Changes in atherosclerotic cardiovascular disease risk over time among people living with HIV.

OBJECTIVE: To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV). METHODS: We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligible for inclusion if they were aged ≥18 years, had started ART, had no previous history of ASCVD and had complete ASCVD risk factor data available within the first 5 years of ART initiation. RESULTS: A total of 3368 adults contributed data, 3221 were from TAHOD and 147 were from AHOD. The median age at ART initiation was 36 [IQR 31-43] years for TAHOD participants, and 42 [IQR 35-50] years for AHOD participants. Most TAHOD (70.4%) and AHOD (91.8%) participants were male. Overall, ASCVD risk increased from 0.84% (95% CI 0.81%-0.87%) at ART initiation to 1.34% (95% CI 1.29%-1.39%) after 5 years on ART. After adjusting for traditional and HIV-associated ASCVD risk factors, ASCVD risk increased at a similar rate among sub-populations defined by HIV exposure (heterosexuals, men who have sex with men, people who inject drugs), race/ethnicity (Caucasian and Asian) and nadir CD4 at ART initiation (<200 and ≥200 cells/mm3). CONCLUSIONS: These findings emphasize the growing burden of ASCVD risk among PLHIV and the need to develop interventions that are effective across a broad range of HIV sub-populations.

MRSA infection in patients hospitalized at Sanglah Hospital: a case series.

This is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HA-MRSA). These strains had resistance to b-lactams but remain susceptible to many non b-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections.

Factors influencing bone mineral density in ARV-naive patients at Sanglah Hospital, Bali.

AIM: to evaluate factors which influence bone mineral density in ARV-naive patients in Sanglah Hospital, Bali. METHODS: a cross-sectional BMD measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN) in 73 ARV-naive HIV-infected patients in out patient clinic of Sanglah Hospital, consecutively, from January to June 2012. Inclusion criteria are ARV-naive HIV-infected patients age 13-50 year old. The relationship among factors influence BMD, CD4 level, HIV RNA, HIV stage (WHO) analysed with Anova and Spearman's correlation test. RESULTS: this study involved 49 males and 24 females. Mean age was 33.08±8.29. Mean CD4 was 144.71±143.40 cell/mmc with the lowest CD4 is 1. Mean viral load (VL) was 272.330±282.990 copies/ml, the lowest VL 400 copies/ml, and the highest 750 000 copies/ml. Low BMD found in 32/73 (43.8%). Osteopenia and osteoporosis were diagnosed in 26/73 (35.6%) and 6/73 (8.2%). 13 (40.6%) of the low BMD cases occurred on the age group 21-30 year. Significant correlation found between low BMD with HIV stage (r=0.337; p<0.001). CONCLUSION: patients with higher HIV stage have higher risk of low BMD in ARV-naive patient. Further study is needed to evaluate correlation of low BMD with its risk factors.

CD4/CD8 Ratio Recovery Among People Living With HIV Starting With First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis.

BACKGROUND: We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization. METHODS: All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who started with triple-ART with at least 1 CD4, CD8 (3-month window), and HIV-1 RNA measurement post-ART were included. CD4/CD8 ratio normalization was defined as a ratio ≥1. Longitudinal changes in CD4/CD8 ratio were analyzed by linear mixed model, the incidence of the normalization by Cox regression, and the differences in ratio recovery by group-based trajectory modeling. RESULTS: A total of 5529 PLWH were included; 80% male, median age 35 years (interquartile range [IQR], 29-43). First-line regimens were comprised of 65% NNRTI, 19% PI, and 16% INSTI. The baseline CD4/CD8 ratio was 0.19 (IQR, 0.09-0.33). PLWH starting with NNRTI- (P = 0.005) or PI-based ART (P = 0.030) had lower CD4/CD8 recovery over 5 years compared with INSTI. During 24,304 person-years of follow-up, 32% had CD4/CD8 ratio normalization. After adjusting for age, sex, baseline CD4, HIV-1 RNA, HCV, and year of ART initiation, PLWH started with INSTI had higher odds of achieving CD4/CD8 ratio normalization than NNRTI- (P < 0.001) or PI-based ART (P = 0.015). In group-based trajectory modeling analysis, INSTI was associated with greater odds of being in the higher ratio trajectory. CONCLUSIONS: INSTI use was associated with higher rates of CD4/CD8 ratio recovery and normalization in our cohort. These results emphasize the relative benefits of INSTI-based ART for immune restoration.