Quality of life and self-reported lower extremity function in adults with HIV-related distal sensory polyneuropathy.

BACKGROUND: Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. Its effects on quality of life (QOL) and function have not been well described. OBJECTIVE: The study objectives were: (1) to compare QOL and lower extremity function in people with HIV-related DSP and people with HIV disease who do not have DSP, (2) to determine the extent to which function predicts QOL, (3) to evaluate the agreement of 2 function scales, and (4) to describe the use of pain management resources. DESIGN: This was a cross-sectional survey study with predictive modeling and measurement tool concordant validation. METHODS: A demographic questionnaire, the Medical Outcomes Study HIV Health Survey, the Lower Extremity Functional Scale (LEFS), the Lower Limb Functional Index (LLFI), and a review of medical records were used. General linear modeling was used to assess group differences in QOL and the relationship between function and QOL. Bland-Altman procedures were used to assess the agreement of the LEFS and the LLFI. RESULTS: Usable data for analyses were available for 82 of the 94 participants enrolled. The 67% of participants who reported DSP symptoms tended to be older, had HIV disease longer, and were more likely to receive disability benefits. Participants without DSP had better LLFI, LEFS, and physical health summary scores. In multivariate models, lower limb function predicted physical and mental health summary scores. The LLFI identified participants with a lower level of function more often than the LEFS. Participants with DSP were more likely to use medical treatment, physical therapy, and complementary or alternative treatments. LIMITATIONS: A sample of convenience was used; the sample size resulted in a low power for the mental health summary score of the Medical Outcomes Study HIV Health Survey. CONCLUSIONS: Quality of life and function were more impaired in participants with HIV disease and DSP. The LLFI was more likely to capture limitations in function than the LEFS. Participants with DSP reported more frequent use of pain management resources.

Injectable poly-L-lactic acid for human immunodeficiency virus-associated facial lipoatrophy: cumulative year 2 interim analysis of an open-label study (FACES).

BACKGROUND: Studies of injectable poly-L-lactic acid (PLLA) in human immunodeficiency virus (HIV)-associated facial lipoatrophy have predominantly included male Caucasians. OBJECTIVE: To report cumulative year 2 interim study results examining the safety and efficacy of injectable PLLA in subjects with HIV categorized according to Fitzpatrick skin type and sex. MATERIALS AND METHODS: This is an ongoing open-label, multicenter, 5-year study of 290 treated subjects. After correction with injectable PLLA, subjects are being followed annually. Primary end points include incidence and severity of treatment-emergent adverse events (TEAEs). Secondary end points include mean change from baseline of James scale severity grade and treatment satisfaction. RESULTS: At 2 years, TEAE incidences were: potentially related to study product (n = 53,18.3%) or injection procedure (n = 71, 24.5%), injection-site nodules (n = 24, 8.3%) and papules (n = 25, 8.6%). No hypertrophic scars, keloids, or product-related serious TEAEs were reported. Mean improvement in James scale grade for all groups was 1.4 (p < .001), and 89.4% of subjects and 95.5% of physicians rated treatment satisfaction as very good or excellent. CONCLUSION: At 2 years, injectable PLLA is a safe and effective long-term treatment for HIV-associated facial lipoatrophy regardless of Fitzpatrick skin type; confirmation of these results will be needed at the completion of this 5-year study.

Evaluation of the pathogenesis of decreasing CD4(+) T cell counts in human immunodeficiency virus type 1-infected patients receiving successfully suppressive antiretroviral therapy.

Most human immunodeficiency virus (HIV)-infected individuals experience increases in peripheral CD4(+) T cell counts with suppressive antiretroviral therapy (ART) that achieves plasma HIV RNA levels that are less than the limit of detection. However, some individuals experience decreasing CD4(+) T cell counts despite suppression of plasma viremia. We evaluated 4 patients with a history of CD4(+) T cell decline despite successfully suppressive ART, from a median of 719 cells/mm(3) (range, 360-1141 cells/mm(3)) to 227 cells/mm(3) (range, 174-311 cells/mm(3)) over a period of 18-24 months; 3 of the patients were receiving tenofovir and didanosine, which may have contributed to this decrease. There was no evidence of HIV replication, nor of antiretroviral drug resistance in the blood or lymphoid tissue, or increased proliferation or decreased thymic production of naive CD4(+) T cells. All 4 patients had significant fibrosis of the T cell zone of lymphoid tissue, which appeared to be an important factor in the failure to reconstitute T cells.

CD4 count improvement following tenofovir to abacavir switch in a patient with persistent lymphopenia despite an undetectable viral load.

Many different antiretroviral regimens can be used as initial therapy for infection with HIV. While all recommended regimens have been shown to be highly effective in suppressing HIV replication to undetectable levels, some differences may exist with regard to the level of immune reconstitution (eg, CD4+ cell population) that occurs. We report a case of a patient with profound and prolonged lymphopenia, despite undetectable HIV RNA levels, that reversed following a switch from a fixed-dose combination of tenofovir/emtricitabine to abacavir/lamivudine in the patient's regimen.

Three-class antiretroviral resistance in a patient with acute HIV-1 infection.

Antiretroviral resistance in treatment-naïve patients with HIV-1 infection is on the rise in both resource-rich and resource-poor countries. We report a case of three-class primary antiretroviral resistance detected by a genotypic assay in a 19-year-old woman with acute HIV-1 infection. Her risk factor for HIV acquisition was unprotected sexual intercourse with a HIV-positive man. At diagnosis, her HIV-1 RNA level was 730,376 copies per milliliter, and 2 weeks later her CD4+ cell count was 465 cells/mm(3). The patient's antiretroviral therapy was chosen based on the genotype of the source patient. Subsequent analysis of our patient's virus revealed an identical genotype to that of the source patient. The patient tolerated therapy well and continues to be virologically suppressed after 1 year of therapy. Her current CD4+ cell count is 537 cells/mm(3) and HIV-1 RNA is less than 400 copies per milliliter. This case supports the current recommendations from several HIV therapy guidelines to perform resistance testing in patients with acute HIV-1 infection.

The effect of group aerobic exercise and t'ai chi on functional outcomes and quality of life for persons living with acquired immunodeficiency syndrome.

OBJECTIVE: This study aimed to assess the usefulness of two interventions in a group rehabilitation medicine setting to determine strategies and exercise guidelines for long-term care of the HIV/AIDS population with human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS). DESIGN: This was a randomized clinical trial investigating the effects of tai chi (TC) and aerobic exercise (EX) on functional outcomes and quality of life (QOL) in patients with AIDS. SETTING: Two outpatient infectious disease clinics in a mid-atlantic state were the setting. SUBJECTS AND INTERVENTION: Thirty-eight (38) subjects with advanced HIV (AIDS) were randomized to one of three groups: TC, EX, or control. Experimental groups exercised twice weekly for 8 weeks. OUTCOME MEASURES: The primary outcomes included QOL as measured by the Medical Outcomes Short Form (MOS-HIV) and Spirituality Well-Being Scale (SWB). Functional measures included the functional reach (FR) for balance, sit and reach (SR) for flexibility, and sit-up (SU) test for endurance. The physical performance test (PPT) was used to determine overall function, and the Profile of Mood States (POMS) was used to evaluate psychologic changes. To consider the patients' explanations for these measurements, qualitative data were collected from subjects' journals, focus groups, and nonparticipant observation. RESULTS: Thirty-eight (38) subjects were included in data analysis: 13 in the TC group, 13 in the EX group, and 12 in the control group. Results of analysis of covariance showed significant changes in the exercise groups in overall functional measures (p < 0.001). The MOS-HIV showed a significant difference on the subscale of overall health (p = 0.04). The POMS showed significant main effect for time in confusion-bewilderment (p = 0.000) and tension-anxiety (p = 0.005). Three dominant themes emerged from the qualitative data, including: positive physical changes, enhanced psychologic coping, and improved social interactions. CONCLUSIONS: This study shows that TC and EX improve physiologic parameters, functional outcomes, and QOL. Group intervention provides a socialization context for management of chronic HIV disease. This study supports the need for more research investigating the effect of other types of group exercise for this population. This study sets the stage for a larger randomized controlled trial to examine the potential short- and long-term effects of group exercise that may prove beneficial in the management of advanced HIV disease. Further research is warranted to evaluate additional exercise interventions that are accessible, safe, and cost-effective for the HIV population.

Evaluation of initial CD4+ T cell counts in individuals with newly diagnosed human immunodeficiency virus infection, by sex and race, in urban settings.

The CD4+ T cell count is an important determinant of disease stage and prognosis in human immunodeficiency virus (HIV)-infected individuals. This study evaluated the CD4+ T cell counts in individuals at the time of diagnosis of HIV infection at 4 community clinics in large urban settings with relatively high frequencies of HIV infection. Of 2223 individuals, 57% and 36% had CD4+ T cell counts < 350 and < 200 cells/mm(3), respectively, at the time of diagnosis. There were no clear differences by sex or race. Enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across sex and race strata in community settings may be important for early identification of individuals with HIV infection. This in turn could impact efforts to reduce transmission, and it could impact the prognosis for patients who receive antiretroviral therapy.