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1.
HIV Med ; 25(1): 95-106, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37670375

RESUMEN

BACKGROUND: Hepatic steatosis is a major cause of chronic liver disease associated with several negative health outcomes. We compared the prevalence of and factors associated with steatosis in people living with and without HIV. METHODS: Older (>50 years) and younger (<50 years) people with HIV and older HIV-negative controls (>50 years) underwent liver transient elastography examination with controlled attenuation parameter (steatosis ≥238 dB/m, moderate/severe steatosis ≥280 dB/m, liver fibrosis ≥7.1 kPa). We compared groups using logistic regression/Chi-squared/Fisher's exact/Kruskal-Wallis tests. RESULTS: In total, 317 participants (109 older people with HIV; 101 younger people with HIV; 107 HIV-negative controls) were predominantly white (86%) and male (76%), and 21% were living with obesity (body mass index ≥30 kg/m2 ). Most (97%) people with HIV had undetectable HIV RNA. The prevalence of fibrosis was 8.4%, 3.0%, and 6.5% in the three groups, respectively (p = 0.26). Fibrosis was predominately (>65%) mild. The prevalence of steatosis was the same in older people with HIV (66.4%) and controls (66.4%) but lower in younger people with HIV (37.4%; p < 0.001). After adjustment, younger people with HIV were less likely to have steatosis (odds ratio [OR] 0.26; 95% confidence interval [CI] 0.14-0.52) than controls, but male sex (OR 2.45; 95% CI 1.20-4.50) and high waist-to-hip ratio (OR 3.04; 95% CI 1.74-5.33) were associated with an increased odds of steatosis. We found no association between steatosis and HIV-related variables. CONCLUSIONS: The prevalence of hepatic steatosis and fibrosis was similar between older participants regardless of HIV status. Age, sex, and abdominal obesity, but not HIV-related variables, were associated with steatosis. Interventions for controlling obesity should be integrated into routine HIV care.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Hígado Graso , Infecciones por VIH , Papaver , Humanos , Masculino , Anciano , Estudios Transversales , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/patología , Hígado Graso/epidemiología , Hígado Graso/patología , Hígado/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Cirrosis Hepática/complicaciones , Obesidad/complicaciones , Obesidad/epidemiología , Diagnóstico por Imagen de Elasticidad/efectos adversos
2.
AIDS Care ; 36(10): 1392-1399, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38289649

RESUMEN

Contemporary evidence is needed to assess whether the prevalence of depression remains high among people living with HIV in the United Kingdom despite recent efforts to improve patients' mental health, and if depression is negatively associated with individuals' adherence to antiretroviral therapy. In a secondary analysis of a cross-sectional clinic-based survey of alcohol consumption and associated health behaviour among people living with HIV in London, of the 221 respondents, 106 (48%) had poor self-reported adherence to antiretroviral therapy (CASE Index) and 69 (31%) screened positive for depression (PHQ-9). Poor self-reported adherence to ART was 72% higher among participants who screened positive for depression in comparison with participants who screened negative. Respondents who were younger, unemployed, and reported problematic drug use were more likely to screen positive for depression. Screening and management of depression as a part of routine HIV care may support adherence to antiretroviral therapy.


Asunto(s)
Depresión , Infecciones por VIH , Cumplimiento de la Medicación , Autoinforme , Humanos , Estudios Transversales , Masculino , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Infecciones por VIH/epidemiología , Adulto , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Depresión/epidemiología , Depresión/psicología , Fármacos Anti-VIH/uso terapéutico , Prevalencia , Reino Unido/epidemiología , Londres/epidemiología
3.
Sensors (Basel) ; 23(3)2023 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-36772166

RESUMEN

The deployment of 5G around the world continues to progress at a rapid pace, especially in North America and Asia. Its advantages and efficiency as a data transmission network have been widely demonstrated in different fields such as agriculture, education, health, and surveillance. However, this process does not have the same dynamics in Latin America, specifically in Colombia. The country is currently implementing actions aimed at facilitating the deployment of this technology in the short term, including pilot tests for the use of the radio spectrum, spectrum auctions, the planning of future auctions, and the review of spectrum caps. The results of this review allow us to conclude that despite the forecasts and the intentions of the Colombian government and mobile communication service operators, 5G in standalone mode will not be commercially available in Colombia before the end of 2023. The main failures in its deployment are related to the lack of available spectrum to support the ultrahigh-reliability and low-latency, enhanced mobile broadband, and massive machine-type communications scenarios, as well as the delay in the auction processes for its assignment.

4.
HIV Med ; 23(3): 209-226, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34634176

RESUMEN

OBJECTIVES: There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. METHODS: The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up. RESULTS: Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74 (2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated with ART non-adherence. After adjusting for demographic and socioeconomic factors, CAGE score ≥ 2 [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.09-2.13], current smoking (aOR = 1.58, 95% CI: 1.10-2.17) and injection drug use (aOR = 2.11, 95% CI: 1.00-4.47) were associated with viral non-suppression. During follow-up of a subset of 592 people virally suppressed at recruitment, a CAGE score ≥ 2 [adjusted hazard ratio (aHR) = 1.66, 95% CI: 1.03-2.74], use of 3 or more non-injection drugs (aHR = 1.82, 95% CI: 1.12-3.57) and injection drug use (aHR = 2.73, 95% CI: 1.08-6.89) were associated with viral rebound. CONCLUSIONS: Screening and treatment for alcohol, cigarette and drug use should be integrated into HIV outpatient clinics, while clinicians should be alert to the potential for poorer virological outcomes.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Minorías Sexuales y de Género , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Cumplimiento de la Medicación , Uso Recreativo de Drogas , Fumar , Carga Viral
5.
Sensors (Basel) ; 22(19)2022 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-36236394

RESUMEN

The growing global demand for food and the environmental impact caused by agriculture have made this activity increasingly dependent on electronics, information technology, and telecommunications technologies. In Colombia, agriculture is of great importance not only as a commercial activity, but also as a source of food and employment. However, the concept of smart agriculture has not been widely applied in this country, resulting in the high production of various types of crops due to the planting of large areas of land, rather than optimization of the processes involved in the activity. Due to its technical characteristics and the radio spectrum considered in its deployment, 5G can be seen as one of the technologies that could generate the greatest benefits for the Colombian agricultural sector, especially in the most remote rural areas, which currently lack mobile network coverage. This article provides an overview of the current 5G technology landscape in Colombia and presents examples of possible 5G/IoT applications that could be developed in Colombian fields. The results show that 5G could facilitate the implementation of the smart farm in Colombia, improving current production and efficiency. It is useful when designing 5G implementation plans and strategies, since it categorizes crops by regions and products. This is based on budget availability, population density, and regional development plans, among others.


Asunto(s)
Agricultura , Productos Agrícolas , Colombia , Ambiente , Tecnología Inalámbrica
6.
J Infect Dis ; 224(12): 2053-2063, 2021 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33974707

RESUMEN

BACKGROUND: Understanding the genetic interplay between human hosts and infectious pathogens is crucial for how we interpret virulence factors. Here, we tested for associations between HIV and host genetics, and interactive genetic effects on viral load (VL) in HIV-positive antiretroviral treatment-naive clinical trial participants. METHODS: HIV genomes were sequenced and the encoded amino acid (AA) variants were associated with VL, human single nucleotide polymorphisms (SNPs), and imputed HLA alleles using generalized linear models with Bonferroni correction. RESULTS: Human (388 501 SNPs) and HIV (3010 variants) genetic data were available for 2122 persons. Four HIV variants were associated with VL (P < 1.66 × 10-5). Twelve HIV variants were associated with a range of 1-512 human SNPs (P < 4.28 × 10-11). We found 46 associations between HLA alleles and HIV variants (P < 1.29 × 10-7). HIV variants and immunotypes when analyzed separately were associated with lower VL, whereas the opposite was true when analyzed in concert. Epitope binding predictions supported our observations. CONCLUSIONS: Our results show the importance of immunotype specificity on viral antigenic determinants, and the identified genetic interplay emphasizes that viral and human genetics should be studied in the context of each other.Clinical Trials Registration: NCT00867048.


Asunto(s)
Genoma Viral , Infecciones por VIH/genética , VIH-1/genética , Polimorfismo de Nucleótido Simple , Carga Viral/genética , Adulto , Epítopos/genética , Femenino , Genoma Humano , Estudio de Asociación del Genoma Completo , Genotipo , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Masculino , Persona de Mediana Edad , Carga Viral/inmunología
7.
Sensors (Basel) ; 21(21)2021 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-34770472

RESUMEN

Wireless technologies are increasingly relevant in different activities and lines of the economy, as well as in the daily life of people and companies. The advent of fifth generation networks (5G) implies a promising synergy with the Internet of Things (IoT), allowing for more automations in production processes and an increase in the efficiency of information transmission, managing to improve the efficiency in decision-making through tools such as big data and artificial intelligence. This article presents a description of the 5G implementation process in Colombia, as well as a revision of opportunities when combining with IoT in featured sectors of the departmental development plans, such as agriculture, tourism, health, the environment, and industry. Results shows that the startup of 5G in Colombia has been a slow process, but there are comparisons with similar procedures in other developed countries. Additionally, we present examples of 5G and IoT applications which can be promoted in Colombia, aimed at improving the quality of life of their habitants and promoting economic development.


Asunto(s)
Inteligencia Artificial , Internet de las Cosas , Colombia , Humanos , Calidad de Vida , Tecnología Inalámbrica
8.
Hepatology ; 69(3): 1135-1150, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30298608

RESUMEN

The role of antiretroviral therapy (ART) in reducing or contributing to liver fibrosis in persons with human immunodeficiency virus (HIV) is unclear. We evaluated participants in the Strategic Timing of AntiRetroviral Treatment (START) trial for liver fibrosis using the AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4), and assessed for a benefit of early versus delayed ART on liver fibrosis progression. ART-naïve persons with high CD4 counts (>500 cells/µL) from 222 clinical sites in 35 countries were randomized to receive ART either at study enrollment (immediate treatment arm) or when their CD4 count fell below 350 cells/µL (deferred treatment arm). The following outcomes were evaluated: fibrosis (APRI > 0.5 or FIB-4 > 1.45), significant fibrosis (APRI > 1.5 or FIB-4 > 3.25), hepatic flare, and resolution of elevated APRI and FIB-4 scores. Of the 4,684 enrolled into the START study, 104 did not have APRI or FIB-4 results and were excluded. Among 4,580 participants (2,273 immediate treatment; 2,307 deferred treatment), the median age was 36 years, 26.9% were female, and 30.4% were black. Three percent had an alcoholism or substance abuse history, 6.4% had hepatitis B and/or C, and 1.1% had significant fibrosis at baseline. The median CD4 count was 651, and 5.3% had HIV RNA ≤ 200. Immediate arm participants were at lower risk of developing increased fibrosis scores than deferred arm participants (hazard ratio [HR] = 0.66; 95% confidence interval [CI] = 0.57-0.78; P < 0.001) and more likely to have resolution of elevated baseline scores (HR 1.6; 95% CI 1.3-1.9; P < 0.001). Conclusions: Significant liver fibrosis was rare among ART-naïve HIV-positive persons with high CD4 counts. Our findings suggest a benefit of early ART in preventing the development of liver fibrosis.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Cirrosis Hepática/etiología , Adulto , Estudios de Cohortes , Progresión de la Enfermedad , Intervención Médica Temprana , Femenino , Humanos , Masculino , Tiempo de Tratamiento
9.
AIDS Behav ; 24(6): 1717-1726, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31664572

RESUMEN

Alcohol misuse has been associated with negative consequences among HIV-positive patients. Data on real prevalence of risky alcohol consumption among the HIV-positive population in the UK are lacking. A cross-sectional questionnaire study using standardised validated instruments among HIV-positive (n = 227) and HIV-negative (n = 69) patients was performed. The prevalence of risky alcohol consumption (AUDIT) and associations with depressive symptoms (PHQ-9), problematic drug use (DUDIT), adherence to ART (CASE Adherence Index), sexual behaviour and demographic characteristics were assessed among both patient groups independently. A quarter (25.1%) of HIV-positive patients and 36.1% of HIV-negative patients reported risky alcohol consumption (AUDIT-score ≥ 8). In the multivariable analysis among HIV-positive patients depressive symptoms (p = 0.03) and problematic drug use (p = 0.007) were associated with risky alcohol consumption. Among HIV-negative patients these associations were not present. Risky alcohol consumption among HIV-positive patients is prevalent, and together with depressive symptoms and problematic drug use, may influence HIV-disease progression and patients' wellbeing.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/epidemiología , Infecciones por VIH/epidemiología , Conductas Relacionadas con la Salud , Cumplimiento de la Medicación/psicología , Conducta Sexual/psicología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/psicología , Terapia Antirretroviral Altamente Activa , Estudios Transversales , Depresión/epidemiología , Depresión/psicología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Seropositividad para VIH , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Conducta Sexual/estadística & datos numéricos , Salud Sexual , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Reino Unido/epidemiología , Sexo Inseguro
10.
Sensors (Basel) ; 20(22)2020 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-33228055

RESUMEN

Spain is Europe's leading exporter of tomatoes harvested in greenhouses. The production of tomatoes should be kept and increased, supported by precision agriculture to meet food and commercial demand. The wireless sensor network (WSN) has demonstrated to be a tool to provide farmers with useful information on the state of their plantations due to its practical deployment. However, in order to measure its deployment within a crop, it is necessary to know the communication coverage of the nodes that make up the network. The multipath propagation of radio waves between the transceivers of the WSN nodes inside a greenhouse is degraded and attenuated by the intricate complex of stems, branches, leaf twigs, and fruits, all randomly oriented, that block the line of sight, consequently generating a signal power loss as the distance increases. Although the COST235 (European Cooperation in Science and Technology - COST), ITU-R (International Telecommunications Union-Radiocommunication Sector), FITU-R (Fitted ITU-R), and Weisbberger models provide an explanation of the radio wave propagation in the presence of vegetation in the 2.4 GHz ICM band, some significant discrepancies were found when they are applied to field tests with tomato greenhouses. In this paper, a novel method is proposed for determining an empirical model of radio wave attenuation for vegetation in the 2.4 GHz band, which includes the vegetation height as a parameter in addition to the distance between transceivers of WNS nodes. The empirical attenuation model was obtained applying regularized regressions with a multiparametric equation using experimental signal RSSI measurements achieved by our own RSSI measurement system for our field tests in four plantations. The evaluation parameters gave 0.948 for R2, 0.946 for R2 Adj considering 5th grade polynomial (20 parameters), and 0.942 for R2, and 0.940 for R2 Adj when a reduction of parameters was applied using the cross validation (15 parameters). These results verify the rationality and reliability of the empirical model. Finally, the model was validated considering experimental data from other plantations, reaching similar results to our proposed model.


Asunto(s)
Ondas de Radio , Telecomunicaciones , Agricultura , Redes de Comunicación de Computadores , Solanum lycopersicum , Reproducibilidad de los Resultados , España
11.
Clin Infect Dis ; 68(6): 1031-1040, 2019 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-30084882

RESUMEN

BACKGROUND: Protease inhibitor monotherapy (PIM) for human immunodeficiency virus (HIV) may exert suboptimal viral control in the central nervous system. We determined whether cerebral blood flow (CBF) and regional brain volumes were associated with PIM, and whether specific cognitive domains were associated with imaging biomarkers. METHODS: Cognitive assessments and brain magnetic resonance imaging were performed after the final visit of a randomized HIV-treatment strategy trial. Participants were virologically suppressed on triple therapy at trial entry and followed for 3-5 years. We studied 37 patients randomized to ongoing triple therapy and 39 randomized to PIM. Resting CBF and normalized volumes were calculated for brain regions of interest, and correlated with treatment strategy and neuropsychological performance. RESULTS: Mean age was 48.1 years (standard deviation 8.6 years), 63 male (83%), and 64 white (84%). Participants had median 8.1 years (interquartile range 6.4, 10.8) of antiretroviral therapy experience and CD4+ counts of median 640 cells/mm3 (interquartile range 490, 780). We found no difference between treatment arms in CBF or regional volumes. Regardless of treatment arm, poorer fine motor performance correlated with lower CBF in the caudate nucleus (P = .01), thalamus (P = .04), frontal cortex (P = .01), occipital cortex (P = .004), and cingulate cortex (P = .02), and was associated with smaller supratentorial white matter volume (decrease of 0.16 in Z-score per -1% of intracranial volume, 95% confidence interval 0.02-0.29; P = .023). CONCLUSIONS: PIM does not confer an additional risk of neurological injury compared with triple therapy. There were correlations between fine motor impairment, grey matter hypoperfusion, and white matter volume loss. CLINICAL TRIALS REGISTRATION: ISRCTN-04857074.


Asunto(s)
Encéfalo/irrigación sanguínea , Encéfalo/patología , Circulación Cerebrovascular , Cognición , Adulto , Biomarcadores , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Femenino , Neuroimagen Funcional , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Seropositividad para VIH , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Inhibidores de Proteasas/efectos adversos , Inhibidores de Proteasas/uso terapéutico , Resultado del Tratamiento
12.
Clin Infect Dis ; 67(3): 420-429, 2018 07 18.
Artículo en Inglés | MEDLINE | ID: mdl-29538636

RESUMEN

Background: Randomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)-positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART). Methods: The initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation. Results: Of 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P = .81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P = .03) and 1.04 (P = .93) among those with other prespecified ART; (P = .07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group. Conclusions: Participants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk.


Asunto(s)
Fármacos Anti-VIH/efectos adversos , Benzoxazinas/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Conducta Autodestructiva/epidemiología , Suicidio , Adulto , Alquinos , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Ciclopropanos , Femenino , Infecciones por VIH/complicaciones , Seropositividad para VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Carga Viral
13.
AIDS Care ; 30(8): 1040-1049, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29502430

RESUMEN

Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression.


Asunto(s)
Ansiedad/psicología , Depresión/psicología , Infecciones por VIH/psicología , Adolescente , Adulto , Cuidadores , Niño , Estudios de Cohortes , Inglaterra , Femenino , Humanos , Masculino , Embarazo , Autoimagen , Adulto Joven
14.
J Antimicrob Chemother ; 72(6): 1760-1768, 2017 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-28369381

RESUMEN

Objectives: Post-exposure prophylaxis (PEP) for HIV is often poorly tolerated and not completed. Alternative PEP regimens may improve adherence and completion, aiding HIV prevention. We conducted a randomized controlled trial of a maraviroc-based PEP regimen compared with a standard-of-care regimen using ritonavir-boosted lopinavir. Methods: Patients meeting criteria for PEP were randomized to tenofovir disoproxil/emtricitabine (200/245 mg) once daily plus ritonavir-boosted lopinavir (Kaletra ® 400/100 mg) or maraviroc 300 mg twice daily. The composite primary endpoint was completion of 28 days of the allocated PEP regimen without grade 3 or 4 clinical or laboratory adverse events (AEs) related to the PEP medication. Results: Two hundred and thirteen individuals were randomized (107 to maraviroc; 106 to Kaletra ® arm). Follow-up rates were high in both groups. There was no difference in the primary endpoint; 70 (71%) in the maraviroc and 64 (65%) in the Kaletra ® arm ( P = 0.36) completed PEP without grade 3 or 4 AEs. Discontinuation of PEP was the same (18%) in both groups. There were no grade 3 or 4 clinical AEs in either arm, but more grade 1 or 2 clinical AEs in the Kaletra ® arm (91% versus 70%; P < 0.001). Antidiarrhoeal medication use was higher in the Kaletra ® arm (67% versus 25%; P < 0.001). There were no HIV seroconversions in the study period. Conclusions: The completion rate in the absence of grade 3 or 4 AEs was similar with both regimens. Maraviroc-based PEP was better tolerated, supporting its use as an option for non-occupational PEP.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Ciclohexanos/uso terapéutico , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil/uso terapéutico , Infecciones por VIH/prevención & control , Lopinavir/uso terapéutico , Profilaxis Posexposición , Ritonavir/uso terapéutico , Triazoles/uso terapéutico , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Recuento de Linfocito CD4 , Ciclohexanos/administración & dosificación , Ciclohexanos/efectos adversos , Combinación de Medicamentos , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil/administración & dosificación , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil/efectos adversos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/administración & dosificación , Inhibidores de la Proteasa del VIH/efectos adversos , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1/efectos de los fármacos , Humanos , Lopinavir/administración & dosificación , Lopinavir/efectos adversos , Masculino , Maraviroc , Cumplimiento de la Medicación , Ritonavir/administración & dosificación , Ritonavir/efectos adversos , Triazoles/administración & dosificación , Triazoles/efectos adversos , Adulto Joven
15.
Clin Infect Dis ; 63(10): 1380-1387, 2016 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-27581764

RESUMEN

BACKGROUND: There is limited evidence about the cognitive performance of older adolescents with perinatally acquired human immunodeficiency virus (HIV) compared with HIV-negative (HIV-) adolescents. METHODS: A total of 296 perinatally HIV-infected (PHIV+) and 97 HIV- adolescents (aged 12-21 and 13-23 years, respectively) completed 12 tests covering 6 cognitive domains. The HIV- participants had PHIV+ siblings and/or an HIV-infected mother. Domain-specific and overall (NPZ-6) z scores were calculated for PHIV+ participants, with or without Centers for Disease Control and Prevention (CDC) stage C disease, and HIV- participants. Linear regression was performed to explore predictors of NPZ-6. RESULTS: One hundred twenty-five (42%) of the PHIV+ and 31 (32%) of the HIV- participants were male; 251 (85%) and 69 (71%), respectively, were black African; and their median ages (interquartile range) were 16 (15-18) and 16 (14-18) years, respectively. In PHIV+ participants, 247 (86%) were receiving antiretroviral therapy, and 76 (26%) had a previous CDC C diagnosis. The mean (standard deviation) NPZ-6 score was -0.81 (0.99) in PHIV+ participants with a CDC C diagnosis (PHIV+/C), -0.45 (0.80) in those without a CDC C diagnosis (PHIV+/no C), and -0.32 (0.76) in HIV- participants (P < .001). After adjustment, there was no difference in NPZ-6 scores between PHIV+/no C and HIV- participants (adjusted coefficient, -0.01; 95% confidence interval, -.22 to .20). PHIV+/C participants scored below the HIV- group (adjusted coefficient, -0.44; -.70 to -.19). Older age predicted higher NPZ-6 scores, and black African ethnicity and worse depression predicted lower NPZ-6 scores. In a sensitivity analysis including PHIV+ participants only, no HIV-related factors apart from a CDC C diagnosis were associated with NPZ-6 scores. CONCLUSIONS: Cognitive performance was similar between PHIV+/no C and HIV- participants and indicated relatively mild impairment compared with normative data. The true impact on day-to-day functioning needs further investigation.


Asunto(s)
Disfunción Cognitiva , Infecciones por VIH/epidemiología , Adolescente , Adulto , Antirretrovirales/uso terapéutico , Población Negra , Niño , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/fisiopatología , VIH-1 , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Factores de Riesgo , Adulto Joven
16.
Clin Infect Dis ; 63(2): 257-64, 2016 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-27143662

RESUMEN

BACKGROUND: To determine whether treatment with ritonavir-boosted protease inhibitor (PI) monotherapy is associated with detrimental effects on neurocognitive function or brain imaging markers compared to standard antiretroviral therapy (ART). METHODS: Neuropsychological assessment and brain magnetic resonance imaging were performed at the last study visit in a subset of participants randomized to PI monotherapy (PI-mono group) or ongoing triple ART (OT group) in the PIVOT trial. We calculated a global z-score (NPZ-7) from the average of the individual test z-scores and the proportion of participants with symptomatic neurocognitive impairment (score >1 standard deviation below normative means in ≥2 cognitive domains and neurocognitive symptoms). In a subgroup, white matter hyperintensities, bicaudate index, global cortical (GCA) and medial temporal lobe atrophy scores and single voxel (basal ganglia) N-acetylaspartate (NAA)/Choline, NAA/Creatine and myo-inositol/Creatine ratios were measured. RESULTS: 146 participants (75 PI-mono) had neurocognitive testing (median time after randomization 3.8 years), of whom 78 were imaged. We found no difference between arms in NPZ-7 score (median -0.4 (interquartile range [IQR] = -0.7; 0.1) vs -0.3 (IQR = -0.7; 0.3) for the PI-mono and OT groups respectively, P = .28), the proportion with symptomatic neurocognitive impairment (13% and 18% in the PI-mono and OT groups respectively; P = .41), or any of the neuroimaging variables (P > .05). Symptomatic neurocognitive impairment was associated with higher GCA score (OR = 6.2 per additional score; 95% confidence interval, 1.7-22.3 P = .005) but no other imaging variables. CONCLUSIONS: Based on a comprehensive neuropsychological assessment and brain imaging, PI monotherapy does not increase the risk of neurocognitive impairment in stable human immunodeficiency virus-positive patients.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Inhibidores de la Proteasa del VIH/uso terapéutico , Seropositividad para VIH/tratamiento farmacológico , Seropositividad para VIH/fisiopatología , Trastornos Neurocognitivos/virología , Ritonavir/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Encéfalo/diagnóstico por imagen , Encéfalo/efectos de los fármacos , Estudios Transversales , Femenino , Inhibidores de la Proteasa del VIH/administración & dosificación , Inhibidores de la Proteasa del VIH/efectos adversos , Seropositividad para VIH/virología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/inducido químicamente , Neuroimagen , Pruebas Neuropsicológicas , Ritonavir/administración & dosificación , Ritonavir/efectos adversos , Carga Viral/efectos de los fármacos
17.
J Neurovirol ; 22(1): 104-13, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26323809

RESUMEN

Sensory peripheral neuropathy (PN) remains a common complication in HIV-positive patients despite effective combination anti-retroviral therapy (ART). Data on PN on second-line ART is scarce. We assessed PN using a standard tool in patients failing first-line ART and for 96 weeks following a switch to PI-based second-line ART in a large Randomised Clinical Trial in Sub-Saharan Africa. Factors associated with PN were investigated using logistic regression. Symptomatic PN (SPN) prevalence was 22% at entry (N = 1,251) and was associated (p < 0.05) with older age (OR = 1.04 per year), female gender (OR = 1.64), Tuberculosis (TB; OR = 1.86), smoking (OR = 1.60), higher plasma creatinine (OR = 1.09 per 0.1 mg/dl increase), CD4 count (OR = 0.83 per doubling) and not consuming alcohol (OR = 0.55). SPN prevalence decreased to 17% by week 96 (p = 0.0002) following similar trends in all study groups (p = 0.30). Asymptomatic PN (APN) increased over the same period from 21 to 29% (p = 0.0002). Signs suggestive of PN (regardless of symptoms) returned to baseline levels by week 96. At weeks 48 and 96, after adjusting for time-updated associations above and baseline CD4 count and viral load, SPN was strongly associated with TB (p < 0.0001). In summary, SPN prevalence was significantly reduced with PI-based second-line therapy across all treatment groups, but we did not find any advantage to the NRTI-free regimens. The increase of APN and stability of PN-signs regardless of symptoms suggest an underlying trend of neuropathy progression that may be masked by reduction of symptoms accompanying general health improvement induced by second-line ART. SPN was strongly associated with isoniazid given for TB treatment.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Lopinavir/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , ARN Viral/sangre , Raltegravir Potásico/uso terapéutico , Ritonavir/uso terapéutico , Adulto , África del Sur del Sahara , Abstinencia de Alcohol , Terapia Antirretroviral Altamente Activa , Antituberculosos/uso terapéutico , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/patología , Linfocitos T CD4-Positivos/virología , Combinación de Medicamentos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/fisiopatología , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/crecimiento & desarrollo , Humanos , Isoniazida/uso terapéutico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/virología , ARN Viral/antagonistas & inhibidores , Fumar/fisiopatología , Tuberculosis Pulmonar/tratamiento farmacológico , Carga Viral/efectos de los fármacos
18.
BMC Infect Dis ; 15: 138, 2015 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-25888119

RESUMEN

BACKGROUND: Increased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono). METHODS: HIV-infected adults with persistent HIV-RNA<50 copies/ml and treated with either a) PImono or b) standard triple-drug cART were recruited for this cross-sectional, exploratory study. Plasma samples were tested for high-sensitivity CRP (hsCRP), Serum Amyloid A (SAA), soluble CD14, IL-6, IL-8 and Cytochrome C. HIV-RNA was measured by real-time PCR (detection limit of 10 copies/ml). RESULTS: 81 patients were recruited (31% on PImono). Two out of 25 (8%) and 3 of 56 (5.4%) patients from the PImono and cART groups respectively had detectable HIV-RNA. Significant correlation between SAA and hsCRP was observed (0.804). No difference between groups was found on prevalence of hsCRP>3 mg/l (21% vs 20% in the PImono and cART groups respectively; p=0.577) or SAA>6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P=0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA>6.4 mg/l (OR=1.74 and 1.46; 95% CI=1.00-3.03 and 1.06-2.01; p=0.051 and 0.02 respectively) and hsCRP>3 mg/l in (OR=2.00 and 1.37; 95% CI=1.09-3.69 and 1.02-1.85; p=0.026 and 0.039 respectively). CONCLUSIONS: We found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Inflamación/tratamiento farmacológico , Inhibidores de Proteasas/uso terapéutico , Ritonavir/uso terapéutico , Viremia/tratamiento farmacológico , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Inflamación/sangre , Inflamación/complicaciones , Inflamación/virología , Interleucina-6/sangre , Interleucina-8/sangre , Masculino , Persona de Mediana Edad , Proteína Amiloide A Sérica/análisis , Viremia/complicaciones
19.
Eur Respir J ; 43(1): 166-77, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23766333

RESUMEN

Mortality of HIV/tuberculosis (TB) patients in Eastern Europe is high. Little is known about their causes of death. This study aimed to assess and compare mortality rates and cause of death in HIV/TB patients across Eastern Europe and Western Europe and Argentina (WEA) in an international cohort study. Mortality rates and causes of death were analysed by time from TB diagnosis (<3 months, 3-12 months or >12 months) in 1078 consecutive HIV/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis. 347 patients died during 2625 person-years of follow-up. Mortality in Eastern Europe was three- to ninefold higher than in WEA. TB was the main cause of death in Eastern Europe in 80%, 66% and 61% of patients who died <3 months, 3-12 months or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (incidence rate ratio (IRR) 0.12, 95% CI 0.04-0.35), standard TB-treatment (IRR 0.45, 95% CI 0.20-0.99) and antiretroviral therapy (IRR 0.32, 95% CI 0.14-0.77) were associated with reduced risk of TB-related death. Persistently higher mortality rates were observed in HIV/TB patients in Eastern Europe, and TB was the dominant cause of death at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise the management of HIV/TB patients and limit TB-associated mortality in this region.


Asunto(s)
Coinfección/mortalidad , Infecciones por VIH/mortalidad , Tuberculosis/mortalidad , Adulto , Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Argentina , Causas de Muerte , Estudios de Cohortes , Europa (Continente) , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Análisis Multivariante , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico
20.
Int J STD AIDS ; 35(1): 71-73, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37728103

RESUMEN

People living with HIV (PLWH) are at higher risk of reactivation of Chagas disease, a neglected tropical disease, caused by Trypanosoma cruzi. There are no data from UK HIV clinics on the prevalence of T. cruzi. We implemented T. cruzi screening at our clinic as part of routine care for PLWH with epidemiological risk factors. Among 86 patients screened, none had positive serology: one seropositive patient was identified due to increased clinician awareness. Implementing T. cruzi screening as part of routine clinical care was feasible, though labour intensive and identified at-risk individuals.


Asunto(s)
Enfermedad de Chagas , Infecciones por VIH , Trypanosoma cruzi , Humanos , Trypanosoma cruzi/fisiología , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/epidemiología , Factores de Riesgo , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Reino Unido/epidemiología
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