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1.
J Assoc Physicians India ; 67(12): 82-83, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801339

RESUMO

Benign glandular enlargement of male breast is called gynaecomastia.Various drugs have been implicated as the cause. Most widely used HAART regimen TLE is enlisted in least common cause of gynaecomastia. A 42 yr old male diagnosed HIV seropositive since last 10 yrs was put on TLE regimen and he presented with gynaecomastia since 11 months. We hereby report this finding on HAART.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Ginecomastia/induzido quimicamente , Adulto , Humanos , Masculino
2.
BMC Infect Dis ; 19(1): 1032, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801471

RESUMO

BACKGROUND: Anemia is a common problem in HIV (human immunodeficiency virus) infected patients, and is associated with decreased functional capacity and quality of life. Ethiopia is one of the countries which has expanded highly active antiretroviral treatment (HAART) over the past years. The effect of HAART on anemia among HIV remains inconsistent and inconclusive, particularly in children. This study thus aimed to synthesize the prevalence of anemia among HIV infected Ethiopian children and its association with HAART initiation. METHODS: MEDLINE/PubMed, EMBASE, PsycINFO, Web of Science and Google scholar were used to identify 12 eligible studies reporting an association between anemia and HIV using a priori set criteria. PRISMA guideline was used to systematically review and meta-analysis these studies. Details of sample size, magnitude of effect sizes, including odds ratio (OR) and standard errors were extracted. Random-effects model was used to calculate the pooled estimates using STATA/SE version-14. I2 and meta-bias statistics assessed heterogeneity and publication bias of the included studies. Sub-group analyses, based on study designs, were also carried out. RESULTS: In Ethiopia, the overall prevalence of anemia in HIV infected children was 22.3% (95% CI: 18.5-26.0%). The OR of anemia-HIV/AIDS comorbidity was 0.4 (95% CI, 0.2-0.5) in HAART initiated children as compared to non-initiated counterparts. Meta-bias and funnel plot detected no publication bias. CONCLUSION: On aggregate, anemia is a common comorbidity in pediatric HIV patients. HAART was significantly associated with a reduced anemia-HIV/AIDS comorbidity. Prompt start of HAART might help decreasing the prevalence of anemia and its subsequent complications.


Assuntos
Anemia/induzido quimicamente , Anemia/epidemiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Criança , Comorbidade , Etiópia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Razão de Chances , Prevalência , Qualidade de Vida , Tamanho da Amostra
3.
Expert Opin Drug Metab Toxicol ; 15(12): 1043-1052, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31715109

RESUMO

Introduction: With the introduction of highly active anti-retroviral therapy (HAART), treatment of HIV infection has improved radically, shifting the concept of HIV disease from a highly mortal epidemic to a chronic illness which needs systematic management. However, HAART does not target the integrated proviral DNA. Hence, prolonged use of antiviral drugs is needed for sustaining life. As a consequence, severe side effects emerge. Several parameters involve in causing these adverse effects. Mitochondrial dysfunctions were pointed as common factor among them. It is, therefore, necessary to critically examine mitochondrial dysfunction in order to understand the side effects.Areas covered: There are many events involved in causing drug-induced side-effects; in this review, we only highlight mitochondrial dysfunctions as one of the events. We present up-to-date findings on mitochondrial dysfunction caused by HIV infection and antiviral drug treatment. Both in vivo and in vitro studies on mitochondrial dysfunction like change in morphology, membrane depolarization, mitophagy, mitochondrial DNA depletion, and intrinsic apoptosis have been discussed.Expert opinion: Mitochondrial dysfunction is associated with severe complications that often lead to discontinuation or change in treatment regimen. Prior knowledge of side effects of antiviral drugs would help in better management and future research should focus to avoid mitochondrial targeting of antiviral drugs while maintaining their antiviral properties.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Mitocôndrias/patologia , Animais , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , DNA Mitocondrial/efeitos dos fármacos , Infecções por HIV/virologia , Humanos
4.
Braz J Infect Dis ; 23(5): 363-367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562853

RESUMO

Erythema multiforme (EM), Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN) have been reported as possible adverse effects of some classes of first-line antiretroviral drugs (ART) for HIV treatment. Herein we report an unusual presentation of TEN lesions associated with ART in an HIV-infected patient. The patient presented disseminated cutaneous eruption and oral lesions from the lips to the oropharynx region, causing odynophagia and dysphagia. In the tongue, circular, atypical erythematous lesions appeared, increasing in diameter over seven days and coalescing since then to complete remission. TEN treatment included efavirenz interruption, use of methylprednisolone, prophylactic antibiotic, and daily laser therapy with low-intensity red light. The circular oral lesions have not been described yet. Reporting our findings and clinical management may help diagnosing other similar cases and guide the clinical conduct. Analgesia and acceleration of oral ulcer repair with red laser therapy are recommended.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Benzoxazinas/efeitos adversos , Infecções por HIV/tratamento farmacológico , Síndrome de Stevens-Johnson/etiologia , Adulto , Benzoxazinas/uso terapêutico , Feminino , Humanos , Síndrome de Stevens-Johnson/diagnóstico
6.
Pan Afr Med J ; 33: 87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489065

RESUMO

Introduction: The introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV infection has provided different good results: like long-term viral suppression, the decrease of opportunistic infections, and repair of the immune system. Methods: We carried out a hospital-based cross-sectional analytic study involving 315 participants 228 were on HAART (group 1) and 87 were HAART-naïve (group 2) at the HIV treatment centre of the Bamenda regional hospital with our study population being all people living with HIV (PLWHIV) in the North West region of Cameroon. The sampling was performed from the 15th of March to the 30th of June 2017. The questionnaire was administered face to face with participants and their vital signs taken. Blood pressure was measured using an automated electronic blood pressure monitor and hypertension (HTN) was considered as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90mmHg. Results: The prevalence of hypertension in the HAART group was 36.44% (n=82, CI: 30.15%-43.10%) compared to that of the HAART-naïve group which was 13.33% (n=12, CI: 7.08%-22.13%, P=0.01). HAART was associated with HTN after controlling for gender, family history of hypertension, body mass index (BMI), smoking and alcohol consumption. The odds ratio of the HAART-treated versus the HAART-naïve was 3.86 (95% CI: 1.98-7.50). We also found an association between TDF/3TC/EFV (OR=2.83), AZT/3TC/NVP (OR=2.82), AZT/3TC+EFV (OR=3.48) and TDF/3TC+NVP (OR=2.36) and HTN whereas those on AZT+3TC+ATV/r (OR=0.84) and TDF+3TC+ATV/r (OR=0.45) were not associated to hypertension. Conclusion: Our result suggests that blood pressure should be periodically measured and treated when necessary in PLWHIV on HAART.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Hipertensão/epidemiologia , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Pressão Sanguínea , Camarões , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
7.
Infect Dis Clin North Am ; 33(3): 787-805, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395145

RESUMO

Antiretroviral therapy has advanced significantly since zidovudine was first approved. Although 31 antiretrovirals have been approved by the FDA, only about half of those are commonly used. Newer, more tolerable agents have made human immunodeficiency virus into a chronic condition, which can be managed with medication. The most common antiretroviral regimens consist of 2 nucleoside reverse transcriptase inhibitors plus a third agent, often an integrase inhibitor because of better tolerability and fewer drug interactions than other regimens. Understanding the dosage forms, adverse effects, and drug interactions of antiretrovirals allow clinicians to choose the most appropriate regimen for their patient. New developments, such as branded generic regimens and long-acting intramuscular injections, may play a larger role in the future.


Assuntos
Antirretrovirais/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Antirretrovirais/efeitos adversos , Antirretrovirais/farmacocinética , Antirretrovirais/farmacologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Interações de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos
9.
Diabetes Metab Syndr ; 13(5): 2833-2841, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31425944

RESUMO

AIM: The global operation of antiretroviral therapy (ART) has averted 30 million new infections and nearly 8 million deaths; however, it has an impact on metabolic syndrome (MS) acquisition. As a result, there is growing concern about MS; but strangely the magnitude of MS in HIV-infected cohort, and its differential contribution ART status in Ethiopia has yet to be abundantly studied. Hence, the aim of this study was to estimate and evaluate the difference of the overall magnitude of MS among ART exposed and ART naïve people living with HIV (PLWH). MATERIALS AND METHODS: An institution based cross-sectional study was conducted at the randomly chosen two hospitals and health centers, in Gedio zone, southern Ethiopia between December 29th, 2017 and January 22nd, 2019. Data were collected using the WHO three step tools. The collected data were fed into Epidata version.3.1 and exported to SPSS version 22 for analysis. The descriptive complex sample analysis method was employed, and the prevalence and differences between groups were computed with a 95% CI. RESULT: A total of 633 (n = 422 ART and n = 211 ART naive) PLWH was involved, with the response rate of 92.1%. Of whom, 22.0% (95% CI: 19.0-25.4) of PLWH had MS. It was slightly higher in the ART-exposed (22.5%, 95% CI: 18.7-26.8) than ART naïve (20.9%, 95% CI: 15.2-27.1) group. CONCLUSION: The global magnitude of MS in the ART-exposed was relatively higher than ART naïve groups. This dictates the existence of HIV associated MS that necessitates immediate prevention and management strategies.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , HIV/isolamento & purificação , Síndrome Metabólica/epidemiologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Seguimentos , HIV/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Síndrome Metabólica/etiologia , Síndrome Metabólica/patologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco
10.
Int J Mol Sci ; 20(15)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366152

RESUMO

Purpose of the review: This review highlights the role of angiogenesis, lymphangiogenesis, and immune markers in human immunodeficiency virus (HIV)-associated preeclamptic (PE) pregnancies in an attempt to unravel the mysteries underlying the duality of both conditions in South Africa. Recent findings: Studies demonstrate that HIV-infected pregnant women develop PE at a lower frequency than uninfected women. In contrast, women receiving highly active anti-retroviral therapy (HAART) are more inclined to develop PE, stemming from an imbalance of angiogenesis, lymphangiogenesis, and immune response. Summary: In view of the paradoxical effect of HIV infection on PE development, this study examines angiogenesis, lymphangiogenesis, and immune markers in the highly HIV endemic area of KwaZulu-Natal. We believe that HAART re-constitutes the immune response in PE, thereby predisposing women to PE development. This susceptibility is due to an imbalance in the angiogenic/lymphangiogenic/immune response as compared to normotensive pregnant women. Further large-scale studies are urgently required to investigate the effect of the duration of HAART on PE development.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Citocinas/sangue , Infecções por HIV/fisiopatologia , Neovascularização Fisiológica/efeitos dos fármacos , Pré-Eclâmpsia/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Sistema Linfático/efeitos dos fármacos , Pré-Eclâmpsia/imunologia , Pré-Eclâmpsia/virologia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/imunologia
11.
J Microbiol Immunol Infect ; 52(5): 720-727, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31358463

RESUMO

BACKGROUND: To determine the prevalence of chronic comorbidities and associated medication costs in Taiwanese HIV patients in order to increase awareness of the disease burden among healthcare providers and patients. METHODS: HIV-diagnosed patients receiving highly active antiretroviral therapy (HAART; 2010-2013) were identified from the Taiwan National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision (ICD-9) code. Comorbidities (type II diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, acute coronary syndrome, and cholelithiasis/nephrolithiasis) were identified according to ICD-9 or relevant medication use. Comorbidity medication and associated costs were identified using the drug classification code from the Anatomical Therapeutic Chemical classification system code series and series outpatient prescriptions. RESULTS: Of 20,726 HIV-diagnosed Taiwanese patients (2010-2013), 13,142 receiving HAART were analyzed. Prevalence of all chronic comorbidities was significantly greater (p < 0.0001) in patients aged ≥40 years versus <40 years (diabetes mellitus, 14.95% vs. 3.30%; hypertension, 46.73% vs. 26.83%; dyslipidemia, 34.93% vs. 18.37%; depression, 23.75% vs. 19.88%; acute coronary syndrome, 1.16% vs. 0.21%; nephrolithiasis/cholelithiasis, 7.26% vs. 4.56%; >2 comorbidities, 24.80% vs. 7.21%). An increase in comorbidity medication spending (2010 vs. 2013 medication costs) was observed (antidyslipidemia, $88,878 vs. $168,180; antihyperglycemia, $32,372 vs. $73,518; antidepressants, $78,220 vs. $125,971; sedatives, $60,009 vs. $85,055; antihypertension, $47,115 vs. $95,134), contributing to overall treatment costs increasing almost two-fold from 2010 to 2013. CONCLUSIONS: Among HIV-infected Taiwanese patients receiving HAART, significant increases in comorbidity prevalence with age, along with rising comorbidity medication costs, suggest the need for preventative as well as chronic care.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Diabetes Mellitus Tipo 2/epidemiologia , Custos de Medicamentos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Síndrome Coronariana Aguda/epidemiologia , Adulto , Colelitíase/epidemiologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Dislipidemias/epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrolitíase/epidemiologia , Prevalência , Taiwan/epidemiologia , Adulto Jovem
12.
PLoS One ; 14(7): e0218649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31269034

RESUMO

BACKGROUND: Tenofovir-containing regimens comprise the preferred first-line antiretroviral therapy (ART) in many countries including South Africa, where utilization of second-line regimens is limited. Considerable HIV drug resistance has occurred among persons failing tenofovir-containing first-line ART. We evaluated drug resistance at the population level using mathematical modeling. SETTING: Heterosexual HIV epidemic in KwaZulu-Natal, South Africa. METHODS: We constructed a stochastic individual-based model and simulated scenarios of ART implementation, either CD4-based (threshold < 500 cells/mL) or Fast-track (81% coverage by 2020), with consideration of major drug-associated mutations (M184V, K65R and non-nucleoside reverse transcriptase inhibitor (NNRTI)). Using base case and uncertainty analyses, we assessed (majority) drug resistance levels. RESULTS: By 2030, the median total resistance (proportion of HIV-infected persons with drug resistance) is predicted to reach 31.4% (interquartile range (IQR): 16.5%-50.2%) with CD4-based ART, decreasing to 14.5% (IQR: 7.7%-25.8%) with Fast-track implementation. In both scenarios, we find comparably high prevalence (~80%) of acquired NNRTI-associated, M184V and K65R mutations. Over 48% of individuals with acquired resistance harbor dual, 44% triple and 7% just single drug mutations. Drug-resistant HIV is predicted to comprise 40% (IQR: 27%-50%) of incident infections, while 70% of prevalent transmitted resistance is NNRTI-associated. At 2018, the projected total resistance is 15% (IQR: 7.5%-25%), with 18% (IQR: 13%-24%) of incident infections from transmitted drug-resistant HIV. CONCLUSIONS: WHO-recommended preferred first-line ART could lead to substantial drug resistance. Effective surveillance of HIV drug resistance and utilization of second-line as well as alternative first-line regimens is crucial.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Farmacorresistência Viral/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Modelos Teóricos , Adulto , Antígenos CD4/efeitos dos fármacos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/patogenicidade , Heterossexualidade , Humanos , Masculino , Inibidores da Transcriptase Reversa/efeitos adversos , Inibidores da Transcriptase Reversa/uso terapêutico , África do Sul/epidemiologia , Tenofovir/efeitos adversos , Tenofovir/uso terapêutico , Carga Viral/efeitos dos fármacos
13.
BMC Oral Health ; 19(1): 129, 2019 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242887

RESUMO

BACKGROUND: The objective of this study was to elucidate the relationship between HIV anti-retroviral therapy and tooth wear. METHODS: Assessment of tooth wear was conducted both with a survey questionnaire and clinical assessment at Russell Street Dental Clinic in Portland, Oregon. The survey questionnaire comprised of questions on study participant's gender, age, HIV status, current medications, awareness of tooth grinding or clenching, jaw soreness, tooth or gum soreness, and frequency of headaches. For the clinical evaluation, a dental provider recorded the degree of wear on each tooth using a scale of 0-3. An individual tooth-wear index was used to rank patients with regard to incisal and occlusal wear. Data analysis included descriptive analysis, tests of association and regression analysis using SPSS V.24. RESULTS: The study sample involved 93 patients (HIV + ve = 60, HIV-ve = 33) with age range of 20-90 yrs. (mean = 49 yrs., s.d = 13.3). 92 and 67% participants of the HIV + ve and HIV-ve groups, respectively, presented with tooth wear. The mean tooth wear index was higher in HIV + ve patients than HIV-ve patients (8.2 vs. 7.8), however, this difference was not statistically significant (p > 0.05). A significant, positive correlation was found between HIV presence and tooth wear index, after accounting for age (B = 0.71, p < 0.05). The number of years on anti-retroviral therapy alone was positively correlated with tooth wear index (R2 = 0.116, p < 0.05). After controlling for age, years of anti-retroviral therapy use was positively correlated with tooth wear index (B = 0.047, p > 0.05). CONCLUSIONS: The findings from this study suggest that HIV + ve patients, who are on anti-retroviral therapy have significant tooth wear, although more studies with larger sample size are needed to confirm this. There is a critical need to initiate a dialogue with medical providers about tooth wear as a possible side effect of antiretroviral therapy and to introduce appropriate preventive measures.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Atrito Dentário/induzido quimicamente , Erosão Dentária/induzido quimicamente , Desgaste dos Dentes/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bruxismo/epidemiologia , Odontologia Comunitária , Estudos Transversais , Esmalte Dentário/patologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Oregon/epidemiologia , Prevalência , Atrito Dentário/epidemiologia , Erosão Dentária/epidemiologia , Desgaste dos Dentes/epidemiologia , Adulto Jovem
14.
Int Rev Neurobiol ; 145: 29-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31208526

RESUMO

HIV-associated neurocognitive disorders (HAND) persist in the era of effective combined antiretroviral therapy (cART). A large body of literature suggests that mitochondrial dysfunction is a prospective etiology of HAND in the cART era. While viral load is often suppressed and the immune system remains intact in HIV+ patients on cART, evidence suggests that the central nervous system (CNS) acts as a reservoir for virus and low-level expression of viral proteins, which interact with mitochondria. In particular, the HIV proteins glycoprotein 120, transactivator of transcription, viral protein R, and negative factor have each been linked to mitochondrial dysfunction in the brain. Moreover, cART drugs have also been shown to have detrimental effects on mitochondrial function. Here, we review the evidence generated from human studies, animal models, and in vitro models that support a role for HIV proteins and/or cART drugs in altered production of adenosine triphosphate, mitochondrial dynamics, mitophagy, calcium signaling and apoptosis, oxidative stress, mitochondrial biogenesis, and immunometabolism in the CNS. When insightful, evidence of HIV or cART-induced mitochondrial dysfunction in the peripheral nervous system or other cell types is discussed. Lastly, therapeutic approaches to targeting mitochondrial dysfunction have been summarized with the aim of guiding new investigations and providing hope that mitochondrial-based drugs may provide relief for those suffering with HAND.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Sistema Nervoso Central/metabolismo , Infecções por HIV/patologia , Sistema Imunitário/metabolismo , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/patologia , Animais , Infecções por HIV/metabolismo , Proteínas do Vírus da Imunodeficiência Humana/metabolismo , Humanos
15.
Int J Antimicrob Agents ; 54(4): 487-490, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31195121

RESUMO

OBJECTIVES: The aim of this study was to compare the tolerability and viro-immunological efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI or NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI). METHODS: All patients diagnosed with AHI and on antiretroviral therapy (ART) between January 2015 and December 2017 from five centers in Italy were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot. RESULTS: Forty-three patients were enrolled: 20 in the DTG group, 23 in the NODTG group. Nine patients (20.9%; four in the DTG group, five in the NODTG group) were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% were male, with a median age of 41 years (interquartile range [IQR] 31-48). Median time between HIV diagnosis and ART initiation was 12 days (IQR 5-28). Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all were in the DTG group (P=0.005). All patients had undetectable HIV-RNA at the end of follow-up except two patients, one of whom had 57 copies and one who was lost to follow-up. In Kaplan-Meier analysis, time to virological suppression was similar in the two groups (log rank: P= 0.7155). After achieving virological suppression, four patients stopped ART because of toxicity: two on DTG, two on EVG for neurological and gastrointestinal toxicity, respectively. CONCLUSION: In our setting, ART in AHI is started very early. DTG showed good viro-immunological efficacy even in the presence of NRTI-transmitted mutations. DTG interruptions were rare.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , Inibidores da Protease de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Contagem de Linfócito CD4 , Feminino , Inibidores de Integrase de HIV/efeitos adversos , Inibidores da Protease de HIV/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Inibidores da Transcriptase Reversa/efeitos adversos , Resposta Viral Sustentada , Resultado do Tratamento
16.
Cien Saude Colet ; 24(5): 1903-1914, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31166523

RESUMO

The aim of this study was to describe metabolic changes in HIV/AIDS patients according to the treatment regimen. It was a retrospective cohort conducted from 2002 to 2014. Researchers surveyed clinical variables and treatment regimen of 538 individuals. They used measures of central tendency and marginal logistic regression to determine the influence of the treatment regimen on clinical variables over time; survival was estimated using Kaplan-Meier curves. 56.2% of patients were male, 82.2% white, 33.8% had 4 to 7 years of study, 49.2% were married, 98.5% had sexual transmission, and 89.0% were heterosexuals. During the study period, 24.4% had hypertension, 18.2% changed cholesterol, 39.7% low HDL, 51.3% high triglycerides and 33.3% hyperglycemia. Treatment regimens with nucleotide reverse transcriptase inhibitors associated with protease inhibitors, and the association of different classes of antiretrovirals have been associated with greater lipid changes. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Doenças Cardiovasculares/epidemiologia , Infecções por HIV/tratamento farmacológico , Lipídeos/sangue , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Brasil/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
AIDS Behav ; 23(11): 2916-2925, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30929149

RESUMO

Using representative data among 1861 in care people living with HIV (PLWH) in four southern states (Texas, Mississippi, Florida, and Georgia) from the 2013-2014 Medical Monitoring Project (MMP) survey, we estimated the prevalence and odds of metabolic syndrome (MetS) among various demographic and HIV related risk factors. Overall MetS prevalence was 34%, with our participants being mostly black (55%), male (72%), ≥ 50 years old (46%), and overweight or obese (60%) with undetectable viral loads (≤ 200 copies/ml, 69%), and were currently taking antiretroviral medication (98%). Compared to those who were ≥ 60 years, 18-39 year olds had a 79% (95% CI 0.13-0.33) lower odds of having MetS. Women were 2.24 times more likely to have MetS than men (95% CI 1.69-2.97). Age and sex were significant predictors of MetS. Since MetS is a combination of chronic disease risk factors, regular screening for MetS risk factors among aging PLWH is crucial.


Assuntos
Antirretrovirais/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , Síndrome Metabólica/epidemiologia , Adulto , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Carga Viral
20.
Viruses ; 11(3)2019 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30818749

RESUMO

Despite effective antiretroviral therapy (ART), people living with HIV (PLWH) still present persistent chronic immune activation and inflammation. This condition is the result of several factors including thymic dysfunction, persistent antigen stimulation due to low residual viremia, microbial translocation and dysbiosis, caused by the disruption of the gut mucosa, co-infections, and cumulative ART toxicity. All of these factors can create a vicious cycle that does not allow the full control of immune activation and inflammation, leading to an increased risk of developing non-AIDS co-morbidities such as metabolic syndrome and cardiovascular diseases. This review aims to provide an overview of the most recent data about HIV-associated inflammation and chronic immune exhaustion in PLWH under effective ART. Furthermore, we discuss new therapy approaches that are currently being tested to reduce the risk of developing inflammation, ART toxicity, and non-AIDS co-morbidities.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Comorbidade , Infecções por HIV/complicações , Inflamação , Senilidade Prematura/etiologia , Fármacos Anti-HIV/uso terapêutico , Doenças Cardiovasculares/etiologia , Infecções por HIV/imunologia , Infecções por HIV/patologia , Humanos , Ativação Linfocitária , Síndrome Metabólica/etiologia
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