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1.
AIDS Behav ; 27(2): 673-677, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35984609

RESUMO

Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012-2016). This was true overall and among those with the greatest number of STIs [age 18-34, men who have sex with men (MSM)]. This likely reflects gains in population-wide virologic control through improved antiretroviral therapy and access to care, which helps mitigate the risk of HIV transmission.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Estudos de Coortes , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Comportamento Sexual
2.
Sex Transm Infect ; 96(2): 89-95, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31907326

RESUMO

OBJECTIVE: A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs. METHODS: We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as incare viral load (ICVL) and percentage with all viral loads less than the limit of detection (%

Assuntos
Infecções por Chlamydia/epidemiologia , Etnicidade/estatística & dados numéricos , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Coinfecção , District of Columbia/epidemiologia , Feminino , Infecções por HIV/sangue , Infecções por HIV/terapia , Infecções por HIV/transmissão , Hispânico ou Latino/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Carga Viral , População Branca/estatística & dados numéricos , Adulto Jovem
3.
J Clin Microbiol ; 56(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29118165

RESUMO

Health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a burden on the health care system. Clinical laboratories play a key role in reducing this burden, as the timely identification of MRSA colonization or infection facilitates infection control practices that are effective at limiting invasive MRSA infections. The Xpert MRSA NxG assay recently received FDA clearance for the direct detection of MRSA from nasal swabs. This multicenter study evaluated the clinical performance characteristics of the Xpert MRSA NxG assay with prospectively collected rayon nasal swabs (n = 1,103) and flocked swab (ESwab) nasal specimens (n = 846). Culture-based identification methods and antimicrobial susceptibility testing were used as the reference standards for comparison. According to the reference method, the positivity rates for MRSA in the population evaluated were 11.1% (122/1,103) for rayon swabs and 11.6% (98/846) for flocked swabs. The overall sensitivity and specificity of the rayon swabs were 91.0% (95% confidence interval [CI], 84.6 to 94.9%) and 96.9% (95% CI, 95.7 to 97.8%), respectively, across eight testing sites. The flocked swab specimens were 92.9% sensitive (95% CI, 86.0 to 96.5%) and 97.6% specific (95% CI, 96.2 to 98.5%) for MRSA detection across six testing sites. The sensitivity and specificity of the combined flocked and rayon swab data were 91.8% (95% CI, 87.4 to 94.8%) and 97.2% (95% CI, 96.3 to 97.9%), respectively. The positive predictive value (PPV) for rayon swabs was 78.7%, versus 83.5% for ESwabs. The negative predictive values (NPVs) for rayon swabs and ESwab specimens were 98.9% and 99.1%, respectively. In conclusion, the Xpert MRSA NxG assay is a sensitive and specific assay for the direct detection of MRSA from nasal swab specimens.


Assuntos
Técnicas Bacteriológicas/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , DNA Bacteriano/genética , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Infecções Estafilocócicas/microbiologia , Adulto Jovem
4.
AIDS Care ; 28(11): 1355-64, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27297952

RESUMO

One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load < 200 copies/ml) at least once, and Kaplan-Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL ≥ 200 copies/ml after achievement of VS). Among the 4311 participants, 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03-1.06 per five-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04-1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51-0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p ≤ .001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.


Assuntos
Infecções por HIV/transmissão , Infecções por HIV/virologia , Disparidades nos Níveis de Saúde , Transmissão Vertical de Doenças Infecciosas , Resposta Viral Sustentada , Adulto , Fatores Etários , Contagem de Linfócito CD4 , Estudos de Coortes , District of Columbia , Feminino , Infecções por HIV/imunologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Grupos Raciais , Fatores Sexuais , População Urbana , Carga Viral , Adulto Jovem
5.
Scand J Infect Dis ; 46(2): 152-4, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24228826

RESUMO

Tumor necrosis factor alpha (TNF-α) inhibitors are widely used for the treatment of various inflammatory conditions. They are associated with an increased risk for infections. We report a case of herpes simplex virus type 1 (HSV-1) encephalitis in a patient receiving etanercept and review the literature on TNF-α and TNF-α inhibitors, and their importance in the pathophysiology of herpes simplex encephalitis.


Assuntos
Encefalite por Herpes Simples/diagnóstico , Herpesvirus Humano 1/isolamento & purificação , Imunoglobulina G/efeitos adversos , Imunossupressores/efeitos adversos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalite por Herpes Simples/virologia , Etanercepte , Humanos , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Receptores do Fator de Necrose Tumoral/uso terapêutico
6.
J Biol Chem ; 286(7): 5069-77, 2011 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-21138841

RESUMO

There are few examples of host signals that are beneficial to bacteria during infection. Here we found that 31 out of 42 host immunoregulatory chemokines were able to induce release of the virulence factor protein A (SPA) from a strain of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Detailed study of chemokine CXCL9 revealed that SPA release occurred through a post-translational mechanism and was inversely proportional to bacterial density. CXCL9 bound specifically to the cell membrane of CA-MRSA, and the related SPA-releasing chemokine CXCL10 bound to both cell wall and cell membrane. Clinical samples from patients infected with S. aureus and samples from a mouse model of CA-MRSA skin abscess all contained extracellular SPA. Further, SPA-releasing chemokines were present in mouse skin lesions infected with CA-MRSA. Our data identify a potential new mode of immune evasion, in which the pathogen exploits a host defense factor to release a virulence factor; moreover, chemokine binding may serve a scavenging function in immune evasion by S. aureus.


Assuntos
Parede Celular/imunologia , Quimiocina CXCL9/imunologia , Processamento de Proteína Pós-Traducional/imunologia , Proteína Estafilocócica A/imunologia , Staphylococcus aureus/imunologia , Fatores de Virulência/imunologia , Animais , Membrana Celular/imunologia , Membrana Celular/metabolismo , Parede Celular/metabolismo , Quimiocina CXCL9/metabolismo , Quimiocina CXCL9/farmacologia , Humanos , Camundongos , Ligação Proteica/imunologia , Proteína Estafilocócica A/metabolismo , Staphylococcus aureus/metabolismo , Staphylococcus aureus/patogenicidade , Fatores de Virulência/metabolismo
7.
Clin Infect Dis ; 51(1): 73-6, 2010 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-20482332

RESUMO

Atrial-esophageal fistula is a rare but often fatal complication of catheter radiofrequency ablation. Patients occasionally have bacteremia and have been misdiagnosed with endocarditis. Infectious diseases specialists are often consulted and need to be aware of this complication. We report a case of atrial-esophageal fistula after radiofrequency ablation that illustrates the salient features of this illness.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Fístula/etiologia , Cardiopatias/etiologia , Diagnóstico Diferencial , Fístula Esofágica/diagnóstico , Fístula/diagnóstico , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
8.
Front Immunol ; 10: 1193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191551

RESUMO

Autoimmune lymphoproliferative syndrome (ALPS) is caused by germline or somatic loss of function FAS mutations resulting in impaired apoptosis and consequent expansion of T-lymphocytes causing organomegaly and autoimmune anemia, neutropenia and thrombocytopenia. Herein, we report on a case of disseminated varicella zoster infection after post-partum vaccination in a patient found to have CD4 lymphopenia and eventually diagnosed with ALPS caused by a novel germline missense mutation in FAS death-domain. A subsequent retrospective analysis of 169 patients of the NIH ALPS-FAS cohort, revealed that CD4-T-cells lymphopenia (< 300 cells/µl) may occur in 5% of ALPS-FAS patients irrespectively of the underlying genetic defect, organomegaly or immunosuppressive treatment. Although immunophenotyping did not show depletion of specific CD4-T-cells subpopulations, CD4-lymphopenic ALPS-FAS subjects had an expansion of a subset of circulating T-follicular-helper (cTfh) cells, associated with autoantibody production (CCR7lowPD-1high). Furthermore, autoantibodies binding on CD4-T-cells were detected in 50% of the CD4-lymphopenic ALPS-FAS patients and caused cytotoxicity in a natural killer (NK)-mediated antibody-dependent-cellular cytotoxicity assay. Such autoantibodies can therefore be associated with CD4-T-cell death, impaired activation induced proliferation or impaired trafficking. The expansion of autoreactive T-cells in ALPS-FAS is known to be associated with autoimmune clinical manifestations, however our study reveals that ALPS-FAS can also be associated with a paradoxical depletion of CD4-T-cells due to the presence of autoantibodies on the surface of CD4-T-cells which can in turn result in increased susceptibility to opportunistic infections. These novel findings have implications for the diagnosis, clinical monitoring, and management of patients with ALPS-FAS.


Assuntos
Autoanticorpos/imunologia , Síndrome Linfoproliferativa Autoimune/complicações , Linfócitos T CD4-Positivos/imunologia , Linfopenia/etiologia , Adolescente , Adulto , Especificidade de Anticorpos , Citotoxicidade Celular Dependente de Anticorpos , Síndrome Linfoproliferativa Autoimune/sangue , Síndrome Linfoproliferativa Autoimune/imunologia , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Vacina contra Varicela/efeitos adversos , Criança , Suscetibilidade a Doenças , Feminino , Mutação em Linhagem Germinativa , Humanos , Hospedeiro Imunocomprometido , Linfopenia/sangue , Linfopenia/imunologia , Masculino , Gravidez , Transtornos Puerperais/etiologia , Transtornos Puerperais/imunologia , Estudos Retrospectivos , Vacinação , Infecção pelo Vírus da Varicela-Zoster/etiologia , Infecção pelo Vírus da Varicela-Zoster/imunologia , Receptor fas/deficiência , Receptor fas/genética
10.
Am J Trop Med Hyg ; 99(6): 1511-1517, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30350769

RESUMO

Malaria acquired in endemic areas poses a substantial risk to travelers arriving in or returning to the United States. Timely diagnosis and recognition of severe illness are crucial; however, many U.S.-based clinicians lack familiarity with this disease. We conducted a retrospective review of 100 cases of malaria in adults seen at a single urban university hospital during 2000-2017. Descriptive and analytical statistics were calculated, including logistic regression modeling case severity. Most of the patients presented with Plasmodium falciparum (76%), most commonly after travel from sub-Saharan Africa (94%). Prior malaria experience was common (50%), but adherence to a prophylactic regimen was exceedingly rare (4%). Twenty-one patients had severe malaria, including 10 with cerebral malaria. Severity was predicted by high parasitemia, bandemia, hypoglycemia, and hypotension at the time of presentation. In 24 patients, the initial treatment regimen was changed, usually because of the appearance of clinical deterioration or drug toxicity. One patient required intravenous artesunate. All patients survived, although one suffered fetal loss. Among 30 patients initially evaluated at other institutions, 43% had been treated for an alternative diagnosis. The most common reasons for transfer of patients to our hospital were inadequate facilities and lack of expertise with malaria. There needs to be increased awareness among U.S.-based travelers and clinicians regarding malaria as a potentially lethal condition, emphasizing the use of appropriate prophylaxis. Our simple model of disease severity could serve frontline physicians when deciding which patients should be admitted to the intensive care unit or transferred for higher level care.


Assuntos
Doenças Transmissíveis Importadas/patologia , Malária Falciparum/patologia , Parasitemia/patologia , Plasmodium falciparum/patogenicidade , Viagem , Adulto , África Subsaariana , Antimaláricos/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , District of Columbia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Universitários , Humanos , Modelos Logísticos , Malária Falciparum/diagnóstico , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Masculino , Pessoa de Meia-Idade , Parasitemia/diagnóstico , Parasitemia/tratamento farmacológico , Parasitemia/parasitologia , Cooperação do Paciente/estatística & dados numéricos , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/isolamento & purificação , Profilaxia Pré-Exposição/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Triagem/métodos
11.
Open Forum Infect Dis ; 5(2): ofy017, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29479550

RESUMO

BACKGROUND: Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. METHODS: We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk. RESULTS: Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5-4.1); age 18-34 years, 10.8 (95% CI, 9.7-12.0); transgender women, 9.9 (95% CI, 6.9-14.0); Hispanics, 9.2 (95% CI, 7.2-11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1-8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL. CONCLUSIONS: STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

12.
BMC Res Notes ; 10(1): 474, 2017 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-28893321

RESUMO

BACKGROUND: Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC. METHODS: We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral. RESULTS: Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0-1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis. CONCLUSIONS: In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered.


Assuntos
Antirretrovirais , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Idoso , District of Columbia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
J Emerg Manag ; 14(1): 17-29, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26963227

RESUMO

To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting.


Assuntos
Defesa Civil/educação , Surtos de Doenças , Serviços Médicos de Emergência/organização & administração , Instalações de Saúde , Planejamento em Saúde/organização & administração , Doença pelo Vírus Ebola , Controle de Infecções , Defesa Civil/organização & administração , Humanos , Equipamento de Proteção Individual
14.
Arch Pathol Lab Med ; 139(2): 194-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24758733

RESUMO

CONTEXT: Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. OBJECTIVE: To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. DESIGN: The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. RESULTS: Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. CONCLUSIONS: Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.


Assuntos
Laboratórios Hospitalares/economia , Técnicas Microbiológicas/economia , Serviços Terceirizados/economia , Serviço Hospitalar de Patologia/economia , Serviços de Laboratório Clínico/economia , Análise Custo-Benefício , Tomada de Decisões Gerenciais , Humanos , Laboratórios Hospitalares/estatística & dados numéricos , Técnicas Microbiológicas/normas , Técnicas Microbiológicas/estatística & dados numéricos , Serviços Terceirizados/estatística & dados numéricos , Serviço Hospitalar de Patologia/estatística & dados numéricos , Médicos , Encaminhamento e Consulta , Estados Unidos , Revisão da Utilização de Recursos de Saúde
15.
Atherosclerosis ; 243(1): 19-29, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26343868

RESUMO

BACKGROUND AND AIMS: Coronary artery disease is a growing clinical problem in HIV-infected subjects. The increased risk of coronary events in this population has been linked to low levels of HDL, but the effects of HIV infection and anti-retroviral treatment (ART) on HDL structure and function remain unknown. Here, we aimed to determine the composition and function of HDL particles isolated from ART-naive and ART-positive HIV-infected patients. METHODS AND RESULTS: Proteomic profiling revealed decreased levels of paraoxonase (PON) 1 and PON 3 in HDL from HIV patients relative to HDL from uninfected controls (p < 0.0001), and PON activity of HDL from control group (0.13 ± 0.01 U/µl) was significantly higher than PON activity of HDL from HIV-infected untreated subjects (0.12 ± 0.01 U/µl, p = 0.0035), subjects treated with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy (0.11 ± 0.01 U/µl, p < 0.0001), subjects treated with protease inhibitor (PI)-based therapy with detectable viral load (0.11 ± 0.01 U/µl, p < 0.0001), and PI-treated patients with undetectable viral load (0.12 ± 0.01 U/µl, p = 0.0164). Lipidomic profiling uncovered a negative correlation between CD4 T cell counts and particle sphingomyelin, lyso-phosphatidylcholine and ether-linked phosphatidylserine content in the ART-naive (R(2) = 0.2611, p < 0.05; R(2) = 0.2722, p < 0.05; and R(2) = 0.3977, p < 0.05, respectively) but not treated HIV-infected subjects. Functional analysis demonstrated a negative correlation between cholesterol efflux capacity of HDL and viral load in the ART-naive HIV-infected group (R(2) = 0.26, p = 0.026). CONCLUSIONS: Taken together, these results indicate that HIV infection associates with a number of both protein and lipid compositional changes in HDL particles. Moreover, HIV infection affects cholesterol efflux function of HDL, thus contributing to an increased risk of atherosclerosis in this patient population.


Assuntos
Infecções por HIV/sangue , Infecções por HIV/complicações , Lipoproteínas HDL/sangue , Adulto , Fármacos Anti-HIV/uso terapêutico , Arildialquilfosfatase/sangue , Linfócitos T CD4-Positivos/metabolismo , Colesterol/metabolismo , Feminino , Humanos , Lipoproteínas LDL/sangue , Lisofosfatidilcolinas/metabolismo , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Oxigênio/metabolismo , Fosfatidilserinas/metabolismo , Proteômica , Carga Viral
16.
J Acquir Immune Defic Syndr ; 69 Suppl 1: S44-55, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25867778

RESUMO

BACKGROUND: Indicators for determining one's status on the HIV care continuum are often measured using clinical and surveillance data but do not typically assess patient perspectives. We assessed patient-reported care status along the care continuum and whether it differed from medical records and surveillance data. METHODS: Between June 2013 and October 2014, a convenience sample of clinic-attending HIV-infected persons was surveyed regarding care-seeking behaviors and self-perceived status along the care continuum. Participant responses were matched to DC Department of Health surveillance data and clinic records. Participants' care patterns were classified using Health Resources Services Administration-defined care status: in care (IC), sporadic care (SC), or out of care (OOC). Semistructured qualitative interviews were analyzed using an open coding process to elucidate relevant themes regarding participants' perceptions of engagement in care. RESULTS: Of 169 participants, most were male participants (64%) and black (72%), with a mean age of 50.7 years. Using self-reported visit patterns, 115 participants (68%) were consistent with being IC, 33 (20%) SC, and 21 (12%) OOC. Among OOC participants, 52% perceived themselves to be fully engaged in HIV care. In the previous year, among OOC participants, 71% reported having a non-HIV-related medical visit and 90% reported current antiretroviral use. Qualitatively, most SC and OOC persons did not see their HIV providers regularly because they felt healthy. CONCLUSIONS: Participants' perceptions of HIV care engagement differed from actual care receipt as measured by surveillance and clinical records. Measures of care engagement may need to be reconsidered as persons not receiving regular HIV care maybe accessing other health care and HIV medications elsewhere.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por HIV/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vigilância em Saúde Pública , Adulto , Idoso , Demografia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Autorrelato
17.
AIDS ; 16(13): 1829-30, 2002 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-12218397

RESUMO

Plasma lipid and lipoprotein levels were measured at baseline and after 8 weeks of highly active antiretroviral therapy among patients receiving delavirdine with or without a protease inhibitor (PI). In patients receiving nucleoside reverse transcriptase inhibitors (NRTI) plus delavirdine, there was a statistically significant increase in cholesterol and HDL levels, whereas those receiving NRTI plus a PI had no significant change in their HDL levels. When delavirdine was combined with a PI, there was a more dramatic increase in both cholesterol and HDL concentrations.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Delavirdina/efeitos adversos , Lipídeos/sangue , Lipoproteínas/sangue , Inibidores da Transcriptase Reversa/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Colesterol/sangue , Delavirdina/uso terapêutico , Quimioterapia Combinada , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1 , Humanos , Lipoproteínas HDL/sangue , Inibidores da Transcriptase Reversa/uso terapêutico
18.
HIV Clin Trials ; 4(4): 231-43, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12916008

RESUMO

PURPOSE: To assess efficacy, safety, and adherence with compact quadruple therapy comprising one lamivudine 150-mg/zidovudine 300-mg tablet (COM) twice daily + one abacavir (ABC) 300-mg tablet twice daily + three efavirenz (EFV) 200-mg capsules at bedtime for 24 weeks, followed by one lamivudine 150-mg/zidovudine 300-mg/ABC 300-mg triple nucleoside tablet (TZV) twice daily + three EFV 200-mg capsules at bedtime for 24 weeks. METHOD: A pilot 48-week, prospective, open-label trial in which 38 antiretroviral-naïve HIV-infected adults (baseline median HIV-1 RNA 5.1 log(10) copies/mL, CD4+ cell count 285/microL) received the above treatment and were monitored regularly with respect to plasma HIV-1 RNA levels, CD4+ cell counts, T-cell receptor excision circles (TRECs), adherence, and adverse events. RESULTS: At Week 48, intent-to-treat, switch-included analysis showed plasma HIV-1 RNA levels <400 copies/mL in 100% (29/29) of patients and <50 copies/mL in 93% (27/29); 59% of patients who achieved <50 copies/mL had <3 copies/mL (16/27). Similar virologic suppression was observed in patients with baseline HIV-1 RNA above or below 100000 copies/mL. HIV-1 RNA and CD4+ cell counts changed from baseline by a median of -3.4 log(10) copies/mL and +172 cells/microL, respectively. One virologic failure occurred at Week 16. Median TRECs/100000 peripheral blood lymphocytes increased 6-fold between baseline and Week 48. Median adherence rates were consistently 100% by self-report and 94% by pill count. Grade 2-4 treatment-related adverse events included dreams (16%), nausea (13%), decreased white cells (8%), dizziness (8%), sleep disorders (8%), and malaise and fatigue (8%). A suspected ABC hypersensitivity reaction occurred in 8% (3/38) of patients. CONCLUSION: COM/ABC/EFV or TZV/EFV produced potent, durable virologic suppression and immunologic benefits, was associated with high adherence rates, and was generally well tolerated.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adulto , Alcinos , Fármacos Anti-HIV/administração & dosagem , Benzoxazinas , Contagem de Linfócito CD4 , Ciclopropanos , Didesoxinucleosídeos/administração & dosagem , Didesoxinucleosídeos/efeitos adversos , Didesoxinucleosídeos/uso terapêutico , Quimioterapia Combinada , Feminino , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/imunologia , HIV-1/fisiologia , Humanos , Lamivudina/administração & dosagem , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oxazinas/administração & dosagem , Oxazinas/efeitos adversos , Oxazinas/uso terapêutico , Cooperação do Paciente , RNA Viral/análise , RNA Viral/sangue , Receptores de Antígenos de Linfócitos T/imunologia , Zidovudina/administração & dosagem , Zidovudina/efeitos adversos , Zidovudina/uso terapêutico
19.
Vaccine ; 26(19): 2408-17, 2008 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-18396361

RESUMO

Necator americanus Ancylostoma Secreted Protein-2 (Na-ASP-2) is a leading larval-stage hookworm vaccine candidate. Recombinant Na-ASP-2 was expressed in Pichia pastoris and formulated with Alhydrogel. In a phase 1 trial, 36 healthy adults without history of hookworm infection were enrolled into 1 of 3 dose cohorts (n=12 per cohort) and randomized to receive intramuscular injections of either Na-ASP-2 or saline placebo. Nine participants in the first, second and third cohorts were assigned to receive 10, 50 and 100 microg of Na-ASP-2, respectively, on study days 0, 56 and 112, while 3 participants in each cohort received placebo. The most frequent adverse events were mild-to-moderate injection site reactions; in 8 participants these were delayed and occurred up to 10 days after immunization. No serious adverse events occurred. Anti-Na-ASP-2 IgG endpoint titers as determined by ELISA increased from baseline in all vaccine groups and peaked 14 days after the third injection, with geometric mean titers of 1:7066, 1:7611 and 1:11,593 for the 10, 50 and 100 microg doses, respectively, compared to <1:100 for saline controls (p<0.001). Antibody titers remained significantly elevated in all vaccine groups until the end of the study, approximately 8 months after the third vaccination. In vitro stimulation of PBMCs collected from participants with Na-ASP-2 resulted in robust proliferative responses in those who received vaccine, which increased with successive immunizations and remained high in the 50 and 100 microg dose groups through the end of the study. This first trial of a human hookworm vaccine demonstrates that the Na-ASP-2 vaccine is well-tolerated and induces a prolonged immune response in adults not exposed to hookworm, justifying further testing of this vaccine in an endemic area.


Assuntos
Proteínas de Helminto/efeitos adversos , Proteínas de Helminto/imunologia , Infecções por Uncinaria/prevenção & controle , Necator americanus/imunologia , Adolescente , Adulto , Animais , Anticorpos Anti-Helmínticos/sangue , Proliferação de Células , Células Cultivadas , Método Duplo-Cego , Expressão Gênica , Proteínas de Helminto/administração & dosagem , Proteínas de Helminto/genética , Infecções por Uncinaria/imunologia , Humanos , Imunização Secundária , Imunoglobulina G/sangue , Injeções Intramusculares , Leucócitos Mononucleares/imunologia , Necator americanus/genética , Pichia/genética , Placebos/administração & dosagem , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/genética , Vacinas Sintéticas/imunologia
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