Active Antiretroviral Therapy Era Research Articles

A STUDY ON PREVALENCE OF ANEMIA AND GROWTH PATTERN AMONG HIV-INFECTED CHILDREN FROM RURAL AREAS ATTENDING GOVT. GENERAL HOSPITAL, VIJAYAWADA, ANDHRA PRADESH, INDIA

The present communication deals with the profile of HIV infected children belonging to pre-HAART (pre-Highly Active Anti Retroviral Therapy) era and HAART era to know the status of anemia and growth pattern who attended the ART centre, Govt. General Hospital, Vijayawada, Andhra Pradesh, India. A cross-sectional record based study was carried out in 125 HIV infected children in ART centre from 2009 to 2011. Hemoglobin, height, weight, BMI, waist and hip ratio were calculated according to the standard protocols. The CD4 count was estimated using BD FACS caliber flow cytometer and results were statistically analyzed. According to the present study 125 subjects of age group 1-20 years were chosen. The subjects in pre-HAART era (75 subjects) showed low level of Hb content 6.9 gm/dL in male and 6.3 gm/dL in female subjects; the mean BMI level was 20.43 in male and 18.47 in female subjects and showed a significant increase (p<0.05) in mean CD4 counts from 592 to 790 cells/cmm from baseline count to follow up count after 18 months. The study patients in HAART era (45 subjects) significant decrease (p<0.001) in Hb content from 7.3 to 6.5 gm/dL and significant increase (p<0.05) in BMI level from 18.1 to 22.6 and showed a significant increase (p<0.001) in CD4 counts from 174 to 902 cells/cmm from baseline to follow up treatments. Our study reinforces the finding that anemia, growth pattern of HIV infection in Indian children with prognostic significance.

Anal Invasive Squamous Cell Cancer and Human Papillomavirus Distribution in HIV-Infected and Non-HIV-Infected Individuals

Invasive-squamous-cell-cancer (ISCC) of the anal canal is an uncommon disease. Human papillomavirus (HPV) is the etiological agent of most of types of ISCC. The incidence of ISCC has been increasing in HIV-infected individuals, even after the introduction of highly active antiretroviral therapy. The aim of this study was to analyze biopsy specimens from patients diagnosed with ISCC at a tertiary hospital from 1983 to 2012 in order to detect HPV-DNA. Methods: Formaldehyde-fixed, paraffin-embedded specimens from patients with ISCC underwent HPV-DNA genotyping using multiplex PCR assay. Results: A total of 31 cases were collected; 10 were HIV-infected (9 men, 1 woman) and 21 non-HIV-infected (11 men, 10 women). HPV infection was detected in 87.5% (7/8) of the HIV-infected patients (DNA from 2 biopsies was degraded) and 76.2% (16/21) of non-HIV-infected individuals. Multiple-type infections were only found in 28.6% (2/7) of the HIV-infected patients (no multiple-type infections in non-HIV-infected individuals). The most prevalent type was HPV-16: 50% (4/8) in the HIV-infected group (57% [4/7] of the HPV-positive samples) and 66.7% (14/21) in the non-HIV-infected group (87.5% (14/16) of the HPV-positive samples). Remarkably, 37.5% (3/8) of the HIV-infected group had high-risk HPV types not included in the vaccines (HPV-33, 51, 52, and 66) compared with 4.8% in the non-HIV-infected group (1/21, HPV-52). All cases of anal ISCC in HIV-infected patients were recorded in the highly active antiretroviral therapy era. Conclusion: HIV-infected patients presented anal ISCC with a higher proportion of high-risk HPV types not covered by the conventional vaccines than non-HIV-infected individuals.

Markers of HIV-1 Disease Progression and Treatment Response in Highly Active Antiretroviral Therapy (HAART) Era: A Review

After the discovery of human immunodeficiency virus 1 (HIV-1) infection more than three decades ago, there has been a significant development in the laboratory diagnosis, treatment and management of patients on highly active antiretroviral therapy (HAART). Initially HIV-1 infection was implicated to cause various cancerous conditions (Kaposi’s sarcoma), and infectious diseases (tuberculosis, other bacterial, viral, parasitic and fungal infections). Studies have demonstrated that HIV-1 infection and the disease course is complex and that many HIV infected patients do not progress to acquired immune deficiency syndrome (AIDS) even after 10-15 years (late/non progressors). Introduction of HAART has significantly reduced the morbidity and mortality in HIV-1 infected patients resulting in extended life on par with HIV non infected individuals. Late research has revealed that HIV-1-infected individuals are at greater risks of developing non infectious complications (liver disease, cardiovascular disease (CVD)) that may precipitate with the initiation of HAART. With the increased availability and affordability of HAART, the focus now is on developing effective strategies to monitor HIV -1 disease progression and treatment response.

Sclerosing cholangitis by cytomegalovirus in highly active antiretroviral therapy era

Sclerosing cholangitis (SC) due to cytomegalovirus (CMV) is very rare. It has been described mainly in immunocompromised patients. Currently, in HIV infected patients it is exceptional. The most of cases belong to pre-highly active antiretroviral therapy (pre-HAART) and those cases were in stage AIDS with less than 100 CD4/ microl. The most frequently involved pathogen in pre-HAART period was Cryptosporidium parvum (30-57 %) and CMV (10-30 %); in late HAART period this information are unaware. CMV has been implicated as a possible etiological agent in primary SC partly because of the ability to cause liver damage and its relationship with smooth muscle antibodies. The most effective treatment for SC was the combination of antiretroviral therapy and endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement.Following, we present the first case of late HAART period which describes a SC extrahepatic without papillary stenosis with CMV as the only cause and clinical presentation of HIV infection in a woman with 177 CD4/microl.

Reply to Bradshaw and Danta

To the Editor—We read with interest the comments by Bradshaw and Danta on our article [1] and would like to address several points. Comparing our study to the UK study is problematic because the UK study described a group of men who have sex with men (MSM) during the early and current highly active antiretroviral therapy (HAART) eras (1998–2008) [2]. In contrast, 83% of participants in our study were enrolled during the pre-HAART era. Because sexual practices in the MSM community changed rapidly as effective anti–human immunodeficiency virus (HIV) therapies evolved, a comparison between our study and the UK study may be confounded by changes in sexual behaviors in the gay community between 1984 and 2011. The authors also state that “rates of URAI [unprotected receptive anal sex] declined in later recruits” and speculate that this decline could be attributed to underreporting. In fact, we did not discuss trends in URAI rates. Rather, we reported in our Table 1 [1] the proportions of men who reported a history of URAI with multiple partners prior to enrollment into the Multicenter AIDS Cohort Study (MACS)—essentially a baseline assessment. However, to address the point raised, we examined the reported rates of URAI and found that those rates for later recruits were comparable to those reported by earlier recruits during follow-up in 2001. Thus, we did not find evidence to support the hypothesis that a greater degree of underreporting of URAI in later recruits occurred. Bradshaw and Danta also note that, in the HIV-infected men recruited from 2001–2003, the hepatitis C virus (HCV) incident rate (IR) declined between 2000–2004 and 2005–2011. However, this was not a statistically significant decline; the 95% confidence intervals (CIs) around the IRs are large and overlap (IR, 6.74 [95% CI, 2.71–10.89] vs 5.16 [95% CI, 2.57–9.23]). Nevertheless, we acknowledge that our finding that HCV incidence did not increase among MSM during this time period is in stark contrast to the 18-fold increase reported in the Swiss HIV Cohort Study (SHCS) [3]. Interestingly, the increase among MSM in the SHCS occurred exclusively between 2008 and 2011. As the SHCS has ongoing enrollment, we will see if the observed HCV increase occurred among a unique group of recent enrollees, and whether this increase continued. The authors note that the association of syphilis and incident HCV is lost in the non–injection drug use (IDU), non–blood transfusion group in our study, and they assert that this observation is in contrast to associations reported in other studies of HIV-infected MSM. Because >50% of our non-IDU, non–blood transfusion study group was HIV negative, the most appropriate group for comparison in our study is all HIV-infected men among whom, as shown in our Table 5 [1], syphilis was independently associated with incident HCV (relative risk, 2.75 [95% CI, 1.76–4.29]). This argues against the authors’ assertion that the MACS is “a relatively unusual MSM cohort.” Last, the authors are concerned that HCV antibody–negative recruits who did not have follow-up HCV testing might have been at higher risk for HCV than those with follow-up HCV testing. The proportion of men who reported having had URAI with ≥2 partners prior to enrollment among those included in our study was not different compared to those who did not have follow-up HCV testing (36% vs 34%; P = .39). Because this important marker of sexual exposure was similar among the MSM included in and excluded from our study, we do not believe that the exclusion of these men is likely to have affected the results of our study.

Current questions in HIV-associated lung cancer

In this review, we explore current questions regarding risk factors contributing to frequent and early onset of lung cancer among populations with HIV infection, treatment, and outcomes of lung cancer in HIV-infected patients as well as challenges in a newly evolving era of lung cancer screening. Lung cancer, seen in three-fold excess in HIV-infected populations, has become the most common non-AIDS defining malignancy in the highly active antiretroviral therapy era. HIV-associated lung cancer appears to be associated with young age at diagnosis, cigarette smoking, advanced stage at presentation, and a more aggressive clinical course. There is no unified explanation for these observations, and aside from traditional risk factors, HIV-related immunosuppression and biological differences might play a role. In addition to smoking cessation interventions, screening and early cancer detection in HIV-infected populations are of high clinical importance, although evidence supporting lung cancer screening in this particularly high-risk subset is currently lacking, as are prospective studies of lung cancer therapy. There is an urgent need for prospective clinical trials in HIV-associated lung cancer to improve understanding of lung cancer pathogenesis and to optimize patient care. Several clinical trials are in progress to address questions in cancer biology, screening, and treatment for this significant cause of mortality in persons with HIV infection.

Molecular characteristics of diffuse large B-cell lymphoma in human immunodeficiency virus-infected and -uninfected patients in the pre-highly active antiretroviral therapy and pre-rituximab era

Human immunodeficiency virus (HIV) infection substantially elevates diffuse large B-cell lymphoma (DLBCL) risk, but its impact on the distinct DLBCL subtypes defined by cell of origin is unclear. We compared DLBCL molecular characteristics and prognosis in 51 HIV-infected and 116 HIV-uninfected cases diagnosed during 1977–2003. Using immunohistochemistry to classify cell of origin based on the Tally algorithm, activated B-cell (ABC)-DLBCL was substantially more common in HIV-infected (83%) than in HIV-uninfected (54%) cases (p < 0.001). Epstein–Barr virus (EBV) was detected in 63% of DLBCLs in HIV-infected cases, occurring almost exclusively in ABC-DLBCL (74% vs. 13% of germinal center B-cell [GCB]-DLBCL, p = 0.002), but was rarely detected in DLBCLs among HIV-uninfected cases (3%). Among HIV-uninfected cases, MYC/IgH [t(8;14)(q24;q32)] and IgH/BCL2 [t(14;18)(q32;q21)] translocations were significantly more common and BCL6/IgH [t(3;14)(q27;q32)] significantly less common in GCB-DLBCL than in ABC-DLBCL (p = 0.010, < 0.001 and = 0.039, respectively). Among HIV-infected cases, translocations other than MYC/IgH [t(8;14)(q24;q32)] (21%) were rare (≤ 6%) and unrelated to cell of origin. ABC-DLBCL was associated with adverse overall survival compared with GCB-DLBCL regardless of HIV status (pHIV-infected = 0.066; pHIV-uninfected = 0.038). Our data demonstrate key differences in the molecular characteristics, cell of origin and prognosis of DLBCL by HIV status in the pre-highly active antiretroviral therapy (HAART) and pre-rituximab era, supporting biologic differences in lymphomagenesis in the presence of HIV.

A Study of Cytomegalovirus Serology among HIV-Infected Patients in the Highly Active Antiretroviral Therapy Era

Cytomegalovirus (CMV) is one of the most common opportunistic viruses in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the CMV seroprevalence among HIV-infected patients and investigate the correlation between the CMV immunoglobulin G (IgG) antibody titers and cluster of differentiation 4 (CD4) T-cell counts, as well as highly active antiretroviral therapy (HAART) use. Serum samples from 69 HIV-infected patients and 65 HIV-seronegative persons attending Dr. Hasan Sadikin General Hospital Bandung in March–June 2012 were examined to detect CMV IgG antibody using electrochemiluminescence immunoassay (ECLIA). Data were analyzed using chi-square test, t-tests and analysis of variance (ANOVA). The results show that there were no statistically significant differences in the seroprevalence of CMV between HIV-infected (97%) and HIV-seronegative persons (94%). The mean of CMV IgG antibodies titers in HIV-infected patients (335.39+174.87 U/mL) were significantly higher than that of HIV-seronegative persons (240.59+192.76 U/mL). There was no significant correlation between CMV IgG antibody titers and CD4 T-cell counts (the mean was 393.58+209.22 cells/mm3). The titers of CMV IgG antibodies were significantly inversely associated with HAART use. The mean of CMV IgG antibody titers in HIV-infected patients on HAART (335.41+172.98 U/mL) were significantly higher than patients without HAART (204.8+213.91 U/mL). In conclusions, this study confirms a high seroprevalence of CMV among HIV-infected patients. High titers of CMV are inversely associated with HAART use while no correlation with CD4 T-cell counts was found. [ MKB . 2013;45(2):112–7] Key words : CD4, Cytomegalovirus (CMV), HAART, HIV, IgG Studi Serologi Cytomegalovirus pada Pasien yang Terinfeksi HIV di Era Highly Active Antiretroviral Therapy Cytomegalovirus (CMV) adalah salah satu virus oportunistik yang paling umum pada pasien yang terinfeksi human immunodeficiency virus (HIV). Tujuan penelitian ini untuk mengetahui seroprevalensi CMV pada pasien HIV dan meneliti korelasi antara titer antibodi imunoglobulin G (IgG) CMV dan jumlah sel-T cluster diferensiasi 4 (CD4) serta penggunaan highly active antiretroviral therapy (HAART). Sampel serum dari 69 pasien HIV dan 65 HIVseronegatif yang berkunjung ke Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret–Juni 2012 diperiksa untuk mendeteksi antibodi IgG CMV dengan immunoassay electro chemiluminescence (ECLIA). Data dianalisis dengan menggunakan uji chi-kuadrat, t, dan analysis of variance (ANOVA). Hasil penelitian menunjukkan tidak ada perbedaan yang signifikan antara seroprevalensi CMV pada pasien HIV (97%) dan HIV-seronegatif (94%). Titer antibodi rata-rata IgG CMV pasien HIV (335,39+174,87 U/mL) signifikan lebih tinggi daripada HIV-seronegatif (240,59+192,76 U/mL). Tidak ada hubungan yang signifikan antara titer antibodi IgG CMV dan jumlah sel-T CD4 (rata-rata 393,58+209,22 sel/mm3). Titer antibodi IgG CMV secara signifikan berhubungan terbalik dengan penggunaan HAART. Titer antibodi IgG CMV rata-rata pasien HIV dengan HAART (335,41+172,98 U/mL) signifikan lebih tinggi dibandingkan dengan pasien tanpa HAART (204,8+213,91 U/mL). Simpulan, penelitian ini menegaskan seroprevalensi CMV pasien HIV dan titer antibodi IgG CMV yang tinggi berhubungan terbalik dengan penggunaan HAART tetapi tidak berkorelasi dengan sel-T CD4. [MKB. 2013;45(2):112–7] Kata kunci : CD4, Cytomegalovirus (CMV), HAART, HIV, IgG DOI: http://dx.doi.org/10.15395/mkb.v45n2.114

Non-AIDS-defining Cancers Among HIV-Infected Patients

In the highly active antiretroviral therapy (HAART) era, the incidence of non-AIDS-defining cancers (NADC) has increased and contributes to a growing proportion of mortality in the aging HIV-infected population. The underlying pathogenic mechanisms of increased cancer risk are incompletely understood. Potential contributors include oncogenic effects of the HIV virus, immunosuppression, chronic inflammation and immune activation, exposure to HAART, higher rates of oncogenic viral coinfections and traditional cancer risk factors. HIV-infected patients often present with NADC at younger ages with more aggressive or advanced stage disease. However, when standard cancer therapy is given, treatment outcomes appear similar to the non-HIV population. These facts highlight the importance of clinicians' maintaining a high index of suspicion, performing age-appropriate screening, and optimizing cancer therapy. Development of novel strategies for screening, prevention, and treatment of NADC will be required to reverse these epidemiologic trends and improve the survival of HIV-infected patients.

Validity of the International HIV Dementia Scale in Brazil

HIV-associated neurocognitive disorders (HAND) remain prevalent in highly active antiretroviral therapy (HAART) era. Tests to detect HAND are needed for early diagnosis and treatment. Validity of International HIV Dementia Scale (IHDS) has been determined in different countries. The aims of this study were validate IHDS in a Brazilian cohort of HIV-patients and verify if IHDS can be reliably administered by a non-clinician health professional. One hundred and eighty-seven (187) patients were submitted to a full neuropsychological assessment. IHDS was administered twice to each patient (by a non-clinician and by a neurologist). HAND was diagnosed in 98 individuals (68 on HAART). IHDS had sensitivity of 55% and specificity of 80%. IHDS had fair agreement with neuropsychological tests (k 0.355) and moderate-to-strong agreement between different evaluators (interclass correlation coefficient (ICC) 0.684). HAND is prevalent nowadays. IHDS is quick and easy to administer, but has marginal sensitivity for the detection of HIV cognitive impairment other than dementia.

Prevalence of Ocular Manifestations of HIV/AIDS in the Highly Active Antiretroviral Therapy (HAART) Era: A Different Spectrum in Central South China

Purpose: To investigate ocular manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in a population in central south China during a time of highly active antiretroviral therapy (HAART).Methods: A cross-sectional study in central south China was performed between June 2009 and April 2010. Ocular examinations were performed on recruited patients with HIV/AIDS. Systemic information (including CD4+ T cell count) was also collected where possible.Results: Among 1041 patients (2082 eyes) with HIV/AIDS enrolled in our study, we found a broad spectrum of ocular manifestations related to HIV/AIDS. The prevalence of HIV-associated ocular disease was 23.73% (247 patients). Of those with ocular complications, 87.85% had CD4 counts <200 cells/µL. HIV retinopathy (12.68%) was the most common HIV-associated ocular finding, followed by cytomegalovirus retinitis (6.72%). Prevalences of visual impairment and blindness were 7.59% and 0.77%, respectively.Conclusions: This epidemiologic study shows the spectrum of ocular lesions associated with HIV/AIDS in central south China. Our findings highlight the need for routine ophthalmic examinations in this population, even in patients who are asymptomatic, especially those at high risk, in the era of HAART.

Changing characteristics and risk factors of patients with and without incident HCV infection among HIV-infected individuals

Chronic hepatitis C virus (HCV) infection has become a leading cause of non-acquired immunodeficiency syndrome (AIDS)-related morbidity and mortality for human immunodeficiency virus (HIV)-infected persons in the highly active antiretroviral therapy (HAART) era. Despite injection drug use (IDU) remaining the main route of HCV infection, recent reports indicate outbreaks of acute HCV infection among HIV-infected men who have sex with men (MSM) and sexually transmitted infections in the absence of IDU. We conducted a retrospective observational study of behavioural and demographic factors of patients with and without incident HCV infection among HIV-infected individuals followed at the AIDS Clinic of the Infectious Disease Department of the University of Ancona from 1989 to 2011. Overall, 440 patients were considered; a total of 145 patients had initial positive HCV antibody test results (HCV+); a total of 295 patients had initial negative HCV antibody test results (HCV-). In the latter population, 14 seroconverted to HCV antibody (neoHCV), with an overall incidence of 0.59 per 100 person-years. While IDU was the principal risk factor of HCV+, the main route of transmission of incident HCV infection was sexual transmission. The HCV- group was significantly older than the other two groups and showed a significantly lower CD4 count at HIV diagnosis than neoHCV. Being Italian and having a low level of education were significantly more represented in HCV+. Younger age at HIV infection, IDU and additional risk factors other than sexual transmission significantly affected the probability of being HCV+. The cumulative probability of developing HCV infection in the HCV- group was calculated to be 6% at 15 years. The epidemiology of the newly acquired HCV in HIV+ persons is changing. Therefore, a frequent and constant counselling about HCV infection is desirable and a periodical screening test is mandatory.

Tenofovir Treatment Duration Predicts Proteinuria in a Multiethnic United States Cohort of Children and Adolescents With Perinatal HIV-1 Infection

Tenofovir is associated with renal proximal tubule injury. Such toxicity has not been extensively studied in HIV-1-infected children, in whom tenofovir is increasingly used. History, urine and blood were collected at regular intervals from 448 children and adolescents with perinatal HIV-1 infection followed in the Pediatric HIV/AIDS Cohort study. Relationships between tenofovir use and proteinuria and chronic kidney disease (CKD) outcomes were examined using multivariable logistic regression models. Proteinuria was defined as at least one urine protein/creatinine ratio (uPCR) ≥ 0.2, and CKD as ≥ 2 sequential uPCR ≥ 0.2 or estimated glomerular filtration rates <60 mL/min/1.73 m with no subsequent resolution, or a clinical diagnosis not contradicted by a normal uPCR. Subjects with ≥ 2 uPCR <0.2, and no abnormal uPCR and eGFR comprised the comparison group. Subjects were 47% male, 72% black, 24% Hispanic, with entry mean age (± standard deviation) of 11.5 ± 2.5 years. Proteinuria prevalence at entry, and annually during 3 years, ranged from 10.3% to 13.7%. The cumulative prevalence of proteinuria was 22% (94/434, 95% confidence interval: 18%-26%) and CKD 4.5% (20/448, 95% confidence interval: 2.7%-6.8%). Duration of tenofovir use was an independent predictor of proteinuria, with >3 years of exposure having the highest risk compared with no exposure (odds ratio: 2.53, 95% confidence interval: 1.23-5.22, overall P = 0.01). Overall, duration of tenofovir use did not significantly predict the presence of CKD. Rates of proteinuria and CKD were lower than those seen in the pre-highly active antiretroviral therapy era. However, prolonged exposure to tenofovir increases risk of renal injury.

Radiation recall dermatitis in course of epidemic Kaposi's sarcoma

Radiation recall dermatitis is an acute, rare skin reaction confined to previously irradiated areas that can be triggered by chemotherapeutic drugs (generally doxorubicin and taxanes), which are administrated after radiotherapy. We describe this case report to discuss the timing of the different choice of treatments of progressive Kaposis's sarcoma (KS) disease. KS, the neoplastic disease associated with HHV-8 infection, is still the most commonly diagnosed malignancy in HIV-1 patients, even if its incidence dramatically declined in the highly active antiretroviral therapy (HAART) era. The cutaneous form of disease generally improves with HAART alone or in association with local treatment (cryotherapy, radiotherapy, intralesion chemotherapy), whereas disseminated and/or progressive disease needs to be treated with systemic chemotherapy. In selected patients with progressive disease, systemic and local therapeutic options should be associated. We report a case of a 30-year-old HIV-1-positive man, affected by epidemic cutaneous and mucosal KS, who received several cycles of chemotherapy in succession with radiotherapy and other chemotherapy treatments for disease progression. After 7 months, the end of the last rechallenge with chemotherapy, the patient presented cutaneous painful and ulcerated lesions on the same skin areas previously irradiated.

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

BackgroundCandidia esophagitis (CE) is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART) era.Methodology/ Principal FindingsA total of 733 HIV-infected patients who underwent upper gastrointestinal (GI) endoscopy were analyzed. Sexual behavior, CD4+ count, HIV-RNA viral load (VL), history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of the 733 subjects, 62 (8.46%) were diagnosed with CE (mild, n = 33; severe, n = 29). Of them, 56.5% (35/62) had no GI symptoms, 30.6% (19/62) had CD4 + ≥200 cells/μL, and 55.3% (21/38) had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4+ counts and higher HIV VL, CE occurrence increased significantly (P<0.01 for trend in odds). Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29) had no GI symptoms and 44.4% (8/18) had no oral candidiasis. Median CD4+ counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04).ConclusionsLow CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

Baseline Antiretroviral Resistance and Clinical Outcomes in an Urban HIV Clinic

AIDS Patient Care and STDsVol. 27, No. 4 Letters to the EditorBaseline Antiretroviral Resistance and Clinical Outcomes in an Urban HIV ClinicOlga M. Klibanov, Christian R. Dolder, Ferealem Assefa, and Tagbo J. EkwonuOlga M. KlibanovSchool of Pharmacy, Wingate University, Wingate, North Carolina.Search for more papers by this author, Christian R. DolderSchool of Pharmacy, Wingate University, Wingate, North Carolina.Search for more papers by this author, Ferealem AssefaSchool of Pharmacy, Wingate University, Wingate, North Carolina.Search for more papers by this author, and Tagbo J. EkwonuEastowne Family Physicians, Charlotte, North Carolina.Search for more papers by this authorPublished Online:8 Apr 2013https://doi.org/10.1089/apc.2013.0023AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited ByTransmitted Antiretroviral Drug Resistance Over a Period of 11 Years, at a Single Center in Southeast United States28 December 2021 | Infectious Diseases in Clinical Practice, Vol. 30, No. 1Sex Differences in HIV Outcomes in the Highly Active Antiretroviral Therapy Era: A Systematic Review Jessica L. Castilho, Vlada V. Melekhin, and Timothy R. Sterling2 May 2014 | AIDS Research and Human Retroviruses, Vol. 30, No. 5 Volume 27Issue 4Apr 2013 InformationCopyright 2013, Mary Ann Liebert, Inc.To cite this article:Olga M. Klibanov, Christian R. Dolder, Ferealem Assefa, and Tagbo J. Ekwonu.Baseline Antiretroviral Resistance and Clinical Outcomes in an Urban HIV Clinic.AIDS Patient Care and STDs.Apr 2013.205-207.http://doi.org/10.1089/apc.2013.0023Published in Volume: 27 Issue 4: April 8, 2013Online Ahead of Print:March 20, 2013PDF download

Decreasing Incidence of Herpes Zoster in the Highly Active Antiretroviral Therapy Era

We evaluated the effect of highly active antiretroviral therapy (HAART) on the incidence of herpes zoster (HZ) in human immunodeficiency virus (HIV)-infected subjects. The annual incidence of HZ per 100 person-years decreased significantly from 6.3 episodes in 1987 to 1.0 episode in 2011, probably reflecting improved immune function.

Non-AIDS–Defining Cancers in New Orleans

Non-AIDS-defining cancers in HIV-infected patients in the highly active antiretroviral therapy era have increased. To our knowledge a comprehensive review of non-AIDS-related malignancies in New Orleans has not yet been conducted. Databases from main institutions in New Orleans were queried retrospectively for the years 2001 to 2011. The International Classification of Diseases, Ninth Revision codes were used to search for HIV infection and cancer comorbidity. A total of 16 patients were diagnosed with lung cancer (mean age 50 years) with 81% of the patients presenting with advanced stages. In all, 20 (mean age 47 years) were diagnosed with anal cancer, and 35% presented in late stages. In all, 14 patients (mean age 42 years) were diagnosed with Hodgkin Lymphoma, and 64% were diagnosed at late stage. A total of 5 women (mean age 44 years) were diagnosed with breast cancer with 40% of them presenting at late stage. Malignancies were diagnosed at late stages in the majority of the cases, presented with worse outcomes, and had higher recurrence rates. The role of HIV and other viruses (Epstein Barr virus, human papillomavirus) and the potential mechanisms or pathways of oncogene activation also need to be clarified.

Epidemic of Lung Cancer in Patients With HIV Infection

The survival of patients with HIV infection has improved dramatically over the past 20 years, largely owing to a significant reduction in opportunistic infections and AIDs-defining malignancies, such as lymphoma and Kaposi sarcoma. However, with improved survival, patients with HIV are experiencing morbidity and mortality from other (non-AIDs-defining) complications, such as solid organ malignancies. Of these, the leading cause of mortality in the HIV-infected population is lung cancer, accounting for nearly 30% of all cancer deaths and 10% of all non-HIV-related deaths. Importantly, the average age of onset of lung cancer in the HIV-infected population is 25 to 30 years earlier than that in the general population and at lower exposure to cigarette smoke. This article provides an overview of the epidemiology of lung cancer in the HIV-infected population and discusses some of the important risk factors and pathways that may enhance the risk of lung cancer in this population.

Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era

Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients. Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33% (95% CI: 2.20-14.25) and 43.38% (95% CI: 31.73-55.03), respectively. Diastolic dysfunction was graded as first [31.85% (95% CI: 24.85-43.73)], second [8.53% (95% CI: 2.12-14.93)], and third degree [3.02% (95% CI: 1.78-4.27)]. At multivariate analysis, a high sensitivity C-reactive protein level >5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95% CI: 1.03-2.77); 1.57 (95% CI: 1.03-2.34); and 15.90 (95% CI: 1.94-329.00), respectively]. Hypertension (OR = 2.30; 95% CI: 1.20-4.50) and older age (OR = 2.50 per 10 years increase; 95% CI: 1.70-3.60) were predictors of left ventricular diastolic dysfunction (Figure 3). Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART.