Antiretroviral Therapy In HIV Patients Research Articles

Pattern of central nervous system related adverse drug reactions (ADRs) due to anti-retroviral therapy in HIV infected patients in tertiary care hospitals in North India

Background: Anti-retroviral therapy is associated with myriads of side-effects. Central nervous system related side effects are troublesome and mostly self limiting. Working knowledge of these side effects can improve the prescription habits of physicians. The study aimed pattern of central system related adverse drug reactions (ADRs) due to anti-retroviral therapy in HIV infected patients in tertiary care hospitals in North India. Materials and methods: A prospective observational study was conducted and all HIV positive patients, previously registered and new; attending OPD who encountered ADRs were enrolled in our study irrespective of their age and sex. Data was collected using ADR reporting form issued by Indian Pharmacopoeia Commission. Causality assessment was done by using Naranjo’s Probability Scale. Modified Hartwig severity scale was used to evaluate severity, WHO criteria for seriousness and guidelines of council for international organizations of medical sciences to decide the predictability of ADRs. Results: A total of 250 patients encountered various types of ADRs during the study period. Total number of ADRs recorded was 452. Out of total ADRs (n=452) recorded, 20.35% (n=92) were central system related ADRs. Most common central nervous system related ADR was dizziness. Most central nervous system related ADRs were of moderate type and possible in nature on causality assessment. Conclusion: Relatively overweight, older age and baseline CD4 absolute count below 250 cells/mm3, were predictors for central nervous system related side effects due to anti-retroviral therapy in HIV patients. We suggest that more stringent evaluation and monitoring should be carefully done in all HIV/AIDS patients who will receive and on efavirenz based anti-retroviral therapy, especially if they have the above predictors.

Positive impact of sulfamethoxazole-trimethoprim prophylaxis on prevention of severe infections in a patient with glycogen storage disease type Ib

ObjectiveGlycogen storage disease type Ib (GSD-Ib) is a very rare disease complicated by neutropenia with consequent recurrent bacterial infections. Treatment with Filgrastim is not always effective.The low CD4 count observed in our patient is likely the underlying cause of this treatment failure. This low value was previously examined in a small-scale study. Therefore, adding sulfamethoxazole-trimethoprim (SMX-TMP) might be a good strategy.MethodsWe present the case of a male patient with GSD-Ib. He has severe neutropenia (380/mm3) with recurrent infections. Despite neutrophil improvement with Filgrastim, he developed three severe infections requiring hospitalization. Lymphocyte phenotyping showed a deficit in T CD4 + cells (280/mm3) which led us to HIV testing returning negative. Based on this finding we initiated prophylaxis with SMX-TMP.ResultsSince the start of SMX-TMP along with Filgrastim, the patient was not admitted to the hospital for any bacterial infection.ConclusionTo date, no study has examined the significance of incorporating antibiotic prophylaxis for neutropenic patients with GSD-Ib based on CD4 count, akin to the approach of adding SMX-TMP to antiretroviral therapy for HIV patients. Cotrimoxazole is empirically prescribed without assessing the CD4 count or conducting a comparative analysis of the advantages of its addition to Filgrastim. Such practices could potentially exert a significant influence on the disease’s presentation and severity.

Time to Virological failure and it's predictor among HIV positive clients with the differentiated service delivery model of HIV at Debre Berhan Comprehensive Specialized Hospital, Amhara Regional state, Ethiopia, 2021: A retrospective cohort study.

Diversified Anti-Retroviral Therapy (ART) approach is needed in methods that were acceptable to communities and maintain good viral suppression outcomes in order to reach the UNAIDS targets to end the HIV/AIDS epidemic by 2030. Ethiopia is fully implementing differentiated service delivery approaches, appointment spacing, and standard care. This study aimed to determine the time to HIV virological failure and its predictors among patients with a differentiated service delivery model. An institution-based retrospective cohort study was conducted with data collection dates ranging from May 1-30, 2021. All adult HIV positive patients (n = 2148) between January 2018 and January 2021 were a source population. Data was extracted using a standard check list by trained data collectors and entered into Epi Data, exported to SPSS version 20 for data management, and then exported to R Studio version 1.4 for analysis. Kaplan-Meier survival curves, the log-rank test, and Cox proportional hazard regression models were employed. The incidence of virologic failure was 86 per 10,000 person-months. The independent predictors for the hazard of Virological failure were being on standard care (AHR = 1.91; 95% CI (1.07 - 3.40)), primarily educated (AHR = 3.46; 95% CI (1.02 - 11.72)), having no education (AHR = 3.45; 95% CI (1.01 - 11.85)), ambulatory status at baseline (AHR = 1.81; 95% CI (1.06 - 3.09)). Patients who had a viral load with a detectable range from 50-999 at engagement (AHR = 2.65; 95% CI (1.33 - 5.27)) and a one-month increase in ART for HIV patients (AHR = 1.045; 95% CI (1.01-1.09)). The incidence of virologic failure was 86 per 10,000 person-months, while the incidences were 52 per 10,000 and 71 per 10,000 person months on ASM and standard care, respectively, with independent predictors: patient category, educational status, baseline functional status, viral load at engagement, and duration of ART.

Association of Hospitalization Rate, Mortality, and CD4 T Cell Count with Comorbidity of COVID-19 and HIV: A Systematic Review and Meta-Analysis.

Epidemiological data demonstrate the greater severity of SARS-CoV-2 infection in HIV patients along with the more hospitalization, and mortality rates. Thus, this meta-analysis aimed to assess the possible differences in hospitalization, mortality, and the CD4 T cell counts between COVID-19/HIV co-infected patients and the control group. The relevant studies were obtained from online databases such as Science Direct, PubMed, Scopus, Web of Science, and Google Scholar using Mesh and Non-Mesh keywords and the meta-analysis was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist. Then, the Newcastle-Ottawa scale (NOS) checklist was used to assess the quality of selected studies. According to the random effect models, the odds ratios of hospitalization, mortality, and CD4 T cell counts were estimated. The odds ratios of hospitalization and mortality rates in COVID-19 patients with HIV were 1.67 (confidence interval [CI]: 0.76 to 3.71) and 0.80 (CI: 0.57 to 1.11), respectively, compared to that of the COVID-19 group. In this meta-analysis, there was no statistically significant difference in the rates of hospitalization, mortality, and CD4 T cell counts between COVID-19 patients with HIV and the control group. The similarity between the studied groups could be attributed to factors such as the rarity of COVID-19/HIV co-infection patients and the presence of random error, administration of antiretroviral therapy in HIV patients, and early hospitalization time in COVID-19/HIV co-infected patients.

Metabolic Syndrome and Combination Antiretroviral Therapy in HIV Patients in Periurban Hospital in Ghana: A Case-Control Study.

There is an increasing prevalence of cardiovascular diseases (CVDs) and risk factors in HIV patients as the levels of AIDS-related mortality and morbidity decrease. Metabolic syndrome (MetS) is the accumulation of various CVD risk factors that predict the occurrence of CVDs. We investigated the prevalence of MetS and associated risk factors in HIV patients treated with combination antiretroviral therapy (cART), cART-naïve HIV patients, and non-HIV controls. In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients, and 156 non-HIV controls were recruited from a periurban hospital in Ghana. A structured questionnaire was used to collect data on demography, lifestyle, and medication. Anthropometric indices and blood pressure were measured. Fasting blood samples were collected to measure the plasma levels of glucose, lipid profile, and CD4+ cells. The presence of MetS was defined using the joint scientific statement criteria. The prevalence of MetS was higher in cART-treated HIV patients compared with cART-naïve HIV patients and non-HIV controls (57.3% vs. 23.6% vs. 19.2% and p < 0.001, respectively). MetS was associated with cART-treated HIV patients (odds ratio (95% CI) = 7.24 (3.41-15.39) and p < 0.001), cART-naïve HIV patients (2.04 (1.01-4.15), p=0.048), and female gender (2.42 (1.39-4.23) and p=0.002). In cART-treated HIV patients, those on zidovudine (AZT)-based regimens were associated with increased likelihood (3.95 (1.49-10.43) and p < 0.006), while those on tenofovir (TDF)-based had decreased likelihood (0.32 (0.13-0.8) and p=0.015) of having MetS. In our study population, there was a high prevalence of MetS in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls. HIV patients on AZT-based regimens had an increased likelihood of having MetS, while those on TDF-based regimens had a reduced likelihood of having MetS.

Bioinspired CRISPR-Mediated Cascade Reaction Biosensor for Molecular Detection of HIV Using a Glucose Meter.

HIV molecular detection plays a significant role in early diagnosis and antiretroviral therapy for HIV patients. CRISPR technology has recently emerged as a powerful tool for highly sensitive and specific nucleic acid based molecular detection when used in combination with isothermal amplification. However, it remains a challenge to improve the compatibility of such a multienzyme reaction system for simple and sensitive molecular detection. Inspired by the multicompartment structures in a living cell, we present a nanoporous membrane-separated (compartmentalized), artificial, cascade reaction system to improve the compatibility of a CRISPR-mediated multienzyme reaction. We further integrated the multienzyme cascade reaction system with a microfluidic platform and glucose biosensing technology to develop a bioinspired, CRISPR-mediated cascade reaction (CRISPR-MCR) biosensor, enabling HIV molecular detection by a simple glucose meter, analogous to diabetes home testing. We applied the bioinspired CRISPR-MCR biosensor to detect HIV DNA and HIV RNA, achieving a detection sensitivity of 43 copies and 200 copies per test, respectively. Further, we successfully validated the bioinspired biosensor by testing clinical plasma samples of HIV, demonstrating its great application potential for point-of-care testing of HIV virus and other pathogens at home or in resource-limited settings.

Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh

Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence. Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospital. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and adherence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS. Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found significant were sex of the patient, the education, the socioeconomic status, financial constraints, family support, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors namely having less than college education, WHO stage at diagnosis, alcohol intake and lack of family support were found to predictors of non-adherence. Conclusions: Family support, treatment of alcohol addiction will improve adherence in HIV positive patients.

IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME AFTER USE OF ANTI-RETROVIRAL THERAPY IN COVID-19

TOPIC: Chest Infections TYPE: Global Case Reports INTRODUCTION: COVID-19 is still an emerging topic and co-existence in HIV patients presents its unique challenge. These patients can range from elite controllers to Acquired immunodeficiency syndrome (T cell CD4 < 200). Throughout our management, we noticed certain trends in our population. Those patients with CD4 T cell < 200 were rarely admitted to hospital with severe cases of COVID-19, requiring if anything minimal oxygen requirements. However, HIV patients who were admitted did not fare well after initiating their anti-retroviral therapy (ART) therapy during index hospitalization. We describe two such cases one in which ART was maintained and one in which ART was help with different outcomes. CASE PRESENTATION: Both patients on admission were admitted for progressive dyspnea with COVID PCR positive, started on ART therapy, given a 10-day course of Dexamethasone 6mg and 5 doses of Remdisivir.Case 1 - 55year old Hispanic male with a history of non-compliance on Triumeq (CD4 count of 34), lymphoma in remission after chemotherapy, and sulfa allergy. On admission he was started on Triumeq, Azithromycin, Clindamycin, Primaquine. Over next 3 days he experienced progressive hypoxia and worsening chest imaging eventually requiring mechanical ventilation.Case 2 - 66year old female non-compliant on ART, and polysubstance abuse. She was also noted to have MSSA pneumonia. She was started on Emricitabine, Tenofovir, Ritonavir, and Atazanorvir. Within 48 hours of ART initiation her oxygen requirement increased. At this time, her antiretrovirals were stopped and started on Solumedrol 40mg twice daily for suspected IRIS. Her respiratory status improved and her oxygen requirements were back to baseline. Upon restarting ART 2 weeks post treatment for IRIS, patient again required an increase in oxygen supplementation. ART was held for an extended period while maintaining opportunistic infection prophylaxis. DISCUSSION: We pose this discussion for the community, as COVID-19 pathophysiology has been hypothesized to be an inflammatory response mitigated by Interleukins and Interferon-gamma, released by CD4 and CD8 T cells {3} Theoretically those with lower CD4 T cells, such as those with AIDs, should produce a lesser inflammatory response;and therefore, be less symptomatic. IRIS is typically determined from clinical context and is seen more frequently in those with CD4 < 100. {1} Treatment is typically steroids with a prolonged taper, with an ongoing discussion on whether ART should be held. {4} CONCLUSIONS: Currently there are no guidelines regarding utilization of ART in HIV patients infected with COVID;which leads to following questions of whether ART be held transiently until the COVID-19 pneumonia has been sufficiently treated? When should ART be restarted in these patients? If a patient's condition is deteriorating, should the patient's ART be held and started on opportunistic infection prophylaxis? REFERENCE #1: Bosamiya, S.S. The immune reconstitution inflammatory syndrome (2011) 56(5) 476-9, Indian J Dermatology. doi : 10.4103/0019-5154.87114 REFERENCE #2: Brown, L.B, Spinelli, M.A., and Gandhi, M. The interplay between HIV and COVID-19: summary of the data and responses to date. (2021) 16(1) 63-73, Current opinion of HIV and AIDs. REFERENCE #3: Kalfaoglu, B., Almeida-Santos, J., Tye, C.A., Satou, Y., and Ono, M. T cell dysregulation in COVID-19 (2020) 29(530) 204-210, Biochem Biophys Res Commun. doi: 10.1016/j.bbrc.2020.10.079 DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response no disclosure on file for Anjali Bakshi;No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Steven Miller, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Gaurav Parhar, source=We Response no disclosure on file for Dhruv Patel;No relevant relationships by Jason Ravidas, source=Web Response No relevant relationships by jad sargi, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response No relevant relationships by John Zeibeq, source=Web Response

Evaluation of Haematoimmunological, Erythropoietic Growth Factor and Virological Status in HIV-Patients

Background: Human Immunodeficiency Virus reduces immune status and diminishes haematological values causing decreased or ineffective haematopoiesis in HIV-infected individuals. Aim: To evaluate haematoimmunological, erythropoietic growth factor and virological status in HIV-patients. Methodology: This study was carried out at Federal Teaching Hospital, Ido-Ekiti. One hundred samples each were collected from HIV positive subjects on ART and ART-naïve, one hundred samples were collected from apparently healthy individuals as control. Six milliliters of whole blood were collected from each subject; 3mls of whole blood was dispensed into K2EDTA bottle for immediate analysis of haematological parameters using haematology analyzer, CD4 and CD8 count were analyzed using flow cytometer. The remaining 3ml of blood was dispensed into plain bottle, serum was extracted for erythropoietin analysis using enzyme-linked immunosorbent assay technique and viral load using polymerase chain reaction. Results: Mean values of RBC indices CD4, CD4/CD8, EPO, TWBC and LYM among ART-naïve were significantly lower (p&lt;0.05) compared to ART and control subjects. Mean values of CD8, VL, NEU, MONO, EOSIN and BASO in ART-naïve were significantly higher (p&lt;0.05) compared to ART and control subjects. Conclusion: HIV infection suppresses erythropoietic growth factor, haematoimmunological, and virological parameters as observed in the study. However, there is an improvement in HIV subjects on ART compared with ART-naïve, this suggested that there is positive response to antiretroviral therapy in HIV patients.

Effect of mobile health interventions on adherence of anti-retroviral therapy in HIV infected Asian patients: A systematic review and meta-analysis

Background: Antiretroviral therapy (ART) is an effective approach to prevent progression of HIV to AIDS, however adherence to HIV medication is still inconclusive. Currently, mobile health intervention (mHealth) is a novel way of delivering healthcare and improving health outcomes. Mobile phone using voice calls and text messages has been shown to be useful to improve adherence rates. Therefore, this study design to investigate effect of mHealth interventions on ART adherence in HIV infected Asian patients. Methods and materials: A systematic search in Embase and Medline was conducted to identify randomized controlled trials (RCTs) comparing mHealth interventions (voice calls and text messages) with control (standard care) in HIV infected patients. We calculated odd ratio (OR) with 95% confidence interval (CI) with random effect model to compare mHealth interventions with control group. Meta-analysis was performed by using RevMan 5.3 software. Results: Out of 1235 retrieved articles, 14 RCTs with 2861 patients from Asia region. From the included studies, patient's age were >14 y and mHealth interventions reported as voice call in 5 studies and text messages in 9 studies. Results from meta-analysis of overall mHealth interventions showed significant improvement (OR: 1.51, 95%CI: 1.19, 1.93; p = 0.0008) in adherence to ART in HIV patients when compared to control group. From subgroup analysis, voice calls showed non-significant association (OR: 1.63, 95%CI: 0.91, 2.92; p = 0.10) and text messages showed significant association (OR: 1.44, 95%CI: 1.12, 1.86; p = 0.004) when compared to control group. However subgroup meta-analysis of text messages, scheduled text messages showed significant improvement (OR: 1.69, 95%CI: 1.24, 2.29; p = 0.0008) and triggered messages showed non-significant association (OR: 1.09, 95%CI: 0.81, 1.46; p = 0.58) in adherence to ART. Conclusion: Overall mHealth interventions have significant impact on ART adherence in HIV infected patients. However, from subgroup data, text messages (scheduled text messages) showed significant improvement in ART adherence, and voice calls and triggered text messages do not have promising impact. Due to preference of voice calls over text messages, further research required to explore voice functions in combination with text messages.

Effect of mobile health interventions on adherence of anti-retroviral therapy in HIV infected Asian patients: A systematic review and meta-analysis

Background: Antiretroviral therapy (ART) is an effective approach to prevent progression of HIV to AIDS, however adherence to HIV medication is still inconclusive. Currently, mobile health intervention (mHealth) is a novel way of delivering healthcare and improving health outcomes. Mobile phone using voice calls and text messages has been shown to be useful to improve adherence rates. Therefore, this study design to investigate effect of mHealth interventions on ART adherence in HIV infected Asian patients. Methods & Materials: A systematic search in Embase and Medline was conducted to identify randomized controlled trials (RCTs) comparing mHealth interventions (voice calls and text messages) with control (standard care) in HIV infected patients. We calculated odd ratio (OR) with 95% confidence interval (CI) with random effect model to compare mHealth interventions with control group. Meta-analysis was performed by using RevMan 5.3 software. Results: Out of 1235 retrieved articles, 14 RCTs with 2861 patients from Asia region. From the included studies, patient's age were > 14 years and mHealth interventions reported as voice call in 5 studies and text messages in 9 studies. Results from meta-analysis of overall mHealth interventions showed significant improvement (OR: 1.51, 95%CI: 1.19, 1.93; P = 0.0008) in adherence to ART in HIV patients when compared to control group. From subgroup analysis, voice calls showed non-significant association (OR: 1.63, 95%CI: 0.91, 2.92; P = 0.10) and text messages showed significant association (OR: 1.44, 95%CI: 1.12, 1.86; P = 0.004) when compared to control group. However subgroup meta-analysis of text messages, scheduled text messages showed significant improvement (OR: 1.69, 95%CI: 1.24, 2.29; P = 0.0008) and triggered messages showed non-significant association (OR: 1.09, 95%CI: 0.81, 1.46; P = 0.58) in adherence to ART. Conclusion: Overall mHealth interventions have significant impact on ART adherence in HIV infected patients. However, from subgroup data, text messages (scheduled text messages) showed significant improvement in ART adherence, and voice calls and triggered text messages do not have promising impact. Due to preference of voice calls over text messages, further research required to explore voice functions in combination with text messages.

Possible Herb-Drug Interaction Risk of Some Nutritional and Beauty Supplements on Antiretroviral Therapy in HIV Patients

This study was carried out to assess the drug interaction potential of a variety of beauty and sports/nutritional supplements when co-administered with antiviral drug therapy, especially anti-HIV drugs. Ethanolic extracts of seven dietary supplements (two beauty products, three nutritional protein supplement products and two weight loss/body building products) were examined in human liver cells (HepG2 cells and primary hepatocytes) for their influence on the hepatic metabolism of five antiviral drugs (elvitegravir, rilpivirine, tenofovir, dolutegravir, and cobicistat), all of which are substrates for a key drug metabolizing enzyme CYP3A4. Our results showed that six of the seven supplements caused a 1.5 – 2 fold induction in PXR transcriptional activity in HepG2 cells. PXR regulates the expression of key drug metabolizing enzymes including CYP3A4. Follow up studies indicated a 1.5 – 3 fold induction in CYP3A4 enzyme activity in HepG2 cells treated with these supplements. We further investigated the effects of the supplement on the metabolism of above mentioned anti-viral drugs in HepG2 cells and primary hepatocytes. Of the five drugs, rilpivirine and dolutegravir metabolism was increased by up to 2-folds over the no supplement control by some of the supplements. Our findings indicate that concomitant consumption of these products with anti-HIV drugs may compromise the efficacy of antivirals therapy due to supplement-induced metabolism via induction of CYP3A4 activity.

Pericytes as novel targets for HIV/SIV infection in the lung

Antiretroviral therapy in HIV patients has lengthened lifespan but led to an increased risk for secondary comorbidities, such as pulmonary complications characterized by vascular dysfunction. In the lung, PDGFRβ+ mesenchymal cells known as pericytes intimately associate with endothelial cells and are key for their survival both structurally and through the secretion of prosurvival factors. We hypothesize that in HIV infection there are functional changes in pericytes that may lead to destabilization of the microvasculature and ultimately to pulmonary abnormalities. Our objective in this study was to determine whether lung pericytes could be directly infected with HIV. We leveraged lung samples from macaque lungs with or without SIV infection and normal human lung for in vitro experiments. Pericytes were isolated based on the marker platelet-derived growth factor receptor-β (PDGFRβ). We determined that lung PDGFRβ-positive (PDGFRβ+) pericytes from both macaques and humans express CD4, the primary receptor for SIV/HIV, as well as the major coreceptors CXCR4 and CCR5. We found cells positive for both PDGFRβ and SIV in lungs from infected macaques. Lung pericytes isolated from these animals also harbored detectable SIV. To confirm relevance to human disease, we demonstrated that human lung pericytes are capable of being productively infected by HIV in vitro, with the time course of infection suggesting development of viral latency. In summary, we show for the first time that SIV/HIV directly infects lung pericytes, implicating these cells as a novel target and potential reservoir for the virus in vivo.

Gender-based Early Immunological Response to Antiretroviral Therapy in HIV Patients at a Tertiary Care Hospital in Coastal Karnataka

Background and Objective: To compare the immunological response to antiretroviral therapy between genders and to identify other factors that could affect the immunological response. Methods: This was a prospective, observational study of 171 HIV patients with a follow-up at six months. The exposure to be measured was gender and the outcome of interest included CD4 count (immunological response) which was classified as adequate, suboptimal and immunological failure. Results: A total of 171 patients completed the study out of which 88 (51.5%) were males and 83 (48.5%) were females. Overall, 130 patients out of 171 (76.0%) showed an adequate response at the end of the first six months of ART. The response was comparable in both men and women, and no significant difference was seen (p = 0.216). Though not statistically significant, more than 80% of the patients with a baseline CD4 cell count less than 300 cells/ mm 3 showed an adequate response. Also, the baseline BMI (classified as underweight, normal, overweight, obese) did not affect the immunological response significantly. Conclusion: Gender did not play a role in the immunological response following the initiation of antiretroviral therapy in treatment naive patients. The baseline CD4 count and the baseline BMI did not significantly affect the immunological response. Key words: Antiretroviral therapy, Immunological response, Response to antiretroviral therapy, Gender and HIV.

Lymphoepithelial Sialadenitis Involving HIV-Infected and Sjogren Syndrome Patients: A Cytologic Study.

Lymphoepithelial salivary gland cysts are rarely seen in autoimmune diseases particularly Sjogren syndrome as well as in HIV for which medical management is advocated. To study the morphology of these cysts, correlate with the disease process and assess the final outcome. Case series. Fine needle aspiration clinic. HIV-infected and autoimmune disease patients with lymphoepithelial cysts. Antiretroviral therapy for HIV-patients and anti-inflammatory drugs for Sjogren syndrome. Three HIV-infected patients (two children and one adult) and three middle aged female patients presented with parotid and submandibular cysts, two of which were bilateral along with submandibular (one each in the HIV and the autoimmune group). In the adult HIV-patient, the cyst was found at the inception of the disease while the other pediatric HIV-patients just crossed a decade. Of the other three cases of Sjogren syndrome, two were primary and one, secondary to rheumatoid arthritis. All the cysts regressed completely with treatment of the respective diseases which was confirmed by ultrasonograms. Lymphoepithelial cysts are produced by release of serous secretion by the acinar and ductal cells within the epithelial islands in the process of their destruction. Possibly, antibody mediated increased secretion in the initial stages also plays a role. Lymphoepithelial cysts of HIV patients may occur in the course of treatment, not necessarily in the beginning, though it resolves spontaneously. Lymphoepithelial cysts of primary or secondary Sjogren syndrome may be repressed sufficiently by anti-inflammatory/immunosuppressant treatment.

Autoimmune Hepatitis Overlap with Primary Biliary Cirrhosis in an HIV Infected Patient

42 year old Hispanic female with HIV on anti-retroviral therapy (ART) since 2009 and polyarthritis referred for evaluation of elevated LFTs. Her only complaint was mild itching of her body. She denied any use of herbal/ dietary supplements, alcohol abuse or illicit drug use. Her exam was unremarkable. Her LFTs were elevated- Alkaline phosphatase 410, AST 213, ALT 153, total bilirubin 0.5 mg/dl. Autoantibody testing showede elevated AMA at 78.6 and ANA titers 1:640. Viral hepatitis serologies including Hepatitis B surface antigen and Hepatitis C RNA PCR were negative. Her iron panel and ceruloplasmin levels were also normal. She was found to have hypergammaglobulinemia with elevated serum IgG levels of 4,117mg/dl (normal IgG less than 1730 mg/dl) and IGg subclass 4 elevated at 264 mg/dl (normal IgG < 86 mg/dl). US Abdomen showed multiple gallstones and gallbladder polyps, CBD was 2 mm and spleen size was normal. Percutaneous liver biopsy was performed and showed highly active portal and lobular hepatitis with evidence of bile duct inflammation and damage consistent with overlap syndrome of autoimmune hepatitis (AIH) with Primary biliary cirrhosis (PBC) and portal and periportal fibrosis with early bridging. Her medications included Hydroxychloroquine & Efavirenz-emtrictabine-tenofovir. Based on her liver biopsy results, patient was started on high dose prednisone 1mg/ kg and Azathioprine with improvement of her LFTs. She was continued on her ART throughout. ‘Overlap’ syndrome is a rare interface between AIH and PBC and is rarely reported in HIV infected adults. The common causes of elevated LFTs in HIV patients include infections and drug induced liver injury secondary to ART. Autoimmune disease in HIV although rare is an important differential while evaluating elevated LFTs in these patients. Unmasking of autoimmune disease is thought to be a manifestation of immune reconstitution with an era of highly effective ART in HIV patients. Our patient was on ART and had a CD4 count >600 suggesting a robust immune system. Her intial chronic liver disease workup suggested autoimmune disease and was confirmed histologically. Early liver biopsy can prevent ART interruption and its related risks. Standard treatment with immune suppressants appears to be effective & safe in HIV patients with high CD4 counts. To the best of our knowledge there is only one other previous case report of biopsy proven overlap syndrome with PBC/AIH in HIV patients.Figure 1Figure 2Figure 3

Hipertensión arterial en el paciente con vih: abordaje y tratamiento

Antiretroviral therapy in HIV patients has achieved a chronicity of the disease for which these patients reach more advanced ages. Hypertension is a major concern for our patients. Adequate metabolic control, and the establishment of a proper treatment, are aspects which necessarily have to be analyzed.

The ARTμS: a novel microfluidic CD4+ T-cell enumeration system for monitoring antiretroviral therapy in HIV patients.

We report on a novel and cost-effective microfluidic platform that integrates immunomagnetic separation and cell enumeration via DNA-induced bead aggregation. Using a two-stage immunocapture microdevice, 10 μL of whole blood was processed to isolate CD4+ T-cells. The first stage involved the immuno-subtraction of monocytes by anti-CD14 magnetic beads, followed by CD4+ T-cell capture with anti-CD4 magnetic beads. The super hydrophilic surface generated during polydimethylsiloxane (PDMS) plasma treatment allowed for accurate metering of the CD4+ T-cell lysate, which then interacted with silica-coated magnetic beads under chaotropic conditions to form aggregates. Images of the resulting aggregates were captured and processed to reveal the mass of DNA, which was used to back-calculate the CD4+ T-cell number. Studies with clinical samples revealed that the analysis of blood within 24 hours of phlebotomy yielded the best results. Under these conditions, an accurate cell count was achieved (R(2) = 0.98) when compared to cell enumeration via flow cytometry, and over a functional dynamic range from 106-2337 cells per μL.

THE USE OF HIV LOAD DETERNINATION FOR MONITORING THE QUALITY OF ANTIRETROVIRAL THERAPY IN SVERDLOVSK REGION

Study objectives: To assess the effectiveness of antiretroviral therapy in HIV patients living in Sverdlovsk Region, to examine the impact of operation of a multiprofessional team on the successfulness of antiretroviral therapy, and to study the 2-year dynamics of cases having undetectable HIV loads. Materials and methods: Based on digital database information, the virological effectiveness of ART in Sverdlovsk Region in 2013-2015 was assesses and the proportion of HIV patients having undetectable HIV loads was determined. The virological success was assumed to be a case where HIV load was found to below 50 copies per 1 mL of blood two times successively. Changed in the proportion of HIV patients having undetectable HIV loads were traced for two years. Results: In Sverdlovsk Region, the proportion of HIV patients having undetectable HIV load upon two successive tests was 63,9% and 70,6% in 2013 and 2015, respectively. The proportion of virological success cases varied in different territories from 80,1% (in Kamensk-Uralskiy) to 27,1% (in Degtiask) in 2013 and from 89,2% to 31,7% in 2015 in the same places. The operation of a multiprofessional team in a territory was associated with a higher proportion of HIV patients with suppressed viremia (68,6% and 76% where a multiprofessional team was present in 2013 and 2015, respectively, vs. 52,3% and 58,1% where no such team was organized). Conclusion: HIV load monitoring based on data included in a unified informa- tional system may be used to assess the quality of health care provided to HIV patients. The presence of a multiprofessional team correlated with higher rates of virological success. From 2013 to 2015, the proportion of HIV patients having undetectable HIV loads increased in Sverdlovsk Region.

Immune reconstitution inflammatory syndrome unmasking erythema nodosum leprosum: a rare case report.

Immune reconstitution inflammatory syndrome (IRIS) occurs as an acute symptomatic expression of a latent infection during the recovery of immune system in response to antiretroviral therapy in HIV patients. IRIS triggers both opportunistic and non-opportunistic infections. We report a case of IRIS in a patient with HIV, presenting as erythema nodosum leprosum (ENL), which led to unmasking of lepromatous leprosy following anti-retroviral therapy (ART).