Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 7 Articles
This case report describes an HIV-positive patient with recurrent tuberculosis in Uganda. After several failed courses\r\nof treatment, the patient was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As adequate in-patient\r\nfacilities were unavailable, we advised the patient to remain at home, and he received treatment at home via his\r\nfamily and a community nurse. The patient had a successful clearance of tuberculosis. This strategy of home-based\r\ncare represents an important opportunity for treatment of patients in East Africa, where human resource\r\nconstraints and inadequate hospital facilities exist for complex patients at high risk of infection to others....
Background: Hepatic Flare (HF) after initiation of highly active antiretroviral therapy (HAART) in HIV-HBV coinfected\r\nindividuals is well recognized but prospective data on predictors and subsequent outcome are limited.\r\nMethods: The Tenofovir in HIV-HBV coinfection study was a randomized clinical trial of HBV-active HAART\r\nincluding lamivudine and/or tenofovir in antiretroviral naÃ?¯ve HIV-HBV individuals in Thailand.\r\nResults: Early HF (EHF) was defined as ALT > 5 Ã?â?? ULN during the first 12 weeks. EHF was observed in 8 (22%) of\r\nindividuals at a median of 56 days. 6/8 EHF cases were asymptomatic and resolved with HAART continuation,\r\nhowever one subject with underlying cirrhosis died following rapid hepatic decompensation. EHF was significantly\r\nassociated with higher baseline ALT (79 IU/L vs 36 IU/L non-EHF, p = 0.008) and HBV DNA (9.9 log10 c/ml vs 8.4\r\nlog10 c/ml non EHF, p = 0.009), and subsequent serological change. HBeAg loss occurred in 75% of EHF cases\r\nversus 22% in non-EHF (p = 0.04), and HBsAg loss in 25% of EHF cases versus 4% of non-EHF (p = 0.053).\r\nConclusion: EHF after HBV active HAART initiation was frequently observed in this population. Timing of EHF,\r\nassociation with elevated ALT and HBV DNA and high rate of seroconversion are all consistent with immune\r\nrestoration as the likely underlying process.\r\nClinical Trial number: NCT00192595...
Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients\r\nreceiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of\r\npost-HAART mortality.\r\nMethods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including\r\nCD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in\r\na prospective observational cohort of HIV-infected U.S. military personnel.\r\nResults: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23\r\ndeaths/100 person-years [PY]) in those with = 50 CD4+ cells/mm3 before HAART initiation, and became progressively\r\nlower as CD4+ counts increased (0.70/100 PY with = 500 CD4+ cells/mm3). In multivariate analysis, factors significantly\r\n(p < 0.05) associated with post-HAART mortality included: increasing age among those = 40 years (Hazard ratio [HR] =\r\n1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), = 50 CD4+ cells/mm3 (vs. CD4+ = 500, HR =\r\n2.97), greater HIV RNA level (HR = 1.36 per one log10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96),\r\nand HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12\r\ngm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.\r\nConclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART\r\ninitiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset\r\nof patients for whom more intensive monitoring, counseling, and care interventions may improve clinical\r\noutcomes and post-HAART survival....
The December 2011 5th International Workshop on HIV Persistence during Therapy addressed the issue of HIV\r\npersistence among 210 scientists from 10 countries involved in the study of HIV reservoirs and the search of an HIV\r\ncure. High quality abstracts were selected and discussed as oral or poster presentations. The aim of this review is\r\nto distribute the scientific highlights of this workshop outside the group as analyzed and represented by experts in\r\nretrovirology, immunology and clinical research....
Background: HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an\r\nestimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in\r\ncontact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART\r\noften fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This\r\nstudy in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.\r\nResults: Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers\r\nand HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all\r\nsexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex\r\noccurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of\r\nunknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed nondisclosure\r\nof HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma\r\n(AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91,\r\np < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive\r\nmethods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75,\r\np < 0.001), compared to condom users.\r\nConclusions: High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the\r\nrisk of HIV transmission to discordant partners. This population can be identified and reached in the community.\r\nPrevention programs need to urgently bring this population into the ambit of prevention and care services.\r\nMoreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV\r\nprevention services, and in reducing risk behaviors....
Background: Delayed-type hypersensitivity (DTH) testing, an in vivo assessment of cell-mediated immunity, is a\r\npredictor of HIV disease progression beyond CD4 cell count. We investigated whether preserved DTH\r\nresponsiveness was characteristic of HIV controllers compared to non-controllers and individuals on suppressive\r\nHAART.\r\nFindings: DTH testing consisted of = 3 recall antigens applied approximately every 6 months. DTH responses were\r\nclassified by the number of positive skin tests: anergic (0), partial anergic (1), or non-anergic (= 2). HIV controllers\r\nwere compared to treatment na�¯ve non-controllers (n = 3822) and a subgroup of non-controllers with VL < 400\r\ncopies/mL on their initial HAART regimen (n = 491). The proportion of non-anergic results at first DTH testing was\r\nsimilar for HIV controllers compared to non-controllers (81.9% vs. 77.6%; P = 0.22), but tended to be greater in HIV\r\ncontrollers compared to the HAART subgroup (81.9% vs. 74.5%; P = 0.07). Complete anergy was observed in 14\r\n(10.1%) HIV controllers with CD4 counts = 400 cells/uL. For longitudinal testing, the average percentage of nonanergic\r\nDTH determinations per participant was higher in HIV controllers compared to non-controllers (81.2 �±\r\n31.9% vs. 70.7 �± 36.8%; P = 0.0002), however this difference was eliminated with stratification by CD4 count: 200-\r\n399 (83.4 �± 35.6% vs. 71.9 �± 40.9%; P = 0.15) and > 400 cells/uL (81.2 �± 31.5% vs. 80.4 �± 32.7%; P = 0.76).\r\nConclusions: Spontaneous virologic control was not associated with DTH responsiveness, and several HIV\r\ncontrollers were anergic despite having elevated CD4 counts. These findings suggest that cellular immunity\r\nassessed by DTH is not a principal factor contributing to spontaneous virologic suppression in HIV controllers...
Background: Even though the prevalence of HIV infection among the adult population in Ethiopia was estimated\r\nto be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective\r\nstudy was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations.\r\nMethods: Medical records of 347 patients (age =13 years) admitted to Tikur Anbesa Hospital from September 2002\r\nto August 2009 were reviewed and demographic and clinical data were collected.\r\nResults: Data from 347 patients were analysed. The mean age was 34.6 years. The diagnosis of HIV was made\r\nbefore current admission in 33.7% and 15.6% were on antiretroviral therapy (ART). Causes of neurological\r\nmanifestation were: cerebral toxoplasmosis (36.6%), tuberculous meningitis (22.5%), cryptococcal meningitis (22.2%)\r\nand bacterial meningitis (6.9%). HIV-encephalopathy, primary central nervous system (CNS) lymphoma and\r\nprogressive multifocal leukoencephalopathy were rare in our patients. CD4 count was done in 64.6% and 89.7%\r\nhad count below 200/mm3[mean = 95.8, median = 57] and 95.7% were stage IV. Neuroimaging was done in 38%\r\nand 56.8% had mass lesion. The overall mortality was 45% and the case-fatality rates were: tuberculous meningitis\r\n(53.8%), cryptococcal meningitis (48.1%), cerebral toxoplasmosiss (44.1%) and bacterial meningitis (33.3%). Change\r\nin sensorium and seizure were predictors of mortality.\r\nConclusions: CNS opportunistic infections were the major causes of neurological manifestations of HIV/AIDS and\r\nwere associated with high mortality and morbidity. Almost all patients had advanced HIV disease at presentation.\r\nEarly diagnosis of HIV, prophylaxis and treatment of opportunistic infections, timely ART, and improving laboratory\r\nservices are recommended. Mortality was related to change in sensorium and seizure....
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