Reliability and validity of the Greek translation of the MOS-HIV health survey in HIV-infected individuals.

OBJECTIVES: This study was intended to present evidence for the reliability and validity of a Greek translation of the Medical Outcomes Study-HIV Health Survey (MOS-HIV). DESIGN: Sample consisted of 154 HIV-positive men and women, regardless of disease stage, who are being followed at the department of Infectious Diseases of a tertiary hospital of Athens, Greece. METHODS: The translated Greek version of the MOS-HIV instrument, a brief, comprehensive 35-item health-related quality of life questionnaire, was used to assess ten dimensions of health including overall quality of life, pain, physical functioning, role functioning, social functioning, mental health, energy/fatigue, cognitive function, health distress, and health transition. Additional socio-demographic data and clinical parameters were also collected. Standard guidelines were followed for questionnaire translation to the Greek language. Internal consistency reliability using Cronbach's alpha and the range of measurement of the MOS-HIV subscales were examined. Convergent validity was further examined with the intercorrelations of subscales. ROC analysis was used to estimate the ability of the subscales to discriminate patients according to the characteristics of the disease [i.e. asymptomatic, symptomatic and AIDS, CD4+ lymphocyte count (<200 cells/mm(3) and >200 cells/mm(3))] and assess concurrent validity. RESULTS: All the MOS-HIV scales exceeded the minimum reliability standard of 0.70. Physical functioning and health distress had the greatest reliability coefficient, equal to 0.87 and 0.88, respectively. Correlations among MOS-HIV scales were all significant. Physical functioning, pain, and physical health summary scales were significantly lower for AIDS patients compared to asymptomatic HIV+ individuals. All scales except for role functioning and health transition could discriminate well subjects with CD4+ lymphocyte count <200 cells/mm(3) and >200 cells/mm(3). CONCLUSIONS: The Greek version of the MOS-HIV had good reliability and validity among patients with AIDS. Convergent and concurrent validity were generally confirmed. The MOS-HIV may be useful in assessing health-related quality of life in AIDS patients in Greece. Further research is needed for the evaluation of the Greek version of the MOS-HIV responsiveness to changes over time.

Multicentric Castleman's disease in HIV infection: a systematic review of the literature.

The objective of this study is to systematically review the epidemiology and the clinical and virologic aspects of multicentric Castleman's disease in HIV-positive patients and to evaluate treatment strategies and outcome, especially in relation to HAART administration. The authors have conducted a systematic review of the English literature for all cases of newly diagnosed multicentric Castleman's disease in HIV-positive patients. The 25 studies which met the selection criteria included 84 HIV-positive patients with multicentric Castleman's disease (20 pre-HAART and 64 post-HAART era). Of them, the majority (90%) were men with 33 months median time from detection of HIV-positivity to multicentric Castleman's disease diagnosis in the HAART era. Fever and lymphadenopathy were the most common presenting symptoms and cytopenias, hypoalbuminemia, polyclonal hypergammaglobulinemia and raised C-reactive protein the most frequently revealed laboratory findings. Kaposi's sarcoma was present in 72% of the patients and respiratory system involvement in 34%. Although the majority of cases reported were positive for human herpesvirus-8, none of the reviewed patients was found to suffer from polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. Of the 48 patients on HAART, 64% were already on HAART at multicentric Castleman's disease diagnosis, having a better immunologic profile and a lower incidence of Kaposi's sarcoma than the 35% of patients who initiated HAART after multicentric Castleman's disease diagnosis. Nevertheless, the two groups did not have significantly different mortality rates (30 vs. 38%). At multicentric Castleman's disease diagnosis, a wide range of CD4 counts was recorded, suggesting that disease presentation could occur at any CD4 count. With regard to treatment, the study confirmed the high rates of response with rituximab (anti-CD20 monoclonal). Monochemotherapy seems to give short-lived responses, which require maintenance to be sustained. Polychemotherapy with CHOP has given long-term remission in a subset of patients. Other regimens used in the treatment of HIV-related multicentric Castleman's disease were antiviral agents, immunomodulatory agents, and thalidomide. The fatality rate among HIV-related multicentric Castleman's disease cases reviewed was 44%, significantly lower than that of HIV-negative individuals (65%), while median survival of the latter was 29 months longer than that of HIV-infected individuals. The fatality rate among pre-HAART patients was 75 vs. 29% among HAART patients. Infection, multiorgan failure, Kaposi's sarcoma, non-Hodgkin lymphoma and progressive multicentric Castleman's disease were the most often reported causes of death. In conclusion, multicentric Castleman's disease is a lymphoproliferative disorder with an increasing prevalence in HIV-infected individuals. Even though life expectancy in multicentric Castleman's disease seems to have significantly improved in the HAART era, it remains a disease with a poor prognosis and an increased incidence of non-Hodgkin lymphoma in the HIV-context.

Revertant multiresistant HIV in chronically infected drug naïve patients: when baseline resistance testing is not enough.

We present a patient with chronic HIV-1 infection and primary multi-drug resistance, the magnitude of which was underestimated by the baseline genotypic resistance testing (GRT) due to reversion of some of the mutations of the transmitted strain. This resulted in complete failure of his first antiretroviral regimen with rapid appearance of presumably archived mutations to more than one antiretroviral classes. Interestingly, his viral load remained high even in the presence of the M184V mutation. Baseline GRT in chronic HIV infection may not give adequate information in the presence of acquired multi-drug-resistant HIV strains, which have one or more of their mutations reverted. The presence of 215 codon polymorphisms should alert physicians to the possible coexistence of archived nucleoside and non-nucleoside reverse transcriptase inhibitor mutations. In such a case, initiation of a regimen with a low genetic barrier to resistance may not be the best choice and, if done, should be done cautiously and with more frequent monitoring of treatment response than usual.

Early HIV diagnosis through use of rapid diagnosis test (RDT) in the community and direct link to HIV care: a pilot project for vulnerable populations in Athens, Greece.

INTRODUCTION: An increase in the incidence of HIV new infections among intravenous drug users (IDUs) by 1500%, was noted in the center of Athens in 2011. Increasing problematic drug use, homelessness, health cuts amidst the economic crisis, have contributed to the epidemic. New cases doubled within a year, challenging the HIV care delivery system (1). MATERIALS AND METHODS: A pilot project funded by the National Strategic Reference Framework (NSRF) 2007-2013 of the European Union (EU), was launched from August 2012 to March 2014. It was a partnership between the HIV Clinic of Evangelismos Hospital and the NGO PRAKSIS. The project is aimed at offering early diagnosis and comprehensive care to hard to reach populations. RDT diagnosis through mobile units, direct linkage to care, elimination of waiting times, flexibility, psychosocial support and link to harm reduction services for active IDUs were offered to the beneficiaries. RESULTS: A total of 117 people enrolled in the program following HIV RDT offered by mobile units of the NGO PRAKSIS in community sites. Sixty-eight percent were IDUs, 12% were men who have sex with men (MSM) and 19.5% were heterosexuals. Men were 74.3% and women were 25.6%. Country born patients were 43.5% and non-country born patients were 56.4%. Nine people were HIV negative but needed post-exposure prophylaxis (PEP), treatment for Hepatitis C and one test was false positive. Two deaths occurred and six people were deported. Of the remaining 100 patients, 84 enrolled in the care program. Of those 77% (65/84) remain in care for three months after the end of the project. Care retention was 73.5% (39/53) for IDUs, 91% (10/11) for MSM, 80% (16/20) for heterosexuals, 73% (25/35) for country born and 82% (40/49) for non-country born individuals. Among those that remain in care, 77.7% (42/54) with <350 CD4 are on antiretroviral therapy (ART). Among those on ART >90% have undetectable viral load. Mean value of CD4 cells at enrollment was 298 cells/mm(3). At follow up, three months after the end of the program, the mean value of CD4 cells was 464 cells/mm(3). CONCLUSIONS: The project has proven the feasibility of a novel approach of active case finding in the community with direct link to care. Retention to care was satisfactory as most of those patients would not have been able to access care through the normal ART delivery mode of the Public Health System. However, more obstacles to care remain. Being homeless, poor nutrition, complicated access to harm reduction services, lack of One Stop Shop services and police operations in the city center impede further progress [2,3].

Course of inflammatory bowel disease in patients infected with human immunodeficiency virus.

BACKGROUND: Human immunodeficiency virus (HIV) infection depletes CD4+ lymphocytes, which may benefit patients with inflammatory bowel disease (IBD). The aim was to compare the course of IBD in HIV patients with a matched group of IBD seronegative patients. METHODS: A total of 20 IBD (14 Crohn's disease, 6 ulcerative colitis) HIV infected patients and 40 matched control seronegative IBD patients (2 controls per case) were compared regarding relapse of their disease. The CD4+ count was followed every 6 months and a value of < or =500 cells/microL was used to define patients with immunosuppression. Relapse rates per year of follow-up were compared among the 2 groups and survival curves for cumulative remission rates were compared with a log-rank test. Multivariate analysis was used to discriminate among the impact of different variables on the risk of IBD relapse. RESULTS: The median duration of follow-up was 8.4 years (range 0.6-18 years). The mean relapse rate for the HIV+IBD group was 0.016/year of follow-up as compared to 0.053/year of follow-up for the IBD-matched control group (P = 0.032). Regarding the HIV-positive/IBD group, 14 patients were immunosuppressed at any given time during the follow-up period. None of these patients experienced an IBD relapse, whereas 3 out of the 6 without immunosuppression relapsed (P = 0.017). According to the multivariate analysis, HIV status was the only risk factor independently associated with a lower probability of IBD relapse. CONCLUSIONS: HIV infection reduces the relapse rates in IBD patients and this may be attributed to the lower CD4+ counts seen in these patients.

Long-term complete regression of nodal marginal zone lymphoma transformed into diffuse large B-cell lymphoma with highly active antiretroviral therapy alone in human immunodeficiency virus infection.

Since the introduction of combination antiretroviral therapy (cART), there has been a decrease in the incidence of non-Hodgkin lymphoma among the HIV-infected population and also significantly improved survival rates. We describe a remarkable case of a HIV-infected patient whose large B-cell lymphoma, most likely arising by transformation of a nodal marginal zone lymphoma, completely regressed with the use of cART alone. He remained disease-free for almost 3 years and he finally died from presumed flare up of his lymphoma. There are very few cases of spontaneous regression of lymphomas with cART alone in the HIV population. This is an extreme example of the significance of cART in improving survival in HIV-non-Hodgkin lymphoma and changing the face of the HIV epidemic in general.