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1.
Medicine (Baltimore) ; 99(11): e19140, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176039

RESUMEN

Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.


Asunto(s)
Antivirales/uso terapéutico , Bencimidazoles/uso terapéutico , Coinfección/tratamiento farmacológico , Fluorenos/uso terapéutico , Infecciones por VIH/complicaciones , Hepacivirus/efectos de los fármacos , Hepatitis C/complicaciones , Uridina Monofosfato/análogos & derivados , Afroamericanos/estadística & datos numéricos , Antivirales/administración & dosificación , Bencimidazoles/administración & dosificación , Coinfección/virología , Femenino , Fluorenos/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Hepatitis C/tratamiento farmacológico , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Estudios Retrospectivos , Resultado del Tratamiento , Uridina Monofosfato/administración & dosificación , Uridina Monofosfato/uso terapéutico
2.
Rev Bras Epidemiol ; 23: e200020, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159630

RESUMEN

INTRODUCTION: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. METHODOLOGY: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. RESULTS: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. CONCLUSION: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Diagnóstico Tardío , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
3.
Infect Dis Poverty ; 9(1): 28, 2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32169118

RESUMEN

BACKGROUND: By the end of October 2019, there were 958 thousand people were reported living with HIV/AIDS in China. Unhealthy lifestyle factors, such as smoking, drinking alcohol, using illicit drugs and no physical activity have been found to mitigate the positive impact of antiretroviral therapy (ART) on viral load and HIV-related quality of life. Moreover, risky sexual behavior among HIV-positive persons places their partners at risk for HIV transmission and other sexually transmitted infections. The aim of the study is to determine the prevalence of unhealthy behavior of people living with HIV/AIDS and related influencing factors, particularly those that are closely connected with HIV infection and ART effects. METHODS: An institutional based cross-sectional study design was used to collect data from people living with HIV/AIDS (PLWHA) in Beijing and Yunnan Province. The following information was included in the questionnaire survey: social-demographic characteristics, health behavior information, sexual risk behaviors. Binary logistic regression model was conducted to analyze the influencing factors of unhealthy general health behaviors and risky sexual behaviors. RESULTS: In total, 2575 PLWHA were included in the study and 78.3% (2017/2575) were male. For the general health behaviors, 34.2% (987/2544) smoke; 33.8% (870/2575) drank alcohol and 2.3% (49/2134) reported the use of illicit drugs in the previous 6 months. From the sexual behaviors perspective, 59.0% (1519/2575) had sex in the previous 6 months. Among people who had sex, 92.0% (1398/1519) had fixed sexual partners. Among those with no fixed sexual partner, 38.0% (46/121) had more than three partners. Among men who had sex, 34.7% (448/1292) reported having sex with men in the previous 6 months and 16.7% (75/448) of these had group sexual activity. Among participants, 72.2% (1053/1458) used condoms every time they had sex while 6.4% (94/1458) of people never used condom. Male people living with HIV/AIDS were more likely to have sexual risk behaviors (adjusted odds ratio [OR] = 2.208, 95% confidence interval [CI]: 1.147-4.252) and unhealthy general health behaviors (adjusted OR = 2.029, 95% CI: 1.480-2.783). The odds of higher risk sexual behaviors was 1.546 times (95% CI: 1.302-1.827, P = 0.001) greater among participants who drank alcohol compared with their non-drinking counterparts. CONCLUSIONS: PLWHA is a group that is vulnerable to problematic health behaviors, especially for men who were more likely to drink alcohol, have more sexual partners, more sexual risk behaviors including group sexual activity, not using condoms and using drugs. Therefore, interventions focusing on gender-specific risk behaviors reduction for people living with HIV/AIDS are now necessary to control the spread of HIV infection and improve the efficacy of antiviral treatment.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Condones/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conductas Relacionadas con la Salud , Conducta Sexual , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , China/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores de Riesgo , Asunción de Riesgos , Parejas Sexuales , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
4.
Nat Rev Drug Discov ; 19(3): 149-150, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32127666
5.
N Engl J Med ; 382(12): 1124-1135, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130806

RESUMEN

BACKGROUND: Long-acting injectable regimens may simplify therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection. METHODS: We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm). RESULTS: At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found in 6 of 283 participants (2.1%) who received long-acting therapy and in 7 of 283 (2.5%) who received oral therapy (adjusted difference, -0.4 percentage points; 95% confidence interval [CI], -2.8 to 2.1), a result that met the criterion for noninferiority for the primary end point (margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 93.6% who received long-acting therapy and in 93.3% who received oral therapy (adjusted difference, 0.4 percentage points; 95% CI, -3.7 to 4.5), a result that met the criterion for noninferiority for this end point (margin, -10 percentage points). Of the participants who received long-acting therapy, 86% reported injection-site reactions (median duration, 3 days; mild or moderate severity, 99% of cases); 4 participants withdrew from the trial for injection-related reasons. Grade 3 or higher adverse events and events that met liver-related stopping criteria occurred in 11% and 2%, respectively, who received long-acting therapy and in 4% and 1% who received oral therapy. Treatment satisfaction increased after participants switched to long-acting therapy; 91% preferred long-acting therapy at week 48. CONCLUSIONS: Therapy with long-acting cabotegravir plus rilpivirine was noninferior to oral therapy with dolutegravir-abacavir-lamivudine with regard to maintaining HIV-1 suppression. Injection-site reactions were common. (Funded by ViiV Healthcare and Janssen; FLAIR ClinicalTrials.gov number, NCT02938520.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Quimioterapia de Inducción , Inyecciones Intramusculares , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
6.
N Engl J Med ; 382(12): 1112-1123, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130809

RESUMEN

BACKGROUND: Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS: In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS: Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS: Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Inyecciones Intramusculares/efectos adversos , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
7.
Medicine (Baltimore) ; 99(7): e18777, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049783

RESUMEN

This study sought to determine the dominant circulating human immunodeficiency virus type 1 (HIV-1) subtype and associated drug resistance mutations in Ghana.This cross-sectional study was conducted with archived samples collected from patients who received care at 2 hospitals in Ghana from 2014 to 2016. Blood samples were earlier processed into plasma and peripheral blood mononuclear cells and stored at -80 °C. Ribonucleic acid (RNA) was extracted from the archived plasma. Two HIV-1 genes; protease and reverse transcriptase, were amplified, sequenced using gene-specific primers and analyzed for subtype and drug resistance mutations using the Stanford HIV Database.Of 16 patient samples successfully sequenced, we identified the predominance of HIV-1 subtype CRF02_AG (11/16, 68%). Subtypes G (2/16, 13%), dual CRF02_AG/G (2/16, 13%), and CRF01_AE (1/16, 6%) were also observed. Major nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations, M184I/V, D67N, T215F, and K70R/E were found. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations, K103N, Y181C, V90I, F227L, and V106A were also prevalent. Additionally, and at a lower level, protease inhibitor (PI)-resistance mutations, M46I, I54 V, V82A, L90 M, and I471 V, were also present in the sequences from antiretroviral therapy (ART)-experienced individuals. Two NRTI-associated drug resistance mutations (DRMs) (D67N and T69N) were present in sequences from 1 ART-naive individual.HIV-1 subtype CRF02_AG was most frequently detected in this study thus confirming earlier reports of dominance of this subtype in the West-African sub-region and Ghana in particular. The detection of these drug resistance mutations in individuals on first-line regimen composed of NRTI and NNRTI is an indication of prolonged drug exposure without viral load monitoring. Routine viral load monitoring is necessary for early detection of virologic failure and drug resistance testing will inform appropriate choice of regimens for such patients.


Asunto(s)
Farmacorresistencia Viral , Infecciones por VIH/virología , VIH-1/clasificación , Mutación , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Evolución Molecular , Femenino , Ghana , Infecciones por VIH/tratamiento farmacológico , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , VIH-1/genética , VIH-1/fisiología , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Carga Viral
8.
Mem Inst Oswaldo Cruz ; 114: e190350, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32022169

RESUMEN

BACKGROUND: Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis. OBJECTIVES: We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters. METHODS: The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4+ T cell counts, serum iron, haematological and anthropometrics parameters were recorded. FINDINGS: Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4+ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01]. MAIN CONCLUSIONS: This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.


Asunto(s)
Antirretrovirales/administración & dosificación , Infecciones por VIH/virología , Hierro en la Dieta/efectos adversos , Carga Viral/efectos de los fármacos , Adulto , Recuento de Linfocito CD4 , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Homeostasis , Humanos , Hierro en la Dieta/análisis , Masculino , Estado Nutricional , Factores Socioeconómicos , Encuestas y Cuestionarios
9.
West Afr J Med ; 37(1): 19-25, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030707

RESUMEN

BACKGROUND AND OBJECTIVES: Healthcare workers are exposed to accidental infections from contaminated body fluids in the course of their duties. HIV post-exposure prophylaxis (PEP) is the measure instituted to manage exposure to potentially contaminated body fluids and prevent HIV infection. Ignorance of the appropriate measures to take may increase the risk of acquiring HIV infection from accidental exposure. This survey was conducted to assess the knowledge, attitude and practice of HIV PEP among doctors in a tertiary hospital. METHODS: This was a cross-sectional survey. A pretested structured questionnaire was administered on randomly selected doctors from all clinical departments of a tertiary hospital. The questionnaire assessed the knowledge, attitude and practice of HIV PEP according to the WHO guidelines. A score of > 75% was adequate for each area. RESULTS: Fifty-one completed questionnaires were returned out of 56 giving a response rate of 91%. The total knowledge score was 60.0 ± 10.2% (mean ± SD). The total score in attitude towards PEP was 66.5 ± 12.2% while for practice it was 47.5 ± 27.0%. There was a significant correlation between participant's knowledge and practice (rho = 0.316, p <0.05) as well as between attitude and practice (rho= 0.393, p< 0.01). There was no significant difference in scores in relation to the cadre or department. CONCLUSION: This study reveals that the knowledge, attitude and practice of HIV PEP among doctors is generally not adequate. Enhanced education will reduce the risk of accidental HIV infection among doctors.


Asunto(s)
Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Médicos , Profilaxis Posexposición , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Encuestas y Cuestionarios , Centros de Atención Terciaria
10.
West Afr J Med ; 37(1): 40-47, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030710

RESUMEN

BACKGROUND: Haematological abnormalities such as anaemia, leucopenia, and thrombocytopenia are common complications of Human Immunodeficiency Virus (HIV) infection. Few researchers have studied the changes in HIV positive patients before and during antiretroviral therapy (ART) in Ghana. This study is aimed at determining the haematological profile of people living with HIV (PLHIV) at baseline and whilst on ART in a tertiary facility in Cape Coast, Ghana. METHODS: This was an analytical cross-sectional study with a retrospective component among PLHIV assessing ART services at the Cape Coast Teaching Hospital, Ghana. Full blood count (FBC) test was performed on blood samples and the results were analyzed and categorized based on WHO definitions. RESULTS: A total of 440 participants were included. The mean haemoglobin level (g/dL) for females at baseline, 6 months after ART and during this study were 9.6 (±1.8), 10.9 (±1.4) and 11.6 (±1.4); and 10.2 (±2.1), 11.6 (±1.7) and 11.8 (±1.6) for males. At baseline, the commonest type of anaemia for both females and males was microcytic hypochromic anaemia. The mean platelet count was 382 x 109/l at baseline but reduced to 298 x 109/L after 6 months on ART. Among male participants in this study, the main factor associated with being anaemic after 6 months on ART was the ART regimen with non-Zidovudine based regimen, having reduced odds of anaemia of OR 0.3 (95%CI 0.1 - 0.9), p-value of 0.04. Among females, having plasma viral load >1000 copies per ml was found to have increased odds of being anaemic (OR 1.4, 95%CI 0.7 - 2.6), though not statistically significant (P-value of 0.32). CONCLUSION: The prevalence of anaemia, though improved on ART, was high among PLHIV. It is essential to ensure that full blood count of PLHIV in Ghana are done regularly, at all levels of service provision, with appropriate referral systems in place. The change to the current TDF based preferred first line ART regimen must also be enforced to reduce the potential risks associated with AZT use. This will improve outcome for PLHIV.


Asunto(s)
Anemia/inducido químicamente , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Anemia/epidemiología , Estudios Transversales , Femenino , Ghana , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria
11.
West Afr J Med ; 37(1): 53-57, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030712

RESUMEN

BACKGROUND: Pruritic papular eruption (PPE) is a frequent cause of substantial morbidity in Human Immunodeficiency Virus (HIV) patients in Nigeria. This skin condition remains the most common cutaneous manifestation in HIV-infected patients and it is more prevalent in developing countries. AIMS: To describe the clinical and pathologic features of PPE in our patients, and compare with those seen in other parts of the world. MATERIALS AND METHODS: Specimen collection, analysis and write-up of the study lasted 18 months (January 2015 to June 2016) after ethical approval of the proposal. The study design was a cross-sectional descriptive study of confirmed HIV-infected patients with clinically active PPE lesions presenting at the Dermatology outpatient clinic, the HIV/ART clinic, and those admitted as in-patients in the medical wards of the University of Benin Teaching Hospital, Benin. Data generated from the study were entered into and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Only 106 patients were histologically confirmed to be PPE and subsequently recruited for the study. The pattern of distribution of PPE-HIV suggested that the rash has a predilection for exposed parts of the body. The body regions most significantly affected were lateral surface of lower limb, upper limb extensor surface, dorsal surface of foot and dorsal surface of hand. The most common secondary changes observed among the patients were excoriated papules, post-inflammatory hyper- and hypopigmentation, scarring, lichenification. CONCLUSION: Lesions of pruritic papular eruptions (PPE) of HIV in this study were distributed predominantly on the exposed parts of the body especially the upper and lower limbs.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Exantema/patología , Infecciones por VIH/tratamiento farmacológico , Prurito/patología , Estudios Transversales , Exantema/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Nigeria/epidemiología , Prurito/epidemiología , Prurito/etiología
12.
West Afr J Med ; 37(1): 67-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030715

RESUMEN

OBJECTIVE: The purpose of this study was to examine trends in clinical characteristics and in-hospital mortality of HIV patients in a low resource setting in the period 2010 to 2016. METHODS: Data on socio-demographic and clinical characteristics of 313 hospitalized HIV positive patients at the University College Hospital, Ibadan, Nigeria were retrospectively extracted, described and examined for trends. Factors independently associated with mortality were identified using multiple logistic regression. RESULTS: The mean age was 39 years (SD = 9.8) and about two thirds were female. The proportion of females decreased significantly from 83.3% in 2010-2011 to 39.8% in 2016. There was a significant reduction in the diagnosis of disseminated tuberculosis and mortality from 19.4% and 42.9% in 2010-2011 to 4.8% and 27.9% in 2016 respectively. On multiple logistic regression, being male, having neurological features, meningitis, and shorter stay in hospital had significantly higher odds of mortality. CONCLUSION: There was a reduction in in-hospital mortality of HIV patients over the period from 2010 to 2016. Being male and presence of neurological features were associated with mortality. Larger prospective studies are needed to further investigate this observed reduction in mortality among hospitalised patients.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por VIH/tratamiento farmacológico , Pacientes Internos/estadística & datos numéricos , Mortalidad/tendencias , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/administración & dosificación , Femenino , Infecciones por VIH/mortalidad , Hospitales de Enseñanza , Hospitales Universitarios , Humanos , Tiempo de Internación , Masculino , Meningitis/complicaciones , Meningitis/mortalidad , Persona de Mediana Edad , Nigeria/epidemiología , Admisión del Paciente/estadística & datos numéricos , Admisión del Paciente/tendencias , Estudios Retrospectivos , Distribución por Sexo , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/mortalidad , Adulto Joven
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(1): 127-130, 2020 Jan 10.
Artículo en Chino | MEDLINE | ID: mdl-32062955

RESUMEN

Frailty syndrome, caused by degenerative changes in the body and the body vulnerability due to a variety of chronic diseases, is associated with adverse outcomes, such as fall, disability and mortality. With the development of antiretroviral therapy, the average life span of HIV/AIDS patients is extended, the number of elderly living with HIV/AIDS has increased, resulting the increase of the incidence of frailty syndrome in this population. The incidence of frailty syndrome in the elderly is associated with HIV infection and adverse reaction of antiretroviral therapy. Early assessment and intervention of frailty syndrome in elderly HIV/AIDS patients can reduce adverse clinical events and improve the quality of life.


Asunto(s)
Anciano Frágil , Infecciones por VIH , Anciano , Envejecimiento , Antivirales/uso terapéutico , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Calidad de Vida , Síndrome
14.
Medicine (Baltimore) ; 99(8): e19213, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080112

RESUMEN

This study described the prevalence of adverse pregnancy outcomes (APOs) in Chinese HIV-infected pregnant women, and examined the relationship between maternal HIV infection /HIV-related factors and APOs.This prospective cohort study was carried out among 483 HIV-infected pregnant women and 966 HIV-uninfected pregnant women. The HIV-infected and HIV-uninfected women were enrolled from midwifery hospitals in Hunan province between October 2014 and September 2017. All data were extracted in a standard structured form, including maternal characteristics, HIV infection status, HIV-related factors and their pregnancy outcomes. APOs were assessed by maternal HIV infection status and HIV-related factors using logistic regression analysis.The incidences of stillbirth (3.9% vs 1.1%), preterm birth (PTB) (8.9% vs 3.7%), low birth weight (LBW) (12.2% vs 3.1%) and small for gestational age (SGA) (21.3% vs 7.0%) were higher in HIV-infected women than HIV-uninfected women, with adjusted ORs of 2.77 (95%CI: 1.24-6.17), 2.37 (95%CI: 1.44-3.89), 4.20 (95%CI: 2.59-6.82) and 3.26 (95%CI: 3.26-4.64), respectively. No differences were found in neonatal asphyxia or birth defects between HIV-infected and HIV-uninfected groups, with adjusted ORs of 1.12 (95%CI: 0.37-3.43) and 1.10 (95%CI: 0.51-2.39), respectively. Among HIV-infected pregnant women, different antiretroviral (ARV) regimens were significantly associated with stillbirths, but not PTB, LBW or SGA. Compared with untreated HIV infection (10.1%), both mono/dual therapy and HAART were associated with a reduced risk of stillbirths (2.0% and 3.2%, respectively), with an AOR of 0.19 (95%CI: 0.04-0.92) and 0.31 (95%CI: 0.11-0.85), respectively. Initial time of ARV drugs use and HIV infection status of the sexual partner were not associated with maternal APOs.The findings of this study indicated that maternal HIV infection was associated with significantly increased risks of stillbirth, PTB, LBW and SGA, but not neonatal asphyxia or birth defects. On the condition that most HIV-infected pregnant women started ARV therapy in or after the second trimester, both mono/dual therapy and HAART had a protective effect on stillbirth compared with untreated HIV infection. As some important confounders were not effectively controlled and the specific regimens of HAART were not analyzed, the above findings may have certain bias.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Factores de Edad , Antirretrovirales/administración & dosificación , Antirretrovirales/efectos adversos , China/epidemiología , Femenino , Humanos , Recién Nacido de Bajo Peso , Embarazo , Nacimiento Prematuro , Estudios Prospectivos , Características de la Residencia , Factores Socioeconómicos , Mortinato/epidemiología , Adulto Joven
15.
Lancet ; 395(10227): 888-898, 2020 03 14.
Artículo en Inglés | MEDLINE | ID: mdl-32085823

RESUMEN

BACKGROUND: Antiretroviral therapy (ART) cannot cure HIV infection because of a persistent reservoir of latently infected cells. Approaches that force HIV transcription from these cells, making them susceptible to killing-termed kick and kill regimens-have been explored as a strategy towards an HIV cure. RIVER is the first randomised trial to determine the effect of ART-only versus ART plus kick and kill on markers of the HIV reservoir. METHODS: This phase 2, open-label, multicentre, randomised, controlled trial was undertaken at six clinical sites in the UK. Patients aged 18-60 years who were confirmed as HIV-positive within a maximum of the past 6 months and started ART within 1 month from confirmed diagnosis were randomly assigned by a computer generated randomisation list to receive ART-only (control) or ART plus the histone deacetylase inhibitor vorinostat (the kick) and replication-deficient viral vector T-cell inducing vaccines encoding conserved HIV sequences ChAdV63. HIVconsv-prime and MVA.HIVconsv-boost (the kill; ART + V + V; intervention). The primary endpoint was total HIV DNA isolated from peripheral blood CD4+ T-cells at weeks 16 and 18 after randomisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02336074. FINDINGS: Between June 14, 2015 and Jul 11, 2017, 60 men with HIV were randomly assigned to receive either an ART-only (n=30) or an ART + V + V (n=30) regimen; all 60 participants completed the study, with no loss-to-follow-up. Mean total HIV DNA at weeks 16 and 18 after randomisation was 3·02 log10 copies HIV DNA per 106 CD4+ T-cells in the ART-only group versus 3·06 log10 copies HIV DNA per 106 CD4+ T-cells in ART + V + V group, with no statistically significant difference between the two groups (mean difference of 0·04 log10 copies HIV DNA per 106 CD4+ T-cells [95% CI -0·03 to 0·11; p=0·26]). There were no intervention-related serious adverse events. INTERPRETATION: This kick and kill approach conferred no significant benefit compared with ART alone on measures of the HIV reservoir. Although this does not disprove the efficacy kick and kill strategy, for future trials enhancement of both kick and kill agents will be required. FUNDING: Medical Research Council (MR/L00528X/1).


Asunto(s)
Vacunas contra el SIDA/administración & dosificación , Antirretrovirales/uso terapéutico , Reservorios de Enfermedades , Infecciones por VIH , Inhibidores de Histona Desacetilasas/administración & dosificación , Vorinostat/administración & dosificación , Adulto , ADN Viral/análisis , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Transcripción Genética/efectos de los fármacos , Resultado del Tratamiento
16.
Hu Li Za Zhi ; 67(1): 55-65, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960397

RESUMEN

BACKGROUND: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear. PURPOSE: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time. METHODS: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm3, >350-500 cells/mm3 and >500 cells/mm3. Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs. RESULTS: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count >500 cells/mm3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count > 500 cells/mm3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.


Asunto(s)
Antirretrovirales/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Recuento de Linfocito CD4/estadística & datos numéricos , Estudios de Cohortes , Infecciones por VIH/diagnóstico , Humanos , Taiwán/epidemiología , Factores de Tiempo
17.
Artículo en Inglés | MEDLINE | ID: mdl-31967210

RESUMEN

A 37-year-old male patient, Fitzpatrick skin phototype IV, a student living in Belem, Amazon region, in 2015 had a confirmed diagnosis of acquired immunodeficiency virus (HIV) infection, but did not initiate antiretroviral treatment at his own option. Three years after the diagnosis, erythematous maculae appeared on the dorsum of the nose with rapid progression to the entire face, with posterior diffuse infiltration and appearance of nodules on the chin and shoulder. In December 2018, the patient presented with exacerbation of the condition with an increase in infiltrated violaceous plaques and disseminated violaceous nodules. A histopathological biopsy of the skin was performed, confirming the diagnosis of angiomatoid proliferation suggestive of Kaposi's sarcoma (KS), with an important dissemination of this disease to the noble organs. In addition, it is important to note that he only started antiretroviral therapy (ART) after the exacerbation of Kaposi (December 2018). In such cases, chemotherapy associated with ART is crucial for the treatment and follow-up of the patient, since Kaposi's sarcoma develops relatively low in patients who do not have immunodeficiency.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/complicaciones , Sarcoma de Kaposi/etiología , Neoplasias Cutáneas/etiología , Adulto , Infecciones por VIH/tratamiento farmacológico , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Humanos , Lamivudine/administración & dosificación , Masculino , Sarcoma de Kaposi/diagnóstico , Tenofovir/administración & dosificación
18.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917782

RESUMEN

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Asunto(s)
Infecciones por VIH/diagnóstico , Defectos del Tubo Neural/epidemiología , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estados Unidos/epidemiología , Adulto Joven
19.
Rev Med Suisse ; 16(676-7): 92-98, 2020 Jan 15.
Artículo en Francés | MEDLINE | ID: mdl-31961093

RESUMEN

This article reviews the novelties in the prevention and treatment of HIV infection as well as the perspectives for a potential cure. The PrEP is a key component in the prevention of infection and the control of the epidemic. In order to decrease long-term toxicities, two-drug antiretroviral regimens are being implemented. Long-acting injectable molecules show promising efficacy and safety and are long awaited for patients tired of taking daily pills. Concerning adverse events, the association between integrase inhibitors and weight gain as well as recent data on the safety of dolutegravir during pregnancy are presented. Finally, a second case of sustained virological suppression in a patient who received a stem cell transplant with a mutation of the co-receptor CCR5 was reported, renewing hopes for possible cure by gene therapy.


Asunto(s)
Infecciones por VIH , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Inhibidores de Integrasa VIH/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos , Humanos
20.
Expert Opin Ther Pat ; 30(3): 195-208, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31944142

RESUMEN

Introduction: Studies presented in the patent applications demonstrate that a new integrase strand transfer inhibitor cabotegravir might be used as long-acting antiretroviral formulation or delivery system that reduces dosing frequency and may therefore increase adherence and thus pre-exposure prophylaxis (PrEP) and treatment efficacy against HIV. As announced in 2019, the developer ViiV Healthcare seeks US and EU approval of long-acting, injectable HIV treatment.Area covered: This review covers all the patent applications published until October 2019 with cabotegravir in the examples or claim section of the patent application document. The patent applications cover drug substance synthesis, solid-state forms, therapeutic applications, in vitro and in vivo efficacy as well as the potential formulations of cabotegravir alone or in combination with other anti-HIV agents.Expert opinion: The results from multiple clinical studies suggest that cabotegravir can be used as PrEP agent and treatment agent against HIV. Multiple studies use cabotegravir in combination with other anti-HIV agents such as rilpivirine. Cabotegravir in combination with rilpivirine is an interesting therapeutic, due to the possibility of formulating long-acting formulation with dosing interval of every 4 weeks or less, thus reducing daily pill burden and improving patient's compliance.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Piridonas/administración & dosificación , Animales , Fármacos Anti-VIH/farmacología , Quimioterapia Combinada , Humanos , Cumplimiento de la Medicación , Patentes como Asunto , Profilaxis Pre-Exposición , Piridonas/farmacología , Rilpivirina/administración & dosificación
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