Adverse Effects Of Antiretroviral Therapy Research Articles

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners.

People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.

The Evaluation of Lipid Profile in HIV/AIDS Patients on Antiretroviral Therapy in University of Abuja Teaching Hospital, Nigeria

Background: Abnormal lipids have being associated with the adverse effect of antiretroviral therapy (ART). Information in these areas is needed, to enhance the proper and adequate management of patients on antiretroviral therapies. This study was carried out to determine the levels of lipid profile in HIV/AIDS patients on antiretroviral therapy (ART), and as well ascertain the degree of metabolic and cardiovascular complications. Method: A hospital base case-control study was carried out in October, 2020 to October, 2021, and a total of 153 subjects were involved in the study, and they were divided into three groups: the control group (which consist of apparently healthy subjects), the study group 1 (consist HIV positive subject not on ART) and study group 2 (consist of HIV/Aids patients on ART). The lipid profile was analyzed using enzyme linked spectrophotometric methods. Result: In the study, increase in Triglyceride (TG) and very low density Lipoprotein (VLDL-C) were observed with P<0.001in the study group 2 compared with the control group (apparently healthy subject); there was no significant difference observed in the study group 1 when compared with the control group P>0.05, for HDL-C, TC and LDC-C; The mean values of the control group for Total Cholesterol (TC), Triglyceride (TG), HDL-C and VLDL-C are: 3.97± 0.69, 1.02± 0.31, 2.88± 0.29, 0.75± 0.51 and 0.26mmol/L respectively. The mean values of the study group 1 for Total Cholesterol, Triglyceride, HDL-C, LDL-C and VLDL-C are 3.02± 0.79, 2.67± 0.93, 1.98± 0.26, 0.85± 0.72 and 0.58± 0.07mmol/L respectively. The values for study group 2 are Total Cholesterol 2.54± 1.30mmol/L. Triglyceride is 3.86± 0.74mmol, HDL-C is 1.24± 0.34mmol/L, and LDL-C is 1.10±1.08mmol/L and 0.17± 0.12mmol/L for VLDL-C. Conclusion: The findings in this study shows elevation of some lipids in HIV/AIDS Patients on Antiretroviral Therapy, which suggests that it could be due to the adverse effects of Anti-Retroviral Therapy (ART).

Nutritional assessment in the HIV-infected older population receiving antiretroviral therapy.

Malnutrition is a pronounced public health issue which often seems underestimated in the older people living with HIV (PLWH) virus infection. PLWH are highly vulnerable to nutritional problems resulting from agingrelated deterioration, disease itself, and adverse effects of antiretroviral therapy (ART). The comprehensive nutritional assessments are necessary to perform routinely in this population to monitor and provide appropriate interventions to reduce comorbid conditions. In this review, we focus on the untoward impacts of malnutrition and nutritional assessments on the morbidity and mortality in the older PLWH. Some predictive factors of nutritional status in this group of patients are discussed. We propose the important components for nutrition assessment tool for older PLWH on ART. Highlighted issue is the need for developing uniform standardized tools for the early diagnosis of malnutrition in this population. Applications of the nutritional assessments, proper nutritional interventions, and regular monitoring of nutritional status in older PLWH liv-ing in every clinical setting may help the patients get better well-being.

Enrollment and retention of female sex workers in HIV care in health facilities in Mbarara city.

Sex work is a global driver of the HIV epidemic, and the risk of acquiring HIV is 13 times higher for female sex workers (FSWs) compared to the general population. The enrollment and retention of FSWs in HIV care is a challenge and has been a major contributing factor to increased new HIV infections. We conducted a qualitative study among 30 FSWs and 21 healthcare workers (HCWs) working in antiretroviral therapy (ART) clinics at the selected three primary health facilities in Mbarara City, Southwestern Uganda. The study participants were enrolled by both purposive and snowball sampling techniques. We obtained informed consent from all the participants, and data were collected using in-depth interviews and thematically analyzed. Three themes emerged as facilitators toward enrollment and retention of FSWs into HIV care, namely, (1) good health living, (2) receptive HCWs and availability of health services, and (3) community outreach services and peer support. The barriers are summarized into four major themes: (1) stigma, community discrimination, and beliefs; (2) social obstacles; (3) adverse effects of ART; and (4) inadequate services at the health facilities. FSWs are challenged by unsupportive environments and communities where they live and work, which hinders their enrollment and retention in HIV care. Creating awareness of the utilization of HIV care services and extending such services to hotspot communities could enhance the response of HIV-positive FSWs to ART.

Altered adipose tissue macrophage populations in people with HIV on integrase inhibitor-containing antiretroviral therapy.

Objective:Antiretroviral therapy (ART) extends the life of people with HIV (PWH), but these individuals are at increased risk for obesity, dyslipidemia, diabetes, and cardiovascular disease. These comorbidities may be a consequence of HIV-related chronic inflammation and/or adverse effects of ART on tissue regulatory adipose tissue macrophages (ATMs). We sought to determine the effects of HIV/ART on metabolically beneficial ATM populations and functions.Design:We examined subcutaneous ATMs from PWH on integrase inhibitor-containing ART (n = 5) and uninfected persons (n = 9). We complemented these studies with ex vivo and in vitro analyses of peripheral blood mononuclear cell (PBMC) and murine macrophage lipid metabolism and fatty acid oxidation gene expression.Methods:ATM populations were examined by flow cytometry. Macrophage lipid metabolism and fatty acid oxidation gene expression were examined by Seahorse assay and quantitative PCR.Results:Adipose tissue from PWH had reduced populations of metabolically activated CD9+ ATMs compared to that of uninfected controls (P < 0.001). PBMCs of PWH had lower fatty acid metabolism compared to those of uninfected controls (P < 0.01). Analysis of murine macrophages revealed that dolutegravir reduced lipid metabolism (P < 0.001) and increased expression of the fatty acid beta-oxidation enzyme enoyl-CoA hydratase, short chain 1 (P < 0.05).Conclusions:We report the loss of metabolically beneficial ATM populations in PWH on ART, altered fatty acid metabolism of blood immune cells, and evidence that dolutegravir alters macrophage fatty acid metabolism. Future studies should examine direct or indirect effects and mechanisms of dolutegravir, and other integrase inhibitors and ART classes, on fatty acid beta-oxidation.

Comparison of Muscle Strength, Aerobic Capacity and Body Composition between Healthy Adolescents and Those Living with HIV: A Systematic Review and Meta-Analysis.

Background: The adverse effects of antiretroviral therapy associated with complications generated by human immunodeficiency virus (HIV) promote impairments in physical fitness in adolescents. Objective: To analyze the aerobic capacity, muscle strength, and body composition of adolescents living with HIV compared with a healthy population of the same age. Methods: Searches were performed in the MEDLINE, Embase, Web of Science, Scopus and SportDiscus databases until September 2019 and updated in April 2020. Eligibility Criteria: adolescents of both sexes in the age group from 10 to 19 years; living with HIV; cross-sectional, case–control, cohort studies; comparing with a healthy population. Mean differences and 95% Confidence intervals (CIs) were calculated using RevMan (software for systematic reviews). Results: Five articles were included, involving 197 adolescents living with HIV (16 to 18 years) and 185 without infection (13 to 18 years), with the sample in each study ranging from 15 to 65 adolescents. Aerobic capacity and muscle strength were reduced in adolescents with HIV, and body mass index was also significantly lower in this group. Conclusion: Adolescents living with HIV have impaired cardiorespiratory fitness, muscle strength, and body composition when compared to their uninfected peers. However, this systematic review provides limited evidence on the differences between the physical fitness outcomes of adolescents living with HIV compared to healthy adolescents.

[Neuropsychiatric comorbidity in HIV infection].

The prevalence of neuropsychiatric disorders in HIV infected individuals is around 50%. Despite this, these diseases are often underdiagnosed and undertreated. Direct effects of the virus, opportunistic infections, adverse effects of antiretroviral therapy and the sociocultural context of the infected persons, contribute to the development of HIV associated neurocognitive disorder (HAND) and major depressive disorder (MDD), both of which have an impact in quality of life and disease progression. To introduce physicians in the pathophysiology, clinical features and management of psychiatric disease in seropositive patients. Early detection and treatment of neuropsychiatric comorbidity in HIV infected individuals improve clinical outcomes, quality of life and is an important milestone in the control of the pandemic.

Adverse effects of antiretroviral therapy or another disease?

Adverse effects of antiretroviral therapy or another disease?

Repeated false reactive ADVIA centaur\xae and bio-rad Geenius\u2122 HIV tests in a patient self-administering anabolic steroids

BackgroundAn individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria.Case presentationA healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient’s HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient’s proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing.Discussion and conclusionsThe erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.

Pharmacologic Management of Human Immunodeficiency Virus and Common Chronic Conditions

There has been an evolution in the care and survival of people living with human immunodeficiency virus (PLWH) and AIDS. Increased survival of PLWH is attributed to antiretroviral therapy. However, adverse effects of antiretroviral therapy increase the likelihood that PLWH may also be diagnosed with chronic conditions such as diabetes mellitus, hypertension, and dyslipidemia. Drug-drug interactions are common when coadministering human immunodeficiency virus drugs and therapies for common chronic conditions managed in primary care. To prevent adverse events, nurse practitioners should know about these interactions before prescribing new regimens or modifying a regimen.

Adverse Drug Reactions Associated with CYP 2B6 Polymorphisms in HIV/AIDS-Treated Patients in Yaoundé, Cameroon.

PurposeThe metabolism of antiretroviral drugs is subject to individual variations of the CYP 2B6 gene. The objective of this study was to evaluate the prevalence of CYP 2B6 516 G>T and 983 T>C polymorphisms and investigate their association with the development of adverse drug reactions (ADRs) in people living with HIV/AIDS in Cameroon.Patients and methodsA total number of 122 patients, attending the Yaoundé Central Hospital HIV Day Clinic, consented to take part in this study. Blood specimens were collected and DNA was extracted using the Chelex method. Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) was performed for the detection of CYP 2B6 Single-Nucleotide Polymorphisms (SNPs). Genotype frequencies were compared between groups with or without ADRs. Logistic regression analysis was performed to assess association between genotype and adverse effects of antiretroviral therapy (ART).ResultsThree types of metabolizers were identified: extensive, intermediate and slow. For the 516G>T polymorphism, prevalences of 8.2% GG, 65.6% GT and 26.2% TT were obtained. For the 983T>C polymorphism, 89.3% TT, 4.1% CT and 6.6% CC prevalences were obtained. Those homozygous for the wild-type allele (516GG) were less likely to develop ADR with a statistically significant difference (OR=0.885, P=0.029). For the CYP2B6 T983C SNP, homozygous mutants (CC) may present a higher risk (threefold) of developing adverse reactions (OR=2.677, P=0.164).ConclusionThese findings demonstrate that ADRs among HIV/AIDS patients under ART may be associated with the genetic variability of the metabolizing enzyme CYP 2B6. Genotyping for this gene may guide the better administration of Efavirenz and Nevirapine to Cameroonian patients.

P5343The presence of anti-apolipoprotein A1 autoantibodies is associated with a pro-atherogenic profile in HIV-infected patients

Abstract Background With the access to antiretroviral therapy (ART), the mortality related to the human immunodeficiency virus (HIV) has dropped, shifting the clinical challenges towards chronic disease management, including cardiovascular disease (CVD) risk assessment. Factors that potentially contribute to the physiopathology of HIV-related CVD include the HI-virus itself, adverse effects of ART, and processes such as dyslipidemia, inflammation, immune/autoimmune activation and endothelial injury. Among autoantibodies of possible cardiovascular relevance, those directed against apolipoprotein A-1 (anti-apoA-1 IgG) were shown to predict major adverse cardiovascular events and promote atherogenesis. Purpose The aim of the study was to evaluate the prevalence of anti-apoA1 IgG in HIV-free and ART experienced and naïve HIV-infected patients as well as the association between anti-apoA1 IgG levels and, indices of viral suppression, clinical parameters (10 year Framingham Risk Score (FRS)) and inflammatory biomarkers, known to underlie atherosclerosis burden in these patients. Methods Anti-apoA1 IgG serum levels were assessed by a homemade ELISA assay in 144 participants from a South African cohort divided in three groups: HIV-free (n=50), HIV-infected/ART experienced (n=50) and HIV-infected/ART naïve (n=44). Inflammatory biomarkers were measured. Results HIV-infected patients displayed an increased pro-atherogenic biomarker profile compared to HIV-free subjects, but not difference in the FRS was observed between these two groups. Regarding anti-apoA1 IgG, 24% of HIV-free patients tested positive compared to 40% and 70% in HIV-infected/ART experienced and naïve groups, respectively. HIV-infected, anti-apoA1 IgG positive patients showed a significant decrease in CD4+ counts (p=0.003) and a significant increase in viremia (p=0.0130), mean heart rate (p=0.0243), albuminuria (p=0.0155), pro-inflammatory biomarkers (IFNγ, IL-10, TNFα, MIPα; all p&lt;0.05), circulating levels of intercellular adhesion molecule (ICAM-1) (p=0.0217) and vascular cell adhesion molecule (VCAM-1) (p=0.003) compared to anti-apoA1 IgG negative ones. Of note, while this profile was maintained in HIV-infected/ART experienced, these significant differences were lost in HIV-infected/ART naïve patients. No significant difference in FRS was observed between anti-apoA1 IgG positive vs negative individuals in all groups. Conclusions HIV-infected patients presented with an increased prevalence of anti-apoA1 IgG compared to HIV-free subjects. In HIV-infected/ART experienced patients, anti-apoA1 IgG levels were associated with low CD4+ counts, levels of adhesion molecules and pro-inflammatory responses, features associated with increased cardiovascular events. ART highlighted pro-atherogenic differences between HIV-infected anti-apoA1 IgG negative and positive patients.

Effect of a Short-term Lifestyle Modification Program on Quality of Life, Anthropometric Characteristics and CD4+T Cell Count of HIV Infected Patients in Tehran/Iran: A Randomized Controlled Trial

Increasing physical activity and promoting healthy behaviors may play a key role in reducing the adverse effects of antiretroviral therapy and HIV. This study investigated the effects of an 8-week lifestyle modification program (LMP) on quality of life, anthropometric characteristics and CD4+T cell count of people living with HIV (PLWH). Thirty PLWH taking ART were randomly assigned to a lifestyle modification program (LMP) (n=15) or standard care control (CON) group (n=15). All volunteers underwent body composition, CD4+T cell count measurement and quality of life assessments at the beginning and end of a two-month experimental period. At follow-up, we observed a significant increase in CD4+T cell count (117.52 cells/mm3; 95% CI, 36.59-198.45) and all subscales and total quality of life score (Short-Form 36 (SF-36) in the LMP group. While we did not observe a significant change in body composition for the LMP group, we did observe a significant increase in body fat (1.75%; 95% CI, 0.15, 2.33) and a reduction in lean body mass (-1.26; 95% CI, -1.26, -2.39) for the CON group. A LMP can be safely used as an effective intervention for improving quality of life and immune competence of PLWH who lack time to participate in a structured exercise regimen. IRCT 201604034076N18. Registered: 2016-05-05 .web address of TRIAL: en.search.irct.ir/trial/4262.

Comparative Modeling, Virtual Screening and Docking of CCR5 with Diverse Libraries: An Initiation towards Rational Drug Design to Identify a New Chemical Entity to Treat HIV

The Antiretroviral Therapy (ART) has reduced the mortality and morbidity of Human Immunodeficiency Virus 1 (HIV 1) in humans. The adverse effect of anti-retroviral therapy is associated with the adherence difficulty, substancial toxicity and abnormal cost. In the process of identifying a novel inhibitor to treat HIV, CCR5 (chemokine receptor 5) remains a novel target. Though there is an FDA approved inhibitor and crystal structure for CCR5, the resolution and interactions lacks explanation with respect to the site of action. Since the coverage and resolution of CCR5 was poor, Comparative modeling was performed to identify a homologues structure with complete coverage. In this study, we focus on identifying a lead to inhibit CCR5 by the process of virtual screening from various libraries of small molecules. Then the associated interactions of CCR5 and the lead molecule for were analyzed. Future works in the current research will be extended to perform meticulous studies on identifying the potency of interactions in a simulated environment, identifying the structure, property and activity relationships between the conformers of lead molecules.

Coping Strategies for Adverse Effects of Antiretroviral Therapy among Adult HIV Patients Attending University of Gondar Referral Hospital, Gondar, Northwest Ethiopia: A Cross-Sectional Study.

Background Adverse effects from antiretroviral therapy (ART) have an impact on quality of life and medication adherence. There is no clear understanding of how people manage the adverse effects of ART. The individual taking medications which cause serious adverse effects may choose to stop or reduce the medications to relieve the adverse effects. Hence, this study was aimed at assessing coping strategies for adverse effects of ART among adult human immunodeficiency virus (HIV) patients. Methods A cross-sectional study was conducted at HIV clinic of University of Gondar Referral Hospital (UoGRH). A total of 394 study participants were recruited by systematic random sampling. Data were collected through interviewing patients. Data were entered to Epi-Info 3.5.4 and analyzed using SPSS-20.0. Descriptive statistics were used to summarize patient's sociodemographic data and the adverse effects of their ART regimen. Binary and multivariate logistic regressions were used to investigate the potential predictors of nonadherence coping strategies. Results The majorities of study participants were females (66%) and aged between 35 and 44 years (38.1%). The major adverse effects reported by the participants were headache (48.2%) followed by fatigability (18%) and loss of appetite (17.5%). Coping strategies used by HIV patients for adverse effect of ART were positive emotion coping strategy (91.1%), social support seeking (76.6%), taking other medications (76.6%), information seeking (48.7%), and nonadherence (35.5%). Younger age (AOR = 29.54, 95% CI = 2.49–35.25, p = 0.007), low level of education (AOR = 5.70, 95% CI = 2.16-15.05, p < 0.001), and living far from the health institution (AOR = 2.68, 95% CI = 1.29–5.57, p = 0.008) were associated with nonadherence coping strategy to relieve the adverse effects of ART. Conclusion The present study revealed that positive emotion coping was the most commonly used strategy. Age, level of education, and distance from health institution were the predictors of nonadherence coping strategy.

Adverse effects of antiretroviral therapy in pregnant women infected with HIV in Brazil from 2000 to 2015: a cohort study

BackgroundAntiretroviral therapy (ART) use in pregnancy presents unquestionable benefits in preventing mother-to-child transmission (MTCT) of HIV although it is associated with maternal adverse effects. The aim of this study was to evaluate the adverse effects of antiretroviral therapy in pregnant women infected with HIV.MethodsCohort study of pregnant women infected with HIV followed at the CAISM/UNICAMP Obstetric Clinic from 2000 to 2015. The following maternal adverse effects were observed: anemia, thrombocytopenia, allergy, liver function test abnormalities, dyslipidemia and diabetes. Data collected from patients’ files was added to a specific database. Descriptive analysis was shown in terms of absolute (n) and relative (%) frequencies and mean, median and standard deviation calculations. Chi-square or Fisher exact test (n < 5) and relative risk (RR) with its respective p values were used for categorical variables and Student t-test (parametric data) or Mann-Whitney (non-parametric data) for the quantitative ones. A 95% confidence interval (CI) and a significant level of 0.05 were used. A multivariate Cox Logistic Regression was also done. Data analysis was conducted using SAS version 9.4.ResultsData from 793 pregnancies were included. MTCT rate was 2.3%, with 0.8% in the last 5 years. Maternal adverse effects were: dyslipidemia (82%), anemia (56%), liver function test abnormalities (54.5%), including hyperbilirubinemia (11.6%), fasting glycemia alteration (19.2%), thrombocytopenia (14.1%), and allergic reaction (2.7%). The majority of adverse effects deemed related to ART in this study were mild according to DAIDS scale. In the multivariate analysis, co-infections and starting ART during pregnancy were risk factors for maternal anemia, while CD4 count higher than 200 cells/mm3 was protective. Nevirapine, nelfinavir and atazanavir regimens increased the risk for liver function tests abnormalities. Lopinavir use during pregnancy increased the risk for fasting glycemia alteration.ConclusionThe evolution of the national guidelines of antiretroviral therapy for pregnant women improved adherence to the treatment and resulted in a significant reduction of MTCT. Despite the high frequency of maternal adverse effects, they are mostly of low severity. Newer ART medications with improved efficacy and significantly more favorable tolerability profiles should reduce the incidence of ART-related adverse effects.

Coordenação motora de crianças e adolescentes portadores do vírus da imunodeficiência humana

Introdução: O vírus da Imunodeficiência Humana é um lentivírus que deprime o sistema imunológico, favorecendo o desencadeamento de déficits, incluindo no sistema motor. Esses déficits podem ser gerados através de efeitos adversos da terapia antirretroviral.Objetivos: Descrever o perfil da coordenação motora de crianças e adolescentes infectadas por via vertical pelo vírus da Imunodeficiência Humana e expostas ao uso de terapias antirretrovirais.Materiais e Métodos: Estudo do tipo observacional e transversal, onde foram avaliadas 34 crianças e adolescentes matriculadas na Unidade de Referência Materno Infantil e Adolescente do Pará e distribuídas em dois grupos: 1) Grupo Controle: n=13, com sorologia negativa para o vírus da imunodeficiência humana, porém expostos a medicação no pré, peri ou pós-natal; 2) Grupo Experimental: n=21, crianças com sorologia positiva para o HIV e exposição prolongada as terapias antirretrovirais há mais de 1 ano. Foi utilizada a bateria de teste Korperkoordination test fur Kinder para análise do desempenho motor. A análise estatística foi realizada pelo software Bioestat® 5.0, considerando nível de significância de 5%.Resultados: Identificou-se no grupo experimental déficit na coordenação motora para tarefas de equilíbrio (p=0,003) e lateralização (p=0,007) comprometendo a conscientização corporal. A análise do quociente motor global e deste com relação a idade cronológica também apresentaram significância, respectivamente p=0,027 e p=0,003.Conclusão: Crianças e adolescentes infectadas por via vertical pelo vírus da Imunodeficiência Humana e expostas ao uso prolongado da terapia antirretroviral apresentaram comprometimento do desempenho motor para as tarefas de equilíbrio e lateralidade.

HIV infection in women

Globally, more than 50% of HIV infected people are women. HIV infection in women has its particularities, especially because of pregnancy and because of the adverse effects of antiretroviral therapy. Heterosexual contact is the most frequent way of HIV transmission in women. Some gynecological infections like vaginal candidiasis seem to be more persistent and more severe as compared to uninfected female patients. Also, HIV infected women have a higher risk for cervical dysplasia and cancer as compared to uninfected women. The risk of mother‑to‑child transmission of the virus has dropped significantly in the last decades because of the implementation of routine HIV screening testing in pregnancy, counseling regarding prevention and the large access to antiretroviral treatment. Today, because of the diversity of the therapeutic options and using good prophylactic measures, HIV infected women can have a normal life.

The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review

BackgroundObserved adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes.MethodsA systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis.ResultsOf the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5–3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0–88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception.ConclusionThis systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.

Neuropsychiatric adverse effects of HIV antiviral medication

IntroductionHIV (human immunodeficiency virus) infection is related to several neuropsychiatric complications, such as dementia, encephalopathy, psychosis, as well as, opportunistic infections of the central nervous system (CNS). The discovery of antiretroviral therapy (ART) has limited these conditions and extended the life span of infected patients into a chronic illness, but it is also associated with neuropsychiatric adverse effects.ObjectivesTo review the literature on the most common neuropsychiatric complications of the ART, since it can be difficult to distinguish drugs toxicity, the effects of the virus, immune system and psycho-social events.MethodsThe authors have conducted an online search in PubMed with the terms: “Psychiatry”, “HIV”, “adverse effects” and “antiretroviral drugs” from 2011 until 2016. From the outcome were collected, analyzed and summarized the articles considered to be relevant.ResultsThe antiretroviral therapy (ART) are associated with a numerous adverse effects on the central and peripheral nervous systems, as well as, metabolic, gastrointestinal, cardiac, and other toxicities. The neuropsychiatric effects are common and highly variable, including depression, cognitive impairment and sleep disturbance. The nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors are one of the two classes of antiviral drugs most frequently associated with neuropsychiatric complications.ConclusionsThe occurrence of new-onset conditions related to ART makes it difficult to determine the association between psychiatric disorders and ART adverse effects, and given the fact that patients commit to lifelong therapy, as well as, they can diminish quality of life; it makes these assessment important in treating these conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.