Combination Of Highly Active Antiretroviral Therapy Research Articles

Regorafenib therapy for hepatocellular carcinoma in a HIV‐1‐infected patient: A case report

Regorafenib therapy for hepatocellular carcinoma in a HIV‐1‐infected patient: A case report

HAART THERAPY IN GHANA: COMPARATIVE ASSESSMENT OF THE EFFECTIVENESS OF DIFFERENT HAART COMBINATIONS AT KOMFO ANOKYE TEACHING HOSPITAL

Objective: Although all marketed antiretrovirals (ARVs) have proven efficacy, genetic differences can result in varied effectiveness. This study was conducted to determine the effectiveness of different Highly Active Antiretroviral Therapy (HAART) combinations among patients attending HIV clinic at a Major Teaching Hospital in Ghana.
 Methods: The study was a retrospective study involving 500 patients at an HIV clinic in the Ashanti Region of Ghana.
 Results: Twelve major antiretroviral combinations for HAART were prescribed at the study center. The most prescribed drug combinations were AZT+3TC+EFV and AZT+3TC+NVP. The study identified that HAART, irrespective of the kind of drug combination used, was effective at increasing CD4 count within the first 6 mo of therapy initiation in the study population. However, the magnitude of the increases differed from combination to combination. All HAART combinations with zidovudine as one of the drugs resulted in higher CD4 counts compared with combinations containing stavudine. HAART with nevirapine also resulted in a higher CD4 count than those with efavirenz. However, efavirenz-based combinations appeared to be more effective in critically ill patients and patients with mean CD4+T helper cells count below 100 cell/mm3. More importantly, efavirenz was common among all HAART combinations that resulted in treatment failure.
 Conclusion: There was significant variation in response to different HAART combination among Ghanaian HIV patients. However, there was no statistically significant difference in mean CD4 count between the two most predominately used HAART i. e AZT+3TC+EFV and AZT+3TC+NVP.

Brief Report: Antimalarial Benefit of HIV Antiretroviral Therapy in Areas of Low to Moderate Malaria Transmission Intensity.

We previously used mathematical modeling to predict reduced malaria incidence in children with protease inhibitor (PI)-, compared with nonnucleoside reverse transcriptase inhibitor-, based highly active antiretroviral therapy (HAART), in moderate to high malaria transmission areas. These effects were accounted for, in part, by pharmacokinetic (PK) interactions between PIs and artemether-lumefantrine (AL). Because of potentially reduced malaria transmission reservoirs in HIV-infected children due to PI/AL PK interactions impacting non-HIV-infected children, we estimate the antimalarial benefit of PI-based HAART in all children, and in HIV-infected children only residing in low to moderate malaria transmission areas. A dynamic model of malaria transmission was developed to evaluate the PK interaction of PI-based HAART with the antimalarial, AL for preventing malaria. To evaluate the benefit of HIV PI-based HAART on malaria incidence, a malaria transmission model with varying degrees of HIV newborn prevalence was developed using recent pediatric clinical trial data in Lilongwe, Malawi. Comparing situations of low to high HIV newborn prevalence, and low to moderate malaria transmission intensities, our model predicts the combination of PI-based HAART with AL-treated malaria prevents 0.04-24.8 and 0.05-34.5 annual incidences of malaria overall per 1000 children, and saves 0.003-1.66 and 0.003-2.30 disability-adjusted life years per 1000 children, respectively. When incorporating seasonality, 0.01-7.3 and 0.01-5.9 annual incidences of malaria overall per 1000 children, and 0.0-0.5 and 0.001-0.41 disability-adjusted life years per 100 children, are prevented, respectively. In low to moderate malaria transmission intensity areas, PI-based HAART may reduce malaria events in children when AL is used.

Five-year trends in treatment changes in an adult cohort of HIV/AIDS patients in Ghana: a retrospective cohort study

BackgroundThere is limited information on patterns of treatment change among new initiators of highly active antiretroviral therapy (HAART) in the regions most affected by HIV/AIDS. This makes it difficult to identify the determinants of treatment change. In this retrospective cohort study, we examined treatment change patterns over a five-year period among initiators of HAART.MethodsDe-identified data were obtained from the Fevers’ Unit Database at the Korle-Bu Teaching Hospital. All adult treatment-naive patients who started treatment with first line HAART between 1st January, 2008 and 31st December, 2012 were followed over a minimum period of three months. The main outcome was the first treatment change, defined as the first substitution/switch in accordance with the standard treatment guidelines. Data were analyzed stratified by year of treatment initiation. Crude and adjusted hazard ratios were calculated.ResultsA total of 3933 patients were followed with almost equal numbers of initiators per year. The mean age (standard deviation) at treatment initiation was 39 (10.3) years. The most prescribed HAART combination was AZT/3TC/EFV and overall for initiators zidovudine combination therapy was about 60%. Utilization of stavudine containing HAART increased gradually until 2010 and then dropped to zero. Over the study period, 44.9% of recorded deaths were from those initiated with a stavudine backbone, 41.1% from a zidovudine backbone, and 11.5% from a tenofovir backbone. Females had a significantly higher rate of treatment change compared to males (p-value = 0.0002), and d4T/3TC/EFV and d4T/3TC/NVP recorded independent treatment change hazard ratios of 12.05 (CI 9.58 to 15.16) and 12.03 (CI 9.27 to 15.61) respectively.. Kaplan-Meier curves showed that treatment change was higher among those who started treatment later in the study period compared with those who started earlier.ConclusionA major treatment change in the utilization of antiretroviral medicines in Ghana occurred during the study period which was associated with type of treatment, year of treatment, gender and disease stage. The influence of a policy change during the period may have made a significant impact.. For diseases involving life-long treatment in particular, it is important to monitor and periodically evaluation treatment utilization patterns.

Eficacia del tratamiento y de la profilaxis antifúngica secundaria en la histoplasmosis asociada al sida. Experiencia del Hospital de Infecciosas Francisco J. Muñiz, de la ciudad de Buenos Aires

BackgroundClassic histoplasmosis is a systemic endemic mycosis due to Histoplasma capsulatum var. capsulatum. A significant reduction in the morbidity and mortality of AIDS-related histoplasmosis has been observed since the introduction of highly active antiretroviral therapy (HAART) and secondary antifungal prophylaxis. AimsThe aim of this study was to determine the current state of prognosis and treatment response of HIV-positive patients with histoplasmosis in the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires City. MethodsA retrospective study was conducted using the demographic, clinical, immunological and treatment data of 80 patients suffering from AIDS-related histoplasmosis. ResultsOf the 80 cases studied 65 were male, the median age was 36 years, with 73.7% of the patients being drug addicts, 82.5% of the patients was not receiving HAART at diagnosis, and 58.7% of the cases had less than 50 CD4+ cells/μl at the beginning of the treatment. The initial phase of treatment consisted of intravenous amphotericin B and/or oral itraconazole for 3 months, with 78.7% of the cases showing a good clinical response. Only 26/63 patients who were discharged from hospital continued with the follow-up of the HAART, secondary prophylaxis with itraconazole or amphotericin B. Secondary prophylaxis was stopped after more than one year of HAART if the patients were asymptomatic, had two CD4+ cell counts greater than 150cells/μl, and undetectable viral loads. No relapses were observed during a two-year follow up after prophylaxis was stopped. ConclusionsThe treatment of histoplasmosis in HIV-positive patients was effective in 78.8% of the cases. The combination of HAART and secondary antifungal prophylaxis is safe, well tolerated, and effective. The low adherence of patients to HAART and the lack of laboratory kits for rapid histoplasmosis diagnosis should be addressed in the future. The usefulness of primary antifungal prophylaxis for cryptococcosis and histoplasmosis HIV-positive patients should be studied.

Current trends in highly active anti-retroviral therapy in an anti-retroviral therapy centre attached to a remote government medical college of Maharashtra, India: a retrospective study

Background: Highly active anti-retroviral therapy (HAART) became the keystone of national AIDS program. There is lack of awareness and inadequate training about drug safety monitoring among health care professionals in India. Hence, the present study was carried out to study current trends in HAART and pattern of associated adverse drug reactions. Methods: A retrospective observational study was conducted at an anti-retroviral therapy (ART) Centre. A total of 151 HIV/AIDS Patients (old and new cases) receiving HAART during July 2015 to December 2015 were randomly included in the study. Causality and severity assessment of adverse drug reactions (ADRs) was done by using Naranjo’s ADR causality scale and modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by institutional ethics committee. Results: The prevalence of HIV/AIDS infection was higher in adult males (51.66%). Zidovudine+lamivudine+nevirapine (ZLN) was the most commonly prescribed HAART combination. Out of 132 ADRs reported, 76.52% of the ADRs were related to haematological system and ZLN was the commonest combination causing ADRs. 90.91% ADRs belong to possible category on causality assessment and 68.94% of the ADRs were of moderate severity. Tuberculosis (28.47%) was the commonest diagnosed opportunistic infection among the HIV/AIDS patients. Conclusions: The prescribing pattern of HAART regimens was in accordance with national guidelines for antiretroviral therapy. We recommend a pharmacovigilance system for sustainable management of ADRs in HIV/AIDS patients as we found under reporting of ADRs.

Evaluation of Direct Cost Incurred for the Management of Adverse Drug Reactions (ADRs) to Highly Active Antiretroviral Therapy (HAART) Immunodeficiency Virus (HIV) Positive Patients

Objectives : To study the direct cost incurred for the management and to explore the economic cost burden imposed by ADRs to HAART in Indian HIV/AIDS patients. Methodology : A prospective observational study was conducted in HIV infected patients by clinical pharmacist in a HIV center for a period of 10 months. Patients of either sex who were on fixed dose drug combination of HAART were included in the study. Evaluation of actual direct cost to ADRs to HAART was based on cost of treatment, cost of hospital stay, consultation charges and cost of laboratory investigation. Results: A total of 380 HIV positive patients experienced at least one ADR to HAART among 1050 enrolled patients with incidence of 36%. A total of 440 ADRs were reported during the study period in which majority of the ADRs were due to Zidovudine + Lamivudine + Nevirapine (n=211, 48%) followed by Stavudine + Lamivudine + Nevirapine (n = 53, 12%). The most observed ADRs were anemia (n = 153, 35%) and vomiting (n = 56, 13%) and rash (n = 39, 9%). A sum of 1,72,130 Indian Rupees (INR) was occurred in management of ADRs, in which majority of direct cost was towards medication to treat the ADRs 80,280 INR (46.5%) followed by hospitalization charges 46,500 INR (27%). Average cost incurred in treating the ADRs was found to be 390 INR. Conclusion : The overall direct cost associated in treating ADRs to HAART was found to be higher and represent that ADRs to HAART increases the overall health care cost in management of HIV and reflects high economic burden to HIV patients. Hence clinicians and pharmacists should focus to prevent occurrence of ADRs to HAART thereby decreasing the ADR related costs.

Redox indexes and progression markers in HIV-infected patients treated with three different HAART combinations

Objective: Highly active antiretroviral therapy (HAART) is the choice to treat cases with an established HIV-infection and to prevent establishment of infection after exposure. Oxidative stress has been associated to HIV infection and, depending of therapy combination, effectiveness and adherence, to HAART. This study assessed the effect of three different HAART combinations, i.e. zidovudine/lamivudine/nevirapine (I), zidovudine/lamivudine/indinavir (II) and stavudine/lamivudine/nevirapine (III), on redox indexes and progression markers of disease on blood. Methods: We recruited 200 individuals of which 160 were HIV+ (40 never treated and 120 were taking different HAART combinations for at least six months), and the other 40 were supposedly healthy voluntaries (SHV). Peroxidation potential, glutathione, malondialdehyde, hydroperoxides, superoxide dismutase (SOD), catalase, advanced oxidation protein products (AOPP), viral load and CD4 lymphocytes T subsets were measured at baseline for all individuals and after 6 months. Results: The comparison between SHV and HIV treated or non-treated patients groups showed significant differences in almost all redox indexes with different molecular significance. Statistically modified values were found in almost all redox indexes at 6 months compared to the baseline except in SOD activity and peroxidation potential for combination I and III combinations and AOPP and SOD activity for combination II. Insignificant differences were found between HIV+ patients groups with respect to CD4 T lymphocyte subsets. The 78% of patients receiving treatment showed a viral load reduction. The multivariate statistical model clearly separated treated groups according progression indexes and redox profile. Conclusion: Therapeutic effectiveness confirmation and its benefits in HIV-infected patients combined with additional oxidative stress impact promoted integral view approach to follow up infection.

Antiretroviral concentration, redox indexes and progression markers in HIV-infected patient and #8217;s blood samples follow-up during six month

Objective: Human immunodeficiency virus (HIV) infection is accompanied by metabolic and immunological dysfunctions. Oxidative stress has been associated to HIV infection, and also its relation to highly active antiretroviral therapy (HAART) is suggested. This study assessed the effect of HAART combination (zidovudine/lamivudine/nevirapine) on redox indexes (RI) and progression markers of disease while monitoring also drugs concentration in blood. Methods: Eighty HIV subjects (40 taking HAART and 40 non-HAART) and 40 supposedly healthy voluntaries (SHV) were recruited. Blood antiretroviral drug concentrations were assessed by high performance liquid chromatography for each patient. Also peroxidation potential (PP), glutathione, malondialdehyde, hydroperoxides, superoxide dismutase (SOD), catalase (CAT), advanced oxidation protein products, viral load (VL) and CD4 T lymphocyte subsets were measured at baseline and at 6 months. Results: Drug concentration follow-up verified compliance of therapeutic range in 76% and 79% of patients studied at baseline and at 6 months without statistical difference. The comparison between SHV and HIV patients groups showed significant differences in almost all RI (except in SOD activity). Significantly modified values were found in almost all RI (except in CAT activity and PP) at 6 months compared to the baseline. Non-significant differences were found between HIV-infected patients with respect to CD4. 78% of patients receiving treatment showed a VL reduction. Conclusion: The confirmation of therapeutic range and its benefits in HIV-infected patients combined with additional oxidative stress impact promoted an integral view approach to follow-up the infection.

The emergence of drug resistant HIV variants at virological failure of HAART combinations containing efavirenz, tenofovir and lamivudine or emtricitabine within the UK Collaborative HIV Cohort

Lamivudine (3TC) and emtricitabine (FTC) are guideline choices for combination highly active antiretroviral therapy (HAART). 3TC has a shorter intracellular half life than FTC and may be more likely to lead to the development of drug resistant HIV variants. In this study we analysed linked data from the observational UK Collaborative HIV Cohort (CHIC) Study and UK HIV Drug Resistance Database (HDRD) to investigate the rate of development of K65R or M184V resistance mutations in patients failing on combinations containing tenofovir (TDF) and efavirenz (EFV) with either 3TC or FTC. Virological failure was defined as 1 viral load >400copies/ml. Rates were stratified by demographic variables, baseline viral load, current CD4 count, current viral load and year of starting regimen. Significant associations were identified using Poisson regression models and multivariable analyses were performed adjusting for the variables above. Logistic regression was used to determine whether there were any significant associations between type of regimen and detection of resistance mutation. 5455 patients received either (or both) 3TC, TDF and EFV or FTC, TDF and EFV contributing 6465 treatment episodes over 9962 person-years follow up. 47 of these episodes were preceded by resistance tests showing development of K65R or M184V mutation and were hence excluded. The majority of treatment episodes consisted of FTC- (n=5190) rather than 3TC- (n=1228) based regimens. 21 cases of K65R were detected over the course of follow up, giving an overall event rate of 0.21 (95% CI: 0.12-0.31)/100 person years follow up (PYFU). The overall event rate for detection of M184V was 0.38 (95% CI: 0.26-0.5)/100 PYFU. 201 patients receiving either regimen for the first time experienced virological failure. Of those receiving 3TC (n=53), 7 (13.2%), 12 (22.6%) and 15 (28.3%) developed K65R, M184V and either K65R or M184V respectively. Of those receiving FTC (n=148), 13 (8.8%), 20 (13.5%) and 26 (17.6%) developed K65R, M184V and either K65R or M184V respectively. Although patients on 3TC were more likely to develop resistance, this was not statistically significant in univariable (OR 1.85 (95% CI: 0.89-3.85, p=0.09)) or multivariable analyses (OR 1.89 (95% CI: 0.89-4.01, p=0.1)). We have not found evidence of an increased risk of development of M184V and K65R in patients exposed to 3TC.

A prospective study of highly active antiretroviral therapy in Indian human immunodeficiency virus positive patients

There are no studies performed in India on the safety of highly active antiretroviral therapy (HAART) combinations which focus on the base-line CD4+ T-cell count. Further, no data on risk factors for Adverse drug reactions (ADRs) to HAART and there is a lack of data on CD4+ T-cell count recovery after HAART. The aim of this study was to assess risk factors for ADRs to HAART. We also compared the efficacy of HAART combinations with respect to base-line CD4+ T-cell count and CD4+ T-cell counts recovery in Indian HIV positive patients. A prospective active surveillance study was adopted at the Antiretroviral Therapy (ART) Centre, District Government Hospital, Udupi, India. HIV-infected patients were intensively monitored to identify risk factors associated with ADRs to HAART from August 2009 to May 2012. The study protocol was approved by the University ethics committee. Baseline CD4+ T-cell count before initiation of HAART and thereafter at every six months of regular follow-up up to 24 months duration was included for comparison. Multivariate logistic regression analysis was used to identify predictors of high risk factors of ADRs. CD4+ T-cell count recovery after HAART from base-line CD4+ T-cell count in different HAART groups was analyzed by test of between-subject effects. P-value <0.05 was considered as statistically significant. A total of 1982 HIV positive patients were enrolled with 1181 (59.6%) males, and 801 (40.4%) females. On multivariate logistic regression analysis, four factors were found to be predictors of high-risk factors for ADRs to HAART: 1) CD4+ T-cell counts, 2) female gender, 3) polypharmacy and 4) opportunistic infections. Between HAART groups, a mean increase of 98 cells/μl of CD4+ T-cell counts recovery was seen in the 3TC + NVP + D4T group (p < 0.001) at 24 months of regular follow-up. In India, Clinician should take into consideration all possible risk factors associated with the use of HAART in order to avoid and minimize ADRs. As initial CD4+ T-cell count and age of patient decides the rise of CD4+ T-cell counts with HAART. HAART should be initiated at the earliest age in order to attain maximum CD4+ T-cell counts recovery.

A Prospective Study Assessing Tumour Response, Survival, and Palliative Care Outcomes in Patients with HIV-Related Kaposi's Sarcoma at Queen Elizabeth Central Hospital, Blantyre, Malawi

Background. Human-Immunodeficiency-Virus- (HIV-) related Kaposi's sarcoma (KS) has a high prevalence in Africa; however, there is minimal published data on treatment and outcomes in this population. Objective and Design. This was a prospective study of 50 patients, aiming to assess the impact of vincristine therapy on tumour response and survival and to assess palliative care outcomes in patients with HIV-related KS. Methods. 50 consecutive patients were recruited during 2008. Vincristine therapy and highly active antiretroviral therapy (HAART) were given. Tumour response, survival, and chemotherapy-related toxicities were documented. Palliative care outcomes were assessed using the African Palliative Care Association (APCA) Palliative Outcome Scale (POS). Results. The majority of patients were male, and the median age was 33 years. At baseline assessment, the median CD4 T-cell count was 263, and 50% patients had evidence of peripheral neuropathy. The overall response rate was 64% at 6 weeks, and median progression-free survival was 30 weeks. Treatment was generally well tolerated, with peripheral neuropathy the main dose-limiting toxicity. Conclusion. The combination of vincristine and HAART is feasible and effective in a low resource setting, although peripheral neuropathy is a dose-limiting factor. This patient group carries a high mortality and as such adequate access to palliative care is crucial.

Une radiothérapie interne contre l’infection au VIH, la dernière pièce du puzzle ?

Although highly active antiretroviral therapy (HAART) has succeeded in many cases in suppressing ongoing viral replication, the HIV-infected cells are not eradicated by this therapy. In this article, the author proposes a new treatment protocol based on administration of radiophosphorus 32 (32P) with HAART combination. The proposed new protocol consists of the following steps: HAART keeps viral replication below the level of detection. Then, 32P is administered for the removal of the “residual disease”. By its beta emission, incorporated 32P to viral RNA or proviral DNA may kill free virions and productively infected cells, reactivates latently infected cells and makes them vulnerable to immune competent cells and antiretroviral therapy. This new combination may exhibit synergistic interactions between virostatic effects of antiretroviral molecules and radiobiological effect of internal radiotherapy and provide a new tool to purge the viral reservoirs.

Altered oxidative stress indexes related to disease progression marker in human immunodeficiency virus infected patients with antiretroviral therapy

Background It is generally accepted that oxidative stress (OS) is implicated in immunological and metabolic abnormalities during HIV infection. The acting mechanism used by Highly Active Antiretroviral Therapy (HAART) comes to add metabolic alterations. Method This is an observational study assessing the effect of two HAART combinations on redox indicators and on progression markers of disease. A cohort of 84 healthy and 84 HIV+ subjects were followed for 6 months. Fifty-six HIV+ subjects were distributed in group I (AZT, 3TC, IND) and group II (D4T, 3TC, NEV) according to drug combination. Peroxidation potential (PP), glutathione (GSH), malondialdehyde (MDA), total hydroperoxides (HPO), superoxide dismutase (SOD), catalase (CAT), advanced oxidation protein products (AOPP), percent of DNA fragmentation (% FDNA), CD4+, CD38+, CD95+ T lymphocytes subsets, viral load and body mass index (BMI) were measured at baseline and at 6 months. Results After HAART started, CAT values for both groups receiving treatment did not showed significant difference. For group II, all other OS indexes were significantly higher than those for group I and the HIV+ not treated group ( p < 0.05), except for GSH values in group II ( p < 0.05) which was lower than group I values. These data suggest poor prognostic for group II. Not significant differences were found between treatment groups respect CD4+, CD8+, CD38+, CD95+ T cell subset count, viral load and BMI. Conclusions The findings suggest that increased OS occurs additionally to persistent redox imbalance associated to HIV infection during apparently successfully HAART. This conclusion does not only underline HAART associated toxicity but it may be also methodologically important for the follow-up of further clinical studies.

Altered oxidative stress indexes related to disease progression marker in human immunodeficiency virus infected patients with antiretroviral therapy

Background It is generally accepted that oxidative stress (OS) is implicated in immunological and metabolic abnormalities during HIV infection. The acting mechanism used by Highly Active Antiretroviral Therapy (HAART) comes to add metabolic alterations. Method This is an observational study assessing the effect of two HAART combinations on redox indicators and on progression markers of disease. A cohort of 84 healthy and 84 HIV+ subjects were followed for 6 months. Fifty-six HIV+ subjects were distributed in group I (AZT, 3TC, IND) and group II (D4T, 3TC, NEV) according to drug combination. Peroxidation potential (PP), glutathione (GSH), malondialdehyde (MDA), total hydroperoxides (HPO), superoxide dismutase (SOD), catalase (CAT), advanced oxidation protein products (AOPP), percent of DNA fragmentation (% FDNA), CD4+, CD38+, CD95+ T lymphocytes subsets, viral load and body mass index (BMI) were measured at baseline and at 6 months. Results After HAART started, CAT values for both groups receiving treatment did not showed significant difference. For group II, all other OS indexes were significantly higher than those for group I and the HIV+ not treated group ( p < 0.05), except for GSH values in group II ( p < 0.05) which was lower than group I values. These data suggest poor prognostic for group II. Not significant differences were found between treatment groups respect CD4+, CD8+, CD38+, CD95+ T cell subset count, viral load and BMI. Conclusions The findings suggest that increased OS occurs additionally to persistent redox imbalance associated to HIV infection during apparently successfully HAART. This conclusion does not only underline HAART associated toxicity but it may be also methodologically important for the follow-up of further clinical studies.

Non-Hodgkin Lymphomas of the Oral Cavity in AIDS Patients in a Reference Hospital of Infectious Diseases in Argentina: Report of Eleven Cases and Review of the Literature

Extranodal non-Hodgkin lymphoma (NHL) were commonly described in AIDS patients and are related with an atypical morphology and aggressive clinical course. In this single institutional study we evaluated the epidemiological, clinical, immunological, virological, histopathological and the outcome of eleven HIV/AIDS patients with oral cavity lymphomas (OCL). Nine were males and seven intravenous drug abusers. The median of age was 33years and the median of CD4 T cell counts at the time of diagnosis was 97cell/µL. The majority of tumors presented as large and ulcerated masses involving the gingiva, the palate and the jaw. Six of these tumors were diffuse large B-cell lymphomas (DLBCL); three were Burkitt's lymphomas and the final case was a plasmablastic lymphoma. An association with Epstein-Barr virus (EBV) was found in three of the ten tested cases by in situ hybridization (EBER 1 and 2 probes) and immunohistochemistry (LMP-1). Human herpes virus-8 (HHV-8) was detected by polymerase chain reaction (PCR) in only one neoplasm. Six patients died without specific treatment; four received chemotherapy and highly active antiretroviral therapy (HAART) and three of them presented a prolonged survival. Combination of HAART and chemotherapy should modify the poor prognosis of AIDS patients with OCL.

Prevalence of Anaemia in HIV-Infected Children at the University of Abuja Teaching Hospital, Gwagwalada

Use of highly active antiretroviral therapy (HAART) has remained the only regimen potent enough to reduce viral replication in HIV-infected individuals. Its combination with cotrimoxazole has also been recommended in those with CD4% of less than 15%. The use of HAART containing zidovudine (ZDV) in combination with co-trimoxazole carries the risk of anaemia in already anaemic predisposed individuals from HIV infections, opportunistic infections, parasitic infestations, sickle cell anaemia, and malnutrition. The aim of the study is to document the effect of use of combination of HAART containing ZDV with cotrimoxazole in haemoglobin profile of HIV-infected children after one year of its administration at the University of Abuja Teaching Hospital (UATH), Gwagwalada. It is also aimed at comparing the result obtained with those on stavudine containing HAART with co-trimoxazole. A two year prospective study of HIV-infected children on treatment with HAART in combination with co-trimoxazole, and attending the paediatric outpatient special treatment clinic (POSTC) for HIV infected children at the UATH, Gwagwalada from November 2006 to October 2008, was carried out to determine effect of these drug combinations in the haemoglobin profile of infected children. Three monthly PCV level was carried out using haematocrit centrifuge and reader. A total of 173 patients were started on HAART during the first year recruitment period, 90 (52.0%) were males, while 83 (48.0%) females, giving a male to female ratio of 1.1:1. One hundred and seventeen (67.7%) of patients were on ZDV containing HAART, while 56 (32.3%) were on stavudine containing combination. All patients were started on co-trimoxazole prophylaxis with the exception of 6 (3.5%) patients because of drug reaction. The mean PCV of patients on ZDV containing combination with cotrimoxazole decreased from 30.2 +/- 5.5% to 29.0 +/- 2.3%, with a net decrease of 1.2% after one year treatment, those on stavudine containing combination with co-trimoxazole instead showed an increased from initial PCVof 28.3 +/- 4.2% to 34.2 +/- 3.0% with a net increase of 5.9% after the same duration of treatment, (p > 0.05). While patients on ZDV combination alone without co-trimoxazole prophylaxis had a minimal decrease of 0.9% in their PCV level after one year treatment, those on stavudine combination alone without any prophylaxis instead showed an increase of 6.8% in their PCV after the same duration of treatment. A combination of HAART containing ZDV plus co-trimoxazole carries risk of anaemia than that of stavudine containing combination with co-trimoxazole. Such combination should therefore not be given to anaemic patients. Regular check in PCV of patients on HAART combination with ZDV and additional cotrimoxazole prophylaxis is required for early detection of significant drop in PCV level.

Palpebral ptosis related to antiretroviral therapy: report of two new cases and review of the literature

Summary Although highly active antiretroviral therapy (HAART) provides durable clinical benefi ts to individuals who are infected with HIV-1, some of these therapies have been associated with the development of toxicity. Some nucleoside reverse transcriptase inhibitors (NRTIs), the cornerstone of HAART combination regimens, have the potential to cause varied side eff ects, many of which are due to their eff ects on mitochondria. We report 2 cases of HIV-infected patients that developed an uncommon type of mitochondrial toxicity: eyelid ptosis, which seem to be related to the HAART. Furthermore we also review the English literature on this condition (PubMed).

Virological Response to Initial Antiretroviral Regimens Containing Abacavir or Tenofovir

Patients with a baseline viral load >100,000 copies/mL receiving abacavir (ABC) as part of the nucleoside-backbone component of their first highly active antiretroviral therapy (HAART) regimen have been reported to have a greater failure rate than those receiving tenofovir (TDF). We analyzed short-term outcomes of the use of HAART combinations that included ABC or TDF. The mean 2-8-week change in viral load was calculated using linear regression. In total, 1136 patients started ABC, and 412 started TDF. After adjustment for baseline viral load and other factors, there was no difference in the change in viral load between the patients who started ABC and those who started TDF (0.03 [95% confidence interval, -0.07 to 0.12]) log copies/mL; P = .59). Furthermore, there was no evidence that this effect differed according to baseline viral load (P = .88 for the interaction between pre-HAART viral load and nucleoside started). Likewise, there was no difference in rates of virological failure between the 2 drugs at 24-48 weeks after starting HAART.

Beneficial Effects of a Combination of Korean Red Ginseng and Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-Infected Patients

To determine whether Korean red ginseng (KRG) has beneficial effects on human immunodeficiency virus type 1 (HIV-1)-infected patients administered highly active antiretroviral therapy (HAART), we analyzed the CD4 T-cell count, viral load, and resistance mutations to HAART in 46 individuals. Thirteen patients harbored resistance mutations at baseline. The study population was divided into two groups: specifically, a group treated with a combination of HAART plus KRG (23 patients) and a group treated with HAART alone (23 patients). The annual increase in CD4 T-cell count in the combination group was significantly higher than that in the group treated with HAART alone (P < 0.05). Overall, 21 patients harbored resistance mutations after 3 years of therapy. Following exclusion of 13 patients displaying baseline resistance mutations, 7.1% of patients (1/14) in the combination group and 42.1% (8/19) in the HAART group were identified with resistance mutations. One patient with baseline resistance mutations in the combination group did not display resistance mutations 3 years after HAART therapy. High-level resistance mutations were significantly lower in the combination group than in the group treated with HAART alone. Five patients showed no improvement in viral copy number (26.3% [5/19]) in the combination group and 9 (45.0% [9/20]) showed no improvement in the HAART-only group. Our data support the clinical utility of KRG intake during HAART therapy.