Low frequency of hypersensitivity reactions to abacavir in HIV infected patients in a referral center in Bahia,Brazil

Abacavir can cause a multi-systemic hypersensitivity reaction (HSR) in 5–8% of the patients, which is related to HLA-B*57-01 allele. In Brazil, the HLA-B*57-01 screening test became available only in March 2018, several years after abacavir was in use. In this retrospective study we reviewed medical charts of all patients receiving an abacavir-containing regimen to evaluate the frequency of HSR in patients followed at a referral center in Salvador, Brazil. A total of 192 patients who received abacavir were identified, most male (67.1%), black or racially mixed (77.8%), and having diagnosis of a previous AIDS defining conditions (83.7%). Only one patient developed HSR (incidence: 0.52%). The main reasons for abacavir-containing antiretroviral therapy discontinuation were virological failure (28%), adverse effects to other components of the regimen (25%), and simplification of therapy (16%). The low incidence of HSR to abacavir does not support the use of HLA-B*57-01 screening test, in Salvador, Brazil.     

成人艾滋病抗病毒治疗效果及影响因素研究

目的通过对国内外文献及指南的全面回顾,描述并分析国内外成人抗病毒治疗病毒学效果及影响因素。方法收集并分析国内外抗病毒治疗相关文献和指南。结果病毒学效果受到治疗时间的影响,随着时间的延长,失败的病人比例会逐渐升高。同时病毒亚型、基线耐药、治疗方案、依从性、不良反应以及一些人口学因素,都会影响到病毒学效果。结论在资源有限地区开展大规模的抗病毒治疗,应尽可能延长一线治疗方案对病毒的抑制时间,提高治疗成功率。通过为病人提供病毒载量和耐药检测,改良治疗方案、提高依从性以及开展耐药监测等措施,能够进一步提高病毒学效果。     

Disappearance of an intracerebral arteriovenous malformation in an HIV-infected patient after initiation of HAART

HIV infection or complications of HIV-induced immunodeficiency may affect the central nervous system (CNS). However, vascular cerebral pathologies are very rare, in particular intracerebral arteriovenous malformations (AVM). We report the case of an HIV-infected patient who had a cerebral AVM leading to symptoms such as recurring focal seizures. Only after initiation of potent antiretroviral combination therapy, but not antiretroviral monotherapy or bitherapy, could the viral load be suppressed and immunodeficiency resolved. Two years after the start of highly active antiretroviral therapy (HAART) total occlusion of the AVM could be demonstrated. Taken together, this case report may demonstrate the potent angiogenic activity of HIV for AVM. Also, this case report might show that inhibition of such a cofactor may lead to resolution of an AVM. Received: June 15, 2001 · Revision accepted: December 3, 2001     

HIV/HCV重叠感染者疾病进展及病毒间相互作用机制的研究进展

自1981年美国首次从男同性恋患者中报道艾滋病(AIDS)以来,相同症状的患者不断被发现,该疾病也以其惊人的速度在世界范围内传播开来。由于丙型肝炎病毒(HCV)与艾滋病病毒(HIV)有相同的传播途径,使HCV在HIV感染者中得到广泛的传播。据报道,全球HCV感染者中大约6%～10%合并HIV感染,HIV感染者中大约有30%合并HCV感染。因此HIV/HCV重叠感染成为AIDS最关注的领域之一。现对HIV/HCV重叠感染者疾病进展及病毒间在人体内相互作用机制的最新研究进展综述如下。     

Opening up the HIV epidemic: a review of HIV seropositive status disclosure among people who inject drugs

HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64–86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners’ willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.     

Low variation in initial CD4 cell count in a HIV referral center,in Salvador,Brazil, from 2002 to 2015

Early initiation of antiretroviral therapy increases the likelihood of effective immune restoration, quality of life, and greater life expectancy for HIV-infected individuals. We evaluated the evolution of mean CD4+ cells count at diagnosis of HIV/AIDS in Salvador, Brazil from 2002 to 2015. We identified HIV/AIDS patients older than 18 years with diagnosis of HIV infection from 2002 to 2015, who had their first laboratory evaluation at Complexo Hospitalar Prof. Edgard Santos, Federal University of Bahia. Initial mean CD4+ cells count and age, over time were evaluated. A total of 1801 patients randomly selected individuals were included in the analysis. Overall mean CD4+ count at diagnosis in the whole period was 279 ± 265, varying from 191 in 2015 to 334 in 2011. There was no improvement in the immunological status at diagnosis from 2002 to 2015. In addition, a higher frequency of CD4+ cells count < 200 cells/mL in the last two years was observed. This suggests that the adopted strategies for early diagnosis of HIV/AIDS in Salvador, Brazil, are still ineffective.     

Fibrosis progression in paired liver biopsies from HIV/HCV co-infected patients

Background

Chronic hepatitis C is more aggressive during HIV infection. Available data about risk factors of liver fibrosis in HIV/HCV co-infected patients derive from studies based on a single liver biopsy.

Objectives

To evaluate the risk factors of liver fibrosis progression (LFP) and to investigate the role of antiretroviral therapy (ARV) in HIV/HCV patients who underwent paired liver biopsy.

Patients and Methods

We retrospectively studied 58 patients followed at two Infectious Diseases Departments in Northern Italy during the period 1988-2005. All specimens were double-blinded and centrally examined by two pathologists. LFP was defined when an increase of at least one stage occurred in the second biopsy, according to the Ishak-Knodell classification.

Results

In a univariate analysis, serum levels of alanine aminotransferase (ALT) > 150 IU/L at the first biopsy (P = 0.02), and a > 20% decrease in CD4+ cell count between the two biopsies (P = 0.007), were significantly associated with LFP. In multivariate analysis, a > 20% decrease in CD4+ cell count remained independently associated to LFP (Odds Ratio, 3.99; 95% confidence interval, 1.25-12.76; P < 0.02). Analysis of life survival curves confirmed the correlation between CD4+ cell count and LFP.

Conclusions

Our findings highlight that in HIV/HCV coinfected patients, an effective antiretroviral therapy that assures a good immune-virological profile contributes to reducing the risk of LFP.     

Survival of HIV patients with tuberculosis started on simultaneous or deferred HAART in the THRio cohort,Rio de Janeiro,Brazil

BackgroundThe timing of highly active antiretroviral therapy (HAART) after a tuberculosis diagnosis in HIV-infected patients can affect clinical outcomes and survival. We compared survival after tuberculosis diagnosis in HIV-infected adults who initiated HAART and tuberculosis therapy simultaneously to those who delayed the start of HAART for at least two months.MethodsThe THRio cohort includes 17,983 patients receiving HIV care in 29 public clinics in Rio de Janeiro, Brazil. HAART-naïve patients at the time of a new TB diagnosis between September 2003 and June 2008 were included. Survival was measured in days from diagnosis of TB. We compared survival among patients who initiated HAART within 60 days of TB treatment (simultaneous – ST) to those who started HAART >60 days of TB treatment or never started (deferred – DT). Kaplan–Meier plots and Cox proportional hazards regression analyses were conducted.ResultsOf 947 patients diagnosed with TB, 572 (60%) were HAART naïve at the time of TB diagnosis; 135 were excluded because of missing CD4 count results. Among the remaining 437 TB patients, 56 (13%) died during follow-up: 25 (10%) among ST patients and 31 (16%) in DT group (p = 0.08). ST patients had lower median CD4 counts at TB diagnosis than DT patients (106 vs. 278, p < 0.001). Cox proportional hazards utilizing propensity score analysis showed that DT patients were more likely to die (adjusted HR = 1.89; 95% CI: 1.05–3.40; p = 0.03).ConclusionHAART administered simultaneously with TB therapy was associated with improved survival after TB diagnosis. HAART should be given to patients with HIV-related TB as soon as clinically feasible.     

抗-R7V抗体与HIV感染后疾病进展关系的初步研究

目的初步了解人类免疫缺陷病毒（HIV）感染者血清抗-R7V抗体阳性与疾病进展之间的相关性。方法检测HIV感染者的抗-R7V抗体,根据结果分为阳性、阴性和灰区3组。跟踪随访,观察各组病例的CD4^＋T细胞计数和病毒载量变化,以及进行高效抗逆转录病毒治疗（HAART）的情况,进行组间比较。结果44例感染者中,发现9例抗-R7V阳性,阳性率为20．45％。其中7例感染HIV均超过10年。经过平均28．5个月随访,阳性组CD4计数下降幅度和开始HAART治疗的患者比例均显著低于阴性组。结论HIV感染者中抗R7V阳性率为20．45％,该抗体阳性和HIV感染后疾病缓慢进展之间存在着较高的相关性。     

Impact of human immunodeficiency virus infection in patients infected with the hepatitis C virus.

BACKGROUND/AIMS: The objective of the present study is to evaluate the impact of human immunodeficiency virus (HIV) in patients with hepatitis C virus (HCV) infection. METHODS: Three different groups of patients were considered: group 1, 385 HCV/HIV coinfected; group 2, 198 HIV monoinfected; and group 3, 311 HCV monoinfected. Demographic and epidemiological data were collected. Blood tests included anti-HCV, HCV-RNA test, genotyping, CD4 cell count, anti-HIV, and HIV viral load. Treatment with interferon and ribavirin was proposed. The fibrosis progression rate was assessed. RESULTS: The most prevalent risk factor in the group of coinfected was the use of intravenous drugs; in the HIV monoinfection group, heterosexual relations at risk; in the HCV monoinfection group, the transfusion of blood. There was no difference concerning the distribution of genotypes or HCV viral load between groups 1 and 3. Although the mean time of duration of HCV infection was greater in group 3 than in group 1, there was no difference when the fibrosis progression rate was evaluated. The response to treatment was similar. CONCLUSION: In the present series there was no relevant impact of HCV infection in patients with HIV.     

Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice

OBJECTIVES: Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting. METHODS: Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks. RESULTS: An overall mean reduction of 16% in total cholesterol, 20% non-HDL cholesterol, and 18% in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7)% with fibrates, -11 (-14)% with statins and -23 (-22)% for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40)% in those treated with fibrates; -1 (-21)% in those with statins alone, and -32 (-42)% in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95% CI: 2.1-48.9; p < 0.005). CONCLUSION: In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.     

HIV and hepatitis C coinfection

The significant burden of HIV/hepatitis C virus (HCV) coinfection is increasingly recognized worldwide, and in particular within the Asia–Pacific region. Individuals who are coinfected with both viruses are at risk from accelerated liver disease and consequently cirrhosis, liver failure, and hepatocellular carcinoma. In addition, coinfected individuals may have altered immunological responses to HAART and are at increased risk of highly active antiretroviral therapy (HAART)–related hepatotoxicity. Treatment for HCV infection in HIV-infected individuals is with standard pegylated interferon and ribavirin therapy, and all HIV/HCV coinfected subjects should undergo suitability for HCV treatment assessment. Response rates to HCV therapy are generally 10–15% lower than in HCV monoinfection, and therapy may be complicated by issues of drug interactions and significant toxicity. However, greater understanding of baseline factors can contribute to better prediction of treatment outcome, and monitoring of on-treatment virological responses increasingly allows individualization of therapy. Where possible, treatment of HCV is often advisable before HAART is required to avoid the issues of drug interactions on HCV therapy and the risk of HAART-related hepatotoxicity. Early diagnosis of both HIV and HCV infection is essential to most effectively manage HIV-HCV-coinfected individuals. New therapies, including HCV protease and polymerase inhibitors, are in development and may widen therapeutic options for HIV-HCV-coinfected individuals into the future.     

HIV/AIDS病人HAART致肝功能损害66例分析

目的探讨高效抗反转录病毒治疗（HAART）对艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）肝功能的影响。方法回顾性分析HIV/AIDS病人抗病毒治疗24个月内肝功能的变化情况。结果共计调查755例HIV/AIDS病人,肝功能损害发生率为8.7%（66/755）,以单项转氨酶或胆红素升高为主,轻、中度肝损害占84.8%（56/66）,发生异常的时间为30-485天,中位数75天。其中含奈韦拉平（NVP）方案治疗者肝功能损害的发生率为7.1%（33/467）、含依非韦伦（EFV）方案发生率为11.5%（33/288）。肝损害级别：1级34例,2级22例,3级10例。结论 HIV/AIDS病人在抗病毒治疗过程中轻中度肝损害常见,应严密观察,及时处理,以保证HAART的顺利进行。     

云南省成人AIDS病人抗病毒治疗的疗效分析

目的评估云南省成人艾滋病病人国家免费抗病毒治疗的疗效。方法采用横断面调查的方法,分析云南省各级定点医疗机构,从2001年1月1日至2012年12月31日,接受国家免费抗病毒治疗的AIDS病人的资料,包括人口学资料、基线CD4＋T淋巴细胞（CD4）计数和病毒载量（VL）。结果在治病人病毒抑制率未随治疗时间延长而降低;女性病毒抑制效果好于男性（P〈0.01）;因静脉注射毒品感染艾滋病病毒（HIV）的病人病毒抑制率低于其他途径感染的人群（P〈0.01）;基线CD4〈100个/μL的病人其病毒抑制率显著高于CD4〉100个/μL的病人;30岁以上病人病毒抑制率好于30岁以下者;未婚病人的病毒抑制率比其他婚姻状况（包括已婚、同居、离异或分居等）的人群差。结论云南省艾滋病病人抗病毒治疗效果情况整体较好,但需要加强对于男性、未婚、30岁以下、吸毒感染,以及基线CD4〉100个/μL病人的依从性教育,及时做好VL检测和评估、耐药筛查等工作;基线CD4〉350个/μL的病人,加强治疗管理可以保证治疗效果。     

我国艾滋病病毒感染孕产妇及所生儿童应用抗反转录病毒药物的状况及变化趋势

目的了解我国部分艾滋病(AIDS)高流行地区,艾滋病感染孕产妇及所生儿童应用抗反转录病毒(ARV)药物状况及变化趋势。方法 2005年1月至2008年12月,在艾滋病病毒(HIV)感染相对高发的5省23个市(县、区),对1 414名HIV-1感染孕产妇及所生儿童进行问卷调查及随访管理,收集研究对象所应用ARV药物种类、方案等一系列信息。结果1 414名研究对象中,2005-2008年各年分别有77.13%、77.73%、78.26%和84.20%的HIV感染孕产妇应用了ARV药物,并呈现逐年递增的趋势(χ2=5.90,P=0.01)。艾滋病感染产妇三联ARV药物应用比例呈现逐年上升趋势,而单一NVP应用比例逐年下降(χ2=237.17,P<0.000 1;χ2=276.49,P<0.000 1)。预防性及治疗性三联药物方案应用比例仍不足40%和15%,上升幅度有限(χ2=45.79,P<0.0001;χ2=151.96,P<0.0001)。结论继续扩大艾滋病感染孕产妇及所生儿童应用高效抗反转录病毒治疗(HAART)覆盖面,提高ARV药物的可及性,尤其是三联ARV药物方案的应用。