Complications In HIV-infected Patients Research Articles

Recurrent thrombosis in an HIV-1 infected child

Though thromboembolic complications in HIV infected patients have been described in literature, recurrent thrombosis is very rare. We present a six-year-old HIV infected boy who presented with recurrent thrombosis. He initially had renal artery thrombosis, then middle cerebral artery thrombosis and finally hepatic vein thrombosis that was fatal.

Platelet-Activating Factor and Its Basic Metabolic Enzymes in Blood of Naive HIV-Infected Patients

Platelet-activating factor (PAF), a mediator of proatherosclerotic inflammatory processes, is also implicated in endothelial dysfunction during human immunodeficiency virus (HIV) infection. We examined PAF metabolism in blood of naive male patients, 8 with early HIV infection (group A) and 17 just before treatment initiation (group B), versus 18 healthy age-matched males (group C). Statistical analysis was performed with 1-way analysis of variance (ANOVA) criterion and Pearson r test. Higher PAF biosynthesis in patients' leukocytes versus group C was accompanied by an increase in lipoprotein-associated phospholipase A2 (Lp-PLA2) activity that degrades PAF. Moreover, PAF synthesis was higher and Lp-PLA2 activity was lower in group B compared to group A. Lipoprotein-associated phospholipase A2 was positively correlated with viral load and negatively correlated with CD4 cell counts in group B. The activities of PAF-basic biosynthetic enzymes in patients' leukocytes were also negatively correlated with CD4 cell counts. The observed continuous increase in PAF biosynthesis during HIV infection progress seems to amplify the risk of AIDS manifestations and/or cardiovascular complications in HIV-infected patients, while a subsequent increase in Lp-PLA2 activity seems to be a host response.

Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69%) were men. At admission all patients were aware of their HIV status and only four (31%) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62%) patients. The neurologic syndromes identified were diffuse encephalitis (n = 7; 62%), polyradiculopathy (n = 7; 54%), focal encephalitis (rhombencephalitis) (n = 1; 8%), and ventriculo-encephalitis (n = 1; 8%). Seven (54%) patients presented extra-neural CMV disease and four (31%) had retinitis. The median of CD4+ T-cell count was 13 cells/µL (range: 1-124 cells/µL). Overall in-hospital mortality was 38%. Eight patients used ganciclovir or foscarnet (in-hospital mortality: 50%) and five patients used ganciclovir and foscarnet (in-hospital mortality: 20%). None of the patients fulfilled the diagnosis criteria of immune reconstitution inflammatory syndrome. Four patients were lost to follow-up, and three patients presented immune recovery and discontinued secondary prophylaxis. Although infrequent, distinct neurological syndromes caused by CMV continue to cause high mortality among AIDS patients. Survival depends upon the use of effective antiviral therapy against CMV and the early introduction of HAART.

HIV Infection, Antiretroviral Therapy and Cardiovascular Risk.

In the last 15 years, highly active antiretroviral therapy (HAART) has determined a dramatic reduction of both morbidity and mortality in human immunodeficiency virus (HIV)-infected subjects, transforming this infection in a chronic and manageable disease. Patients surviving with HIV in the developed world, in larger number men, are becoming aged. As it would be expected for a population of comparable age, many HIV-infected individuals report a family history of cardiovascular disease, a small proportion have already experienced a cardiovascular event and an increasing proportion has diabetes mellitus. Smoking rate is very high while an increasing proportion of HIV-infected individuals have dyslipidaemia. Studies suggest that these traditional risk factors could play an important role in the development of cardiovascular disease in these patients as they do in the general population. Thus, whilst the predicted 10-year cardiovascular disease risk remains relatively low at present, it will likely increase in relation to the progressive aging of this patient population. Thus, the long-term follow-up of HIV infected patients has to include co-morbidity management such as cardiovascular disease prevention and treatment. Two intriguing aspects related to the cardiovascular risk in patients with HIV infection are the matter of current investigation: 1) while these subjects share many cardiovascular risk factors with the general population, HIV infection itself increases cardiovascular risk; 2) some HAART regimens too influence atherosclerotic profile, partly due to lipid changes. Although the mechanisms involved in the development of cardiovascular complications in HIV-infected patients remain to be fully elucidated, treatment guidelines recommending interventions to prevent cardiovascular disease in these individuals are already available; however, their application is still limited.

Prevalence of Cardiac Manifestations in HIV-Infected Patients in Iran

Prevalence of Cardiac Manifestations in HIV-Infected Patients in Iran

Operations about Hip in Human Immunodeficiency Virus-Positive Patients

BackgroundThe number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.MethodsThis study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).ResultsThe preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.ConclusionsThere were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.

Metabolic syndrome associated with HIV and highly active antiretroviral therapy

The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of HIV disease with increased survival rates. However, some HAART regimens, especially those including protease inhibitors, have been shown to cause in a high proportion of HIV-infected patients metabolic (dyslipidemia, insulin resistance) and somatic (lipodystrophy/lipoatrophy) changes that are associated with an increased risk of cardiovascular disease (coronary artery disease and stroke). The pathogenesis of HAART-associated metabolic syndrome and of its atherogenic profile is complex, and several factors are involved, including direct effects of HAART on lipid metabolism, endothelial and adipocyte cell function, activation of proinflammatory cytokines, and mitochondrial dysfunction. A better understanding of the molecular mechanisms responsible for this syndrome will lead to the discovery of new drugs that will reduce the incidence of lipodystrophy and related metabolic complications in HIV-infected patients facing long-term HAART.

Evaluation of quantitative liver function tests in HIV-positive patients under anti-retroviral therapy

Background and aimsQuantitative tests of liver function (QTLF) which are based on the hepatic metabolism or clearance of test substances have been successfully used to predict prognosis of a variety of different liver diseases. Still sufficient data in HIV-patients under anti-retroviral therapy (ART) are lacking. Therefore, the aim of this prospective study was to investigate if and to what extent ART influences a broad panel of quantitative tests of liver function in patients with HIV-infection.Patients and methodsNineteen patients (14 males, 5 females, mean age 40 years) with HIV-infection underwent QTLF including lidocaine half-life test (LHT), galactose elimination capacity (GEC), and indocyanine green clearance (IGC). These tests were performed before and 3 to 6 months after initiation of anti-retroviral therapy. Twenty age-matched healthy, medication-and virus-free adults served as controls.ResultsLidocaine half-life was significantly lower in HIV-patients without ART. Combining anti-retroviral therapies shifted cytochrome p450 activity back into standard ranges. Galactose elimination capacity as a parameter of cytosolic liver function and indocyanine green clearance as a parameter of liver perfusion were not affected by ART.ConclusionsQTLF may be a tool to predict prognosis or hepatic complications in HIV-infected patients with liver disease. Early determination of lidocaine half-life seems to be useful - this should be considered during the treatment of HIV-positive individuals.

PPARs in Viral Disease

This special issue of PPAR Research contains an exciting array of valuable reviews examining the relationship between PPARs and various viral infections, varying from HIV to HCV and HBV. This assembly of reviews includes a group of three complimentary reviews addressing different facets of the cross-talk between HIV infection and antiretroviral treatment as well as the potential beneficial role of PPARγ in HIV-associated lipodystrophy. First, Giralt et al. detail the cross-talk between HIV infection and PPARγ leading to the reported negative impact of this interplay on adipose tissue physiology. They also present literature on the reciprocal, yet contradictory roles of PPARα and PPARγ on HIV-1 replication and transcription. Second, Caron et al. describe the effect of ART on adipocyte PPARγ expression in vitro, in animal models, and in HIV-infected patients. These authors also report on the intriguing connection between PPARγ, activated macrophages found in the adipose tissue and ART. In the third review of this series, J. Sutinen closely examines the results of 14 different clinical trials which evaluated if the PPARγ thiazolidinedione agonists could be useful in the treatment of HAART-associated metabolic complications in HIV-infected patients. Upon careful evaluation of the reported results, Sutinen concludes that these agonists produce a very modest, if any, effect on lipoatrophic subcutaneous adipose tissue, despite their improvement of insulin sensitivity in treated patients. The review by Doran and coworkers focuses on the studies dealing with the potential role of PPARγ in HIV-1-associated bone disease. These authors put forth a provocative hypothesis which stipulates a potential role for PPARγ in the reduced bone mass associated with HIV-1 infection and treatment. Specifically, they suggest a possible dysregulation of the activity of PPARγ in undifferentiated stromal cells or in partially differentiated preosteoblast and preadipocyte cells. The liver which is impacted not only by HIV but also by HBV and HCV is the focus of several excellent reviews in this special issue. In a review by Lemoine and coauthors, the role that PPARs play in HIV infection, in terms of associated metabolic disorders, disease progression, coinfections with HBV or HCV, and response to antiviral treatment, is featured. In addition, the summary by Lemoine et al. of the experimental and clinical data regarding PPARS in HIV-associated liver disease provides a rationale for the use of PPARγ agonists as therapeutic agents in these patients. Further, Negro reviews experimental and clinical data suggesting that HCV may interfere with hepatic insulin signaling, possibly involving the downregulation of the PPARγ. Capitalizing on the known involvement of PPARs in lipid metabolism, inflammatory process, and fibrogenesis, Dharancy et al. have summarized experimental and human studies showing a diminished expression and function of PPARα and PPARγ during HCV infection. These authors also review the potential benefits of nonhepatotoxic PPARα/γ agonists as therapeutic agents to treat chronic hepatitis C. In another valuable review by Dubuquoy and coauthors, the potential of PPARs to modulate HBV transcription and replication is summarized. The authors report that, in HBV transgenic mouse model, activation of PPARα increased the transcription and replication of HBV, thus concluding that modulating the PPARα/RXR heterodimer may be an interesting therapeutic option to control HBV infection. We are assured that the reviews presented in this special issue, on the interplay between PPARs and viral disease, will be highly useful for those with interest in the field. Jacqueline Capeau Lawrence Serfaty Mostafa Badr

Cardiovascular complications and atherosclerotic manifestations in the HIV-infected population: type, incidence and associated risk factors

Before the introduction of successful antiretroviral therapy (ART), cardiovascular complications in HIV-infected patients were largely those resulting from immunosuppression (e.g. myocarditis, pericarditis, tamponade). With the advent of ART, there has been a spectacular decrease in morbidity and mortality in HIV-infected individuals. However, alongside metabolic complications caused by ART such as insulin resistance, dyslipidemia and lipodystrophy syndrome have been observed, which potentially increase the risk of cardiovascular complications, in particular coronary artery disease. Whether HIV infection and ART are independent and individual coronary risk factors is still controversial. More and more data are available demonstrating that increasing the duration of exposure to ART, and in particular protease inhibitors, increases the risk of myocardial infarction. At the same time, chronic infection, inflammation and the disruption of immune balance as a result of HIV infection itself may have the potential to alter vascular structure and function. In this article, we will review cardiovascular complications in HIV-infected patients before and after the advent of ART, focusing on coronary artery disease, its diagnosis, prognosis and therapy.

Oral HPV complications in HIV-infected patients

Human papillomavirus (HPV) infection and disease, including that of the oral cavity, has not dramatically declined since the introduction of potent combination therapy to control HIV. Two manifestations of HPV in the oral cavity that may be on the rise are HPV-32-associated oral warts and HPV-16-associated oral cancers. A current research focus is the natural history of HPV infections in the oral cavity. A better understanding of the natural history of oral HPV infections could lead to improved diagnosis and treatment for oral HPV complications in HIV-positive patients.

Diagnosis and Management of Common Chronic Metabolic Complications in HIV-infected Patients

Human immunodeficiency virus (HIV) infection has become a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Metabolic complications such as dyslipidemia, insulin resistance, diabetes mellitus, obesity, and fat distribution abnormalities are associated with increased risk of cardiovascular disease. Cardiovascular disease is now a leading cause of death among HIV-infected patients. Lipid abnormalities, now often characteristically seen with HIV infection, include elevated triglycerides and low elevated total cholesterol (TC), and low high-density lipoprotein (HDL) levels of total and HDL cholesterol. Many antiretroviral drugs are associated with lipid abnormalities, which commonly include hypertriglyceridemia and increased total and low-density lipoprotein cholesterol levels. The management of dyslipidemia includes lifestyle modifications, lipid-lowering therapy, and switching antiretroviral therapy (ART). The increased prevalence of insulin resistance, impaired glucose tolerance, and diabetes is multifactorial in etiology. Management and goals of diabetes should follow the same practice guidelines in non-HIV-infected patients. Drug interactions and switching ART are additional management measures in diabetic HIV-infected patients. Since the treatment of lipodystrophy is a challenge, its prevention by selecting appropriate ART is the key.

HIV-Associated Non-Hodgkin Lymphoma in 114 Patients with Undetectable HIV Viral Load at NHL Diagnosis.

Although the incidence of HIV-associated Non-Hodgkin lymphoma (NHL) has decreased since the use of combination antiretroviral therapy (cART) and survival has improved, NHL still represents one of the most frequent and severe complications in HIV-infected patients. Out of the 361 patients included in a cohort of HIV-NHL from 1996 to 2006, 114 patients had undetectable (? 500 copies/ml) plasma HIV-RNA. These patients were included in a study to analyze the characteristics of NHL over time according to the duration of HIV infection control. All available histological samples were reviewed by a single pathologist. Tumor was defined as virus-associated (VposNHL) if EBV (ISH, IHC or PCR) or HHV-8 (IHC or PCR) were detected in the tumor cells, and not virus-associated (VnegNHL) if nor EBV nor HHV8 were detected. Comparisons were performed using non parametric tests. All patients were treated with cART, with a median duration of 24 months (IQR, 2–119). The median duration of HIV replication control was 9.3 months (IQR, 0.13–90.5). Most cases (63%) had occurred within 18 months of HIV control versus only 37% after M18. When comparing characteristics of NHL in patients with less or more than 18 months of HIV control, the patients were older (52 years versus 41 years, P<10–4), have a longer median duration of HIV infection (4 years versus 2.4 years, P=.006), and a higher median CD4 cell count (346 × 106/L versus 275 × 106/L, P=.03) when HIV control was >18 months versus ?18 months. None of the NHL features (histology, phenotype, staging, ECOG, LDH, B symptoms) were different between the 2 groups. Virus-association could be assessed for EBV and HHV-8 in 96 cases (84%): 52 patients presented with a virus-associated tumor (31 EBV+, 13 HHV-8+, 8 both) and 43 tumors were not virus-associated. There was no difference in this repartition according to the duration of HIV control (P=.62).VposNHLVnegNHLVundeterNHLHIV-RNA <500 cop/ml < 18 months302814HIV-RNA <500 cop/ml > 18 months16134Median CD4 cell count (×106/L)280290317Virus-associated tumors were neither associated with CD4 cell count (P=.86), nor with CD8 cell count (P=.78). In conclusion, NHL still occur in patients with HIV controled infection (30% of HIV-NHL), but within the first 18 months after plasma HIV-RNA becomes undetectable in most patients. After 18 months, the incidence dramaticaly decreased. However, characteristics of NHL and specifically the association with EBV and/or HHV-8 were not different according to the duration of control of HIV infection.

Visceral Fat as Target of Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome

HIV-associated lipodystrophy or lipoatrophy, unreported before the introduction of highly active antiretroviral therapy (HAART), was first described in 1998, and has a prevalence ranging from 18% to 83%. As in genetic lipodystrophy syndromes, fat redistribution may precede the development of metabolic complications (dyslipidemia, insulin resistance) in HIV-infected patients receiving HAART. The pathogenesis of HAART-associated lipodystrophy and metabolic syndrome is complex and a number of factors are involved, including direct effects of HAART on lipid metabolism, endothelial and adipocyte cell function, and mitochondria. Protease inhibitors are responsible for a decrease in cytoplasmic retinoic-acid protein-1, in low density lipoprotein-receptor-related protein and in peroxisome proliferator activated receptor type-gamma. Nucleoside reverse transcriptase inhibitors, and thymidine analogues, are responsible for mitochondrial dysfunction as demonstrated by a decrease in subcutaneous adipose tissue mitochondrial DNA content. Both phenomena are responsible for a decreased differentiation of adipocytes, increased levels of free fatty acids and lipoatrophy. The increased levels of proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha and interleukin-6 may further contribute in development of lipodystrophy. TNF-alfa activates 11-beta-hydroxysteroid dehydrogenase type-1, which converts inactive cortisone to active cortisol, resulting in increased lipid accumulation in adipocytes and insulin resistance. HAART drugs and inflammatory cytokines are associated with a decrease in adiponectin. The levels of adiponectin and adiponectin-to-leptin ratio correlate positively with insulin resistance in HIV-infected patients with lipodystrophy. HAART-associated metabolic syndrome is an increasingly recognized clinical entity. The atherogenic profile of this syndrome may increase the risk of cardiovascular disease even in young HIV-infected patients. A better understanding of the molecular mechanisms responsible for this syndrome will lead to the discovery of new drugs that will reduce the incidence of lipodystrophy and related metabolic complications in HIV-infected patients receiving HAART.

First Italian Consensus Statement on Diagnosis, Prevention and Treatment of Cardiovascular Complications in HIV-infected Patients in the HAART Era (2006)

The present document contains recommendations for assessment, prevention and treatment of cardiovascular risk for HIV-infected patients. All recommendations were graded according to the strength and quality of the evidence and were voted on by 73 members of the Italian Cardiovascular Risk Guidelines Working Group which includes both experts in HIV/AIDS care and in cardiovascular and metabolic medicine. Since antiretroviral drug exposure represents only one risk factor, continued emphasis on an integrated management is given. This should include prevention and treatment of known cardiovascular risk factors (such as dyslipidaemia, diabetes, insulin resistance, healthy diet, physical activity, avoidance of smoking), but also rational switch of antiretroviral drugs. A rational switch strategy should consider both metabolic and anthropometric disturbances and effectiveness of antiretroviral regimens.

Venous and arterial thrombosis in patients with HIV infection

Thromboembolic complications in HIV-infected patients have been reported. To our knowledge, no case-control studies have compared the prevalence of thromboembolic events between HIV-positive and HIV-negative individuals. One hundred and sixty-nine HIV-infected patients and 180 randomly selected blood donors were enrolled. Selected patients completed a specific questionnaire and were subsequently interviewed. Information was collected on family and personal history of cardiovascular disorders and the presence of personal risk factors for venous and arterial thrombosis. All reported events were adjudicated only if adequate documentation of objective tests was available. Mean age and sex were similar in the two groups. A vascular event was documented in six HIV-infected patients (3.55%) and in none of the controls (P=0.0108). Family history of cardiovascular disorders, cigarette smoking and hypertriglyceridemia were more prevalent in HIV patients than in controls. In multivariate analysis, neither family traditional cardiovascular risk factors nor HIV infection were independently associated with the presence of thromboembolic events. The results confirm the hypothesis that HIV-positive patients have an increased risk of thromboembolic disorders. Whether this increased risk has been provoked by HIV infection itself or by other associated risk factors for cardiovascular events, such as cigarette smoking and hypertriglyceridemia, remain to be clarified.

Cardiovascular complications of HIV: an overview of risk and a novel approach to prevention ??? the HIV polypill study

To review the risk of cardiovascular complications in HIV-infected patients receiving combination antiretroviral treatment. Recent data suggest that patients with chronic HIV infection will require continuous lifelong combination antiretroviral treatment, which may increase the risk of cardiovascular disease in all populations by substantial amounts. Simple, safe and effective interventions to reduce cardiovascular complications in HIV-infected patients will be required. Studies in the general population suggest that the primary prevention of cardiovascular disease with a pill combining blood-pressure-lowering, cholesterol-lowering and antiplatelet treatments (a polypill) might decrease cardiovascular events. An HIV polypill study with 8000 HIV-infected patients with a moderate risk of cardiovascular disease randomized to either a polypill of low-dose pravastatin, aspirin, hydrochlorothiazide and lisinopril or to placebo is described. The primary clinical endpoint would be a composite of cardiovascular mortality, non-fatal myocardial infarction and stroke. A vanguard study of 400 patients could assess changes in cholesterol, blood pressure and other risk factors. The clinical endpoint study described would have 80% power to detect a 23% reduction in the rate of cardiovascular events in the polypill arm. A study of a polypill like that proposed for the general population will provide crucial information on the risks and benefits of primary cardiovascular prevention in HIV-infected patients.

Clinical characteristics and mid‐term prognosis of acute coronary syndrome in HIV‐infected patients on antiretroviral therapy

Acute coronary syndromes (ACSs) and coronary artery disease are emerging complications in HIV-infected patients on highly active antiretroviral treatment. The aim of this study was to determine the mid-term prognosis of ACS in HIV-infected patients. We evaluated the clinical characteristics and follow-up profile [38+/-15 months; mean+/-standard deviation (SD)] of ACS in 20 HIV-infected patients (mean +/-SD: age 44+/-8 years; range 35-65 years). All had coronary angiograms performed mean time 3+/-48 h after the onset of symptoms. Eighteen patients were on antiretroviral therapy, of whom 13 patients were on regimens including protease inhibitors (mean duration+/-SD: 19+/-13 months). Fifteen patients had a first episode of ST segment elevation ACS and five had non-ST segment elevation ACS. Tobacco consumption (80%) and hypercholesterolaemia (50%) were the most frequent cardiovascular risk factors. During initial hospitalization, four patients were treated with thrombolysis, two had primary coronary angioplasty and seven had secondary coronary angioplasty. At follow up, 10 patients (50%) had had 18 cardiovascular events: one cardiovascular death, seven episodes of recurrent myocardial ischaemia in four patients, three pulmonary oedemas in two patients, and seven revascularization procedures in five patients. This preliminary report highlights the risk of ACS and related complications in HIV-infected patients and raises questions regarding the implications of antiretroviral treatment.

HAART-related nephropathies in HIV-infected patients

There is no doubt that highly active antiretroviral therapy (HAART) has been the most important progress in the therapy of human immunodeficiency virus (HIV)-infected patients in the last decade. A growing number of observations suggest that the beneficial effects of HAART also include improvement of HIV-related renal complications. Consequently, the cohort of HIV-infected patients requiring HAART has increased and includes patients with preexisting nephropathies, whether related or unrelated to HIV infection. However, some antiretroviral drugs may have renal- and life-threatening side-effects, especially if underlying renal abnormalities exist. In this review, we focus on those aspects that require particular attention in preventing new health complications in HIV-infected patients.

Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS‐related Burkitt's lymphoma

Treatment of AIDS-related malignant lymphoma (ARL) remains a therapeutic challenge. There are concerns not only about infectious and haematological complications in HIV-infected patients during intensive chemotherapy, but also about potential interactions between chemotherapy and highly active antiretroviral therapy (HAART). Current data on patients treated concomitantly with intensive chemotherapy and HAART are limited, and no data exist on patients with ARL suffering from active opportunistic infections. We report the case of a 38-year-old man with advanced HIV-1 infection, pulmonary tuberculosis and Burkitt's lymphoma. Intensive chemotherapy was administered in parallel with tuberculostatic therapy and HAART. Six months later, the patient achieved not only a complete remission of Burkitt's lymphoma and sustained viral suppression, but also a full recovery from tuberculosis. This case report provides some useful observations on the successful application of intensive chemotherapy in addition to tuberculostatic therapy and HAART in HIV-infected patients.