Administration Of Antiretroviral Therapy Research Articles

Maternal Antiretroviral Therapy for the Prevention of Mother-To-Child Transmission of HIV in Malawi: Maternal and Infant Outcomes Two Years after Delivery

BackgroundOptimized preventive strategies are needed to reach the objective of eliminating pediatric AIDS. This study aimed to define the determinants of residual HIV transmission in the context of maternal antiretroviral therapy (ART) administration to pregnant women, to assess infant safety of this strategy, and to evaluate its impact on maternal disease.Methodology/Principal FindingsA total of 311 HIV-infected pregnant women were enrolled in Malawi in an observational study and received a nevirapine-based regimen from week 25 of gestation until 6 months after delivery (end of breastfeeding period) if their CD4+ count was > 350/mm3 at baseline (n = 147), or indefinitely if they met the criteria for treatment (n. 164). Mother/child pairs were followed until 2 years after delivery. The Kaplan-Meier method was used to estimate HIV transmission, maternal disease progression, and survival at 24 months. The rate of HIV infant infection was 3.2% [95% confidence intervals (CI) 1.0-5.4]. Six of the 8 transmissions occurred among mothers with baseline CD4+ count > 350/mm3. HIV-free survival of children was 85.8% (95% CI 81.4-90.1). Children born to mothers with baseline CD4+ count < 350/mm3 were at increased risk of death (hazard ratio 2.6, 95% CI 1.1-6.1). Among women who had stopped treatment the risk of progression to CD4+ count < 350/mm3 was 20.6% (95% CI 9.2-31.9) by 18 months of drug discontinuation.ConclusionsHIV transmission in this cohort was rare however, it occurred in a significative proportion among women with high CD4+ counts. Strategies to improve treatment adherence should be implemented to further reduce HIV transmission. Mortality in the uninfected exposed children was the major determinant of HIV-free survival and was associated to maternal disease stage. Given the considerable proportion of women reaching the criteria for treatment within 18 months of drug discontinuation, life-long ART administration to HIV-infected women should be considered.

The challenges experienced by nongovernmental organisations with regard to the roll-out of antiretroviral therapy in KwaZulu-Natal

AbstractBackground: Successful administration of antiretroviral therapy (ART) requires full adherence to the regimen by the patient. The introduction of ART needs a well-functioning health system with adequately trained health professionals, laboratory support, a constant supply of drugs and social systems to assist with patients' adherence and to prevent future treatment failure.Objectives: The objective of this study was to explore and describe the challenges experienced by nongovernmental organisations with regard to the roll-out of antiretroviral therapy.Design:A qualitative, exploratory and descriptive study was conducted to determine the challenges experienced by nongovernmental organisations (NGOs) with regard to the roll-out of ART in KwaZulu-Natal. Nine participants were included purposefully from the NGOs that participated in this study. Data were collected through semi-structured individual interviews. Open coding for analysis was used.Results: The findings revealed four themes: challenges rela...

Personal Factors Influencing Patients' Adherence to ART in Addis Ababa, Ethiopia

Our study attempted to identify personal (patient-related) factors influencing antiretroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive design was used. Structured interviews were conducted with 355 HIV-infected patients on ART. The findings revealed that stigma, discrimination, depression, and alcohol use negatively affected patients' ART adherence levels. However, patients' knowledge levels had no influence on their ART adherence levels, contrary to other researchers' reports. Addressing stigma and discrimination at community levels might enhance patients' abilities to take their medications in the presence of others. Health care professionals should be educated to diagnose and treat depression in patients during the early stages of ART administration. Patients who are nonadherent to ART should be counseled about potential alcohol abuse. Stigma-related challenges also need to be addressed.

Can we prevent pediatric HIV? An experience at a tertiary care hospital

BackgroundParent-to-child transmission (PTCT) is the commonest mode of acquiring HIV in more than 90% children. The risk during pregnancy varies from 20 to 45% and with specific interventions in mother and baby; it can be reduced to less than 2%. This study was conducted to assess the efficacy of comprehensive PPTCT programme. MethodThis descriptive study was conducted at a tertiary care hospital, from Jan 2008 till Jul 2010. 32 HIV-positive pregnant mothers were enrolled in the study. They were evaluated, given triple drug antiretroviral therapy and followed up. Babies were given single dose nevirapine and zidovudine till 6 weeks of age. DNA-PCR was done for confirming the HIV status of baby. ResultsThe yearly period prevalence of pregnant mothers found HIV positive at antenatal clinic showed a downward trend, from 0.39% in 2008 to 0.18% in 2010. Mean CD4 count of mothers at diagnosis was 459.41 [SD – 238.37]. Twenty eight mothers (93.3%) received antiretroviral therapy. 15 (50%) babies were delivered by cesarean section and 26 infants were given replacement feeding. All the babies were singletons, 29 (96.7%) born at term with an average birth weight of 2.60 kg (SD = 0.5) and male to female ratio of 0.87:1. Twenty nine (96.7%) infants were declared HIV-negative and parent-to-child transmission rate at our center was 3.3%. ConclusionA comprehensive PPTCT programme with administration of antiretroviral therapy to the mother and infant, safe delivery practices, avoidance of breastfeeding, and close follow up, the incidence of PTCT can be reduced to negligible rates as seen in our study.

ART and tuberculosis: the final nail in nevirapine's coffin?

Tuberculosis is the most common indication for initiation of antiretroviral therapy (ART) in low-resource settings. Incidence of tuberculosis in patients with HIV/AIDS receiving ART is much higher than in the general population, even for patients who respond to treatment and whose CD4 cell counts increase to the normal range.1 Therefore treatment of both diseases is frequently necessary. However, concomitant administration of antituberculosis treatment and ART is associated with drug interactions, mediated largely by the inducing effect of rifampicin, and shared drug toxicity.

Tackling HIV/AIDS - Are we there yet?

Copyright: © 2013 Alla NR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. It has been three decades since HIV has been discovered [1] and over seventeen years Antiretroviral Therapy (ART) has emerged as the first line of therapy to cure the disease that has affected millions of lives. Currently close to 34 million people around the globe are suffering with HIV/AIDS and over 8 million people are receiving ART in low and middle income countries [2]. ART has dramatically improved the expectancy and quality of life of HIV/AIDS victims. Nevertheless, current ART cannot get rid of HIV infection totally and requires lifelong adherence. ART administration is burdensome to the public health systems because of the cost associated with it. Hence there is a need for other possible treatment strategies for lifetime treatment to patients with affordable costs to health systems. Failure to eradicate HIV during ART indicates the inherent stability of the viral genome. Persistence of HIV in small pool of CD4+ T cells even under the viral suppression with ART establishes latency. The CD4+ T cells with stable and longlived latent virus serve as a HIV reservoir. The permanence of the HIV reservoirs might be responsible for prolonged immune activation and inflammation observed in people with suppressed viremia, which, in line, may be associated with co-morbidities like cardiovascular events, renal insufficiency and hepatic failure [3]. A study by Ho et al. published in the journal Cell has shown that the latent viral reservoir is 60 times larger than previously believed [4]. Hence this reservoir poses threat for the complete eradication of HIV/AIDS.

Effect of early anti-retroviral therapy on the pathogenic changes in mucosal tissues of SIV infected rhesus macaques

BackgroundThe gastrointestinal tissue plays an important role in the pathogenesis of HIV/SIV infection and serves as a viral reservoir in infected individuals under antiretroviral therapy (ART). However, the effect of ART administration in the very early stage of infection on HIV/SIV replication and pathogenesis in gastrointestinal tissue has not been fully studied. In this current study, rhesus monkeys infected with SIV were treated with ART starting at day 7 post-infection. The effect of early ART on SIV replication and infection-related pathogenic changes in mucosal tissues of the infected monkeys was examined.MethodsNuclear acids were extracted from snap frozen ileum and colon tissues and mesentery lymph nodes from SIV infected monkeys with or without ART. SIV RNA and DNA loads as well as levels of CD3, CD4 and cytokine mRNA were measured by PCR and RT PCR from the isolated nuclear acids. Tissue sections were stained by immuno-fluorescence labeled antibodies for CD3 and CD4.ResultsWithout ART treatment, these monkeys underwent a mild SIV infection with low viral loads and slightly decreased CD4+ T cell counts in peripheral blood. In ART treated monkeys, SIV RNA loads were undetectable in blood with normal CD4+ T cell counts, however, SIV RNA and DNA were detected in the intestinal tissues and mesentery lymph nodes although the levels were lower than those in untreated monkeys. The levels of CD3 and CD4 positive cells in the tissues were similar between the infected untreated monkeys and infected ART treated monkeys based on RT-PCR and immune-fluorescence staining of the tissue sections. Furthermore, compatible levels of IL-6, TNF-a, IL-1b and MyD88 mRNAs were detected in most of intestinal tissues and mesentery lymph nodes of infected ART treated and infected untreated monkeys.ConclusionsThese results suggest that early ART administration could not effectively inhibit SIV replication in intestinal tissues and mesentery lymph nodes and could not reduce the immune activation induced by SIV infection in the intestinal tissues.

HPV Genotyping in North Indian Women Infected With HIV

Investigating the prevalence of high-risk human papilloma virus (HPV) genotypes in human immunodeficiency virus (HIV)-infected women is vital to generate data for formulating guidelines for prevention/screening of cervical cancer in this vulnerable group. The study was aimed to analyze the HPV genotypes in HIV-infected women. It was a prospective, hospital-based, and cross-sectional study. HIV-infected women were enrolled from the antiretroviral clinic and controls from the gynecology outpatient. The HPV genotyping array kit was used for identifying 21 HPV genotypes. Detection of HPV was confirmed by performing an HPV type-specific polymerase chain reaction. A Pap smear was collected in all women. One hundred thirty HIV-infected women and 64 controls were enrolled. All women with low CD4 counts (n=97) were receiving antiretroviral therapy. Twenty-six (20%) HIV-infected women and 12 (18.7%) women in the control group tested positive for high-risk HPV (P=1.0). HPV 16 was the most common type, detected in 42% of HPV-positive women in the HIV-infected cohort, followed by HPV 45 (15%), HPV 18/52/31/58 (11.5% each), and HPV 33 (7.6%). The corresponding figures in the control group were as follows: HPV 16 (66.6%), HPV 45/18/31 (16.6% each), and HPV 33/58/68 (8.3% each). Cervical intraepithelial neoplasia was detected in 2.3% of HIV-infected women. The prevalence of high-risk HPV in HIV-infected women (20%) was similar to the prevalence in controls (18.7%). This and the incidence of cervical intraepithelial neoplasia are lower than those in previous reports. It is plausible that administration of antiretroviral therapy contributed to the reduced prevalence. The currently available vaccine would likely be beneficial to the local HIV-infected population, as nearly half the HPV-infected women harbored genotypes 16 or 18.

Quality of life of people living with HIV and AIDS and antiretroviral therapy.

The development of antiretroviral drugs has significantly changed the perception of HIV/AIDS from a very fatal to a chronic and potentially manageable disease, and the availability and administration of antiretroviral therapy (ART) has significantly reduced mortality and morbidity associated with HIV and AIDS. There is a relationship between ART and quality of life of people living with HIV and AIDS, and several studies have reported a strong positive association between ART and improved quality of life in different domains among people living with HIV and AIDS in both developed and developing countries. However, a few studies have reported on the negative effects of ART, which directly or indirectly relate to the quality of life and longevity of HIV-infected persons. In this review, the effects and benefits of ART on people living with HIV and AIDS based on studies done in developed and developing countries is examined.

Untreated HIV Infection Is Associated With Higher Blood Alcohol Levels

Alcohol abuse has been associated with HIV/AIDS progression, but the effects of HIV infection and treatment on alcohol exposure have not been explored to date. This pilot study examines the relationship of untreated HIV infection to blood alcohol concentrations (BAC) relative to BAC after initiation of antiretroviral therapy (ART). Fifteen volunteers with untreated HIV/AIDS participated in 2 sets of alcohol or alcohol placebo administration studies before and after initiation of ART. Oral alcohol (1 g/kg) or alcohol placebo was administered, participants were followed for pharmacokinetics, subjective responses, and cognitive effects over 8 hours. After initial alcohol studies, the ART regimen selected by participant clinicians was instituted. Observed ART dosing took place for at least 2 weeks. Participants then returned for a second set of alcohol/placebo administration studies while on ART. Participants had significantly higher BAC (P < 0.001) before ART than after ART administration. Alcohol area under the curve was significantly higher in untreated HIV disease (P = 0.011) with significantly higher C(max) (P = 0.015) and C(min) (P = 0.05). The elimination rate was not different between pre-ART and post-ART conditions. Despite declines in BAC after ART initiation, no differences in subjective responses were observed with alcohol administration. Untreated HIV infection is associated with risk for higher BAC than that observed after ART. These findings indicate that patients with untreated HIV disease who ingest alcohol are at greater risk for alcohol associated adverse events and toxicities and underscores the need for simultaneous treatment of alcohol use disorders and HIV in patients with co-occurring conditions.

Measles Vaccine, HIV Infection, and Antiretroviral Therapy--A Window of Opportunity

Measles virus infection, a systemic rash illness commonly acquired in infancy and early childhood, is one of the most contagious infectious diseases in humans [1]. Measles is also an important cause of global morbidity and mortality, primarily among infants and children living in resource-limited settings [2]. Since the development of measles vaccines in the 1960s, intensive vaccination efforts, especially in the 21st century, have led to substantial reductions in measles-related deaths on a global scale, resulting in a reduction in mortality from almost 750 000 childhood deaths worldwide in 2000 to 164 000 in 2008 [3]. Eradication of measles infection on a global scale can, in theory, be accomplished because measles virus has no nonhuman reservoirs, and vaccination strategies to prevent transmission are available and feasible [4]. However, because of the highly contagious nature of measles virus, at least 95% vaccination coverage with at least 1 dose (and preferably 2 doses) of measles vaccine must be achieved to suppress and eventually eradicate continued global measles transmission [5]. One important characteristic of measles infection is that it produces more serious illness and increased mortality among immunocompromised individuals, primarily those with defects in T-cell immunity [6]. Because >90% of human immunodeficiency virus (HIV)–infected children live in regions where measles is still endemic [7, 8], achieving high rates of measles vaccine coverage is especially important among these populations to suppress excess measles-associated morbidity and mortality. However, live virus vaccines may also result in disease and, in general, are not recommended for administration to severely immunocompromised individuals. Measles vaccines are also known to induce short-term immunosuppressive effects and, therefore, the risk of further adverse events among HIV-infected infants and children is of concern. Moreover, it is well known that the immunogenicity of live virus vaccines, including measles vaccines, among HIV-infected children is limited and primarily related to degree of immunocompromise [9]. Knowledge gaps in understanding measles immunogenicity among HIV-infected children arise because the preponderance of studies regarding measles vaccine immunogenicity are derived from domestic settings, and generally from healthy infants and children. In contrast, data from resourcelimited settings rarely include populations of HIV-infected children, and may also be confounded by other factors, such as malnutrition and other environmental factors that may affect information about safety and immunogenicity of measles vaccines. In addition, the impact of HIV-related immunocompromise and subsequent effects of antiretroviral therapy (ART) on immune reconstitution and, ultimately, on vaccine immunogenicity are unclear. In this issue of the Journal, Abzug and colleagues describe the safety and immunogenicity of 1 or 2 measles vaccine booster doses administered to HIV-infected children, living in the United States, who had received at least 1 prior measles-mumps-rubella (MMR) vaccine, and after stable administration of ART [10]. They investigated the baseline and long-term humoral immunity to measles, as measured by measles plaque reduction neutralizing antibodies, among 193 HIV-infected children aged 2–18 years before and after 1 booster dose of measles vaccine administered at least 6 months after initiation of ART for HIV infection. Not surprisingly, the investigators found that baseline measles seroprotection was only 52%, as defined by measles neutralizing antibody levels ≥120 mIU/mL. However, after 1 booster dose of measles vaccine, seroprotective measles antibody titers increased to 89% eight weeks later, and were sustained in 80% of children 80 weeks after the booster. Among a subset of 65 children Received and accepted 9 April 2012; electronically published 12 June 2012. Correspondence: Yvonne Maldonado, MD, Department of Pediatrics, Stanford University School of Medicine, Rm G312, MC 5208, Stanford, CA 94305 (bonniem@stanford.edu). The Journal of Infectious Diseases 2012;206:466–8 © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/infdis/jis392

Depression of Local Cell-mediated Immunity and Histological Characteristics of Disseminated AIDS-related &lt;i&gt;Mycobacterium avium&lt;/i&gt; Infection after the Initiation of Antiretroviral Therapy

The aim of the present study was to examine the immunohistological characteristics of disseminated Mycobacterium avium infection after the initiation of antiretroviral therapy (ART) for acquired immunodeficiency syndrome (AIDS). We histologically investigated five autopsied AIDS patients with systemic M. avium infection. The inflammatory cell composition in the affected tissues was assessed using immunohistochemistry. The celiac lymph nodes and intestinal canal were the most commonly involved organs in the AIDS cases. The most common histological feature was unstructured aggregation of histiocytes. Immunohistochemistry revealed depression of CD4(+), CD8(+) and CD57(+) cells in the gut lamina propria and mesenteric lymph nodes. These findings suggest that local cell-mediated immunity is depressed in affected tissues and that the primary histological feature is poor organization of granulomas in mycobacterial lesions, despite the administration of adequate ART.

Implementation of HIV Early Infant Diagnosis and HIV Type 1 RNA Viral Load Determination on Dried Blood Spots in Cameroon: Challenges and Propositions

The testing of dried blood spots (DBSs) for human immunodeficiency type 1 (HIV-1) proviral DNA by PCR is a technology that has proven to be particularly valuable in diagnosing exposed infants. We implemented this technology for HIV-1 early infant diagnosis (EID) and HIV-1 RNA viral load determination in infants born of HIV-1-seropositive mothers from remote areas in Cameroon. The samples were collected between December 2007 and September 2010. Fourteen thousand seven hundred and sixty-three (14,763) DBS samples from infants born of HIV-positive mothers in 108 sites nationwide were tested for HIV. Of these, 1452 were positive on first PCR analyses (PCR1), giving an overall infection rate of 12.30%. We received only 475 DBS specimen for a second PCR testing (PCR2); out of these, 145 were positive. The median HIV-1 RNA viral load for 169 infant DBS samples tested was 6.85 log copies/ml, with values ranging from 3.37 to 8 log copies/ml. The determination of the viral load on the same DBS as that used for PCR1 allowed us to bypass the PCR2. The viral load values were high and tend to decrease with age but with a weak slope. The high values of viral load among these infants call for early and effective administration of antiretroviral therapy (ART). The findings from this study indicate that the use of DBS provides a powerful tool for perinatal screening programs, improvement on the testing algorithm, and follow-up during treatment, and thus should be scaled up to the entire nation.

Critical Illness in HIV-Infected Patients in the Era of Combination Antiretroviral Therapy

As HIV-infected persons on combination antiretroviral therapy (ART) are living longer and rates of opportunistic infections have declined, serious non-AIDS-related diseases account for an increasing proportion of deaths. Consistent with these changes, non-AIDS-related illnesses account for the majority of ICU admissions in more recent studies, in contrast to earlier eras of the AIDS epidemic. Although mortality after ICU admission has improved significantly since the earliest HIV era, it remains substantial. In this article, we discuss the current state of knowledge regarding the impact of ART on incidence, etiology, and outcomes of critical illness among HIV-infected patients. In addition, we consider issues related to administration of ART in the ICU and identify important areas of future research.

Knowledge and attitudes of caregivers of HIV-infected children toward antiretroviral treatment in Ethiopia

ObjectiveTo determine the knowledge and attitude of caregivers of HIV-infected children taking antiretroviral therapy (ART) in Ethiopia. MethodsA total of 390 caregivers of HIV infected children were surveyed in selected ART units in Addis Ababa. Data was collected using a pretested and structured questionnaire. ResultsSeventy two (18.5%) of the caregivers believed that HIV can be cured by taking antiretroviral (ARV) medications. Three hundred and nineteen (81.8%) participants reported that taking ARVs incorrectly would bring about resistance to the drug. Three hundred and eighty (97.4%) caregivers had favorable attitude toward administration of ARV medication to children. Almost all of the caregivers (379, 97.2%) reported to have had enough privacy in their consultation with the doctor or nurse. Having enough privacy during consultation (OR 7.18; 95% CI 1.24–41.6) and knowledge that HIV cannot be cured by ART (OR 3.89; 95% CI 1.05–14.4) were associated with favorable attitude toward ART administration. ConclusionThe majority of the caregivers had good knowledge and favorable attitude toward administration of ARV medication to children. However some misconceptions such as beliefs that ART cures HIV/AIDS exist. Practical implicationsHealth education efforts should continue focusing on the objective of ART treatment and toward dispelling the prevailing misconceptions.

AIDS in Brazilian Children: History, Surveillance, Antiretroviral Therapy, and Epidemiologic Transition, 1984–2008

We present a systematic review of historical, political, and epidemiologic aspects of AIDS in Brazilian children. Over 25 years, Brazil has developed different strategies to control AIDS in children. Three revisions of criteria for defining AIDS cases in children and nine national guidelines on antiretroviral therapy administration for management of HIV infection were published. These guidelines represent important progress, including aspects of HIV/AIDS surveillance, antiretroviral treatment, opportunistic conditions, prophylaxis, and laboratory testing. Brazil has significantly expanded access to free therapy with different classes of antiretroviral drugs. Initially focusing on treatment for HIV and opportunistic conditions, the scope of treatment guidelines gradually expanded to comprehensive health care for children and adolescents. From 1996 to 2008, the number of AIDS cases and deaths in children has been reduced by 67% and 65%, respectively, as a result of different strategies to prevent mother-to-child transmission of HIV and highly active antiretroviral therapy administration to infected children. Improved morbidity, mortality, and survival of Brazilian children with AIDS demonstrate clear benefits of adopting a policy of free and universal access to antiretroviral drugs associated with comprehensive care. However, important issues remain to be resolved, mainly concerning social, operational, and regional inequalities in coverage and quality of care, and epidemiological surveillance in different regions of the country. This broad review shows that the overall situation of pediatric AIDS in Brazil represents an incomplete process of epidemiologic and demographic transition, with the coexistence of old and new clinical and epidemiologic challenges.

Knowledge, attitudes and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: a multicentre study

Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers' knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.

Nutrition outcomes of HIV‐infected malnourished adults treated with ready‐to‐use therapeutic food in sub‐Saharan Africa: a longitudinal study

BackgroundAmong people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure.MethodsWe present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m2 enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.ResultsOverall, 1340 of 8685 (15.4%) HIV-positive adults were enrolled in the nutrition programme. At admission, median body mass index was 15.8 kg/m2 (IQR 14.9-16.4) and 12% received combination antiretroviral therapy (ART). After a median of four months of follow up (IQR 2.2-6.1), 524 of 1106 (47.4%) patients were considered cured. An overall total of 531 of 1106 (48.0%) patients failed nutrition therapy, 132 (11.9%) of whom died and 250 (22.6%) defaulted from care. Men (OR = 1.5, 95% CI 1.2-2.0), patients with severe malnutrition at nutrition programme enrolment (OR = 2.2, 95% CI 1.7-2.8), and those never started on ART (OR = 4.5, 95% CI 2.7-7.7 for those eligible; OR = 1.6, 95% CI 1.0-2.5 for those ineligible for ART at enrolment) were at increased risk of nutrition programme failure. Diagnosed tuberculosis at nutrition programme admission or during follow up, and presence of diarrhoeal disease or extensive candidiasis at admission, were unrelated to nutrition programme failure.ConclusionsConcomitant administration of ART and ready-to-use therapeutic food increases the chances of nutritional recovery in these high-risk patients. While adequate nutrition is necessary to treat malnourished HIV patients, development of improved strategies for the management of severely malnourished patients with HIV/AIDS are urgently needed.

Protocol of Determining the Effect of Selenium Supplementation on CD4 + T Lymphocyte Count in HIV/AIDS Patients: A Randomized Double Blind Placebo Controlled Trial

Background: Acquired immune deficiency syndrome (AIDS) is believed to be both among major epidemics and a critical global health issue. The administration of antiretroviral therapy is recently proposed for all patients with CD4 + T cell count of ≤ 350/μlit in different studies The accessibility of combination therapy has been restricted due to high costs of drugs, particularly in low and middle income countries. In Iran, according to WHO, drugs were distributed among only 6% of adults and 4% - 14% of children in 2009. Moreover, new strains are created and therefore, resistance to the current medication along with a considerable risk of ART-related toxic adverse effects points out the need for more affordable, effective and safer treatments. The use of antioxidants such as Selenium (Se) has been indicated to be beneficial in these patients. Method: In a double-blind randomized placebo control trial, 100 HIV positive, HAART-receiving patients will be selected from more than 2000 individuals covered under IRCHA (Iranian Referral HIV/AIDS Research Centre). They are then randomized to receive daily Se supplement of 200 μgr elemental Se and placebo for 6 months. The baseline assessment of the patients who meet the inclusion and exclusion criteria includes doing some lab tests to determine the absolute count of CD4 + T lymphocyte and the plasma levels of Se. The incidence of opportunistic infection will be assessed during the monthly visits in the first six months of the follow-up and the one performed at the end of the 9th month. For evaluating the trend of CD4 + T cells changes, the absolute count of CD4 + T lymphocyte will be measured every 3 months in the 5th, 8th, and 9th, visits. The plasma levels of Se will be measured in the final follow-up session and compared with the baseline value.

Clinical monitoring and correlates of nephropathy in SIV-infected macaques during high-dose antiretroviral therapy

BackgroundIn many preclinical AIDS research studies, antiretroviral therapy (ART) is administered to experimentally simian immunodeficiency (SIV)-infected rhesus macaques for reduction of viral load to undetectable levels. Prolonged treatment of macaques with a high dose of PMPA (9-[2-(r)-(phosphonomethoxy) propyl] adenine or tenofovir; 30 mg/kg of body weight subcutaneously once daily) can result in proximal renal tubular dysfunction, a Fanconi-like syndrome characterized by glucosuria, aminoaciduria, hypophosphatemia, and bone pathology. In contrast, chronic administration of a low dose of PMPA (10 mg/kg subcutaneously once daily) starting at birth does not seem to be associated with any adverse health effects within 3 years of treatment. In contrast to PMPA, limited information on systemic toxicity in rhesus monkeys is available for FTC (5-fluoro-1-(2R,5S)-[2-(hydroxymethyl)-1,3-oxathiolan-5-yl]cytosine; emtricitabine) and stavudine (d4T).ResultsIn this study, the clinical and biochemical correlates of tubular nephrosis in SIV-infected rhesus macaques associated with systemic administration of high-dose ART consisting of the three nucleoside analog inhibitors PMPA, FTC, and d4T were investigated. It was found that acute renal failure was uncommon (7.1% of treated animals) and that morphologic evidence of nephropathy, which persisted for more than 300 days following discontinuation of the drug cocktail, was more frequent (52.4% of treated animals). While parameters from single time points lacked predictive value, biochemical alterations in Blood Urea Nitrogen (BUN) and phosphorus were frequently identified longitudinally in the blood of ART-treated animals that developed evidence of nephropathy, and these longitudinal changes correlated with disease severity.ConclusionsRecommendations are proposed to limit the impact of drug-induced renal disease in future SIV macaque studies.