Virological rather than host factors are associated with transaminase levels among HIV/HCV-coinfected patients.

Alanine aminotransferase (ALT) is a routine parameter in the assessment and monitoring of chronic hepatitis C viral (HCV) infection. Hepatitis C virus-infected African Americans (AAs) have been reported to have lower ALT levels. In this retrospective, cross-sectional, multicenter study, host and virological factors possibly associated with ALT levels were analyzed by multivariate regression analyses among HIV/HCV-coinfected patients. Of the 289 patients included, 142 were African Americans and 144 Caucasians. In multivariate analysis, only HCV genotype 3 (B 0.2 [95% CI 13.39-52.33]; P = .001) and HCV RNA >500 000 IU/mL (B 3.1 [95% CI 7.67-34.75]; P = .002) were independent predictors of higher ALT levels. Per the American Association for the Study of Liver Disease (AASLD) definition, 18.2% had ALT levels within normal limits. Male sex and HCV RNA <500 000 IU/mL predicted ALT within normal limits. Hepatitis C viral factors rather than race were associated with ALT levels in this HIV/HCV-coinfected population. ALT were within normal limits in 18% of patients, who more often were male and had lower Hepatitis C viral load.

First HAART in HIV-infected patients with high viral load: value of HIV RNA levels at 12 weeks to predict virologic outcome.

The aim of this study is to identify the role of incomplete suppression during the first months of highly active antiretroviral treatment (HAART) to predict virologic failure in patients with high levels of HIV replication. In a retrospective, longitudinal, and multicenter study, response to HAART was assessed in treatment-naive adults with HIV RNA >100 000 copies/mL, and factors predicting failure were analyzed through regression analyses. A total of 118 patients were included. Virologic failure occurred more often in patients with >500 copies/mL at week 12 (Cox regression: Exp (B) 3.22; P = .02). HIV RNA >500 copies/mL at week 12 predicted incomplete virologic response (odds ratio [OR] = 9.33; P = .002] but not viral rebound. Major antiretroviral resistant mutations were present in 11 of 14 patients. HIV RNA >500 copies/mL at week 12 of first HAART predicts incomplete virologic response in patients with high levels of replication at baseline. Most patients carried resistance mutations at the time of failure.

Rheumatic manifestations of human immunodeficiency virus infection.

Rheumatic complaints are common in patients with HIV, and HIV positivity confers an increased susceptibility in populations with similar risk factors for HIV infection. With the advent of the modern combined antiretroviral treatment, HAART has had a profound beneficial effect on survival in HIV-infected patients, with lifelong control of HIV infection and normalization of life expectancy; but it has also contributed to both an altered frequency and a different nature of rheumatic complications now being observed in this population, with new rheumatic complications, such as osteoporosis, osteonecrosis, gout, mycobacterial, mycotic osteoarticular infections, and neoplasia perhaps more prevalent. Rheumatologists, internists, and general physicians need to be aware of these changes to provide optimal diagnosis and how to disclose the results to their patients. They also need to be familiar with the management of HIV infection and to direct careful attention to the prevention of HIV transmission in health care facilities.

[Epidemiology of HIV infection: twenty-years of experience]. / Epidemiología de la infección por virus de inmunodeficiencia adquirida: veinte años de experiencia.

In the 20 years since the isolation of HIV, an overwhelming amount of information about this entity has come up and transform this disease into a chronic and manageable one. In spite of all this knowledge, failure to prevent new infections is still common in many parts of the world, especially those acquired by sexual and intravenous drug use. Sub-Saharan Africa is still the most affected region of the world, where the meridional region presents the largest incidence of all (30%) and contains only 2% of the world population. Asia and Eastern Europe epidemics are still growing, mostly because IVU drug use and sexual commerce. Latin America presents an epidemic concentrated to high risk behavioral groups, especially in South America. Mexico has 71,526 registered cases; the most them between 25-34 years, 51% have died up to date. The main route of transmission is sexual. A lot is still to come in the future years, but we have to pay special attention to the prevention of this disease.

Prospective, randomized, open label trial of Efavirenz vs Lopinavir/Ritonavir in HIV+ treatment-naive subjects with CD4+<200 cell/mm3 in Mexico.

OBJECTIVE: To compare the efficacy of efavirenz (EFV) vs lopinavir/ritonavir (LPV/r) in combination with azidothymidine/lamivudine in antiretroviral therapy naive, HIV+ individuals presenting for care with CD4 counts <200/mm. METHODS: Prospective, randomized, open label, multicenter trial in Mexico. HIV-infected subjects with CD4 <200/mm were randomized to receive open label EFV or LPV/r plus azidothymidine/lamivudine (fixed-dose combination) for 48 weeks. Randomization was stratified by baseline CD4 cell count (< or =100 or >100/mm). The primary endpoint was the percentage of patients with plasma HIV-1 RNA <50 copies/mL at 48 weeks by intention-to-treat analysis. RESULTS: A total of 189 patients (85% men) were randomized to receive EFV (95) or LPV/r (94). Median baseline CD4 were 64 and 52/mm, respectively (P = not significant). At week 48, by intention-to-treat analysis, 70% of EFV and 53% of LPV/r patients achieved HIV-1 RNA <50 copies/mL [estimated difference 17% (95% confidence interval 3.5 to 31), P = 0.013]. The proportion with HIV-1 RNA <400 copies/mL was 73% with EFV and 65% with LPV/r (P = 0.25). Virologic failure occurred in 7 patients on EFV and 17 on LPV/r. Mean CD4 count increases (cells/mm) were 234 for EFV and 239 for LPV/r. Mean change in total cholesterol and triglyceride levels were 50 and 48 mg/dL in EFV and 63 and 116 mg/dL in LPV/r (P = 0.24 and P < 0.01). CONCLUSIONS: In these very advanced HIV-infected ARV-naive subjects, EFV-based highly active antiretroviral therapy had superior virologic efficacy than LPV/r-based highly active antiretroviral therapy, with a more favorable lipid profile.

Epidemiología de la infección por virus de inmunodeficiencia adquirida: veinte años de experiencia / Epidemiology of HIV infection: Twenty-years of experience

A dos décadas del reconocimiento de la infección por el virus de inmunodeficiencia humana, se han logrado grandes avances en cuanto al diagnóstico y tratamiento de esta enfermedad, transformándola en una enfermedad crónica y manejable. Sin embargo, a pesar de conocer los mecanismos de transmisión y, por lo tanto, medidas de prevención, la drogadicción intravenosa y las relaciones sexuales de riesgo, continúan siendo hoy en día motores importantes para la propagación de la epidemia. África Subsahariana es, con mucho, la región más afectada por la epidemia de VIH/SIDA a nivel mundial. Los países de la región meridional presentan la incidencia más alta y albergan aproximadamente a 30% de las personas que viven con VIH/SIDA en el mundo y, sin embargo, contienen tan sólo a 2% de la población mundial. Las epidemias de Asia y el Pacífico, así como de Europa Oriental siguen creciendo, la mayor parte de estas nuevas epidemias emergentes son debidas al consumo de drogas intravenosas, con la propagación añadida del VIH a través del comercio sexual. Latinoamérica presenta en forma global epidemias altamente concentradas, especialmente en América del Sur. En México se han registrado 71,526 casos acumulados de SIDA hasta el 1 de noviembre del 2003, de los cuales 51% han fallecido, la principal vía de transmisión en México es la sexual, y la población más afectada por la epidemia son los jóvenes de 25-34 años edad. Mucho queda aún por hacer en los años venideros tanto en los avances de la atención médica de estos enfermos, pero sobre todo en aspectos de vigilancia epidemiológica y medidas de prevención.

In the 20 years since the isolation of VIH, an overwhelming amount of information about this entity has come up and transform this disease into a chronic and manageable one. In spite of all this knowledge, failure to prevent new infections is still common in many parts of the world, specially those acquired by sexual and intravenous drug use. Sub-Saharan Africa is still the most affected region of the world, where the meridional region presents the largest incidence of all (30%) and contains only 2% of the world population. Asia and Eastern Europe epidemics are still growing, mostly because IVU drug use and sexual commerce. Latin America presents an epidemic concentrated to high risk behavioral groups, especially in South America. Mexico has 71,526 registered cases; the most them between 25-34 years, 51% have died up to date. The main route of transmission is sexual. A lot is still to come in the future years, but we have to pay special attention to the prevention of this disease.