAART) reduced the percentages of CD14highCD16+ monocyte subsets, but did not recover the percentages of CD14lowCD16+ subsets. Eighty-four chronic HIV-infected, HAART-naïve individuals and 55 HIV-negative subjects (31 without hyperlipidemia and 24 with hypertriglyceridemia) were enrolled. Plasma HIV-1 RNA level...

  8. HIV-1 and T cell dynamics after interruption of highly active antiretroviral therapy (HAART) in patients with a history of sustained viral suppression

    Science.gov (United States)

    Davey, Richard T.; Bhat, Niranjan; Yoder, Christian; Chun, Tae-Wook; Metcalf, Julia A.; Dewar, Robin; Natarajan, Ven; Lempicki, Richard A.; Adelsberger, Joseph W.; Miller, Kirk D.; Kovacs, Joseph A.; Polis, Michael A.; Walker, Robert E.; Falloon, Judith; Masur, Henry; Gee, Dennis; Baseler, Michael; Dimitrov, Dimiter S.; Fauci, Anthony S.; Lane, H. Clifford

    1999-01-01

    Identifying the immunologic and virologic consequences of discontinuing antiretroviral therapy in HIV-infected patients is of major importance in developing long-term treatment strategies for patients with HIV-1 infection. We designed a trial to characterize these parameters after interruption of highly active antiretroviral therapy (HAART) in patients who had maintained prolonged viral suppression on antiretroviral drugs. Eighteen patients with CD4+ T cell counts ≥ 350 cells/μl and viral load below the limits of detection for ≥1 year while on HAART were enrolled prospectively in a trial in which HAART was discontinued. Twelve of these patients had received prior IL-2 therapy and had low frequencies of resting, latently infected CD4 cells. Viral load relapse to >50 copies/ml occurred in all 18 patients independent of prior IL-2 treatment, beginning most commonly during weeks 2–3 after cessation of HAART. The mean relapse rate constant was 0.45 (0.20 log10 copies) day−1, which was very similar to the mean viral clearance rate constant after drug resumption of 0.35 (0.15 log10 copies) day−1 (P = 0.28). One patient experienced a relapse delay to week 7. All patients except one experienced a relapse burden to >5,000 RNA copies/ml. Ex vivo labeling with BrdUrd showed that CD4 and CD8 cell turnover increased after withdrawal of HAART and correlated with viral load whereas lymphocyte turnover decreased after reinitiation of drug treatment. Virologic relapse occurs rapidly in patients who discontinue suppressive drug therapy, even in patients with a markedly diminished pool of resting, latently infected CD4+ T cells. PMID:10611346

  9. Impacto da Haart na prevalência de otite média crônica em crianças brasileiras infectadas pelo HIV Haart impact on prevalence of chronic otitis media in Brazilian HIV-infected children

    Directory of Open Access Journals (Sweden)

    Raimar Weber

    2006-08-01

    Full Text Available O advento de novas drogas anti-retrovirais como os inibidores de protease provocou mudanças sensíveis na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto das novas drogas anti-retrovirais (Highly Active Anti-retroviral Therapy - HAART na prevalência de otite média crônica em população pediátrica infectada pelo HIV. MÉTODOS: Analisamos os prontuários de 471 crianças com idade entre zero e 12 anos e 11 meses portadoras de HIV atendidas no ambulatório de AIDS de Clínica Otorrinolaringológica do HCFMUSP. As crianças foram divididas em dois grupos, de acordo com a faixa etária: 0 a 5 anos e 11 meses e 6 a 12 anos e 11 meses, e classificadas como portadoras de otite média crônica, baseadas em achados de anamnese, otoscopia, audiometria e imitanciometria. As prevalências de otite média crônica apresentadas e as contagens de linfócitos T CD4+ foram comparadas entre as crianças em uso ou não de HAART. RESULTADOS: Das 459 crianças atendidas, 65 (14,2% apresentavam otite média crônica. Observamos, nas crianças de 0 a 5 anos e 11 meses que o uso de HAART esteve associado a significante menor prevalência de otite média crônica (p = 0,02, e maior contagem de linfócitos T CD4+ (p The advent of new antiretroviral drugs such as protease inhibitors has generated sensible changes in morbity and mortality in HIV-infected patients. OBJECTIVES: To evaluate the impact of Highly Active Antiretroviral Therapy (HAART on the prevalence of chronic otitis media in HIV-infected pediatric population. METHODS: We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection from an Ambulatory of ENT and AIDS. Children were divided according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months and classified as having chronic otitis media based on history, physical examination, audiologic and tympanometric data. Prevalence of chronic otitis media, as well as

  10. Access to highly active antiretroviral therapy (HAART) for injecting drug users in the WHO European Region 2002-2004

    DEFF Research Database (Denmark)

    Donoghoe, Martin C; Bollerup, Annemarie R; Lazarus, Jeff;

    2007-01-01

    Providing equitable access to highly active antiretroviral treatment (HAART) to injecting drug users (IDUs) is both feasible and desirable. Given the evidence that IDUs can adhere to HAART as well as non-IDUs and the imperative to provide universal and equitable access to HIV/AIDS treatment for a...

  11. A prospective study, to determine adverse effects of anti-retroviral agents in rural tertiary care teaching hospital

    OpenAIRE

    Swapnil Chudaman Jaykare; Jyoti Ramchandra Patil; Vijay Motiram Motghare; Sudhir Laxmanrao Padwal; Vinod Shivajirao Deshmukh; Harshal Nutanrao Pise

    2016-01-01

    Background: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Objective of this study was to evaluate the adverse drug reaction profile of anti-retroviral drugs in HIV patients in terms of causality, severity and preventability. Methods: Patients newly started on ART were followed prospectively for a period of initial six months and were interviewed in person during their routine follow-up or visit following ...

  12. The occurrence of anti-retroviral compounds used for HIV treatment in South African surface water

    International Nuclear Information System (INIS)

    The study and quantification of personal care products, such as pharmaceuticals, in surface water has become popular in recent years; yet very little description of these compounds’ presence in South African surface water exists in the literature. Antiretrovirals (ARVs), used to treat human immunodeficiency virus (HIV) are rarely considered within this field. A new method for the simultaneous quantification of 12 antiretroviral compounds in surface water using the standard addition method is described. Water samples were concentrated by a generic automated solid phase extraction method and analysed by ultra-high pressure liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). Substantial matrix effect was encountered in the samples with an average method detection limit of 90.4 ng/L. This is the first reported countrywide survey of South African surface water for the quantification of these compounds with average concentrations ranging between 26.5 and 430 ng/L. - Highlights: • An LC-MS/MS method for the detection of 12 antiretroviral drugs was developed. • The compounds were detected in South African surface water for the first time. • Targets occurred in the low to mid ng/L range. • Nevirapine occurred ubiquitously across all the samples tested. • Matrix effect was corrected for using a modified standard addition method. - This work represents the first quantitative description of anti-retrovirals, as a group, in surface water using a modified standard addition method and UHPLC-MS/MS

  13. Premature and accelerated aging: HIV or HAART?

    NARCIS (Netherlands)

    R.L. Smith; R. de Boer; S. Brul; Y. Budovskaya; H. van der Spek

    2013-01-01

    Highly active antiretroviral therapy (HAART) has significantly increased life expectancy of the human immunodeficiency virus (HIV)-positive population. Nevertheless, the average lifespan of HIV-patients remains shorter compared to uninfected individuals. Immunosenescence, a current explanation for t

  14. Perinatal genotoxicity and carcinogenicity of anti-retroviral nucleoside analog drugs

    International Nuclear Information System (INIS)

    The current worldwide spread of the human immunodeficiency virus-1 (HIV-1) to the heterosexual population has resulted in approximately 800 000 children born yearly to HIV-1-infected mothers. In the absence of anti-retroviral intervention, about 25% of the approximately 7000 children born yearly to HIV-1-infected women in the United States are HIV-1 infected. Administration of zidovudine (AZT) prophylaxis during pregnancy reduces the rate of infant HIV-1 infection to approximately 7%, and further reductions are achieved with the addition of lamivudine (3TC) in the clinical formulation Combivir. Whereas clinically this is a remarkable achievement, AZT and 3TC are DNA replication chain terminators known to induce various types of genotoxicity. Studies in rodents have demonstrated AZT-DNA incorporation, HPRT mutagenesis, telomere shortening, and tumorigenicity in organs of fetal mice exposed transplacentally to AZT. In monkeys, both AZT and 3TC become incorporated into the DNA from multiple fetal organs taken at birth after administration of human-equivalent protocols to pregnant dams during gestation, and telomere shortening has been found in monkey fetuses exposed to both drugs. In human infants, AZT-DNA and 3TC-DNA incorporation as well as HPRT and GPA mutagenesis have been documented in cord blood from infants exposed in utero to Combivir. In infants of mice, monkeys, and humans, levels of AZT-DNA incorporation were remarkably similar, and in newborn mice and humans, mutation frequencies were also very similar. Given the risk-benefit ratio, these highly successful drugs will continue to be used for prevention of vertical viral transmission, however evidence of genotoxicity in mouse and monkey models and in the infants themselves would suggest that exposed children should be followed well past adolescence for early detection of potential cancer hazard

  15. A randomized, controlled trial of initial anti-retroviral therapy with abacavir/lamivudine/zidovudine twice-daily compared to atazanavir once-daily with lamivudine/zidovudine twice-daily in HIV-infected patients over 48 weeks (ESS100327, the ACTION Study

    Directory of Open Access Journals (Sweden)

    McClernon Daniel

    2009-04-01

    Full Text Available Abstract Background Traditional first line regimens containing a non-nucleoside reverse transcriptase inhibitor or protease inhibitor may not be suitable for a subset of antiretroviral-naïve patients such as those with certain co-morbidities, women of child-bearing potential, and intolerability to components of standard first line therapy. This study was conducted to determine if alternate treatment options may meet the needs of both general and special patient populations. The ACTION study was a randomized, open-label, multicenter, 48-week trial that compared the safety and efficacy of a triple nucleoside regimen versus a protease inhibitor plus a dual nucleoside regimen in HIV-1 treatment-naïve subjects. Results 279 HIV-infected subjects with HIV-1 RNA (VL >5000 but 3 were randomized (1:1 to receive abacavir sulfate/lamivudine/zidovudine (ABC/3TC/ZDV twice-daily or atazanavir (ATV once-daily plus lamivudine/zidovudine (3TC/ZDV twice-daily. Protocol-defined virologic failure was based on multiple failure criteria. Non-inferiority of ABC/3TC/ZDV to ATV+3TC/ZDV was established with 62% vs. 59% of subjects achieving a VL Conclusion ABC/3TC/ZDV demonstrated comparable virologic efficacy to ATV+3TC/ZDV in this population over 48 weeks. In those with a baseline VL ≥ 100,000 c/mL, subjects in the ATV+3TC/ZDV showed better virologic efficacy. Both regimens offer benefits in select therapy-naïve subjects. Trial Registration [Clinical Trials Identifier, NCT00082394].

  16. Avaliação ultra-sonográfica, ecocardiográfica fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral Ultrasound examination, fetal echocardiography and prenatal outcome in HIV-positive pregnant women under antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Marco Antonio Borges Lopes

    2007-10-01

    Full Text Available OBJETIVO: descrever as alterações estruturais e/ou funcionais fetais à ultra-sonografia e à ecocardiografia fetais e os resultados perinatais em gestantes soropositivas para o vírus da imunodeficiência humana (HIV em relação a um grupo controle de pacientes atendidas pelo pré-natal de baixo risco. MÉTODOS: foram avaliadas, prospectivamente, 109 gestantes soropositivas para o HIV em uso de anti-retrovirais (Grupo de Estudo, GE e 200 gestantes controles (GC, sendo realizado acompanhamento ultra-sonográfico obstétrico mensal e ecocardiografia fetal e pós-natal com a avaliação do volume de líquido amniótico, da adequação do peso fetal, da presença de alterações estruturais fetais e dos resultados perinatais. RESULTADOS: foram observados oito casos de alterações estruturais fetais (7,3% contra dois (1% no GC (p=0,61. Observamos quatro casos de cardiopatia congênita e quatro de hidronefrose no GE, com diferença estatística para as cardiopatias (p=0,015. Foram diagnosticados, no GE, oito (7,3% casos de oligoidrâmnio e 11 (10% casos de polidrâmnio contra dois casos (1% de oligoidrâminio e nenhum de polidrâmnio (p de 0,004 e pPURPOSE: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV. METHODS: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group and 200 low risk pregnant patients (Control Group. All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. RESULTS: there were eight (7.3% cases of fetal structural abnormality in the Study Group and two (1% in the Control Group (p=0.616. There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group

  17. Late Reporting Among Newly Registered Patients for Anti Retroviral Therapy in a Central District Ujjain, India

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    Vidit Khandelwal, Yogesh D Sabde, Riddhi Pradhan, Mehta Chandra Sathsh

    2013-01-01

    Conclusion: Late reporting at the initiation of ART was reported in about one third of the patients which could adversely affect effectiveness of ART. Efforts to investigate lesser representation of women and rural people are indicated. The study raised concerns about the possible routes of transmission need more investigation.

  18. Detection and quantification of proviral HIV-1 184 M/V in circulating CD4(+) T cells of patients on HAART with a viremia less than 1000 copies/ml

    DEFF Research Database (Denmark)

    Mohey, Rajesh; Jørgensen, Anne Louise; Møller, Bjarne K;

    2005-01-01

    Background Highly active anti-retroviral therapy (HAART) effectively reduces HIV replication but does not completely hinder it. Sub-optimal therapy leads to HIV resistance to the drugs administered. However, the role of low-level viremia (viral-load less than 1000 copies/ml) on mutation genesis and...... proviral HIV-1 was detected and quantified by a specific and sensitive assay combining a TaqMan real-time PCR analysis with the amplification-refractory mutation system (ARMS) principle. Results Fifty-six percent of patients with low-level viremia had 184V in the CD4+ T cellular DNA compartment as compared...... had a median viral load of 498 copies/ml (P = 0.006). No significant differences between the groups were observed in proviral HIV-1 DNA load. Conclusions The frequency of the 184V mutation was significantly lower, in the CD4+ T cellular compartment of patients with a viral load of less than 20 copies...

  19. Preventive measures to prevent loss to follow-up in highly active antiretroviral therapy (HAART): implementing a strategy in Ziguinchor (Casamance, Senegal) in 2014.

    Science.gov (United States)

    Randé, H; Rouffy, D

    2016-05-01

    Since 2010, the Pharmacie et Aide Humanitaire (PAH) in Casamance (Senegal) has been maintaining a software package (Tacojo) that allows monthly monitoring of the distribution of treatment to every patient with HIV infection receiving highly active antiretroviral therapy (HAART). We used this program to set up measures to prevent the loss to follow-up of patients receiving HAART. Our involvement focused on two main areas. First, each patient is routinely contacted after inclusion, to help us to understand the patient's experience of the disease and the treatment. This process aims to improve adherence to the treatment. Then, all patients who miss an appointment are routinely contacted by telephone within seven days of that appointment. The goal is to understand the reasons for the absence and to encourage patients to continue their treatment. Despite the lack of distance due to the relative newness of this program, these preventive measures have shown hopeful results (80% of the patients came back after a call). It would be interesting to apply it in a sustainable manner and in more medical facilities. PMID:27412981

  20. Les Determinants du Desir De Grossesse chez les Femmes Seropositives sous Traitement AntiRetroviral dans le District de Rwamagana

    OpenAIRE

    Claudien Uwanyirigira; Cyprien Munyanshongore

    2013-01-01

    L’étude vise à analyser les déterminants du désir de grossesse chez les femmes séropositives sous traitement anti-retroviral, afin de contribuer à la réduction de la transmission du virus de la mère à l’enfant. Elle a pour objectifs spécifiques de déterminer la proportion des grossesses chez les femmes à sérologie VIH positive, d’évaluer l’attitude du personnel de santé à l’égard des messages à donner aux femmes séropositives sous ARVs en ce qui concerne le désir de la grossesse, et relever l...

  1. Terapia hipolipemiante em situações especiais: síndrome de imunodeficiência adquirida Hypolipidemic therapy under special conditions: acquired immune deficiency syndrome

    Directory of Open Access Journals (Sweden)

    Pai Ching Yu

    2005-10-01

    Full Text Available Dislipidemias podem ser observadas precocemente entre pacientes com AIDS. Frequentemente, estas anormalidades lipídicas incluem HDL baixo e moderado aumento dos triglicérides sanguíneos. A terapia anti-retroviral combinada (HAART pode agravar a dislipidemia nestes pacientes, com importante aumento nos triglicérides e no LDL. Vários mecanismos são propostos para explicar a dislipidemia mista observada nestes indivíduos, incluindo diferentes etapas do metabolismo lipídico. A importância do tratamento desses distúrbios lipídicos tem se tornado evidente com o aumento da expectativa de vida e os relatos de complicações cardiovasculares nestes pacientes. Existe um estado de resistência à insulina nos pacientes com AIDS em tratamento com HAART,que apresentam lipodistrofia, hipertrigliceridemia e baixos níveis de HDL. Drogas retro-antivirais são metabolizadas pelo CYP P450 3A4 e interações com algumas estatinas, especialmente com sinvastatina podem ocorrer. O tratamento com agentes hipolipemiantes deve ser baseado no perfil lipídico e no risco de coronariopatia. Para hipertrigliceridemias, fibratos (principalmente fenofibrato ou bezafibrato devem ser as drogas de escolha, bem como as estatinas (principalmente pravastatina. Terapia combinada usando estatinas mais fibratos é recomendada para dislipidemias mistas graves e sempre sob rigoroso monitoramento de efeitos adversos.Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life

  2. Suplementação de N-acetilcisteína em pacientes infectados pelo HIV submetidos ao primeiro tratamento anti-retroviral: Avaliação do efeito sobre a carga viral, TNF-α, IL-6, IL-8, β2-microglobulina, IgA, IgG e IgM, haptoglobina e α1-glicoproteína ácida N-acetylcysteine supplementation of HIV-infected patients under the first anti-retroviral treatment: Evaluation of the effect on viral load, TNF-α, IL-6, IL-8, β2-microglobulin, IgA, IgG, IgM, haptoglobin and α1-acid glycoprotein

    Directory of Open Access Journals (Sweden)

    Aricio Treitinger

    2002-03-01

    alterations are characterized by elevated levels of tumor necrosis factor alpha (TNF-α, interleukin 8 (IL-8, β2-microglobulin, IgA, IgG, IgM, haptoglobin and a1-acid glycoprotein. The goal of this double blind placebo-controlled study was to evaluate the effect of N-acetylcysteine supplementation on virological, immunological and inflammatory markers in 24 HIVinfected individuals who were taking their first anti-retroviral therapy. Eleven individuals were treated with anti-retroviral therapy plus placebo supplementation and thirteen were treated with anti-retroviral therapy plus 600 mg/day of Nacetylcysteine. The levels of the studied markers were evaluated at the day before and after 60, 120 and 180 days of treatment. In both groups a significant decrease in serum levels of TNF-α (p=0.0001, IL-6 (p>0.05, IL-8 (p=0.0001, b2 microglobulin (p=0.0005, IgA (p=0.007, IgG (p=0.001, IgM (p=0.0001, haptoglobin (p=0.0001 e α1-acid glycoprotein (p=0.012 was found due to anti-retroviral therapy. N-acetylcysteine supplementation had no additive or synergistic effects on the studied parameters. In conclusion, N-acetylcysteine had no additional beneficial effects, at least at the dose used in this study, on the treatment of HIV-infected patients under anti-retroviral therapy.

  3. Effectiveness of antiretroviral therapy (haart In hiv positive patients admitted to the treatment Program of “atencion integral ips” in the city of Cartagena. Colombia

    Directory of Open Access Journals (Sweden)

    Torres-Mora Gustavo

    2011-06-01

    Full Text Available Background: Although HIV infection / AIDS are one of the major health problems inColombia, there are few clinical and epidemiological studies assessing the treatment ofthese patients. The city of Cartagena de Indias, has favorable conditions for infectionwith HIV because of their status as tourist district and for being an epicenter of socialand demographic changes that are associated with an increased risk of HIV infection(4, however no studies have evaluated the effectiveness of antiretroviral treatment.Aim: To estimate effectiveness of six months of HAART therapy in HIV patients admittedto a treatment program in a health center of the city.Methods: Retrospective descriptive study that examined all patients assigned to theprogram for HIV / AIDS in the health center “Atencion integral” from January 2007 toJuly 2010. We studied demographic variables as sex, age, weight, body mass index,different antiretroviral schemes, CD4 count and viral load.Results: There were 167 patients assigned to the program. Nine cases wereexcluded for failing to adherence HAART and 96 for not having the reportof viral load before or after treatment. A total of 62 cases were analyzed.59.7% were male, average age was 35 years with standard deviation (SD of 9.4 years.49.5% of patients were 30 years or less, the minimum age was 20 and maximum of 58years. An average of 44.4% of medical charts had no reports of any of the initial labs.16.1% of patients had anemia, 19.4% hipertrigliridemia 17.7% hypercholesterolemiaand 21.0% low HDL cholesterol levels.The five schemes more frequently used of HAART were Lamivudine Stavudine Nevirapinewith 29.0% of cases, 19.4% Lamivudine Zidovudine Efavirenz, 11.3% Kaletra®Stavudine Lamivudine and 8.1% Lamivudine Abacavir Kaletra®. The effectiveness ofHAART, taking into account the above parameters, shows that there is a statisticallysignificant decrease in viral load. The proportion of overall effectiveness of HAART was9.9% for decrease

  4. Anti-retroviral treatment outcomes among older adults in Zomba district, Malawi.

    Directory of Open Access Journals (Sweden)

    Joel Negin

    Full Text Available BACKGROUND: There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes. METHODS: A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan-Meier survival plots and Cox proportional hazards regression models. RESULTS: There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419 were more likely to be male (P<0.0001 and located in rural areas (P = 0.003 than those aged 25-49. Crude survival estimates among those aged 50-59 were not statistically different from those aged 25-49 (P = 0.925. However, survival among those aged 60 and older (N = 345 was worse (P = 0.019 than among those 25-59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998 but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032 for those aged 60 and older compared to those aged 25-49. CONCLUSIONS: Treatment outcomes of those aged 50-59 are similar to those aged 25-49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.

  5. Les Determinants du Desir De Grossesse chez les Femmes Seropositives sous Traitement AntiRetroviral dans le District de Rwamagana

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    Claudien Uwanyirigira

    2013-06-01

    Full Text Available L’étude vise à analyser les déterminants du désir de grossesse chez les femmes séropositives sous traitement anti-retroviral, afin de contribuer à la réduction de la transmission du virus de la mère à l’enfant. Elle a pour objectifs spécifiques de déterminer la proportion des grossesses chez les femmes à sérologie VIH positive, d’évaluer l’attitude du personnel de santé à l’égard des messages à donner aux femmes séropositives sous ARVs en ce qui concerne le désir de la grossesse, et relever les facteurs déterminant le désir d’avoir des enfants après la mise ne route d’un traitement par antirétroviraux . Il s’agit d’une étude descriptive transversale. Elle a été conduite auprès de 260 femmes infectées par le VIH sous ARVs et suivies dans les FOSA, ayant les services de VCT/PMTCT et des ARVs. L’étude montre que 26,9% des femmes ont été enceintes après avoir été informées de leur statut sérologique positif pour le VIH et que 38,5% des femmes séropositives sous traitement anti-rétroviral désirent avoir des enfants dans le futur. La majorité des femmes (82,7% reconnaissent l’importance de l’utilisation des contraceptifs alors que le pourcentage des femmes qui connaissent l’importance d’utiliser les ARVs pendant la grossesse et l’accouchement pour réduire le risque de transmission de la mère à l’enfant est de 76,9%. Les facteurs déterminant le désir de la grossesse parmi les femmes séropositives sont : La confiance attribuée aux anti-rétroviraux, la parité c’est-à-dire les femmes qui n’ont pas eu d’enfant ont un désir de maternité deux fois supérieur que les femmes qui ont eu au moins un enfant, et la non utilisation des méthodes contraceptives chez les femmes à sérologie VIH positives pour réduire le risque de transmission de la mère à l’enfant. Nous recommandons de renforcer l’intégration des activités de santé de la reproduction et de Planning

  6. Effect of micronutrient and probiotic fortified yogurt on immune-function of anti-retroviral therapy naive HIV patients

    NARCIS (Netherlands)

    R.B.S. Hummelen (Ruben); J. Hemsworth (Jaimie); J. Changalucha (John); N.L. Butamanya (Nicodemus); S. Hekmat (Sharareh); J.D.F. Habbema (Dik); G. Reid (Gregor)

    2011-01-01

    textabstractBackground: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving t

  7. Multi-scale modeling of HIV infection in vitro and APOBEC3G-based anti-retroviral therapy.

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    Iraj Hosseini

    2012-02-01

    Full Text Available The human APOBEC3G is an innate restriction factor that, in the absence of Vif, restricts HIV-1 replication by inducing excessive deamination of cytidine residues in nascent reverse transcripts and inhibiting reverse transcription and integration. To shed light on impact of A3G-Vif interactions on HIV replication, we developed a multi-scale computational system consisting of intracellular (single-cell, cellular and extracellular (multicellular events by using ordinary differential equations. The single-cell model describes molecular-level events within individual cells (such as production and degradation of host and viral proteins, and assembly and release of new virions, whereas the multicellular model describes the viral dynamics and multiple cycles of infection within a population of cells. We estimated the model parameters either directly from previously published experimental data or by running simulations to find the optimum values. We validated our integrated model by reproducing the results of in vitro T cell culture experiments. Crucially, both downstream effects of A3G (hypermutation and reduction of viral burst size were necessary to replicate the experimental results in silico. We also used the model to study anti-HIV capability of several possible therapeutic strategies including: an antibody to Vif; upregulation of A3G; and mutated forms of A3G. According to our simulations, A3G with a mutated Vif binding site is predicted to be significantly more effective than other molecules at the same dose. Ultimately, we performed sensitivity analysis to identify important model parameters. The results showed that the timing of particle formation and virus release had the highest impacts on HIV replication. The model also predicted that the degradation of A3G by Vif is not a crucial step in HIV pathogenesis.

  8. Intensive Care Usage by HIV-Positive Patients in the HAART Era

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    L. Turtle

    2011-01-01

    Full Text Available In the 1980s the outlook for patients with the acquired immunodeficiency syndrome (AIDS and critical illness was poor. Since then several studies of outcome of HIV+ patients on ICU have shown improving prognosis, with anti-retroviral therapy playing a large part. We retrospectively examined intensive care (ICU admissions in a large HIV unit in London. Between April 2001 and April 2006 43 patients were admitted to the ICU. The mean age of patients was 44 years and 74% were male. Fifty-six percent of admissions were receiving anti-retroviral therapy and 44% had an AIDS defining diagnosis. The median CD4 count was 128 cells/mL and the median APACHE II score was 21. The commonest diagnostic ICU admission category was respiratory disease. This group experienced higher mortality despite slightly lower APACHE II scores, though this did not achieve statistical significance. The follow up period was one year or until April 2007, when data were censored. ICU mortality was 33%, in hospital mortality was 51% and overall mortality at the end of the study period was 67%. Median survival was 1008 days. The CD4 count did not predict long-term survival, although the sample size was too small for this to be conclusive.

  9. Radiological patterns in HIV-associated pulmonary tuberculosis: Comparison between HAART-treated and non-HAART-treated patients

    International Nuclear Information System (INIS)

    AIM: To evaluate whether highly active antiretroviral therapy (HAART) modifies radiographic appearances of pulmonary tuberculosis (TB), in terms of patterns and their relative frequencies, among patients with human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: Chest radiographs were obtained in 209 HIV-infected patients with culture confirmed pulmonary TB. Computed tomography (CT) images were also reviewed for 42 patients whose chest radiographs were normal or showed questionable abnormalities. Imaging was evaluated for the presence and distribution of consolidation, cavitation, interstitial changes, pleural disease, adenopathy, and were classified as a primary or post-primary pattern. RESULTS: A post-primary pattern was more frequent after 1996 when HAART came into clinical use. Forty-four percent (77/176) of patients not on HAART had a post-primary pattern in comparison with 82% (27/33) of patients receiving HAART (p3). CONCLUSION: HIV patients receiving HAART with pulmonary TB, had a post-primary pattern more frequently than those not receiving this treatment. This observation is consistent with the partial restoration of cell-mediated immunity that can be induced by HAART

  10. Occurrence of intestinal parasites amongst persons on highly active antiretroviral drug therapy in Calabar, Cross River State, Nigeria

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    Paul C. Inyang-Etoh

    2015-02-01

    Full Text Available Opportunistic and intestinal parasite infections are common health problem among HIV/AIDS patients. Early detection and treatment of these parasites are important to improve the quality of life of this category of patients. The occurrence of intestinal parasites among 400 patients on highly active anti-retroviral drug therapy (HAART aged 11-60 years was investigated. Standard parasitological techniques like direct microscopy, formol ether concentration and modified Ziehl- Neelsen staining techniques were used to analyze the stool samples. Intestinal parasite infections were positive in 116 (29% of the subjects on HAART while control subjects had 12 (12% and the difference was statistically significant (P<0.05. Subjects in the age group 21-30 years had the highest infection rate 54 (35.1%. There was no statistically significant difference in infection according to age (P>0.05. Females 76 (32.5% had a higher prevalence rate than males 40 (24.1%. But there was no statistically significant difference in infection according to gender (P<0.05. Patients with CD4 count of less than 200 cells/mm3 were observed to be more infected than those with CD4 count of more than 200 cells/mm3. There was a strong positive correlation (r=0.94 between CD4 count and the occurrence of intestinal parasite infection. Protozoan parasites 84 (21.0% accounted for a higher prevalence rate than helminthic parasites 32 (8.0%. These findings has revealed a high prevalence of intestinal parasite infection among patients on HAART thus the routine screening of stool samples from these category of patients for intestinal parasites is advocated for effective management of the disease.

  11. Genetic evolution of HIV in patients remaining on a stable HAART regimen despite insufficient viral suppression

    DEFF Research Database (Denmark)

    Kristiansen, Thomas B; Pedersen, Anders; Eugen-Olsen, Jesper;

    2005-01-01

    Our objective was to investigate whether steadily increasing resistance levels are inevitable in the course of a failing but unchanged Highly Active Antiretroviral Therapy (HAART) regimen. Patients having an unchanged HAART regimen and a good CD4 response (100 cells/microl above nadir) despite co...

  12. Influência da terapêutica anti-retroviral na história natural da infecção por VIH

    OpenAIRE

    Prata, Margarida Isabel Ribeiro Beato

    2009-01-01

    O número de indivíduos que controlam o VIH, mercê de uma terapêutica anti-retroviral (TARV) mais eficaz, tem vindo a aumentar nas últimas décadas. Ao longo deste trabalho, pretende demonstrar-se qual o efeito da TARV nos doentes infectados com o VIH. São apresentadas exposições relativas à História Natural da Infecção, ao Diagnóstico e Monitorização e, ainda, aos Princípios Gerais da TARV. Servem estes textos para preparar a apresentação de um caso concreto, seguido da sua Discussão e das...

  13. Influence of Age and Neurotoxic HAART Use on Frequency of HIV Sensory Neuropathy

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    Olajumoke Oshinaike

    2012-01-01

    Full Text Available Background. Sensory neuropathy (SN is one of the most common AIDS-associated neurologic disorders especially in the era of highly active antiretroviral therapy (HAART. The aim of this study was to determine the prevalence of SN among highly-active-antiretroviral-therapy- (HAART- experienced and HAART-naïve HIV-positive individuals and to investigate the relationship to demographic, clinical, and laboratory factors. Methods. 323 patients with HIV infection (142 on HAART and 181 HAART naïve were enrolled in a cross-sectional neuropathy screening program. Data was collected using structured questionnaires which contained the brief peripheral neuropathy screening tool of AIDS Clinical Trial Group protocol. Neuropathy was defined by the presence of at least 1 clinical sign in a distal, symmetrical pattern. Patients were classified as symptomatic if they described aching, stabbing, or burning pain, paresthesia, or numbness in a similar distribution. Demographic, clinical, and laboratory details were documented as risk factors. Result. The prevalence of sensory neuropathy was 39.0% (126/323, (of which 29/126 (23% were symptomatic. Amongst those on HAART, 60/142 (42.3% had SN compared to 66/181 (36.5% HAART-naïve individuals (P=0.29. On multivariate analyses, the independent associations with SN were increasing age (P=0.03 and current exposure to stavudine (P=0.00. Gender (P=0.99 height (P=0.07 use of HAART (P=0.50, duration of HAART treatment (P=0.10, and lower CD4 count (P=0.12 were not associated with an increased SN risk. Conclusion. HIV SN remains common despite improved immunologic function associated with HAART and decreased neurotoxic HAART use. In this cross-sectional analysis, age and stavudine-based therapies were the independent risk factors.

  14. Toxic metabolic syndrome associated with HAART

    DEFF Research Database (Denmark)

    Haugaard, Steen B

    2006-01-01

    Acquired fat redistribution, that is, peripheral fat loss often accompanied by central fat accumulation in patients with HIV infection is the most common form of lipodystrophy in man. Approximately 30 - 50% of HIV-infected individuals after > or = 12 months on highly active antiretroviral therapy...... (HAART) may encounter the HIV-associated lipodystrophy syndrome (HALS), which attenuates patient compliance to this treatment. HALS is characterised by impaired glucose and lipid metabolism and other risk factors for cardiovascular disease. This review depicts the metabolic abnormalities associated...

  15. PDT in periodontal disease of HAART resistance patients

    Science.gov (United States)

    Giovani, Elcio M.; Noro-Filho, Gilberto A.; Caputo, Bruno V.; Casarin, Renato; Costa, Claudio; Salgado, Daniela; Santos, Camila C.

    2016-03-01

    HIV/Aids patients present a change of microbiota associated with host immunodeficiency. Photodynamic therapy (PDT) showed as a promising and viable alternative in reducing microbiota. Present study evaluate effectiveness of photodynamic therapy in periodontal disease of AIDS patients with highly activity antiretroviral therapy (HAART) failure, measuring the clinical periodontal parameters and periodontal microbiota. Twelve patients with HARRT resistance (R group) divided into two groups (control and PDT) and 12 patients with no HAART resistance (NR group) divided into two groups (control and PDT). The results show the difference in baseline of CD4 cells count, NR group 640.0 +/- 176.2 cells/mm3 R group and 333.3 +/- 205.8 cells / mm3 (pperiodontal parameters (PD and CAL), PDT was more effective than the control group only in the NR group (p periodontal parameters between the both R groups (p>0.05%). Microbiological evaluation in R group presents a general reduction in the Aa at 3 and 6 months. Furthermore, demonstrated a reduction of Pg in all groups at 6 months and in R group at 3 months. The impact assessment of photodynamic therapy in patients with different levels of immunosuppression determined that the combination of mechanical periodontal treatment with photodynamic therapy in patients with HAART failure did not cause additional benefits. Therefore, PDT in this study could not been indicated in HAART resistance patients.

  16. Pessoas vivendo com HIV/AIDS: variáveis associadas à adesão ao tratamento anti-retroviral Persons living with HIV/AIDS: factors associated with adherence to antiretroviral treatment

    Directory of Open Access Journals (Sweden)

    Eliane Maria Fleury Seidl

    2007-10-01

    Full Text Available O estudo objetivou descrever o comportamento de adesão ao tratamento anti-retroviral em pessoas vivendo com HIV/AIDS e investigar preditores da adesão entre as variáveis escolaridade, presença de efeitos colaterais, interrupção anterior da terapia anti-retroviral (TARV por conta própria, auto-estima, expectativa de auto-eficácia, estratégias de enfrentamento, suporte social e satisfação com a relação profissional de saúde-usuário. Adesão foi medida pelo auto-relato da perda do número de comprimidos/cápsulas dos medicamentos anti-retrovirais na última semana e mês, sendo considerada satisfatória na ocorrência de omissão inferior a 5% do total prescrito. Participaram 101 pessoas, 60,4% homens, idades entre 20 a 71 anos (M = 37,9 anos, 73,3% sintomáticos. A coleta de dados incluiu entrevista e instrumentos auto-aplicáveis. A maioria (n = 73; 72,3% relatou adesão igual ou superior a 95%. Nos resultados da regressão logística, interrupção anterior da TARV e expectativa de auto-eficácia foram preditores significativos da adesão. Faz-se necessária a qualificação da assistência pela constituição de equipes interdisciplinares, para o desenvolvimento de abordagens adequadas às dificuldades médicas e psicossociais de adesão das pessoas vivendo com HIV/AIDS.This study aimed to describe the adherence of persons living with HIV/AIDS to antiretroviral therapy (ART and to investigate adherence predictors among the following: level of schooling, presence of side effects, current or previous interruption of ART by the persons themselves, self-esteem, self-efficacy expectation, coping strategies, social support, and satisfaction with the health professional-patient relationship. Adherence was measured by self-reported number of ART pills/capsules missed during the previous week and previous month, evaluated as satisfactory when less than 5%. 101 HIV+ adults took part in this study, 60.4% males, ranging from 20 to 71 years

  17. Longitudinal comparison between plasma and seminal HIV-1 viral loads during antiretroviral treatment Comparação longitudinal entre cargas virais seminais e plasmáticas do HIV-1 durante terapia anti-retroviral

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    Lauro Ferreira da Silva Pinto Neto

    2003-12-01

    Full Text Available This study was designed to investigate the impact of anti-retroviral therapy on both plasma and seminal HIV-1 viral loads and the correlation between viral loads in these compartments after treatment. Viral load, CD4+ and CD8+ T-cell counts were evaluated in paired plasma and semen samples from 36 antiretroviral therapy-naïve patients at baseline and on days 45, 90, and 180 of treatment. Slopes for blood and seminal viral loads in all treated patients were similar (p = 0.21. Median HIV-1 RNA titers in plasma and semen at baseline were 4.95 log10 and 4.48 log10 copies/ml, respectively. After 180 days of therapy, the median viral load declined to 3.15 log10 copies/ml (plasma and 3.2 log10 copies/ml (semen. At this timepoint 22 patients presented HIV-1 viral load below 400 copies/ml in either plasma or semen, but only 9 had viral loads below 400 copies/ml in both compartments.Este estudo foi desenhado para investigar o impacto do tratamento com anti-retrovirais na evolução das cargas virais plasmáticas e seminais do HIV-1. A carga viral do HIV-1 e a contagem de linfócitos T CD4+ e CD8+ foi determinada em amostras pareadas de sangue e sêmen de 36 pacientes virgem de tratamento nos dias 0, 45, 90 e 180 após o início da terapia. As curvas de declínio das cargas virais plasmática e seminal foram semelhantes (p= 0.21. As medianas da carga viral plasmática e seminal no pré-tratamento (dia 0 foram 4.95 e 4.48 log10 cópias/ml, respectivamente. Seis meses após o início da terapia, a mediana da carga viral plasmática era 3.15 log10 cópias/ml e a seminal 3.2 log10 cópias/ml. Neste mesmo periodo, 22 pacientes apresentavam carga viral abaixo de 400 cópias/ml no plasma e/ou sêmen, enquanto apenas 9 pacientes apresentavam carga viral abaixo do limite de detecção nos dois compartimentos.

  18. The changing role of HIV-associated oral candidiasis in the era of HAART.

    Science.gov (United States)

    Patuwo, Christopher; Young, Keane; Lin, Meng; Pardi, Vanessa; Murata, Ramiro M

    2015-02-01

    Oral candidiasis is the most common fungal opportunistic infection to affect the oral cavity among HIV patients. The advent of highly active antiretroviral therapy (HAART) has changed the epidemiology of candidiasis, with many studies reporting a decrease in prevalence. However, some studies report rare cases of increased prevalence. This systematic review clarifies the role of oral candidiasis in the HAART era as a marker of immune status and successful therapy for the HIV-infected population.

  19. Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

    DEFF Research Database (Denmark)

    May, M; Sterne, JAC; Sabin, C;

    2007-01-01

    OBJECTIVE: To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy. DESIGN: A collaborative analysis of data from 12 cohorts in Europe and North America on 20,379 adults who started...... HAART between 1995 and 2003. METHODS: Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention......: On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org....

  20. A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from Lesotho.

    Directory of Open Access Journals (Sweden)

    Niklaus Daniel Labhardt

    Full Text Available OBJECTIVE: To assess the positive predictive value (PPV of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART failure in rural Lesotho. METHODS: Patients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point, CD4-count below baseline (1, 25% and 50% drop from peak CD4-count (1 and 2, hemoglobin drop≥1 g/dL (1, CD4 count40 copies (95%CI: 84-100, and of 90% to detect a VL ≥ 5000 copies (70-97. Within the score, adherence<95%, CD4-count<100/µl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17% died before or within 4 weeks after being switched. Overall mortality was 4 (20% among those with score ≥ 5 and 4 (5% if score<5 (OR 4.3; 95%CI: 0.96-18.84, p = 0.057. CONCLUSION: A score ≥ 5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.

  1. Dysregulated Immune Activation in Second-Line HAART HIV+ Patients Is Similar to That of Untreated Patients

    Science.gov (United States)

    Espíndola, Milena S.; Lima, Leonardo J. G.; Soares, Luana S.; Cacemiro, Maira C.; Zambuzi, Fabiana A.; de Souza Gomes, Matheus; Amaral, Laurence R.; Bollela, Valdes R.; Martins-Filho, Olindo A.; Frantz, Fabiani G.

    2015-01-01

    Background Successful highly active antiretroviral therapy (HAART) has changed the outcome of AIDS patients worldwide because the complete suppression of viremia improves health and prolongs life expectancy of HIV-1+ patients. However, little attention has been given to the immunological profile of patients under distinct HAART regimens. This work aimed to investigate the differences in the immunological pattern of HIV-1+ patients under the first- or second-line HAART in Brazil. Methods CD4+ T cell counts, Viral load, and plasma concentration of sCD14, sCD163, MCP-1, RANTES, IP-10, IL-1β, IL-6, TNF-α, IL-12, IFN-α, IFN-γ, IL-4, IL-5, and IL-10 were assessed for immunological characterization of the following clinical groups: Non-infected individuals (NI; n = 66), HIV-1+ untreated (HIV; n = 46), HIV-1+ treated with first-line HAART (HAART 1; n = 15); and HIV-1+ treated with second-line HAART (HAART 2; n = 15). Results We found that the immunological biosignature pattern of HAART 1 is similar to that of NI individuals, especially in patients presenting slow progression of the disease, while patients under HAART 2 remain in a moderate inflammatory state, which is similar to that of untreated HIV patients pattern. Network correlations revealed that differences in IP-10, TNF-α, IL-6, IFN-α, and IL-10 interactions were primordial in HIV disease and treatment. Heat map and decision tree analysis identified that IP-10>TNF-α>IFN-α were the best respective HAART segregation biomarkers. Conclusion HIV patients in different HAART regimens develop distinct immunological biosignature, introducing a novel perspective into disease outcome and potential new therapies that consider HAART patients as a heterogeneous group. PMID:26684789

  2. Eradication of HIV and Cure of AIDS, Now and How?

    OpenAIRE

    Zhang, Jielin; Crumpacker, Clyde

    2013-01-01

    Recent studies have highlighted the importance of eradication of human immunodeficiency virus (HIV) and cure of acquired immunodeficiency syndrome (AIDS). However, a pivotal point that the patient immunity controls HIV reactivation after highly active anti-retroviral therapy [HAART or combination anti-retroviral therapy (cART)] remains less well addressed. In spite of the fact that both innate and adaptive immunities are indispensable and numerous cells participate in the anti-HIV immunity, m...

  3. The effects of intermittent, CD4-guided antiretroviral therapy on body composition and metabolic parameters

    NARCIS (Netherlands)

    E. Martinez; F. Visnegarwala; B. Grund; A. Thomas; C. Gibert; J. Shlay; F. Drummond; D. Pearce; S. Edwards; P. Reiss; W. El-Sadr; A. Carr

    2010-01-01

    Objective: To assess the effects of decreased antiretroviral therapy exposure on body fat and metabolic parameters. Design: Substudy of the Strategies for Management of Anti-Retroviral Therapy study, in which participants were randomized to intermittent CD4-guided [Drug Conservation (DC) group] or t

  4. Estudo da Adesão à Quimioprofilaxia Anti-retroviral para a Infecção por HIV em Mulheres Sexualmente Vitimadas Study of Adherence to Antiretroviral Chemoprophylaxis for HIV Infection in Sexually Abused Women

    Directory of Open Access Journals (Sweden)

    Jefferson Drezett

    1999-10-01

    Full Text Available Objetivos: embora não existam dados apropriados para estabelecer sua eficácia, alguns serviços tem utilizado, profilaticamente, a terapia anti-retroviral para o HIV nos casos de violência sexual. O objetivo deste estudo foi avaliar a aceitabilidade, tolerância e adesão a um esquema quimioprofilático para o HIV. Pacientes e método: foram avaliadas 62 mulheres vítimas de estupro e/ou atentado violento ao pudor com coito ectópico anal. Os agressores foram referidos como desconhecidos. A profilaxia foi iniciada dentro das primeiras 48 h da violência e mantida por 4 semanas, sendo administrados diariamente: zidovudina, 600 mg; indinavir, 2.400 mg e lamivudina, 300 mg. Resultados: a taxa de descontinuidade foi de 24,2%, sendo em 12 casos (80% decorrente de intolerância gástrica. Os efeitos colaterais estiveram presentes em 43 casos (69,4%, sendo as náuseas e vômitos os mais freqüentes. A complexidade posológica e o tempo de uso foram fatores possivelmente associados ao uso inadequado das drogas, ocorrendo em 10,6% dos casos. Conclusão: a taxa de descontinuidade da quimioprofilaxia foi semelhante à observada em outras indicações.Purpose: some medical institutions have been prophylactically ministrating anti-HIV therapy in cases of sexual violence, although there are no appropriate basic facts to establish its efficacy. The aim of the present study was to evaluate the acceptance, tolerance and adhesion of these women under a chemoprophylaxis plan for HIV. Methods: sixty-two women victims of rape and/or anal intercourse with unknown aggressors have been evaluated. Prophylaxis has been started within the first 48 h after violence and maintained for 4 weeks, with daily administration of zidovudine, 600 mg; indinavir, 2,400 mg and lamivudine, 300 mg. Results: the discontinuance rate was 24.2%, withe 12 cases (80% due to gastric intolerance. The side effects were present in 43 cases (69.4%, including nausea and vomitting as the most

  5. Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort

    Directory of Open Access Journals (Sweden)

    Lifson Alan R

    2012-02-01

    Full Text Available Abstract Background Although highly active antiretroviral therapy (HAART has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality. Methods We evaluated baseline (prior to HAART initiation clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel. Results Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY] in those with ≤ 50 CD4+ cells/mm3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm3. In multivariate analysis, factors significantly (p 3 (vs. CD4+ ≥ 500, HR = 2.97, greater HIV RNA level (HR = 1.36 per one log10 increase, hepatitis C antibody or chronic hepatitis B (HR = 1.96, and HIV diagnosis before 1996 (HR = 2.44. Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06, and hemoglobin Conclusions Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.

  6. Molecular Mechanisms in Activation of Latent HIV-1

    NARCIS (Netherlands)

    H. Rafati (Haleh)

    2014-01-01

    markdownabstract__Abstract__ Finding a cure for the human immunodeficiency virus type 1 (HIV-1) is extremely challenging. Development of highly active anti-retroviral therapy (HAART), transformed HIV-1 infection from an acute syndrome into chronic disease. Although using HAART results in suppressio

  7. Adipokines in the HIV/HAART-associated lipodystrophy syndrome.

    Science.gov (United States)

    Paruthi, Jason; Gill, Natasha; Mantzoros, Christos S

    2013-09-01

    The use of highly active antiretroviral therapy (HAART) in the treatment of human immunodeficiency virus has dramatically altered both the landscape of this disease and the prognosis for those affected. With more patients now receiving HAART, adverse effects such as lipodystrophy and metabolic syndrome have emerged. In HIV/HAART-associated lipodystrophy syndrome (HALS), patients demonstrate fat maldistribution with dyslipidemia, insulin resistance, and other metabolic complications. Recent studies have contributed to the elucidation of the pathophysiological abnormalities seen in this syndrome and have provided guidance for the study and use of potential treatments for these patients, but widely accepted guidelines have not yet been established. Two adipokines, leptin and adiponectin, are decreased in patients with HALS and lipoatrophy or lipodystrophy. Further, recent proof-of-concept clinical trials have proven the efficacy of leptin replacement and medications that increase circulating adiponectin levels in improving the metabolic profile of HALS patients. This review article highlights recent evidence on leptin replacement and compares leptin's efficacy to that of other treatments, including metformin and thiazolidinediones, on metabolic abnormalities such as impaired insulin-glucose homeostasis associated with lipodystrophy in patients receiving HAART. It is hoped that forthcoming large phase III clinical trials will allow the addition of leptin to our therapeutic armamentarium for use in patients suffering from this disease state.

  8. Prevalence and clinical and laboratory characteristics of kidney disease in anti-retroviral-naive human immunodeficiency virus-infected patients in South-South Nigeria

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    U H Okafor

    2016-01-01

    Full Text Available Since the emergence of acquired immune deficiency syndrome (AIDS about three decades ago, several renal disorders have been reported as common complications of human immunodeficiency virus (HIV infection. These renal disorders result from diverse etiologies. The aim of this cross-sectional study was to determine the prevalence and clinical and laboratory characteristics of anti-retroviral-naοve HIV-infected patients with impaired kidney disorder in South-South Nigeria. This study was conducted on patients presenting at the University of Benin Teaching Hospital, Benin City in South-South Nigeria for six months. The patients′ demographic data and clinical, hematological and biochemical parameters were assessed. Their glomerular filtration rate (GFR was calculated and the protein excretion was assessed from the protein- creatinine ratio. Data were analyzed using statistical software program SPSS version 15.0. Threehundred and eighty-three patients with a mean age of 35.39 ± 8.78 years and a male: female ratio of 1:1 were studied; 53.3% had evidence of kidney disorder. The main clinical features in patients with kidney disorder were evidence of fluid retention, urinary symptoms, pallor and encephalopathy. The mean systolic and diastolic blood pressures were 115.33 ± 17.17 and 72.33 ± 14.31 mm Hg, respectively. The mean estimated GFR was 52.5 mL/min/1.73 m 2 . Patients with kidney disorder had higher proteinuria (P = 0.001, lower mean CD4 cell count and packed cell volume (P = 0.019 and 0.001, respectively. Kidney disorder is a common complication in HIV-infected patients, and they have clinical and laboratory anomalies. Screening of HIV/AIDS patients at the time of diagnosis will facilitate early diagnosis of kidney disorders in them.

  9. Evaluation of Potential Anti-Pathogenic and Anti-Retroviral Effects of a Proprietary Bioactive Silicate Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH

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    D Townsend

    2010-12-01

    Full Text Available Summary: Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH, a modified sodium silicate dietary supplement manufactured by Cisne Enterprises Inc. (Odessa, TX was evaluated for its in vitro anti-retroviral and anti-pathogenic effects. Effects on nitric oxide (NO dependent antiviral activities were measured in neutrophils using standard assays. Assays for inhibition of HIV-II reverse transcriptase (RT, HIV-II protease (PR and glucohydrolase [glucuronidase (GH-1 and glucosidase (GH-2] important for viral replication, coat assembly and virulence respectively, were performed using standard kits. Higher NO (~ 2 fold was detected in neutrophil medium indicating an increase NO mediated antipathogeic activity. Results suggest that the product significantly decreased HIV-RT activity in a dose dependent manner (ED50= 20.4 mM. HIV-PR activity decreased (IC50=14.6 mM with increasing product concentration. The product also decreased the HIV-II virulence by inhibiting the GH-1 (IC50= 34.29 mM and GH-2 (IC50=14.6 mM activity which decreased protein glucosylation and glucuronylation. Changes in surface EPS carbohydrates assed in Pseudomonas aeruginosa suggested a modulatory effect on various carbohydrates and therefore the composition of EPS. Industrial relevance: Pathologies caused by retroviral agents and microorganisms are prevalent both in developed and developing countries.  Indiscriminate use of single target medical drugs has resulted in the development of resistance in these pathogens. Development of novel therapeutic  agents that can effect multiple intrinsic and extrinsic targets in host and the pathogen may prove to be more effective and are less likely to promote drug induced selection. The effectiveness of Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH in mitigating various virulence and survival pathways in pathogens is promising. Additionally, it was also effective in inducing a NO mediated immune response.

  10. Self-reported side-effects of anti-retroviral treatment among IDUs: a 7-year longitudinal study (APROCO-COPILOTE COHORT ANRS CO-8).

    Science.gov (United States)

    Carrieri, Maria Patrizia; Villes, Virginie; Raffi, François; Protopopescu, Camelia; Preau, Marie; Salmon, Dominique; Taieb, Audrey; Lang, Jean-Marie; Verdon, Renaud; Chene, Geneviève; Spire, Bruno

    2007-08-01

    The introduction of potent anti-retroviral treatment (ART) has transformed HIV disease into a chronic condition with the prospect, for the patient, of strict adherence to effective but life-long treatments. Within this framework, a major issue that can negatively affect adherence is the side-effects of the treatment. To date, studies documenting how individuals HIV-infected through drug injection (IDUs) experience ART-related side effects are sparse. Longitudinal data collected from the APROCO-COPILOTE cohort have been used to compare the experience of ART-related side-effects who have been HIV-infected via injecting drug use and non-IDU patients. A 20-item list was used to collect self-reported side-effects over a 7-year follow up period. Of 922 patients, 15% were IDUs. At any given visit, IDUs reported a significantly higher number of side-effects and had approximately twice the risk of reporting any side effect than non-IDUs. Most commonly reported side-effects were dry skin, fatigue, vomiting, bone troubles, insomnia. After adjustment for social conditions, depressive symptoms, use of sleeping pills and time since HIV diagnosis, IDUs reported experiencing significantly more side-effects than non-IDUs. Whether or not this is related to sensitivity to pain or to other comorbidities is difficult to establish. Further research is needed to understand how substitution treatment can mediate the relationship between exposure to opioids and side-effects. Providing appropriate care to reduce side-effects, thereby increasing adherence to ART in this population, remains a major challenge especially in those countries scaling up ART. Incorporating symptom management and improving access to analgesic medications within a model of comprehensive care for HIV-infected IDUs, could reduce the impact of drug-related and HIV-related harms and induce better long-term treatment outcomes and quality of life. PMID:17689377

  11. Impact of Anti-Retroviral Treatment and Cotrimoxazole Prophylaxis on Helminth Infections in HIV-Infected Patients in Lambarene, Gabon.

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    Saskia Janssen

    2015-05-01

    Full Text Available Foci of the HIV epidemic and helminthic infections largely overlap geographically. Treatment options for helminth infections are limited, and there is a paucity of drug-development research in this area. Limited evidence suggests that antiretroviral therapy (ART reduces prevalence of helminth infections in HIV-infected individuals. We investigated whether ART exposure and cotrimoxazole preventive therapy (CTX-P is associated with a reduced prevalence of helminth infections.This cross-sectional study was conducted at a primary HIV-clinic in Lambaréné, Gabon. HIV-infected adults who were ART-naïve or exposed to ART for at least 3 months submitted one blood sample and stool and urine samples on 3 consecutive days. Outcome was helminth infection with intestinal helminths, Schistosoma haematobium, Loa loa or Mansonella perstans. Multivariable logistic regression was used to assess associations between ART or CTX-P and helminth infection. In total, 408 patients were enrolled. Helminth infection was common (77/252 [30.5%]. Filarial infections were most prevalent (55/310 [17.7%], followed by infection with intestinal helminths (35/296 [11.8%] and S. haematobium (19/323 [5.9%]. Patients on CTX-P had a reduced risk of Loa loa microfilaremia (adjusted odds ratio (aOR 0.47, 95% CI 0.23-0.97, P = 0.04, also in the subgroup of patients on ART (aOR 0.36, 95% CI 0.13-0.96, P = 0.04. There was no effect of ART exposure on helminth infection prevalence.CTX-P use was associated with a decreased risk of Loa loa infection, suggesting an anthelminthic effect of antifolate drugs. No relation between ART use and helminth infections was established.

  12. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults : A Systematic Review and Meta-Analysis of Randomized Trials

    NARCIS (Netherlands)

    Ayele, Henok Tadesse; Mourik, Maaike S M van; Debray, Thomas P A; Bonten, Marc J M

    2015-01-01

    BACKGROUND: Infection with Human Immunodeficiency virus (HIV) is an important risk factor for Tuberculosis (TB). Anti-Retroviral Therapy (ART) has improved the prognosis of HIV and reduced the risk of TB infected patients. Isoniazid Preventive Therapy (IPT) aims to reduce the development of active T

  13. Plasma Mitochondrial DNA Levels as a Biomarker of Lipodystrophy Among HIV-infected Patients Treated with Highly Active Antiretroviral Therapy (HAART).

    Science.gov (United States)

    Dai, Z; Cai, W; Hu, F; Lan, Y; Li, L; Chung, C; Caughey, B; Zhang, K; Tang, X

    2015-01-01

    Lipodystrophy is a common complication in HIV-infected patients taking highly active antiretroviral therapy. Its early diagnosis is crucial for timely modification of antiretroviral therapy. We hypothesize that mitochondrial DNA in plasma may be a potential marker of LD in HIV-infected individuals. In this study, we compared plasma mitochondrial DNA levels in HIV-infected individuals and non-HIV-infected individuals to investigate its potential diagnostic value. Total plasma DNA was extracted from 67 HIV-infected patients at baseline and 12, 24 and 30 months after initiating antiretroviral therapy. Real-time quantitative PCR was used to determine the mitochondrial DNA levels in plasma. Lipodystrophy was defined by the physician-assessed presence of lipoatrophy or lipohypertrophy in one or more body regions. The mitochondrial DNA levels in plasma were significantly higher at baseline in HIV-infected individuals than in non-HIV-infected individuals (pmitochondrial DNA levels in lipodystrophy patients were significantly higher compared to those without lipodystrophy at month 24 (pmitochondrial DNA level (with cut-off value mitochondrial DNA levels may help to guide therapy selection with regards to HIV lipodystrophy risk.

  14. Metropolitan social environments and pre-HAART/HAART era changes in mortality rates (per 10,000 adult residents among injection drug users living with AIDS.

    Directory of Open Access Journals (Sweden)

    Samuel R Friedman

    Full Text Available BACKGROUND: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents after highly active antiretroviral therapy (HAART was developed. METHODS: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially control for pre-HAART epidemic history and study how other independent variables affected the outcomes. RESULTS: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. CONCLUSIONS: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be

  15. Current oral manifestations of HIV infection.

    Science.gov (United States)

    Navazesh, M

    2001-02-01

    The oral manifestations of human immunodeficiency virus infection have changed drastically since the introduction of the highly active anti-retroviral therapy (HAART) in developed countries. Recent studies have documented significant reductions in morbidity and mortality rates among HIV-infected patients on HAART. This article focuses on the latest information about the oral manifestations of HIV infection and will discuss the impact of HAART.

  16. Impact of Non-HIV and HIV Risk Factors on Survival in HIV-Infected Patients on HAART: A Population-Based Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Obel, Niels; Omland, Lars Haukali; Kronborg, Gitte;

    2011-01-01

    We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse...

  17. TTV viral load as a marker for immune reconstitution after initiation of HAART in HIV-infected patients

    DEFF Research Database (Denmark)

    Madsen, Chris; Eugen-Olsen, Jesper; Kirk, Ole;

    2002-01-01

    PURPOSE: To investigate whether TT virus (TTV) viral load may be used as a surrogate marker for functional immune reconstitution in HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHOD: Fifteen protease inhibitor-naïve HIV-infected patients were included in a longi......PURPOSE: To investigate whether TT virus (TTV) viral load may be used as a surrogate marker for functional immune reconstitution in HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHOD: Fifteen protease inhibitor-naïve HIV-infected patients were included...... in a longitudinal study. From each patient, three serum samples taken before HAART initiation and three samples taken during HAART were analyzed. TTV was detected by polymerase chain reaction (PCR) and was quantitated by competitive PCR. TTV viral heterogeneity was determined by restriction fragment length...

  18. Terapia hipolipemiante em situações especiais: síndrome de imunodeficiência adquirida Hypolipidemic therapy under special conditions: acquired immune deficiency syndrome

    OpenAIRE

    Pai Ching Yu; Daniela Calderaro; Enéas M. O. Lima; Bruno Caramelli

    2005-01-01

    Dislipidemias podem ser observadas precocemente entre pacientes com AIDS. Frequentemente, estas anormalidades lipídicas incluem HDL baixo e moderado aumento dos triglicérides sanguíneos. A terapia anti-retroviral combinada (HAART) pode agravar a dislipidemia nestes pacientes, com importante aumento nos triglicérides e no LDL. Vários mecanismos são propostos para explicar a dislipidemia mista observada nestes indivíduos, incluindo diferentes etapas do metabolismo lipídico. A importância do tra...

  19. Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia

    OpenAIRE

    Kumela K; Amenu D; Chelkeba L

    2015-01-01

    Background: More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. Objective: To determine the effectiveness of highly active antiretroviral and short course antiretroviral regimens in prevention of mother-to-child transmission of HIV and associated factors Jimma University Specialized Hospital (JUSH). Method: A hospital based retrospective cohort study w...

  20. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Glenn Wagner

    2012-09-01

    Full Text Available In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy—ART to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their “already healed” peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, “taking care of other illness”, and reducing worries. When high religiosity among people living with HIV (PHAs becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.

  1. Overestimates of survival after HAART: implications for global scale-up efforts.

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    Gregory P Bisson

    Full Text Available BACKGROUND: Monitoring the effectiveness of global antiretroviral therapy scale-up efforts in resource-limited settings is a global health priority, but is complicated by high rates of losses to follow-up after treatment initiation. Determining definitive outcomes of these lost patients, and the effects of losses to follow-up on estimates of survival and risk factors for death after HAART, are key to monitoring the effectiveness of global HAART scale-up efforts. METHODOLOGY/PRINCIPAL FINDINGS: A cohort study comparing clinical outcomes and risk factors for death after HAART initiation as reported before and after tracing of patients lost to follow-up was conducted in Botswana's National Antiretroviral Therapy Program. 410 HIV-infected adults consecutively presenting for HAART were evaluated. The main outcome measures were death or loss to follow-up within the first year after HAART initiation. Of 68 patients initially categorized as lost, over half (58.8% were confirmed dead after tracing. Patient tracing resulted in reporting of significantly lower survival rates when death was used as the outcome and losses to follow-up were censored [1-year Kaplan Meier survival estimate 0.92 (95% confidence interval, 0.88-0.94 before tracing and 0.83 (95% confidence interval, 0.79-0.86 after tracing, log rank P<0.001]. In addition, a significantly increased risk of death after HAART among men [adjusted hazard ratio 1.74 (95% confidence interval, 1.05-2.87] would have been missed had patients not been traced [adjusted hazard ratio 1.41 (95% confidence interval, 0.65-3.05]. CONCLUSIONS/SIGNIFICANCE: Due to high rates of death among patients lost to follow-up after HAART, survival rates may be inaccurate and important risk factors for death may be missed if patients are not actively traced. Patient tracing and uniform reporting of outcomes after HAART are needed to enable accurate monitoring of global HAART scale-up efforts.

  2. "Every drug goes to treat its own disease…" - a qualitative study of perceptions and experiences of taking anti-retrovirals concomitantly with anti-malarials among those affected by HIV and malaria in Tanzania

    DEFF Research Database (Denmark)

    Mangesho, Peter E; Reynolds, Joanna; Lemnge, Martha;

    2014-01-01

    BACKGROUND: Little is known about how people living with human immunodeficiency virus (HIV) experience malaria and the concomitant use of anti-malarial treatments with anti-retrovirals (ARVs). An understanding of how patients make sense of these experiences is important to consider in planning...... and supporting the clinical management and treatment for co-infected individuals. METHODS: A qualitative study was conducted in Tanzania alongside a clinical trial of concomitant treatment for HIV and malaria co-infection. Focus group discussions were held with people receiving treatment for HIV and/or malaria......, and in-depth interviews with health workers responsible for HIV care and members of the clinical trial team. Data were analysed inductively to identify themes and develop theoretical narratives. RESULTS: Results suggest that people living with HIV perceived malaria to be more harmful to them due...

  3. Trends of tuberculosis in cohorts of positives HIV patients before and after the HAART era in health institutions of Medellin (1996-2005

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    Alexánder Arbeláez

    2007-02-01

    Full Text Available Tuberculosis (TB is still an important disease with public health impact. Which has increased since HIV epidemic emergence. The preventive role of highly effective antiretroviral (HAART against TBdisease is not enough to control TB because it requires regular administration and adherence to therapy. Since HAART implementation around the world, de TB, co morbidity has decreased, but is no the only factor to control it. Objectives: to determine TB trend in HIV infected patients, during HAART implementation in two patient cohorts coming from different health centers of Medellín. Methods: a descriptive study was conducted based on registries and data bases from a referral program to care HIV/AIDS patiens in different health centers in the city during 1996 to 2002, and a retrospective cohort of HIV patients with data from clinical registries which was comprised in order to compare TB risk in a prophylaxis study during 2003-2005. Results: we report an increasing trend of HAART therapy use during the period of study, with 60% of HIV patients with irregular therapy during the last period (2003-2005. The annual TB incidence was between 0.1 to 5.1%. The TB proportion among the HIV patients who did not received haart effectiviness was 60% (RR=0.4. Conclusion: HAART therapy must be administered at each HIV/AIDSpatients when the risk of developing TB is high, according to this results, HAART therapy is effective but is not the only factor to control TB in this population.

  4. Intestinal parasitosis in relation to CD4+T cells levels and anemia among HAART initiated and HAART naive pediatric HIV patients in a Model ART center in Addis Ababa, Ethiopia.

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    Hylemariam Mihiretie Mengist

    Full Text Available Intestinal parasites (IPs are major concerns in most developing countries where HIV/AIDS cases are concentrated and almost 80% of AIDS patients die of AIDS-related infections. In the absence of highly active antiretroviral therapy (HAART, HIV/AIDS patients in developing countries unfortunately continue to suffer from the consequences of opportunistic and other intestinal parasites. The aim of the study was to determine the prevalence of intestinal parasites in relation to CD4+ T cells levels and anemia among HAART initiated and HAART naïve pediatric HIV patients in a Model ART center in Addis Ababa, Ethiopia.A prospective comparative cross-sectional study was conducted among HAART initiated and HAART naive pediatric HIV/AIDS patients attending a model ART center at Zewditu Memorial Hospital between August 05, 2013 and November 25, 2013. A total of 180 (79 HAART initiated and 101 HAART naïve children were included by using consecutive sampling. Stool specimen was collected and processed using direct wet mount, formol-ether concentration and modified Ziehl-Neelsen staining techniques. A structured questionnaire was used to collect data on socio-demographic and associated risk factors. CD4+ T cells and complete blood counts were performed using BD FACScalibur and Cell-Dyn 1800, respectively. The data was analyzed by SPSS version 16 software. Logistic regressions were applied to assess any association between explanatory factors and outcome variables. P values < 0.05 were taken as statistically significant.The overall prevalence of IPs was 37.8% where 27.8% of HAART initiated and 45.5% of HAART naive pediatric HIV/AIDS patients were infected (p < 0.05. Cryptosporidium species, E. histolytica/dispar, Hook worm and Taenia species were IPs associated with CD4+ T cell counts <350 cells/μμL in HAART naive patients. The overall prevalence of anemia was 10% in HAART and 31.7% in non-HAART groups. Hook worm, S. stercoralis and H. nana were helminthes

  5. Adherence to HAART : processes explaining adherence behavior in acceptors and non-acceptors

    NARCIS (Netherlands)

    Vervoort, Sigrid C. J. M.; Grypdonck, Mieke H. F.; de Grauwe, Annelies; Hoepelman, Andy I. M.; Borleffs, Jan C. C.

    2009-01-01

    In order to explore and clarify the underlying processes which lead to (non)-adherence behavior in patients treated with highly active antiretroviral therapy (HAART), a qualitative study was conducted. Thirty-seven in-depth interviews were held with 30 Caucasian HIV-positive patients. Additional dat

  6. Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America.

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    Brenda Crabtree-Ramírez

    Full Text Available Since 2009, earlier initiation of highly active antiretroviral therapy (HAART after an opportunistic infection (OI has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in "real life" settings in Latin America has not been evaluated.Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet ≥18 years of age at enrolment, from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH group (those initiating within 4 weeks of an OI and a delayed HAART (DH group (those initiating more than 4 weeks after an OI. All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009 were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models.A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%, followed by Pneumocystis pneumonia (24%, Invasive Candidiasis (16% and Toxoplasmosis (9%. Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1 weeks before 2009 to 4.3 (IQR 2.0-7.1 after 2009 (p<0.01. Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001, having a non-tuberculosis OI (p<0.001, study site (p<0.001, and more recent years of OI diagnosis (p<0.001.The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the

  7. Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America

    Science.gov (United States)

    Crabtree-Ramírez, Brenda; Caro-Vega, Yanink; Shepherd, Bryan E.; Grinsztejn, Beatriz; Wolff, Marcelo; Cortes, Claudia P.; Padgett, Denis; Carriquiry, Gabriela; Fink, Valeria; Jayathilake, Karu; Person, Anna K.; McGowan, Catherine; Sierra-Madero, Juan

    2016-01-01

    Background Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in “real life” settings in Latin America has not been evaluated. Methods Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001–2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. Results A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8–12.1) weeks before 2009 to 4.3 (IQR 2.0–7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001). Discussion The time from diagnosis of an OI to HAART initiation has

  8. The Changing Pathology of NeuroAIDS Associated with Drug Abuse in the Era of HAART

    Directory of Open Access Journals (Sweden)

    Jeanne E. Bell

    2006-01-01

    Full Text Available Compliance with highly active antiretroviral therapy (HAART arrests HIV induced immune collapse and reduces the prevalence of severe central nervous system (CNS complications, including HIV associated dementia and encephalitis. However minor cognitive disorders remain common and recent autopsy studies have demonstrated the presence of subtle neuropathological abnormalities in HAART treated individuals, including persistent neuroinflammation and enhanced deposition in the brain of proteins associated with neurodegeneration. The closest comparison group from the pre-HAART era is that comprising presymptomatic HIV infected individuals dying from non HIV related causes. HIV is believed to enter the CNS at or soon after the time of initial infection. Whether this occurs in all HIV infected individuals is unknown. The virus is probably restrained from progressing to a productive CNS infection by systemic and innate immune controls which include surveillance of brain tissue by patrolling CD8 lymphocytes. However HIV is not eliminated from the CNS compartment and is present at low level in the brains of some HAART treated just as in pre-HAART subjects. Brain viral isolates appear to be neuroadapted and clearly persist long term in the sanctuary of the CNS. This review compares and contrasts data derived from studies of the brain in pre and post HAART cohorts. The implications of increasing longevity in treated individuals who may have low level HIV infection of brain tissue, associated with lymphocytic infiltration and microglial/macrophage activation, are discussed. The exact roles of these cellular reactions in relation to viral suppression are unclear at present. The complexity of this scenario is further heightened when other factors such as illicit drug intake and hepatitis-induced encephalopathy contribute to the clinical outcome. These added insults lead to damaging effects in the brain which may augment those induced by HIV/AIDS. Taken together

  9. Qualitative and quantitative assessments of HAART adherence of substance-abusing women.

    Science.gov (United States)

    Powell-Cope, G M; White, J; Henkelman, E J; Turner, B J

    2003-04-01

    This study was set up to examine factors affecting adherence to highly active antiretroviral therapy (HAART) by substance abusing women and to conduct a pilot study of a reminder device intervention. Three focus groups totaling 24 HIV-positive women developed priority lists of issues affecting adherence. Another group of 24 HIV-positive women received a timer-reminder with structured interviews on adherence at baseline and two monthly follow up intervals. Focus groups described key barriers to HAART adherence as substance abuse, forgetting, feeling ill, others' negative attitudes, obtaining refills and confidentiality. Primary disadvantages to HAART were side effects, pill-taking schedule and burden of taking medications. Facilitators included reminders (e.g. pill boxes) and spirituality. After receiving the reminder, missing a dose was less common (p < 0.05) due to sleeping through dose, being busy and feeling too good while a favourable trend (p = 0.07) was seen for change in daily routine and having too many pills to take. Although well accepted, the reminder did not affect the proportion missing a dose in the past two weeks: baseline (33%), first follow-up (30%) and second follow-up (30%). Forgetting to take HAART was only one of many cited barriers to adherence in these HIV-positive women; well-received reminder devices did not affect adherence. To improve substance-abusing women's adherence, multidimensional interventions are warranted. PMID:12856345

  10. AIDS in the HAART era: New York's heterogeneous geography.

    Science.gov (United States)

    Wallace, Robert G

    2003-03-01

    During the 1990s, the number of new AIDS cases in New York City, USA, declined precipitously. The declines, beginning before highly active antiretroviral therapy (HAART) was introduced, were geographically heterogeneous across two New York City boroughs analyzed. From 1993 to 1998, zip codes in Lower Manhattan, with large white and affluent populations, had declines as much as 55% more than the rest of Manhattan. Bronx zip codes underwent still lesser declines. Declines also differed within zip codes among subpopulations. White zip code populations tended to have greater declines than Latino populations, which in turn tended to have greater declines than black populations. According to bivariate and stepwise regressions, an array of socioeconomic and community stress variables acted in combination on the decline in New York AIDS. Manhattan's declines in total AIDS incidence were primarily defined by changes in AIDS incidence for whites and for men who have sex with men, racial segregation, and the proportions of households in upper income classes and under rent stress. Bronx declines in total AIDS are principally explained by a broader range of income classes, and social instability as marked by housing overcrowding and cirrhosis and drug mortalities. Whatever the combination of proximate causes for the decline in AIDS incidence in 1990s New York (educational campaigns, HAART, demographic stochasticity), the decline was shaped by the city's socioeconomic structure and political and ecological history. That structure and history generates the geographically defined aggregates of behaviors that promote or impede AIDS decline. Such spatial heterogeneity may provide for HIV refugia, areas where the virus can weather the epidemic's contraction, a troubling possibility with the accelerating microbicidal failures of combination therapies.

  11. Study of T Cell subsets and IL-7 protein expression in HIV-1-infected patients after 7 years HAART

    Directory of Open Access Journals (Sweden)

    Shou C

    2011-11-01

    Full Text Available Abstract Objective To study the changes in T cell subsets and IL-7 in HIV-1-infected patients after seven years of highly active antiretroviral therapy (HAART. Methods Seventy-five individuals were included in this study (25 with effective HAART, 18 with ineffective HAART, 17 untreated HIV+ patients, and 15 volunteers in the HIV negative control group. The counts of CD4+, CD8+, CD8/CD38+, and CD8/HLADR+ T cells as well as the IL-7 protein expression was measured at 5 time points during a period of seven years in patients starting HAART (baseline and in the HIV negative control group. The expression of CD127 on CD3+ T cells was measured by flow cytometry at a single time point (after 7 years in patients with HAART and was compared with untreated HIV+ patients and the HIV negative control group. Results At baseline CD4+ T cell counts of HIV-1-infected patients were lower than that in the control group (p +, CD8/HLADR+ and CD8/CD38+ T cell counts were higher than those in the control group (p 0.01. After seven years of effective HAART, the CD4+ T cell counts had increased and the CD8+ T cell count had decreased, although not to the normal levels (p + and CD8/CD38+ T cell counts had gradually approached those of the control group (p > 0.05. In the ineffective HAART group, the CD8/CD38+ T cell count had not decreased significantly, and CD8/HLADR+ T cell count gradually decreased. Before treatment, IL-7 serum levels of patients were significantly higher than that in the control group (p p + CD8+ T cells in effective HAART patients was higher than in untreated HIV+ patients (p p + CD4+ T cells was not significantly different among the control group, untreated HIV+ patients and effective HAART group. Conclusion After seven years of effective HAART, the quantity and capacity of T cell subsets and IL-7 in HIV-1-infected patients had been partially restored, and the abnormal immune activation has significantly diminished.

  12. 高效抗反转录病毒治疗相关性脂肪代谢综合征%Highly active antiretroviral therapy(HAART)-related lipodystrophy syndrome

    Institute of Scientific and Technical Information of China (English)

    江雪艳; 卢洪洲

    2008-01-01

    自1996年高效抗反转录病毒治疗(HAART)应用于临床以来,艾滋病的发病率和死亡率已经大大降低.但HAART治疗需长期或终身服药,因此,药物的毒副作用容易导致患者的依从性下降.其中脂肪代谢综合征就是HAART用药过程中的一个比较常见的远期不良反应之一.HAART药物中与脂肪代谢有关的主要是蛋白酶抑制剂(PIs)和核苷类逆转录酶抑制剂(NRTIs),可以引起各种代谢异常和内分泌紊乱综合征.其具体的发病机制目前尚不清楚.本文就脂肪代谢综合征的发病机制、检测及治疗进行了阐述.

  13. suPAR associates to glucose metabolic aberration during glucose stimulation in HIV-infected patients on HAART

    DEFF Research Database (Denmark)

    Andersen, Ove; Eugen-Olsen, Jesper; Kofoed, Kristian;

    2008-01-01

    OBJECTIVE: We have recently shown that the level of soluble urokinase plasminogen activator receptor (suPAR), which is associated with the immune status of HIV-infected patients undergoing highly active antiretroviral therapy (HAART), correlates with the insulin action of such patients. Here we e...

  14. Patentes farmacêuticas e saúde pública: desafios à política brasileira de acesso ao tratamento anti-retroviral Pharmaceutical patents and public health: challenges for the Brazilian antiretroviral treatment policy

    Directory of Open Access Journals (Sweden)

    Constance Marie Milward de Azevedo Meiners

    2008-07-01

    Full Text Available O preço elevado de medicamentos patenteados tem intensificado o debate em torno do impacto do regime da propriedade intelectual sobre o acesso a tratamentos de saúde, merecendo destaque o caso do HIV/AIDS. A política brasileira de tratamento anti-retroviral, parte de um programa nacional que integra medidas de prevenção e promoção da saúde, permitiu o alcance de uma ampla cobertura com qualidade, tendo sido apontada como modelo para outros países. Não obstante, conforme amadurece o Programa Nacional de DST e AIDS, os gastos com a incorporação de anti-retrovirais patenteados ao esquema terapêutico para pacientes em tratamento atinge um peso, cada vez maior, em seu orçamento. O presente artigo toma em conta os desafios apresentados pelas patentes farmacêuticas à saúde pública e discute possíveis caminhos para a sustentação da política de acesso universal e gratuito ao tratamento contra HIV/AIDS no Brasil.The high prices of patented drugs have fueled the debate regarding the impact of the intellectual property system on access to treatment, with a special focus on HIV/AIDS. The Brazilian policy for antiretroviral treatment, part of a comprehensive program that includes both disease prevention and health promotion activities, has allowed the country to meet goals for coverage and quality and has been considered a model for other countries. However, as the Brazilian STD/AIDS Program reaches maturity, the increasing incorporation of patented drugs into the AIDS treatment regimen imposes an increasing burden on the country's health budget. This article discusses the public health challenges raised by pharmaceutical patents and discusses possible ways to sustain the national policy for free, universal access to HIV/AIDS treatment.

  15. Challenges faced by elderly guardians in sustaining the adherence to antiretroviral therapy in HIV-infected children in Zimbabwe

    OpenAIRE

    2011-01-01

    Abstract Grandparents throughout sub-Saharan Africa have shown immense courage and fortitude in providing care and support for AIDS-affected children. However, growing old comes with a number of challenges which can compromise the care and support given to children affected by AIDS, particularly for children infected by HIV and enrolled on anti-retroviral therapy (ART) programmes. For ART to have an impact, and for children not to develop drug-resistance, a rigid treatment regimen...

  16. Terapia anti-retroviral: fatores que interferem na adesão de crianças com HIV/AIDS Terapia anti-retroviral: factores que interfieren en la adherencia de niños con VIH/SIDA Antiretroviral therapy: factors interfering in the adherence of children with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Ana Claúdia Feitosa

    2008-09-01

    Full Text Available O objetivo deste estudo foi conhecer os fatores que interferem na adesão à terapêutica medicamentosa em crianças infectadas pelo HIV/AIDS, relatados por 12 cuidadores em um serviço de referência em AIDS, em Fortaleza-CE. Os dados foram obtidos mediante entrevista, e, com eles, foram apurados fatores que dificultaram a adesão terapêutica, evidenciando relatos referentes à apresentação da droga, horário da tomada do medicamento, efeitos colaterais, falta na distribuição de medicamento gratuito, dificuldade de acesso regular ao serviço de saúde e problemas financeiros. Constatou-se a importância de conhecer o contexto social no qual a criança está inserida e as dificuldades no uso dos anti-retrovirais para intervir de forma eficiente e possibilitar uma melhor qualidade de vida às crianças.La finalidad de este estudio fue conocer los factores que interfieren en la adherencia a la terapéutica medicamentosa en niños infectados por el VIH/sida relatados por 12 cuidadores en un servicio de referencia en sida, en Fortaleza-CE, Brasil. Los datos fueron obtenidos mediante entrevista, y, con ellos fueran apurados factores que dificultaron la adherencia terapéutica, evidenciando relatos referentes a la presentación de la droga, horario de la toma del medicamento, efectos colaterales, falta en la distribución de medicamento gratuito, dificultad de acceso regular al servicio de salud y problemas financieros. Se constató la importancia de conocer el contexto social en que el niño está insertado y las dificultades en el uso de los anti-retrovirales para intervenir de forma eficiente y posibilitar una mejor calidad de vida a los niños.This study aimed to get to know the factors that interfere in medication treatment adherence among children infected by HIV/aids, as reported by 12 caregivers in a service reference to aids in Fortaleza/CE, Brazil. Data were collected through interviews, verifying factors that made treatment adherence difficult, evidencing reports about drug forms, time of medication intake, collateral effects, shortage in the free drugs distribution, difficulty to get regular access to the health service and financial problems. The importance was revealed of getting to know the social context the child is inserted in and the difficulties in the use of antiretroviral drugs, so as to intervene efficiently and permit a better quality of life for the children.

  17. Terapia antirretroviral altamente eficaz para infecção pelo vírus da imunodeficiência humana aumenta a rigidez aórtica Potent antiretroviral therapy for human immunodeficiency virus infection increases aortic stiffness

    Directory of Open Access Journals (Sweden)

    Margareth Eira

    2012-01-01

    controls were 9.77 m/s (95% CI 9.17-10.36, , 9.00 m/s (95% CI 8.37-9.63, 9.90 m/s (95% CI 9.32-10.49, and 9.28 m/s (95% CI 8.61-9.95, respectively, for men (P-value for trend = 0.14, and 9.61 m/s (95% CI 8.56-10.66, 8.45 m/s (95% CI 7.51-9.39, 9.83 (95% CI 9.21-10.44, and 7.79 m/s (95% CI 6.99-8.58, respectively, for women (P-value for trend <0.001. Post-hoc analysis revealed a significant difference between the mean PWV values in the HAART group and controls in women (P-value <0.01. After adjusting for other potential covariates, including systolic blood pressure and diabetes, these results did not change. The findings indicate that the impact of HAART treatment on aortic stiffness was amplified in women with hypertension, dyslipidemia, and metabolic syndrome. CONCLUSION: Potent anti-retroviral agents used in the treatment of HIV infection increases aortic stiffness, mainly among women with higher cardiovascular risk.

  18. Terapia antirretroviral altamente eficaz para infecção pelo vírus da imunodeficiência humana aumenta a rigidez aórtica Potent antiretroviral therapy for human immunodeficiency virus infection increases aortic stiffness

    Directory of Open Access Journals (Sweden)

    Margareth Eira

    2012-12-01

    controls were 9.77 m/s (95% CI 9.17-10.36, , 9.00 m/s (95% CI 8.37-9.63, 9.90 m/s (95% CI 9.32-10.49, and 9.28 m/s (95% CI 8.61-9.95, respectively, for men (P-value for trend = 0.14, and 9.61 m/s (95% CI 8.56-10.66, 8.45 m/s (95% CI 7.51-9.39, 9.83 (95% CI 9.21-10.44, and 7.79 m/s (95% CI 6.99-8.58, respectively, for women (P-value for trend <0.001. Post-hoc analysis revealed a significant difference between the mean PWV values in the HAART group and controls in women (P-value <0.01. After adjusting for other potential covariates, including systolic blood pressure and diabetes, these results did not change. The findings indicate that the impact of HAART treatment on aortic stiffness was amplified in women with hypertension, dyslipidemia, and metabolic syndrome. CONCLUSION: Potent anti-retroviral agents used in the treatment of HIV infection increases aortic stiffness, mainly among women with higher cardiovascular risk.

  19. Predictors of change in CD4 lymphocyte count and weight among HIV infected patients on anti-retroviral treatment in Ethiopia: a retrospective longitudinal study.

    Directory of Open Access Journals (Sweden)

    Ayalu A Reda

    Full Text Available BACKGROUND: Antiretroviral treatment (ART has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment. OBJECTIVE: To determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia. METHODS: A retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort. RESULTS: Both the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48-8.34; p 0.000 and weight (beta 0.15; 95% CI 0.13-0.18; p 0.000. Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05. CONCLUSION: We detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.

  20. Liver ultrastructural morphology and mitochondrial DNA levels in HIV/hepatitis C virus coinfection: no evidence of mitochondrial damage with highly active antiretroviral therapy.

    Science.gov (United States)

    Matsukura, Motoi; Chu, Fanny F S; Au, May; Lu, Helen; Chen, Jennifer; Rietkerk, Sonja; Barrios, Rolando; Farley, John D; Montaner, Julio S; Montessori, Valentina C; Walker, David C; Côté, Hélène C F

    2008-06-19

    Liver mitochondrial toxicity is a concern, particularly in HIV/hepatitis C virus (HCV) coinfection. Liver biopsies from HIV/HCV co-infected patients, 14 ON-highly active antiretroviral therapy (HAART) and nine OFF-HAART, were assessed by electron microscopy quantitative morphometric analyses. Hepatocytes tended to be larger ON-HAART than OFF-HAART (P = 0.05), but mitochondrial volume, cristae density, lipid volume, mitochondrial DNA and RNA levels were similar. We found no evidence of increased mitochondrial toxicity in individuals currently on HAART, suggesting that concomitant HAART should not delay HCV therapy. PMID:18525271

  1. CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

    Science.gov (United States)

    BUCCHERI, Renata; KASSAB, Maria José; de FREITAS, Vera Lucia Teixeira; da SILVA, Sheila Cristina Vicente; BEZERRA, Rita C.; KHOURY, Zarifa; SHIKANAI-YASUDA, Maria Aparecida; VIDAL, José E.

    2015-01-01

    The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease. PMID:27049711

  2. The influence of HCV coinfection on clinical, immunological and virological responses to HAART in HIV-patients

    Directory of Open Access Journals (Sweden)

    Ricardo A. Carmo

    2008-06-01

    Full Text Available The potential impact of the hepatitis C virus (HCV on clinical, immunological and virological responses to initial highly active antiretroviral therapy (HAART of patients infected with human immunodeficiency virus (HIV is important to evaluate due to the high prevalence of HIV-HCV coinfection. A historical cohort study was conducted among 824 HIV-infected patients starting HAART at a public referral service in Belo Horizonte, Brazil, to assess the impact of HCV seropositivity on appearance of a new AIDS-defining opportunistic illness, AIDS-related death, suppression of viral load, and an increase in CD4-cell count. A total of 76 patients (9.2% had a positive HCV test, 26 of whom (34.2% had a history of intravenous drug use. In multivariate analysis, HCV seropositivity was associated with a smaller CD4-cell recovery (RH=0.68; 95% CI [0.49-0.92], but not with progression to a new AIDS-defining opportunistic illness or to AIDS-related death (RH=1.08; 95% CI [0.66-1.77], nor to suppression of HIV-1 viral load (RH=0.81; 95% CI [0.56-1.17] after starting HAART. These results indicate that although associated with a blunted CD4-cell recovery, HCV coinfection did not affect the morbidity or mortality related to AIDS or the virological response to initial HAART.

  3. Mitochondrial toxicity in HAART: an overview of in vitro evidence.

    Science.gov (United States)

    Apostolova, Nadezda; Blas-García, Ana; Esplugues, Juan V

    2011-01-01

    The combined antiretroviral therapeutic approach currently employed for the treatment of HIV infection, known as Higly Active Antiretroviral Therapy (HAART), has dramatically reduced AIDS-related morbidity and mortality. However, the adverse reactions associated with the long term use of this therapy have now become a major issue and researchers have focused on understanding the cellular mechanisms underlying these drug-induced detrimental effects which englobe a large list of different events including rash and hypersensibility reactions, hepatotoxicity, metabolic disturbances including lipodystrophy, and other metabolic syndrome-like disturbances such as hyperlactatemia, hyperlipedimia, insulin resistance and pancreatitis. Other events include CNS toxic effects, peripheral neuropathies as well as nephrotoxicity and increased risk of cardiovascular diseases. Many of these reactions have been shown to develop as e result of mitochondrial dysfunction. The mitochondrial effect of N(t)RTI (Nucleos(t)ide Reverse Transcriptase Inhibitors) class of drugs, which has been widely studied, is believed to originate from the inhibitory action of these drugs on DNA polymerase gamma, the enzyme responsible for replication of mitochondrial DNA. However, additional mitochondrial targets have also been described and need to be considered. As to NNRTI (Non-Nucleoside-Transcriptase Inhibitor) or PI (Protease Inhibitors), evidence of the implication of mitochondria has also been reported, however the details of the mechanisms underlying these actions are still not fully known. This review covers the current knowledge of mitochondrial toxicities, particularly the available in vitro evidence, regarding the most commonly used groups of HIV drugs. Novel findings of mtDNA-independent mitochondrial dysfunction have received special attention. PMID:21718249

  4. 广东省艾滋病长期抗病毒治疗患者耐药情况调查%Investigation of HIV-1 drug resistance prevalence in AIDS patients with long-term HAART therapy in Guangdong Province

    Institute of Scientific and Technical Information of China (English)

    于国龙; 鄢心革; 秦冰; 李杰; 刁丽梅; 况轶群; 付笑冰; 颜瑾; 林鹏

    2013-01-01

    Objective To find the HIV-1 drug resistance prevalence in AIDS patients with HAART therapy over four years.Methods Recruited the HIV/AIDS patients with HAART for more than four years,counted CD4 + T lymphocyte and HIV-1 viral load; and then detected the genotype drug resistance when the samples with virus load more than 1000 copies/ml by the IN-house method.Firstly amplified the whole genome of HIV-1 protease and part of reverse transcriptase genome,secondly sequenced the PCR products,and then assembled the sequence.Blast the sequence with the Stanford HIV-1 Drug Resistance Database and get the drug resistance mutation and drug resistance.Results CD4 + T Lymphocytes partly reconverted again and the virus load uncontrolled is 18.3%; about 10% patients (12 patients) were with high genotypic resistance.Major drug resistance mutations in RT region are as follows:Y181C、G190A、K101Q/E/N、M184IMV、K219KR.No major mutation was found in PI region.The NNTRI drug resistance is 100%,92% to NVP and EFV respectively.The NTRI Drug resistance to 3TC、FTC and ABC is 83%,83% and 42% respectively.Conclusions HIV-1 drug resistance in therapy patients for long time was already more than 10 percent in Guangdong province.Viruses with high drug resistance to NNTRI and NTRI were found in this population,and more measure should be done in these people.%目的 了解广东省艾滋病长期抗病毒治疗患者耐药情况.方法 在接受HAART治疗方案4年以上的120例艾滋病患者,对其中病毒载量大于1 000 copies/ml的22例患者,进行HIV-1耐药基因型检测.采用In-House方法,扩增HIV-l的POL基因蛋白酶区(PR)基因全长和逆转录酶区(RT)基因部分片段,通过HIV-1耐药数据库,获得个体耐药突变位点及药物耐受情况.结果 该人群HIV-1病毒未抑制率为18.3% (22/120);基因型高度耐药12例,高度耐药比例为10%,RT区常见耐药突变:Y181C、G190A、K101Q/E/N、M184IMV和K219KR,PR区未见主要耐药

  5. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting.

    Directory of Open Access Journals (Sweden)

    Julio S G Montaner

    Full Text Available BACKGROUND: There has been renewed call for the global expansion of highly active antiretroviral therapy (HAART under the framework of HIV treatment as prevention (TasP. However, population-level sustainability of this strategy has not been characterized. METHODS: We used population-level longitudinal data from province-wide registries including plasma viral load, CD4 count, drug resistance, HAART use, HIV diagnoses, AIDS incidence, and HIV-related mortality. We fitted two Poisson regression models over the study period, to relate estimated HIV incidence and the number of individuals on HAART and the percentage of virologically suppressed individuals. RESULTS: HAART coverage, median pre-HAART CD4 count, and HAART adherence increased over time and were associated with increasing virological suppression and decreasing drug resistance. AIDS incidence decreased from 6.9 to 1.4 per 100,000 population (80% decrease, p = 0.0330 and HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115. New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004 with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003. Finally, our models suggested that for each increase of 100 individuals on HAART, the estimated HIV incidence decreased 1.2% and for every 1% increase in the number of individuals suppressed on HAART, the estimated HIV incidence also decreased by 1%. CONCLUSIONS: Our results show that HAART expansion between 1996 and 2012 in BC was associated with a sustained and profound population-level decrease in morbidity, mortality and HIV transmission. Our findings support the long-term effectiveness and sustainability of HIV treatment as prevention within an adequately resourced environment with no financial barriers to diagnosis, medical care or antiretroviral drugs. The 2013 Consolidated World Health Organization Antiretroviral

  6. Effect of anemia on hepatotoxicity of HAART in HIV patients in Benin city

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    Rose A Ugiagbe

    2011-01-01

    Full Text Available Background: Hepatotoxicity is a relevant adverse effect of highly active antiretroviral Treatment owing to its frequency, and it can cause interruption of therapy, hepatitis, and death. There is dearth of information on hepatotoxicity arising from highly active antiretroviral therapy (HAART in anemic patients. Anemia is the most common symptom in human immunodeficiency virus (HIV/acquired immunodeficiency syndrome. We studied the effect of anemia on hepatotoxicity in HIV patients who were about to start HAART, attending clinic, or in the medical wards. Materials and Methods: This was a prospective study in which patients were recruited consecutively and followed up for 24 weeks. Results: In all, 84 patients were recruited and 42 were enrolled as controls. The mean ages of the cases and controls were 35.2΁9.9 and 35.5΁9.0 years, respectively. The age range of the cases was 18-68 years with a median age of 31.5 years, whereas the mean age of the controls was 20-57 years with a median age of 33.5 years. There was no difference (t=0.197, df=124, and P=0.844. There were 61 females (72.6% and 23 males (27.4% in the cases, whereas in the controls, there were 34 females (81.0% and 8 males (19.0%. Among the cases, 30 (35.7% were anemic, while 54 (64.3% were not anemic. Six (20% of the anemic patients had hepatotoxicity, and 9 (16.7% of the patients with normal packed cell volume had hepatotoxicity. Among the controls, all 42 (100% patients had normal packed cell volume. Four (9.5% of the patients had hepatotoxicity. There was no association between hepatotoxicity and anemia (χ2 =3.243, df=2, P=0.198. Conclusion: Anemia did not affect hepatotoxicity of HAART in this study.

  7. HIV-Associated Burkitt Lymphoma: Good Efficacy and Tolerance of Intensive Chemotherapy Including CODOX-M/IVAC with or without Rituximab in the HAART Era

    Directory of Open Access Journals (Sweden)

    J. A. Rodrigo

    2012-01-01

    Full Text Available Background. The outcome of HIV-associated non-Hodgkin lymphoma (NHL has improved substantially in the highly active antiretroviral therapy (HAART era. However, HIV-Burkitt lymphoma (BL, which accounts for up to 20% of HIV-NHL, has poor outcome with standard chemotherapy. Patients and Methods. We retrospectively reviewed HIV-BL treated in the HAART era with the Magrath regimen (CODOX-M/IVAC±R at four Canadian centres. Results. Fourteen patients with HIV-BL received at least one CODOX-M/IVAC±R treatment. Median age at BL diagnosis was 45.5 years, CD4 count 375 cells/mL and HIV viral load (VL 250 cells/mL and undetectable, respectively, in 4. Conclusion. Intensive chemotherapy with CODOX-M/IVAC±R yielded acceptable toxicity and good survival rates in patients with HIV-associated Burkitt lymphoma receiving HAART.

  8. Brain viral burden, neuroinflammation and neurodegeneration in HAART-treated HIV positive injecting drug users.

    Science.gov (United States)

    Smith, Donald B; Simmonds, Peter; Bell, Jeanne E

    2014-02-01

    The long-term impact of chronic human immunodeficiency virus (HIV) infection on brain status in injecting drug users (IDU) treated with highly active antiretroviral therapy (HAART) is unknown. Viral persistence in the brain with ongoing neuroinflammation may predispose to Alzheimer-like neurodegeneration. In this study, we investigated the brains of ten HAART-treated individuals (six IDU and four non-DU), compared with ten HIV negative controls (six IDU and four non-DU). HIV DNA levels in brain tissue were correlated with plasma and lymphoid tissue viral loads, cognitive status, microglial activation and Tau protein and amyloid deposition. Brain HIV proviral DNA levels were low in most cases but higher in HIV encephalitis (n = 2) and correlated significantly with levels in lymphoid tissue (p = 0.0075), but not with those in plasma. HIV positive subjects expressed more Tau protein and amyloid than HIV negative controls (highest in a 58 year old), as did IDU, but brain viral loads showed no relation to Tau and amyloid. Microglial activation linked significantly to HIV positivity (p = 0.001) and opiate abuse accentuated these microglial changes (p = 0.05). This study confirms that HIV DNA persists in brains despite HAART and that opiate abuse adds to the risk of brain damage in HIV positive subjects. Novel findings in this study show that (1) plasma levels are not a good surrogate indicator of brain status, (2) viral burden in brain and lymphoid tissues is related, and (3) while Tau and amyloid deposition is increased in HIV positive IDU, this is not specifically related to increased HIV burden within the brain.

  9. Pronounced lipoatrophy in HIV-infected men receiving HAART for more than 6 years compared with the background population

    DEFF Research Database (Denmark)

    Hansen, AB; Lindegaard, B; Obel, N;

    2006-01-01

    OBJECTIVES: To establish the prevalence and quantify the severity of body fat redistribution and dyslipidaemia in HIV-infected men after long-term highly active antiretroviral therapy (HAART) compared with the background population. METHODS: In a cross-sectional study, we included 87 HIV......-infected men who had received HAART for at least 6 years and 34 HIV-negative men. Regional body composition was assessed using dual-energy X-ray absorptiometry. Fasting metabolic parameters were obtained. Associations between regional body fat distribution and metabolic parameters were evaluated. RESULTS: HIV......-infected patients and controls did not differ with regard to height and lean body mass. Compared with controls, HIV-infected men had reduced total fat mass (median 12.3 versus 19.2 kg, P

  10. Analysis of Tuberculosis-Associated Immune Reconstitution Inlfammatory Syndrome in HIV/TB Co-infected Patients During HAART

    Institute of Scientific and Technical Information of China (English)

    Yang Zhou; Hui Wang; Sha-xi Li; Gui-lin Yang; Ying-xia Liu

    2014-01-01

    ObjectivesTo investigate the clinical features of tuberculosis (TB)-associated immune reconstitution inlfammatory syndrome (TB-IRIS) in patients co-infected with HIV/TB or latent infection during highly active antiretroviral therapy (HAART). Methods HIV-infected patients treated in the Third People’s Hospital of Shenzhen, China between March 2012 and March 2013 were recruited, and divided into 3 groups: 1) HIV/TB co-infection group (n = 50), 2) HIV/MTB latent infection group (n = 50), and 3) HIV infection group (n = 50), with 12-month follow-up. Patients in the HIV/TB co-infection group were treated with HAART 2 weeks after TB therapy. Patients were assessed at different time-points. ResultsThe incidence and mortality rates of TB-IRIS were 40% and 10% in the HIV/TB co-infected patients, and 2% (and no mortality) in the HIV/MTB group. The HIV infected group did not display TB-IRIS or death. About 95% HIV/TB co-infected patients were 20-39 years old when TB-IRIS occurred, and 65% of the patients developed TB-IRIS 2 weeks after HAART. For the co-infection group, those with TB-IRIS (20/20, 100%) had fever, with a signiifcantly higher incidence than those who did not develop TB-IRIS (6.7%, 2/30,P < 0.05). The patients with TB-IRIS in co-infection group displayed markedly higher clinical biochemical markers, acute phase reactants, increased CD4+ cell counts, and 2 log10-decreases of HIV RNA loads, compared with the patients not presenting with TB-IRIS (P < 0.05). Conclusion HIV/TB co-infected patients presented with a high-risk of developing TB-IRIS during HAART treatment. Early diagnosis and treatment could decrease mortality rates in TB-IRIS.

  11. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

    OpenAIRE

    Brennan, Aline; Jackson, Arthur; Horgan, Mary; Bergin, Colm J; Browne, John P

    2015-01-01

    BACKGROUND: It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. METHODS: A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Irelan...

  12. HIV Quasispecies Dynamics during Pro-Active Treatment Switching: Impact on Multi-Drug Resistance and Resistance Archiving in Latent Reservoirs

    OpenAIRE

    Max von Kleist; Stephan Menz; Hartmut Stocker; Keikawus Arasteh; Christof Schütte; Wilhelm Huisinga

    2011-01-01

    The human immunodeficiency virus (HIV) can be suppressed by highly active anti-retroviral therapy (HAART) in the majority of infected patients. Nevertheless, treatment interruptions inevitably result in viral rebounds from persistent, latently infected cells, necessitating lifelong treatment. Virological failure due to resistance development is a frequent event and the major threat to treatment success. Currently, it is recommended to change treatment after the confirmation of virological fai...

  13. Hepatocellular carcinoma, human immunodeficiency virus and viral hepatitis in the HAART era

    Institute of Scientific and Technical Information of China (English)

    Douglas C Macdonald; Mark Nelson; Mark Bower; Thomas Powles

    2008-01-01

    The incidence of hepatocellular carcinoma (HCC) in patients with human immunodeficiency virus (HIV) is rising. HCC in HIV almost invariably occurs in the context of hepatitis C virus (HCV) or hepatitis B virus (HBV) co-infection and, on account of shared modes of transmission, this occurs in more than 33% and 10% of patients with HIV worldwide respectively. It has yet to be clearly established whether HIV directly accelerates HCC pathogenesis or whether the rising incidence is an epiphenomenon of the highly active antiretroviral therapy (HAART) era, wherein the increased longevity of patients with HIV allows long-term complications of viral hepatitis and cirrhosis to develop. Answering this question will have implications for HCC surveillance and the timing of HCV/HBV therapy, which in HIV co-infection presents unique challenges. Once HCC develops, there is growing evidence that HIV co-infection should not preclude conventional therapeutic strategies, including liver transplantation.

  14. [The in vitro HAART pharmacodynamics study with dolutegravir as the "anchor"].

    Science.gov (United States)

    Guo, Jia-mei; Guo, Ying

    2015-01-01

    This study is to evaluate the HAART pharmacodynamics with dolutegravir as the "anchor" in vitro. A nucleoside reverse transcriptase inhibitors (NRTIs) resistant recombinant virus model (VSVG/HIV-1(RT-D67N,K70R,T215F)) and an integrase inhibitors (INIs) resistant recombinant virus model (VSVG/HIV-1(IN-G140S,QI48H)) were constructed and established. The anti-viral pharmacodynamics was evaluated with drug combinations including two NRTIs along with one INI or one NNRTI. The results showed that the combination with an INI gave a stronger synergism on wild type HIV-1 replication comparing to that with an NNRTI. Comparing the two INIs as the "anchor" for HAART, DTG exhibited an equivalent CI to that of RAL on wild type HIV-1 replication; but a greater synergy than RAL on INI-resistant HIV-1 replication. Besides of the pharmacodynamics results of DTG-based drug combination, the results may contribute to clinical antiviral therapy. PMID:25924475

  15. [The in vitro HAART pharmacodynamics study with dolutegravir as the "anchor"].

    Science.gov (United States)

    Guo, Jia-mei; Guo, Ying

    2015-01-01

    This study is to evaluate the HAART pharmacodynamics with dolutegravir as the "anchor" in vitro. A nucleoside reverse transcriptase inhibitors (NRTIs) resistant recombinant virus model (VSVG/HIV-1(RT-D67N,K70R,T215F)) and an integrase inhibitors (INIs) resistant recombinant virus model (VSVG/HIV-1(IN-G140S,QI48H)) were constructed and established. The anti-viral pharmacodynamics was evaluated with drug combinations including two NRTIs along with one INI or one NNRTI. The results showed that the combination with an INI gave a stronger synergism on wild type HIV-1 replication comparing to that with an NNRTI. Comparing the two INIs as the "anchor" for HAART, DTG exhibited an equivalent CI to that of RAL on wild type HIV-1 replication; but a greater synergy than RAL on INI-resistant HIV-1 replication. Besides of the pharmacodynamics results of DTG-based drug combination, the results may contribute to clinical antiviral therapy.

  16. P26Evaluation of HIV-1 genotypic tropism among HIV-1 infected patients failing HAART in Santos and São Paulo cities, Brazil

    OpenAIRE

    Stevenson, M; Cohen, M.; Bautista, S.; Perno, C-F; I Weller; R. Gulick; Soto-Ramirez, L; Cortes, C.; Padget, D; Grinsztejn, B; Gotuzzo, E; Bacon, M; Jayathilake, K.; Shepherd, B.; Zaire, C

    2013-01-01

    Treatment of HIV/AIDS While an outright cure or a preventive vaccine for HIV/AIDS remains elusive, remarkable advances in HIV treatment have been achieved over the past two decades. Most significant among these advances is the development of highly active antiretroviral therapy (HAART). Two international clinical trials presented at the 1996 International AIDS Conference in Vancouver, served as the cornerstone for the emergence of triple therapy regimens based on the use of two nucleosides pl...

  17. The cameroon mobile phone sms (CAMPS trial: a protocol for a randomized controlled trial of mobile phone text messaging versus usual care for improving adherence to highly active anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    Mba Robert

    2011-01-01

    Full Text Available Abstract Background This trial aims at testing the efficacy of weekly reminder and motivational text messages, compared to usual care in improving adherence to Highly Active Antiretroviral Treatment in patients attending a clinic in Yaoundé, Cameroon. Methods and Design This is a single-centered randomized controlled single-blinded trial. A central computer generated randomization list will be generated using random block sizes. Allocation will be determined by sequentially numbered sealed opaque envelopes. 198 participants will either receive the mobile phone text message or usual care. Our hypothesis is that weekly motivational text messages can improve adherence to Highly Active Antiretroviral Treatment and other clinical outcomes in the control group by acting as a reminder, a cue to action and opening communication channels. Data will be collected at baseline, three months and six months. A blinded program secretary will send out text messages and record delivery. Our primary outcomes are adherence measured by the visual analogue scale, self report, and pharmacy refill data. Our secondary outcomes are clinical: weight, body mass index, opportunistic infections, all cause mortality and retention; biological: Cluster Designation 4 count and viral load; and quality of life. Analysis will be by intention-to-treat. Covariates and subgroups will be taken into account. Discussion This trial investigates the potential of SMS motivational reminders to improve adherence to Highly Active Antiretroviral Treatment in Cameroon. The intervention targets non-adherence due to forgetfulness and other forms of non-adherence. Trial Registration Pan-African Clinical Trials Registry PACTR201011000261458 http://clinicaltrials.gov/NCT01247181

  18. Pilot, randomized study assessing safety, tolerability and efficacy of simplified LPV/r maintenance therapy in HIV patients on the 1 PI-based regimen.

    Directory of Open Access Journals (Sweden)

    Pedro Cahn

    Full Text Available OBJECTIVES: To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART with a ritonavir-boosted protease inhibitor (PI/r and 2 nucleoside reverse-transcriptase inhibitors (NRTIs to lopinavir/ritonavir (LPV/r monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART. METHODS: This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL, time-to-virologic rebound, patient-reported outcomes (PROs and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE. RESULTS: Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART patients completed treatment, while 9(2:LPV/r;7:HAART discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98% patients on LPV/r and 37(95% on HAART had VL<200 copies/mL (P = 0.61. Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%, headache (18% and influenza (16%. Four (10% patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART patients. CONCLUSION: At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re

  19. Relationship between oral Kaposi 's sarcoma and HAART: contribution of two case reports.

    Science.gov (United States)

    Campo-Trapero, Julián; Del Romero-Guerrero, Jorge; Cano-Sánchez, Jorge; Rodríguez-Martín, Carmen; Martínez-González, José Ma; Bascones-Martínez, Antonio

    2008-11-01

    Two HIV infected patients not receiving Highly Active Antiretroviral Treatment (HAART) presented with epidemic Kaposi's sarcoma of the oral cavity. One patient initially refused HAART, but when the lesion became large enough to be noticeable he agreed to HAART associated with excision of the intraoral lesion by CO2 laser. The other patient developed KS and progressed to AIDS at two years after ceasing HAART due to adverse effects; he was referred to hospital for renewed administration of HAART. In both cases, the lesions observed in the oral cavity were the first clinical manifestation of AIDS. These reports underline the close relationship between the use of HAART and the control of KS lesions, highlighting the important role of the dentist in the identification and early diagnosis of these oral lesions.

  20. Access to HAART in HIV-infected immigrants: a retrospective multicenter Italian study.

    Science.gov (United States)

    Saracino, A; El-Hamad, I; Prato, R; Cibelli, D C; Tartaglia, A; Palumbo, E; Pezzoli, M C; Angarano, G; Scotto, G

    2005-09-01

    Since 1996, AIDS has declined in the Italian population, but cases in foreign patients, including both recent immigrants and long-term residents, have increased from 3.9% in 1995-1996 to 15.4% in 2001-2002. This increase can only be partly explained by a higher migratory flow and might reflect a delayed access to health facilities and to antiretroviral therapy in migrants. We performed a survey for the year 2003 of HIV-infected immigrants to Italy from countries outside the European Union to verify which factors might influence a lack of access to highly active antiretroviral therapy (HAART). Italian centers of infectious diseases were requested to send sociodemographic and clinical data of HIV-infected immigrant patients. A total of 553 HIV-infected immigrants (49.9% women) were evaluated, representing 6.5% of all HIV-infected patients from these centers. The mean duration of residency in Italy was 6.6 +/- 5.0 years. The country of origin was Africa (64.5%), North and South America (24.2%), Eastern Europe (7.0%), and Asia (3.8%). A total of 407 of 553 patients (73.6%) were taking antiretroviral drugs at the time of screening. Females presented a younger age (p = 0.001), a lower frequency of Centers for Disease Control (CDC) stage B/C (p = 0.008) and a more frequent heterosexual exposure to HIV (p immigrants (p = 0.018) and registered in the National Health Service (p = 0.014) were significantly more likely to receive HAART compared to illegal immigrants. PMID:16164386

  1. A randomized controlled trial comparing the effects of counseling and alarm device on HAART adherence and virologic outcomes.

    Directory of Open Access Journals (Sweden)

    Michael H Chung

    2011-03-01

    Full Text Available BACKGROUND: Behavioral interventions that promote adherence to antiretroviral medications may decrease HIV treatment failure. Antiretroviral treatment programs in sub-Saharan Africa confront increasing financial constraints to provide comprehensive HIV care, which include adherence interventions. This study compared the impact of counseling and use of an alarm device on adherence and biological outcomes in a resource-limited setting. METHODS AND FINDINGS: A randomized controlled, factorial designed trial was conducted in Nairobi, Kenya. Antiretroviral-naïve individuals initiating free highly active antiretroviral therapy (HAART in the form of fixed-dose combination pills (d4T, 3TC, and nevirapine were randomized to one of four arms: counseling (three counseling sessions around HAART initiation, alarm (pocket electronic pill reminder carried for 6 months, counseling plus alarm, and neither counseling nor alarm. Participants were followed for 18 months after HAART initiation. Primary study endpoints included plasma HIV-1 RNA and CD4 count every 6 months, mortality, and adherence measured by monthly pill count. Between May 2006 and September 2008, 400 individuals were enrolled, 362 initiated HAART, and 310 completed follow-up. Participants who received counseling were 29% less likely to have monthly adherence <80% (hazard ratio [HR] = 0.71; 95% confidence interval [CI] 0.49-1.01; p = 0.055 and 59% less likely to experience viral failure (HIV-1 RNA ≥5,000 copies/ml (HR 0.41; 95% CI 0.21-0.81; p = 0.01 compared to those who received no counseling. There was no significant impact of using an alarm on poor adherence (HR 0.93; 95% CI 0.65-1.32; p = 0.7 or viral failure (HR 0.99; 95% CI 0.53-1.84; p = 1.0 compared to those who did not use an alarm. Neither counseling nor alarm was significantly associated with mortality or rate of immune reconstitution. CONCLUSIONS: Intensive early adherence counseling at HAART initiation resulted

  2. Prevalence and correlates of probable common mental disorders in a population with high prevalence of HIV in Zimbabwe

    OpenAIRE

    Chibanda, D.; Cowan, F.; Gibson, L; Weiss, HA; Lund, C.

    2016-01-01

    Background In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). The incidence of non-communicable diseases has increased markedly in PLWH as mortality is reduced due to use of HAART. Common mental disorders (CMD) are highly prevalent in PLWH. We aimed to determine factors associated with probable CMD and depression, assessed by 2 locally validated screening tools in a population with high prevalence of HIV in Ha...

  3. Causes of death among people living with AIDS in the pre- and post-HAART Eras in the city of Sao Paulo, Brazil.

    Directory of Open Access Journals (Sweden)

    Carmen-Silvia Bruniera Domingues

    Full Text Available OBJECTIVE: We examine the trend in causes of death among people living with AIDS in the city of São Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART, and we investigate potential disparities across districts of residence. METHODS: Descriptive study of three periods: pre-HAART (1991-1996; early post-HAART (1997-1999; and late post-HAART (2000-2006. The data source was the São Paulo State STD/AIDS Program and São Paulo State Data Analysis Foundation. Causes of death were classified by the ICD-9 (1991-1995 and ICD-10 (1996-2006. We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence. We used Pearson's chi-square test or Fisher's exact test to compare categorical variables. Areas of residence were categorized using a socioeconomic index. To analyze trends we apply generalized linear model with Poisson regression. RESULTS: We evaluated 32,808 AIDS-related deaths. Between the pre- and late post-HAART periods, the proportion of deaths whose underlying causes were non-AIDS-related diseases increased from 0.2% to 9.6% (p<0.001: from 0.01% to 1.67% (p<0.001 for cardiovascular diseases; 0.01% to 1.62% (p<0.001 for bacterial/unspecified pneumonia; and 0.03% to 1.46% (p<0.001 for non-AIDS-defining cancers. In the late post-HAART period, the most common associated causes of death were bacterial/unspecified pneumonia (35.94%, septicemia (33.46%, cardiovascular diseases (10.11% and liver diseases (8.0%; and common underlying causes, besides AIDS disease, included non-AIDS-defining cancers in high-income areas, cardiovascular diseases in middle-income areas and assault in low-income areas. CONCLUSIONS: The introduction of HAART has shifted the mortality profile away from AIDS-related conditions, suggesting changes in the pattern of morbidity, but

  4. Efficacy of Pravastatin in Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI and Protease Inhibitor (PI-based HAART in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Susan A. Eaton

    2008-01-01

    Full Text Available Pravastatin has generally been considered a safe and effective option for HIV-infected patients on highly active antiretroviral therapy (HAART. However, pravastatin concentrations are known to significantly decrease with concomitant efavirenz (EFV use. Currently there are no studies determining if these reductions in pravastatin possibly translate into an attenuation of its lipid lowering efficacy when used in HIV-infected patients on non-nucleoside reverse transcriptase inhibitor (NNRTI-based HAART. To evaluate the differences in the lipid lowering efficacy of pravastatin for the treatment of dyslipidemia in HIV-infected patients on NNRTI-based HAART compared to protease inhibitor (PI-based regimens. A single center, retrospective evaluation of a comprehensive electronic HIV registry that identified HIV-infected, Veterans Affairs (VA patients who received pravastatin 20 mg plus NNRTI or PI-based HAART from January 1997 to November 2006 who met the strict criteria for inclusion. A total of 18 patients [NNRTI (n = 7 and PI (n = 11] met the strict criteria for inclusion. In HIV-infected patients taking NNRTI-based HAART there was a reduction in TC by -10.1%, LDL by -12% and non-HDL by -12.2% within 6 months after starting pravastatin 20 mg. In HIV-infected patients taking PI-based HAART, there was a reduction in TC by -10.1%, in LDL by -21.1% and in non-HDL by -13.8% within 6 months after starting pravastatin 20 mg. In both groups, only one additional patient achieved their patient specific lipid goals. In either group these reductions were seen without any apparent adverse drug events or compromise to virologic or immunologic control. This initial evaluation suggests that pravastatin’s efficacy may be attenuated with NNRTIs versus PI-based HAART, possibly due to known reductions in pravastatin concentrations when administered with NNRTI-based regimens. These effects were seen without any apparent compromises to safety and should be validated in

  5. Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

    OpenAIRE

    Kartik K Venkatesh; Srikrishnan, AK; Safren, Steven A.; Triche, Elizabeth W.; Thamburaj, E.; Prasad, Lakshmi; Lurie, Mark N; Kumar, M. Suresh; N Kumarasamy; Solomon, Suniti; Mayer, Kenneth H.

    2011-01-01

    The current study examines sexual behaviors among HIV-infected Indians in primary care, where access to highly active antiretroviral therapy (HAART) has recently increased. Between January to April 2008, we assessed the sexual behaviors of 247 HIV-infected South Indians in care. Multivariable logistic regression models were used to determine predictors of being in a HIV-seroconcordant primary relationship, being sexually active, and reporting unprotected sex. Over three-fourths (80%) of parti...

  6. Sex Differences in HIV Outcomes in the Highly Active Antiretroviral Therapy Era: A Systematic Review

    OpenAIRE

    Castilho, Jessica L; Melekhin, Vlada V.; Sterling, Timothy R

    2014-01-01

    To assess sex disparities in AIDS clinical and laboratory outcomes in the highly active antiretroviral therapy (HAART) era we conducted a systematic review of the published literature on mortality, disease progression, and laboratory outcomes among persons living with HIV and starting HAART. We performed systematic PubMed and targeted bibliographic searches of observational studies published between January, 1998, and November, 2013, that included persons starting HAART and reported analyses ...

  7. German-austrian recommendations for HIV1-therapy in pregnancy and in HIV1-exposed newborn - update 2008

    Directory of Open Access Journals (Sweden)

    Buchholz Bernd

    2009-11-01

    Full Text Available Abstract German-Austrian recommendations for HIV1-therapy in pregnancy - Update 2008 Bernd Buchholz (University Medical Centre Mannheim, Pediatric Clinic, Matthias Beichert (Mannheim, Gynecology and Obstetrics Practice, Ulrich Marcus (Robert Koch Institute, Berlin, Thomas Grubert, Andrea Gingelmaier (Gynecology Clinic of the Ludwig Maximilians University of Munich, Dr. med. Annette Haberl (HIV-Department, J. W. Goethe-University Hospital, Frankfurt, Dr. med. Brigitte Schmied (Otto-Wagner Spital, Wien. In Germany during the last years about 200-250 HIV1-infected pregnant women delivered a baby each year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV1-infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV1 was reduced to 1-2%. This low transmission rate has been achieved by the combination of anti-retroviral therapy of pregnant women, caesarean section scheduled before onset of labour, anti-retroviral post exposition prophylaxis in the newborn and refraining from breast-feeding by the HIV1-infected mother. To keep pace with new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV1-infected adults, in 1998, 2001, 2003 and 2005 an interdisciplinary consensus meeting was held. Gynaecologists, infectious disease specialists, paediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO were participating in this conference to update the prevention strategies. A fifth update became necessary in 2008. The updating process was started in January 2008 and was terminated in September 2008. The guidelines provide new recommendations on the indication and the starting point for HIV-therapy in pregnancies without complications, drugs and drug combinations to be

  8. Use of third line antiretroviral therapy in Latin America.

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    Carina Cesar

    Full Text Available BACKGROUND: Access to highly active antiretroviral therapy (HAART is expanding in Latin America. Many patients require second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART, essential for program planning, is not known. METHODS: Antiretroviral-naïve patients ≥18 years who started first HAART after January 1, 2000 in Caribbean, Central and South America Network (CCASAnet sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART. RESULTS: Of 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3% failed a second line regimen and 44 (0.8% received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18-2.00, p = 0.001, younger age (HR = 2.76 for 20 vs. 40 years, 95% CI 1.86-4.10, p<0.001, and prior AIDS (HR = 2.17, 95% CI 1.62-2.90, p<0.001. CONCLUSIONS: Third line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third line regimens is warranted.

  9. Antiretroviral Therapy Initiation Before, During, or After Pregnancy in HIV-1-Infected Women: Maternal Virologic, Immunologic, and Clinical Response

    OpenAIRE

    Melekhin, Vlada V.; Shepherd, Bryan E.; Stinnette, Samuel E.; Peter F Rebeiro; Gema Barkanic; Raffanti, Stephen P.; Sterling, Timothy R

    2009-01-01

    BACKGROUND: Pregnancy has been associated with a decreased risk of HIV disease progression in the highly active antiretroviral therapy (HAART) era. The effect of timing of HAART initiation relative to pregnancy on maternal virologic, immunologic and clinical outcomes has not been assessed. METHODS: We conducted a retrospective cohort study from 1997-2005 among 112 pregnant HIV-infected women who started HAART before (N = 12), during (N = 70) or after pregnancy (N = 30). RESULTS: Women initiat...

  10. The Effectiveness of a Bioactive Food Compound in the Lipid Control of Individuals with HIV/AIDS

    Science.gov (United States)

    dos Santos Ferreira, Rosângela; de Cássia Avellaneda Guimarães, Rita; Jardim Cury Pontes, Elenir Rose; Aragão do Nascimento, Valter; Aiko Hiane, Priscila

    2016-01-01

    Cardiovascular events due to decompensated lipid metabolism are commonly found in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients using anti-retroviral therapy (HAART). Thus, the aim of this study was to identify the effect of a bioactive food compound (BFC) containing functional foods on individuals with HIV undergoing HAART. Particularly, this study aims to verify the clinical outcome in the change of the lipid profile due to the use of this compound. This study includes 115 individuals with HIV on HAART. All patients received dietary guidelines; however, sixty-one consumed BFC while fifty-one did not (NO BFC). Biochemical examinations and socio-demographic and clinical profiles were evaluated. As result, in patients using hypolipidemic and/or hypoglycemic drugs, there was 28.6% decrease in triglyceride levels (p HIV/AIDS patients using HAART are more vulnerable to lipid disorders. PMID:27740592

  11. Eradication of HIV and Cure of AIDS, Now and How?

    Directory of Open Access Journals (Sweden)

    Jie Lin eZhang

    2013-10-01

    Full Text Available Recent studies have highlighted the importance of eradication of human immunodeficiency virus (HIV and cure of acquired immunodeficiency syndrome (AIDS. However, a pivotal point that the patient immunity controls HIV reactivation after highly active anti-retroviral therapy (HAART, or combination anti-retroviral therapy, cART remains less well addressed. In spite of the fact that both innate and adaptive immunities are indispensable and numerous cells participate in the anti-HIV immunity, memory CD4 T-cells are indisputably the key cells organizing all immune actions against HIV while being the targets of HIV. Here we present a view and multidisciplinary approaches to HIV/AIDS eradication and cure. We aim at memory CD4 T-cells, utilizing the stem cell properties of these cells to reprogram an anti-HIV memory repertoire to eliminate the viral reservoir, toward achieving an AIDS-free world.

  12. Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women123

    Science.gov (United States)

    Flax, Valerie L; Adair, Linda S; Allen, Lindsay H; Shahab-Ferdows, Setarah; Hampel, Daniela; Chasela, Charles S; Tegha, Gerald; Daza, Eric J; Corbett, Amanda; Davis, Nicole L; Kamwendo, Deborah; Kourtis, Athena P; van der Horst, Charles M; Jamieson, Denise J; Bentley, Margaret E

    2015-01-01

    Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings. Objective: We examined associations of highly active antiretroviral therapy (HAART) and lipid-based nutrient supplements (LNS) with concentrations of selected micronutrients in HIV-infected Malawian women at 24 wk postpartum. Methods: Plasma micronutrient concentrations were measured in a subsample (n = 690) of Breastfeeding, Antiretrovirals, and Nutrition (BAN) study participants who were randomly assigned at delivery to receive HAART, LNS, HAART+LNS, or no HAART/no LNS (control). HAART consisted of protease inhibitor–based triple therapy. LNS (140 g/d) met energy and micronutrient requirements of lactation. Multivariable linear regression tested the association of HAART and LNS, plus their interaction, with micronutrient concentrations, controlling for season, baseline viral load, and baseline CD4 count. Results: We found significant HAART by LNS interactions for folate (P = 0.051), vitamin B-12 (P < 0.001), and transferrin receptors (TfRs) (P = 0.085). HAART was associated with lower folate (with LNS: −27%, P < 0.001; without LNS: −12%, P = 0.040) and higher TfR concentrations (with LNS: +14%, P = 0.004; without LNS: +28%, P < 0.001), indicating iron deficiency. LNS increased folate (with HAART: +17%, P = 0.037; without HAART: +39%, P < 0.001) and decreased TfR concentrations (with HAART only: −12%, P = 0.023). HAART was associated with lower vitamin B-12 concentrations only when LNS was present (−18%, P = 0.001), whereas LNS increased vitamin B-12 only when no HAART was present (+27%, P < 0.001). HAART, but not LNS, was associated with higher retinol-binding protein (RBP; +10%, P = 0.007). We detected no association of HAART or LNS with selenium, ferritin, or hemoglobin. Conclusion: The association of HAART with lower folate, iron

  13. Prevalence of Lipodystrophy in HIV-infected Children in Tanzania on Highly Active Antiretroviral Therapy

    NARCIS (Netherlands)

    Kinabo, G.; Sprengers, M.; Msuya, L.J.; Shayo, A.M.; Asten, H.A.G.H. van; Dolmans, W.M.V.; Ven, A.J.A.M. van der; Warris, A.

    2013-01-01

    OBJECTIVE: : Highly active antiretroviral therapy (HAART) has been associated with lipodystrophy (LD) in adults but data are more limited for children. The purpose of this study was to determine the prevalence of and risk factors for LD in Tanzanian children receiving HAART by clinical assessment an

  14. Immunological Analysis of Treatment Interruption After Early Highly Active Antiretroviral Therapy

    NARCIS (Netherlands)

    I.M.M. Schellens; K. Pogany; G.H.A. Westerlaken; J.A.M. Borghans; F. Miedema; I.G.M. van Valkengoed; F.P. Kroon; J.M.A. Lange; K. Brinkman; J.M. Prins; D. van Baarle

    2010-01-01

    We longitudinally evaluated HIV-specific T-cell immunity after discontinuation of highly active antiretroviral therapy (HAART). After treatment interruption (TI), some individuals could maintain a low plasma viral load (<15,000 copies/mL), whereas others could not (>50,000 copies/mL). Before HAART w

  15. A randomized trial comparing initial HAART regimens of nelfinavir/nevirapine and ritonavir/saquinavir in combination with two nucleoside reverse transcriptase inhibitors

    DEFF Research Database (Denmark)

    Kirk, Ole; Lundgren, Jens D; Pedersen, Court;

    2003-01-01

    measurements 5.0 copies/ml (1.3-6.4) in both groups. A total of 102 (86%) and 101 (88%) were antiretroviral-naive. 44% discontinued randomized therapy; P = 0.13. Of these, 80 and 73% switched therapy due to adverse events; P = 0.99. At week 48, 69 and 56%, respectively, had a HIV RNA < or = 20 copies/ml; P = 0...... long-term consequences of triple class HAART regimens, including the development of broad drug resistance....

  16. Viral persistence, latent reservoir, and blips: a review on HIV-1 dynamics and modeling during HAART and related treatment implications

    Energy Technology Data Exchange (ETDEWEB)

    Rong, Libin [Los Alamos National Laboratory; Perelson, Alan [Los Alamos National Laboratory

    2008-01-01

    HIV-1 eradication from infected individuals has not been achieved with the use of highly active antiretroviral therapy (HAART) for a prolonged period of time. The cellular reservoir for HIV-1 in resting memory CD4{sup +} T cells remains a major obstacle to viral elimination. The reservoir does not decay significantly over long periods of time as is able to release replication competent HIV-1 upon cell activation. Residual ongoing viral replication may likely occur in many patients because low levels of virus can be detected in plasma by sensitive assays and transient episodes of viremia, or HIV-1 blips, are often observed in patients even with successful viral suppression for many years. Here we review our current knowledge of the factors contributing to viral persistence, the latent reservoir, and blips, and mathematical models developed to explore them and their relationships. We show how mathematical modeling can help improve our understanding of HIV-1 dynamics in patients on HAART and the quantitative events underlying HIV-1 latency, reservoir stability, low-level viremic persistence, and emergence of intermittent viral blips. We also discuss treatment implications related to these studies.

  17. Transient elastography discloses identical distribution of liver fibrosis in chronic hepatitis C between HIV-negative and HIV-positive patients on HAART

    Directory of Open Access Journals (Sweden)

    Grünhage F

    2010-04-01

    Full Text Available Abstract Objective Progressive immunodeficiency associated with HIV-infection leads to a progressive course of liver disease in HIV/HCV-co-infected patients. Highly active antiretroviral therapy (HAART efficiently restores and preserves immune functions and has recently been demonstrated to also result in reduced liver-related mortality in HIV/HCV-co-infected patients. Methods To analyse differences in current liver fibrosis as a possible effect of HAART on fibrosis progression we assessed hepatic fibrosis by transient elastography in a cross-sectional comparison between HCV-mono-infected and HIV/HCV-co-infected patients presenting at our outpatient department in 2007. Results Overall, we did not find any difference in the distribution of liver stiffness between mono- (n = 84 and double-infected (n = 57 patients (14.4 kPa (10.8 - 18.2 versus 12.4 kPa (9.1 - 16.1, mean (95%-CI. However, in the 8 HIV+ patients with CD4 counts Conclusions These findings are in line with other data that show an improved prognosis of chronic hepatitis C in HIV+ patients under effective HAART, and may be a hint that fibrosis progression in well-treated HIV+ patients will no longer be different from that in HCV-mono-infected patients.

  18. The prevalence of co-morbidities in patients on HAART referred for physiotherapy in three public hospitals in KwaZulu-Natal, South Africa: a short report

    Directory of Open Access Journals (Sweden)

    S. S. Mahraj

    2010-02-01

    Full Text Available Introduction: The roll-out of Highly Active Antiretroviral Therapy (HAART to patients infected with the Human Immuno-deficient Virus (HIV is presenting with co-morbidities as a result of the side effects of the drugs or the prolonged lifespan of the HIV positive individual. This poses a challenge to physiotherapists for rehabilitation which has changed from prophylaxis and management of opportunistic infections to managing the co-morbidities. The aim of this preliminary study was to determine the number of patients on HAART with co-morbidities admitted to three public hospitals in KwaZulu-Natal and referred for physiotherapy.Method: This descriptive epidemiological study used a cross-sectional design to determine the prevalence of co-morbidities associated with HAART. Baseline data of patients and their demographics, AIDS status and clinical co-morbidities were recorded. The sample consisted of 78 patients with an average CD4 count of 338 cells/mm³ and a viral load of 133 copies/mL. Patients were categorised according to their HIV stages: 13 (17% asymptomatic, 44 (56% ‘AIDS-related complex’ and 21 (27% had full blown AIDS.Results: Patients referred for physiotherapy presented with peripheral neuropathy 36 (46%, pulmonary tuberculosis 29 (37%, musculo-skeletal pain 17(22%, myopathies 9 (12%, pneumonia 8 (10%, enthesopathies 4 (5%, cerebral vascular accidents 2 (3% and abdominal pain 1(1%. Conclusion: To rehabilitate the HIV infected individual successfully physiotherapists should note the side effects and co-morbidities associated with HAART.

  19. Patient-Related Risks for Nonadherence to Antiretroviral Therapy among HIV-Infected Youth in the United States: A Study of Prevalence and Interactions

    OpenAIRE

    Rudy, Bret J.; Murphy, Debra A.; Harris, D. Robert; Muenz, Larry; Ellen, Jonathan

    2009-01-01

    Adherence continues to be a major barrier to successful treatment with highly active antiretroviral therapy (HAART) for HIV-infected individuals. HIV-infected adolescents and young adults face a lifetime of treatment with HAART. Often, individuals who struggle with adherence to HAART face multiple barriers that would therefore impact on the success of any single modality intervention. Thus, we conducted a cross-sectional, observational study to determine the prevalence of personal barriers to...

  20. Treatment of Recurrent Hepatocellular Carcinoma with Sorafenib in a HIV/HCV Co-Infected patient in HAART: A Case Report

    Directory of Open Access Journals (Sweden)

    De Nardo Pasquale

    2012-06-01

    Full Text Available Abstract Background Liver disease is the second cause of death among HIV patients receiving highly active antiretroviral therapy (HAART in Europe. HIV patients have a high prevalence of chronic HBV (6–10% and HCV (33% co-infection, and accelerated progression of viral hepatitis. Furthermore, the long duration of both HIV and HCV diseases in the HAART era increases the risk of hepatocellular carcinoma. Findings We report the case of a 49 year -old HIV/HCV co-infected male patient who developed hepatocellular carcinoma. The patient underwent a partial hepatectomy, and a few months later was treated with transcatheter arterial chemoembolisation due to hepatocarcinoma recurrence. Two months later, advanced hepatocellular carcinoma was diagnosed and sorafenib therapy was initiated. The patient achieved partial response of the main lesions, complete regression of the smallest lesions and did not experience clinical progression during the 20-month follow-up period. During therapy with sorafenib, the patient was treated with HAART with good viral and immunological responses. We used the therapeutic drug monitoring to assess antiretroviral concentrations during co-administration of sorafenib. Fosamprenavir Ctrough was found under the minimum level recommended by international guidelines. No grade 3 or 4 toxicities were observed. At month 20 of treatment, new liver lesions with portal vein thrombosis were diagnosed. After 28 months of sorafenib therapy, the patient deceased for severe liver insufficiency. Conclusions Sorafenib monotherapy demonstrated a marked delay in HCC disease progression in an HIV/HCV co-infected patient. Fosamprenavir Ctrough was found under the minimum level recommended by international guidelines, suggesting a possible interaction.

  1. Mycobacterium avium-Intracellulare Complex (MAC) Producing a Periportal Pseudotumor in a Patient With HIV and a Normal CD4 Count

    Science.gov (United States)

    Johnson, Jessica; Driscoll, Meghan; Cohen, Michael

    2016-01-01

    Mycobacterium avium-intracellulare complex (MAC) is an opportunistic infection typically associated with profound immunosuppression, such as AIDS. The presentation of disseminated MAC can be subtle and mimic systemic symptoms associated with lymphoma; abdominal pseudotumor is an exceptionally rare presentation. In the era of highly active anti-retroviral therapy (HAART), opportunistic infections are increasingly rare, and secondary prophylaxis for MAC may be discontinued after adequate therapy and immune reconstitution. Recurrence of disseminated MAC after adequate therapy may be due to macrolide resistance, but with an adequate CD4 T-cell count and undetectable HIV viral load, recurrence raises questions of more subtle immune dysregulation.

  2. Correlation between viral load, plasma levels of CD4 - CD8 T lymphocytes and AIDS-related oral diseases: a multicentre study on 30 HIV+ children in the HAART era.

    Science.gov (United States)

    Nesti, M; Carli, E; Giaquinto, C; Rampon, O; Nastasio, S; Giuca, M R

    2012-01-01

    This experimental retrospective multicenter study carried out on 30 seropositive children treated with Highly Active Antiretroviral Therapy (HAART), between the ages of 18 months and 14 years, in the clinical categories Centers for Disease Control (CDC) classification 1993 A (mildly symptomatic), B (moderately symptomatic) and C (severely symptomatic) aims to: 1) clinically and immunologically demonstrate the therapeutic benefits of HAART; 2) monitor the frequency of AIDS-related oral diseases in seropositive children with HAART therapy; 3) monitor the plasma levels of total CD4, CD4 percent, CD8 percent, CD4-CD8 lymphocytes and viral load from 1997 to 30 April, 2011. The statistic methods used are the analysis of covariance and the Bonferroni Test. More than 100 AIDS-related oral diseases were found in the study samples, the most frequent being: oral candidiasis, oropharyngeal candidiasis, HSV-1 herpetic esophagyitis, herpetic gingivolstomatitis (RHOG), recurrent aphthous stomatitis (RAS), parotid swelling, oral hairy leukoplakia (OHL), Herpes simplex 1 (HSV-1), linear gingival erythema (LGE), necrotizing gingivitis (NUG), facial lipodistrophy, facial-cervical lymphadenopathy (FCL), xerostomia, dysgeusia, hyposmia, oral mucosa hyperpigmentation (OMP). The Bonferroni test showed a significant difference between the mean plasma values (mpVTL) of total CD4, CD4 percentage, CD4-CD8 T lymphocytes and Viral Load (VL) of the various oral diseases found in the study samples. The therapeutic benefits of HAART are: immune reconstitution; reduction of the HIV/AIDS-related stomatology diseases; prevention and cure of the AIDS correlated neoplasias; reduction in maternal-fetal transmission of the HIV virus. The negative effects of HAART in relation to odontostomatolgy are: increase in oral lesions from HPV; xerostomia; dysgeusia/ageusia, hyposmia, perioral paresthesia; hyperpigmentation of oral mucosa; facial lipodystrophy, recurrent aphthous stomatitis (RAS). No case of

  3. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Mocroft, Amanda; Gatell, Jose M;

    2002-01-01

    The risk of clinical progression for human immunodeficiency virus (HIV)-infected persons receiving treatment with highly active antiretroviral therapy (HAART) is poorly defined. From an inception cohort of 8457 HIV-infected persons, 2027 patients who started HAART during prospective follow-up wer...

  4. Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Andersen, Ove; Eugen-Olsen, Jesper; Kofoed, Kristian;

    2008-01-01

    Circulating soluble urokinase plasminogen activator receptor (suPAR) reflects the immune and pro-inflammatory status of the HIV-infected patient. Highly active antiretroviral therapy (HAART) suppresses suPAR. Independent of the immune response to HAART, suPAR remains elevated in some HIV-infected...

  5. Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study

    NARCIS (Netherlands)

    Nieuwkerk, PT; Sprangers, MAG; Burger, DM; Hoetelmans, RMW; Hugen, PWH; Danner, SA; van der Ende, Marchina E.; Schneider, MME; Schrey, G; Meenhorst, PL; Sprenger, HG; Kauffmann, RH; Jambroes, M; Chesney, MA; de Wolf, F; Lange, JMA

    2001-01-01

    Background: Adherence to highly active antiretroviral therapy (HAART) for human immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain viral suppression and prevent drug resistance. We investigated adherence to HAART among patients in a clinical cohort study. Methods: Patients re

  6. Incidence of oral lesions in HIV-1-infected women: reduction with HAART.

    Science.gov (United States)

    Greenspan, D; Gange, S J; Phelan, J A; Navazesh, M; Alves, M E A F; MacPhail, L A; Mulligan, R; Greenspan, J S

    2004-02-01

    Few studies assess the effectiveness of HAART on reducing the incidence and recurrence of oral lesions. We investigated such changes among 503 HIV+ women over six years in the Women's Interagency HIV Study. The incidence of erythematous candidiasis (EC), pseudomembranous candidiasis (PC), hairy leukoplakia (HL), and warts was computed over follow-up visits after HAART initiation compared with before HAART initiation. Analysis of our data demonstrates a strong decrease in candidiasis after HAART initiation. The incidence of EC fell to 2.99% from 5.48% (RR 0.545); PC fell to 2.85% from 6.70% (RR 0.425); and EC or PC fell to 3.43% from 7.35% (RR 0.466). No changes were seen in HL or warts. Higher HIV-RNA was associated with greater incidence of candidiasis and HL, but not warts. Analysis of these data indicates that recurrence and incidence of candidiasis are reduced by HAART, and that recurrence is reduced independently of CD4 and HIV-RNA.

  7. Antiretroviral Therapy-Associated Acute Motor and Sensory Axonal Neuropathy

    Directory of Open Access Journals (Sweden)

    Kimberly N. Capers

    2011-01-01

    Full Text Available Guillain-Barré syndrome (GBS has been reported in HIV-infected patients in association with the immune reconstitution syndrome whose symptoms can be mimicked by highly active antiretroviral therapy (HAART-mediated mitochondrial toxicity. We report a case of a 17-year-old, HIV-infected patient on HAART with a normal CD4 count and undetectable viral load, presenting with acute lower extremity weakness associated with lactatemia. Electromyography/nerve conduction studies revealed absent sensory potentials and decreased compound muscle action potentials, consistent with a diagnosis of acute motor and sensory axonal neuropathy. Lactatemia resolved following cessation of HAART; however, neurological deficits minimally improved over several months in spite of immune modulatory therapy. This case highlights the potential association between HAART, mitochondrial toxicity and acute axonal neuropathies in HIV-infected patients, distinct from the immune reconstitution syndrome.

  8. Impact of switching antiretroviral therapy on lipodystrophy and other metabolic complications: a review

    DEFF Research Database (Denmark)

    Hansen, Birgitte R; Haugaard, Steen B; Iversen, Johan;

    2004-01-01

    Following the introduction of highly active antiretroviral therapy (HAART), metabolic and morphological complications known as HIV associated lipodystrophy syndrome (HALS) have been increasingly common. The approaches to target these complications span from resistance exercise, diet and use...

  9. Adverse outcomes of pregnancy in HIV-positive women in the era of HAART: a perspective from an outer London centre in the UK

    Directory of Open Access Journals (Sweden)

    P Thayaparan

    2012-11-01

    Full Text Available Background: Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods: It is a retrospective case note review of all the women attended our unit and had HIV care from 2008–2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results: Mean age was 34 yrs ranging from 20–43 yrs. Majority (91% were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti-retroviral therapy (ART during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11% and late presentation (9%. 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post-partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P<0.05 with having a foetal complication such as prematurity 8%, low birth weight 7% or

  10. Compatibility studies of nevirapine in physical mixtures with excipients for oral HAART

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, G.G.G. de; Ferraz, H.G. [Department of Pharmacy, Faculty of Pharmaceutical Health, University of Sao Paulo, Sao Paulo 05508-900 (Brazil); Severino, P. [Department of Biotechnological Processes, School of Chemical Engineering, University of Campinas, Campinas 13083-970 (Brazil); Department of Pharmaceutical Technology, Faculty of Health Sciences, Fernando Pessoa University, Porto 4200-150 (Portugal); Souto, E.B., E-mail: eliana@ufp.edu.pt [Department of Pharmaceutical Technology, Faculty of Health Sciences, Fernando Pessoa University, Porto 4200-150 (Portugal); Institute for Biotechnology and Bioengineering, Centre for Genomics and Biotechnology, University of Tras-os-Montes e Alto Douro (IBB-CGB/UTAD), 5001-801 Vila Real (Portugal)

    2013-03-01

    Nevirapine is a hydrophobic non-nucleoside reverse transcriptase inhibitor, used in first line regimens of highly active antiretroviral therapy (HAART). The drug has more than one crystalline form, which may have implications for its behaviour during production and also for its in vivo performance. This study was aimed at exploring the suitability of thermoanalytical methods for the solid-state characterization of commercial crystalline forms of nevirapine. The drug powder was characterized by ultraviolet spectrophotometry, stereoscopy, scanning electron microscopy, wide-angle X-ray diffraction, measurements of density, flowability, solubility and intrinsic dissolution rate (IDR), differential scanning calorimetry, thermogravimetric analysis, and photostability measurements. The results showed that nevirapine has high stability and is not susceptible to degradation under light exposure. The drug showed compatibility with the excipients tested (lactose, microcrystalline cellulose, polyvinylpyrrolidone and polyvinyl acetate copolymer (PVP/PVA), and hydroxypropylmethylcellulose (HPMC)). Nevirapine has low solubility, an acid medium being the most appropriate medium for assessing the release of the drug from dosage forms. However, the data obtained from IDR testing indicate that dissolution is the critical factor for the bioavailability of this drug. - Graphical abstract: Bulk nevirapine powder analysed by scanning electron microscopy and the drug solubility profile in various buffer solutions. The pH values of the media in which the tests were conducted are also presented. Highlights: Black-Right-Pointing-Pointer Nevirapine shows more than one crystalline form, that influence its in vivo and in vitro behaviour. Black-Right-Pointing-Pointer DSC and TGA were used for solid-state characterization of crystalline forms of nevirapine. Black-Right-Pointing-Pointer Nevirapine is compatible with lactose, microcrystalline cellulose, PVP/PVA copolymers and HPMC. Black

  11. Compatibility studies of nevirapine in physical mixtures with excipients for oral HAART

    International Nuclear Information System (INIS)

    Nevirapine is a hydrophobic non-nucleoside reverse transcriptase inhibitor, used in first line regimens of highly active antiretroviral therapy (HAART). The drug has more than one crystalline form, which may have implications for its behaviour during production and also for its in vivo performance. This study was aimed at exploring the suitability of thermoanalytical methods for the solid-state characterization of commercial crystalline forms of nevirapine. The drug powder was characterized by ultraviolet spectrophotometry, stereoscopy, scanning electron microscopy, wide-angle X-ray diffraction, measurements of density, flowability, solubility and intrinsic dissolution rate (IDR), differential scanning calorimetry, thermogravimetric analysis, and photostability measurements. The results showed that nevirapine has high stability and is not susceptible to degradation under light exposure. The drug showed compatibility with the excipients tested (lactose, microcrystalline cellulose, polyvinylpyrrolidone and polyvinyl acetate copolymer (PVP/PVA), and hydroxypropylmethylcellulose (HPMC)). Nevirapine has low solubility, an acid medium being the most appropriate medium for assessing the release of the drug from dosage forms. However, the data obtained from IDR testing indicate that dissolution is the critical factor for the bioavailability of this drug. - Graphical abstract: Bulk nevirapine powder analysed by scanning electron microscopy and the drug solubility profile in various buffer solutions. The pH values of the media in which the tests were conducted are also presented. Highlights: ► Nevirapine shows more than one crystalline form, that influence its in vivo and in vitro behaviour. ► DSC and TGA were used for solid-state characterization of crystalline forms of nevirapine. ► Nevirapine is compatible with lactose, microcrystalline cellulose, PVP/PVA copolymers and HPMC. ► The acid form of nevirapine is the most appropriate for assessing release profile from

  12. Treatment of primary HIV-1 infection with cyclosporin A coupled with highly active antiretroviral therapy

    Science.gov (United States)

    Rizzardi, G. Paolo; Harari, Alexandre; Capiluppi, Brunella; Tambussi, Giuseppe; Ellefsen, Kim; Ciuffreda, Donatella; Champagne, Patrick; Bart, Pierre-Alexandre; Chave, Jean-Philippe; Lazzarin, Adriano; Pantaleo, Giuseppe

    2002-01-01

    Primary HIV-1 infection causes extensive immune activation, during which CD4+ T cell activation supports massive HIV-1 production. We tested the safety and the immune-modulating effects of combining cyclosporin A (CsA) treatment with highly active antiretroviral therapy (HAART) during primary HIV-1 infection. Nine adults with primary HIV-1 infection were treated with CsA along with HAART. At week 8, all patients discontinued CsA but maintained HAART. Viral replication was suppressed to a comparable extent in the CsA + HAART cohort and in 29 control patients whose primary infection was treated with HAART alone. CsA restored normal CD4+ T cell levels, both in terms of percentage and absolute numbers. The increase in CD4+ T cells was apparent within a week and persisted throughout the study period. CsA was not detrimental to virus-specific CD8+ or CD4+ T cell responses. At week 48, the proportion of IFN-γ–secreting CD4+ and CD4+CCR7– T cells was significantly higher in the CsA + HAART cohort than in the HAART-alone cohort. In conclusion, rapid shutdown of T cell activation in the early phases of primary HIV-1 infection can have long-term beneficial effects and establish a more favorable immunologic set-point. Appropriate, immune-based therapeutic interventions may represent a valuable complement to HAART for treating HIV infection. PMID:11877476

  13. Early Postseroconversion CD4 Cell Counts Independently Predict CD4 Cell Count Recovery in HIV-1–Postive Subjects Receiving Antiretroviral Therapy

    Science.gov (United States)

    Kulkarni, Hemant; Okulicz, Jason F.; Grandits, Greg; Crum-Cianflone, Nancy F.; Landrum, Michael L.; Hale, Braden; Wortmann, Glenn; Tramont, Edmund; Polis, Michael; Dolan, Matthew; Lifson, Alan R.; Agan, Brian K.; Ahuja, Sunil K.; Marconi, Vincent C.

    2013-01-01

    Background The relationship between CD4+ T-cell counts determined soon after seroconversion with HIV-1 (baseline CD4), nadir CD4, and CD4 levels attained during highly active antiretroviral therapy (HAART) is unknown. Methods Longitudinal, including baseline (at or soon after HIV diagnosis), intermediate (nadir), and distal (post-HAART) CD4+ T-cell counts were assessed in 1085 seroconverting subjects who achieved viral load suppression from a large well-characterized cohort. The association of baseline with post-HAART CD4+ T-cell count was determined after adjustment for other relevant covariates. Results A higher baseline CD4+ T-cell count predicted a greater post- HAART CD4+ T-cell count, independent of the nadir and other explanatory variables. Together, baseline and nadir strongly predicted the post-HAART CD4+ count such that a high baseline and lower nadir were associated with a maximal immune recovery after HAART. Likelihood of recovery of the baseline count after HAART was significantly higher when the nadir/baseline count ratio was consistently ≥0.6. Conclusions Among viral load suppressing seroconverters, the absolute CD4+ T-cell count attained post-HAART is highly dependent on both baseline and nadir CD4+ T-cell counts. These associations further support the early diagnosis and initiation of HAART among HIV-infected persons. PMID:21546844

  14. Treatment of LDs induced by HAART with a view of the phlegm and blood stasis in TCM%从痰瘀论治HAART致脂肪代谢障碍综合征

    Institute of Scientific and Technical Information of China (English)

    张晓伟; 李强; 蒋自强; 郭会军

    2011-01-01

    Lipodystrophy syndrome is the common side effects of highly active anti-retroviral therapy, it is a broad term that refers to a variety of body shape changes and metabolic abnormalities, such as fat accumulation、 lipoatrophy、 insulin resistance, hyperlipidemia, etc. It can be understood that a state of the phlegm and blood stasis in TCM, the main pathogenesis of lipodystrophy syndrome is Qi stagnation, phlegm and blood stasis, the phlegm and blood stasis is the pathological changes throughout the process of the disease. The treatment should be activating blood and resolving stasis, soothing liver and relieving depression, tonifying qi and removing toxin and pay attention to nursing the Stomach-qi.%脂肪代谢障碍综合征是艾滋病患者使用抗逆转录病毒治疗后常见的副反应,它涉及脂肪重新分布和代谢障碍等内容,脂肪重新分布又包括脂肪沉积和脂肪萎缩两部分内容,代谢障碍即代谢综合征或经X综合征主要指胰岛素抵抗、高血脂等.中医从痰、瘀角度来认识此病,气机郁滞、痰凝水聚、瘀血阻痹是主要病机变化过程,痰浊、瘀血贯穿在整个病理变化过程中.治疗当从祛痰化瘀、疏肝解郁、益气解毒之法,并注意顾护胃气.

  15. HIV INFECTION STAGE, ANTIRETROVIRAL THERAPY SCHEME AND PATIENT IMMUNE STATUS INFLUENCE ON HIV/TB CO-INFECTION OUTCOME

    Directory of Open Access Journals (Sweden)

    A. V. Mordyk

    2016-01-01

    Full Text Available Retrospective research of 381 clinical records is conducted to study HIV infection influence on stationary stage of tuberculosis treatment outcome in HIV-TB co-infected patients. All cases were divided depending on a hospitalization outcome on favorable and adverse. At most of patients tuberculosis of respiratory organs met. Immunological researches were conducted, the stage of HIV infection was registered and the issue of purpose of anti-retroviral therapy was resolved. Besides, as indirect signs of an immunodeficiency at the patients with a combination of tuberculosis and HIV infection who were on hospitalization the indicators received when carrying out clinical laboratory trials were analyzed: absolute and relative quantity of lymphocytes according to the general blood test, the contents the globulin fractions and circulating immune complexes concentration according to the clinical chemistry blood test. At an assessment of results in both groups of research more than at a half of patients existence of HIV infection at late stages that speaks about late identification and neglect of an immunodeficiency was revealed. At patients with tuberculosis of lungs in combination with HIV infection at a failure statistically significant decrease in an immunoregulatory index is revealed. It is interesting that the level of CD4 lymphocytes and a stage of HIV infection had no impact on the co-infection’s outcome. However, existence of virus loa ding more than 100 000 copies/ml reduced probability favorable an outcome of treatment of tuberculosis at the patient with HIV infection. Timely purpose of anti-retroviral therapy at patients with co-infection increased chances of treatment of tuberculosis at patients with an immunodeficiency. Frequency of adverse side effect of antiviral therapy met equally often at patients in both groups. Thus, patients at any stages of HIV infection with any forms of tuberculosis, including generalized, had a

  16. Hypercholesterolemia is associated with the apolipoprotein C-III (APOC3 genotype in children receiving HAART: an eight-year retrospective study.

    Directory of Open Access Journals (Sweden)

    Carlos A Rocco

    Full Text Available Polymorphisms in apolipoprotein genes have shown to be predictors of plasma lipid levels in adult cohorts receiving highly active antiretroviral therapy (HAART. Our objective was to confirm the association between the APOC3 genotype and plasma lipid levels in an HIV-1-infected pediatric cohort exposed to HAART. A total of 130 HIV-1-infected children/adolescents that attended a reference center in Argentina were selected for an 8-year longitudinal study with retrospective data collection. Longitudinal measurements of plasma triglycerides, total cholesterol, HDL-C and LDL-C were analyzed under linear or generalized linear mixed models. The contribution of the APOC3 genotype at sites -482, -455 and 3238 to plasma lipid levels prediction was tested after adjusting for potential confounders. Four major APOC3 haplotypes were observed for sites -482/-455/3238, with estimated frequencies of 0.60 (C/T/C, 0.14 (T/C/C, 0.11 (C/C/C, and 0.11 (T/C/G. The APOC3 genotype showed a significant effect only for the prediction of total cholesterol levels (p<0.0001. However, the magnitude of the differences observed was dependent on the drug combination (p = 0.0007 and the drug exposure duration at the time of the plasma lipid measurement (p = 0.0002. A lower risk of hypercholesterolemia was predicted for double and triple heterozygous individuals, mainly at the first few months after the initiation of Ritonavir-boosted protease inhibitor-based regimens. We report for the first time a significant contribution of the genotype to total cholesterol levels in a pediatric cohort under HAART. The genetic determination of APOC3 might have an impact on a large portion of HIV-1-infected children at the time of choosing the treatment regimens or on the counter-measures against the adverse effects of drugs.

  17. Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era

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    Kimberley L. S. Ambler

    2012-01-01

    Full Text Available The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 109/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6% had an ITP diagnosis and platelet count <20 × 109/L. Initial ITP treatment included IVIG, n=12; steroids, n=10; anti-RhD, n=8; HAART, n=3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71% required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.

  18. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption

    DEFF Research Database (Denmark)

    Dore, Gregory J; Soriano, Vicente; Rockstroh, Jürgen;

    2010-01-01

    BACKGROUND: The impact of antiretroviral therapy (ART) interruption in HIV-hepatitis B virus (HBV)-coinfected patients was examined in the Strategic Management of AntiRetroviral Therapy (SMART) study. METHODS: Plasma HBV DNA was measured in all hepatitis B surface antigen-positive (HBV.......0002), nondetectable HBV DNA at baseline (P = 0.007), and black race (P = 0.03). Time to ART reinitiation was shorter (7.5, 15.6, and 17.8 months; P hepatitis C virus-positive and non-HBV/hepatitis...... C virus participants in the drug conservation arm. No hepatic decompensation events occurred among HBV-positive participants in either arm. CONCLUSION: HBV DNA rebound following ART interruption is common and may be associated with accelerated immune deficiency in HIV-HBV-coinfected patients....

  19. Effect of Nadir CD4+ T cell count on clinical measures of periodontal disease in HIV+ adults before and during immune reconstitution on HAART.

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    Lance T Vernon

    Full Text Available BACKGROUND: The contribution of HIV-infection to periodontal disease (PD is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD. METHODS: We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART 0mm, clinical attachment level (CAL ≥ 4.0mm, and bleeding on probing (BOP at ≥ 4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD. RESULTS: Forty (40 subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001 and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001; concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001. Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04 and CAL (9.06%; p<0.001. Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027, and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively. Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD. CONCLUSION: Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.

  20. Factors influencing cerebrospinal fluid and plasma HIV-1 RNA detection rate in patients with and without opportunistic neurological disease during the HAART era

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    Aleixo Agdemir W

    2007-12-01

    Full Text Available Abstract Background In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments. Methods A prospective study was conducted on 90 HIV-infected patients submitted to lumbar puncture as part of a work-up for suspected neurological disease. Seventy-one patients had active neurological diseases while the remaining 19 did not. Results HIV-1 RNA was quantified in 90 CSF and 70 plasma samples. The HIV-1 RNA detection rate in CSF was higher in patients with neurological diseases, in those with a CD4 count lower than 200 cells/mm3, and in those not receiving antiretroviral therapy, as well as in patients with detectable plasma HIV-1 RNA. Median viral load was lower in CSF than in plasma in the total population, in patients without neurological diseases, and in patients with toxoplasmic encephalitis, while no significant difference between the two compartments was observed for patients with cryptococcal meningitis and HIV-associated dementia. CSF viral load was lower in patients with cryptococcal meningitis and neurotoxoplasmosis under HAART than in those not receiving HAART. Conclusion Detection of HIV-1 RNA in CSF was more frequent in patients with neurological disease, a CD4 count lower than 200 cells/mm3 and detectable plasma HIV-1. Median HIV-1 RNA levels were generally lower in CSF than in

  1. Advanced research of the HAART and mitochondrial toxicity In Children%儿童抗HIV治疗和线粒体毒性研究进展

    Institute of Scientific and Technical Information of China (English)

    孙玉; 陈德喜

    2009-01-01

    Highly active anti-retrovirus therapy (HAART) has resulted in a substantial reduction in paediatric HIV-associated mortality and morbidity and mother-to-child transmission. However, it is inevitable that children with HIV infection will be exposed to HAART for an ever-increasing length of time throughout their lives, and the cumulative toxicities of HAAT are becoming progressively apparent. This review is to summarize the most recent work and provide an overview to the clinical manifestations and pathogenesis of mitochondrial toxicity resulted from paediatric HAAT.%HAART明显降低了儿童HIV相关疾病的发病率及病死率,在预防母婴传播中起到了非常重要的作用.由于HIV感染儿童将面临一生的抗病毒治疗,药物相关的线粒体毒性问题日益受到重视.此文对儿童抗病毒治疗所致线粒体毒性的临床表现、发病机制及相关临床和实验室研究等进行了综述.

  2. Oxidative Imbalance in HIV-1 Infected Patients Treated with Antiretroviral Therapy

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    Antonella Mandas

    2009-01-01

    Full Text Available It is generally accepted that oxidative stress is involved in HIV infection. However, the role in oxidative balance of Highly Active Antiretroviral Therapy (HAART is still debated. In our study we assessed serum oxidant and antioxidant levels in an HIV-1-infected population treated with HAART, and compared them with those of untreated HIV-1 patients and HIV-1-negative subjects. The study included 116 HIV-1-infected patients (86 HAART-treated and 30 untreated, and 46 HIV-negative controls. Serum oxidant levels were significantly higher in the HIV-1 treated group as compared to untreated and control groups. In addition, a decrease of serum total antioxidant status was observed in the HIV-1 treated group. To be noted is that patients who rigorously follow antiretroviral therapy (optimal HAART adherence have significantly higher oxidative status than those who do not closely follow the therapy (poor HAART adherence. Analysis of variance revealed no significant further increase in oxidative status in HIV-1-infected patients taking antiretroviral and other drugs with the exception of psychiatric drugs (e.g. anxiolytics or antidepressants. Taken together, our results indicate that HAART may affect oxidative stress in HIV-1-infected patients and suggest that antiretroviral therapy plays an important role in the synergy of HIV infection and oxidative stress.

  3. Molecular diversity of HIV-1 and surveillance of transmitted drug resistance variants among treatment Naïve patients, 5 years after active introduction of HAART in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Ong, Lai Yee; Razak, Siti Nur Humaira; Lee, Yeat Mei; Sri La Sri Ponnampalavanar, Sasheela; Syed Omar, Sharifah Faridah; Azwa, Raja Iskandar; Tee, Kok Keng; Kamarulzaman, Adeeba

    2014-01-01

    Expansion of antiretroviral treatment programs have led to the growing concern for the development of antiretroviral drug resistance. The aims were to assess the prevalence of drug resistant HIV-1 variants and to identify circulating subtypes among HAART-naïve patients. Plasma specimens from N = 100 HIV+ HAART-naïve adult were collected between March 2008 and August 2010 and viral RNA were extracted for nested PCR and sequenced. PR-RT sequences were protein aligned and checked for transmitted drug resistance mutations. Phylogenetic reconstruction and recombination analysis were performed to determine the genotypes. Based on the WHO consensus guidelines, none of the recruited patients had any transmitted drug resistance mutations. When analyzed against the Stanford guidelines, 35% of patients had at least one reported mutation that may reduce drug susceptibility to PI (24%), NRTI (5%), and NNRTI (14%). The commonly detected mutation that may affect current first line therapy was V179D (3%), which may lead to reduced susceptibility to NNRTI. The predominant circulating HIV-1 genotypes were CRF01_AE (51%) and CRF33_01B (17%). The prevalence of unique recombinant forms (URF) was 7%; five distinct recombinant structures involving CRF01_AE and subtype B' were observed, among them a cluster of three isolates that could form a novel circulating recombinant form (CRF) candidate. Transmitted drug resistance prevalence among HAART-naïve patients was low in this cohort of patients in Kuala Lumpur despite introduction of HAART 5 years ago. Owing to the high genetic diversity, continued molecular surveillance can identify the persistent emergence of HIV-1 URF and novel CRF with significant epidemiological impact.

  4. Modeling of HIV-1 infection: insights to the role of monocytes/macrophages, latently infected T4 cells, and HAART regimes.

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    Qiang Li

    Full Text Available A novel dynamic model covering five types of cells and three connected compartments, peripheral blood (PB, lymph nodes (LNs, and the central nervous system (CNS, is here proposed. It is based on assessment of the biological principles underlying the interactions between the human immunodeficiency virus type I (HIV-1 and the human immune system. The simulated results of this model matched the three well-documented phases of HIV-1 infection very closely and successfully described the three stages of LN destruction that occur during HIV-1 infection. The model also showed that LNs are the major location of viral replication, creating a pool of latently infected T4 cells during the latency period. A detailed discussion of the role of monocytes/macrophages is made, and the results indicated that infected monocytes/macrophages could determine the progression of HIV-1 infection. The effects of typical highly active antiretroviral therapy (HAART drugs on HIV-1 infection were analyzed and the results showed that efficiency of each drug but not the time of the treatment start contributed to the change of the turnover of the disease greatly. An incremental count of latently infected T4 cells was made under therapeutic simulation, and patients were found to fail to respond to HAART therapy in the presence of certain stimuli, such as opportunistic infections. In general, the dynamics of the model qualitatively matched clinical observations very closely, indicating that the model may have benefits in evaluating the efficacy of different drug therapy regimens and in the discovery of new monitoring markers and therapeutic schemes for the treatment of HIV-1 infection.

  5. Dyslipidemia in a Cohort of HIV-infected Latin American Children Receiving Highly Active Antiretroviral Therapy*

    OpenAIRE

    Brewinski, Margaret; Megazzini, Karen; Freimanis Hance, Laura; Cruz, Miguel Cashat; Pavia-Ruz, Noris; Della Negra, Marinella; Ferreira, Flavia Gomes Faleiro; Marques, Heloisa; Hazra, Rohan

    2010-01-01

    In order to describe the prevalence of hypercholesterolemia and hypertriglyceridemia in a cohort of HIV-infected children and adolescents in Latin America and to determine associations with highly active antiretroviral therapy (HAART), we performed this cross-sectional analysis within the NICHD International Site Development Initiative pediatric cohort study. Eligible children had to be at least 2 years of age and be on HAART. Among the 477 eligible HIV-infected youth, 98 (20.5%) had hypercho...

  6. Socio-economic impact of antiretroviral treatment in HIV patients. An economic review of cost savings after introduction of HAART.

    Science.gov (United States)

    Gonzalo, Teresa; García Goñi, Manuel; Muñoz-Fernández, María Angeles

    2009-01-01

    Star celebrities such as Rock Hudson, Freddie Mercury, Magic Johnson, and Isaac Asimov have unfortunately something in common: they were all victims of the HIV global pandemic. Since then HIV infection has become considered a pandemic disease, and it is regarded as a priority in healthcare worldwide. It is ranked as the first cause of death among young people in industrialized countries, and it is recognized as a public healthcare problem due to its human, social, mass media, and economic impact. Incorporation of new and highly active antiretroviral treatment, available since 1996 for HIV/AIDS treatment, has provoked a radical change in the disease pattern, as well as in the impact on patient survival and quality of life. The pharmaceutical industry's contribution, based on the research for more active new drugs, has been pivotal. Mortality rates have decreased significantly in 20 years by 50% and now AIDS is considered a chronic and controlled disease. In this review we have studied the impact of HAART treatment on infected patients, allowing them to maintain their status as active workers and the decreased absenteeism from work derived from this, contributing ultimately to overall social wealth and, thus, to economic growth. Furthermore, an analysis of the impact on healthcare costs, quality of life per year, life per year gained, cost economic savings and cost opportunity among other parameters has shown that society and governments are gaining major benefits from the inclusion of antiretroviral therapies in HIV/AIDS patients.

  7. Opportunistic infections in relation to antiretroviral status among AIDS patients from south India

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    S Srirangaraj

    2011-01-01

    Full Text Available Background: There is a need to generate data from India on relative frequencies of specific opportunistic infections (OIs in different regions and their relation to the choice of commonly used generic highly active anti-retroviral therapy (HAART regimens. Objectives: To document the prevailing prevalence pattern of OIs both before and after HAART, to look for reduction in OIs following HAART, to assess the risk of developing new OIs within 6 months of HAART initiation and to see if there is any difference in the risk of developing a new OI within 6 months of HAART initiation, for those on Efavirenz (EFV-based regimens and Nevirapine (NVP-based regimens. Materials and Methods: In a prospective observational cohort study conducted in South India involving 108 ART-naive AIDS patients, different pathogens were isolated and identified using standard laboratory techniques. Data analysis was done using SPSS software (version 16.0. Risk of developing an OI after HAART initiation was assessed using the likelihood ratio test from Cox regression models. Results: Tuberculosis (53.4%, oral Candidiasis (27.2% and Herpes Zoster (14.7% were the common infections seen. There was a drastic reduction of 96.59% in OI events after 6 months of HAART. The risk of developing an OI within 6 months of HAART initiation was 5.56%. Time to development of an OI in the first 6 months of HAART was shorter for the NVP-based regimens than with EFV-based regimens, but this difference was not statistically significant (HR=0.891, 95% CI: 0.179-4.429; P=0.888. Conclusion: Tuberculosis is the most important OI before initiation of HAART. Both EFV and NVP-based regimens are equally efficacious in controlling OIs.

  8. Impact of highly active antiretroviral therapy on salivary flow in patients with human-immuno deficiency virus disease in Southern India

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    S Pavithra

    2013-01-01

    Full Text Available Aims: To ascertain and compare between highly active antiretroviral therapy (HAART and non-HAART patients, the stimulated salivary flow rates and unstimulated salivary flow rates (USFR and SSFR and to correlate the salivary flow rates with immune suppression. Materials and Methods: One hundred human-immuno deficiency virus seropositive patients attending RAGAS-YRG CARE were examined and divided into two groups, a HAART group (patients on combination antiretroviral therapy comprising 50 patients and a non-HAART group comprising 50 patients. The HAART group was followed every 3 months after the baseline visit (0 for a period of 9 months, during which a clinical oral examination and collection of unstimulated and stimulated saliva was done. Their salivary gland function was assessed using a xerostomia inventory during each visit. The study on non-HAART group was cross-sectional. Statistical Analysis: Statistical analysis were performed with the aid of the Statistical Package for the Social Sciences (SPSS version 10.05 software. Results: There was no significant difference in mean SSFR and USFR between the two groups at baseline. In the HAART group, the mean stimulated salivary flow rate increased from baseline to 3 months ( P = 0.02, with the increase being maintained at 6 months and 9 months. When salivary flow rates were correlated with Cluster of Differentiation, CD4 counts, patients in the HAART group with a CD4 ≤ 200 at 6 months visit had a higher mean stimulated salivary flow rate when compared with patients with CD4 ≥ 200 ( P = 0.02. The xerostomia inventory did not reveal any significant difference between the two groups and HAART was not significantly associated with xerostomia. Conclusion: In our study HAART was neither associated with xerostomia nor a reduction in salivary flow rate and immune suppression was not a significant factor for decreasing the salivary flow rate.

  9. Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit Eg; Obel, N; Nielsen, H;

    2011-01-01

    The aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIV-infected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART).......The aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIV-infected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART)....

  10. The Impact of Neuropsychological Functioning on Adherence to HAART in HIV-Infected Substance Abuse Patients

    OpenAIRE

    Applebaum, Allison J.; Reilly, Laura C.; Gonzalez, Jeffrey S.; Richardson, Mark A.; Leveroni, Catherine L.; Steven A Safren

    2009-01-01

    This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning ...

  11. Treinamento físico para indivíduos HIV positivo submetidos à HAART: efeitos sobre parâmetros antropométricos e funcionais Physical training for HIV positive individuals submitted to HAART: effects on anthropometric and functional parameters

    Directory of Open Access Journals (Sweden)

    Edmar Lacerda Mendes

    2013-02-01

    Full Text Available INTRODUÇÃO: A terapia antirretroviral fortemente ativa (HAART tem melhorado a prognose em indivíduos infectados pelo HIV. No entanto, a HAART tem sido associada ao desenvolvimento de anormalidades metabólicas e na distribuição de gordura corporal conhecida como síndrome lipodistrófica associada ao HIV (SLHIV. OBJETIVO: Este estudo investigou o impacto de 24 semanas de exercício resistido com componente aeróbico (ERCA sobre parâmetros antropométricos e funcionais de portadores de HIV submetidos à HAART. MÉTODOS: Noventa e nove indivíduos infectados pelo HIV foram randomicamente alocados em quatro grupos: exercício e lipodistrofia (n = 24; EX+LIP; exercício sem lipodistrofia (n = 21; EX+NoLIP; controle e lipodistrofia (n = 27; NoEX+LIP; controle sem lipodistrofia (n = 27; NoEX+NoLIP. Os indivíduos dos grupos exercitados (EX+LIP e EX+NoLIP participaram de 24 semanas de ERCA. Nos momentos pré e pós 24 semanas de intervenção foram realizadas medidas antropométricas, testes de força e aptidão cardiorrespiratória. RESULTADOS: Vinte e quatro semanas de ERCA alteraram os perímetros corporais avaliados (P INTRODUCTION: The use of highly active antiretroviral therapy (HAART has improved the prognosis of HIV-infected individuals. However, HAART has been associated with the development of metabolic and fat distribution abnormalities, known as HIV-associated lipodystrophy syndrome (SLHIV. OBJECTIVE: This study investigated the impact of 24 weeks of resistance exercise with aerobic component (REAC on anthropometric and functional parameters in HIV-infected patients undergoing HAART. METHODS: Ninety- nine HIV-infected patients were randomly allocated into four groups: exercise and lipodystrophy (n = 24; EX + LIP; exercise without lipodystrophy (n = 21; EX + NoLIP; control and lipodystrophy (n = 27; NoEX + LIP; control without lipodystrophy (n = 27; NoEX + NoLIP. Subjects from exercised groups (EX+LIP and EX+NoLIP participated in a 24

  12. Impact of gender on response to highly active antiretroviral therapy in HIV-1 infected patients

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristina; Ladelund, Steen; Jensen-Fangel, Søren;

    2012-01-01

    ABSTRACT: BACKGROUND: Impact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial. METHODS: From a nationwide cohort of Danish HIV infected individuals we identified all heterosex......ABSTRACT: BACKGROUND: Impact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial. METHODS: From a nationwide cohort of Danish HIV infected individuals we identified all...... counts (adjusted p=0.21). We observed no delay in time to initiation of HAART in women compared to men (HR 0.91, 95% CI 0.79-1.06). There were no gender differences in risk of treatment modification of the original HAART regimen during the first year of therapy for either toxicity (IRR 0.97 95% CI 0.......66-1.44) or other/unknown reasons (IRR 1.18 95% CI 0.76-1.82). Finally, CD4 counts and the risk of having a detectable viral load at 1, 3 and 6 years did not differ between genders. CONCLUSIONS: In a setting with free access to healthcare and HAART, gender does neither affect time from eligibility to HAART...

  13. The CCL3L1-CCR5 genotype influences the development of AIDS, but not HIV susceptibility or the response to HAART

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, Tanmoy [Los Alamos National Laboratory; Stanton, Jennifer [NORTHWESTERN UNIV; Kim, Eun - Young [NORTHWESTERN UNIV; Kunstman, Kevin [NORTHWESTERN UNIV; Phair, John [NORTHWESTERN UNIV; Jacobson, Lisa P [JOHNS HOPKINS UNIV; Wolinsky, Steven M [NORTHWESTERN UNIV

    2008-01-01

    A selective advantage against infectious diseases such as HIV/AIDS is associated with differences in the genes relevant to immunity and virus replication. The CC chemokine receptor 5 (CCR5), the principal coreceptor for HIV, and its chemokine ligands, including CCL3L1, influences the CD4+ target cells susceptibility to infection. The CCL3L1 gene is in a region of segmental duplication on the q-arm of human chromosome 17. Increased numbers of CCL3L1 gene copies that affect the gene expression phenotype might have substantial protective effects. Here we show that the population-specific CCL3L1 gene copy number and the CCR5 {Delta}32 protein-inactivating deletion that categorizes the CCL3L1-CCR5 genotype do not influence HIV/AIDS susceptibility or the robustness of immune recovery after the initiation of highly active antiretroviral therapy (HAART).

  14. Birth outcomes in South African women receiving highly active antiretroviral therapy: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    van der Merwe Karin

    2011-08-01

    Full Text Available Abstract Background Use of highly active antiretroviral therapy (HAART, a triple-drug combination, in HIV-infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development. Methods Our objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts ≤250 cells/mm3 attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight ( Results Among HAART-unexposed infants, 27% (60/224 were low birth weight compared with 23% (90/388 of early HAART-exposed (exposed 3 increase, 95% CI 0.45-0.71, p 3 increase, 95% CI 0.55-0.85, p = 0.001. HAART exposure was associated with an increased preterm birth rate (15%, or 138 of 946, versus 5%, or seven of 147, in unexposed infants, p = 0.001, with early nevirapine and efavirenz-based regimens having the strongest associations with preterm birth (AOR 5.4, 95% CI 2.1-13.7, p Conclusions In this immunocompromised cohort, in utero HAART exposure was not associated with low birth weight. An association between NNRTI-based HAART and preterm birth was detected, but residual confounding is plausible. More advanced immunosuppression was a risk factor for low birth weight and preterm birth, highlighting the importance of earlier HAART initiation in women to optimize maternal health and improve infant outcomes.

  15. Coinfecciones por HBV y HCV en pacientes HIV positivos en la "era HAART": nuevos desafíos Hbv and hcv co-infections in hiv positive patients in the "HAART era": new challenges

    Directory of Open Access Journals (Sweden)

    Natalia L. Laufer

    2007-02-01

    Full Text Available Las coinfecciones con virus de la hepatitis C (HCV y/o virus de la hepatitis B (HBV en pacientes infectados por el virus de la inmunodeficiencia humana (HIV son un hallazgo frecuente en virtud de las similares vías de transmisión que estos agentes presentan (sexual, parenteral y vertical. Desde el advenimiento del tratamiento antirretroviral de alta eficiencia (TARV se evidenció una marcada disminución en la morbi-mortalidad de los pacientes; sin embargo, ante la prolongación de su sobrevida, las complicaciones crónicas debidas a las coinfecciones con estos virus hepatotropos han cobrado importancia, convirtiéndose la enfermedad hepática en una de las primeras causas de morbi-mortalidad de los pacientes HIV positivos en los países desarrollados. Se disponen en la actualidad de nuevas terapias y métodos de diagnóstico y seguimiento para HBV y HCV, lo cual permite un mejor control de ambas coinfecciones.Co-infections with HIV and HCV/HBV are frequently found due to the similar routes of transmission (sexual, parenteral and vertical. Since the introduction of highly active antiretroviral therapy (HAART there has been a notably decrease in patients morbidity and mortality, nevertheless with the prolonged survival, many of these patients are at risk of developing chronic complication, secondary to the infection of hepatotropic viruses. End stage liver disease is one of the main causes of morbid-mortality among HIV patients in developed countries. Nowadays there are new available therapies, diagnostic and follow up techniques for HBV and HCV, what provides a better control of both co-infections.

  16. Prevalence of dyslipidemia among HIV-infected patients using first-line highly active antiretroviral therapy in Southern Ethiopia: a cross-sectional comparative group study

    Directory of Open Access Journals (Sweden)

    Tadewos Agete

    2012-10-01

    Full Text Available Abstract Background Data on lipid profile abnormalities among patients receiving highly active antiretroviral treatment in Ethiopia are very limited. The aim of this study was to determine the prevalence of dyslipidemia and characteristics of lipid profiles among patients living with human immunodeficiency virus (HIV using first-line highly active antiretroviral therapy (HAART in Southern Ethiopia. Methods This cross sectional comparative group study was conducted between March and May 2012, and included 113 HIV infected patients treated for a minimum of one year with first-line HAART regimens that included Efavirenz and Nevirapine (HAART group and others 113 who had never received HAART (pre-HAART group. Serum lipid profiles were determined after overnight fasting and dyslipidemia was assessed according to the United State National Cholesterol Education program-III guideline. For statistical analysis Chi-square, student’s t-test, and logistic regression were used using Statistical Package for Social Sciences (SPSS Version 20. Result Ninety-three (82.3% of HAART and 87 (76.9% pre-HAART patients had at least one laboratory abnormality, which is compatible with a diagnosis of dyslipidemia. Total cholesterol ≥ 200 mg/dl occurred in 43.4% of HAART and 15.9% pre-HAART patients (p= Conclusion Use of first-line antiretroviral therapy regimens that contain Efavirenz and Nevirapine were associated with raised total cholesterol, LDL-cholesterol, and triglycerides, an established atherogenic lipid profiles. Lipid profiles should be performed at baseline before commencement of antiretroviral therapy and then periodically through treatment follow-up to monitor any rising trends.

  17. Small-Molecule Inhibition of HIV pre-mRNA Splicing as a Novel Antiretroviral Therapy to Overcome Drug Resistance

    OpenAIRE

    Nadia Bakkour; Yea-Lih Lin; Sophie Maire; Lilia Ayadi; Florence Mahuteau-Betzer; Chi Hung Nguyen; Clément Mettling; Pierre Portales; David Grierson; Benoit Chabot; Philippe Jeanteur; Christiane Branlant; Pierre Corbeau; Jamal Tazi

    2007-01-01

    Author Summary Over the two decades highly active antiretroviral therapy (HAART) for the treatment of HIV infection has led to a significant decline in morbidity and mortality rates among HIV-infected individuals. HAART uses a combination of molecules that target the virus itself. However, naturally occurring and extensive genetic variation found in the virus allow the emergence of drug-resistant viruses, which rapidly render individuals untreatable. An alternative approach for effective anti...

  18. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy

    Science.gov (United States)

    Porco, Travis C.; Martin, Jeffrey N.; Page-Shafer, Kimberly A.; Cheng, Amber; Charlebois, Edwin; Grant, Robert M.; Osmond, Dennis H.

    2008-01-01

    Objective Little is known about the degree to which widespread use of antiretroviral therapy in a community reduces uninfected individuals’ risk of acquiring HIV. We estimated the degree to which the probability of HIV infection from an infected partner (the infectivity) declined following the introduction of highly active antiretroviral therapy (HAART) in San Francisco. Design Homosexual men from the San Francisco Young Men’s Health Study, who were initially uninfected with HIV, were asked about sexual practices, and tested for HIV antibodies at each of four follow-up visits during a 6-year period spanning the advent of widespread use of HAART (1994 to 1999). Methods We estimated the infectivity of HIV (per-partnership probability of transmission from an infected partner) using a probabilistic risk model based on observed incident infections and self-reported sexual risk behavior, and tested the hypothesis that infectivity was the same before and after HAART was introduced. Results A total of 534 homosexual men were evaluated. Decreasing trends in HIV seroincidence were observed despite increases in reported number of unprotected receptive anal intercourse partners. Conservatively assuming a constant prevalence of HIV infection between 1994 and 1999, HIV infectivity decreased from 0.120 prior to widespread use of HAART, to 0.048 after the widespread use of HAART – a decline of 60% (P = 0.028). Conclusions Use of HAART by infected persons in a community appears to reduce their infectiousness and therefore may provide an important HIV prevention tool. PMID:15090833

  19. Effects of highly active anti-retroviral therapy on infant growth and development of pregnancy with HIV%高效抗逆转录病毒治疗妊娠合并HIV对婴儿生长发育的影响

    Institute of Scientific and Technical Information of China (English)

    周敏

    2014-01-01

    目的 分析高效抗逆转录病毒治疗妊娠合并HIV感染对婴儿生长发育的影响.方法 选择在本院接受治疗及分娩的妊娠合并HIV感染39例患者作为研究对象,分别给予单药或双药抗逆转录病毒治疗及三联高效抗逆转录病毒治疗,比较两组患者的妊娠结局、新生儿结局、新生儿身高及体质量等情况差异.结果 观察组顺产率(45.83%)、新生儿Apgar评分(8.54±1.52)、身高(55.39±3.25)cm均明显高于对照纽;HIV阳性率(5.88%)及不良反应发生率(11.76%)均明显低于对照组(P<0.05).结论 高效抗逆转录病毒治疗可以有效改善产妇及新生儿结局,有效促进婴儿生长发育.

  20. Factors associated with HIV/AIDS diagnostic disclosure to HIV infected children receiving HAART: a multi-center study in Addis Ababa, Ethiopia.

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    Sibhatu Biadgilign

    Full Text Available BACKGROUND: Diagnostic disclosure of HIV/AIDS to a child is becoming an increasingly common issue in clinical practice. Nevertheless, some parents and health care professionals are reluctant to inform children about their HIV infection status. The objective of this study was to identify the proportion of children who have knowledge of their serostatus and factors associated with disclosure in HIV-infected children receiving HAART in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18, 2008-April 28, 2008. The study populations were parents/caretakers and children living with HIV/AIDS who were receiving Highly Active Antiretroviral Therapy (HAART in selected hospitals in Addis Ababa. Univariate and multivariate logistic regression analysis were carried out using SPSS 12.0.1 statistical software. RESULTS: A total of 390 children/caretaker pairs were included in the study. Two hundred forty three children (62.3% were between 6-9 years of age. HIV/AIDS status was known by 68 (17.4% children, 93 (29% caretakers reported knowing the child's serostatus two years prior to our survey, 180 (46.2% respondents said that the child should be told about his/her HIV/AIDS status when he/she is older than 14 years of age. Children less than 9 years of age and those living with educated caregivers are less likely to know their results than their counterparts. Children referred from hospital's in-patient ward before attending the HIV clinic and private clinic were more likely to know their results than those from community clinic. CONCLUSION: The proportion of disclosure of HIV/AIDS diagnosis to HIV-infected children is low. Strengthening referral linkage and health education tailored to educated caregivers are recommended to increase the rate of disclosure.

  1. Increase in non-AIDS related conditions as causes of death among HIV-infected individuals in the HAART era in Brazil.

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    Antonio G Pacheco

    Full Text Available BACKGROUND: In 1996, Brazil became the first developing country to provide free and universal access to HAART. Although a decrease in overall mortality has been documented, there are no published data on the impact of HAART on causes of death among HIV-infected individuals in Brazil. We assessed temporal trends of mortality due to cardiovascular diseases (CVD, diabetes mellitus (DM and other conditions generally not associated with HIV-infection among persons with and without HIV infection in Brazil between 1999 and 2004. METHODOLOGY/PRINCIPAL FINDINGS: Odds ratios were used to compare causes of death in individuals who had HIV/AIDS listed on any field of the death certificate with those who did not. Logistic regression models were fitted with generalized estimating equations to account for spatial correlation; co-variables were added to the models to control for potential confounding. Of 5,856,056 deaths reported in Brazil between 1999 and 2004 67,249 (1.15% had HIV/AIDS listed on the death certificate and non-HIV-related conditions were listed on 16.3% in 1999, increasing to 24.1% by 2004 (p<0.001. The adjusted average yearly increases were 8% and 0.8% for CVD (p<0.001, and 12% and 2.8% for DM (p<0.001, for those who had and did not have HIV/AIDS listed on the death certificate, respectively. Similar results were found for these conditions as underlying causes of death. CONCLUSIONS/SIGNIFICANCE: In Brazil between 1999 and 2004 conditions usually considered not to be related to HIV-infection appeared to become more likely causes of death over time than reported causes of death among individuals who had HIV/AIDS listed on the death certificate than in those who did not. This observation has important programmatic implications for developing countries that are scaling-up access to antiretroviral therapy.

  2. Comparison of screening tools for the detection of neurocognitive impairment in HAART-treated patients

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    P Lorenzini

    2012-11-01

    Full Text Available Background: Neurocognitive impairment (NCI and HIV-associated neurocognitive disorders (HAND remain prevalent despite HAART. We examined sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and correct classification rate (CCR of screening tools for the detection of NCI and HAND in HAART treated patients. Methods: We examined 101 unselected HAART-treated patients. Patients were administered the self-reported three questions (EACS Guidelines, the International HIV-Dementia Scale (IHDS, the Mini-Mental Status Examination (MMSE, and a comprehensive 6-domain (17-test neuropsychological (NP battery (120 minutes that included, among others, the Digit Symbol (DS, the Trail Making Modalities (TM, and the Grooved Pegboard (GP tests. NCI was defined according to the AAN criteria. HAND was diagnosed after exclusion of confounding conditions. Results: Our cohort was relatively healthy (mean CD4 count: 575 cells/mm3, undetectable plasma HIV RNA 85%. Prevalence of NCI and HAND were 39.6% (40 of 101 and 30.7% (31 of 101, respectively. Mean scores of IHDS (9.9 vs 10.8; p<0.001 and MMSE (26.8 vs 28.2; p=0.004 differed significantly between impaired and unimpaired patients, while mean three-questions scores (8.0 vs 7.0; p=0.23 did not. The three questions showed also poor sensitivity for the detection of both NCI (20% and HAND (22%. The IHDS showed fairly good sensitivity (55% and NPV (73.5%. Adding to the IHDS some easy to administer NP tests, i.e. TM, DS, and GP, resulted in an increase in sensitivity and NPV for the detection of NCI (table. Similar results were obtained regarding the detection of HAND (not shown in table. Conclusions: Both NCI and HAND are still very prevalent in HAART-treated patients. Among screening tools the self-reported three question show poor sensitivity. The IHDS performed better in terms of sensitivity, PPV, and NPV. Combinations of easy-to-administer NP tests with the IHDS resulted in increased

  3. Addressing the fear and consequences of stigmatization - a necessary step towards making HAART accessible to women in Tanzania: a qualitative study

    DEFF Research Database (Denmark)

    Theilgaard, Zahra P; Katzenstein, Terese L; Chiduo, Mercy G;

    2011-01-01

    ) for HAART never registered at the CTCs. Few studies have focused on the motivating and deterring factors to presenting for HAART particularly in relation to women. This study seeks to remedy this gap in knowledge. Methodology A qualitative approach using in-depth interviews and focus group discussions...

  4. The Impact of Comorbid Clinical Depression on The Health-Related Quality of Life of Adults on Highly Active Antiretroviral Therapy in Maiduguri, Northeastern Nigeria

    OpenAIRE

    Ibrahim Abdu Wakawa; Jidda Mohammed Said; Wakil Musa Abba; Saleh Shehu; Isa Bukar Rabbebe; Omeiza Beida

    2014-01-01

    Background: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. Materials and Methods: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disord...

  5. Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa

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    Mark Faesen

    2012-06-01

    Full Text Available Background: The risk of squamous intra-epithelial lesions (SIL is higher in HIV-positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART, their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV-positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV-positive women in South Africa. Methods: A prospective observational study of HIV-seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs, adjusted for age, CD4 count and other potential confounders. Results: Median follow-up time was 445 days (inter-quartile range 383, 671. The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL 12.7, 19.9 per 100 person-years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1 per 100 person-years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR=0.55 (95% CL 0.37, 0.80. Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure. Conclusion: HAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV-positive women.

  6. From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston.

    Science.gov (United States)

    Behforouz, H L; Farmer, P E; Mukherjee, J S

    2004-06-01

    Like tuberculosis, human immunodeficiency virus (HIV) disease is associated with poverty and social inequalities, conditions that hamper the delivery of care. Like tuberculosis, treatment of HIV infection requires multidrug regimens, and the causative agent acquires drug resistance, which can be transmitted to others. A pilot project in rural Haiti introduced DOT-HAART (directly observed therapy with highly active antiretroviral therapy) for the care of patients with advanced acquired immune deficiency syndrome. A similar DOT-HAART effort was launched in Boston for patients with drug-resistant HIV disease who had experienced failure of unsupervised therapy. In both settings, community health promoters or accompagnateurs provide more than DOT: they offer psychosocial support and link patients to clinical staff and available resources. DOT-HAART in these 2 settings presents both challenges and opportunities. These models of care can be applied to other poverty-stricken populations in resource-poor settings.

  7. Diabetic ketoacidosis in an HIV-infected patient undergoing antiretroviral therapy

    DEFF Research Database (Denmark)

    Holm, MR; Hansen, Birgitte Rønde; Røder, ME

    2006-01-01

    Following the introduction of highly active antiretroviral therapy (HAART), a number of metabolic and morphologic alterations, known as HIV-associated lipodystrophy syndrome (HALS), have been increasingly common in HIV-infected patients being treated with this therapy. The use of protease...

  8. Investigating Signs of Recent Evolution in the Pool of Pro-viral DNA during Years of Successful HAART

    DEFF Research Database (Denmark)

    Mens, H.; Pedersen, Anders Gorm; Jørgensen, L. B.;

    2007-01-01

    In order to shed light on the nature of the persistent reservoir of human immunodeficiency virus type 1 (HIV-1), we investigated signs of recent evolution in the pool of proviral DNA in patients on successful HAART. Pro-viral DNA, corresponding to the C2-V3-C3 region of the HIV-1 env gene...

  9. Glucose production, oxidation and disposal correlate with plasma lactate levels in HIV-infected patients on HAART

    DEFF Research Database (Denmark)

    Haugaard, S.B.; Andersen, Ove; Madsbad, Sten;

    2007-01-01

    .g. glucose turnover may contribute to hyperlactatemia. METHODS: HIV-infected patients receiving HAART who had lipodystrophy (LIPO, n=18) or were without lipodystrophy (NONLIPO, n=18) were investigated. Insulin sensitivity (M-value), glucose oxidation rate (GOX) and fasting endogenous glucose production (EGP...

  10. Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012.

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    Claudia Palladino

    Full Text Available OBJECTIVES: To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents. DESIGN: Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain. METHODS: Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation. RESULTS: 104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0and viral load was 5.1 (4.6-5.6 log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104 was 64.5 months; second HAART (n = 56 69.8 months; and third HAART (n = 21 66.5 months. Eleven (11% patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively. The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70. CONCLUSIONS: Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.

  11. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.

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    Edward J Mills

    2006-11-01

    Full Text Available BACKGROUND: Adherence to highly active antiretroviral therapy (HAART medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. METHODS AND FINDINGS: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005, Campbell Collaboration (inception to June 2005, CinAhl (inception to June 2005, Cochrane Library (inception to June 2005, Embase (inception to June 2005, ERIC (inception to June 2005, MedLine (inception to June 2005, and NHS EED (inception to June 2005. We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys. Seventy-two studies (35 qualitative were conducted in developed nations, while the remaining 12 (two qualitative were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of

  12. Fifteen years of HAART: comparison of time to failure and percentage of undetectable in two successive cohorts

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    D Dal Piva

    2012-11-01

    Full Text Available Early and current HAART drug combinations' efficacy is comparable but pill burden and tolerability are strikingly different. Demographic, biological and virological aspects of an early and late cohort from the HAART era were evaluated, focusing on time to failure and percentage of undetectable at first year of treatment. Retrospective observational study of two HIV reactive patients cohorts clustered by the year starting their first HAART; cohort 1 from January 1996 to June 2003; cohort 2 from July 2003 to January 2011. Standarized collected data from clinical records were median age of diagnosis, sex, CDC stage category, median CD4+ count at the time of starting treatment, percentage of patients failing their first HAART, time to failure and percentage of undetectable at the first year of treatment. Exclusion criteria: lack of viral load at the first year of initial HAART and loss of patient following. Evaluation of adherence: number of absences to scheduled appointments, number of pills dispensed per patient and accomplishment self-reporting. Taking less than 90% pills in a month was considered as low adherence. Virological rebound was defined as two successive viral loads >50 copies of HIV-1 RNA/ml after one detection of a viral load <50 copies/ml. A percentage analysis was applied to biological and demographic variables, x2 test was implemented when comparing cohorts. From 958 clinical records, 215 were eligible for the study. Cohort 1 enrolled 84 patients; cohort 2, 131. Table 1 compares demographic, biologic and virological variables. Median CD4+ count when starting first HAART showed no significant difference between groups: 254 and 235 cells/ml; group 2, 235 cells/ml. Failure to first treatment: cohort 1, 38 (45%; cohort 2, 17 (13%. Mean time to failure: 118 and 94 weeks in cohort 1 and 2 respectively (p 0.13. Percentage of undetectable at the first year of treatment: cohort 1, 84%; cohort 2, 82% (p 0.34. This comparison shows that drugs

  13. Cross-sectional analysis of late HAART initiation in Latin America and the Caribbean: late testers and late presenters.

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    Brenda Crabtree-Ramírez

    Full Text Available BACKGROUND: Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI in this region. METHODOLOGY: Cross-sectional analysis from 9817 HIV-infected treatment-naïve patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico from October 1999 to July 2010. LHI had CD4(+ count ≤200 cells/mm(3 prior to HAART. Late testers (LT were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters (LP initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed. PRINCIPAL FINDINGS: Among subjects starting HAART (n = 9817 who had baseline CD4(+ available (n = 8515, 76% were LHI: Argentina (56%[95%CI:52-59], Chile (80%[95%CI:77-82], Haiti (76%[95%CI:74-77], Honduras (91%[95%CI:87-94], Mexico (79%[95%CI:75-83], Peru (86%[95%CI:84-88]. The proportion of LHI statistically changed over time (except in Honduras (p≤0.02; Honduras p = 0.7, with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses (CSA. Older patients were more likely LHI in Argentina and Peru (OR 1.21 per +10-year of age, 95%CI:1.02-1.45; OR 1.20, 95%CI:1.02-1.43; respectively, but not in CSA (OR 1.07, 95%CI:0.94-1.21. Higher education was associated with decreased risk for LHI in Chile (OR 0.92 per +1-year of education, 95%CI:0.87-0.98 (similar trends in Mexico, Peru, and CSA. LHI with date of HIV-diagnosis available, 55% were LT and 45% LP. CONCLUSION: LHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation are needed

  14. 281例艾滋病患者采用高效抗反转录病毒疗法后血脂变化与中医证型临床分析%Clinical analysis on lipid metabolism and syndrome of TCM in 281 cases of acquired immune deficiency syndrome treating by HAART

    Institute of Scientific and Technical Information of China (English)

    李强; 郭会军; 蒋自强; 张晓伟; 谢正

    2011-01-01

    Objective: Highly active antiretroviral therapy (HAART) has a significant impact on the natural history of human immunodeficiency virus (HIV) infection, leading to a remarkable decrease in its morbidity and mortality, but is frequently associated with metabolic complications, such as dyslipidemia and cardiovascular complications. The purpose of this study is to explore the possible complications of HAART in treated patients on lipid metabolism and syndrome of TCM (TCM). Methods: A retrospective study was conducted in the outpatients. We selected 281 infected men who were receiving HAART. Fasting total cholesterol, triglyceride, high-density lipopmtein cholesterol (HDL), low-density lipopmtein (LDL), cholesterol values were compared in various treatment prescription. Statistic analysis of the data was carried out on lipid metabolism and syndrome of TCM. Results: Protease inhibitors (Pis) the incidence of dyslipidemia was significantly higher than other drug combinations in their programs the incidence of dyslipidemia. AIDS patients receiving HAART lipid levels in triglycerides (TGs) increased more in various treatment perscription (82%). Syndrome differentiation type was mainly phlegm or phlegm stasis (78%). Conclusion: These data suggested that HAART was associated with dyslipidemia in patients. In addition to AIDS patients on HAART conventional treatment, and related lipid changes also should pay attention to, TCM treatment should mainly invigorate the spleen and eliminate phlegm.%目的:探讨艾滋病患者HAART后血脂变化与中医证型的关系.方法:对281例艾滋病接受HAART患者,采用BECKMAN全自动生化分析仪测定血清总胆固醇(TC)、甘油三酯(TGs)、低密度脂蛋白胆固醇( LDL-C)和高密度脂蛋白胆固醇(HDL-C)指标.同时对检测指标达到血脂异常标准者进行中医辨证分型.结果:使用蛋白酶抑制剂血脂异常发病率明显高于其他药物在各自组合方案中血

  15. Effectiveness and safety of 30 mg versus 40 mg stavudine regimens: a cohort study among HIV-infected adults initiating HAART in South Africa

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    Maskew Mhairi

    2012-03-01

    Full Text Available Abstract Background As stavudine remains an important and widely prescribed drug in resource-limited settings, the effect of a reduced dose of stavudine (from 40 mg to 30 mg on outcomes of highly active antiretroviral therapy (HAART remains an important public health question. Methods We analyzed prospectively collected data from the Themba Lethu Clinic in Johannesburg, South Africa. We assessed the relationship between stavudine dose and six- and/or 12-month outcomes of stavudine substitution, failure to suppress viral load to below 400 copies/ml, development of peripheral neuropathy, lipoatrophy and hyperlactatemia/lactic acidosis. Since individuals with a baseline weight of less than 60 kg were expected to have received the same dose of stavudine throughout the study period, analysis was restricted to individuals who weighed 60 kg or more at baseline. Data were analyzed using logistic regression. Results Between 1 April 2004 and 30 September 2009, 3910 patients were initiated on antiretroviral therapy (ART with a recorded stavudine dose and were included in the analysis. Of these, 2445 (62.5% received a 40 mg stavudine dose while 1565 (37.5% received 30 mg. In multivariate analysis, patients receiving a 40 mg dose were more likely to discontinue stavudine use (adjusted odds ratio, OR 1.71; 95% confidence limits, CI 1.13-2.57 than those receiving 30 mg by 12 months on ART. Additionally, patients receiving 40 mg doses of stavudine were more likely to report peripheral neuropathy (OR 3.12; 95% CI 1.86-5.25, lipoatrophy (OR 11.8; 95% CI 3.2-43.8 and hyperlactatemia/lactic acidosis (OR 8.37; 95% CI 3.83-18.29 in the same time period. Failure to suppress HIV viral load within 12 months of HAART initiation was somewhat more common among those given 40 mg doses (OR 1.62; 95% CI 0.88, 2.97 although this result lacked precision. Sensitivity analyses accounting for death and loss to follow up generally supported these estimates. Conclusions Lower

  16. PPARgamma Pro12Ala polymorphism in HIV-1-infected patients with HAART-related lipodystrophy.

    Science.gov (United States)

    Saumoy, Maria; Veloso, Sergi; Alonso-Villaverde, Carlos; Domingo, Pere; Chacón, Matilde R; Miranda, Merce; Aragonès, Gerard; Gutiérrez, Maria Mar; Viladés, Consuelo; Peraire, Joaquim; Sirvent, Joan-Josep; López-Dupla, Miguel; Aguilar, Carmen; Richart, Cristóbal; Vidal, Francesc

    2009-09-01

    Peroxisome proliferator-activated receptor gamma (PPARgamma) is involved in obesity and in some components of the metabolic syndrome in unselected population. To determine whether PPARgamma genetic variants are associated with the risk of developing lipodystrophy and its associated metabolic disturbances in HIV-1-infected patients treated with HAART and to assess PPARgamma mRNA expression in subcutaneous adipose tissue (SAT). The study group comprised 278 patients infected with HIV-1 and treated with antiretroviral drugs (139 with lipodystrophy and 139 without) and 105 uninfected controls (UC). The PPARgamma Pro12Ala (C%>G) single nucleotide polymorphism (SNP) was assessed using PCR-RFLPs on white cell DNA. PPARgamma mRNA expression in SAT was assessed in 38 patients (25 with lipodystrophy and 13 without) and in 21 UC by real-time PCR. Statistical analysis was based on Student's T tests, Chi(2) tests, Spearman's correlations tests and logistic regression tests. PPARgamma Pro12Ala genotype distribution and allele frequencies were non-significantly different between both HIV-1-infected categories, lipodystrophy vs non-lipodystrophy (p=0.9 and p=0.87, respectively). Lipodystrophic patients harbouring the rare X/Ala genotype (Ala/Ala plus Pro/Ala) had significantly greater plasma total and LDL cholesterol levels compared with carriers of the common Pro/Pro genotype (p=0.029 and p=0.016, respectively) at univariate analyses. At multivariate analyses these associations were no longer significant. There was a near-significant decreased SAT PPARgamma mRNA expression in patients with lipodystrophy compared to UC (p=0.054). PPARgamma Pro12Ala SNP has no effect on the risk of developing lipodystrophy in HIV-1-infected patients treated with HAART. PPARgamma mRNA SAT expression appears decreased in lipodystrophy.

  17. Lopinavir/ritonavir as part of schemes of HAARt in HIV-positive pregnant women and women of reproductive age: the dynamics of clinical and immunological and virological indicators

    Directory of Open Access Journals (Sweden)

    A. B. Konkova-Reidman

    2015-01-01

    Full Text Available The paper presents the results of an open randomized comparative study of the clinical, immunological and virological efficacy of regimens of HAART, including lopinavir/ritonavir (LPV/RTV – “Kaletra”, Abbvie pregnant women (n= 104 women and women of reproductive age (n=50 c HIV infection. The incidence of adverse events requiring change therapeutic scheme with the inclusion of LPV/RTV did not exceed 2% in both study groups and did not differ statistically. Despite the fact that in the comparison group women significantly differed more advanced stage of the disease, more severe immunosuppression and high activity of viral replication, HAART using LPV/RTV in this group after four weeks of its implementation was significantly better than in the group of women who received the same therapy on a background of pregnancy. Pharmacokinetics of antiviral drugs during pregnancy may require dose increase in order to achieve more rapid virological response and reduce the risk of vertical transmission of HIV from mother to child. 

  18. Smart nanoparticles as targeting platforms for HIV infections

    Science.gov (United States)

    Adhikary, Rishi Rajat; More, Prachi; Banerjee, Rinti

    2015-04-01

    While Human Immunodeficiency Virus (HIV) infections are reducing in incidence with the advent of Highly Active Anti-retroviral Therapy (HAART), there remain a number of challenges including the existence of reservoirs, drug resistance and anatomical barriers to antiretroviral therapy. To overcome these, smart nanoparticles with stimuli responsive release are proposed for delivery of anti-retroviral agents. The paper highlights the strategic similarities between the design of smart antiretroviral nanocarriers and those optimized for cancer chemotherapy. This includes the development of nanoparticles capable of passive and active targeting as well as those that are responsive to various internal and external triggers. For antiretroviral therapy, the relevant triggers for stimuli responsive release of drugs include semen, enzymes, endosomal escape, temperature and magnetic field. Deriving from the experience of cancer chemotherapy, additional potential triggers are light and ultrasound which remain hitherto unexplored in HIV therapy. In addition, the roles of nanomicrobicides (nanogels) and virus mimetic nanoparticles are discussed from the point of view of prevention of HIV transmission. The challenges associated with translation of smart nanoparticles for HIV infections to realize the Millennium Development Goal of combating HIV infections are discussed.

  19. The Effect Evaluation of Highly Active Antiretroviral Therapy to Patients with AIDS in Hubei Province of China

    Institute of Scientific and Technical Information of China (English)

    Xuehua LI; Yihua XU; Shaofa NIE; Hao XIANG; Chongjian WANG

    2009-01-01

    The effects of highly active antiretroviral therapy (HAART) to patients with AIDS in Hubei province of China were investigated in order to provide scientific evidence to reinforce the management of HAART. Self-made questionnaires and descriptive method of epidemiology were used to collect and describe the changes of clinical symptoms, HIV RNA concentration, and immune function of patients with AIDS. After HAART, the effective rate of fever, cough, diarrhea, lymphadenectasis, weight loss,tetter, debility and fungous infection was 92.4%, 90.85%, 92.91%, 90.73%, 93.69%, 89.04%, 92.34%,and 83.1%, respectively. Of 117 patients with detected HIV RNA concentration, 41.03% had declined over 0.5 log, and 52.99% less than 0.5 log. CD4+T cell count was obviously increased: the average number after HAART for 3 or 6 months was 237/μL (26-755/μL) and 239/μL (17-833/μL), respectively.HAART can improve AIDS patients' clinical symptoms, reduce HIV RNA concentration, and maintain immune function. It is very important for the effectiveness of HAART to raise clinical adherence of pa-tients with AIDS and have a persistent surveillance.

  20. Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort.

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    Félix Gutierrez

    Full Text Available BACKGROUND: Limited information exists on long-term prognosis of patients with sustained virologic response to antiretroviral therapy. We aimed to assess predictors of unfavorable clinical outcome in patients who maintain viral suppression with HAART. METHODS: Using data collected from ten clinic-based cohorts in Spain, we selected all antiretroviral-naive adults who initiated HAART and maintained plasma HIV-1 RNA levels <500 copies/mL throughout follow-up. Factors associated with disease progression were determined by Cox proportional-hazards models. RESULTS: Of 2,613 patients who started HAART, 757 fulfilled the inclusion criteria. 61% of them initiated a protease inhibitor-based HAART regimen, 29.7% a nonnucleoside reverse-transcriptase inhibitor-based regimen, and 7.8% a triple-nucleoside regimen. During 2,556 person-years of follow-up, 22 (2.9% patients died (mortality rate 0.86 per 100 person-years, and 40 (5.3% died or developed a new AIDS-defining event. The most common causes of death were neoplasias and liver failure. Mortality was independently associated with a CD4-T cell response <50 cells/L after 12 months of HAART (adjusted hazard ratio [AHR], 4.26 [95% confidence interval {CI}, 1.68-10.83]; P = .002, and age at initiation of HAART (AHR, 1.06 per year; 95% CI, 1.02-1.09; P = .001. Initial antiretroviral regimen chosen was not associated with different risk of clinical progression. CONCLUSIONS: Patients with sustained virologic response on HAART have a low mortality rate over time. Long-term outcome of these patients is driven by immunologic response at the end of the first year of therapy and age at the time of HAART initiation, but not by the initial antiretroviral regimen selected.

  1. COMPARISON OF ANTIRETROVIRAL SCHEMES USED IN INITIAL THERAPY FOR TREATMENT OF HIV/AIDS

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    Luana LENZI

    2015-12-01

    Full Text Available A problem of highly active antiretroviral therapy (HAART in HIV patients is their adherence to treatment. The aim of this study was to compare the schemes adopted in the initial therapy of these treatments with their adherence, changes in HAART schemes and treatment costs. The study included patients over 16 years old, HIV positive, in treatment for more than 30 days. Adherence to HAART was calculated based on the withdrawal of the drug, which was related to the total treatment time. We evaluated how many patients changed HAART. The costs of each regimen were also estimated and related to the benefit of each treatment. 142 patients who were between 38 and 1,150 days of treatment were included (57.7% women. The schemes with lower costs, highest adherence and greater benefit were efavirenz with biovir and efavirenz with lamivudine and tenofovir. This study suggested the advantageous therapeutic regimens to start of treatment, both from the point of view of patients and the health system. This information can serve as a subsidy to clinicians in the decision of starting HAART.

  2. 10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒临床分析%Clinical analysis of hyperlactacidemia/lactic acidosis after receiving HAART in 10 HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    黄维; 黄葵; 蓝珂; 邬剑威; 刘宁; 蒙江明

    2012-01-01

    目的 探讨HIV/AIDS患者高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)后继发高乳酸血症或乳酸酸中毒的临床表现和治疗方案.方法 回顾性分析10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒的临床表现、实验室检测结果和治疗效果等资料.结果 10例在继发高乳酸血症或乳酸酸中毒前均服用过含有核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)组合的HAART方案,临床症状以乏力、恶心、腹胀、肌肉酸痛和呼吸困难多见,血乳酸浓度为5.14~10.74mmol/L,其中8例出现高乳酸血症或乳酸酸中毒的相关症状,2例未出现.6例经换药或停药处理后好转,4例死亡.结论 引起高乳酸血症或乳酸酸中毒的主要原因是使用含有NRTIs的组合方案,其中司他夫定最为常见,其次为齐多夫定.治疗时应立刻换药或停药.%Objective To investigate the clinical manifestations and treatment of HIV/AIDS patients who are affected with hy-perlactacidemia/lactic acidosis after receiving highly active antiretroviral therapy (HAART). Methods The clinical manifestations, laboratory findings and treatment efficacy were retrospectively analyzed in 10 HIV/AIDS patients who were affected with hyperlacta-cidemia/lactic acidosis after receiving HAART. Results All the 10 HIV/AIDS patients had received HAART regimens including nu-cleoside reverse transcriptase inhibitors (NRTIs) before being affected with hyperlactacidemia/lactic acidosis. The common clinical symptoms were fatigue, nausea, abdominal distension, muscle aches and difficulty of breathing. The blood lactic acid level of the 10 patients was 5.14-10.74 mmol/L, symptoms related to hyperlactacidemia/lactic acidosis occurring in 8 patients. Six patients were improved on cessation or switching to another medication, and 4 died. Conclusions The major cause that leads to hyperlactacidemia/ lactic acidosis is receiving HAART including

  3. Pregnancy and virologic response to antiretroviral therapy in South Africa.

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    Daniel Westreich

    Full Text Available BACKGROUND: Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART. METHODS AND FINDINGS: We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 2004 and 30 September 2009, and followed up until an event, death, transfer, drop-out, or administrative end of follow-up on 31 March 2010. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study; final sample size for analysis was 5,494 women. Main exposure was incident pregnancy, experienced by 541 women; main outcome was virologic failure, defined as a failure to suppress virus to ≤ 400 copies/ml by six months or virologic rebound >400 copies/ml thereafter. We calculated adjusted hazard ratios using marginal structural Cox proportional hazards models and weighted lifetable analysis to calculate adjusted five-year risk differences. The weighted hazard ratio for the effect of pregnancy on time to virologic failure was 1.34 (95% confidence limit [CL] 1.02, 1.78. Sensitivity analyses generally confirmed these main results. CONCLUSIONS: Incident pregnancy after HAART initiation was associated with modest increases in both relative and absolute risks of virologic failure, although uncontrolled confounding cannot be ruled out. Nonetheless, these results reinforce that family planning is an essential part of care for HIV-positive women in sub-Saharan Africa. More work is needed to confirm these findings and to explore specific etiologic pathways by which such effects may operate.

  4. Effect of a short-term HAART on SIV load in macaque tissues is dependent on time of initiation and antiviral diffusion.

    OpenAIRE

    Durand-Gasselin Lucie; Roucairol Camille; Sellier Pierre; Mannioui Abdelkrim; Bourry Olivier; Dereuddre-Bosquet Nathalie; Benech Henri; Roques Pierre; Le Grand Roger

    2010-01-01

    Abstract Background HIV reservoirs are rapidly established after infection, and the effect of HAART initiated very early during acute infection on HIV reservoirs remains poorly documented, particularly in tissue known to actively replicate the virus. In this context, we used the model of experimental infection of macaques with pathogenic SIV to assess in different tissues: (i) the effect of a short term HAART initiated at different stages during acute infection on viral dissemination and repl...

  5. The Challenge of a "Functional Cure" for AIDS by Gene Modified HSCT Therapy.

    Science.gov (United States)

    Xu, Lei; Chen, Hu; Zhang, Bin

    2015-01-01

    Acquired immunodeficiency syndrome (AIDS), an infectious disease which is difficult to be cured, is regularly and effectively treated with anti-retroviral therapy in clinic. When considering about the defects of antiretroviral therapy (ART), patients need a new way to cure AIDS. With the development of genetic engineering technology and humanized mouse models, a new way has been found to achieve a "functional cure" for AIDS. One/some specific gene(s), such as CCR5 and CXCR4, can be knocked out to produce HIV-resisting cells, so as to achieve the purpose of curing AIDS. To find a safe and effective therapy for AIDS, treatment strategy and technical scheme should be improved and optimized in many aspects. Moreover, different stages of works have been done in laboratory and in clinic based on this gene mutation strategy. However, a great deal of challenge has emerged while great progress has been made. Safety considerations and effectiveness of gene modified stem cell in clinic are major obstacles of the application of this strategy. PMID:25986619

  6. Lipid peroxidation and total cholesterol in HAART-naive patients infected with circulating recombinant forms of human immunodeficiency virus type-1 in Cameroon.

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    Georges Teto

    Full Text Available BACKGROUND: HIV infection has commonly been found to affect lipid profile and antioxidant defense. OBJECTIVES: To determine the effects of Human Immunodeficiency Virus (HIV infection and viral subtype on patient's cholesterol and oxidative stress markers, and determine whether in the absence of Highly Active Antiretroviral Therapy (HAART, these biochemical parameters could be useful in patient's management and monitoring disease progression in Cameroon. For this purpose, we measured total cholesterol (TC, LDL cholesterol (LDLC, HDL cholesterol (HDLC, total antioxidant ability (TAA, lipid peroxidation indices (LPI, and malondialdehyde (MDA in HIV negative persons and HIV positive HAART-naïve patients infected with HIV-1 group M subtypes. METHODS: We measured serum TC, LDLC, HDLC, plasma MDA, and TAA concentrations, and calculated LPI indices in 151 HIV-positive HAART-naïve patients and 134 seronegative controls. We also performed gene sequence analysis on samples from 30 patients to determine the effect of viral genotypes on these biochemical parameters. We also determined the correlation between CD4 cell count and the above biochemical parameters. RESULTS: We obtained the following controls/patients values for TC (1.96±0.54/1. 12±0. 48 g/l, LDLC (0. 67±0. 46/0. 43±0. 36 g/l, HDLC (105. 51±28. 10/46. 54±23. 36 mg/dl TAA (0. 63±0. 17/0. 16±0. 16 mM, MDA (0. 20±0. 07/0. 41±0. 10 µM and LPI (0. 34±0. 14/26. 02±74. 40. In each case, the difference between the controls and patients was statistically significant (p<0.05. There was a positive and statistically significant Pearson correlation between CD4 cell count and HDLC (r = +0.272; p<0.01, TAA (r = +0.199; p<0.05 and a negative and statistically significant Pearson correlation between CD4 cell count and LPI (r = -0.166; p<0.05. Pearson correlation between CD4 cell count and TC, CD4cell count and LDLC was positive but not statistically significant while it was negative but

  7. Sclerosing cholangitis by cytomegalovirus in highly active antiretroviral therapy era

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    Carmen Hidalgo-Tenorio

    2013-10-01

    Full Text Available Sclerosing colangitis (SC due to cytomegalovirus (CMV is very rare. It has been described mainly in immunocompromised patients. Currently, in HIV infected patients it is exceptional. The most of cases belong to pre-highly active antiretroviral therapy (pre-HAART and those cases were in stage AIDS with less than 100 CD4/μl. The most frequently involved pathogen in pre-HAART period was Cryptosporidium parvum (30-57% and CMV (10-30%; in late HAART period this information are unaware. CMV has been implicated as a possible etiological agent in primary SC partly because of the ability to cause liver damage and its relationship with smooth muscle antibodies. The most effective treatment for SC was the combination of antiretroviral therapy and endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement. Following, we present the first case of late HAART period which describes a SC extrahepatic without papillary stenosis with CMV as the only cause and clinical presentation of HIV infection in a woman with 177 CD4/μl.

  8. HIV-Antiretroviral Therapy Induced Liver, Gastrointestinal, and Pancreatic Injury

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    Manuela G. Neuman

    2012-01-01

    Full Text Available The present paper describes possible connections between antiretroviral therapies (ARTs used to treat human immunodeficiency virus (HIV infection and adverse drug reactions (ADRs encountered predominantly in the liver, including hypersensitivity syndrome reactions, as well as throughout the gastrointestinal system, including the pancreas. Highly active antiretroviral therapy (HAART has a positive influence on the quality of life and longevity in HIV patients, substantially reducing morbidity and mortality in this population. However, HAART produces a spectrum of ADRs. Alcohol consumption can interact with HAART as well as other pharmaceutical agents used for the prevention of opportunistic infections such as pneumonia and tuberculosis. Other coinfections that occur in HIV, such as hepatitis viruses B or C, cytomegalovirus, or herpes simplex virus, further complicate the etiology of HAART-induced ADRs. The aspect of liver pathology including liver structure and function has received little attention and deserves further evaluation. The materials used provide a data-supported approach. They are based on systematic review and analysis of recently published world literature (MedLine search and the experience of the authors in the specified topic. We conclude that therapeutic and drug monitoring of ART, using laboratory identification of phenotypic susceptibilities, drug interactions with other medications, drug interactions with herbal medicines, and alcohol intake might enable a safer use of this medication.

  9. T-CELL RESPONSE OF ADVANCED AIDS PATIENTS AFTER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

    Institute of Scientific and Technical Information of China (English)

    Ai-xia Wang; Tai-sheng Li; Yun-zhen Cao; Yang Han; Zhi-feng Qiu; Jing Xie

    2005-01-01

    Objective To investigate the response on late stage Chinese AIDS patients after highly active antiretroviral therapy (HAART).Methods From October 2002 to March 2004, 20 cases of late stage Chinese AIDS patients were selected to participate in this opened and randomised study, we purposely chose those with CD4+ T cell counts < 100/mm3. All of them had one or two opportunistic infections and none had been treated with anti-HIV drugs. All patients were tested with CD4+(naive CD4+ T cell defined by CD45RA+ and CD62L+, memory CD4+ T cell defined by CD45RA-), CD8+ T cell,plasma HIV viral load, and clinical manifestations on before, during, and after HAART (5 different regimes) on 1, 3, 6, 9,and 12 months.Results Before HAART mean CD4+ T cell counts were 32 ± 31 (range 2-91)/mm3, and plasma HIV viral load were 5.07±0.85(range 2.04-5.70) log copies/mL. In 1 month's time patients treated with HAART had mean CD4+ and CD8T cell counts increasing rapidly. After 1 month the increasing speed turned to slow down, but HIV viral load decreased predominantly within the first 3 months. The major part of increasing CD4+ T cells were memory CD4+ T cells, as for naive CD4+ T cells increasing low and slow. Clinical symptoms and signs improved, and opportunistic infections reduced. The quality of life will be far much better than before. Each patient was followed for 12 months, and had finished 12 months' HAART.Conclusion This is the first report in China that late stage Chinese AIDS patients after HAART could have their immune reconstitution. The regular pattern is similar to what had been reported in Western countries and also in China. So it is worth to treat late stage Chinese AIDS patients with HAART.

  10. Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia

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    Felix F. Widjaja

    2011-02-01

    Full Text Available Background: Highly active antiretroviral therapy (HAART can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia.Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale  (HIVASES, Beck Depression Inventory (BDI-II and Interpersonal Support Evaluation List (ISEL was adapted to assess self-efficacy, depression level and social support, respectively.Results: We found that 96% (n=53 of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply  forget’.Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia. (Med J Indones 2011; 20:50-5Keywords: adherence, depression, HAART, HIV, self-efficacy, social support

  11. Rates and reasons for early change of first HAART in HIV-1-infected patients in 7 sites throughout the Caribbean and Latin America.

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    Carina Cesar

    Full Text Available BACKGROUND: HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%-70% of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. METHODOLOGY: Antiretroviral-naïve patients >or= 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. PRINCIPAL FINDINGS: Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31-44, and median CD4 count was 105 cells/uL (IQR, 38-200. Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI 15-17% and 28% (95% CI 27-29%, respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR = 1.7 (95% CI 1.1-2.6 and 2.1 (95% CI 1.7-2.5 comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1-1.5 for clinical AIDS at HAART initiation. The primary reason for change among HAART initiators were adverse events (14%, death (5.7% and failure (1.3% with specific toxicities varying among sites. After change, most patients remained in first line regimens. CONCLUSIONS: Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed and require

  12. Relationship of long-term highly active antiretroviral therapy on salivary flow rate and CD4 Count among HIV-infected patients

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    J Vijay Kumar

    2015-01-01

    Full Text Available Objectives: To determine if long-term highly active antiretroviral therapy (HAART therapy alters salivary flow rate and also to compare its relation of CD4 count with unstimulated and stimulated whole saliva. Materials and Methods: A cross-sectional study was performed on 150 individuals divided into three groups. Group I (50 human immunodeficiency virus (HIV seropositive patients, but not on HAART therapy, Group II (50 HIV-infected subjects and on HAART for less than 3 years called short-term HAART, Group III (50 HIV-infected subjects and on HAART for more than or equal to 3 years called long-term HAART. Spitting method proposed by Navazesh and Kumar was used for the measurement of unstimulated and stimulated salivary flow rate. Chi-square test and analysis of variance (ANOVA were used for statistical analysis. Results: The mean CD4 count was 424.78 ΁ 187.03, 497.82 ΁ 206.11 and 537.6 ΁ 264.00 in the respective groups. Majority of the patients in all the groups had a CD4 count between 401 and 600. Both unstimulated and stimulated whole salivary (UWS and SWS flow rates in Group I was found to be significantly higher than in Group II (P < 0.05. Unstimulated salivary flow rate between Group II and III subjects were also found to be statistically significant (P < 0.05. ANOVA performed between CD4 count and unstimulated and stimulated whole saliva in each group demonstrated a statistically significant relationship in Group II (P < 0.05. There were no significant results found between CD4 count and stimulated whole saliva in each groups. Conclusion:The reduction in CD4 cell counts were significantly associated with salivary flow rates of HIV-infected individuals who are on long-term HAART.

  13. Affective disorders in patients with HIV infection: impact of antiretroviral therapy.

    Science.gov (United States)

    Arendt, Gabriele

    2006-01-01

    At the beginning of the AIDS pandemic, affective disorders (such as depressed mood) were seen in a considerable number of HIV-1-infected individuals. These disorders were a result of the poor physical condition of the patients, brain involvement by the virus (e.g. encephalopathy) or a reaction to disadvantageous living conditions (losing friends, jobs, etc.). In the era of highly active antiretroviral therapy (HAART), mental illness related to physical weakness is declining, as is the incidence of HIV-1-associated encephalopathy. However, depressed mood and fatigue caused by efavirenz (a standard component of HAART) is becoming increasingly important, particularly in individuals who are infected long-term with HIV-1. Whatever the cause of affective disorders, their presence has been shown to negatively influence adherence to HAART and HIV-1 disease progression. Specialist knowledge of HIV-1 infection, and HAART and its psychiatric complications (particularly in subgroups of patients such as drug abusers and older people), is needed to care adequately for patients. Furthermore, prospective studies are needed to more fully differentiate between the various aetiologies of affective disorders seen in individuals living with HIV/AIDS and to determine their incidence and prevalence. Such information is important to ensure that affective disorders are recognised and adequately treated, which will in turn improve the efficacy of HAART. PMID:16734500

  14. The prevalence of metabolic syndrome in Danish patients with HIV infection: the effect of antiretroviral therapy

    DEFF Research Database (Denmark)

    Hansen, Birgitte Rønde; Petersen, J; Haugaard, S B;

    2009-01-01

    OBJECTIVES: The prevalence of metabolic syndrome (MS) in HIV-infected patients on highly active antiretroviral therapy (HAART) is a subject of debate. We investigated the prevalence of MS in a cohort of Danish HIV-infected patients and estimated the effect of the various classes of antiretroviral...

  15. A case of atypical progressive outer retinal necrosis after highly active antiretroviral therapy.

    Science.gov (United States)

    Woo, Se Joon; Yu, Hyeong Gon; Chung, Hum

    2004-06-01

    This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

  16. A case of atypical progressive outer retinal necrosis after highly active antiretroviral therapy.

    Science.gov (United States)

    Woo, Se Joon; Yu, Hyeong Gon; Chung, Hum

    2004-06-01

    This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients. PMID:15255240

  17. Women experience a better long-term immune recovery and a better survival on HAART in Lao People’s Democratic Republic

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    Bastard Mathieu

    2013-01-01

    Full Text Available Abstract Background In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART. Methods We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4 Results A total of 1365 patients entered the programme and 913 (66.9% received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0% at 4 months and 9.1% (95% CI 7.3-11.3% at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44 and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47 were independently associated with a lower death rate. Conclusions Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.

  18. Immune control of HIV-1 infection after therapy interruption: immediate versus deferred antiretroviral therapy

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    Bernaschi Massimo

    2009-10-01

    Full Text Available Abstract Background The optimal stage for initiating antiretroviral therapies in HIV-1 bearing patients is still a matter of debate. Methods We present computer simulations of HIV-1 infection aimed at identifying the pro et contra of immediate as compared to deferred Highly Active Antiretroviral Therapy (HAART. Results Our simulations highlight that a prompt specific CD8+ cytotoxic T lymphocytes response is detected when therapy is delayed. Compared to very early initiation of HAART, in deferred treated patients CD8+ T cells manage to mediate the decline of viremia in a shorter time and, at interruption of therapy, the virus experiences a stronger immune pressure. We also observe, however, that the immunological effects of the therapy fade with time in both therapeutic regimens. Thus, within one year from discontinuation, viral burden recovers to the value at which it would level off in the absence of therapy. In summary, simulations show that immediate therapy does not prolong the disease-free period and does not confer a survival benefit when compared to treatment started during the chronic infection phase. Conclusion Our conclusion is that, since there is no therapy to date that guarantees life-long protection, deferral of therapy should be preferred in order to minimize the risk of adverse effects, the occurrence of drug resistances and the costs of treatment.

  19. Metabolic Disturbances in Liver {sup 1}H MR Spectroscopy in HIV and HCV Co-infected Patients as a Potential Marker of Hepatocyte Activation

    Energy Technology Data Exchange (ETDEWEB)

    Tarasow, E.; Wierciska-Drapao, A.; Jaroszewicz, J.; Siergiejczyk, L.; Orzechowska-Bobkiewicz, A.; Prokopowicz, D.; Walecki, J. [Medical Academy Hospital, Bialystok (Poland). Dept. of Radiology

    2004-12-01

    Purpose : To evaluate proton magnetic resonance spectroscopy ({sup 1}H MRS) features in order to assess hepatocellular activation in chronic hepatitis C and human immunodeficiency virus/hepatitis C (HIV/HCV) co-infected patients. Material and Methods : Liver in vivo {sup 1}H MR spectra were obtained in 14 patients with hepatitis C virus infection (HCV), 20 HIV/HCV co-infected individuals, and 24 healthy volunteers. Resonances of lipids, glutamine/glutamate (Glx), phosphomonoesters (PME), glycogen/glucose (Glc) were assessed and metabolite ratios to total lipids (TL) were calculated. Results : A significant increase in Glx/TL and PME/TL was observed in the HCV group as compared to healthy individuals. Patients with HIV and HCV co-infection had a further increase of all metabolite ratios. Changes in metabolite ratios were due to both the increase in particular metabolite contents and to the decrease in lipid levels. HIV/HCV-infected patients treated with highly active anti-retroviral therapy (HAART) showed elevated PME and Glx levels and significantly decreased TL compared to patients not undergoing anti-retroviral treatment. Conclusions : Our findings suggest clinical usefulness of liver {sup 1}H MR spectroscopy in detecting even slight disturbances in liver metabolism.

  20. Stealth anti-CD4 conjugated immunoliposomes with dual antiretroviral drugs--modern Trojan horses to combat HIV.

    Science.gov (United States)

    Ramana, Lakshmi Narashimhan; Sharma, Shilpee; Sethuraman, Swaminathan; Ranga, Udaykumar; Krishnan, Uma Maheswari

    2015-01-01

    Highly active antiretroviral therapy (HAART) is the currently employed therapeutic intervention against AIDS where a drug combination is used to reduce the viral load. The present work envisages the development of a stealth anti-CD4 conjugated immunoliposomes containing two anti-retroviral drugs (nevirapine and saquinavir) that can selectively home into HIV infected cells through the CD4 receptor. The nanocarrier was characterized using transmission electron microscopy, FTIR, differential scanning calorimetry, particle size and zeta potential. The cell uptake was also evaluated qualitatively using confocal microscopy and quantitatively by flow cytometry. The drug to lipid composition was optimized for maximum encapsulation of the two drugs. Both drugs were found to localize in different regions of the liposome. The release of the reverse transcriptase inhibitor was dominant during the early phases of the release while in the later phases, the protease inhibitor is the major constituent released. The drugs delivered via anti-CD4 conjugated immunoliposomes inhibited viral proliferation at a significantly lower concentration as compared to free drugs. In vitro studies of nevirapine to saquinavir combination at a ratio of 6.2:5 and a concentration as low as 5 ng/mL efficiently blocked viral proliferation suggesting that co-delivery of anti-retroviral drugs holds a greater promise for efficient management of HIV-1 infection. PMID:25500283

  1. Kidney disease in children and adolescents with perinatal HIV-1 infection

    Directory of Open Access Journals (Sweden)

    Rajendra Bhimma

    2013-06-01

    Full Text Available Introduction: Involvement of the kidney in children and adolescents with perinatal (HIV-1 infection can occur at any stage during the child's life with diverse diagnoses, ranging from acute kidney injury, childhood urinary tract infections (UTIs, electrolyte imbalances and drug-induced nephrotoxicity, to diseases of the glomerulus. The latter include various immune-mediated chronic kidney diseases (CKD and HIV-associated nephropathy (HIVAN. Discussion: The introduction of highly active anti-retroviral therapy (HAART has dramatically reduced the incidence of HIVAN, once the commonest form of CKD in children of African descent living with HIV, and also altered its prognosis from eventual progression to end-stage kidney disease to one that is compatible with long-term survival. The impact of HAART on the outcome of other forms of kidney diseases seen in this population has not been as impressive. Increasingly important is nephrotoxicity secondary to the prolonged use of anti-retroviral agents, and the occurrence of co-morbid kidney disease unrelated to HIV infection or its treatment. Improved understanding of the molecular pathogenesis and genetics of kidney diseases associated with HIV will result in better screening, prevention and treatment efforts, as HIV specialists and nephrologists coordinate clinical care of these patients. Both haemodialysis (HD and peritoneal dialysis (PD are effective as renal replacement therapy in HIV-infected patients with end-stage kidney disease, with PD being preferred in resource-limited settings. Kidney transplantation, once contraindicated in this population, has now become the most effective renal replacement therapy, provided rigorous criteria are met. Given the attendant morbidity and mortality in HIV-infected children and adolescents with kidney disease, routine screening for kidney disease is recommended where resources permit. Conclusions: This review focuses on the pathogenesis and genetics, clinical

  2. Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Sinha Sanjeev

    2012-07-01

    Full Text Available Abstract Background For antiretroviral therapy (ART naive human immunodeficiency virus (HIV infected adults suffering from tuberculosis (TB, there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART after starting antituberculosis treatment (ATT, in order to minimize mortality, HIV disease progression, and adverse events. Methods In a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART. Findings A total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART and 62 after 8-12 weeks (delayed ART of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045. Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05. Rates of adverse events were similar. Interpretation Early initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability. Trial registration CTRI/2011/12/002260

  3. Non-polymeric nano-carriers in HIV/AIDS drug delivery and targeting.

    Science.gov (United States)

    Gupta, Umesh; Jain, Narendra K

    2010-03-18

    Development of an effective drug delivery approach for the treatment of HIV/AIDS is a global challenge. The conventional drug delivery approaches including Highly Active Anti Retroviral Therapy (HAART) have increased the life span of the HIV/AIDS patient. However, the eradication of HIV is still not possible with these approaches due to some limitations. Emergence of polymeric and non-polymeric nanotechnological approaches can be opportunistic in this direction. Polymeric carriers like, dendrimers and nanoparticles have been reported for the targeting of anti HIV drugs. The synthetic pathways as well polymeric framework create some hurdles in their successful formulation development as well as in the possible drug delivery approaches. In the present article, we have discussed the general physiological aspects of the infection along with the relevance of non-polymeric nanocarriers like liposomes, solid lipid nanoparticles (SLN), ethosomes, etc. in the treatment of this disastrous disease. PMID:19913579

  4. Investigating signs of recent evolution in the pool of proviral HIV type 1 DNA during years of successful HAART

    DEFF Research Database (Denmark)

    Mens, Helene; Pedersen, Anders G; Jørgensen, Louise B;

    2007-01-01

    In order to shed light on the nature of the persistent reservoir of human immunodeficiency virus type 1 (HIV-1), we investigated signs of recent evolution in the pool of proviral DNA in patients on successful HAART. Pro-viral DNA, corresponding to the C2-V3-C3 region of the HIV-1 env gene...... HIV genomes in some patients. Interestingly, stop-codons were present at the same two positions in several independent clones and across patients. Simulation studies indicated that this phenomenon could be explained as the result of parallel evolution and that some sites were inherently more likely...

  5. The naive CD4+ count in HIV-1-infected patients at time of initiation of highly active antiretroviral therapy is strongly associated with the level of immunological recovery

    DEFF Research Database (Denmark)

    Michael, OG; Kirk, O; Mathiesen, Lars Reinhardt;

    2002-01-01

    Current antiretroviral therapy can induce considerable, sustained viral suppression followed by immunological recovery, in which naive CD4 + cells are important. Long-term immunological recovery was investigated during the first 3 y of highly active antiretroviral therapy (HAART) in 210 HIV-1...... immunological recovery that can be obtained from treatment. Surprisingly, the naive CD4 + cell count tended to stabilize at a subnormal level after 18 months of HAART. This finding merits further investigation.......-infected patients. The focus was on the naive CD4 + cell time course and associations between naive CD4 + cell counts and established prognostic markers. Total and naive CD4 + cell counts were measured using flow cytometry. The HIV-RNA detection limit was 20 copies/ml. During 36 months of HAART, the total...

  6. Drug-Drug Interactions Based on Pharmacogenetic Profile between Highly Active Antiretroviral Therapy and Antiblastic Chemotherapy in Cancer Patients with HIV Infection.

    Science.gov (United States)

    Berretta, Massimiliano; Caraglia, Michele; Martellotta, Ferdinando; Zappavigna, Silvia; Lombardi, Angela; Fierro, Carla; Atripaldi, Luigi; Muto, Tommaso; Valente, Daniela; De Paoli, Paolo; Tirelli, Umberto; Di Francia, Raffaele

    2016-01-01

    The introduction of Highly Active Antiretroviral Therapy (HAART) into clinical practice has dramatically changed the natural approach of HIV-related cancers. Several studies have shown that intensive antiblastic chemotherapy (AC) is feasible in HIV-infected patients with cancer, and that the outcome is similar to that of HIV-negative patients receiving the same AC regimens. However, the concomitant use of HAART and AC can result in drug accumulation or possible toxicity with consequent decreased efficacy of one or both classes of drugs. In fact, many AC agents are preferentially metabolized by CYP450 and drug-drug interactions (DDIs) with HAART are common. Therefore, it is important that HIV patients with cancer in HAART receiving AC treatment at the same time receive an individualized cancer management plan based on their liver and renal functions, their level of bone marrow suppression, their mitochondrial dysfunction, and their genotype profile. The rationale of this review is to summarize the existing data on the impact of HAART on the clinical management of cancer patients with HIV/AIDS and DDIs between antiretrovirals and AC. In addition, in order to maximize the efficacy of antiblastic therapy and minimize the risk of drug-drug interaction, a useful list of pharmacogenomic markers is provided.

  7. Drug–Drug Interactions Based on Pharmacogenetic Profile between Highly Active Antiretroviral Therapy and Antiblastic Chemotherapy in Cancer Patients with HIV Infection

    Science.gov (United States)

    Berretta, Massimiliano; Caraglia, Michele; Martellotta, Ferdinando; Zappavigna, Silvia; Lombardi, Angela; Fierro, Carla; Atripaldi, Luigi; Muto, Tommaso; Valente, Daniela; De Paoli, Paolo; Tirelli, Umberto; Di Francia, Raffaele

    2016-01-01

    The introduction of Highly Active Antiretroviral Therapy (HAART) into clinical practice has dramatically changed the natural approach of HIV-related cancers. Several studies have shown that intensive antiblastic chemotherapy (AC) is feasible in HIV-infected patients with cancer, and that the outcome is similar to that of HIV-negative patients receiving the same AC regimens. However, the concomitant use of HAART and AC can result in drug accumulation or possible toxicity with consequent decreased efficacy of one or both classes of drugs. In fact, many AC agents are preferentially metabolized by CYP450 and drug–drug interactions (DDIs) with HAART are common. Therefore, it is important that HIV patients with cancer in HAART receiving AC treatment at the same time receive an individualized cancer management plan based on their liver and renal functions, their level of bone marrow suppression, their mitochondrial dysfunction, and their genotype profile. The rationale of this review is to summarize the existing data on the impact of HAART on the clinical management of cancer patients with HIV/AIDS and DDIs between antiretrovirals and AC. In addition, in order to maximize the efficacy of antiblastic therapy and minimize the risk of drug–drug interaction, a useful list of pharmacogenomic markers is provided. PMID:27065862

  8. Long-term kinetics of T cell production in HIV-infected subjects treated with highly active antiretroviral therapy

    Science.gov (United States)

    Fleury, S.; Rizzardi, G. P.; Chapuis, A.; Tambussi, G.; Knabenhans, C.; Simeoni, E.; Meuwly, J.-Y.; Corpataux, J.-M.; Lazzarin, A.; Miedema, F.; Pantaleo, G.

    2000-01-01

    The long-term kinetics of T cell production following highly active antiretroviral therapy (HAART) were investigated in blood and lymph node in a group of HIV-infected subjects at early stage of established infection and prospectively studied for 72 wk. Before HAART, CD4 and CD8 T cell turnover was increased. However, the total number of proliferating CD4+ T lymphocytes, i.e., CD4+Ki67+ T lymphocytes, was not significantly different in HIV-infected (n = 73) and HIV-negative (n = 15) subjects, whereas proliferating CD8+Ki67+ T lymphocytes were significantly higher in HIV-infected subjects. After HAART, the total body number of proliferating CD4+Ki67+ T lymphocytes increased over time and was associated with an increase of both naive and memory CD4+ T cells. The maximal increase (2-fold) was observed at week 36, whereas at week 72 the number of proliferating CD4+ T cells dropped to baseline levels, i.e., before HAART. The kinetics of the fraction of proliferating CD4 and CD8 T cells were significantly correlated with the changes in the total body number of these T cell subsets. These results demonstrate a direct relationship between ex vivo measures of T cell production and quantitative changes in total body T lymphocyte populations. This study provides advances in the delineation of the kinetics of T cell production in HIV infection in the presence and/or in the absence of HAART. PMID:10805798

  9. The impact of antiretroviral therapy on HPV and cervical intraepithelial neoplasia: current evidence and directions for future research

    Directory of Open Access Journals (Sweden)

    Sahasrabuddhe Vikrant V

    2010-05-01

    Full Text Available Abstract Increasing numbers of human immunodeficiency virus (HIV-infected women are now accessing life-prolonging highly active antiretroviral therapy (HAART in developing countries. There is a need for better understanding of interactions of human papillomavirus (HPV and HIV, especially in the context of increasing life expectancy due to HAART. The data regarding the impact of HAART on reducing the incidence and progression and facilitating the regression of HPV infection and cervical abnormalities is largely inconsistent. Published studies differ in their study designs (prospective or retrospective cohorts or record linkage studies, screening and diagnostic protocols, duration and type of HAART use, recruitment and referral strategies, and definitions of screening test and disease positivity. Due to the ethical and resource limitations in conducting randomized trials of the impact of HAART on incidence of HPV, CIN, and cervical cancer among HIV-infected women, it is important to consider innovative study designs, including quasi-experimental trials and operations research in sentinel populations to answer the critical research questions in this area.

  10. Genome-Wide Association Study Identifies Single Nucleotide Polymorphism in DYRK1A Associated with Replication of HIV-1 in Monocyte-Derived Macrophages

    NARCIS (Netherlands)

    S.M. Bol; P.D. Moerland; S. Limou; Y. van Remmerden; C. Coulonges; D. Manen; J.T. Herbeck; J. Fellay; M. Sieberer; J.G. Sietzema; R. van 't Slot; J. Martinson; J.F. Zagury; H. Schuitemaker; A.B. van 't Wout

    2011-01-01

    Background: HIV-1 infected macrophages play an important role in rendering resting T cells permissive for infection, in spreading HIV-1 to T cells, and in the pathogenesis of AIDS dementia. During highly active anti-retroviral treatment (HAART), macrophages keep producing virus because tissue penetr

  11. Non-Hodgkin lymphoma in HIV-infected patients in the era of highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Kirk, O; Pedersen, C; Cozzi-Lepri, A;

    2001-01-01

    This study was designed to assess the influence of highly active antiretroviral therapy (HAART) on non-Hodgkin lymphoma (NHL) among patients infected with human immunodeficiency virus (HIV). Within EuroSIDA, a multicenter observational cohort of more than 8500 patients from across Europe, the inc...

  12. Association between diarrhea and quality of life in HIV-infected patients receiving highly active antiretroviral therapy

    NARCIS (Netherlands)

    Tramarin, A; Parise, N; Campostrini, S; Yin, DD; Postma, MJ; Lyu, R; Grisetti, R; Capetti, A; Cattelan, AM; Di Toro, MT; Mastroianni, A; Pignattari, E; Mondardini, [No Value; Calleri, G; Raise, E; Starace, F

    2004-01-01

    Diarrhea is a common symptom that many HIV patients experience either as a consequence of HIV infection or of highly active antiretroviral therapy (HAART). A multicenter, prospective observational study was conducted in 11 AIDS clinics in Italy to determine the effect of diarrhea on health-related q

  13. Depleted skeletal muscle mitochondrial DNA, hyperlactatemia, and decreased oxidative capacity in HIV-infected patients on highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Pedersen, Steen B;

    2005-01-01

    hyperlactatemia is associated with depletion of skeletal muscle (sm)-mtDNA and decreased oxidative capacity in HIV-infected patients on NRTI based highly active antiretroviral therapy (HAART) and whether HIV infection itself is associated with sm-mtDNA depletion. Sm-mtDNA was determined in 42 HIV...... in part could be mediated through an enhanced pro-inflammatory response....

  14. A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men

    DEFF Research Database (Denmark)

    May, Margaret; Sterne, Jonathan A C; Shipley, Martin;

    2007-01-01

    Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors...

  15. T-cell mean telomere lengths changes in treatment naïve HIV-infected patients randomized to G-CSF or placebo simultaneously with initiation of HAART

    DEFF Research Database (Denmark)

    Aladdin, H; Von Essen, M; Schjerling, P;

    2001-01-01

    of the mean CD8+ T-cell TRF length. However, G-CSF given simultaneously with HAART induces an inhibition of the expected lengthening in mean TRF length. These results do therefore not support the use of adjuvant G-CSF treatment simultaneously when initiating HAART and should further be evaluated before use...

  16. Toll-like receptor 7 controls the anti-retroviral germinal center response.

    Directory of Open Access Journals (Sweden)

    Edward P Browne

    2011-10-01

    Full Text Available The development of vaccines that can enhance immunity to viral pathogens is an important goal. However, the innate molecular pathways that regulate the strength and quality of the immune response remain largely uncharacterized. To define the role of Toll-like receptor (TLR signaling in control of a model retroviral pathogen, Friend virus (FV, I generated mice in which the TLR signaling adapter Myd88 was selectively deleted in dendritic cell (DC or in B cell lineages. Deletion of Myd88 in DCs had little effect on immune control of FV, while B cell specific deletion of Myd88 caused a dramatic increase in viral infectious centers and a significantly reduced antibody response, indicating that B cell-intrinsic TLR signaling plays a crucial role, while TLR signaling in DCs is less important. I then identified the single-stranded RNA sensing protein TLR7 as being required for antibody-mediated control of FV by analyzing mice deficient in TLR7. Remarkably, B cells in infected TLR7-deficient mice upregulated CD69 and CD86 early in infection, but failed to develop into germinal center B cells. CD4 T cell responses were also attenuated in the absence of TLR7, but CD8 responses were TLR7 independent, suggesting the existence of additional pathways for detection of retroviral particles. Together these results demonstrate that the vertebrate immune system detects retroviruses in vivo via TLR7 and that this pathway regulates a key checkpoint controlling development of germinal center B cells.

  17. Neurocognitive Change in the Era of HIV Combination Antiretroviral Therapy: The Longitudinal CHARTER Study

    Science.gov (United States)

    Heaton, Robert K.; Franklin, Donald R.; Deutsch, Reena; Letendre, Scott; Ellis, Ronald J.; Casaletto, Kaitlin; Marquine, Maria J.; Woods, Steven P.; Vaida, Florin; Atkinson, J. Hampton; Marcotte, Thomas D.; McCutchan, J. Allen; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin B.; Sacktor, Ned; Morgello, Susan; Simpson, David M.; Abramson, Ian; Gamst, Anthony C.; Fennema-Notestine, Christine; Smith, David M.; Grant, Igor; Grant, Igor; McCutchan, J. Allen; Ellis, Ronald J.; Marcotte, Thomas D.; Franklin, Donald; Ellis, Ronald J.; McCutchan, J. Allen; Alexander, Terry; Letendre, Scott; Capparelli, Edmund; Heaton, Robert K.; Atkinson, J. Hampton; Woods, Steven Paul; Dawson, Matthew; Smith, David M.; Fennema-Notestine, Christine; Taylor, Michael J.; Theilmann, Rebecca; Gamst, Anthony C.; Cushman, Clint; Abramson, Ian; Vaida, Florin; Marcotte, Thomas D.; Marquie-Beck, Jennifer; McArthur, Justin; Rogalski, Vincent; Morgello, Susan; Simpson, David; Mintz, Letty; McCutchan, J. Allen; Toperoff, Will; Collier, Ann; Marra, Christina; Jones, Trudy; Gelman, Benjamin; Head, Eleanor; Clifford, David; Al-Lozi, Muhammad; Teshome, Mengesha

    2015-01-01

    Background. Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) can show variable clinical trajectories. Previous longitudinal studies of HAND typically have been brief, did not use adequate normative standards, or were conducted in the context of a clinical trial, thereby limiting our understanding of incident neurocognitive (NC) decline and recovery. Methods. We investigated the incidence and predictors of NC change over 16–72 (mean, 35) months in 436 HIV-infected participants in the CNS HIV Anti-Retroviral Therapy Effects Research cohort. Comprehensive laboratory, neuromedical, and NC assessments were obtained every 6 months. Published, regression-based norms for NC change were used to generate overall change status (decline vs stable vs improved) at each study visit. Survival analysis was used to examine the predictors of time to NC change. Results. Ninety-nine participants (22.7%) declined, 265 (60.8%) remained stable, and 72 (16.5%) improved. In multivariable analyses, predictors of NC improvements or declines included time-dependent treatment status and indicators of disease severity (current hematocrit, albumin, total protein, aspartate aminotransferase), and baseline demographics and estimated premorbid intelligence quotient, non-HIV-related comorbidities, current depressive symptoms, and lifetime psychiatric diagnoses (overall model P < .0001). Conclusions. NC change is common in HIV infection and appears to be driven by a complex set of risk factors involving HIV disease, its treatment, and comorbid conditions. PMID:25362201

  18. Financial burden of morbidity in HIV infected adults in Manipur, India: comparison between patients with different co-infection

    Directory of Open Access Journals (Sweden)

    Ngaihte EN

    2013-01-01

    Full Text Available Background: The negative impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS is seen to have lessened with the introduction of the highly active anti-retroviral therapy (HAART. However, there is a few consensus on whether the introduction of HAART has significantly relieved the economic burden of HIV/AIDS, particularly with regards to out-of-pocket expenditure (OOPE for people living with HIV/AIDS (PLHAs and the possible differential impact of HIV/AIDS care and treatment on PLHAs with different co-infection. The health related expenditure of HIV-infected adults with different co-infections who are at different stage of treatment is reported and analysed in this paper.Methods: Cross-sectional data were collected from 496 PLHA respondents through interview schedule. Respondents were also asked to report all costs due to the PLHA's infection in the reference period. Differences in the components of costs were analysed using Statistical Package for Social Sciences (SPSS software version 20.0.Results: There was no statistically significant relationship between presence or absence of opportunistic infections (OI and the amount of expenditure incurred on all other component of costs except the expenditure on medicine. The difference in mean expenditure for medicines, test and others were statistically significant between those on Anti-Retroviral Therapy (ART and the pre-ART group at 95% level of confidence. The mean costs incurred on all components of costs were significantly different across different types of OI/co-infection.Conclusions: The cost of healthcare for those infected with HIV is significant even when there is free provision of HIV/AIDS related care and treatment. The costs of healthcare are significant especially with the presence of certain specific co-infection.

  19. HIV-Specific ADCC Improves After Antiretroviral Therapy and Correlates With Normalization of the NK Cell Phenotype

    DEFF Research Database (Denmark)

    Jensen, Sanne S; Hartling, Hans J; Tingstedt, Jeanette L;

    2015-01-01

    BACKGROUND: Natural killer (NK) cell phenotype and function have recently gained much attention as playing crucial roles in antibody-dependent cellular cytotoxicity (ADCC). We investigated NK cell function, as measured by ADCC, in HIV-1-positive individuals before and 6 months after highly active...... antiretroviral therapy (HAART) initiation. METHOD: The ability of antibodies and NK cells to mediate ADCC was investigated separately and in combination in an autologous model. The NK cell subset distribution and NK cell phenotype (ie, expression of maturation and activation markers within NK cell subsets) were....... For individuals with no increase in ADCC after 6 months of HAART, the frequency of NK cells expressing NKp46 was downregulated. The ability of antibodies to mediate ADCC alone and in combination in an autologous model was not improved. CONCLUSIONS: HAART improves the ability of NK cells to mediate ADCC after 6...

  20. Soluble urokinase receptor levels in plasma during 5 years of highly active antiretroviral therapy in HIV-1-infected patients

    DEFF Research Database (Denmark)

    Ostrowski, Sisse R; Katzenstein, Terese L; Piironen, Timo;

    2004-01-01

    High blood levels of the soluble urokinase receptor (suPAR) strongly predict increased mortality in human immunodeficiency virus-1 (HIV-1)-infected patients. This study investigated the plasma concentration of suPAR in 29 treatment-naive HIV-1-infected patients during 5 years treatment with highly...... active antiretroviral therapy (HAART). Plasma suPAR decreased after introducing HAART, most pronounced during the first treatment year. The change in plasma suPAR was independent of changes in viral replication and CD4+ cells but it was strongly correlated with plasma levels of the soluble TNF receptor...... II. Compared with healthy individuals, plasma suPAR and sTN-FrII was increased in untreated patients. After initiating HAART, plasma sTNFrII remained increased whereas plasma suPAR decreased to a level comparable with healthy individuals. The present data indicate that the circulating suPAR level is...

  1. A relationship between CD4 count and oral manifestations of human immunodeficiency virus-infected patients on highly active antiretroviral therapy in urban population

    Science.gov (United States)

    Satyakiran, Gadavalli Vera Venkata; Bavle, Radhika Manoj; Alexander, Glory; Rao, Saritha; Venugopal, Reshma; Hosthor, Sreelatha S

    2016-01-01

    Introduction: Human immunodeficiency virus (HIV) infection gradually destroys the body's immune system, which makes it harder for the body to fight infections. HIV infection causes a quantitative and qualitative depletion of CD4 lymphocyte count, which increases the risk of opportunistic infections. Thus, CD4 count is one of the key factors in determining both the urgency of highly active antiretroviral therapy (HAART) initiation and the need of prophylaxis for opportunistic infections. Aim: This study aims to evaluate the prevalence and variations in the oral manifestations of HIV/acquired immune deficiency syndrome patients on HAART therapy in urban population and their association with CD4 count. Materials and Methods: A study was conducted by screening eighty patients who were HIV positive in an urban location. Both adult and pediatric patients were screened for oral manifestations and simultaneously CD4 count was also evaluated. Patients with HIV infection for variable time period who are under HAART were considered. Statistical Analysis: Measures of central tendency were used to analyse the data. Results: HIV infection destroys the immune system of an individual, making the patient susceptible to various infections and malignancies. With the advent of antiretroviral therapy, the scenario has changed drastically. We have observed that patients with CD4 counts between 164 and 1286 show relatively few oral manifestations. Long-term HAART therapy causes pigmentation, xerostomia and angular cheilitis but is taken up quite well by the patients. Conclusion: In this study, eighty patients with HAART from urban population showed very minimal oral findings because of good accessibility for treatment and awareness about HIV infections. The patients who were on long-standing HAART treatment also showed minimal oral manifestation such as pigmentation and xerostomia. Hence, we conclude that recognition, significance and treatment of these lesions in patients with HIV

  2. Treatment discontinuation in HIV-1-infected individuals starting their first-line HAART after 2008: data from the ICONA Foundation Study Cohort

    OpenAIRE

    Antonio Di Biagio; Alessandro Cozzi-Lepri; Roberta Prinapori; Gioacchino Angarano; Andrea Gori; Tiziana Quirino; Andrea De Luca; Andrea Costantini; Cristina Mussini; Giuliano Rizzardini; Andrea Antinori; Foundation Study d’Arminio Monforte, Antonella on behalf of the ICONA

    2014-01-01

    Introduction: The aim of this study was to analyze the likelihood and the predictors of discontinuation of first-line regimen in the late HAART era. Methodology: An observational multi-center analysis of HIV-positive patients enrolled in ICONA. Patients eligible were those starting a first-line HAART after 1 January 2008. Discontinuation was defined as stop and/or switch of at least one drug of the regimen. All causes of discontinuation, as reported by the treating physician, were evaluated a...

  3. Women experience a better long-term immune recovery and a better survival on HAART in Lao People’s Democratic Republic

    OpenAIRE

    Bastard Mathieu; Soulinphumy Khamphang; Phimmasone Prasith; Saadani Ahmed Hassani; Ciaffi Laura; Communier Arlette; Phimphachanh Chansy; Ecochard René; Etard Jean-François

    2013-01-01

    Abstract Background In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART. Methods We performed a retrospective database analy...

  4. Cancer risk in HIV-infected individuals on HAART is largely attributed to oncogenic infections and state of immunocompetence

    Directory of Open Access Journals (Sweden)

    Vogel M

    2011-03-01

    Full Text Available Abstract Objectives To estimate the cancer risk of HIV-infected patients in the HAART era with respect to a general reference population and to determine risk factors for malignancy. Methods Long term (1996-2009 cancer incidence of the Bonn single centre HIV cohort was compared to the incidence of the reference population of Saarland using standardized incidence ratios (SIR. Poisson regression analysis was used to identify predictors of cancer risk. Results 1,476 patients entered the cohort, enabling 8,772 person years of observation. 121 tumours in 114 patients, 7 in-situ and 114 invasive cancers, were identified. Malignancies associated with infectious agents such as Kaposi sarcoma (SIRs: male: 5,683; female: 277, non-Hodgkin lymphoma (SIRs male: 35; female: 18, anal cancer (SIRs male: 88; female: 115 as well a cervical carcinoma (SIR female: 4 and Hodgkin's disease (SIR male: 39 and liver cancer (SIR male: 18 were substantially more frequent in HIV-infected patients than in the general population (p Conclusions HAART and preserved CD4 cells preferentially reduce the risk of malignancies associated with oncogenic infections.

  5. HIV-1/HAART-Related Lipodystrophy Syndrome (HALS Is Associated with Decreased Circulating sTWEAK Levels.

    Directory of Open Access Journals (Sweden)

    Miguel López-Dupla

    Full Text Available Obesity and HIV-1/HAART-associated lipodystrophy syndrome (HALS share clinical, pathological and mechanistic features. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK is a multifunctional cytokine that plays an important role in obesity and related diseases. We sought to explore the relationship between HALS and circulating levels of soluble (s TWEAK and its scavenger receptor sCD163.This was a cross-sectional multicenter study of 120 HIV-1-infected patients treated with a stable HAART regimen; 56 with overt HALS and 64 without HALS. Epidemiological and clinical variables were determined. Serum levels of sTWEAK and sCD163 levels were measured by ELISA. Results were analyzed with Student's t-test, Mann-Whitney U and χ2 test. Pearson and Spearman correlation were used to estimate the strength of association between variables.Circulating sTWEAK was significantly decreased in HALS patients compared with non-HALS patients (2.81±0.2 vs. 2.94±0.28 pg/mL, p = 0.018. No changes were observed in sCD163 levels in the studied cohorts. On multivariate analysis, a lower log sTWEAK concentration was independently associated with the presence of HALS (OR 0.027, 95% CI 0.001-0.521, p = 0.027.HALS is associated with decreased sTWEAK levels.

  6. Disseminated rhodococcus equi infection in HIV infection despite highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Ferretti Francesca

    2011-12-01

    Full Text Available Abstract Background Rhodococcus equi (R.equi is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART. Case presentation We report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years. Conclusions Our report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.

  7. Nutritional and metabolic assessment of HIV patients in use of antiretroviral therapy at Northeastern Brazil

    OpenAIRE

    Liana Aguiar Braga; Carlos Antonio Bruno da Silva

    2010-01-01

    Objective: To evaluate nutritional and metabolic changes in HIV infected (HIV+) patients on use of antiretroviral therapy. Methods:  A cross-sectional descriptive study involving HIV+ patients on use of Highly Active Antiretroviral Therapy (HAART). The demographic data studied were gender, birth date and time of use of antiretroviral medication. Anthropometric variables were weight and height with calculation of body mass index (BMI). Biochemical data were lipid profile, blood glucose, renal ...

  8. Infecções oportunistas em indivíduos com infecção pelo HIV e relação com uso de terapia antirretroviral - doi: 10.4025/actascihealthsci.v32i2.4508 Opportunistic infections in individuals with HIV infection and relationship with the use of anti-retroviral therapy - doi: 10.4025/actascihealthsci.v32i2.4508

    OpenAIRE

    Miguel Spack Junior; Sandra Vieira; João Henrique Torquato Oliveira; Vinicius Henrique Veraldo Fagundes; Áurea Regina Telles Pupulin

    2010-01-01

    O uso da terapia antirretroviral e a generalização das profilaxias primária e secundária levaram à redução do número de infecções oportunistas. É fato estabelecido a relação entre a não-adesão ao tratamento antirretroviral e o desenvolvimento de resistência do vírus HIV. Este trabalho avaliou a ocorrência de infecções oportunistas em pacientes HIV, relacionado-as ao uso regular/irregular de terapia antirretroviral. Foram realizadas avaliação clínica e consulta a prontuários e laudos de exames...

  9. A randomized trial comparing initial HAART regimens of nelfinavir/nevirapine and ritonavir/saquinavir in combination with two nucleoside reverse transcriptase inhibitors

    DEFF Research Database (Denmark)

    Kirk, Ole; Lundgren, Jens D; Pedersen, Court;

    2003-01-01

    BACKGROUND: A triple-class HAART regimen may be associated with a better virological effect than conventional regimens, but may also lead to toxicity and more profound resistance. METHODS: Randomized, controlled, open-label trial of 233 protease inhibitor- and non-nucleoside reverse transcriptase...

  10. Decrease in immune activation in HIV-infected patients treated with highly active antiretroviral therapy correlates with the function of hematopoietic progenitor cells and the number of naive CD4+ cells

    DEFF Research Database (Denmark)

    Nielsen, S D; Sørensen, T U; Ersbøll, A K;

    2000-01-01

    This study was conducted to determine the impact of immune activation, cytokine production and apoptosis on the naive CD4+ cell count and the function of hematopoietic progenitor cells during the initial phase of highly active antiretroviral therapy (HAART). Blood samples from 11 HIV......-infected patients were collected prior to HAART and after 4 and 12 weeks of therapy. Flow cytometry was used to determine the naive CD4+ count and activated T cells. The cloning efficiency of progenitor cells was determined using a colony-forming cells assay. Finally, apoptosis and cytokine production were...... cells. A negative correlation was found between apoptosis and the naive CD4+ count. Alterations in cytokine production during HAART or correlation between cytokine production and the naive CD4+ count or the cloning efficiency of progenitor cells were not detected. In conclusion, immune activation in HIV...

  11. Microsocial environmental influences on highly active antiretroviral therapy outcomes among active injection drug users: the role of informal caregiving and household factors.

    Science.gov (United States)

    Knowlton, Amy R; Arnsten, Julia H; Gourevitch, Marc N; Eldred, Lois; Wilkinson, James D; Rose, Carol Dawson; Buchanan, Amy; Purcell, David W

    2007-11-01

    Active injection drug users (IDUs) are at high risk of unsuccessful highly active antiretroviral therapy (HAART). We sought to identify baseline factors differentiating IDUs' treatment success versus treatment failure over time among those taking HAART. Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE) study participants were assessed at baseline and at 6- and 12-month follow-ups. Multinominal regression determined baseline predictors of achieving or maintaining viral suppression relative to maintaining detectable viral loads over 12 months. Of 199 participants who were retained and remained on HAART, 133 (67%) had viral load change patterns included in the analysis. At follow-up, 66% maintained detectable viral loads and 15% achieved and 19% maintained viral suppression. Results indicated that those having informal care (instrumental or emotional support) were 4.6 times more likely to achieve or maintain viral suppression relative to experiencing treatment failure. Those who maintained viral suppression were 3.5 times less likely to live alone or to report social discomfort in taking HAART. Study results underscore the importance of microsocial factors of social network support, social isolation, and social stigma for successful HAART outcomes among IDUs. The findings suggest that adherence interventions for IDUs should promote existing informal HIV caregiving, living with supportive others, and positive medication-taking norms among social networks. PMID:18089980

  12. Rehabilitation Program for the Quality of Life for Individuals on Highly Active Antiretroviral Therapy in KwaZulu-Natal, South Africa: A Short Report

    Science.gov (United States)

    Maharaj, Sonill S.; Chetty, Verusia

    2011-01-01

    Patients on highly active antiretroviral therapy (HAART) spend less time on vigorous activities due to lower aerobic capacity with functional limitations that can be attributed to a detraining effect, resulting in a poor quality of life (QoL). The overall aims of rehabilitation are to restore, to maintain, and to enhance the QoL and this…

  13. Predictors of immunological failure after initial response to highly active antiretroviral therapy in HIV-1-infected adults: a EuroSIDA study

    DEFF Research Database (Denmark)

    Dragsted, Ulrik Bak; Mocroft, Amanda; Vella, Stefano;

    2004-01-01

    BACKGROUND: Factors that determine the immunological response to highly active antiretroviral therapy (HAART) are poorly defined. OBJECTIVE: Our aim was to investigate predictors of immunological failure after initial CD4(+) response. METHODS: Data were from EuroSIDA, a prospective, international...

  14. A one-year clinical trial using didanosine, stavudine and nevirapine for highly active antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    ZHOU Hua-ying; ZHENG Yu-huang; ZHANG Chun-ying; DING Pei-pei; ZOU Wen

    2005-01-01

    @@ Antiretroviral therapy is a key determinant in the treatment and prevention of human immunodeficiency virus (HIV) infection. Initial treatment for patients with HIV infection generally includes two nucleoside reverse transcriptase inhibitors (NRTI) and a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI). The combination antiretroviral therapy (refers to highly active antiretroviral therapy or HAART) showed a significant effect upon reducing morbidity and mortality of HIV disease. Cao and colleagues1 began the clinical application of HAART in 1999 and completed the first clinical trial in China using a combination of two NRTIs and one PI. The result in using combivir (AZT+3TC) and indinavir (2 NRTIs+1 PI) are consistent with those reported in the literature.2 In this study, we report the first virological and immunological outcomes in HIV infected Chinese patients treated with a combination of didanosine, stavudine and nevirapine (2 NRTIs+1 NNRTI) for 52 weeks.

  15. Cost-effectiveness evaluation of initial HAART regimens for managing HIV-infected patients according to real clinical practice

    Directory of Open Access Journals (Sweden)

    A Castagna

    2012-11-01

    Full Text Available We evaluated the single-tablet regimen (STR versus multiple-tablet regimen (MTR strategies through an incremental cost-effectiveness analysis in a large cohort of patients starting their first HAART. Adult HIV-1-naïve patients, followed at the San Raffaele Hospital, starting their first-line regimen from June 2008 to April 2012, were included in the analysis. First-line HAART regimens more frequently used (>10% were grouped into two classes as follows: a single-tablet regimen (STR of TDF + FTC + EFV; b multiple-tablet regimen (MTR including TDF + FTC + EFV, TDF + FTC + ATV/r, TDF + FTC + DRV/r TDF + FTC + LPV/r. The incremental cost-effectiveness analysis was carried out by means of a Markov model calculating quality of life and costs for each patient, according to the given regimen (including any subsequent switch if occurred, through 1-year cycles. The outcome measure was quality-adjusted life-years (QALYs. Data were analysed from the point of view of the Lombardy Regional Health Service (RHS: HAART, hospitalisations, visits, examinations and other concomitant non-HAART drugs costs were evaluated, price variations included. 474 naïve patients: 90% males, mean age 42.2 years, mean baseline HIV-RNA 4.50 log10copies/ml and CD4+ count of 310 cells/µL with a mean follow-up of 28 months. Patients starting with an STR treatment were less frequently HCVAb positive (4% vs 11%, P=0.040, had higher mean CD4+ values [351 vs 297, P=0.004] as compared to MTR patients. The mean year cost/patient was €9,213 (range: €6,574.71–€33,570.00 with a mean per patient QALYs of 0.986 (range: 0.878–0.999 among STR patients; the mean year cost/patient was €14,277 (range: €5,908.89–€82,310.30 with a mean QALY of 0.933 (0.830–0.976 among MTR patients. STR dominates (i.e. is more effective and less costly compared to MTR. (Fig. 1 At multivariable analysis, after adjustment for age, gender, HCVAb status, HIV risk

  16. Investigating signs of recent evolution in the pool of proviral HIV type 1 DNA during years of successful HAART

    DEFF Research Database (Denmark)

    Mens, Helene; Pedersen, Anders G; Jørgensen, Louise B;

    2007-01-01

    In order to shed light on the nature of the persistent reservoir of human immunodeficiency virus type 1 (HIV-1), we investigated signs of recent evolution in the pool of proviral DNA in patients on successful HAART. Pro-viral DNA, corresponding to the C2-V3-C3 region of the HIV-1 env gene...... there were temporal trends indicating ongoing replication and evolution. In summary, it was not possible to detect definitive signs of ongoing evolution in either the bulk-sequenced or the clonal data with the methods employed here, but our results could be consistent with localized expression of archival...... HIV genomes in some patients. Interestingly, stop-codons were present at the same two positions in several independent clones and across patients. Simulation studies indicated that this phenomenon could be explained as the result of parallel evolution and that some sites were inherently more likely...

  17. Effects of medical male circumcision (MC on plasma HIV viral load in HIV+ HAART naive men; Rakai, Uganda.

    Directory of Open Access Journals (Sweden)

    Godfrey Kigozi

    Full Text Available BACKGROUND: Medical male circumcision (MC of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. METHODS: 195 consenting HIV-positive, HAART naïve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE. RESULTS: Of the 195 men, 129 had a CD4 count ≧ 350 and 66 had CD4 <350 cells/mm3. Men with CD4 counts <350 had higher baseline mean log10 plasma viral load than those with CD4 counts ≧ 350 cells/mm3 (4.715 vs 4.217 cps/mL, respectively, p = 0.0005. Compared to baseline, there was no statistically significant increase in post-MC HIV plasma viral loads irrespective of CD4. Multivariate analysis showed that higher baseline log10 plasma viral load was significantly associated with reduction in mean log10 plasma viral load following MC (coef.  = -0.134, p<0.001. CONCLUSION: We observed no increase in plasma HIV viral load following MC in HIV-infected, HAART naïve men.

  18. HAART and related research in TB/HIV co-infected patients%针对结核/艾滋病双重感染病人实施抗病毒治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    王旭

    2013-01-01

    针对结核/艾滋病(TB/HIV)双重感染病人的治疗极其复杂,并非是简单地将抗结核药物和抗病毒药物相加而成.由于药物的不良反应,免疫重构综合征的发生以及高死亡率等原因,TB/HIV双重感染的治疗在治疗方案和治疗时点上仍然没有明确的定论.截至目前,中国仍然无任何针对TB/HIV双重感染病人进行治疗的临床资料可借鉴.为此,文章对世界上各国针对TB/HIV双重感染治疗的研究进展进行综述.%The therapy of co-infection with human immunodeficiency virus (HIV) and tuberculosis (TB) is very complicated,because it is not simply a combination of TB medicaments plus antiviral drugs.Due to drug interactions and the occurrence of immune reconstitution inflammatory syndrome (IRIS) and a high risk of mortality,the therapy regimen and timing for starting highly active antiretroviral therapy (HAART) in co-infected patients remains unclear.So far,there is no clinical data for the reference in China,thus the therapies through the world to TB/HIV co-infected patients are briefly described in this article.

  19. Treatment discontinuation in HIV-1-infected individuals starting their first-line HAART after 2008: data from the ICONA Foundation Study Cohort

    Directory of Open Access Journals (Sweden)

    Antonio Di Biagio

    2014-11-01

    Full Text Available Introduction: The aim of this study was to analyze the likelihood and the predictors of discontinuation of first-line regimen in the late HAART era. Methodology: An observational multi-center analysis of HIV-positive patients enrolled in ICONA. Patients eligible were those starting a first-line HAART after 1 January 2008. Discontinuation was defined as stop and/or switch of at least one drug of the regimen. All causes of discontinuation, as reported by the treating physician, were evaluated and cumulative risk of stopping was investigated according to age, gender, co-morbidity, years since starting HAART, immuno-virological status, third drug and backbone of the first regimen. Kaplan Meier (KM analysis and Cox proportional hazards model were used for the outcome discontinuation of ≥1 drug regardless of the reason. For the KM estimates a competing risk approach was used to estimate the contribution of each of the reasons over time to the cumulative risk of stopping over time. Results: Data of 1759 patients who started first HAART and had at least one month of clinical follow-up were analyzed. The overall discontinuation risk was 33% over a median follow-up of 12 months. The likelihood of discontinuation by KM was 27% by one year (95% CI 25–29 and 41% by two years (95% CI 38–44. Main reason for stopping at least one drug in regimen was simplification (10%, followed by intolerance (7%, toxicity (5%, failure (2% and other causes (8%. Estimates of the cumulative risk of discontinuation of ≥1 drug over time and according to reason are shown in Figure 1. In a multivariable Cox model independent predictors of discontinuation regardless of the reason were: longer time from HIV diagnosis to date of starting HAART (hazard ratio [HR] 0.96; 95% CI 0.93–1.00; p=0.039, regimens containing ZDV/3TC (HR 2.86; 95% CI 1.42–5.76; p=0.003 vs TDF/FTC and an NNRTI-based regimen (HR 2.47; 95% CI 0.91–6.72; p=0.07 vs regimens not NNRTI-based. Conclusions

  20. Clinical outcomes and immune reconstitution in 103 advanced AIDS patients undergoing 12-month highly active antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    DAI Yi; QIU Zhi-feng; LI Tai-sheng; HAN Yang; ZUO Ling-yan; XIE Jing; MA Xiao-jun; LIU Zheng-yin; WANG Ai-xia

    2006-01-01

    Background Highly active antiretroviral therapy (HAART) roduces profound suppression of HIV replication, substantial increase in CD4+ T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients.Methods One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4+ count: <100 cells/ μl or ≥ 100 cells/μl. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART.Results One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2±0.7) lg copies/ml, the CD4+ count increased to (168±51) cells/μl [among which the naive phenotype (CD45RA+CD62L+) increased to (49±27) cells/μl and the memory phenotype (CD45RA ̄) increased to (119±55) cells/μl], and the percentage of CD4+CD28+ cells increased. At the same time, there was a significant reduction of CD8+ T cell activation. In the 69 patients with the baseline CD4+ count <100 cells/μl, 37 had a VL <50 copies/ml; while in the 34 patients with the baseline CD4+ count ≥ 100 cells/μl, 25 had a VL <50 copies/ml, the difference between the two groups was statistically significant. The CD4+ T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4+ count and plasma VL. Over 12 months of HAART,10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects,8 skin rashes, 10 lipodystrophy and 1 renal calculus.Conclusions Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS

  1. The adverse reactions and causes of drug switch in 214 HIV/AIDS patients with HAART%214例HIV/AIDS病人的HAART不良反应及换药原因分析

    Institute of Scientific and Technical Information of China (English)

    覃川; 蒋忠胜; 温小凤

    2014-01-01

    目的 探讨艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)高效抗反转录病毒治疗(HAART)的不良反应及换药原因.为保证HAART合理用药及用药安全提供依据.方法 全部病人均使用国家免费艾滋病HAART药物,按照国家免费艾滋病抗病毒药物治疗手册要求,全部病例均在HAART后1、2、3、6、9、12个月随访1次,统计病人不良反应及换药原因,数据分析用SPSS 19.0软件处理,以P<0.05为差异有统计学意义.结果 95例病人中90例出现抗病毒药物不良反应、3例一线治疗失败、2例因药物配伍禁忌更换抗病毒药物.其中90例病人因AZT、NVP、D4T不良反应更换抗病毒药物.另有3例初始HAART方案包含EFV的病人,出现神经系统症状,均自行缓解,未更换药物.将初始HAART方案包含AZT、NVP、D4T的病例分为未换药组和换药组,将两组病人的基线CD4+ T淋巴细胞(简称CD4细胞)计数值进行统计学比较,差异无统计学意义.结论 HAART的主要换药原因为抗病毒药物不良反应.在包含AZT、D4T、NVP的HAART方案中,治疗前3个月着重监测AZT、NVP的不良反应,治疗6个月后着重监测D4T的不良反应,且不良反应的出现与基线CD4细胞计数无关.同时须及早发现耐药,并须掌握药物配伍禁忌.%Objective To investigate the adverse reaction and causes of drug switch in HIV/AIDS patients with highly active antiretroviral therapy (HAART),in order to provide the basis for the rational use of drugs and drug safety.Methods All the patients took free national antiretroviral drugs.According to the requirements of free national antiretroviral treatment manual,all patients were followed up at 1,2,3,6,9 and 12 months after HAART,collecting data of adverse reaction and causes of drug switch.The data was analyzed using SPSS 19.0 software.P< 0.05 was considered statistically significant.Results There were 95 patients switching antiretroviral drugs due to

  2. HIV-infected patients with a large thymus maintain higher CD4 counts in a 5-year follow-up study of patients treated with highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Kolte, L; Ryder, L P; Albrecht-Beste, E;

    2009-01-01

    CD4 recovery in HIV-infected patients treated with highly active antiretroviral therapy (HAART) is in part believed to be dependent on the degree of preserved thymic function. We investigated whether the thymus has a prolonged effect on CD4 recovery. Total and naïve CD4 counts as well as thymic...... with larger thymic size at follow-up. However, no difference in the increase in thymic output was seen between thymic groups. In conclusion, the importance of the thymus to the rate of cellular restoration seems primarily to lie within the first two years of HAART. However, patients with larger thymic size...

  3. Desarrollo de neoplasias e infecciones definitorias de sida después de iniciar la terapia antirretroviral de alta eficacia Development of AIDS-related malignancies and infections after starting HAART

    Directory of Open Access Journals (Sweden)

    Eduardo Warley

    2010-02-01

    Full Text Available Con el objetivo de evaluar la incidencia de neoplasias e infecciones definitorias de Sida (NIDS y los posibles factores asociados a su desarrollo luego de iniciada la terapia antirretroviral de alta eficacia (HAART analizamos las historias clínicas de los pacientes que iniciaron tratamiento entre julio 2003 y octubre 2007. Todos recibieron profilaxis con trimetoprima-sulfametoxazol y azitromicina según la recomendación actual. Evaluamos el desarrollo de NIDS en los 6 meses posteriores al inicio de la terapia y su asociación con variables clínicas y epidemiológicas. Analizamos 235 historias clínicas: 118 mujeres (50.2% y 117 hombres (49.8%. Observamos 11 casos de NIDS: 3 formas pulmonares y 3 ganglionares de tuberculosis, 3 meningitis por Criptococcus neoformans, 1 chagoma cerebral y 1 linfoma no Hodgkin. Presentar recuento de células CD4 menor a 100 o 150 células/ml se asoció con riesgo de desarrollar NIDS. La media de células CD4 fue 73 en los pacientes que desarrollaron NIDS y 143 en los que no la desarrollaron. No hubo asociación con las otras variables analizadas. En pacientes con CD4 menor a 150 células/ml observamos un caso de chagoma cerebral entre 4 con serología reactiva para Chagas, y ninguno de toxoplasmosis cerebral entre 46 con serología reactiva para toxoplasmosis. Concluimos que la tasa de incidencia de NIDS fue del 4.7%, siendo tuberculosis en primer lugar y criptococosis en segundo las enfermedades más frecuentemente observadas. Presentar bajo recuento de células CD4 se asoció de manera significativa al desarrollo de NIDS. Debería reevaluarse el rol de la quimioprofilaxis.In order to evaluate the incidence rate and possible risk factors associated with AIDS-related malignancies and infections (ARMI we performed data analysis of clinical charts of HIV patients in two hospital cohorts, that started high activity antiretroviral therapy (HAART between July 2003 and October 2007. Trimethoprim-sulfamethoxazole and

  4. Prevalence and risk factors associated to chronic kidney disease in HIV-infected patients on HAART and undetectable viral load in Brazil.

    Directory of Open Access Journals (Sweden)

    Andréia M Menezes

    Full Text Available BACKGROUND: To determine the prevalence and associated factors with chronic kidney disease (CKD in a cohort of HIV-positive individuals with undetectable viral load on HAART. METHODS: From March, 2009 to September 2009, 213 individuals between 18-70 years, period on HAART ≥12 months, viral load < 50 copies/mm(3, and CD4 ≥ 200 cells/mm(3, were consecutively enrolled at the outpatient clinic of Hospital de Clínicas, Porto Alegre, Brazil. Exclusion criteria were obesity, malnourishment, amputee, paraplegic, previous history of renal disease, pregnancy and hepatic insufficiency. Renal function was determined by estimated glomerular filtration rate (eGFR assessed by the modification of diet in renal disease. CKD was defined as an eGFR less or equal than 60 ml/min/1.73 m(2, for a period of at least 3 months. Poisson regression was used to determine factors associated with CKD. RESULTS: CKD was diagnosed in 8.4% of the population, and after adjustment, the risk factors were hypertension (RR = 3.88, 95%CI, 1.84-8.16, time on HAART (RR = 1.15, 95%CI,1.03-1.27 and tenofovir exposure (RR = 2.25, 95%CI, 1.04-4.95. Higher weight (RR = 0.88 95%CI, 0.82-0.96 was associated to normal function. CONCLUSIONS: CKD was a common finding in this cohort of patients and was related to hypertension, time on HAART and tenofovir exposure. We suggest a more frequent monitoring of renal function, especially for those with risk factors to early identify renal impairment.

  5. High level HIV-1 DNA concentrations in brain tissues differentiate patients with post-HAART AIDS dementia complex or cardiovascular disease from those with AIDS

    Institute of Scientific and Technical Information of China (English)

    ZHAO Li; GALLIGAN Derek C.; LAMERS Susanna L.; YU Stephanie; SHAGRUN Lamia; SALEMI Marco; MCGRATH Michael S.

    2009-01-01

    Highly active antiretroviral treatment (HAART) has had a significant Impact on survival of individuals with acquired immunodeficiency syndrome (AIDS); however, with the longer life-span of patients with AIDS, there is increasing prevalence of AIDS dementia complex (ADC) and other non-AIDS-defining illness, and cardiovascular diseases (CVD) are also common. The influence of these varied disease processes on HIV-1 DNA concentration in brain tissues has not been thoroughly assessed in the post-HAART era. The purpose of the current study is to clarify the impacts of ADC and other complications of HIV disease on the viral load in the brains in AIDS patients with post-HARRT. We examined autopsy specimens from the brains of thirteen patients who died from complications of AIDS with quantitative poiymerase chain reaction (QPCR). All but one patient had HAART prior to death since 1995. Two patients died with severe CVD, multiple cerebrovascular atherosclerosis (CVA)throughout the brain and five patients died with ADC. Six patients had no ADC/CVA. A QPCR was used to measure the presence of HIV-1 DNA in six brain tissues (meninges, frontal grey matter, frontal white matter, temporal subcortex, cerebellum and basal ganglia). In the post-HARRT era, for non-ADC/CVA patients, HIV-1 DNA concentration in brain tissues was statistically higher than that in patients with ADC. in a new finding, two patients who suffered from severe CVD, especially CVA, also had high concentrations of HIV-1 in brain compartments not showing ADC related changes. To our knowledge,this is the first report of a relationship between the CVA and HIV-1 viral burden in brain. The current observations suggest that HAART-resistant HIV reservoirs may survive within ADC lesions of the brain as well as the macrophage rich atherosclerosis, which needs to be confirmed by more AIDS cases with CVA.

  6. Why HIV Positive Patients on Antiretroviral Treatment and/or Cotrimoxazole Prophylaxis Use Traditional Medicine: Perceptions of Health Workers, Traditional Healers and Patients: A Study in Two Provinces of South Africa

    OpenAIRE

    Puoane, TR; Hughes, GD; Uwimana, J.; Q. Johnson; Folk, WR

    2012-01-01

    The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART). The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART), using an exploratory qualitative design in two provinces of South Africa: an urban township health facility in the Western Cape...

  7. Evolution of hepatitis C virus in HIV coinfected patients under antiretroviral therapy.

    Science.gov (United States)

    Sede, Mariano; Parra, Micaela; Manrique, Julieta M; Laufer, Natalia; Jones, Leandro R; Quarleri, Jorge

    2016-09-01

    Five patients (P) were followed-up for an average of 7.73years after highly active antiretroviral therapy (HAART) initiation. Patients' immune and virological status were determined by periodical CD4+T-cell counts and HIV and HCV viral load. HCV populations were studied using longitudinal high throughput sequence data obtained in parallel by virological and immunological parameters. Two patients (P7, P28) with sub-optimal responses to HAART presented HCV viral loads significantly higher than those recorded for two patients (P1, P18) that achieved good responses to HAART. Interestingly, HCV populations from P7 and P28 displayed a stable phylogenetic structure, whereas HCV populations from P1 and P18showeda significant increase in their phylogenetic structure, followed by a decrease after achieving acceptable CD4+T-cell counts (>500 cell/μl). The fifth patient (P25) presented high HCV viral loads, preserved CD4+T-cell counts from baseline and all along the follow-up, and displayed a constant viral phylogenetic structure. These results strongly suggest that HAART-induced immune recovery induces a decrease in HCV viral load and an increase in the HCV population phylogenetic structure likely reflecting the virus diversification in response to the afresh immune response. The relatively low HCV viral load observed in the HAART responder patients suggests that once HCV is adapted it reaches a maximum number of haplotypes higher than that achieved during the initial stages of the immune response as inferred from the two recovering patients. Future studies using larger number of patients are needed to corroborate these hypotheses. PMID:27234841

  8. Lupus anticoagulant in human immunodeficiency virus -infected patients on highly active antiretroviral therapy

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    Awodu Omolade

    2010-01-01

    Full Text Available Background: Lupus anticoagulant (LA is a heterogeneous group of antibodies that causes a variety of clinical and laboratory effects; has been described in infections such as human immunodeficiency virus. LA has not been previously described in Nigerians with human immunodeficiency virus infection on highly active antiretroviral therapy (HAART. Aim: To determine the frequency of LA in patients infected with the human immunodeficiency virus on HAART. Methods: Cross sectional study of patients with human immunodeficiency virus infection undergoing HAART at a tertiary hospital in Nigeria. Screening for LA was done using the activated partial thromboplastin time (aPTT and kaolin clotting time (KCT. Mixing experiments were conducted on samples with prolonged clotting time. KCT ratio was calculated. A positive result was taken as KCT ratio greater than or equal to 1.2. Fisher′s exact test was used to test the association between LA and sex. Association between aPTT and KCT was tested according to Pearson. P-value < 0.05 was considered significant. Results: Fifty-eight patients aged 18- 60 years were studied, comprising of 28 males (mean age 40.50 plus/minus 8.8 years and 30 females (mean age 35.4 plus/minus 9.02. Frequency of LA among human immunodeficiency infected patients was 5.2%, (frequency in males and females were 3.6 and 6.7 % respectively. This was lower than 46% reported in patients not on HAART. There was no statistically significant difference in LA prevalence between males and females P greater than0.05. A positive correlation was observed between the clotting tests aPTT and KCT (r is equal to 0.9406, p less than 0.0001. Conclusion: HAART may prevent development of LA in HIV-infected patients.

  9. Langerhans cells in periodontal disease of HIV- and HIV+ patients undergoing highly active antiretroviral therapy

    OpenAIRE

    Takeshi Kato Segundo; Giovanna Ribeiro Souto; Ricardo Alves Mesquita; Fernando Oliveira Costa

    2011-01-01

    The aim of this study was to assess and compare quantitatively the presence of S100+ Langerhans cells (LC) by immunochemistry techniques in HIV+ and HIV- gingivitis and periodontitis subjects. Additionally, it aimed to evaluate the correlation among densities of these cells with CD4+ and CD8+ T cells, and viral load levels in HIV+ subjects, all using Highly Active Antiretroviral Therapy (HAART). The samples were allocated into four groups: 1) 15 subjects with moderate chronic periodontitis (M...

  10. Characteristics of HIV-1-specific CD8 T-cell responses and their role in loss of viremia in children chronically infected with HIV-1 undergoing highly active antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zheng; ZHAO Qing-xia; FU Jun-liang; YAO Jin-xia; HE Yun; JIN Lei; WANG Fu-sheng

    2006-01-01

    Background Few studies have examined the properties of human immunodeficiency virus type 1 (HIV-1) epitope-specific cytotoxic T lymphocyte (CTL) responses in children. To address this issue, we characterized epitope-specific CTL responses and analyzed the determinants that may affect CTL responses before and after highly active antiretroviral therapy (HAART) in children with HIV-1 infection.Methods A total of 22 HIV-1-infected children and 23 uninfected healthy children as control were enrolled in the study. Circulating CD4 T cells and HIV-1 RNA load in plasma were routinely measured. Peripheral HIV-1-specific CTL frequency and HIV-1 epitope-specific, interferon-γ (IFN-γ)-producing T lymphocytes were measured using tetramer staining and enzyme-linked immunospot (ELISPOT) assay, respectively.Circulating dendritic cell (DC) subsets were monitored with FACS analysis.Results More than 80% of the children with HIV-1 infection exhibited a positive HIV-1-epitope-specific CTL response at baseline, but HIV-specific CTLs and IFN-γ-producing lymphocytes decreased in patients who responded to HAART in comparison with non-responders and HAART-naive children. The duration of virus suppression resulted from HAART was inversely correlated with CTL frequency. While in HAART-naive children, HIV-1-specific CTL frequency was positively correlated with myeloid DC (mDC) frequency,although the cause and effect relationship between the DCs and CTLs remains unknown.Conclusions HIV-1-epitope-specific CTL responses are dependent on antigenic stimulation. The impaired DC subsets in blood might result in a defect in DC-mediated T cell responses. These findings may provide insight into understanding the factors and related mechanisms that influence the outcome of HIV-1 carriers to HAART or future antiviral therapies.

  11. Analysis of virological efficacy in trials of antiretroviral regimens: drawbacks of not including viral load measurements after premature discontinuation of therapy

    DEFF Research Database (Denmark)

    Kirk, Ole; Pedersen, Court; Law, Matthew;

    2002-01-01

    OBJECTIVES: To compare two analytic approaches to assess the virological effect of HAART according to the intention-to-treat (ITT) principle. MATERIAL: Data from 2318 patients enrolled in 10 randomised clinical trials (RCTs) and from 3091 patients followed in an observation cohort (EuroSIDA) star......OBJECTIVES: To compare two analytic approaches to assess the virological effect of HAART according to the intention-to-treat (ITT) principle. MATERIAL: Data from 2318 patients enrolled in 10 randomised clinical trials (RCTs) and from 3091 patients followed in an observation cohort (Euro......SIDA) starting their first HAART regimen. METHODS: Two classifications of defining virological response 48 weeks after starting the therapy to be evaluated were compared: 1) only patients remaining on the therapy and having a plasma viral load (pVL) below a given cut-off level at week 48 were classified as...... to ITT/s=f, 22-70% of the patients starting a HAART regimen in a RCT experienced a virological response at week 48. Only two RCTs had complete follow-up data (n=424): between 29 and 62% achieved a virological response at week 48 in the six treatment arms evaluated in the studies according to ITT...

  12. Married men’s perceptions of barriers for HIV-positive pregnant women accessing highly active antiretroviral therapy in rural Uganda

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    Duff P

    2012-05-01

    Full Text Available Putu Duff,1 Tom Rubaale,2 Walter Kipp1,21School of Public Health, University of Alberta, Edmonton, Canada; 2Community ARV Project, Fort Portal, UgandaBackground: The aim of this study was to describe the perceptions of married men about barriers to accessing and accepting highly active antiretroviral therapy (HAART by pregnant/postnatal women positive for human immunodeficiency virus (HIV and registered in Kabarole District’s Program for the Prevention of HIV from Mother to Child (PMTCT-Plus.Materials and methods: Our study was a qualitative descriptive exploratory study using thematic analysis. Four focus group discussions were held with a convenience sample of 40 married men.Results: Lack of disclosure of a positive HIV diagnosis to the partner and stigmatization of persons with HIV were two major obstacles for women in accessing HAART. In addition, men felt that their low knowledge of HAART and their low HIV testing rate also constituted important barriers to these women taking treatment. Men complained that they were not sufficiently involved in the reproductive care of women and that couples’ counseling could be a step towards addressing this problem.Conclusion: Barriers to HAART experienced by pregnant/postnatal women need to be addressed in order to improve their uptake of treatment, increase their low treatment coverage, improve their survival, and at the same time dramatically reduce HIV transmission from mother to child.Keywords: men, highly active antiretroviral therapy, pregnant women, Uganda

  13. Therapeutic immunization with HIV-1 Tat reduces immune activation and loss of regulatory T-cells and improves immune function in subjects on HAART.

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    Barbara Ensoli

    Full Text Available UNLABELLED: Although HAART suppresses HIV replication, it is often unable to restore immune homeostasis. Consequently, non-AIDS-defining diseases are increasingly seen in treated individuals. This is attributed to persistent virus expression in reservoirs and to cell activation. Of note, in CD4(+ T cells and monocyte-macrophages of virologically-suppressed individuals, there is continued expression of multi-spliced transcripts encoding HIV regulatory proteins. Among them, Tat is essential for virus gene expression and replication, either in primary infection or for virus reactivation during HAART, when Tat is expressed, released extracellularly and exerts, on both the virus and the immune system, effects that contribute to disease maintenance. Here we report results of an ad hoc exploratory interim analysis (up to 48 weeks on 87 virologically-suppressed HAART-treated individuals enrolled in a phase II randomized open-label multicentric clinical trial of therapeutic immunization with Tat (ISS T-002. Eighty-eight virologically-suppressed HAART-treated individuals, enrolled in a parallel prospective observational study at the same sites (ISS OBS T-002, served for intergroup comparison. Immunization with Tat was safe, induced durable immune responses, and modified the pattern of CD4(+ and CD8(+ cellular activation (CD38 and HLA-DR together with reduction of biochemical activation markers and persistent increases of regulatory T cells. This was accompanied by a progressive increment of CD4(+ T cells and B cells with reduction of CD8(+ T cells and NK cells, which were independent from the type of antiretroviral regimen. Increase in central and effector memory and reduction in terminally-differentiated effector memory CD4(+ and CD8(+ T cells were accompanied by increases of CD4(+ and CD8(+ T cell responses against Env and recall antigens. Of note, more immune-compromised individuals experienced greater therapeutic effects. In contrast, these changes

  14. Nutritional and metabolic assessment of HIV patients in use of antiretroviral therapy at Northeastern Brazil - doi: 10.5020/18061230.2010.p368

    OpenAIRE

    Liana Aguiar Braga; Carlos Antonio Bruno da Silva

    2012-01-01

    Objective: To evaluate nutritional and metabolic changes in HIV infected (HIV+) patients on use of antiretroviral therapy. Methods:  A cross-sectional descriptive study involving HIV+ patients on use of Highly Active Antiretroviral Therapy (HAART). The demographic data studied were gender, birth date and time of use of antiretroviral medication. Anthropometric variables were weight and height with calculation of body mass index (BMI). Biochemical data were lipid profile, blood glucose, renal ...

  15. Changes in HIV-related hospitalizations during the HAART era in an inner-city hospital.

    Science.gov (United States)

    Pulvirenti, Joseph; Muppidi, Uma; Glowacki, Robert; Cristofano, Michael; Baker, Laurie

    2007-08-01

    We evaluated admissions of HIV-positive persons to an inner-city hospital from 2000 to 2005. There was a decline in the number of substance abusers, homeless persons, injection drug abusers, and African Americans, and there was an increase in patients older than 50 years. There were no significant changes in CD4 counts or in utilization of highly active antiretroviral therapy,m but there were more admissions of persons with HIV RNA levels less than 1000 copies/mL, internal medicine problems, cancers, and skin infections. Changes in the demographics of this patient population may reflect external factors (eg, gentrification of low-income housing areas, opening of a new hospital). Lower viral loads suggest better response in those on a highly active antiretroviral regimen, and changes in diagnoses leading to hospitalization may reflect the aging of the HIV population. PMID:17717882

  16. Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial

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    Guwatudde David

    2012-11-01

    Full Text Available Abstract Background Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA of micronutrients (including vitamins B-complex, C, and E in slowing disease progression among HIV-infected adults receiving HAART in Uganda. Methods/Design We are using a randomized, double-blind, placebo-controlled trial study design. Eligible patients are HIV-positive adults aged at least 18 years, and are randomized to receive either a placebo; or multivitamins that include a single RDA of the following vitamins: 1.4 mg B1, 1.4 mg B2, 1.9 mg B6, 2.6 mcg B12, 18 mg niacin, 70 mg C, 10 mg E, and 0.4 mg folic acid. Participants are followed for up to 18 months with evaluations at baseline, 6, 12 and 18 months. The study is primarily powered to examine the effects on immune reconstitution, weight gain, and quality of life. In addition, we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event, including all-cause mortality; ARV regimen change from first- to second-line therapy; and other adverse events as indicated by incident peripheral neuropathy, severe anemia, or diarrhea. Discussions The conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy (multivitamin supplementation among HIV-infected adults receiving HAART in a developing country setting. Trial registration Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique

  17. The Effectiveness of a Bioactive Food Compound in the Lipid Control of Individuals with HIV/AIDS

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    Rosângela dos Santos Ferreira

    2016-10-01

    Full Text Available Cardiovascular events due to decompensated lipid metabolism are commonly found in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS patients using anti-retroviral therapy (HAART. Thus, the aim of this study was to identify the effect of a bioactive food compound (BFC containing functional foods on individuals with HIV undergoing HAART. Particularly, this study aims to verify the clinical outcome in the change of the lipid profile due to the use of this compound. This study includes 115 individuals with HIV on HAART. All patients received dietary guidelines; however, sixty-one consumed BFC while fifty-one did not (NO BFC. Biochemical examinations and socio-demographic and clinical profiles were evaluated. As result, in patients using hypolipidemic and/or hypoglycemic drugs, there was 28.6% decrease in triglyceride levels (p < 0.001 in the NO BFC group, and 18.3% reduction in low density lipoprotein cholesterol (LDL-C (p < 0.001 in the BFC group. In patients who did not use hypolipidemic and/or hypoglycemic drugs in the NO BFC group, there was 30.6% increase in triglycerides, 11.3% total cholesterol and 15.3% LDL-C levels (p < 0.001 while for the BFC group there was 4.5% reduction in total cholesterol (p < 0.001. In conclusion, this study evidenced that the dietary intervention containing BFC positively affected in lipid control, since these HIV/AIDS patients using HAART are more vulnerable to lipid disorders.

  18. HIV-associated wasting in the HAART era: guidelines for assessment, diagnosis, and treatment.

    Science.gov (United States)

    Polsky, B; Kotler, D; Steinhart, C

    2001-08-01

    Wasting (malnutrition) and lipodystrophy are the two major nutritional alterations in human immunodeficiency virus (HIV)-infected individuals. Both wasting and lipodystrophy may involve a decrease in body fat content, while wasting-but not lipodystrophy-also includes the loss of lean body mass. Lipodystrophy has made the identification of wasting increasingly more difficult. The diagnosis of wasting depends on a definition of the condition that takes into account sex and cultural differences, as well as measurements of body cell mass. Patient management involves a concurrent, comprehensive approach designed to restore lost body cell mass and weight. The authors make recommendations for defining, diagnosing, and treating HIV-associated wasting. Specific therapies include testosterone replacement, other anabolic steroids, and recombinant human growth hormone. Other adjunctive measures, such as progressive resistance exercise and cytokine modulation, may also be utilized. Expected outcomes from effective treatment include restored body cell mass, improvement in quality of life, and reduced rates of hospitalization. Future directions for research should address the need for optimal treatment strategies. PMID:11522215

  19. HIV-related Pneumocystis carinii Pneumonia in Older Patients Hospitalized in the Early HAART Era

    Science.gov (United States)

    Kim, Benjamin; Lyons, Thomas M; Parada, Jorge P; Uphold, Constance R; Yarnold, Paul R; Hounshell, Jennie B; Sipler, Alison M; Goetz, Matthew B; DeHovitz, Jack A; Weinstein, Robert A; Campo, Rafael E; Bennett, Charles L

    2001-01-01

    OBJECTIVE To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocustis carinii pneumonia (PCP), as determined in our prior study from the 1980s. DESIGN Retrospective chart review. PATIENTS/SETTING Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission (89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P <.002), and survive hospitalization (82% vs 90%, P < .003). However, age was not a significant predicator of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illenss at admission, and delays in initiation of PCP-specific treatments among older individuals—factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged. PMID:11556938

  20. Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

    Institute of Scientific and Technical Information of China (English)

    Juanarita Jaafar; Wan Hazabbah Wan Hitam; Raja Azmi Mohd Noor

    2012-01-01

    A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

  1. Human immunodeficiency virus/acquired immunodeficiency syndrome and tropical diseases: a Brazilian perspective

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    Mariza G Morgado

    2000-01-01

    Full Text Available The paper summarizes recent findings on the epidemiology and pathogenesis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/Aids, highlighting the role of co-infections with major tropical diseases. Such co-infections have been studied in the Brazilian context since the beginning of the Aids epidemic and are expected to be more frequent and relevant as the Aids epidemic in Brazil proceeds towards smaller municipalities and the countryside, where tropical diseases are endemic. Unlike opportunistic diseases that affect basically the immunocompromised host, most tropical diseases, as well as tuberculosis, are pathogenic on their own, and can affect subjects with mild or no immunossuppression. In the era of highly active anti-retroviral therapies (HAART, opportunistic diseases seem to be on decrease in Brazil, where such medicines are fully available. Benefiting from HAART in terms of restoration of the immune function, putative milder clinical courses are expected in the future for most co-infections, including tropical diseases. On the other hand, from an ecological perspective, the progressive geographic diffusion of Aids makes tropical diseases and tuberculosis a renewed challenge for Brazilian researchers and practitioners dealing with HIV/Aids in the coming years.

  2. Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiological study

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    Dauby Nicolas

    2011-03-01

    Full Text Available Abstract Background Non-AIDS-defining malignancies (NADM are becoming a major cause of mortality in the era of highly active antiretroviral therapy. We wished to investigate the incidence, risks factors and outcome of NADM in an urban cohort. Methods We carried out an observational cohort of HIV patients with 12,746 patient-years of follow up between January 2002 and March 2009. Socio-demographics and clinical characteristics of patients diagnosed with NADM were retrospectively compared with the rest of the cohort. Causes of death and risk factors associated with NADM were assessed using logistic regression. Survival analyses were performed with Kaplan-Meier estimates. Cancer incidences were compared with those of the general population of the Brussels-Capital Region using the standardized incidence ratio (SIR. Results Forty-five NADM were diagnosed. At inclusion in the study, patients with NADM were older than patients without NADM (47 years vs. 38 years, p 3 vs. 224 cells/mm3, p 3 (OR 3.10; 95% CI 1.40-6.87 were associated with NADM. NADM were independently associated with higher mortality in the cohort (OR 14.79; 95% CI 6.95-31.49. Women with cancer, the majority of whom were of sub-Saharan African origin, had poorer survival compared with men. The SIR for both sexes were higher than expected for Hodgkin's lymphoma (17.78; 95% CI 6.49-38.71, liver cancers (8.73; 95% CI 2.35-22.34, anal cancers (22.67; 95% CI 8.28-49.34 and bladder cancers (3.79; 95% CI 1.02-9.70. The SIR for breast cancer was lower in women (SIR 0.29; 95% CI 0.06-0.85. Conclusions Age over 45 and a nadir CD4 count of less than 200 cells/mm3 were predictive of NADM in our cohort. Mortality was high, especially in sub-Saharan African women. Cancers with increased incidences were Hodgkin's lymphoma and anal, bladder and liver cancers in both sexes; women had a lower incidence of breast cancer.

  3. Longitudinal microarray analysis of cell surface antigens on peripheral blood mononuclear cells from HIV+ individuals on highly active antiretroviral therapy

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    Wang Bin

    2008-03-01

    Full Text Available Abstract Background The efficacy of highly active antiretroviral therapy (HAART determined by simultaneous monitoring over 100 cell-surface antigens overtime has not been attempted. We used an antibody microarray to analyze changes in the expression of 135 different cell-surface antigens overtime on PBMC from HIV+ patients on HAART. Two groups were chosen, one (n = 6 achieved sustainable response by maintaining below detectable plasma viremia and the other (n = 6 responded intermittently. Blood samples were collected over an average of 3 years and 5–8 time points were selected for microarray assay and statistical analysis. Results Significant trends over time were observed for the expression of 7 cell surface antigens (CD2, CD3epsilon, CD5, CD95, CD36, CD27 and CD28 for combined patient groups. Between groups, expression levels of 10 cell surface antigens (CD11a, CD29, CD38, CD45RO, CD52, CD56, CD57, CD62E, CD64 and CD33 were found to be differential. Expression levels of CD9, CD11a, CD27, CD28 and CD52, CD44, CD49d, CD49e, CD11c strongly correlated with CD4+ and CD8+ T cell counts, respectively. Conclusion Our findings not only detected markers that may have potential prognostic/diagnostic values in evaluating HAART efficacy, but also showed how density of cell surface antigens could be efficiently exploited in an array-like manner in relation to HAART and HIV-infection. The antigens identified in this study should be further investigated by other methods such as flow cytometry for confirmation as biological analysis of these antigens may help further clarify their role during HAART and HIV infection.

  4. Preliminary outcomes of a paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa

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    Holst Helga L

    2007-03-01

    Full Text Available Abstract Background Few studies address the use of paediatric highly active antiretroviral therapy (HAART in Africa. Methods We performed a retrospective cohort study to investigate preliminary outcomes of all children eligible for HAART at Sinikithemba HIV/AIDS clinic in KwaZulu-Natal, South Africa. Immunologic, virologic, clinical, mortality, primary caregiver, and psychosocial variables were collected and analyzed. Results From August 31, 2003 until October 31, 2005, 151 children initiated HAART. The median age at HAART initiation was 5.7 years (range 0.3–15.4. Median follow-up time of the cohort after HAART initiation was 8 months (IQR 3.5–13.5. The median change in CD4% from baseline (p 95%adherence. Seventeen patients (11.3% had a regimen change; two (1.3% were due to antiretroviral toxicity. The Kaplan-Meier one year survival estimate was 90.9% (95%confidence interval (CI 84.8–94.6. Thirteen children died during follow-up (8.6%, one changed service provider, and no children were lost to follow-up. All 13 deaths occurred in children with advanced HIV disease within 5 months of treatment initiation. In multivariate analysis of baseline variables against mortality using Cox proportional-hazards model, chronic gastroenteritis was associated with death [hazard ratio (HR, 12.34; 95%CI, 1.27–119.71 and an HIV-positive primary caregiver was found to be protective against mortality [HR, 0.12; 95%CI, 0.02–0.88. Age, orphanhood, baseline CD4%, and hemoglobin were not predicators of mortality in our cohort. Fifty-two percent of the cohort had at least one HIV-positive primary caregiver, and 38.4% had at least one primary caregiver also on HAART at Sinikithemba clinic. Conclusion This report suggests that paediatric HAART can be effective despite the challenges of a resource-limited setting.

  5. Evolution of Framingham cardiovascular risk score in HIV-infected patients initiating EFV- and LPV/r-based HAART in a Latin American cohort

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    Diego Cecchini

    2014-11-01

    Full Text Available Introduction: Epidemiological studies suggest that some antiretroviral drugs may contribute to increase cardiovascular risk in HIV-infected patients. However, data from Latin American countries are limited, as impact of HAART on cardiovascular risk remains understudied. In this context, we aimed to evaluate if 10-year Framingham Cardiovascular Risk Score (FCRS increases in patients following exposure to EFV- and LPV/r-based HAART in a Latin American cohort. Materials and Methods: Retrospective 48-week cohort study. We reviewed clinical charts of randomly selected samples of patients initiating (according to national guidelines EFV first-line HAART and LPV/r first- or second-line (but first PI-based HAART assisted at a reference HIV centre in Buenos Aires, Argentina (period 2004–2012. Each patient could only be included in one arm. FCRS was calculated according to National Institutes of Health risk assessment tool (http://cvdrisk.nhlbi.nih.gov/. Results: A total of 357 patients were included: 249 in EFV arm and 108 in LPV/r arm (80 as first line and 28 as second line, but first PI-based HAART. Baseline characteristics (median, interquartile range: age, 38 (33–45 years; male, 247 (69%; viral load, 98200 (20550–306000 copies/mL; CD4 T-cell count, 115 (60–175 cel/µL; total cholesterol, 159 (135–194 mg/dL; HDL: 39 (31–41 mg/dL; LDL: 94 (72–123 mg/dL; current smoker, 29%; on antihypertensive drugs: 14 (4%, diabetic: 4 (1%. Most frequent accompanying nucleoside reverse transcriptase inhibitors (NRTIs were 3TC (92% and zidovudine (AZT; 76%. Baseline FCRS was low, moderate and high for 93%, 7% and 0% of patients on EFV arm and 96.7%, 1.7% and 1.7% on LPV/r arm. On EFV arm, an increase in FCRS category (low to moderate or moderate to high was observed in 1 patient (0.9% at 24 weeks and 6 (5,6% at 48 weeks; 5 (4.7% decreased category. On LPV/r arm no one varied FCRS category at 24 weeks and 2 (3.4% increased from low to moderate at 48 weeks

  6. Nutritional and metabolic assessment of HIV patients in use of antiretroviral therapy at Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Liana Aguiar Braga

    2010-12-01

    Full Text Available Objective: To evaluate nutritional and metabolic changes in HIV infected (HIV+ patients on use of antiretroviral therapy. Methods:  A cross-sectional descriptive study involving HIV+ patients on use of Highly Active Antiretroviral Therapy (HAART. The demographic data studied were gender, birth date and time of use of antiretroviral medication. Anthropometric variables were weight and height with calculation of body mass index (BMI. Biochemical data were lipid profile, blood glucose, renal function, albumin, uric acid, oxalacetic and pyruvic transaminases and red blood cells count. Results: The study population comprised 70 patients, 36 (51.4% men and 34 (48.6% women with an average time of HAART-use of 34.5 + 16.5 months. We observed a prevalence of 42 (60% healthy weight for BMI, changes in lipid profile and reduction of lean mass in 18 (50% men and increased abdominal obesity in 23 (67.7% women. Conclusion: The studied subjects in use of HAART showed to have loss of subcutaneous fat, lipid changes and higher prevalence of abdominal obesity in women.

  7. Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children

    International Nuclear Information System (INIS)

    The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount an immune response and is termed immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution disease. IRIS is widely reported in the literature in adult patients, most commonly associated with mycobacterial infections. There is, however, a paucity of data documenting the radiological findings of IRIS in children. Radiologists need to be aware of this entity. As a diagnosis of exclusion it is essential that the radiological findings be assessed in the context of the clinical presentation. This article reviews the common clinical and radiological manifestations of IRIS in HIV-infected children. (orig.)

  8. On the Estimation of Expected Survival Time of AIDS Patients Undergoing Antiretroviral Therapy Using Censored Generalized Poisson Regression Model

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    Gurprit GROVER

    2014-03-01

    Full Text Available Objective: The progression of HIV infection depends not only on the combination of drugs and adherence to the Anti Retroviral therapy (ART, but also on various other factors. The survival of an HIV patient depends on interaction of these factors with the therapy. Material and Methods: The parametric approach with and without covariates have been used to analyze the survival data of HIV/AIDS patients. When covariates are not considered, survival distributions are fitted and best one chosen. The inclusion of covariates is analyzed using Censored Generalized Poisson Regression Model (CGPR. Results: For a retrospective right censored data of 1689 HIV/AIDS patients undergoing ART at the Ram Manohar Lohia Hospital, New Delhi, India, appropriate survival distributions in the absence of covariates are fitted. Using the Akaike Information Criterion, Gamma distribution is found to be the distribution of best fit. Assuming Gamma survival distribution with right censored survival time data, the mean survival time of AIDS patients using the method of maximum likelihood is found to be 11.14 years. Also, CGPR model for estimating the survival time while accounting for the impact of cofactors is used for the first time on the AIDS dataset. Conclusion: The advantage of using a CGPR model over the gamma right censored distribution is that the mean survival time of the AIDS patient undergoing ART can be estimated in the presence of significant prognostic factors. Using this model, age, gender, smoking status, alcoholism, WHO staging, improvement in CD4 count, opportunistic infections, number of visits and weight at initiation of ART are identified as significant prognostic factors effecting the survival time. On averaging the predicted survival times based on CGPR model, the mean survival time of AIDS patients on ART is found to be 12.12 years.

  9. Persistence of pathological distribution of NK cells in HIV-infected patients with prolonged use of HAART and a sustained immune response.

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    Mario Frias

    Full Text Available A prospective analysis of the distribution of NK subsets and natural cytotoxicity receptors (NKp30/NKp46 in HIV patients with long-term HAART use and sustained virological and immunological response.The main inclusion criteria were: at least 3 years' receipt of HAART; current CD4+ count ≥ 500 cells/mm3; undetectable viral load for at least 24 months; no hepatotropic virus co-infection. Percentages of CD56dim, CD56bright NK cells and CD56neg CD16+ cells were obtained. Expression of the NCRs, NKp30 and NKp46 was analysed in CD56+ cells. Thirty-nine infected patients and sixteen healthy donors were included in the study.The percentages of total CD56+ and CD56dim NK cells were significantly lower in HIV-infected patients than in healthy donors (70.4 vs. 50.3 and 80.9 vs. 66.1 respectively. The percentage of total CD56+ NK cells expressing NCR receptors was lower in HIV patients than in healthy donors (NKp30: 25.20 vs. 58.63; NKp46: 24.8 vs. 50.59. This was also observed for CD56dim and CD56bright NK cells. Length of time with undetectable HIV viral load was identified as an independent factor associated with higher expression of NKp30 and NKp46.Despite the prolonged and effective use of HAART, HIV-infected patients do not fully reconstitute the distribution of NK cells. Length of time with an undetectable viral load was related to greater recovery of NKp30/NKp46 receptors.

  10. Cumulative Viral Load and Virologic Decay Patterns after Antiretroviral Therapy in HIV-Infected Subjects Influence CD4 Recovery and AIDS

    Science.gov (United States)

    Marconi, Vincent C.; Grandits, Greg; Okulicz, Jason F.; Wortmann, Glenn; Ganesan, Anuradha; Crum-Cianflone, Nancy; Polis, Michael; Landrum, Michael; Dolan, Matthew J.; Ahuja, Sunil K.; Agan, Brian; Kulkarni, Hemant

    2011-01-01

    Background The impact of viral load (VL) decay and cumulative VL on CD4 recovery and AIDS after highly-active antiretroviral therapy (HAART) is unknown. Methods and Findings Three virologic kinetic parameters (first year and overall exponential VL decay constants, and first year VL slope) and cumulative VL during HAART were estimated for 2,278 patients who initiated HAART in the U.S. Military HIV Natural History Study. CD4 and VL trajectories were computed using linear and nonlinear Generalized Estimating Equations models. Multivariate Poisson and linear regression models were used to determine associations of VL parameters with CD4 recovery, adjusted for factors known to correlate with immune recovery. Cumulative VL higher than the sample median was independently associated with an increased risk of AIDS (relative risk 2.38, 95% confidence interval 1.56–3.62, p<0.001). Among patients with VL suppression, first year VL decay and slope were independent predictors of early CD4 recovery (p = 0.001) and overall gain (p<0.05). Despite VL suppression, those with slow decay during the first year of HAART as well as during the entire therapy period (overall), in general, gained less CD4 cells compared to the other subjects (133 vs. 195.4 cells/µL; p = 0.001) even after adjusting for potential confounders. Conclusions In a cohort with free access to healthcare, independent of established predictors of AIDS and CD4 recovery during HAART, cumulative VL and virologic decay patterns were associated with AIDS and distinct aspects of CD4 reconstitution. PMID:21625477

  11. Cumulative viral load and virologic decay patterns after antiretroviral therapy in HIV-infected subjects influence CD4 recovery and AIDS.

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    Vincent C Marconi

    Full Text Available BACKGROUND: The impact of viral load (VL decay and cumulative VL on CD4 recovery and AIDS after highly-active antiretroviral therapy (HAART is unknown. METHODS AND FINDINGS: Three virologic kinetic parameters (first year and overall exponential VL decay constants, and first year VL slope and cumulative VL during HAART were estimated for 2,278 patients who initiated HAART in the U.S. Military HIV Natural History Study. CD4 and VL trajectories were computed using linear and nonlinear Generalized Estimating Equations models. Multivariate Poisson and linear regression models were used to determine associations of VL parameters with CD4 recovery, adjusted for factors known to correlate with immune recovery. Cumulative VL higher than the sample median was independently associated with an increased risk of AIDS (relative risk 2.38, 95% confidence interval 1.56-3.62, p<0.001. Among patients with VL suppression, first year VL decay and slope were independent predictors of early CD4 recovery (p = 0.001 and overall gain (p<0.05. Despite VL suppression, those with slow decay during the first year of HAART as well as during the entire therapy period (overall, in general, gained less CD4 cells compared to the other subjects (133 vs. 195.4 cells/µL; p = 0.001 even after adjusting for potential confounders. CONCLUSIONS: In a cohort with free access to healthcare, independent of established predictors of AIDS and CD4 recovery during HAART, cumulative VL and virologic decay patterns were associated with AIDS and distinct aspects of CD4 reconstitution.

  12. Considerations in using text messages to improve adherence to highly active antiretroviral therapy: a qualitative study among clients in Yaoundé, Cameroon

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    Mbuagbaw L

    2012-04-01

    Full Text Available Lawrence Mbuagbaw1,2, Renée Cécile Bonono-Momnougui1, Lehana Thabane2,31Centre for the Development of Best Practices in Health (CDBPH, Yaoundé Central Hospital, Yaoundé, Cameroon; 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 3Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, CanadaAbstract: Poor adherence to highly active antiretroviral therapy (HAART is a major hindrance to the reduction of mortality and morbidity due to HIV. This qualitative study used focus groups to explore the views and experiences of HIV patients on HAART with adherence reminders, especially the text message (SMS [short message service]. The ethnographic data obtained were used to design a clinical trial to assess the effect of motivational text messages versus usual care to enhance adherence to HAART among HIV patients in Yaoundé, Cameroon. Participants appreciated the idea of a timely SMS reminder, and cited the physician as a role model. They expressed concerns about privacy. Long-term life goals were a motivating factor to adhere. Overall, text messaging was viewed positively as a tool with a dual function of reminder and motivator. Messages coming from the attending physician may have a stronger impact. Trials investigating the use of text messages to improve adherence to HAART need to consider the content and timing of SMS, taking into account technical challenges and privacy.Keywords: focus groups, adherence, highly active antiretroviral therapy (HAART, text message, short message service (SMS, human immunodeficiency virus (HIV

  13. High level HIV-1 DNA concentrations in brain tissues differentiate patients with post-HAART AIDS dementia complex or cardiovascular disease from those with AIDS

    Institute of Scientific and Technical Information of China (English)

    GALLIGAN; Derek; C.; LAMERS; Susanna; L.; YU; Stephanie; SHAGRUN; Lamia; SALEMI; Marco; MCGRATH; Michael; S.

    2009-01-01

    Highly active antiretroviral treatment(HAART) has had a significant impact on survival of individuals with acquired immunodeficiency syndrome(AIDS);however,with the longer life-span of patients with AIDS,there is increasing prevalence of AIDS dementia complex(ADC) and other non-AIDS-defining illness,and cardiovascular diseases(CVD) are also common.The influence of these varied disease processes on HIV-1 DNA concentration in brain tissues has not been thoroughly assessed in the post-HAART era.The purpose of the current study is to clarify the impacts of ADC and other complications of HIV disease on the viral load in the brains in AIDS patients with post-HARRT.We examined autopsy specimens from the brains of thirteen patients who died from complications of AIDS with quantitative polymerase chain reaction(QPCR).All but one patient had received HAART prior to death since 1995.Two patients died with severe CVD,multiple cerebrovascular atherosclerosis(CVA) throughout the brain and five patients died with ADC.Six patients had no ADC/CVA.A QPCR was used to measure the presence of HIV-1 DNA in six brain tissues(meninges,frontal grey matter,frontal white matter,temporal subcortex,cerebellum and basal ganglia).In the post-HARRT era,for non-ADC/CVA patients,HIV-1 DNA concentration in brain tissues was statistically higher than that in patients with ADC.In a new finding,two patients who suffered from severe CVD,especially CVA,also had high concentrations of HIV-1 in brain compartments not showing ADC related changes.To our knowledge,this is the first report of a relationship between the CVA and HIV-1 viral burden in brain.The current observations suggest that HAART-resistant HIV reservoirs may survive within ADC lesions of the brain as well as the macrophage rich atherosclerosis,which needs to be confirmed by more AIDS cases with CVA.

  14. Behavioral and emotional problems among children aged 6-14 years on highly active antiretroviral therapy in Addis Ababa: a cross-sectional study.

    Science.gov (United States)

    Tadesse, Amare Worku; Berhane Tsehay, Yemane; Girma Belaineh, Belaineh; Alemu, Yonas Baheretibeb

    2012-01-01

    Children infected with human immunodeficiency virus (HIV) are at particular risk for psychological disturbance. Little is known about the mental health status of children on highly active antiretroviral therapy (HAART). A hospital-based cross-sectional study of 318 children aged 6-14 on HAART in Addis Ababa was conducted. Behavioral and emotional problem was assessed using the child behavior check list (CBCL/6-18). Logistic regression analysis was done to select the best subset of predictor variables and determine their association with behavioral and emotional problems. Of the 318 caregivers of children aged 6-14 on HAART, 39.3% of the children had behavioral and emotional problems. Low family monthly income (AOR, 3.44, 95% CI, 1.89-6.25), older age (AOR, 2.27, 95% CI, 1.34-3.83), and parental loss (AOR, 1.89, 95% CI, 1.10-3.25) were found to be determinants of behavioral and emotional problems in the multivariate logistic regression. There is high prevalence of behavioral and emotional problems in children on HAART in Addis Ababa. More support is needed to children from families of low income and those who lost their parents. Further research should be carried out to enhance better understanding and appropriate response to behavioral and emotional problems.

  15. Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy

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    Aline Francielle Mota Segatto

    2011-08-01

    Full Text Available INTRODUCTION: Lipodystrophy is related to the use of highly active antiretroviral therapy (HAART and can cause aesthetic stigma and increase the risk of developing cardiovascular diseases. Physical activity may be a valid alternative for the treatment and prevention of lipodystrophy. However, few studies address this issue. The objective of this study was to assess lipodystrophy related to highly active antiretroviral therapy in HIV/AIDS patients with different physical activity habits. METHODS: The sample was composed of 42 HIV/AIDS patients taking HAART medication who were visiting the Counseling and Testing Center (CTC in Presidente Prudente. The level of physical activity was obtained using the International Physical Activity Questionnaire (IPAQ; lipodystrophy was diagnosed using a self-report questionnaire that was administered to the patient and then followed up by medical confirmation. The percentage of trunk fat was estimated by dual X-Ray absorptiometry (DEXA. Information about sex, age, length of HAART treatment, CD4+ T lymphocyte count (CD4 and viral load was also collected. RESULTS: A higher prevalence of lipodystrophy was observed in the sedentary group when compared to the physically active group, which indicates that physical activity may be a protective factor in relation to the occurrence of lipodystrophy. The group that had a higher CD4 had a higher proportion of lipodystrophy and a higher proportion of younger and physically active individuals. The patients with lipodystrophy had a higher percentage of trunk fat and were more sedentary than active individuals. CONCLUSIONS: A physically active lifestyle has a protective effect against the occurrence of lipodystrophy related to HAART.

  16. Comparison of bone and renal effects in HIV-infected adults switching to abacavir or tenofovir based therapy in a randomized trial.

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    Thomas A Rasmussen

    Full Text Available INTRODUCTION: Our objective was to compare the bone and renal effects among HIV-infected patients randomized to abacavir or tenofovir-based combination anti-retroviral therapy. METHODS: In an open-label randomized trial, HIV-infected patients were randomized to switch from zidovudine/lamivudine (AZT/3TC to abacavir/lamivudine (ABC/3TC or tenofovir/emtricitabine (TDF/FTC. We measured bone mass density (BMD and bone turnover biomarkers (osteocalcin, osteocalcin, procollagen type 1 N-terminal propeptide (P1NP, alkaline phosphatase, type I collagen cross-linked C-telopeptide (CTx, and osteoprotegerin. We assessed renal function by estimated creatinine clearance, plasma cystatin C, and urinary levels of creatinine, albumin, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL. The changes from baseline in BMD and renal and bone biomarkers were compared across study arms. RESULTS: Of 40 included patients, 35 completed 48 weeks of randomized therapy and follow up. BMD was measured in 33, 26, and 27 patients at baseline, week 24, and week 48, respectively. In TDF/FTC-treated patients we observed significant reductions from baseline in hip and lumbar spine BMD at week 24 (-1.8% and -2.5% and week 48 (-2.1% and -2.1%, whereas BMD was stable in patients in the ABC/3TC arm. The changes from baseline in BMD were significantly different between study arms. All bone turnover biomarkers except osteoprotegerin increased in the TDF/FTC arm compared with the ABC/3TC arm, but early changes did not predict subsequent loss of BMD. Renal function parameters were similar between study arms although a small increase in NGAL was detected among TDF-treated patients. CONCLUSION: Switching to TDF/FTC-based therapy led to decreases in BMD and increases in bone turnover markers compared with ABC/3TC-based treatment. No major difference in renal function was observed. TRIAL REGISTRATION: Clinicaltrials.gov NCT00647244.

  17. Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

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    Suleiman IA

    2016-04-01

    Full Text Available Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Results: Three hundred and forty eight (57.9% of the subjects were females and 253 (42.1% were males. The majority of them, 557 (92.7% have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%, had ≥95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%, and “wanted to avoid the side-effects of drugs” 33(5.5%. There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5% at therapy initiation to 338 (56.3% at study period (p<0.0001. Conclusion: The adherence level of 73.4% was low

  18. Global HIV-1 transmitted drug resistance in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

    DEFF Research Database (Denmark)

    Baxter, J D; Dunn, D; White, E;

    2015-01-01

    on a modified 2009 World Health Organization definition to reflect newer resistance mutations. RESULTS: Baseline resistance testing was available in 1946 study participants. Higher rates of testing occurred in Europe (86.7%), the USA (81.3%) and Australia (89.9%) as compared with Asia (22.2%), South America (1...

  19. Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature

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    Barr David A

    2012-10-01

    Full Text Available Abstract Background The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI.Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS as a cause of liver disease in patients initiating HAART, which could also cause jaundice. Case presentations We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa. All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS in the other four. In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated – in addition to epithelioid histiocytes and Langhans giant cells – neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. Conclusion In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be

  20. DISCORDANCE BETWEEN BODY MASS INDEX AND ANTHROPOMETRIC MEASUREMENTS AMONG HIV-1-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY AND WITH LIPOATROPHY/LIPOHYPERTROPHY SYNDROME

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    Lismeia Raimundo SOARES

    2015-04-01

    Full Text Available Introduction: Highly Active Antiretroviral Therapy (HAART has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP. The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI and percentage of body fat (% BF. The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR and waist circumference (WC. Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively. In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726. The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005 and (p = 0.011. Conclusions

  1. PATIENTS ON ANTIRETROVIRAL THERAPY WHO WERE LOST TO FOLLOW-UP AT A TERTIARY CARE HOSPITAL, PUNE, INDIA

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    Dileep B.

    2014-09-01

    Full Text Available Importance: With increasing number of persons living with Human Immunodeficiency Virus (HIV in major cities there is a need to have a comprehensive strategy to reduce the number of drop outs from the anti-retroviral (ART therapy. This can be done effectively only when we study the reasons why patients are lost to follow up. This study has brought to light novel causes of non-adherence to ART, like migration, discordance and resort to alternative therapies. DESIGN: This is a qualitative study conducted at ART Center, Byramjee Jeejeebhoy Medical College (BJMC and Sassoon General Hospital (SGH, Pune, a tertiary referral center in India. We included all those patients who were initiated antiretroviral therapy and lost to follow-up (LFU any time during the entire month after three months during which the appointment was scheduled. All these patients were interviewed during restart of ART, in ART center, BJMC and SGH. MAIN OUTCOMES AND MEASURES: All socio-demographic and clinical factors associated with antiretroviral therapy adherence. RESULTS: Out of a total 51patients lost to follow-up, patients above thirty five years of age and male sex were associated with a higher chance of being lost to LFU. Illiteracy rate was high in age group above 35 years (64.1% and in females. Male drivers were lost to follow-up at a greater extent [14(24.75%]. Out of 24(47.06% married patients, 12(50% male patients were sero-discordant. The chance of defaulting from therapy was high in the first three months and one year later from the initiation of therapy. Migration led to drop out of 13(25.49% patients. Other important factors leading to loss to follow up were: death in family, side effects of drugs and family disturbance. Alcoholism was the cause in 23(45.10% male patients. CONCLUSION AND RELEVANCE: Migration, illiteracy, alcoholism, discordant couples, death in family, low socio-economic status, resorting to alternative therapies were the prominent factors which

  2. Treinamento físico para indivíduos HIV positivo submetidos à HAART: efeitos sobre parâmetros antropométricos e funcionais

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    Edmar Lacerda Mendes

    2013-02-01

    Full Text Available INTRODUÇÃO: A terapia antirretroviral fortemente ativa (HAART tem melhorado a prognose em indivíduos infectados pelo HIV. No entanto, a HAART tem sido associada ao desenvolvimento de anormalidades metabólicas e na distribuição de gordura corporal conhecida como síndrome lipodistrófica associada ao HIV (SLHIV. OBJETIVO: Este estudo investigou o impacto de 24 semanas de exercício resistido com componente aeróbico (ERCA sobre parâmetros antropométricos e funcionais de portadores de HIV submetidos à HAART. MÉTODOS: Noventa e nove indivíduos infectados pelo HIV foram randomicamente alocados em quatro grupos: exercício e lipodistrofia (n = 24; EX+LIP; exercício sem lipodistrofia (n = 21; EX+NoLIP; controle e lipodistrofia (n = 27; NoEX+LIP; controle sem lipodistrofia (n = 27; NoEX+NoLIP. Os indivíduos dos grupos exercitados (EX+LIP e EX+NoLIP participaram de 24 semanas de ERCA. Nos momentos pré e pós 24 semanas de intervenção foram realizadas medidas antropométricas, testes de força e aptidão cardiorrespiratória. RESULTADOS: Vinte e quatro semanas de ERCA alteraram os perímetros corporais avaliados (P < 0,0001 e a relação cintura/quadril (P = 0,017 nos dois grupos exercitados. Reduções foram observadas (P < 0,0001 para o somatório das sete dobras cutâneas avaliadas, percentual de gordura corporal, massa corporal gorda, gordura subcutânea total, central e periférica em resposta ao ERCA. A massa corporal magra aumentou (P < 0,0001 nos grupos exercitados, independente do desfecho (LIP ou NoLIP. A força muscular e a aptidão cardiorrespiratória aumentaram (P < 0,0001, para os dois grupos exercitados em resposta ao ERCA. CONCLUSÃO: Vinte e quatro semanas de ERCA impediram a manifestação das alterações decorrentes da SLHIV e contribuíram para a redução destas.

  3. Are HIV positive patients resistant to statin therapy?

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    Bennett Matthew T

    2007-10-01

    Full Text Available Abstract Background Patients with HIV are subject to development of HIV metabolic syndrome characterized by dyslipidemia, lipodystrophy and insulin resistance secondary to highly active antiretroviral therapy (HAART. Rosuvastatin is a highly potent HMG-CoA reductase inhibitor. Rosuvastatin is effective at lowering LDL and poses a low risk for drug-drug interaction as it does not share the same metabolic pathway as HAART drugs. This study sought to determine the efficacy of rosuvastatin on lipid parameters in HIV positive patients with HIV metabolic syndrome. Results Mean TC decreased from 6.54 to 4.89 mmol/L (25.0% reduction, p Conclusion This study found that rosuvastatin is effective at improving potentially atherogenic lipid parameters in HIV-positive patients. The lipid changes we observed were of a smaller magnitude compared to non-HIV subjects. Our results are further supported by a small, pilot trial examining rosuvastatin effectiveness in HIV who reported similar median changes from baseline of -21.7% (TC, -22.4% (LDL-C, -30.1% (TG with the exception of a 28.5% median increase in HDL. In light of the results revealed by this pilot study, clinicians may want to consider a possible resistance to statin therapy when treating patients with HIV metabolic syndrome.

  4. Efficiency of HAART in the prevention of mother to children HIV-1 transmission at Saint Camille medical centre in Burkina Faso, West Africa

    Institute of Scientific and Technical Information of China (English)

    Laure Stella Ghoma Linguissi; Remy Moret; Jean Baptiste Nikiema; Jacques Simpore; Cyrille Bisseye; Tani Sagna; Bolni Marius Nagalo; Djeneba Ouermi; Florencia W Djigma; Salvatore Pignatelli; Joseph D Sia; Virginio Pietra

    2012-01-01

    Objective: To evaluate efficiency of HAART in the prevention of mother to child HIV transmission. Methods: A longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre from September 2010 to July 2011. The HIV status of mothers was determined by rapid tests and ELISA. Discordant results were confirmed by real-time PCR. PCR was used to determine HIV status of children born from HIV-positive mothers. Results: Among 1 300 pregnant women tested for HIV, 378 were seropositive. Mothers were predominantly housewives (69.7%), and their mean age was (28.32±0.15) years. The overall prevalence of HIV transmission from mother to child was 4.8% (18/378). This prevalence differed significantly from 0.0% (0/114) to 6.8% (18/264) in children born from mothers under HAART and those with mothers under New Prophylactic Protocol (AZT + 3TC + NVP), respectively (P<0.01). Children’s mortality rate during the medical follow up was 1.3% (5/378). Among 16 women with HIV dubious status by ELISA, the Real Time PCR confirmed 2/16 (12.5%) as HIV positive. Conclusions: The protocol of prevention of mother to children HIV transmission (PMTCT) is effective. The rate of HIV vertical transmission is significantly reduced. Early diagnosis determined by PCR of children born from HIV- positive mother is necessary and recommended in the context of PMTCT in Burkina Faso. We also found that PCR is an effective tool to confirm HIV status in pregnant women.

  5. A comparison of HAART outcomes between the US military HIV Natural History Study (NHS and HIV Atlanta Veterans Affairs Cohort Study (HAVACS.

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    Jodie L Guest

    Full Text Available INTRODUCTION: The Department of Defense (DoD and the Department of Veterans Affairs (VA provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. METHODS: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS and 1199 patients from the US Military HIV Natural History Study (NHS. Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. RESULTS: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only and 26.8% to 4.1% (combined mortality or AIDS when controlling for clinical and demographic variables. CONCLUSION: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

  6. 温脾补肾法联合高效抗逆转录病毒治疗对HIV/AIDS患者免疫功能影响的研究%Research on the effects of warming spleen and tonifying kidney combined with HAART on immune function of HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    吴广伟; 朱克武; 李茂清; 陈美玲; 肖学义

    2014-01-01

    目的 探讨温脾补肾法联合高效抗逆转录病毒疗法(HAART)对HIV/AIDS患者免疫功能的影响.方法 将30例HIV/AIDS患者分为中西医结合治疗组(治疗组)14例,西医治疗组(对照组)16例.对照组采用HAART疗法,治疗组在此基础上联合以温脾补肾法为组方原则的中药艾可清优化处方治疗,共治疗6个月.监测全部患者治疗前、后的卡洛夫斯基积分、临床症状、外周血T淋巴细胞亚群CD4+计数及CD4+/CD8+比值、血常规及肝肾功能等,并综合比较两组的临床疗效.结果 ①治疗后治疗组、对照组的临床受益率分别100.0%和87.5%,两组比较差异有统计学意义(P<0.05);②治疗后治疗组卡洛夫斯基积分、体重有所改善(P<0.05),在改善中医临床症状乏力、纳呆及总积分方面也优于对照组(P<0.05);③治疗后治疗组CD4+细胞计数、白细胞计数分别为(264.97±52.94)个/mm3和(6.94±0.97)×109/L,优于对照组的(238.73±50.13)个/mm3和(5.57±1.29)×109/L (P<0.05);④两组在治疗期间未出现明显不良反应.结论温脾补肾法联合HAART治疗HIV/AIDS患者可明显地改善临床症状,并能增强机体的免疫功能和提高生活质量,对于实现本病的功能性治愈可起到一定的作用.%Objective To investigate the effects of warming spleen and tonifying kidney combined with highly active antiretroviral therapy (HAART) on immune function of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) patients.Methods 30 patients with HIV/AIDS were divided into integrated traditional Chinese and western medicine treatment group (the treatment group) with 14 cases,western medicine control group (the control group) with 16 cases.The control group was given HAART,while the treatment group was given warming spleen and tonifying kidney combined with HAART.The treatment course for both groups was six months.Karovsky Performance Status,clinical symptoms,CD4+T cell count,CD4

  7. The Effect of Arthrospira platensis Capsules on CD4 T-Cells and Antioxidative Capacity in a Randomized Pilot Study of Adult Women Infected with Human Immunodeficiency Virus Not under HAART in Yaoundé, Cameroon

    Directory of Open Access Journals (Sweden)

    Frank Stéphane Winter

    2014-07-01

    Full Text Available Dietary supplements are often used to improve the nutritional status of people living with HIV/AIDS (PLHIV. Arthrospira platensis (Asp, also known as Spirulina, is a cyanobacterium rich in proteins and micronutrients. Cell and animal trials described immune-modulating, antiretroviral and antioxidant activities. This pilot study describes the effects of the supplementation of 5 g/day of Asp on a pre-highly-active antiretroviral therapy (pre-HAART, HIV-infected, adult female population. It was conducted as a three-month randomized controlled trial (RCT that compared a cup supplementation of five grams/day of Asp with a placebo of equal protein content and energy. The study included 73 HIV-infected women. The immediate outcome variables were CD4 T-cells, viral load and immune activation by CD8 T-cells expressing CD38. The antioxidant status was assessed by way of the total antioxidant capacity of the serum (TAOS. The renal function was documented by way of creatinine, urea and the calculated glomerular filtration rate. Statistical analyses were carried out with non-parametric tests, and the effect size of each interaction was calculated. No differences in the immunological and virological markers between the Asp and the placebo group could be observed. In the placebo group, 21 of 30 patients (70% developed concomitant events, while in the Asp group, only 12 of 28 patients (43% did. Both groups registered a significant weight increase; 0.5 kg (p < 0.05 in the Asp group and 0.65 kg (p < 0.05 in the placebo group. The antioxidant capacity increase of 56 (1–98 µM for Asp was significantly different from the decrease observed in the placebo group (p < 0.001. A slight increase in the creatinine level of 0.1 g/dL (p < 0.001 was observed in the Asp group, and no effect was observed in the urea levels. The improvement of the antioxidant capacity under Asp, shown for the first time on PLHIV, could become a focus for future research on the nutritional and

  8. An oral high dose of cholecalciferol restores vitamin D status in deficient postmenopausal HIV-1-infected women independently of protease inhibitors therapy: a pilot study.

    Science.gov (United States)

    Pepe, Jessica; Mezzaroma, Ivano; Fantauzzi, Alessandra; Falciano, Mario; Salotti, Alessandra; Di Traglia, Mario; Diacinti, Daniele; Biondi, Piergianni; Cipriani, Cristiana; Cilli, Mirella; Minisola, Salvatore

    2016-07-01

    The best repletion and maintenance dosing regimens with cholecalciferol in vitamin D-deficient HIV-1 patients remain unknown. Protease inhibitors (PIs) have been shown to inhibit vitamin D 1α- and 25α-hydroxylation in hepatocyte and monocyte cultures. We therefore evaluated the effect of a single high dose of cholecalciferol in vitamin D-deficient HIV-1 postmenopausal women undergoing treatment with highly active anti-retroviral therapy (cART), with and without PIs. Forty HIV-1 postmenopausal women treated with cART, with hypovitaminosis D (ng/ml), were enrolled. We measured serum changes of 25-hydroxyvitamin D [25(OH)D]; 1,25-dihydroxyvitamin D [1,25(OH)2D], parathyroid hormone (PTH), serum calcium, and urinary calcium excretion following a loading dose of 600,000 IU of cholecalciferol after 3, 30, 60, 90, and 120 days. Patients were divided into two groups, whether or not they were taking PI. A significant increase in mean 25(OH)D and 1,25(OH)2D levels at day 3 and throughout the entire observation period was found in both groups (p < 0.001). PTH levels concomitantly decreased in both groups (p < 0.001). Mean albumin-adjusted serum calcium increases with respect to baseline were significant only at day 3 and day 30 for both groups (p < 0.01). Considering remaining parameters, there were no significant differences between the groups at any time, by two-way RM ANOVA. An oral dose of 600,000 IU of cholecalciferol in HIV-1 postmenopausal women rapidly increases 25(OH)D and 1,25(OH)2D levels reducing PTH levels, regardless of the presence of PIs in the cART scheme. PMID:26254790

  9. Atherogenic index of plasma in highly active antiretroviral therapy-naïve patients with human immunodeficiency virus infection in Southeast Nigeria

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    Cajetan C Onyedum

    2014-01-01

    Full Text Available Introduction: Metabolic abnormalities are often common among human immunodeficiency virus (HIV patients. The atherogenic index of plasma (AIP is increasingly being used as a screening tool for dyslipidemia as it predicts the presence of small, dense, and highly atherogenic low density lipoprotein (LDL and high density lipoprotein (HDL particles. The aim of this study was to identify the pattern and predictors of an abnormal atherogenic index in highly active antiretroviral therapy (HAART-naïve HIV patients. Materials and Methods: HAART-naïve patients with HIV infection were recruited for this cross-sectional study. Anthropometric indices, blood pressure, CD4 count, viral load, fasting blood glucose, and lipid profiles were determined. Total cholesterol (TCH/HDL, triglyceride (TG/HDL, and LDL/HDL ratios were calculated. The AIP was calculated as log (TG/HDL. The correlations between AIP and the other lipoprotein ratios and predictors of AIP were determined using stepwise multiple linear regression. P 0.24 constituted up to 226 (64% of the patients. There were significant correlations between AIP and CD4 count, body mass index, LDL, TCH/HDL, and LDL/HDL. Predictors of AIP were CD4 count, TCH/HDL, and LDL/HDL. Conclusion: Abnormal AIP is frequent in HAART-naïve HIV patients and is inversely related to their level of immunity. We recommend that AIP estimation should be part of baseline assessment of HIV patients before the commencement of therapy.

  10. Impact of HIV-1 infection and highly active antiretroviral therapy on the kinetics of CD4+ and CD8+ T cell turnover in HIV-infected patients

    Science.gov (United States)

    Lempicki, Richard A.; Kovacs, Joseph A.; Baseler, Michael W.; Adelsberger, Joseph W.; Dewar, Robin L.; Natarajan, Ven; Bosche, Marjorie C.; Metcalf, Julia A.; Stevens, Randy A.; Lambert, Laurie A.; Alvord, W. Gregory; Polis, Michael A.; Davey, Richard T.; Dimitrov, Dimiter S.; Lane, H. Clifford

    2000-01-01

    To evaluate the effects of HIV infection on T cell turnover, we examined levels of DNA synthesis in lymph node and peripheral blood mononuclear cell subsets by using ex vivo labeling with BrdUrd. Compared with healthy controls (n = 67), HIV-infected patients (n = 57) had significant increases in the number and fraction of dividing CD4+ and CD8+ T cells. Higher percentages of dividing CD4+ and CD8+ T cells were noted in patients with the higher viral burdens. No direct correlation was noted between rates of T cell turnover and CD4+ T cell counts. Marked reductions in CD4+ and CD8+ T cell proliferation were seen in 11/11 patients 1–12 weeks after initiation of highly active antiretroviral therapy (HAART). These reductions persisted for the length of the study (16–72 weeks). Decreases in naïve T cell proliferation correlated with increases in the levels of T cell receptor rearrangement excision circles. Division of CD4+ and CD8+ T cells increased dramatically in association with rapid increases in HIV-1 viral loads in 9/9 patients 5 weeks after termination of HAART and declined to pre-HAART-termination levels 8 weeks after reinitiation of therapy. These data are consistent with the hypothesis that HIV-1 infection induces a viral burden-related, global activation of the immune system, leading to increases in lymphocyte proliferation. PMID:11095734

  11. Epstein-Barr virus DNA loads in adult human immunodeficiency virus type 1-infected patients receiving highly active antiretroviral therapy

    Science.gov (United States)

    Ling, Paul D.; Vilchez, Regis A.; Keitel, Wendy A.; Poston, David G.; Peng, Rong Sheng; White, Zoe S.; Visnegarwala, Fehmida; Lewis, Dorothy E.; Butel, Janet S.

    2003-01-01

    Patients with human immunodeficiency virus type 1 (HIV-1) infection are at high risk of developing Epstein-Barr virus (EBV)-associated lymphoma. However, little is known of the EBV DNA loads in patients receiving highly active antiretroviral therapy (HAART). Using a real-time quantitative polymerase chain reaction assay, we demonstrated that significantly more HIV-1-infected patients receiving HAART than HIV-1-uninfected volunteers had detectable EBV DNA in blood (57 [81%] of 70 vs. 11 [16%] of 68 patients; P=.001) and saliva (55 [79%] of 68 vs. 37 [54%] of 68 patients; P=.002). The mean EBV loads in blood and saliva samples were also higher in HIV-1-infected patients than in HIV-1-uninfected volunteers (P=.001). The frequency of EBV detection in blood was associated with lower CD4+ cell counts (P=.03) among HIV-1-infected individuals, although no differences were observed in the EBV DNA loads in blood or saliva samples in the HIV-1-infected group. Additional studies are needed to determine whether EBV-specific CD4+ and CD8+ cells play a role in the pathogenesis of EBV in HIV-1-infected patients receiving HAART.

  12. Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices

    Science.gov (United States)

    Radix, Asa; Sevelius, Jae; Deutsch, Madeline B

    2016-01-01

    Introduction Studies have shown that transgender women (TGW) are disproportionately affected by HIV, with an estimated HIV prevalence of 19.1% among TGW worldwide. After receiving a diagnosis, HIV-positive TGW have challenges accessing effective HIV treatment, as demonstrated by lower rates of virologic suppression and higher HIV-related mortality. These adverse HIV outcomes have been attributed to the multiple sociocultural and structural barriers that negatively affect their engagement within the HIV care continuum. Guidelines for feminizing hormonal therapy among TGW recommend combinations of oestrogens and androgen blockers. Pharmacokinetic studies have shown that certain antiretroviral therapy (ART) agents, such as protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and cobicistat, interact with ethinyl estradiol, the key oestrogen component of oral contraceptives (OCPs). The goal of this article is to provide an overview of hormonal regimens used by TGW, to summarize the known drug-drug interactions (DDIs) between feminizing hormonal regimens and ART, and to provide clinical care recommendations. Methods The authors identified English language articles examining DDIs between oestrogen therapy, androgen blockers and ART published between 1995 and 2015 using PubMed, Cumulative Index to Nursing and Allied Health Literature and EBSCOhost. Results and Discussion Published articles predominantly addressed interactions between ethinyl estradiol and NNRTIs and PIs. No studies examined interactions between ART and the types and doses of oestrogens found in feminizing regimens. DDIs that may have the potential to result in loss of virologic suppression included ethinyl estradiol and amprenavir, unboosted fosamprenavir and stavudine. No clinically significant DDIs were noted with other anti-retroviral agents or androgen blockers Conclusions There are insufficient data to address DDIs between ART and feminizing hormone regimens used by TGW

  13. Pulmonary toxoplasmosis in human immunodeficiency virus-infected patients in the era of antiretroviral therapy.

    Science.gov (United States)

    Velásquez, Jorge N; Ledesma, Bibiana A; Nigro, Monica G; Vittar, Natalia; Rueda, Nestor; De Carolis, Luis; Figueiras, Olga; Carnevale, Silvana; Corti, Marcelo

    2016-01-01

    Toxoplasmosis is a severe opportunistic infection in patients infected with the human immunodeficiency virus (HIV). The lung is a major site of infection after the central nervous system. In this report we described two cases of pneumonia due to Toxoplasma gondii infection in HIV patients with antiretroviral therapy. Clinical and radiological abnormalities are not specific. Pulmonary toxoplasmosis should be considered in HIV-infected patients with late stage of HIV, CD4 count less than 100 cells/µl and a poor adherence to HAART.

  14. Foamy Virus Vectors for HIV Gene Therapy

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    Grant D. Trobridge

    2013-10-01

    Full Text Available Highly active antiretroviral therapy (HAART has vastly improved outcomes for patients infected with HIV, yet it is a lifelong regimen that is expensive and has significant side effects. Retroviral gene therapy is a promising alternative treatment for HIV/AIDS; however, inefficient gene delivery to hematopoietic stem cells (HSCs has so far limited the efficacy of this approach. Foamy virus (FV vectors are derived from non-pathogenic viruses that are not endemic to the human population. FV vectors have been used to deliver HIV-inhibiting transgenes to human HSCs, and they have several advantages relative to other retroviral vectors. These include an attractive safety profile, broad tropism, a large transgene capacity, and the ability to persist in quiescent cells. In addition, the titers of FV vectors are not reduced by anti-HIV transgenes that affect the production of lentivirus (LV vectors. Thus FV vectors are very promising for anti-HIV gene therapy. This review covers the advantages of FV vectors and describes their preclinical development for anti-HIV gene therapy.

  15. Inhibition of human immunodeficiency virus type-1 by cdk inhibitors

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    Kehn-Hall Kylene

    2010-03-01

    Full Text Available Abstract Current therapy for human immunodeficiency virus (HIV-1 infection relies primarily on the administration of anti-retroviral nucleoside analogues, either alone or in combination with HIV-protease inhibitors. Although these drugs have a clinical benefit, continuous therapy with the drugs leads to drug-resistant strains of the virus. Recently, significant progress has been made towards the development of natural and synthetic agents that can directly inhibit HIV-1 replication or its essential enzymes. We previously reported on the pharmacological cyclin-dependent kinase inhibitor (PCI r-roscovitine as a potential inhibitor of HIV-1 replication. PCIs are among the most promising novel antiviral agents to emerge over the past few years. Potent activity on viral replication combined with proliferation inhibition without the emergence of resistant viruses, which are normally observed in HAART patients; make PCIs ideal candidates for HIV-1 inhibition. To this end we evaluated twenty four cdk inhibitors for their effect on HIV-1 replication in vitro. Screening of these compounds identified alsterpaullone as the most potent inhibitor of HIV-1 with activity at 150 nM. We found that alsterpaullone effectively inhibits cdk2 activity in HIV-1 infected cells with a low IC50 compared to control uninfected cells. The effects of alsterpaullone were associated with suppression of cdk2 and cyclin expression. Combining both alsterpaullone and r-roscovitine (cyc202 in treatment exhibited even stronger inhibitory activities in HIV-1 infected PBMCs.

  16. Role of MRP Transporters in Regulating Antimicrobial Drug Inefficacy and Oxidative Stress-induced Pathogenesis during HIV-1 and TB Infections

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    Upal eRoy

    2015-09-01

    Full Text Available Multi-Drug Resistance Proteins (MRPs are members of the ATP binding cassette (ABC drug-efflux transporter superfamily. MRPs are known to regulate the efficacy of a broad range of anti-retroviral drugs (ARV used in highly active antiretroviral therapy (HAART and antibacterial agents used in Tuberculus Bacilli (TB therapy. Due to their role in efflux of glutathione (GSH conjugated drugs, MRPs can also regulate cellular oxidative stress, which may contribute to both HIV and/or TB pathogenesis. This review focuses on the characteristics, functional expression, and modulation of known members of the MRP family in HIV infected cells exposed to ARV drugs and discusses their known role in drug-inefficacy in HIV/TB-induced dysfunctions. Currently, nine members of the MRP family (MRP1-MRP9 have been identified, with MRP1 and MRP2 being the most extensively studied. Details of the other members of this family have not been known until recently, but differential expression has been documented in inflammatory tissues. Researchers have found that the distribution, function and reactivity of members of MRP family vary in different types of lymphocytes and macrophages, and are differentially expressed at the basal and apical surfaces of both endothelial and epithelial cells. Therefore, the prime objective of this review is to delineate the role of MRP transporters in HAART and TB therapy and their potential in precipitating cellular dysfunctions manifested in these chronic infectious diseases. We also provide an overview of different available options and novel experimental strategies that are being utilized to overcome the drug resistance and disease pathogenesis mediated by these membrane transporters.

  17. Second-line protease inhibitor-based highly active antiretroviral therapy after failing non-nucleoside reverse transcriptase inhibitors-based regimens in Asian HIV-infected children

    Science.gov (United States)

    Bunupuradah, Torsak; Puthanakit, Thanyawee; Fahey, Paul; Kariminia, Azar; Yusoff, Nik Khairulddin Nik; Khanh, Truong Huu; Sohn, Annette H.; Chokephaibulkit, Kulkanya; Lumbiganon, Pagakrong; Hansudewechakul, Rawiwan; Razali, Kamarul; Kurniati, Nia; Huy, Bui Vu; Sudjaritruk, Tavitiya; Kumarasamy, Nagalingeswaran; Fong, Siew Moy; Saphonn, Vonthanak; Ananworanich, Jintanat

    2013-01-01

    Background The WHO recommends boosted protease inhibitor (bPI)-based highly active antiretroviral therapy (HAART) after failing non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment. We examined outcomes of this regimen in Asian HIV-infected children. Methods Children from five Asian countries in the TREAT Asia Pediatric HIV Observational Database (TApHOD) with ≥24 weeks of NNRTI-based HAART followed by ≥24 weeks of bPI-based HAART were eligible. Primary outcomes were the proportions with virologic suppression (HIV-RNA <400 copies/ml) and immune recovery (CD4% ≥25% if age <5 years and CD4 count ≥500 cells/mm3 if age ≥5 years) at 48 and 96 weeks. Results Of 3422 children, 153 were eligible; 52% were female. At switch, median age was 10 years, 26% were in WHO stage 4. Median weight-for-age z-score (WAZ) was −1.9 (n=121), CD4% was 12.5% (n=106), CD4 count was 237 (n=112) cells/mm3, and HIV-RNA was 4.6 log10copies/ml (n=61). The most common PI was lopinavir/ritonavir (83%). At 48 weeks, 61% (79/129) had immune recovery, 60% (26/43) had undetectable HIV-RNA and 73% (58/79) had fasting triglycerides ≥130mg/dl. By 96 weeks, 70% (57/82) achieved immune recovery, 65% (17/26) virologic suppression, and hypertriglyceridemia occurred in 66% (33/50). Predictors for virologic suppression at week 48 were longer duration of NNRTI-based HAART (p=0.006), younger age (p=0.007), higher WAZ (p=0.020), and HIV-RNA at switch <10,000 copies/ml (p=0.049). Conclusion In this regional cohort of Asian children on bPI-based second-line HAART, 60% of children tested had immune recovery by one year, and two-thirds had hyperlipidemia, highlighting difficulties in optimizing second-line HAART with limited drug options. PMID:23296119

  18. HAART-related hepatoxicity in pediatric HIV/AIDS%艾滋病患儿高效抗逆转录病毒治疗相关肝毒性

    Institute of Scientific and Technical Information of China (English)

    李在村; 吴昊

    2008-01-01

    抗逆转录病毒药物引起肝毒性比较常见,而且每类药物肝毒性机制不同.儿童患者HAART相关肝毒性的发生机制与成人患者相似,但发生率要低一些.HAART开始后的早期阶段要加强对肝毒性的监测,及时发现肝功能异常,如果肝酶升高超过10倍正常上限或出现肝炎症状要及时停药,如果肝毒性是由奈韦拉平或阿巴卡韦引起的,停药后不要再次应用,以防致命反应的发生.%HAART-related hepatoxieity is common and the mechanisms vary in different class of andretrovimls.The mechanisms are similar in children and adults,but hepatoxicity is less frequent in children.Close monitoring is needed,especially at the early stage of HAART.Discontinuation of HAART is necessary when liver enzymes are elevated to greater than 10-fold upper limit of normal or symptomatic hepatitis development.Nevirapine or abacavir should not be reehallenged after discontinuation due to hepatoxicity.

  19. Activation and coreceptor expression of T lymphocytes induced by highly active antiretroviral therapy in Chinese HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zi-ning; SHANG Hong; JIANG Yong-jun; LIU Jing; DAI Di; DIAO Ying-ying; GENG Wen-qing; JIN Xin; WANG Ya-nan

    2006-01-01

    Background At the end of 2005, 650 000 people lived with human immunodeficiency virus type-1 (HIV-1) in (HAART) supported by the "China CARES" program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution.Methods Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.Results The activation percents of CD4+, CD8+ T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47± 18.85 vs 11.54±4.10; CD38/CD4: 81.34± 10.86 vs 53.34± 11.44;HLA-DR/CD8:63.94±12.71 vs 25.67±9.18; CD38/CD8:86.56±11.41 vs 58.84±6.16, all P<0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4:28.31 ± 13.48; CD38/CD4:69.88 ± 12.64; HLA-DR/CD8: 46.56±18.64;CD38/CD8: 70.17± 14.54, all P<0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8+ T lymphocytes was up-regulated while CXCR4 expression on CD8+ T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5:70.9 1± 10.03 vs 52.70 ±7.68; CD8/CXCR4: 24.14± 11.08 vs 50.05± 11.68, all P<0.01). After 6-month HAART, CCR5 expression on CD8+ T lymphocytes significantly decreased (56.35±12.96, P<0.01), while CXCR4 expression on CD8+ T lymphocytes increased (36.95±9.96, P<0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4+ T lymphocyte counts after HAART (P<0.05).Conclusions Reduced activation of T lymphocytes

  20. 高效抗反转录病毒治疗相关脂肪营养不良综合征的发生及其影响因素%Prevalence and risk factors of lipodystrophy syndrome in acquired immunodeficiency syndrome patients treated with highly active antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    黄宝国; 蔡卫平; 戴朝霞; 胡凤玉; 李凌华; 唐小平

    2014-01-01

    Objective To investigate the prevalence and risk factors of highly active antiretroviral therapy (HAART)-associated lipodystrophy syndrome (LD) in patients with acquired immunodeficiency syndrome (AIDS) treated with HAART in China.Methods A total of 137 AIDS patients treated with HAART for more than 2 years were analyzed.Sixteen clinical parameters (including gender,age,baseline body mass index,baseline human immunodeficiency virus [HIV] viral load,stage of disease,routes of HIV transmission,baseline CD4+ T lymphocyte count,white blood cell count,fasting plasma glucose level,serum triglycerides level,serum cholesterol level and other laboratory results,and HAART regimens) that might be associated with HAART-LD occurrence were evaluated using Cox proportional hazards models.Results HAART regimens were significantly correlated with HAART-LD (P=0.031),while the remaining 15 factors were not associated with the risk of HAART-LD (all P>0.05).Patients who received stavudine d4T)-containing regimen was 2.684 times more likely to develop HAART-LD than patients who received zidovudine (AZT)-containing regimen (95 % CI:1.302-5.531,P=0.007) ; HAART-LD prevalence rates were gradually increased with treatment duration in both groups.First HAART-LD was seen at 24 weeks in both d4T group and AZT group,and the prevalence rates were 2.7%,1.6% at 24 weeks,27.0%,7.9% at 48 weeks and 37.8%,15.9% at 96 weeks respectively.The prevalence of HAART-LD in d4T group was much higher than that in AZT group and the difference was statistically significant (x2 =8.285,P=0.004).Conclusions HAART regimen is an independent predictor of HAART-LD.HAART-LD tend to occur more frequently in patients treated with d4T or AZT,especially d4T.Our study recommends to avoid the use of d4T-contained HAART regimen.%目的 了解我国HIV/艾滋病患者HAART相关脂肪营养不良综合征的发生率并探讨其影响因素.方法 采用Cox比例风险模型,前瞻性地对137例接受HAART 2

  1. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003).

    Science.gov (United States)

    Peretti-Watel, P; Spire, B; Pierret, J; Lert, F; Obadia, Y

    2006-04-01

    This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.

  2. Mutations Related to Antiretroviral Resistance Identified by Ultra-Deep Sequencing in HIV-1 Infected Children under Structured Interruptions of HAART.

    Science.gov (United States)

    Vazquez-Guillen, Jose Manuel; Palacios-Saucedo, Gerardo C; Rivera-Morales, Lydia G; Garcia-Campos, Jorge; Ortiz-Lopez, Rocio; Noguera-Julian, Marc; Paredes, Roger; Vielma-Ramirez, Herlinda J; Ramirez, Teresa J; Chavez-Garcia, Marcelino; Lopez-Guillen, Paulo; Briones-Lara, Evangelina; Sanchez-Sanchez, Luz M; Vazquez-Martinez, Carlos A; Rodriguez-Padilla, Cristina

    2016-01-01

    Although Structured Treatment Interruptions (STI) are currently not considered an alternative strategy for antiretroviral treatment, their true benefits and limitations have not been fully established. Some studies suggest the possibility of improving the quality of life of patients with this strategy; however, the information that has been obtained corresponds mostly to studies conducted in adults, with a lack of knowledge about its impact on children. Furthermore, mutations associated with antiretroviral resistance could be selected due to sub-therapeutic levels of HAART at each interruption period. Genotyping methods to determine the resistance profiles of the infecting viruses have become increasingly important for the management of patients under STI, thus low-abundance antiretroviral drug-resistant mutations (DRM's) at levels under limit of detection of conventional genotyping (drugs. The results could suggest that the evaluated STI program is virologically safe, but strict and carefully planned studies, with greater numbers of patients and interruption/restart cycles, are still needed to evaluate the selection of DRM's during STI. PMID:26807922

  3. HIV quasispecies dynamics during pro-active treatment switching: impact on multi-drug resistance and resistance archiving in latent reservoirs.

    Directory of Open Access Journals (Sweden)

    Max von Kleist

    Full Text Available The human immunodeficiency virus (HIV can be suppressed by highly active anti-retroviral therapy (HAART in the majority of infected patients. Nevertheless, treatment interruptions inevitably result in viral rebounds from persistent, latently infected cells, necessitating lifelong treatment. Virological failure due to resistance development is a frequent event and the major threat to treatment success. Currently, it is recommended to change treatment after the confirmation of virological failure. However, at the moment virological failure is detected, drug resistant mutants already replicate in great numbers. They infect numerous cells, many of which will turn into latently infected cells. This pool of cells represents an archive of resistance, which has the potential of limiting future treatment options. The objective of this study was to design a treatment strategy for treatment-naive patients that decreases the likelihood of early treatment failure and preserves future treatment options. We propose to apply a single, pro-active treatment switch, following a period of treatment with an induction regimen. The main goal of the induction regimen is to decrease the abundance of randomly generated mutants that confer resistance to the maintenance regimen, thereby increasing subsequent treatment success. Treatment is switched before the overgrowth and archiving of mutant strains that carry resistance against the induction regimen and would limit its future re-use. In silico modelling shows that an optimal trade-off is achieved by switching treatment at days after the initiation of antiviral therapy. Evaluation of the proposed treatment strategy demonstrated significant improvements in terms of resistance archiving and virological response, as compared to conventional HAART. While continuous pro-active treatment alternation improved the clinical outcome in a randomized trial, our results indicate that a similar improvement might also be reached after

  4. Motivos de internación vinculados a la infección por HIV en la era pre y post-tratamiento antirretroviral de alta eficacia HIV patient hospitalization during the pre and post-HAART era

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    Eduardo Pérez

    2005-12-01

    Full Text Available El objetivo del estudio fue describir y comparar las características de internación de pacientes infectados por el HIV en dos períodos, uno previo y otro posterior a la disponibilidad del tratamiento antirretroviral de alta eficacia en nuestro medio. Diseñamos un estudio retrospectivo observacional. Se relevó la información demográfica y las características de las internaciones: motivo, días de hospitalización, evolución y tratamiento antirretroviral al ingreso. Se revisaron 522 internaciones correspondientes a 330 pacientes en 2 períodos: 1995-96 (n=289 y 2001-02 (n=233. Los motivos más frecuentes de internación fueron las enfermedades marcadoras de sida: 57.1% y 59.7% en los períodos 1 y 2 respectivamente. La tuberculosis fue la causa principal de internación en ambos períodos (23.9% y 15.5%, seguida de criptococosis (3.5% y 7.3%, neumonía por Pneumocystis jiroveci (5.9% y 9.4% y toxoplasmosis (6.9% y 8.6%. La mortalidad no se modificó de manera significativa (13.5% y 16.1%. La infección por HIV se diagnosticó en el 30% de los pacientes internados. Durante el 2° período, observamos una disminución en el número de pacientes que se internaron más de una vez (41.7% y 26.8%. El porcentaje de pacientes con tratamiento antirretroviral al ingreso aumentó del 8% al 25%. No observamos diferencias en las causas de internación y en la evolución de los pacientes en los períodos estudiados. La tuberculosis fue la enfermedad que más frecuentemente motivó la hospitalización. El número de internaciones se mantuvo estable, mientras que se observó un aumento en el número de consultas ambulatorias en ambos períodos (1678, 2512, 5670 y 7074 consultas para los años 1995, 1996, 2001 y 2002 respectivamente.The purpose of this study was todescribe and to compare the characteristics of patient admissions during two periods, one pre HAART and the other when HAART was fully available. A retrospective analysis of demographic data

  5. Prevalence of drug resistance mutations in HAART patients infected with HIV-1 CRF06_cpx in Estonia.

    Science.gov (United States)

    Avi, Radko; Pauskar, Merit; Karki, Tõnis; Kallas, Eveli; Jõgeda, Ene-Ly; Margus, Tõnu; Huik, Kristi; Lutsar, Irja

    2016-03-01

    HIV-1 drug resistance mutations (DRMs) and substitutions were assessed after the failure of the first line non-nucleoside reverse transcriptase inhibitors (NNRTIs) + 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) treatment regimens (efavirenz [EFV] + lamivudine[3TC] + zidovudine [ZDV] vs. EFV + 3TC + ddI) among the HIV-1 CRF06_cpx infected subjects in Estonia. HIV-1 genomic RNA was sequenced; DRMs and amino acid substitutions were compared in 44 treatment naïve and 45 first-line NNRTI + 2 NRTI treatment failed patients consisting of EFV + 3TC + ZDV (n = 17) and EFV + 3TC + didanosine[ddI] (n = 21) therapy failed sub-populations. At least one DRM was found in 78% of treatment experienced patients. The most common NRTI mutations were M184V (80%), L74V (31%), L74I (17%), K219E (9%), and M184I (9%), NNRTI mutations were K103N (83%), P225H (14%), L100I (11%), and Y188L (11%), reflecting generally the similar pattern of DRMs to that seen in treatment failed subtype B viruses. Sub-population analysis revealed that EFV + 3TC + ddI failed patients had more DRMs compared to EFV + 3TC + ZDV failed patients, especially the ddI DRM L74IV and several additional NNRTI DRMs. Additionally, CRF06_cpx specific mutation E179V and substitutions R32K, K122E, and V200AE were also detected in treatment experienced population. After the failure of the first-line EFV + 3TC + ddI therapy HIV-1 CRF06_cpx viruses develop additional NRTI and NNRTI mutations compared to EFV + 3TC + ZDV regimen. Therefore the usage of EFV + 3TC + ddI in this subtype decreases the options for next regimens containing abacavir, and NNRTI class agents. PMID:26291050

  6. HIV and HCV Co-Culture Promotes Profibrogenic Gene Expression through an Epimorphin-Mediated ERK Signaling Pathway in Hepatic Stellate Cells

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    Shi, Lei; Qin, Enqiang; Zhou, Junnian; Zhao, Juanjuan; Nie, Weimin; Jiang, Tianjun; Chen, Weiwei; Wu, Dan; Huang, Lei; Liu, Liying; Lv, Liping; Zhao, Min; Zhang, Zheng; Wang, Fusheng

    2016-01-01

    Accelerated fibrosis in patients co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has been a major cause of mortality in the highly active anti-retroviral therapy (HAART) era. However, the role of co-infection in accelerating the progression of liver fibrosis, particularly with regard to the effects of co-infection on hepatic stellate cells (HSCs), remains unclear. We hypothesized that HIV and HCV induce liver fibrosis synergistically by altering the regulation of epimorphin production, and thereby indirectly alter HSC function. Here, we examined the effects of epimorphin on HSC proliferation and invasion, and the changes in fibrogenesis-related gene activity in HSCs (LX2) in the presence of inactivated CXCR4-tropic HIV and HCV (JFH1). The combination of HIV and HCV significantly increased epimorphin expression, which increased the proliferation and invasion capabilities of HSCs. Epimorphin also induced the expression of profibrogenic tissue inhibitor of metalloproteinase 1 (TIMP1) in an extracellular signal-regulated kinase (ERK)-dependent manner. These data indicated that the effects of HIV/HCV co-infection on hepatic fibrosis might be mediated in part by EPM. Strategies to limit the expression of EPM might represent a novel therapeutic approach to prevent the progression of hepatic fibrosis during HIV/HCV co-infection. PMID:27362846

  7. HIV and HCV Co-Culture Promotes Profibrogenic Gene Expression through an Epimorphin-Mediated ERK Signaling Pathway in Hepatic Stellate Cells.

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    Lei Shi

    Full Text Available Accelerated fibrosis in patients co-infected with hepatitis C virus (HCV and human immunodeficiency virus (HIV has been a major cause of mortality in the highly active anti-retroviral therapy (HAART era. However, the role of co-infection in accelerating the progression of liver fibrosis, particularly with regard to the effects of co-infection on hepatic stellate cells (HSCs, remains unclear. We hypothesized that HIV and HCV induce liver fibrosis synergistically by altering the regulation of epimorphin production, and thereby indirectly alter HSC function. Here, we examined the effects of epimorphin on HSC proliferation and invasion, and the changes in fibrogenesis-related gene activity in HSCs (LX2 in the presence of inactivated CXCR4-tropic HIV and HCV (JFH1. The combination of HIV and HCV significantly increased epimorphin expression, which increased the proliferation and invasion capabilities of HSCs. Epimorphin also induced the expression of profibrogenic tissue inhibitor of metalloproteinase 1 (TIMP1 in an extracellular signal-regulated kinase (ERK-dependent manner. These data indicated that the effects of HIV/HCV co-infection on hepatic fibrosis might be mediated in part by EPM. Strategies to limit the expression of EPM might represent a novel therapeutic approach to prevent the progression of hepatic fibrosis during HIV/HCV co-infection.

  8. Trends and predictors of mortality among HIV positive patients in the era of highly active antiretroviral therapy in Uganda

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    John Rubaihayo

    2015-09-01

    Full Text Available Knowledge of mortality trends and predictors among HIV-positive patients in the era of highly active antiretroviral therapy (HAART in resource poor settings is still limited. The aim of this study was to describe trends and predictors of mortality among HIV-positive patients in the era of HAART in Uganda. Data from 2004 to 2013 for adult HIV-positive patients (≥15 years obtaining care and treatment from the AIDS Support Organization in Uganda were reviewed for mortality. Descriptive statistics were analyzed by frequencies and cross tabulations. Calendar period was used as a proxy measure for HAART exposure and a time plot of the proportion of HIV-positive patients reporting dead per year was used to describe the trends. Logistic regression was used to determine the predictors of mortality at bivariate and multivariate levels, respectively. We included in the analysis 95,857 HIV positive patients; 64% were female with median age of 33 years (interquartile range 27-40. Of these 36,133 (38% were initiated on ART and a total of 4279 (4.5% died; 19.5% (835/4279 of those who died had an opportunistic infection. Overall, mortality first increased between 2004 and 2006 and thereafter substantially declined (X2trend=211.9, P<0.001. Mortality was relatively higher in Eastern Uganda compared to other geographical areas. Male gender, older age (>45 years, being from Eastern or Northern Uganda, having none or primary education, being unemployed, advanced immunodeficiency (CD4 count <100 cell/μL or WHO stage III or IV and underweight (<45 kg weight at HAART initiation and calendar period 2004-2008 were significant predictors of mortality (P<0.001. Overall, the expanding coverage of HAART is associated with a declining trend in mortality among HIV positive patients in Uganda. However, mortality trends differed significantly by geographical area and men remain potentially at higher risk of death probably because of delayed initiation on ART. There is urgent

  9. Contracepção hormonal e anti-retrovirais em mulheres infectadas pelo HIV Hormonal contraception and antiretroviral therapy among HIV-infected women

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    Eliana Amaral

    2006-11-01

    Full Text Available Há controvérsia sobre a relação entre o uso de contraceptivos hormonais e o risco de adquirir o vírus da imunodeficiência humana (HIV, e pouco se sabe sobre os efeitos da contracepção hormonal em mulheres infectadas (efeitos colaterais, distúrbios menstruais, progressão da doença, interações com terapias anti-retrovirais. O objetivo deste artigo foi revisar os dados disponíveis quanto à vulnerabilidade ao HIV e à sua transmissibilidade na vigência do uso de contraceptivos hormonais bem como as conseqüências potenciais do uso desses contraceptivos por mulheres HIV-positivas sob terapia anti-retroviral (TARV, com ênfase nas interações medicamentosas. Concluiu-se que ainda não é possível elaborar recomendações, baseadas em evidências, sobre a contracepção hormonal em mulheres portadoras do HIV sob TARV. Assim, os infectologistas e os ginecologistas devem estar atentos às interações potenciais que possam representar aumento de efeitos adversos, individualizando a orientação sobre os esteróides contraceptivos, suas doses e vias de administração, considerando a TARV em uso.There is much controversy regarding the realtionship between the use of hormonal contraceptives and the risk of acquiring human immunodeficiency virus (HIV, and little is known about the effects of hormonal contraception in HIV-infected women (adverse events, menstrual disorders, disease progression, antiretroviral therapy interactions. The aim of the present study was to review available data regarding HIV vulnerability and transmission associated with hormonal contraceptives and the use of these contraceptives by women on antiretroviral therapy, with emphasis on drug interactions. In conclusion, it was not possible to offer evidence-based recommendations for the use of hormonal contraceptives among HIV-infected women under antiretroviral therapy. Infectious disease specialists and gynecologists providing care should be cautious about potential

  10. HIV antiretroviral therapy in resource-limited settings: experiences from Haiti.

    Science.gov (United States)

    Krain, Alysa; Fitzgerald, Daniel W

    2005-06-01

    An unprecedented international effort to expand high activity antiretroviral therapy (HAART) to resource-poor nations has been launched. The World Health Organization (WHO) has created antiretroviral (ARV) treatment guidelines adapted to resource-poor settings. The first-line regimen is two nucleoside reverse transcriptase inhibitors (NsRTIs) and one nonnucleoside reverse transcriptase inhibitor (NNRTI). Therapy is initiated by clinical staging and CD4 T-cell counts when available. Adherence is the responsibility of health care workers. The use of ARV therapy in resource-poor settings faces several challenges, including the poverty of patients, political and social upheavals and violence, social stigma associated with HIV/AIDS, unreliable pharmacy systems, tuberculosis, and lack of trained health care workers. Using our experience in Haiti, we describe how we have addressed these challenges with the goal of increasing access to care for the poor with HIV/AIDS.

  11. Naïve T-Cell Dynamics in Human Immunodeficiency Virus Type 1 Infection: Effects of Highly Active Antiretroviral Therapy Provide Insights into the Mechanisms of Naïve T-Cell Depletion

    Science.gov (United States)

    Di Mascio, Michele; Sereti, Irini; Matthews, Lynn T.; Natarajan, Ven; Adelsberger, Joseph; Lempicki, Richard; Yoder, Christian; Jones, Elizabeth; Chow, Catherine; Metcalf, Julia A.; Sidorov, Igor A.; Dimitrov, Dimiter S.; Polis, Michael A.; Kovacs, Joseph A.

    2006-01-01

    Both naïve CD4+ and naïve CD8+ T cells are depleted in individuals with human immunodeficiency virus type 1 (HIV-1) infection by unknown mechanisms. Analysis of their dynamics prior to and after highly active antiretroviral therapy (HAART) could reveal possible mechanisms of depletion. Twenty patients were evaluated with immunophenotyping, intracellular Ki67 staining, T-cell receptor excision circle (TREC) quantitation in sorted CD4 and CD8 cells, and thymic computed tomography scans prior to and ∼6 and ∼18 months after initiation of HAART. Naïve T-cell proliferation decreased significantly during the first 6 months of therapy (P < 0.01) followed by a slower decline. Thymic indices did not change significantly over time. At baseline, naïve CD4+ T-cell numbers were lower than naive CD8+ T-cell numbers; after HAART, a greater increase in naïve CD4+ T cells than naïve CD8+ T cells was observed. A greater relative change (n-fold) in the number of TREC+ T cells/μl than in naïve T-cell counts was observed at 6 months for both CD4+ (median relative change [n-fold] of 2.2 and 1.7, respectively; P < 0.01) and CD8+ T cell pools (1.4 and 1.2; P < 0.01). A more pronounced decrease in the proliferation than the disappearance rate of naïve T cells after HAART was observed in a second group of six HIV-1-infected patients studied by in vivo pulse labeling with bromodeoxyuridine. These observations are consistent with a mathematical model where the HIV-1-induced increase in proliferation of naïve T cells is mostly explained by a faster recruitment into memory cells. PMID:16501076

  12. HAART治疗期间艾滋病儿童口腔健康与免疫功能的相关研究%Relationships between oral cavity condition and immune function in AIDS children undergoing HAART

    Institute of Scientific and Technical Information of China (English)

    黄玉晓; 唐志荣; 彭圆媛; 陶人川

    2012-01-01

    目的:调查已接受高效抗逆转录病毒治疗(HAART)的艾滋病(AIDS)患儿口腔健康状况和免疫功能,探讨其相关关系及与HAART治疗的时相关系.方法:纳入2010年2~8月期间由广西壮族自治区疾病预防控制中心确诊的AIDS患儿49例,通过病史采集,口腔专科检查收集临床资料,并结合辅助检测获得患儿唾液念珠菌负荷,治疗基线及治疗后外周血CD4+T淋巴细胞绝对数及百分比等数据,进行相关分析.结果:49例AIDS患儿均接受HAART,其中男25例,女24例,年龄3~11岁,平均6.18±2.05岁,共14例(28.6%)存在口腔黏膜病损,依次为口腔念珠菌病8例,口腔溃疡5例,带状疱疹1例.全部患儿中,有31例检出口腔念珠菌(63.3%).患儿治疗基线及治疗后CD4+T淋巴细胞百分比均数分别为0.162±0.110和0.309±0.063 (P <0.01),治疗后的CD4+T淋巴细胞百分比明显高于治疗基线水平.免疫抑制程度与HAART时限之间呈负相关关系(r=-0.418,P=0.003),而与口腔病损之间呈正相关关系(r=0.322,P=0.024).结论:HAART能明显提高艾滋病儿童的免疫功能,但在HAART治疗期间,口腔病损的存在提示艾滋病患儿处于免疫抑制状态.%Objective: To observe oral health condition and immune function in AIDS children undergoing HAART, and to investigate the correlativity of them and the relationships between them and HAART stage. Method: A total of 49 AIDS children were included in this study.and all of them had received HAART in Guangxi Center for Disease Control and Prevention from February 2010 to August 2010. Clinic datum was carried out. Including history taking and oral examination. And assist detection was used to detect and analysis the salivary candidal carriage, the absolute numbers of CD4+ lymphocytes in peripheral blood and the percentages of CD4+ T lymphocytes in the total lymphocytes. Result: Among total of 49 AIDS children undergoing HAART in this study, there were 25 males and 24 females

  13. Mutations Related to Antiretroviral Resistance Identified by Ultra-Deep Sequencing in HIV-1 Infected Children under Structured Interruptions of HAART.

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    Jose Manuel Vazquez-Guillen

    Full Text Available Although Structured Treatment Interruptions (STI are currently not considered an alternative strategy for antiretroviral treatment, their true benefits and limitations have not been fully established. Some studies suggest the possibility of improving the quality of life of patients with this strategy; however, the information that has been obtained corresponds mostly to studies conducted in adults, with a lack of knowledge about its impact on children. Furthermore, mutations associated with antiretroviral resistance could be selected due to sub-therapeutic levels of HAART at each interruption period. Genotyping methods to determine the resistance profiles of the infecting viruses have become increasingly important for the management of patients under STI, thus low-abundance antiretroviral drug-resistant mutations (DRM's at levels under limit of detection of conventional genotyping (<20% of quasispecies could increase the risk of virologic failure. In this work, we analyzed the protease and reverse transcriptase regions of the pol gene by ultra-deep sequencing in pediatric patients under STI with the aim of determining the presence of high- and low-abundance DRM's in the viral rebounds generated by the STI. High-abundance mutations in protease and high- and low-abundance mutations in reverse transcriptase were detected but no one of these are directly associated with resistance to antiretroviral drugs. The results could suggest that the evaluated STI program is virologically safe, but strict and carefully planned studies, with greater numbers of patients and interruption/restart cycles, are still needed to evaluate the selection of DRM's during STI.

  14. Mutations Related to Antiretroviral Resistance Identified by Ultra-Deep Sequencing in HIV-1 Infected Children under Structured Interruptions of HAART

    Science.gov (United States)

    Vazquez-Guillen, Jose Manuel; Palacios-Saucedo, Gerardo C.; Rivera-Morales, Lydia G.; Garcia-Campos, Jorge; Ortiz-Lopez, Rocio; Noguera-Julian, Marc; Paredes, Roger; Vielma-Ramirez, Herlinda J.; Ramirez, Teresa J.; Chavez-Garcia, Marcelino; Lopez-Guillen, Paulo; Briones-Lara, Evangelina; Sanchez-Sanchez, Luz M.; Vazquez-Martinez, Carlos A.; Rodriguez-Padilla, Cristina

    2016-01-01

    Although Structured Treatment Interruptions (STI) are currently not considered an alternative strategy for antiretroviral treatment, their true benefits and limitations have not been fully established. Some studies suggest the possibility of improving the quality of life of patients with this strategy; however, the information that has been obtained corresponds mostly to studies conducted in adults, with a lack of knowledge about its impact on children. Furthermore, mutations associated with antiretroviral resistance could be selected due to sub-therapeutic levels of HAART at each interruption period. Genotyping methods to determine the resistance profiles of the infecting viruses have become increasingly important for the management of patients under STI, thus low-abundance antiretroviral drug-resistant mutations (DRM’s) at levels under limit of detection of conventional genotyping (<20% of quasispecies) could increase the risk of virologic failure. In this work, we analyzed the protease and reverse transcriptase regions of the pol gene by ultra-deep sequencing in pediatric patients under STI with the aim of determining the presence of high- and low-abundance DRM’s in the viral rebounds generated by the STI. High-abundance mutations in protease and high- and low-abundance mutations in reverse transcriptase were detected but no one of these are directly associated with resistance to antiretroviral drugs. The results could suggest that the evaluated STI program is virologically safe, but strict and carefully planned studies, with greater numbers of patients and interruption/restart cycles, are still needed to evaluate the selection of DRM’s during STI. PMID:26807922

  15. Changing mortality profile among HIV-infected patients in Rio de Janeiro, Brazil: shifting from AIDS to non-AIDS related conditions in the HAART era.

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    Beatriz Grinsztejn

    Full Text Available INTRODUCTION: We describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC, Oswaldo Cruz Foundation (FIOCRUZ. METHODS: Adult patients enrolling from 1986 through 2009 with a minimum follow up of 60 days were included. Vital status was exhaustively checked using patients' medical charts, through active contact with individuals and family members and by linkage with the Rio de Janeiro Mortality database using a previously validated algorithm. The CoDe protocol was used to establish the cause of death. Extended Cox proportional hazards models were used for multivariate modeling. RESULTS: A total of 3530 individuals met the inclusion criteria, out of which 868 (24.6% deceased; median follow up per patient was 3.9 years (interquartile range 1.7-9.2 years. The dramatic decrease in the overall mortality rates was driven by AIDS-related causes that decreased from 9.19 deaths/100PYs n 1986-1991 to 1.35/100PYs in 2007-2009. Non-AIDS related mortality rates remained stable overtime, at around 1 death/100PYs. Immunodeficiency significantly increased the hazard of both AIDS-related and non-AIDS-related causes of death, while HAART use was strongly associated with a lower hazard of death from either cause. CONCLUSIONS: Our results confirm the remarkable decrease in AIDS-related mortality as the HIV epidemic evolved and alerts to the conditions not traditionally related to HIV/AIDS which are now becoming more frequent, needing careful monitoring.

  16. 云南省1194名接受HAART的艾滋病病人的生命质量测评及影响因素分析%Quality of life and related factors among 1 194 AIDS patients receiving HAART in Yunnan province

    Institute of Scientific and Technical Information of China (English)

    王晓锋; 王启林; 杨霞

    2011-01-01

    目的 探讨接受高效抗反转录病毒治疗(HAART)的艾滋病病人的生命质量及其影响因素.方法 采取典型抽样的方法,使用中文版SF 36量表和自编基本情况调查表,对研究对象进行横断面调查,应用Epi Data 3.1建立数据库,SPSS 12.0进行统计分析.结果 选择1个省级、2个州级、5个县级抗病毒治疗医院作为研究现场,选择在2009年4月以前在8个研究现场入组并接受抗病毒治疗的艾滋病病人作为研究对象.①1 194名调查对象,SF 36量表8个领域百分转换得分中,躯体功能(PF)得分最高(86.00±18.48),总健康(GH)得分最低(44.37±21.59),领域间得分差异有统计学意义(P<0.01).②女性病人的GH、肌体疼痛(BP)维度得分高于男性病人(P<0.05);不同年龄的病人在PF、GH 2个领域的得分差异有统计学意义(P<0.05),年龄小的病人PF、GH得分高于年龄大的病人;不同文化程度的病人的PF、生命力(VT)、情感角色(RE)、心理健康(MH)、BP得分差异有统计学意义(P<0.05),文化程度低的病人以上领域得分低于文化程度高的病人;不同婚姻状况的病人生命质量8个领域得分差异均有统计学意义(P<0.05),已婚病人生命质量好于未婚和离异/独居/分居病人;农村户籍的调查对象的PF、GH、社会功能(SF)3个维度得分明显高于城镇户籍的调查对象(P<0.05);不同职业的病人生命质量8个领域得分差异均有统计学意义(P<0.05),公职人员、个体从业人员的生命质量好于无业人员和农民.结论 性别、年龄、文化程度、婚姻状况、户籍、职业是影响高效抗反转录病毒治疗艾滋病病人生命质量的因素.%Objective To investigate the quality of life and related factors among AIDS patients receiving highly active antiretroviral therapy(H AART) . Methods One provincial-level , two prefecture-level and five county-level HAART hospitals were selected as research sites by

  17. Burden of subclinical heart and lung disease detected on thoracic CT scans of HIV patients on HAART

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    Stefano Zona

    2014-11-01

    Full Text Available Introduction: The aim was to determine the prevalence of lung and heart abnormalities on thoracic CT scans in HIV-infected patients who were treated with antiretroviral therapy (ART. Material and Methods: Thoracic CT scans of 903 patients infected with HIV (mean age 48±7 yrs, 29% females were reviewed by three radiologists by consensus. Patients were phenotyped according to smoking status, pack years and years since cessation for ex-smokers. Individuals known to have active lung or heart disease at the time of CT scanning were excluded. Multimorbidity lung and heart disease (MLHD was defined by the presence of >2 lung or heart abnormalities on the CT scan. Results: Prevalence of lung abnormalities were: 326 patients (36.1% with emphysema, 271 (30.0% with bronchiolitis, 44 (4.9% with non-calcified lung nodules, 568 (63% with significant bronchial wall thickening, 150 (16.7% with bronchiectasis, 9 (1% with interstitial lung disease. Overall, 445 patients (49.3% had >2 lung abnormalities. Imaging findings suggestive of prior myocardial infarction (MI were found in 1.4% (13 patients; 26.6% (240 patients had CAC scores of 1 to 100, and 9.8% (89 patients had CAC>100. 13.6% (123 patients of the patients had CAC>100 and/or previous MI. MLHD was present in 484 patients (53.6% and among 78 patients (16% who never smoked. Table 1 describes CT findings according to pack year and stop smoking groups vs never smokers.MLHD increased proportional to cumulative smoking history (p for trend <0.001 and decreased in proportion to the number of years since smoking cessation (p for trend=0.017. Independent predictors for MLHD were: age (OR=1.07, CI 1.05–1.10, sex (OR=1.59, CI 1.15–2.19, current smoking (OR=1.76, CI 1.08–2.89, and pack-years history of smoking (OR=1.03, CI 1.02–1.05. In patients who never smoked, nadir CD4<200 was significantly associated with MLHD after adjustment for age and sex (OR=1.98, CI 1.98–3.63. Conclusions: MLHD is common in HIV

  18. Opportunistic diseases in HIV-infected patients in Gabon following the administration of highly active antiretroviral therapy: a retrospective study.

    Science.gov (United States)

    Okome-Nkoumou, Madeleine; Guiyedi, Vincent; Ondounda, Magloire; Efire, Nora; Clevenbergh, Philippe; Dibo, Mireille; Dzeing-Ella, Arnaud

    2014-02-01

    Opportunistic diseases cause substantial morbidity and mortality to human immunodeficiency virus (HIV)-infected patients. Highly active antiretroviral therapy (HAART) leading to immune reconstitution is the most effective treatment of preventing opportunistic diseases. This retrospective study established an epidemiologic profile of opportunistic diseases 10 years after the introduction of HAART. The HIV antiretroviral therapy-naive patients matching inclusion criteria were included. The primary outcome was the prevalence of opportunistic diseases. From January 1, 2002 to September 30, 2010, 654 opportunistic diseases were identified in 458 patients. Pulmonary tuberculosis, herpes zoster, cerebral toxoplasmosis, oral candidiasis, and severe pneumonia accounted for 22.05%, 15.94%, 14.19%, 14.19%, and 9.39%, respectively. Cryptococcal meningitis and pneumocystosis accounted for 0.44% and 0.21%, respectively. The prevalence of opportunistic diseases in Gabon remains high. New guidelines emphasize the importance of initiating antiretroviral therapy early to reconstitute the immune system, and reduce disease risk, and treat the primary opportunistic infection of pulmonary tuberculosis.

  19. Bezafibrate for the treatment of hypertriglyceridemia in HIV1-infected patients on highly active antiretroviral therapy

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    Juliana Geraix

    2006-06-01

    Full Text Available The use of highly active antiretroviral therapy (HAART in HIV-infected patients has been associated with the development of risk factors for cardiovascular diseases (CD including dyslipidemia and insulin resistance, hypertriglyceridemia being the most frequent metabolic disturbance in these patients. Fibrates are indicated when hypertriglyceridemia is accentuated and persists for over six months. We evaluated the efficacy and safety of bezafibrate for the treatment of hypertriglyceridemia in HIV-infected individuals on HAART. All patients received 400mg/day of bezafibrate and were evaluated three times: Mo (pre-treatment, M1 (one month after treatment, and M2 (six months after treatment. Fifteen adult individuals, eight males and seven females with mean age = 41.2 ± 7.97 years and triglyceride serum levels > 400mg/dL were included in the study. Smoking, alcohol ingestion and sedentarism rates were 50%, 6.66% and 60%, respectively. Family history of CD, hypertension and diabetes mellitus was reported in 33.3%, 40% and 46.7% of the cases, respectively, while dyslipidemia was reported by only 13.3%. More than half of the patients were using a protease inhibitor plus a nucleotide analog transcriptase inhibitor. Eutrophy and tendency toward overweight were observed at all three study time points. There were significant reductions in triglyceride serum levels from Mo to M1 and from Mo to M2. No significant changes were observed in the serum levels of creatine phosphokinase, hepatic enzymes, CD4+, CD8+ and viral load. Therefore, bezafibrate seems to be safe and effective for the reduction of hypertriglyceridemia in HIV-infected patients on HAART.

  20. Self-perception of knowledge and adherence reflecting the effectiveness of antiretroviral therapy

    Science.gov (United States)

    Dagli-Hernandez, Carolina; Lucchetta, Rosa Camila; de Nadai, Tales Rubens; Galduróz, José Carlos Fernandez; Mastroianni, Patricia de Carvalho

    2016-01-01

    Objectives To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART) effectiveness and the factors related to adherence. Method This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ]) and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH) was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ) and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self-report (SMAQ) during monthly drug refill, since it allows monitoring adherence through pharmaceutical assistance. Therefore, patient adherence to HAART could be evaluated using self-perception (CEAT-VIH) and the viral load test. PMID:27695297

  1. Tumores perianais provocados pelo herpes simples Perianal tumors provoked by herpes simplex

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    Sidney Roberto Nadal

    2007-03-01

    dense inflammatory process composed of lymphocytes and plasma cells. Multinucleated giant epithelial cells may be seen in the epidermis. Immunohistochemical tests show HSV presence. Medical therapy is indicated. It is very important to establish the correct diagnosis to relieve symptoms and to avoid an unnecessary surgical treatment. Highly active anti-retroviral therapy (HAART must be introduced for HIV-infected patients to improve immunity.

  2. Atypical manifestation of progressive outer retinal necrosis in AIDS patient with CD4+ T-cell counts more than 100 cells/microL on highly active antiretroviral therapy.

    Science.gov (United States)

    Vichitvejpaisal, Pornpattana; Reeponmahar, Somporn; Tantisiriwat, Woraphot

    2009-06-01

    Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/microL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/microL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient's visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome.

  3. Atypical manifestation of progressive outer retinal necrosis in AIDS patient with CD4+ T-cell counts more than 100 cells/microL on highly active antiretroviral therapy.

    Science.gov (United States)

    Vichitvejpaisal, Pornpattana; Reeponmahar, Somporn; Tantisiriwat, Woraphot

    2009-06-01

    Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/microL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/microL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient's visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome. PMID:19702067

  4. Magnitude of opportunistic infections and associated factors in HIV-infected adults on antiretroviral therapy in eastern Ethiopia

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    Mitiku H

    2015-05-01

    Full Text Available Habtamu Mitiku, Fitsum Weldegebreal, Zelalem Teklemariam Haramaya University, College of Health and Medical Sciences, Department of Medical Laboratory Sciences, Harar, Ethiopia Purpose: The aim of this study was to assess the prevalence of opportunistic infections (OIs and associated factors among HIV-infected adults on anti-retroviral therapy (ART in Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Patients and methods: A hospital-based retrospective study was conducted in 358 HIV-infected adult patients on ART from April to June 2014. Data were collected through review of clinical records. The data was entered and analyzed by using SPSS version 16.0. Univariate and multivariate analyses were performed to determine the association of each independent variable with occurrence of OIs. A 95% confidence interval (CI and P-value less than 0.05 were considered as significant association. Results: A total of 358 patients were included in the study, in which majority (68.4% were females. The mean age of patients was 34 (standard deviation [SD] ±9.8 years. The overall of prevalence of OIs among HIV/AIDS patients on ART was 48%. The highest prevalent rates of OIs observed were tuberculosis (TB (21.23%, followed by Herpes zoster (11.2% and oral candidiasis (9.5%. Baseline CD4 cell count <200 cells/mm3 (adjusted odds ratio [AOR] =1.645, 95% CI =2.187, 3.983, baseline World Health Organization (WHO clinical stage III (AOR =2.801, 95% CI =1.958, 7.165 and IV (AOR =3.856; 95% CI =2.691, 10.390, and not using prophylaxis (AOR =1.912, 95% CI =1.444, 3.824 were found to have strong association with acquisition of OIs. Conclusion: There was a high prevalence of OIs observed in this study. Baselines CD4 count of <200 cells/mm3, advanced WHO clinical stages, and not using prophylaxis were found to be predictors of OIs. Interventions were aimed at promoting early HIV testing and enrollment of HIV-infected individuals into ART services needed before CD4

  5. Low Prevalence of Varicella Zoster Virus and Herpes Simplex Virus Type 2 in Saliva from Human Immunodeficiency Virus-Infected Persons in the Era of Highly Active Antiretroviral Therapy

    Science.gov (United States)

    Wang, Chunmei C.; Yepes, Luis C.; Danaher, Robert J.; Berger, Joseph R.; Mootoor, Yunanan; Kryscio, Richard J.; Miller, Craig S.

    2009-01-01

    Objectives Human herpesviruses (HHVs), e.g. herpes simplex virus (HSV) type 1, Epstein-Barr virus and cytomegalovirus, appear in saliva at greater frequency in persons infected with human immunodeficiency virus (HIV) than healthy individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2 appear simultaneously during HIV infection at greater frequency in saliva during this era of highly active antiretroviral therapy (HAART). The aim of this study was to investigate the prevalence and amounts of VZV and HSV-2 in the saliva of HIV-infected, orally asymptomatic patients. Study Design Quantitative polymerase chain reaction was used to investigate the prevalence, quantity, risk, and correlates of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and 53 healthy controls in a case-control, cross-sectional study. Seventy-eight percent of the HIV-seropositive patients (46/59) were taking HAART. Results VZV DNA was detected in the saliva of 5.1% (3/59) of the HIV-positive group and in only one healthy control 1.9% (1/53; P = 0.62). The amount of VZV DNA in the expressors was low, generally less than 1,100 copies/mL with no observed difference between the HIV-positive group and the controls (P= 1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV shedding occurred in those on HAART, but was not associated with oral lesions, specific CD4+ or CD8+ T-cell levels, or demographic factors. Conclusions VZV was detected at low prevalence in the saliva of HIV-infected persons whereas HSV-2 was not detected in the saliva of this cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding. PMID:20123407

  6. Long-term hepatitis B virus (HBV response to lamivudine-containing highly active antiretroviral therapy in HIV-HBV co-infected patients in Thailand.

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    Woottichai Khamduang

    Full Text Available Approximately 4 million of people are co-infected with HIV and Hepatitis B virus (HBV. In resource-limited settings, the majority of HIV-infected patients initiate first-line highly active antiretroviral therapy containing lamivudine (3TC-containing-HAART and long-term virological response of HBV to lamivudine-containing HAART in co-infected patients is not well known.HIV-HBV co-infected patients enrolled in the PHPT cohort (ClinicalTrials.gov NCT00433030 and initiating a 3TC-containing-HAART regimen were included. HBV-DNA, HIV-RNA, CD4+ T-cell counts and alanine transaminase were measured at baseline, 3 months, 12 months and then every 6 months up to 5 years. Kaplan-Meier analysis was used to estimate the cumulative rates of patients who achieved and maintained HBV-DNA suppression. Of 30 co-infected patients, 19 were positive for HBe antigen (HBeAg. At initiation of 3TC-containing-HAART, median HBV DNA and HIV RNA levels were 7.35 log(10 IU/mL and 4.47 log(10 copies/mL, respectively. At 12 months, 67% of patients achieved HBV DNA suppression: 100% of HBeAg-negative patients and 47% of HBeAg-positive. Seventy-three percent of patients had HIV RNA below 50 copies/mL. The cumulative rates of maintained HBV-DNA suppression among the 23 patients who achieved HBV-DNA suppression were 91%, 87%, and 80% at 1, 2, and 4 years respectively. Of 17 patients who maintained HBV-DNA suppression while still on 3TC, 4 (24% lost HBsAg and 7 of 8 (88% HBeAg-positive patients lost HBeAg at their last visit (median duration, 59 months. HBV breakthrough was observed only in HBeAg-positive patients and 6 of 7 patients presenting HBV breakthrough had the rtM204I/V mutations associated with 3TC resistance along with rtL180M and/or rtV173L.All HBeAg-negative patients and 63% of HBeAg-positive HIV-HBV co-infected patients achieved long-term HBV DNA suppression while on 3TC-containing-HAART. This study provides information useful for the management of co-infected patients

  7. Genetic Modification of Hematopoietic Stem Cells as a Therapy for HIV/AIDS

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    Patrick Younan

    2013-11-01

    Full Text Available The combination of genetic modification and hematopoietic stem cell (HSC transplantation may provide the necessary means to develop an alternative treatment option to conventional antiretroviral therapy. As HSCs give rise to all hematopoietic cell types susceptible to HIV infection, modification of HSCs is an ideal strategy for the development of infection-resistant immune cell populations. Although promising results have been obtained in multiple animal models, additional evidence is needed to convincingly demonstrate the feasibility of this approach as a treatment of HIV-1 infected patients. Here, we review the potential of HSC transplantation and the recently identified limitations of this approach. Using the Berlin Patient as a model for a functional cure, we contrast the confines of autologous versus allogeneic transplantation. Finally, we suggest that although autologous, gene-modified HSC-transplantation may significantly reduce plasma viremia, reaching the lower detection limits currently obtainable through daily HAART will remain a challenging endeavor that will require innovative combinatorial therapies.

  8. Langerhans cells in periodontal disease of HIV- and HIV+ patients undergoing highly active antiretroviral therapy

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    Takeshi Kato Segundo

    2011-06-01

    Full Text Available The aim of this study was to assess and compare quantitatively the presence of S100+ Langerhans cells (LC by immunochemistry techniques in HIV+ and HIV- gingivitis and periodontitis subjects. Additionally, it aimed to evaluate the correlation among densities of these cells with CD4+ and CD8+ T cells, and viral load levels in HIV+ subjects, all using Highly Active Antiretroviral Therapy (HAART. The samples were allocated into four groups: 1 15 subjects with moderate chronic periodontitis (MCP, HIV+; 2 15 subjects with MCP, HIV-; 3 10 subjects with gingivitis (G, HIV+; and 4 10 subjects with G, HIV-. The S100+ cells were assessed in the pocket epithelium, gingival epithelium, and lamina propria. A statistically significant increase of total S100+ cells in HIV+ periodontitis subjects was observed in relation to HIV- periodontitis subjects. No increase of S100+ cells with increased inflammation was observed. No statistically significant correlation among S100+ cells and blood levels of CD4, CD8, and viral load was observed. In conclusion, the use of HAART can aid in achieving viral loads, and it is suggested that it may prevent the destruction of the LC.

  9. Proton Therapy

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Proton Therapy Proton therapy delivers radiation to tumor tissue ... feel during and after the procedure? What is proton therapy and how is it used? Protons are ...

  10. Oxygen Therapy

    Science.gov (United States)

    Oxygen therapy is a treatment that provides you with extra oxygen. Oxygen is a gas that your body ... machine in your home. A different kind of oxygen therapy is called hyperbaric oxygen therapy. It uses oxygen ...

  11. Liver injury in HIV-1-infected patients receiving non-nucleosides reverse transcriptase inhibitors-based antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    LI Zai-cun; LI Hong-jun; DAI Li-li; GAO Yan-qing; CAI Wei-ping; LI Hai-ying; HUANG Xiao-jie; ZHANG Tong; WU Hao

    2010-01-01

    Background Liver injury is one of the most important adverse effects of antiretroviral therapy, leading to therapy changing or discontinuation. Data on liver injury in human immunodeficiency virus-1-infected patients receiving antiretroviral therapy are limited in China. The purpose of this study was to investigate the features of liver injury in human immunodeficiency virus type 1-infected patients receiving non-nucleosides reverse transcriptase inhibitors-based antiretroviral therapy in China.Methods Seventy-five patients on antiretroviral therapy containing non-nucleosides reverse transcriptase inhibitors were retrospectively studied. The patients were divided into 2 groups: group 1 (with liver injury, n=45) and group 2(without liver injury, n=30). The features of liver injury were analyzed. The sex, age, baseline CD4 counts, hepatitis B virus (HBV) and/or hepatitis C virus (HCV) co-infection, hepatotoxic drug use and nevirapine or efavirenz use were compared between two groups.Results Forty-five patients (60.0%), 31 (68.9%) males and 14 (31.1%) females, aged 12 to 52 years (averaged (3g±9)years), experienced at least one episode of liver injury. Forty (53.3%) patients were co-infected with HBV and/or HCV, 42 (56%) patients had concomitant use of antituberculosis drugs or cotrimoxazole, 46 (61.3%) and 29 (38.7%) patients received regimen containing nevirapine and efavirenz, respectively. Grade 1 liver injuries were observed in 26 (57.8%)patients, grade 2 in 16 (35.6%), grade 3 in 2 (4.0%) and grade 4 in 1 (2.2%). Three (6.7%) patients discontinued highly active antiretroviral therapy (HAART) due to liver injury. In group 1, there were 29 (64.4%) patients co-infected with HBV and/or HCV, 32 (71.1%) patients received regimen containing nevirapine, and 30 (66.7%) patients had concomitant use of anti-tuberculosis drugs or cotrimoxazole, respectively, significantly higher than those in group 2 (11 (36.7%), 14 (46.7%)and 12 (40%), respectively; P=0.018, 0.033, 0

  12. Abnormal humoral immune response to influenza vaccination in pediatric type-1 human immunodeficiency virus infected patients receiving highly active antiretroviral therapy

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    Carlos J Montoya

    2007-06-01

    Full Text Available Given that highly active antiretroviral therapy (HAART has been demonstrated useful to restore immune competence in type-1 human immunodeficiency virus (HIV-1-infected subjects, we evaluated the specific antibody response to influenza vaccine in a cohort of HIV-1-infected children on HAART so as to analyze the quality of this immune response in patients under antiretroviral therapy. Sixteen HIV-1-infected children and 10 HIV-1 seronegative controls were immunized with a commercially available trivalent inactivated influenza vaccine containing the strains A/H1N1, A/H3N2, and B. Serum hemagglutinin inhibition (HI antibody titers were determined for the three viral strains at the time of vaccination and 1 month later. Immunization induced a significantly increased humoral response against the three influenza virus strains in controls, and only against A/H3N2 in HIV-1-infected children. The comparison of post-vaccination HI titers between HIV-1+ patients and HIV-1 negative controls showed significantly higher HI titers against the three strains in controls. In addition, post vaccination protective HI titers (defined as equal to or higher than 1:40 against the strains A/H3N2 and B were observed in a lower proportion of HIV-1+ children than in controls, while a similar proportion of individuals from each group achieved protective HI titers against the A/H1N1 strain. The CD4+ T cell count, CD4/CD8 T cells ratio, and serum viral load were not affected by influenza virus vaccination when pre- vs post-vaccination values were compared. These findings suggest that despite the fact that HAART is efficient in controlling HIV-1 replication and in increasing CD4+ T cell count in HIV-1-infected children, restoration of immune competence and response to cognate antigens remain incomplete, indicating that additional therapeutic strategies are required to achieve a full reconstitution of immune functions.

  13. Prevalence, correlates and under-diagnosis of clinical depression among adults on highly active antiretroviral therapy in a Tertiary Health Institution in northeastern Nigeria

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    Abdu Wakawa Ibrahim

    2014-11-01

    Full Text Available Clinical depression is a highly debilitating illness, which is often under-diagnosed and negatively impacts on the quality of life of its sufferers. When it co-exists with other medical conditions, its effect is even more incapacitating. Undiagnosed depression in the context of HIV infection leads to accelerated decline in CD4+ cell counts with concomitant increase in the viral load and poor adherence to the antiretroviral medications which lead to viral mutation and the evolution of resistant strains. This study examined the prevalence of depression, its correlates and the frequency of the diagnosis of the condition among HIV+ subjects on highly active antiretroviral therapy (HAART by the internists and general physicians at the University of Maiduguri Teaching Hospital in Northeastern Nigeria. Three hundred and fifty representative samples of HIV+ adults on HAART were drawn from the Antiretroviral Therapy Clinic of the Institution. Diagnosis of depression was made using the International Classification of Diseases-10 criteria based on Composite International Diagnostic Interview generated data. Socio-demographic and clinical variables were also analyzed for their correlation with depression in the subjects. About 20% of the respondents were diagnosed with clinical depression and no diagnosis of the condition was hitherto entertained in all the respondents. The independent determinants of depression in the participants were: female gender [odds ratio (OR=3.87 (95% confidence interval, CI: 2.089-7.183], past history of psychiatric illness [OR=43.81 (95% CI: 9.731-197.30] and family history of psychiatric illness in first-degree relatives of the subjects [OR=14.364 (95% CI=5.327- 38.729]. Depression is a relatively common psychiatric condition among adults on HAART, there is therefore the need for routine screening of this condition among HIV+ subjects in order to optimize patient care and improve clinical outcomes.

  14. Effects of HAART on the prevalence of cytomegalovirus,herpesviruses 6,7 and 8 in saliva from human im munodeficiency virus-seropositive subjects.%HAART对HIV感染者唾液d类疱疹病毒5-8型分布的影响

    Institute of Scientific and Technical Information of China (English)

    葛柳莹; 李承文; 白劲松; 史会萍; 李榕; 李重熙; 段开文

    2011-01-01

    Objective: This study aimed to determine the presence of CMV, HHV-6, HHV-7 and HHV-8 and HHV-8 in the saliva of HIV-seropositive patients with HAART and non-HAART. Method:CMV, HHV-6, HHV-7 and HHV-8 DNA of Unstimulated whole saliva from 245 HIV-infected patients and 30 healthy HIV-seronegative controls were analyzed by nested- PCR assays. The data was analyzed by the use of SPSS Statistical software version 18.0. Result: There was no difference of detection rates of these four HHVs in saliva between HIV patients with HAART group and non-HAART group CP >0.05) .HAART group, non-HAART group compared with the normal group differences,and the three groups are present CMV, HHV-6, HHV-7 and HHV-8 multiple infections. Conclusion:Oral herpesvirus infection in patients with HIV infection is very common, of which the most prominent are HHV-6 and HHV-7. Saliva may play a possible role in HHVs spread.%目的:探讨高效抗逆转录病毒治疗(HAART)对HIV感染者唾液中人类疱疹病毒5至8型即CMV、HHV-6、HHV-7和HHV-8的分布影响情况.方法:利用巢式PCR技术对受试人群唾液CMV、HHV-6、HHV-7和HHV-8 DNA的存在进行检测,并采用SPSS 18.0软件建立数据库并进行相关指标的统计分析.结果:HIV患者HAART组与非HAART组比较,4种HHV唾液检出率并无差异(P>0.05),HAART组、非HAART组与正常组比较有差异性,而且三组都存在CMV、HHV-6、HHV-7和HHV-8多重感染,HIV人群病毒共同检出率高于正常组,非HAART组高于其它两组.结论:HIV患者中口腔疱疹病毒5-8型感染较为普遍,其中以HHV-6和HHV-7最为突出,HHV-8最低,唾液可能在疱疹病毒传播中起作用.

  15. Cardiometabolic disease risk and HIV status in rural South Africa : establishing a baseline

    NARCIS (Netherlands)

    Clark, Samuel J.; Gomez-Olive, F. Xavier; Houle, Brian; Thorogood, Margaret; Klipstein-Grobusch, Kerstin; Angotti, Nicole; Kabudula, Chodziwadziwa; Williams, Jill; Menken, Jane; Tollman, Stephen

    2015-01-01

    Background: To inform health care and training, resource and research priorities, it is essential to establish how non-communicable disease risk factors vary by HIV-status in high HIV burden areas; and whether long-term anti-retroviral therapy (ART) plays a modifying role. Methods: As part of a coho

  16. Interpreting Liver Function Test in HIV-HBV Coinfection.

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    Tamal Mukherjee

    2013-08-01

    Such co-infected individuals also face increased risk of hepatotoxicity from anti-retroviral therapy. Individuals with HIV-HBV co-infection should have both the infections completely assessed in order to decide on the best therapeutic option for both viruses. [Natl J Med Res 2013; 3(4.000: 342-345

  17. Baseline prevalence and predictors of liver fibrosis among HIV-positive individuals

    DEFF Research Database (Denmark)

    Matthews, G V; Neuhaus, J; Bhagani, S;

    2015-01-01

    deferred antiretroviral therapy (ART) on liver fibrosis progression. METHODS: Sites in the Strategic Timing of AntiRetroviral Treatment (START) study with access to FibroScan® were invited to participate in the Liver Fibrosis Progression Substudy. All substudy participants underwent FibroScan® at baseline...

  18. Pleuropulmonary Kaposi Sarcoma in the Setting of Immune Reactivation

    Science.gov (United States)

    Suresh, Karthik; Semaan, Roy; Arias, Sixto; Karakousis, Petros; Lee, Hans

    2016-01-01

    We present a case of a 26 year with history of HIV/AIDS who presented with a pleural effusion. Serial radiography, pleural fluid analysis as well as clinical symptoms revealed development of Kaposi Sarcoma related immune reconstitution inflammatory syndrome (KS-IRIS) in the setting of initiation of effective anti- retroviral therapy.

  19. Adherence to highly active antiretroviral therapy and its correlates among HIV infected pediatric patients in Ethiopia

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    Amberbir Alemayehu

    2008-12-01

    Full Text Available Abstract Background The introduction of combination antiretroviral therapy (ART has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. This study determines the rates and factors associated with adherence to Antiretroviral (ARV Drug therapy in HIV-infected children who were receiving Highly Active Antiretroviral Therapy (HAART in Addis Ababa, Ethiopia in 2008. Methods A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18 – April 28, 2008. The study population entailed parents/caretaker and index children who were following ART in the health facilities. A structured questionnaire was used for data collection. Results A total of 390 children respondents were included in the study with a response rate of 91%. The majority, equaling 205 (52.6% of the children, were greater than 9 years of age. Fifty five percent of the children were girls. A total of 339 children (86.9% as reported by caregivers were adherent to antiretroviral drugs for the past 7 days before the interview. Numerous variables were found to be significantly associated with adherence: children whose parents did not pay a fee for treatment [OR = 0.39 (95%CI: 0.16, 0.92], children who had ever received any nutritional support from the clinic [OR = 0.34 (95%CI: 0.14, 0.79] were less likely to adhere. Whereas children who took co-trimoxazole medication/syrup besides ARVs [OR = 3.65 (95%CI: 1.24, 10.74], children who did not know their sero-status [OR = 2.53 (95%CI: 1.24, 5.19] and children who were not aware of their caregiver's health problem [OR = 2.45 (95%CI: 1.25, 4.81] were more likely to adhere than their counterparts. Conclusion Adherence to HAART in children in Addis Ababa was higher than

  20. Effectiveness and cost of treatment with maraviroc in HIV infection

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    Viola Sacchi

    2009-12-01

    Full Text Available Since 1995, life expectancy and quality of life of HIV patients improved significantly due to the use of Highly Active Anti-Retroviral Therapy (HAART, consisting of different combinations of three classes of antiretroviral agents, nucleoside and non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. Recently, new treatment options for individuals developing resistance to these drugs have become available, with the appearance of new drug classes like integrase inhibitors, fusion inhibitors and CCR5 antagonists. Maraviroc is the first antiretroviral agent belonging to the latter drug class approved for clinical use. CCR5 receptor antagonists act by blocking the interaction of the HIV virus with the CCR5 chemokine receptor, a co-receptor essential to the entry process of R5-tropic viruses. The drug is indicated, in combination with other antiretroviral products, for treatment-experienced adult patients infected with only CCR5-tropic HIV-1 detectable virus strains. Results of main phase III clinical trials indicate that maraviroc, in combination with optimized background therapy (OBT, causes significantly greater reductions in viral load and increases in CD4+ cell count, as compared to OBT alone in this kind of patients. In Italy, the monthly cost of maraviroc therapy is about € 780. A number of economic evaluations, performed for different settings, demonstrate that the therapy including maraviroc is cost-effective if compared to OBT alone, determining an ICER generally below the threshold of three times the GDP per capita. In the Italian context, the ICER determined by OBT + maraviroc vs OBT alone is approximately 45,000 €/LYG.

  1. Long-term therapy with nevirapine and tropism

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    S Bressan

    2012-11-01

    Full Text Available Objective: A more potent effect on the residual viraemia was ascribed to nevirapine (NVP with respect to other antiretroviral drugs; moreover a selection of X4 strains was described in patients (pts with undetectable viraemia; our aim was to study viro-immunological parameters and tropism for co-receptor in pts on a long term successful therapy with NVP. Methods: 14 pts on HAART from 130 months (GL, median value, range 118–156 months without occurrence of blips, as assessable with the available methods at that time, were retrospectively selected from a single center cohort (Bolzano. Tropism for V3 was determined by population sequencing on blood, and using geno2pheno algorithm; cellular HIV DNA load was analysed by in-house Real-Time. A further eighteen months (mo follow up was then observed. Data were compared with those obtained from a control group of 50 naïve pts (GS, evaluated after a 36-mo successful therapy (median, range 12–84 with various drug combinations, with median baseline (BL CD4 of 50/μl, comparable value with the GL cohort. Results: In 7 pts a R5-tropic (GLR5, FPR median 84.8% and in 7 an X4-tropic strain (GLX4, FPR median 1.1% was demonstrated. BL data of GLR5 were 46 y old, CD4 54/l, HIV-RNA 104,000 cps/ml; HAART from 142 mo, with NVP from 125 (one after 70 mo on NVP switched to protease from 57; at follow up CD4 were 679/l, HIV-DNA 60 cps/106 PBMCs (range<5–252. GLX4 were 46 y, at BL 38 CD4/l, HIV-RNA 250,000 cps/ml; in HAART from 121 mo, with NVP from 97; at follow up CD4 902/l, HIV-DNA 60 cps/106 PBMCs (range<5–225. Six out of seven pts of the two groups were on treatment with abacavir+lamivudine (ABC+3TC and one with tenofovir+emtricitabine. In the subsequent 18 mo four blips were observed (21–71 cps/ml; the backbone was changed to raltegravir in two GLR5 and one GLX4 for convenience. In the 50 GS pts at follow up an X4 strain was found in 50% of 14 efavirenz-treated, in 16% of 6 NVP, and 63% of 30 protease

  2. Newer Gene Editing Technologies toward HIV Gene Therapy

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    Premlata Shankar

    2013-11-01

    Full Text Available Despite the great success of highly active antiretroviral therapy (HAART in ameliorating the course of HIV infection, alternative therapeutic approaches are being pursued because of practical problems associated with life-long therapy. The eradication of HIV in the so-called “Berlin patient” who received a bone marrow transplant from a CCR5-negative donor has rekindled interest in genome engineering strategies to achieve the same effect. Precise gene editing within the cells is now a realistic possibility with recent advances in understanding the DNA repair mechanisms, DNA interaction with transcription factors and bacterial defense mechanisms. Within the past few years, four novel technologies have emerged that can be engineered for recognition of specific DNA target sequences to enable site-specific gene editing: Homing Endonuclease, ZFN, TALEN, and CRISPR/Cas9 system. The most recent CRISPR/Cas9 system uses a short stretch of complementary RNA bound to Cas9 nuclease to recognize and cleave target DNA, as opposed to the previous technologies that use DNA binding motifs of either zinc finger proteins or transcription activator-like effector molecules fused to an endonuclease to mediate sequence-specific DNA cleavage. Unlike RNA interference, which requires the continued presence of effector moieties to maintain gene silencing, the newer technologies allow permanent disruption of the targeted gene after a single treatment. Here, we review the applications, limitations and future prospects of novel gene-editing strategies for use as HIV therapy.

  3. Humanized mice recapitulate key features of HIV-1 infection: a novel concept using long-acting anti-retroviral drugs for treating HIV-1

    OpenAIRE

    Nischang, Marc; Sutmuller, Roger; Gers-Huber, Gustavo; Audigé, Annette; Li, Duo; Rochat, Mary-Aude; Baenziger, Stefan; Hofer, Ursula; Schlaepfer, Erika; Regenass, Stephan; Amssoms, Katie; Stoops, Bart; Van Cauwenberge, Anja; Boden, Daniel; Kraus, Guenter

    2012-01-01

    BACKGROUND: Humanized mice generate a lymphoid system of human origin subsequent to transplantation of human CD34+ cells and thus are highly susceptible to HIV infection. Here we examined the efficacy of antiretroviral treatment (ART) when added to food pellets, and of long-acting (LA) antiretroviral compounds, either as monotherapy or in combination. These studies shall be inspiring for establishing a gold standard of ART, which is easy to administer and well supported by the mice, and for s...

  4. Mechanisms mediating the effects of alcohol and HIV anti-retroviral agents on mTORC1,mTORC2 and protein synthesis in myocytes

    Institute of Scientific and Technical Information of China (English)

    Ly; Q; Hong-Brown; Abid; A; Kazi; Charles; H; Lang

    2012-01-01

    Alcoholism and acquired immune deficiency syndrome are associated with severe muscle wasting.This impairment in nitrogen balance arises from increased protein degradation and a decreased rate of protein synthesis.The regulation of protein synthesis is a complex process involving alterations in the phosphorylation state and protein-protein interaction of various components of the translation machinery and mammalian target of rapamycin(mTOR) complexes.This review describes mechanisms that regulate protein synthesis in cultured C2C12 myocytes following exposure to either alcohol or human immunodeficiency virus antiretroviral drugs.Particular attention is given to the upstream regulators of mTOR complexes and the downstream targets which play an important role in translation.Gaining a better understanding of these molecular mechanisms could have important implications for preventing changes in lean body mass in patients with catabolic conditions or illnesses.

  5. Demographic and HIV-specific characteristics of participants enrolled in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

    DEFF Research Database (Denmark)

    Sharma, S; Babiker, A G; Emery, S;

    2015-01-01

    , 14% as Latino/Hispanic, 8% as Asian and 3% as other. The route of HIV acquisition is reported as men who have sex with men in 55% of participants, heterosexual sex in 38%, injecting drug use in 1% and other/unknown in 5%. Median time since HIV diagnosis is 1.0 year (IQR 0.4-3.0 years) and the median...

  6. Fatores associados à interrupção de tratamento anti-retroviral Factors associated to glycaemic control in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Daniel Panarotto

    2008-08-01

    Full Text Available OBJETIVO: Avaliar as variáveis que influenciam no controle glicêmico de indivíduos diabéticos tipo 2 que freqüentam um serviço de saúde terciário. MÉTODOS: Estudo retrospectivo realizado através de revisão de prontuários dos pacientes atendidos no Ambulatório de Diabetes da Universidade de Caxias do Sul. Avaliamos os pacientes quanto ao controle glicêmico e metabólico e os subdividimos em compensados e descompensados segundo à hemoglobina glicada no início e no final do período avaliado. Analisamos os fatores associados ao controle glicêmico. RESULTADOS: Incluímos na análise 73 pacientes. Em média, observamos que houve melhora de parâmetros relacionados com o controle glicêmico, pressórico e lipídico no período médio de 20 meses de tratamento. No início do acompanhamento, 25% estavam com hemoglobina glicada OBJECTIVE: Evaluate the factors influencing blood glucose control of type 2 diabetic patients attended at a tertiary health care center. METHODS: A retrospective study by review of medical records of patients who attended the Diabetes Clinic at the University of Caxias do Sul was carried out. Patients were evaluated for glycaemic and metabolic control and divided according to glycated hemoglobin at the beginning and end of the period in question, in compensated and not compensated. The factors associated with glycaemic control were analyzed. RESULTS: Seventy three patients were included in the analysis. On the average, improvement of parameters related to glycaemic, pressure and lipid control during the average of 20 months of treatment was observed. In the beginning of the follow-up period, 25% of patients had glycated hemoglobin < 7%, 22.7% had LDL cholesterol < 100mg/dL, 8.7% had systolic blood pressure < 130 mmHg and diastolic < 80 mmHg and no patients had all parameters meeting the recommended goals. At the last visit the percentages were, 42.3%, 37.5%, 30.2% and 9.6% respectively. In the multivariate analysis, younger age, higher levels of LDL cholesterol and insulin use were associated with poor blood glucose control. CONCLUSION: A small part of the sample simultaneously achieved the goals for blood glucose, lipids and blood pressure control. Some factors, such as age and gender can be determinants to achieve control of diabetes. Greater efforts are still needed to achieve the goals for treatment in type 2 diabetic patients.

  7. Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART in Three Chinese Provinces, 2010-2011.

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    Liyan Wang

    Full Text Available Although AIDS-related deaths have had significant economic and social impact following an increased disease burden internationally, few studies have evaluated the cause of AIDS-related deaths among patients with AIDS on combination anti-retroviral therapy (cART in China. This study examines the causes of death among AIDS-patients in China and uses a methodology to increase data accuracy compared to the previous studies on AIDS-related mortality in China, that have taken the reported cause of death in the National HIV Registry at face-value.Death certificates/medical records were examined and a cross-sectional survey was conducted in three provinces to verify the causes of death among AIDS patients who died between January 1, 2010 and June 30, 2011. Chi-square analysis was conducted to examine the categorical variables by causes of death and by ART status. Univariate and multivariate logistic regression were used to evaluate factors associated with AIDS-related death versus non-AIDS related death.This study used a sample of 1,109 subjects. The average age at death was 44.5 years. AIDS-related deaths were significantly higher than non-AIDS and injury-related deaths. In the sample, 41.9% (465/1109 were deceased within a year of HIV diagnosis and 52.7% (584/1109 of the deceased AIDS patients were not on cART. For AIDS-related deaths (n = 798, statistically significant factors included CD4 count <200 cells/mm3 at the time of cART initiation (AOR 1.94, 95%CI 1.24-3.05, ART naïve (AOR 1.69, 95%CI 1.09-2.61; p = 0.019 and age <39 years (AOR 2.96, 95%CI 1.77-4.96.For the AIDS patients that were deceased, only those who initiated cART while at a CD4 count ≥200 cells/mm3 were less likely to die from AIDS-related causes compared to those who didn't initiate ART at all.

  8. Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

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    Côté José

    2012-10-01

    Full Text Available Abstract Background Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I’immunodéficience Humaine–Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™ intervention was developed to provide persons living with HIV (PLHIV with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART among PLHIV. Methods/design A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0, after 3 months (T3 and 6 months (T6 of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT analysis will be carried out to evaluate the true value of the intervention in a real context. Discussion Carrying out this online RCT

  9. Factores relacionados con rehusar el tratamiento antirretroviral en prisión Factors related to refuse antiretroviral therapy in prison

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    Luis Sordo del Castillo

    2008-04-01

    Full Text Available Introducción: A pesar de los beneficios sobre la morbilidad y la mortalidad que tiene el tratamiento antirretroviral de gran actividad, hay pacientes seropositivos que rehúsan tomarlo. Las prisiones nos permiten acceder con más facilidad a esta población. Objetivo: Determinar las características psicosociales de los reclusos que rehúsan el tratamiento antirretroviral. Metodología: Estudio transversal realizado a 580 reclusos seropositivos de 3 cárceles andaluzas. Como variable dependiente se estableció estar en tratamiento o rehusarlo. Las variables independientes fueron: sociodemográficas, psicosociales, relacionadas con el medio penitenciario, clínicas, y relacionadas con el estado de salud y con las drogodependencias. Se realizó un análisis de regresión logística para determinar qué factores se relacionaban con rehusar el tratamiento antirretroviral. Resultados: Al 73,1% de los reclusos seropositivos se les recomendaba el tratamiento con antirretrovirales. De éstos, el 23,1% rechazaba tomarlo, mientras el 76,9% lo tomaba. Los factores relacionados con los reclusos que rehusaban el tratamiento antirretroviral fueron una carga viral elevada, una peor salud autopercibida, un mayor número de entradas en la cárcel y ser visitados por personas diferentes a los familiares. Conclusiones: Hay un grupo de reclusos con características propias que rechazan el tratamiento antirretroviral, sobre el que deben realizarse intervenciones específicas encaminadas a que conozcan las consecuencias de su decisión sobre la evolución de su enfermedad.Introduction: Despite the benefits of highly-active antiretroviral therapy (HAART on morbidity and mortality, some seropositive patients refuse to accept this treatment. Prisons provide easier access to this population. Objective: To determine the psychosocial characteristics of prisoners who refuse HAART. Methods: We performed a cross-sectional study in 580 seropositive prisoners in 3 hospitals in

  10. Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report

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    A. Despotovic

    2016-01-01

    Full Text Available Non-tuberculous mycobacteria are rare but important causes of infection in HIV-positive individuals. A 28-year-old HIV-positive male presented with a high fever, non-productive cough, right subcostal pain, splenomegaly, a very low CD4 count, elevated C-reactive protein and erythrocyte sedimentation rate, and a normal white blood cell count. The suspicion of tuberculosis (TB was very high, and sputum samples were positive for acid-fast bacilli. Standard quadruple anti-TB therapy was initiated, but once culture of the sample revealed Mycobacterium kansasii, pyrazinamide was withdrawn. Highly active antiretroviral therapy (HAART was initiated soon after, consisting of abacavir/lamivudine and efavirenz. The patient's general condition deteriorated 2 weeks after HAART initiation, which could have been due to the development of immune reconstitution inflammatory syndrome (IRIS. The patient recovered and was discharged in good condition. However, the results of resistance testing of the isolated organism arrived after discharge, and showed isoniazid and streptomycin resistance. This is the first case report of M. kansasii infection from Serbia and shows the difficulties encountered during the course of treatment.

  11. Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report.

    Science.gov (United States)

    Despotovic, A; Savic, B; Salemovic, D; Ranin, J; Jevtovic, Dj

    2016-01-01

    Non-tuberculous mycobacteria are rare but important causes of infection in HIV-positive individuals. A 28-year-old HIV-positive male presented with a high fever, non-productive cough, right subcostal pain, splenomegaly, a very low CD4 count, elevated C-reactive protein and erythrocyte sedimentation rate, and a normal white blood cell count. The suspicion of tuberculosis (TB) was very high, and sputum samples were positive for acid-fast bacilli. Standard quadruple anti-TB therapy was initiated, but once culture of the sample revealed Mycobacterium kansasii, pyrazinamide was withdrawn. Highly active antiretroviral therapy (HAART) was initiated soon after, consisting of abacavir/lamivudine and efavirenz. The patient's general condition deteriorated 2 weeks after HAART initiation, which could have been due to the development of immune reconstitution inflammatory syndrome (IRIS). The patient recovered and was discharged in good condition. However, the results of resistance testing of the isolated organism arrived after discharge, and showed isoniazid and streptomycin resistance. This is the first case report of M. kansasii infection from Serbia and shows the difficulties encountered during the course of treatment. PMID:26603644

  12. Treatment outcomes in a decentralized antiretroviral therapy program: a comparison of two levels of care in north central Nigeria.

    Science.gov (United States)

    Okonkwo, Prosper; Sagay, Atiene S; Agaba, Patricia A; Yohanna, Stephen; Agbaji, Oche O; Imade, Godwin E; Banigbe, Bolanle; Adeola, Juliet; Oyebode, Tinuade A; Idoko, John A; Kanki, Phyllis J

    2014-01-01

    Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.

  13. Radiation Therapy

    Science.gov (United States)

    ... therapy. At this time, you will have a physical exam , talk about your medical history , and maybe have imaging tests . Your doctor or nurse will discuss external beam radiation therapy, its benefits and side effects, and ways you can care ...

  14. Self-perception of knowledge and adherence reflecting the effectiveness of antiretroviral therapy

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    Dagli-Hernandez C

    2016-09-01

    Full Text Available Carolina Dagli-Hernandez,1 Rosa Camila Lucchetta,1 Tales Rubens de Nadai,2 José Carlos Fernandez Galduróz,3 Patricia de Carvalho Mastroianni1 1Department of Drugs and Medications, School of Pharmaceutical Sciences of the UNESP – Univ Estadual Paulista, Araraquara, 2Department of Surgery and Anatomy, Americo Brasiliense State Hospital, 3Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP, São Paulo, Brazil Objectives: To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART effectiveness and the factors related to adherence. Method: This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ] and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP] to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results: Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion: A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self

  15. Tissue-specific B-cell dysfunction and generalized memory B-cell loss during acute SIV infection.

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    Sandrine Peruchon

    Full Text Available BACKGROUND: Primary HIV-infected patients display severe and irreversible damage to different blood B-cell subsets which is not restored by highly efficient anti-retroviral therapy (HAART. Because longitudinal investigations of primary HIV-infection is limited by the availability of lymphoid organs, we studied the tissue-specific B-cell dysfunctions in acutely simian immunodeficiency virus (SIV mac251-infected Cynomolgus macaques. METHODS AND FINDINGS: Experiments were performed on three groups of macaques infected for 14, 21 or 28 days and on three groups of animals treated with HAART for two-weeks either initiated at 4 h, 7 or 14 days post-infection (p.i.. We have simultaneously compared changes in B-cell phenotypes and functions and tissue organization of B-cell areas in various lymphoid organs. We showed that SIV induced a steady decline in SIgG-expressing memory (SIgD(-CD27(+ B-cells in spleen and lymph nodes during the first 4 weeks of infection, concomitant to selective homing/sequestration of B-cells to the small intestine and spleen. SIV non-specific Ig production was transiently increased before D14p.i., whereas SIV-specific Ig production was only detectable after D14p.i., coinciding with the presence of CD8(+ T-cells and IgG-expressing plasma cells within germinal centres. Transient B-cell apoptosis on D14p.i. and commitment to terminal differentiation contributed to memory B-cell loss. HAART abrogated B-cell apoptosis, homing to the small intestine and SIV-specific Ig production but had minimal effect on early Ig production, increased B-cell proportions in spleen and loss of memory B-cells. Therefore, virus-B-cell interactions and SIV-induced inflammatory cytokines may differently contribute to early B-cell dysfunction and impaired SIV/HIV-specific antibody response. CONCLUSIONS: These data establish tissue-specific impairments in B-cell trafficking and functions and a generalized and steady memory B-cell loss in secondary lymphoid

  16. 艾滋病合并丙型肝炎抗病毒治疗中肝损害的相关因素%Correlation factors for hepatic lesion in HIV and HCV coinfected patients during the course of antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    李凌华; 唐小平; 蔡卫平

    2010-01-01

    由于传播途径和易感人群相似,HIV合并HCV感染相当常见.HAART虽然改善了患者的寿命和预后,但在HIV合并HCV感染者中长期的用药会使得肝损害的发生率增加,不仅导致治疗费用支出增多,还妨碍了对HIV的长期抑制作用.目前对于HIV合并HCV感染者HAART过程中肝损害的机制了解不多,此文对可能的损害因素,包括HIV/HCV合并感染的双重影响、HAART引起的免疫重建、抗病毒药物的肝毒性、肝脏相关的超敏反应、合并其他机会性感染及酒精暴露等进行综述.合理有效的HAART和抗HCV治疗,可减缓HAART过程中肝损害的发生.%HIV/HCV coinfection is very common because both have similar transmission routes and susceptible population. Although highly active antiretroviral therapy (HAART) has greatly improved the longevity and prognosis of HIV/AIDS patients, the morbidity of hepatic lesion in patients coinfected with HIV and HCV increases after long-term HAART, not only leading to the growth in medical expenditure but also hindering the long-term suppression effects on HTV. As the mechanism of hepatic lesion during the course of HAART in patients with HTV/HCV coinfection is still obscure, the correlation factors about hepatic lesion such as HTV/HCV coinfection, immune reconstitution after HAART, hepatotoxicity caused by antiviral drugs, liver-related supersensitivity, complication with other opportunistic infection, and exposure to alcohol are reviewed in the article. The reasonable and effective therapy regimen against HIV and HCV could decrease the incidence rate of hepatic lesion during the course of HAART.

  17. Economic evaluation of initial antiretroviral therapy for HIV-infected patients: an update of Italian guidelines

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    Colombo GL

    2013-10-01

    Full Text Available Giorgio L Colombo,1,2 Sergio Di Matteo,2 Andrea Antinori,3 Massimo Medaglia,4 Silvia Murachelli,3 Giuliano Rizzardini51Department of Drug Sciences, University of Pavia, Pavia, Italy; 2SAVE – Studi Analisi Valutazioni Economiche, Milan, Italy; 3National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy; 4Pharmaceutical Department, L. Sacco Hospital, Milan, Italy; 5First Division of Infectious Disease, L. Sacco Hospital, Milan, Italy Introduction: Highly active antiretroviral therapy (HAART has allowed many HIV-infected patients to enjoy longer survival and a better quality of life. We performed an economic analysis to estimate the cost-effectiveness of HAART regimens in Italy for managing HIV-naïve infected patients with a viral load below 100,000 copies/mL.Patients and methods: The population considered in the model consisted of adult subjects with an HIV viral load below 100,000 copies/mL who received antiretroviral HAART treatment for the first time, according to the Italian National Guidelines with recommendation grade A1. The incremental cost-effectiveness analysis of quality-adjusted life years (QALYs was carried out by means of a Markov model. Both the outcomes (QALYs and the costs were discounted by 3.5%. The time horizon adopted in the model was 10 years. The point of view of the analysis was that of the Italian national health service.Results: The tenofovir (TDF/emtricitabine (FTC/rilpivirine (RPV single-tablet regimen (STR (€7,417.00 revealed the lowest mean treatment cost. TDF/FTC + raltegravir (RAL showed a better quality of life (0.906 QALY/year, followed by TDF/FTC/RPV (STR; 0.900 QALY/year, TDF/FTC + RPV (multipill regimen (0.889 QALY/year, and TDF/FTC + atazanavir (ATV/r (0.886 QALY/year. TDF/FTC/RPV (STR appeared to be the most cost-effective therapeutic choice (€13,655.00, followed by TDF/FTC + RPV (multipill regimen (€15,803.00, and TDF/FTC + efavirenz (EFV (€16,181.00. The sensitivity analysis on

  18. Therapy Services.

    Science.gov (United States)

    Austin Independent School District, TX.

    Reviewed are the goals and activities of the therapy services in the Austin Early Childhood Special Education Program. Specific sections detail activities for speech therapy (such as diagnostic assessment, habilitation, consultation, and reporting procedures), occupational therapy (including identification and assessment, and services to children,…

  19. Predictors of attrition and immunological failure in HIV-1 patients on highly active antiretroviral therapy from different healthcare settings in Mozambique.

    Directory of Open Access Journals (Sweden)

    Claudia Palladino

    Full Text Available In Mozambique, the evaluation of retention in HIV care and ART programmes is limited. To assess rate and predictors of attrition (no retention in care and HAART effectiveness in HIV-1 infected patients who pay for medication and laboratory testing in Mozambique, we conducted a multicenter survey of HIV-1-infected patients who started HAART during 2002-2006. Cox proportional hazard models were used to assess risk of attrition and of therapy failure. Overall, 142 patients from 16 healthcare centers located in the capital city Maputo were followed-up for 22.2 months (12.1-46.7. The retention rate was 75%, 48% and 37% after one, two and three years, respectively. Risk of attrition was lower in patients with higher baseline CD4 count (P = 0.022 and attending healthcare center 1 (HCC1 (P = 0.013. The proportion of individuals with CD4 count ≤ 200 cells/µL was 55% (78/142 at baseline and decreased to 6% (3/52 at 36 months. Among the patients with available VL, 86% (64/74 achieved undetectable VL levels. The rate of immunologic failure was 17.2% (95% CI: 12.6-22.9 per 100 person-years. Risk of failure was associated to higher baseline CD4 count (P = 0.002, likely reflecting low adherence levels, and decreased with baseline VL ≥ 10,000 copies/mL (P = 0.033. These results suggest that HAART can be effective in HIV-1 infected patients from Mozambique that pay for their medication and laboratory testing. Further studies are required to identify the causes for low retention rates in patients with low CD4 counts and to better understand the association between healthcare setting and attrition rate.

  20. Soft tissue abscess and lymphadenitis due to Mycobacterium avium Complex as an expression of immune reconstitution inflammatory syndrome after a second scheme of highly active antiretroviral therapy Linfadenitis y absceso subcutáneo por Complejo Mycobacterium avium como manifestación de síndrome inflamatorio de reconstitución inmune luego de un segundo esquema de terapia antirretroviral de gran actividad

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2007-08-01

    Full Text Available Immune reconstitution inflammatory syndrome (IRIS is an atypical and unexpected reaction related to highly active antiretroviral therapy (HAART in human immunodeficiency virus (HIV infected patients. IRIS includes an atypical response to an opportunistic pathogen (generally Mycobacterium tuberculosis, Mycobacterium avium complex, cytomegalovirus and herpes varicella-zoster, in patients responding to HAART with a reduction of plasma viral load and evidence of immune restoration based on increase of CD4+ T-cell count. We reported a case of a patient with AIDS which, after a first failure of HAART, developed a subcutaneous abscess and supraclavicular lymphadenitis as an expression of IRIS due to Mycobacterium avium complex after starting a second scheme of HAART.El síndrome inflamatorio de reconstitución inmune (SIRI es una reacción atípica e inesperada relacionada con el tratamiento antirretroviral de gran actividad (TARGA en pacientes infectados por el virus de la inmunodeficiencia humana (VIH. El SIRI representa una respuesta inflamatoria frente a un patógeno oportunista (generalmente Mycobacterium tuberculosis, Complejo Mycobacterium avium, citomegalovirus y herpes varicela-zóster en pacientes que responden a la TARGA con una marcada reducción de la carga viral en plasma y evidencia de una recuperación inmunológica expresada por el incremento de los niveles de linfocitos T CD4+. Presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida que desarrolló un absceso subcutáneo en muslo derecho y una adenitis supraclavicular izquierda como manifestación de SIRI por Complejo Mycobacterium avium luego del inicio de un segundo esquema de TARGA.

  1. Clinical evolution of chronic renal patients with HIV infection in replacement therapy.

    Science.gov (United States)

    Saracho, Ramón; Martín Escobar, Eduardo; Comas Farnés, Jordi; Arcos, Emma; Mazuecos Blanca, Auxiliadora; Gentil Govantes, Miguel Ángel; Castro de la Nuez, Pablo; Zurriaga, Óscar; Ferrer Alamar, Manuel; Bouzas Caamaño, Encarnación; García Falcón, Teresa; Portolés Pérez, José; Herrero Calvo, José A; Chamorro Jambrina, Carlos; Moina Eguren, Íñigo; Rodrigo de Tomás, María Teresa; Abad Díez, José María; Sánchez Miret, José I; Alvarez Lipe, Rafael; Díaz Tejeiro, Rafael; Moreno Alía, Inmaculada; Torres Guinea, Marta; Huarte Loza, Enma; Artamendi Larrañaga, Marta; Fernández Renedo, Carlos; González Fernández, Raquel; Sánchez Álvarez, Emilio; Alonso de la Torre, Ramón

    2015-01-01

    Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.

  2. Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong

    Institute of Scientific and Technical Information of China (English)

    CHAN Chi-wai; CHENG Lai-sim; CHAN Wai-kit; WONG Ka-hing

    2005-01-01

    Background Morbidity and mortality of advanced human immunodeficiency virus infection (HIV) have declined in Western industrialized countries since the availability of highly active antiretroviral therapy (HAART). It is unclear if this has also happened in Hong Kong.Methods We studied a retrospective cohort of patients with advanced HIV disease in Hong Kong, China. First, the mortality of advanced HIV disease per year was calculated for the decade 1993 to 2002, both annually and according to patient observation before and after 1997. Second, the event rates were estimated for the clinical end points of acquired immune deficiency syndrome (AIDS) and death. Univariate and multivariate analyses were then performed to identify associated factors. Results The crude mortality of advanced HIV disease declined from 10.8-30.4 per 100 patients during 1993-1996, to 0.8-6.9 per 100 patients during 1997-2002. A rate ratio of 4.04 (95% CI, 2.52-6.47) was evident for those observed in 1993-1996, compared to those in 1997-2002. In a multivariate analysis where calendar period was adjusted, use of highly active antiretroviral therapy was associated with rate ratios of 0.13 (95% CI, 0.05-0.33) for death after AIDS, 0.08 (95% CI, 0.04-0.19) for AIDS after a CD4 cell count <200/μl, and 0.21 (95% CI, 0.07-0.67) for death after CD4 cell count <200/μl. In the same analysis, calendar period ceased to be a significant factor after adjustment for use of HAART.Conclusions The mortality and morbidity of advanced human immunodeficiency virus disease have declined in Hong Kong. This improved prognosis was attributable to the use of highly active antiretroviral therapy.

  3. Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings

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    Abrogoua DP

    2012-03-01

    Full Text Available Danho Pascal Abrogoua1,2, Brou Jerome Kablan1, Boua Alexis Thierry Kamenan1,3, Gilles Aulagner4, Konan N'Guessan1, Christian Zohoré11Laboratoire de Pharmacie Clinique, Pharmacologie et Therapeutique – UFR Sciences Pharmaceutiques et Biologiques, 2Laboratoire de Pharmacologie Clinique, CHU de Cocody, 3Service de Pharmacie, CHU de Cocody, Abidjan, Cote d'Ivoire, 4Service Pharmaceutique Hopital Louis Pradel, Lyon, FranceObjective: The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting.Methods: Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring.Results: At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm3. At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8 of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response.Conclusion: The relationship between adherence and CD4

  4. Vulnerability and non-adherence to antiretroviral therapy among HIV patients, Minas Gerais State, Brazil Vulnerabilidade e não-adesão à terapia antiretroviral, Minas Gerais, Brasil

    Directory of Open Access Journals (Sweden)

    Palmira de Fátima Bonolo

    2008-11-01

    Full Text Available The aim of the present study was to describe vulnerability profiles and to verify their association with non-adherence to antiretroviral therapy (ART among 295 HIV-patients receiving their first prescription in two public-referral centers in Minas Gerais States, Brazil. The cumulative incidence of non-adherence was 36.9%. Three pure vulnerability profiles (lower, medium and higher were identified based on the Grade of Membership method (GoM. Pure type patients of the "higher vulnerability" profile had, when compared to the overall sample, an increased probability of being younger, not understanding the need of ART, having a personal reason to be HIV-tested, not disclosing their HIV status, having more than one (non-regular sexual partner, reporting use of alcohol, tobacco and illicit drugs, and having sex among men. Non-adherence to ART was statistically associated (p Este estudo teve como objetivos descrever os perfis de vulnerabilidade e verificar suas associações com a não-adesão à terapia anti-retroviral (TARV entre os 295 pacientes com HIV que recebiam suas primeiras prescrições em dois serviços públicos de referência de Minas Gerais, Brasil. A incidência cumulativa de não-adesão foi 36,9%. Foram identificados três perfis puros de vulnerabilidade (baixa, média e alta baseados no método Grade of Membership (GoM. Os tipos puros de pacientes do perfil de "alta vulnerabilidade" tinham, comparados aos outros, probabilidade maior de serem jovens, de não perceberem a necessidade da TARV, de terem uma razão pessoal para realização do teste HIV, de não terem revelado seu status HIV, de terem mais de um (não fixo parceiro sexual, de relatarem uso de álcool, tabaco e drogas ilícitas e sexo entre homens. Não-adesão à TARV foi associada significativamente a esse perfil (p < 0,001. A heterogeneidade da amostra foi alta, pois mais de 40% dos pacientes eram tipos mistos. Conclui-se que os profissionais de saúde devem ser

  5. Proton therapy

    International Nuclear Information System (INIS)

    Proton therapy has become a subject of considerable interest in the radiation oncology community and it is expected that there will be a substantial growth in proton treatment facilities during the next decade. I was asked to write a historical review of proton therapy based on my personal experiences, which have all occurred in the United States, so therefore I have a somewhat parochial point of view. Space requirements did not permit me to mention all of the existing proton therapy facilities or the names of all of those who have contributed to proton therapy. (review)

  6. Cost analysis of initial highly active antiretroviral therapy regimens for managing human immunodeficiency virus-infected patients according to clinical practice in a hospital setting

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    Colombo GL

    2013-12-01

    Full Text Available Giorgio L Colombo,1,2 Antonella Castagna,3 Sergio Di Matteo,2 Laura Galli,3 Giacomo Bruno,2 Andrea Poli,3 Stefania Salpietro,3 Alessia Carbone,3 Adriano Lazzarin3,41Department of Drug Sciences, School of Pharmacy, University of Pavia, Italy; 2Studi Analisi Valutazioni Economiche (S.A.V.E., Milan, 3Infectious Diseases Department, San Raffaele Hospital, Milan, 4Vita-Salute San Raffaele University, Milan, ItalyObjective: In the study reported here, single-tablet regimen (STR versus (vs multi-tablet regimen (MTR strategies were evaluated through a cost analysis in a large cohort of patients starting their first highly active antiretroviral therapy (HAART. Adult human immunodeficiency virus (HIV 1-naïve patients, followed at the San Raffaele Hospital, Milan, Italy, starting their first-line regimen from June 2008 to April 2012 were included in the analysis.Methods: The most frequently used first-line HAART regimens (>10% were grouped into two classes: 1 STR of tenofovir disoproxil fumarate (TDF + emtricitabine (FTC + efavirenz (EFV and 2 MTR including TDF + FTC + EFV, TDF + FTC + atazanavir/ritonavir (ATV/r, TDF + FTC + darunavir/ritonavir (DRV/r, and TDF + FTC + lopinavir/ritoavir (LPV/r. Data were analyzed from the point of view of the Lombardy Regional Health Service. HAART, hospitalizations, visits, medical examinations, and other concomitant non-HAART drug costs were evaluated and price variations included. Descriptive statistics were calculated for baseline demographic, clinical, and laboratory characteristics; associations between categorical variables and type of antiretroviral strategy (STR vs MTR were examined using chi-square or Fisher's exact tests. At multivariate analysis, the generalized linear model was used to identify the predictive factors of the overall costs of the first-line HAART regimens.Results: A total of 474 naïve patients (90% male, mean age 42.2 years, mean baseline HIV-RNA 4.50 log10 copies/mL, and cluster of

  7. Effects of intermittent IL-2 alone or with peri-cycle antiretroviral therapy in early HIV infection: the STALWART study.

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    Jorge A Tavel

    Full Text Available BACKGROUND: The Study of Aldesleukin with and without antiretroviral therapy (STALWART evaluated whether intermittent interleukin-2 (IL-2 alone or with antiretroviral therapy (ART around IL-2 cycles increased CD4(+ counts compared to no therapy. METHODOLOGY: Participants not on continuous ART with > or = 300 CD4(+ cells/mm(3 were randomized to: no treatment; IL-2 for 5 consecutive days every 8 weeks for 3 cycles; or the same IL-2 regimen with 10 days of ART administered around each IL-2 cycle. CD4(+ counts, HIV RNA, and HIV progression events were collected monthly. PRINCIPAL FINDINGS: A total of 267 participants were randomized. At week 32, the mean CD4(+ count was 134 cells greater in the IL-2 alone group (p<0.001, and 133 cells greater in the IL-2 plus ART group (p<0.001 compared to the no therapy group. Twelve participants in the IL-2 groups compared to 1 participant in the group assigned to no therapy experienced an opportunistic event or died (HR 5.84, CI: 0.59 to 43.57; p = 0.009. CONCLUSIONS: IL-2 alone or with peri-cycle HAART increases CD4(+ counts but was associated with a greater number of opportunistic events or deaths compared to no therapy. These results call into question the immunoprotective significance of IL-2-induced CD4(+ cells. TRIAL REGISTRATION: ClinicalTrials.gov NCT00110812.

  8. GENETIC VARIABILITY OF CYP2B6 G516T AND THEIR IMPACT IN EFAVIRENZ BASED HAART: A META-ANALYSIS

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    Anwar Mulugeta et al.

    2012-03-01

    Full Text Available Background: The non-nucleoside reverse transcriptase inhibitor efavirenz is recommended as part of first-line therapy in HIV-infected patients and prescribed at a standard dose of 600 mg once daily. EFV is extensively metabolized primarily by hepatic CYP2B6 with partial involvement of CYP3A4 and CYP2A6. The aim of the study was to assess CYP 2B6 G516T polymorphism and their impact in efavirenz based therapy Methods: A computerized literature search was conducted using the Medline, PubMed, and High wire. Statistical analysis was conducted using comprehensive Meta analysis version 2 software.Result: From fifty four articles only twenty two articles were included in the study based on the inclusion criteria. The average frequency of CYP 2B6 G516T polymorphism, from forest plot of 7 studies, was around 30% which strengthened the idea of substantial number of this polymorphism. Most of the studies had high proportion of mutant allele and the average of the all is around 49%. The mean plasma efavirenz concentration among 516GG, 516 GT and 516 TT holders was 2.869 ± 0.294 µg/ml, 3.464 ± 0.276 µg/ml and 9.659 ± 1.262 µg/ml, respectively and it has significant association with genetic polymorphism of CYP 2B6 G516T. Conclusion: The most common type of CYP 2B6 polymorphism is CYP 2B6 G516T that have significant association with plasma efavirenz concentration. Having genetic test before drug starting is promising in HIV therapy to decrease side effects and to have better treatment outcome.

  9. Factors associated with esophageal candidiasis and its endoscopic severity in the era of antiretroviral therapy.

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    So Nishimura

    Full Text Available Candidia esophagitis (CE is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART era.A total of 733 HIV-infected patients who underwent upper gastrointestinal (GI endoscopy were analyzed. Sexual behavior, CD4(+ count, HIV-RNA viral load (VL, history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II or severe (grade III/IV. Of the 733 subjects, 62 (8.46% were diagnosed with CE (mild, n = 33; severe, n = 29. Of them, 56.5% (35/62 had no GI symptoms, 30.6% (19/62 had CD4 + ≥200 cells/μL, and 55.3% (21/38 had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4(+ counts and higher HIV VL, CE occurrence increased significantly (P<0.01 for trend in odds. Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29 had no GI symptoms and 44.4% (8/18 had no oral candidiasis. Median CD4(+ counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04.Low CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

  10. Immune-based Therapeutic Intervention and Treating AIDS with TCM%免疫干预疗法与中医药治疗艾滋病

    Institute of Scientific and Technical Information of China (English)

    关崇芬

    2004-01-01

    In the treatment of AIDS the highly-active anti-retroviral therapy(HAART) is potential and effective,but after one year of practice, many disadvantages appeared: After withdrawal of medication (short or long term) the plasma virus level rapidly rebound to that of before treatment which existed originally in the lymph nodes ; there are different types of HIV susceptible cells, some of them could not be reached or being insensitive by anti-retroviral therapy(ART) ;ART agent's target is designed against different life cycle, they can lower the plasma VL level to undetectable level, but they cannot revive the destroyed immune system to normal immune function, as soon as withdrawaI occurred, the body still couldn't yield immune response to HIV ; the original combination using of ART is to clear the virus and prevent the drug tolerance, but under the pressure of highdosage of ART, the appearance of tolerance is inevitable. After HAART treatment. 4 kinds of treatment occurred: 40 % patients after effective inhibit plasma VL. immune reconstitution appeared; 40% patients VL does not reduce, but CD4 gradually increase ; 5 % patients VL began to lower, but CD4 without recovery: Completely ineffective, without any improvement both in VL and CD4 count. The tolerance of ART and immune impairment are 2 important factors, the latter is more important. Lymphocyte is activated against HIV replication, including HIV specific cytotoxic action, cytokine secretion, etc. But the large amount of infected cells, the specific viral gene and phenotype variation would cause the activated lymphocyte unable to clear-up the HIV and HIV-infected cells, the specific cytotoxic lymphocyte(CTL)and CD4 T helper inactivated. Three kinds of medicine were being used; Immune cell activator (IL-2, IFN-γ), immunosuppressor ( cyclosporin A) and virus replication inlibitor(IL-10,MIP-lα)to activate macrophage and promote immune response. TCM immuno-modulatory effect in treating AIDS: Immune

  11. Sweat Therapy.

    Science.gov (United States)

    Colmant, Stephen A.; Merta, Rod J.

    2000-01-01

    A study combined group sweating and group counseling. Four adolescent boys with disruptive behavior disorders participated in 12 sweat therapy sessions. They reported the sessions useful for sharing personal concerns and receiving assistance with problem solving. Three boys showed improvement in self-esteem. Advantages of sweat therapy over other…

  12. Gene therapy.

    OpenAIRE

    Mota Biosca, Anna

    1992-01-01

    Applications of gene therapy have been evaluated in virtually every oral tissue, and many of these have proved successful at least in animal models. While gene therapy will not be used routinely in the next decade, practitioners of oral medicine should be aware of the potential of this novel type of treatment that doubtless will benefit many patients with oral diseases.

  13. Optimal control of combined therapy in a single strain HIV-1 model

    Directory of Open Access Journals (Sweden)

    Winston Garira

    2005-05-01

    Full Text Available Highly active antiretroviral therapy (HAART is administered to symptomatic human immunodeficiency virus (HIV infected individuals to improve their health. Various administration schemes are used to improve patients' lives and at the same time suppressing development of drug resistance, reduce evolution of new viral strains, minimize serious side effects, improve patient adherence and also reduce the costs of drugs. We deduce an optimal drug administration scheme useful in improving patients' health especially in poor resourced settings. In this paper we use the Pontryagin's Maximum Principle to derive optimal drug dosages based on a mathematical dynamical model. We use methods of optimal control to determine optimal controls analytically, and then use the Runge-Kutta scheme of order four to numerically simulate different therapy effects. We simulate the different effects of a drug regimen composed of a protease inhibitor and a nucleoside reverse transcriptase inhibitor. Our results indicate that for highly toxic drugs, small dosage sizes and allowing drug holidays make a profound impact in both improving the quality of life and reducing economic costs of therapy. The results show that for drugs with less toxicity, continuous therapy is beneficial.

  14. Myocarditis in CD8-depleted SIV-infected rhesus macaques after short-term dual therapy with nucleoside and nucleotide reverse transcriptase inhibitors.

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    Lakshmanan Annamalai

    Full Text Available BACKGROUND: Although highly active antiretroviral therapy (HAART has dramatically reduced the morbidity and mortality associated with HIV infection, a number of antiretroviral toxicities have been described, including myocardial toxicity resulting from the use of nucleotide and nucleoside reverse transcriptase inhibitors (NRTIs. Current treatment guidelines recommend the use of HAART regimens containing two NRTIs for initial therapy of HIV-1 positive individuals; however, potential cardiotoxicity resulting from treatment with multiple NRTIs has not been addressed. METHODOLOGY/PRINCIPAL FINDINGS: We examined myocardial tissue from twelve CD8 lymphocyte-depleted adult rhesus macaques, including eight animals infected with simian immunodeficiency virus, four of which received combined antiretroviral therapy (CART consisting of two NRTIs [(9-R-2-Phosphonomethoxypropyl Adenine (PMPA and (+/--beta-2',3'-dideoxy-5-fluoro-3'-thiacytidine (RCV] for 28 days. Multifocal infiltrates of mononuclear inflammatory cells were present in the myocardium of all macaques that received CART, but not untreated SIV-positive animals or SIV-negative controls. Macrophages were the predominant inflammatory cells within lesions, as shown by immunoreactivity for the macrophage markers Iba1 and CD68. Heart specimens from monkeys that received CART had significantly lower virus burdens than untreated animals (p<0.05, but significantly greater quantities of TNF-α mRNA than either SIV-positive untreated animals or uninfected controls (p<0.05. Interferon-γ (IFN-γ, IL-1β and CXCL11 mRNA were upregulated in heart tissue from SIV-positive monkeys, independent of antiretroviral treatment, but CXCL9 mRNA was only upregulated in heart tissue from macaques that received CART. CONCLUSIONS/SIGNIFICANCE: These results suggest that short-term treatment with multiple NRTIs may be associated with myocarditis, and demonstrate that the CD8-depleted SIV-positive rhesus monkey is a useful

  15. Clinical value of duodenal biopsies--beyond the diagnosis of coeliac disease.

    Science.gov (United States)

    Walker, Marjorie M; Talley, Nicholas J

    2011-09-15

    At upper gastrointestinal endoscopy to investigate unexplained diarrhea and iron deficiency anemia, duodenal biopsies are often taken to exclude a diagnosis of coeliac disease. While histology remains the gold standard for this diagnosis, recent developments in serological testing may overtake this as a first line test and biopsy restricted to confirming the diagnosis. Established coeliac disease on biopsy is straightforward, but early lesions may pose a challenge. Newer endoscopic procedures such as push-pull enteroscopy (balloon enteroscopy) with biopsy allow access to the small bowel beyond the second part of the duodenum. Controversy remains as to what constitutes the normal histology of the duodenum, and small bowel. Lymphocytic duodenosis (increased intraepithelial lymphocytes with normal villous architecture) in patients with negative coeliac serology can be associated with Helicobacter pylori, drugs, autoimmune and other diseases including food allergy. Full thickness small intestinal biopsies can aid in investigation of enteric neuropathies in severe dysmotility disorders. Biopsies are also taken to investigate malabsorption due to suspected infectious and metabolic disorders. Despite highly active anti-retroviral therapy (HAART), immunosuppressed patients may be affected by duodenal pathogens. The histology of duodenal mucosa in acid related disorders reflects the damage seen at endoscopy. Although the prevalence of duodenal ulcer disease is decreasing, drugs causing ulceration remain an important disease entity. Recent observations in functional bowel disorders suggest that the duodenum may be a key site for pathology. In functional dyspepsia, patients with early satiety may have excess eosinophil infiltration, and the mast cell is probably a key player in the irritable syndrome in the small intestine. PMID:21940106

  16. Proton magnetic resonance spectroscopy reveals neuroprotection by oral minocycline in a nonhuman primate model of accelerated NeuroAIDS.

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    Eva-Maria Ratai

    Full Text Available BACKGROUND: Despite the advent of highly active anti-retroviral therapy (HAART, HIV-associated neurocognitive disorders continue to be a significant problem. In efforts to understand and alleviate neurocognitive deficits associated with HIV, we used an accelerated simian immunodeficiency virus (SIV macaque model of NeuroAIDS to test whether minocycline is neuroprotective against lentiviral-induced neuronal injury. METHODOLOGY/PRINCIPAL FINDINGS: Eleven rhesus macaques were infected with SIV, depleted of CD8+ lymphocytes, and studied until eight weeks post inoculation (wpi. Seven animals received daily minocycline orally beginning at 4 wpi. Neuronal integrity was monitored in vivo by proton magnetic resonance spectroscopy and post-mortem by immunohistochemistry for synaptophysin (SYN, microtubule-associated protein 2 (MAP2, and neuronal counts. Astrogliosis and microglial activation were quantified by measuring glial fibrillary acidic protein (GFAP and ionized calcium binding adaptor molecule 1 (IBA-1, respectively. SIV infection followed by CD8+ cell depletion induced a progressive decline in neuronal integrity evidenced by declining N-acetylaspartate/creatine (NAA/Cr, which was arrested with minocycline treatment. The recovery of this ratio was due to increases in NAA, indicating neuronal recovery, and decreases in Cr, likely reflecting downregulation of glial cell activation. SYN, MAP2, and neuronal counts were found to be higher in minocycline-treated animals compared to untreated animals while GFAP and IBA-1 expression were decreased compared to controls. CSF and plasma viral loads were lower in MN-treated animals. CONCLUSIONS/SIGNIFICANCE: In conclusion, oral minocycline alleviates neuronal damage induced by the AIDS virus.

  17. Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro

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    Fabiana C. Serra

    2007-10-01

    Full Text Available We made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS and its incidence rate in tuberculosis (TB-human immunodeficiency virus (HIV co-infected patients. The incidence rate (IR was calculated using a Poisson regression. The confidence interval (CI that was stipulated was 95%. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART during a mean of 61.7 (±59 days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm³in 50% of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and recovered from TB within a mean of 91 days (±30 days. One relapse of TB was observed, but there were no IRS-related deaths. The incidence rate was higher (IR=11.18; CI, 1.41-88.76 in patients that had superficial lymph node enlargement at the moment of TB diagnosis (not associated with TB, extrapulmonary TB (IR=1.97; CI, 0.44-8.79, were antiretroviral naive (IR=1.85; CI, 0.48-7.16, and CD4 counts <100 cells/mm³ (IR=1.50; CI, 0.40-5.59, although with a wide CI. IRS was frequent in our sample, occurred more frequently in HIV-naive patients with lymph-node enlargement and extrapulmonary TB. No cases of new pulmonary lesions or worsening of pulmonary infiltrates were observed.

  18. Current human immunodeficiency virus epidemic and its response in China

    Institute of Scientific and Technical Information of China (English)

    KANG Lai-Yi

    2012-01-01

    The first patient with acquired immunodeficiency syndrome (AIDS) was identified in 1985; since then, as of October 31, 2010, a total accumulative number of 370 000 patients with human immunodeficiency virus (HIV)/AIDS have been reported. The estimated number of patients living with HIV (PLHIV) in China was 740 000 in 2009. Although China is still a low-HIV prevalence region (rate of 0.057%), the epidemic has spread more widely from the high-risk groups to the general population. This paper covers five topics of importance, i.e., current trends of the HIV epidemic; HIV-1 subtype diversity; emergence of HIV drug resistance (HIVDR); the country's response to the disease; and future challenges and additional actions needed. This paper emphasizes sexual transmission as the predominant route of transmission and it being spread more frequently among men who have sex with men; the epidemic being concentrated over particular areas in China. We also discuss the fact that diverse HIV-1 subtypes have been found throughout the entire country and that recombinant subtypes became predominant. We also explore other topics such as the possibility of HIVDR, including primary and secondary resistance, with the use of free highly active anti-retroviral therapy (HAART); the integrated strategy of HIVDR surveillance and individual clinical HIVDR testing as a new attempt in China. For many years both policy-makers and professionals (including non-governmental organizations) have expressed strong commitment to prevention, control, and care of HIV/sexual transmission infection (STI), promoted the research and conducted different actions to slow the rising trend of the HIV epidemics. Although China is facing many challenges, its citizens need to be persistent on continuing the campaign of the State Council titled "Information of Strengthening Work on Prevention and Control of AIDS".

  19. Papular pruritic eruptions: A marker of progressive HIV disease in children: Experience from eastern India

    Directory of Open Access Journals (Sweden)

    Samanta Moumita

    2009-01-01

    Full Text Available Context: Papular pruritic eruptions (PPEs are a commonly seen dermatological manifestation in children with Human Immunodeficiency Virus (HIV stage 2 disease, whereas recurrent upper respiratory tract infection (URTI (>2 episodes in 6 months is the most common presenting illness in this category. Papular pruritic eruptions has been associated with progressive HIV disease in adults though it is categorized in early stage. Aim: To evaluate PPE as a clinical marker for progressive pediatric HIV. Setting and Design: In Pediatric HIV/AIDS clinic, Medical College, Kolkata, a prospective longitudinal hospital-based observational study was carried out. Materials and Methods: A total of 108 children in WHO stage 2 HIV disease aged between 2 and 12 years were selected, of which 58 had recurrent URTI without PPE and another 50 had PPE with or without secondary bacterial infection. Clinico-immunological deterioration was compared between the groups in terms of progression to undernutrition, WHO clinical stage 4 disease, severe immunodeficiency, need for initiation of Highly Active Anti Retroviral Therapy (HAART and mortality over a period of 2 years. Statistical Analysis: SPSS statistical software version 10 was used. P value, relative risk (RR with 95% Confidence Interval (CI, sensitivity and specificity was estimated. P < 0.05 was considered significant. Results: Significantly higher incidence (P < 0.001 of clinico-immunological progression of disease at a significantly shorter time period (P < 0.05 was found in those with PPE in comparison to those without PPE. Papular pruritic eruption has high sensitivity, specificity and positive predictive value as a clinical marker for severe immunodeficiency. Conclusion: Papular pruritic eruption could be a useful clinical marker of progressive HIV disease in children.

  20. HIV-1 tropism and CD4 T lymphocyte recovery in a prospective cohort of patients initiating HAART in Ribeirão Preto, Brazil

    Directory of Open Access Journals (Sweden)

    Andre Minhoto Lanca

    2012-02-01

    Full Text Available While human immunodeficiency virus (HIV-1 chemokine co-receptors 5 tropism and the GWGR motif in the envelope third variable region (V3 loop have been associated with a slower disease progression, their influence on antiretroviral response remains unclear. The impact of baseline V3 characteristics on treatment response was evaluated in a randomised, double blind, prospective cohort study with patients initiating highly active antiretroviral therapy with lopinavir or efavirenz plus azithothymidine/3TC (1:1 over 48 weeks. Similar virological and immunological responses were observed for both treatment regimens. The 43 individuals had a mean baseline CD4 T cell count of 119 cells/mm³ [standard deviation (SD = 99] and a mean viral load of 5.09 log10 copies/mL (SD = 0.49. The GWGR motif was not associated with a CD4 T cell response, but predicted R5 tropism by the geno2pheno[clinical20%] algorithm correlated with higher CD4 T cell levels at all monitoring points (p < 0.05. Moreover, higher false-positive rates (FPR values from this analysis revealed a strong correlation with CD4 T cell recovery (p < 0.0001. Transmitted drug resistance mutations, documented in 3/41 (7.3% cases, were unrelated to the assigned antiretroviral regimen and had no impact on patient outcomes. In conclusion, naÏve HIV-1 R5 infected patients exhibited higher CD4 T cell counts at baseline; this difference was sustained throughout therapy. The geno2pheno[clinical] option FPR positively correlated with CD4 T cell gain and may be useful in predicting CD4 T cell recovery.

  1. The correlation between nonalcoholic fatty liver (NAFLD) and levels of leptin, adiponectin and insulin sensitivity index in AIDS patients with HAART%瘦素、脂联素和胰岛素敏感指数与艾滋病HAART后非酒精性脂肪肝相关性分析

    Institute of Scientific and Technical Information of China (English)

    李鑫; 肖江; 宋淑静; 郜桂菊; 李兴旺; 赵红心

    2012-01-01

    Objective To explore the association between nonalcoholic fatty liver (NAFLD) after HAART in HIV/ AIDS patients and leptin, adiponectin and insulin sensitivity index ( HOMA-ISI). Methods In this cross-sectional observational study, NAFLD was detected by color Doppler ultrasound in AIDS patients with HAART. Comparison with non-NAFLD patients, and the changes of BMI, CD4 cell levels, fasting blood glucose and lipid levels, insulin levels (FINS) , insulin sensitivity index and resistance index, liver and kidney functions, leptin and adiponectin levels were detected in NAFLD patients after HAART; and independent risk factors with NAFLD were analyzed by logistic regression model. Results In 75 patients with HAART treatment, NAFLD had been found in 25 patients. In logistic regression multivariate regression analysis model, leptin levels ( OR = 2. 88 , P =0. 001 ) and HOMA-ISI (OR = 0.56 , P =0. 004) demonstrated a high degree of correlation with NAFLD, in which HOMA-ISI was a protective factor of NAFLD after HAART. Conclusion In NAFLD patients after HAART Triglycerides and insulin levels, insulin resistance index and leptin levels increased significantly, adiponectin levels and insulin sensitivity index is lower significantly. It was suggested that leptin levels is independent risk factors and HOMA-ISI is a protective factor in NAFLD after HAART.%目的 探讨瘦素、脂联素和胰岛素敏感指数与艾滋病HAART后非酒精性脂肪肝(NAFLD)的相关性.方法 我们利用横断面观察研究,通过彩超检测发现艾滋病HAART后合并NAFLD的患者;这些患者和非NAFLD比较,探讨HAART后合并NAFLD的患者体重指数(BMI)、CD4细胞水平、空腹血糖和血脂水平、胰岛素水平(FINS)、胰岛素敏感指数(HOMA-ISI)和抵抗指数、肝肾功能、瘦素和脂联素的变化;并运用Logistic回归分析HAART后合并NAFLD的独立风险因素.结果 在75例接受HAART患者中,发现25例NAFLD患者;在Logistic回归多变量回归

  2. Physical Therapy and Occupational Therapy in Progeria

    Science.gov (United States)

    Physical Therapy and Occupational Therapy in Progeria Information for Families and Caretakers from The Progeria Research Foundation Written ... accelerated aging in children. Children with Progeria need Physical Therapy (PT) and Occupational Therapy (OT) as often as ...

  3. Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Marina Hjertquist Tremeschin

    2011-06-01

    Full Text Available INTRODUCTION: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART regimens that include a protease inhibitor (PI can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336, and 136 (63 - 271 versus control group: 54.5 (20 - 162; p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273 versus 67.5 (33 - 117; p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58 and 36 (23 - 43; control 49.5 (34 - 69; p = 0.004]. CONCLUSIONS: HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.

  4. Oxygen Therapy

    Science.gov (United States)

    Oxygen therapy is a treatment that provides you with extra oxygen. Oxygen is a gas that your body needs to function. Normally, your lungs absorb oxygen from the air you breathe. But some conditions ...

  5. Oxygen Therapy

    Science.gov (United States)

    ... therapy works, it helps to understand how your respiratory system works. This system is a group of organs and tissues that help you breathe. The respiratory system includes the airways and lungs. The airways carry ...

  6. Maintenance Therapy in IBD

    Science.gov (United States)

    ... Help Center Home > Resources > Maintenance Therapy Go Back Maintenance Therapy Email Print + Share The term "maintenance therapy" ... are referred to as "maintenance therapies." Why is Maintenance Therapy Needed in IBD? Both Crohn's disease and ...

  7. Efficacy and safety of switching to abacavir/lamivudine (ABC/3TC) plus rilpivirine (RPV) in virologically suppressed HIV-infected patients on HAART.

    Science.gov (United States)

    Palacios, R; Pérez-Hernández, I A; Martínez, M A; Mayorga, M L; González-Domenech, C M; Omar, M; Olalla, J; Romero, A; Romero, J M; Pérez-Camacho, I; Hernández-Quero, J; Santos, J

    2016-05-01

    We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC + RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI + NNRTI or 2 NRTI + INI to ABC/3TC + RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/μL; p = 0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p < 0.0001) and LDL-cholesterol (-11.0 mg/dL; p < 0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC + RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol. PMID:26879392

  8. Family therapy

    Directory of Open Access Journals (Sweden)

    Shaikh Altamash

    2013-01-01

    Full Text Available Another major force not letting us succeed in the treatment of diabetes remains right inside the patients home, their family members. Hence, it is important to know the perception of the close family members about this simple and strong tool in diabetes, ′insulin′. The drug is nearing its century, it has not fully being accepted gracefully even in todays electronic savvy society. So, we need to strongly discover the reason for its non-acceptance, while trials are out inventing new drugs. One vital thing that can change this attitude is increasing the understanding of this drug, insulin in depth to close people around the patient, the ′family′. Underestimating family′s perception about disease and treatment for diabetes is detrimental to both diseased and the doctor. This consists of a biopsychosocial model; biological, psychological and social factors. Family forms the most important part of it. The strategies in family therapy include psychodynamic, structural, strategic, and cognitive-behavioral component. Diabetes has and will continue to rise, so will be the treatment options. From the clinicians side its to fix fasting first but from patients its fix family first. Family therapy demonstrates the importance of insulin initiation and maintenance in insulin naive patients, and continuation for others. The specific needs of such patients and their impact on family life are met with family therapy. Who needs family therapy? Benefits of family therapy and a case based approach is covered.

  9. Art Therapy

    DEFF Research Database (Denmark)

    Skov, Vibeke; Pedersen, Inge Nygaard

    2014-01-01

    Abstract Based on a Jungian approach, this article will introduce an integrative model to therapeutic change using art therapy methods as practical tools, with the aim of improving quality of life and in the prevention of depression. In a research study involving six participants, painting, clay...... work and drumming were used together with imagination and personal dialogues linked to the artwork. These art therapy processes attempted to combine the participant’s experience of inner and outer reality. The effect of gaining more knowledge about their inner reality using dreams and symbols......, was that participants gained a new understanding about their personal life. In addition, some participants were able to continue to use art therapy experiences as selfdevelopmental tools after the research study terminated. Jung’s description of the interactive relationship between the two living parts of the psyche...

  10. 接受HAART治疗的1718例HIV/AIDS患者中医证候研究%Study of TCM Syndrome in Patients with HIV/AIDS Syndrome in 1718 Cases Treated with HAART

    Institute of Scientific and Technical Information of China (English)

    段呈玉; 方路; 葛锋

    2015-01-01

    Objective:To understand the symptoms distribution of patients with HIV/AIDS treated by HAART to explore the characteris-tics of TCMsyndrome.Methods:Selected 1718 patients treated with HAART for more than 3 months to cross sectional survey.Collect four diagnostic information of TCM and modern biological information and descriptive statistics of symptoms,signs,frequency (time). Results:The most common symptoms were fatigue,anorexia,cough,headache,menstrual disorder (female),joint pain,skin itching, pain,muscle pain,fever;tongue color to red,crimson red,pale purple,fat and tooth marked tongue,a whitish fur and yellow greasy,thick and greasy fur see;pulse compound,after decomposition to fine pulse,slippery pulse,taut pulse.There are 24 kinds of TCM syndrome type,deficiency of both QI and qi-yin asthenia are the most common syndrome,followed by stagnation of QI due to depression of the liv-er.For more complex syndrome,decomposition occurred after up to 32 kinds of documents.Main deficiency,followed by empirical,defi-ciency of at least.The incidence rate of organs from high to low according to the spleen,lung,kidney,liver,heart,spleen system among the highest incidence,and is often associated with lung,liver,kidney and to a disease.The incidence of viscera number is successively from high to low:three viscera comorbidity,two viscera comorbidity,four viscera comorbidity,five viscera comorbidity.Conclusion:The clinical symptoms of patients with HIV/AIDS treated with HAART showed diverse,complex disease,asthenia-sthenia zheng complica-tions,common multi viscera disease.%目的:通过调查接受HAART治疗的HIV/AIDS患者的症状分布规律,探讨该类患者的中医证候特点。方法:选取接受HAART治疗3个月以上的HIV/AIDS患者1718例进行横断面调查,采集中医四诊信息和现代生物学信息,对这些患者进行症状、体征、证候出现频率(次)的描述性统计。结果:常见症状依次为:乏力、纳呆、