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1.
Altern Ther Health Med ; 17(2): 30-5, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21717822

RESUMEN

BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with dyslipidemia and increased risk for cardiovascular events; however, the use ofstatins in HIV-infected people is complicated by pharmacokinetic interactions and overlapping toxicities with antiretroviral medications. Policosanol is a dietary supplement derived from sugar cane that is widely used as a statin alternative in Latin America. PRIMARY STUDY OBJECTIVE: To collect feasibility data on sugar cane-derived policosanol to normalize dyslipidemic profiles in a sample of medically underserved HIV-infected people. METHODS/DESIGN: Randomized, controlled, double-blind clinical trial. SETTING: Two infectious disease outpatient clinics located in a Health Resources Service Administration-designated medically underserved neighborhood in Chicago, Illinois. PARTICIPANTS: Fifty-four clinically stable HIV-infected people (91% black) with at least one lipid abnormality that warranted dietary modifications and/or drug therapy. INTERVENTION: Participants received either 20 mg/day of policosanol or placebo for 12 weeks, followed by a 4-week washout and crossover to the other arm. PRIMARY OUTCOME MEASURES: Efficacy measures included the standard lipid panel (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides) and nuclear magnetic resonance (NMR)-derived lipoprotein particle profiles. Safety measures included CD4+ T lymphocyte counts, plasma HIV ribonucleic acid levels, serum creatinine, and liver function tests. RESULTS: Policosanol supplementation was not associated with normalization of any dyslipidemic parameters as measured by the standard lipid panel or NMR spectroscopy-measured lipoprotein size or concentration. The supplement was well tolerated and was not associated with any changes in parameters of HIV disease progression. CONCLUSIONS: Our findings corroborate recent studies conducted outside Cuba that have failed to find any lipid modulatory effects for policosanol.


Asunto(s)
Anticolesterolemiantes/administración & dosificación , Dislipidemias/tratamiento farmacológico , Alcoholes Grasos/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Área sin Atención Médica , Adulto , Terapia Antirretroviral Altamente Activa/efectos adversos , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Cruzados , Método Doble Ciego , Dislipidemias/inducido químicamente , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Insuficiencia del Tratamiento , Triglicéridos/sangre
2.
Clin Infect Dis ; 36(Suppl 2): S52-62, 2003 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-12652372

RESUMEN

Nutritional management is integral to the care of all patients infected with human immunodeficiency virus (HIV). HIV infection results in complicated nutritional issues for patients, and there is growing evidence that nutritional interventions influence health outcomes in HIV-infected patients. We define levels of nutritional care, and we discuss when patients should be referred to providers (i.e., registered dietitians) with nutritional and HIV expertise.


Asunto(s)
Infecciones por VIH/dietoterapia , Fenómenos Fisiológicos de la Nutrición , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Prestación Integrada de Atención de Salud , Interacciones Alimento-Droga , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Humanos , Tamizaje Masivo , Evaluación Nutricional , Reproducibilidad de los Resultados , Resultado del Tratamiento
3.
Future Microbiol ; 6(5): 595-7, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21585265

RESUMEN

Eggerthella lenta is an anaerobic, nonspore-forming Gram-positive rod and is a common gut commensal. Bacteremia from this organism is rare but when present is always clinically significant. Gastrointestinal disease and malignancy are the most common causes for bacteremia from this organism. Eggerthella species have been isolated in feces from patients with inflammatory bowel disease, but bacteremia has not been reported to the best of our knowledge. Here we report the case of a young African-American female with Crohn's disease who developed Eggerthella lenta bacteremia after ileocaecal resection.


Asunto(s)
Actinobacteria/aislamiento & purificación , Bacteriemia/microbiología , Ciego/cirugía , Enfermedad de Crohn/cirugía , Infecciones por Bacterias Grampositivas/microbiología , Íleon/cirugía , Actinobacteria/clasificación , Adulto , Femenino , Humanos , Adulto Joven
4.
J Clin Lipidol ; 3(6): 379-384, 2009 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-20161509

RESUMEN

BACKGROUND: HIV infection is associated with dyslipidemia and increased risk for cardiovascular events. Few studies have described lipid status in medically-underserved, HIV-infected ethnic minorities, a group that is characterized by health disparities. OBJECTIVE: The objective was to characterize the lipid profile of a medically-underserved, largely ethnic minority sample of HIV-infected persons using standard lipid panels and nuclear magnetic resonance (NMR) -derived lipoprotein particle profiles. METHODS: Participants were recruited from a randomized controlled trial of a dietary supplement to manage HIV-related dyslipidemia (N=132). At the initial screening visit, sociodemographic, clinical, and behavioral data were collected, and fasting peripheral venous blood specimens were obtained and lipid status was analyzed using the standard lipid panel and the NMR-derived lipoprotein particle profile. RESULTS: Using NMR-derived LDL particle cutoffs, a higher percentage of participants was outside the target range (50%) than when standard LDL cholesterol NCEP cutoffs were used (24%). Antiretroviral therapy, especially protease inhibitor-containing regimens, was associated with higher LDL particle concentration. CONCLUSION: Substantial numbers of medically-underserved, asymptomatic HIV-infected minorities may be at increased risk for CHD based on NMR-derived lipoprotein values.

5.
J Acquir Immune Defic Syndr ; 30(2): 191-5, 2002 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-12045682

RESUMEN

Hyperlipidemia has been seen in patients receiving protease inhibitor-based antiretroviral therapy, prompting concern that such patients are at risk for accelerated coronary artery disease (CAD). To assess the risk of CAD in antiretroviral-treated HIV-infected men, we quantified coronary artery calcium (CAC), a sensitive and established marker of subclinical CAD, using electron beam computed tomography (EBCT) of coronary vessels. Sixty HIV-infected men who met the following criteria (cases) were enrolled in the study: age of 40 years or older; naive to antiretroviral therapy or use of a stable antiretroviral regimen for >or=6 months (mean duration, 25.9 months; 41 patients were receiving protease inhibitor therapy); and no known CAD or no use of lipid-lowering agents. EBCT-derived CAC scores, serum lipid levels, history of antiretroviral therapy, and risk factors for CAD were obtained. Each case was compared with three age-, sex-, and race-matched HIV-negative controls randomly selected from a database including >9000 patients who had undergone EBCT. We determined differences in the proportion of cases and controls with CAC scores of >0 (detectable calcium) and clinically significant CAC for age range. There were no statistically significant differences between the number of cases and controls with detectable CAC (33% and 39%, respectively) and clinically significant CAC (18% and 17%, respectively). This study suggests that the rate of coronary atherosclerosis among HIV-infected patients who receive short-term antiretroviral therapy with or without protease inhibitors is not higher than that among age-, sex-, and race-matched HIV-negative controls. These results need to be confirmed in larger long-term studies, with controls well matched for coronary risk factors.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Infecciones por VIH/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Humanos , Persona de Mediana Edad , Medición de Riesgo
6.
J Infect Dis ; 189(3): 369-76, 2004 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-14745693

RESUMEN

OBJECTIVE: To define clinical and laboratory features that identify patients with neurosyphilis. METHODS: Subjects (n=326) with syphilis but no previous neurosyphilis who met 1993 Centers for Disease Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count >20 cells/ microL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result. RESULTS: Sixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer > or =1 : 32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)-uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4+ T cell count < or =350 cells/ microL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more stringently defined as a reactive CSF VDRL test result. CONCLUSION: Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.


Asunto(s)
Sífilis/etiología , Treponema pallidum/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/etiología , Neurosífilis/inmunología , Reaginas/sangre , Factores de Riesgo , Sífilis/líquido cefalorraquídeo , Sífilis/inmunología
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