Duration Of Highly Active Antiretroviral Therapy Research Articles

Prevalence of integrase strand transfer inhibitor resistance in people living with HIV and virological failure.

This study aims to delineate the resistance profiles of integrase strand transfer inhibitors (INSTIs) among patients in southern Taiwan who had experienced antiretroviral therapy (ART) failure. We focused on individuals previously treated with highly active ART (HAART) regimens, providing insights into the implications of INSTI resistance in a broader treatment-experienced population. Data were collected from patients failing an INSTI-containing regimen in a medical center in southern Taiwan between 2009 and 2022. Virological failure was defined as a plasma viral load >1000 copies/mL. Reverse transcriptase, protease, and integrase coding regions were sequenced at failure. Resistance-associated mutations included in the 2022 International Antiviral Society (IAS)-USA list were used. Drug resistance was analyzed using the HIV Stanford HIVDB 9.4 edition algorithm. Logistic regression analysis was used to analyze the risk factors associated with INSTI failure. A total of 184 patients were enrolled for genotypic drug resistance testing due to virological failure, of whom 104 failed on nonnucleoside reverse transcriptase inhibitors, 58 on protease inhibitors (PIs), and 21 on INSTIs. Among 21 patients who failed INSTI therapy, 6 failed raltegravir-based treatment, 3 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/COBI/FTC/TAF), 2 bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), and 10 abacavir/dolutegravir/lamivudine (ABC/DTG/3TC). Only 10 patients had INSTI drug resistance testing results available, and 40% (4/10) showed INSTI resistance at failure. Among the seven patients who failed on second-generation INSTIs with drug resistance reports available, one harbored E157Q and another with R263K mutations, respectively. Multivariable logistic regression analysis showed that patients with INSTI failure were less likely to have pol resistance (p = 0.007, adjusted odds ratio [OR], 0.176, 95% CI, 0.050-0.618), less previous exposure to NNRTI (p = 0.003, aOR, 0.063, 95% CI, 0.010-0.401), PIs (p = 0.002, aOR, 0.030, 95% CI, 0.003-0.272), and with long duration of HAART (p = 0.018, aOR, 1.02, 95% CI, 1.003-1.037). INSTI resistance was uncommon when used as the first-line single tablet regimen in Taiwan. The results confirmed the robustness of ABC/DTG/3TC and BIC/FTC/TAF regarding integrase resistance in cases of virological failure in routine clinical care.

Physical growth and sexual maturation of perinatally HIV-infected adolescent males in a southeast Nigerian tertiary hospital: a comparative cross-sectional study

BackgroundThe advent of highly-active anti-retroviral therapy (HAART) has resulted in the survival of children with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) into adolescence. Their prolonged survival has translated into co-morbidities like endocrine deficiencies which may manifest as growth and pubertal delay. This study aimed to determine the physical growth and sexual maturation of perinatally HIV-infected adolescent males and compare them with those of age-matched HIV-negative controls.MethodsWe conducted a comparative cross-sectional study of 104 perinatally HIV-infected males on HAART aged 10 to 19 years, and 104 age-matched HIV-negative males who served as controls. The subjects and controls were enrolled and assessed at a Nigerian tertiary hospital over six months. Anthropometric measurements such as weight, height, and BMI were obtained and Z scores for age were derived for weight, height, and BMI to determine physical growth using WHO AnthroPlus software. Sexual maturation was assessed using the method proposed by Marshall and Tanner. Data analysis and appropriate statistics were conducted with the Statistical Package for Social Sciences (SPSS) version 25 Chicago IL. A p-value < 0.05 was adopted as the level of statistical significance.ResultsThe mean height, weight, and BMI Z scores of the subjects were all lower than those of the controls. The difference between the mean weight of the subjects (44.60 ± 13.32 kg) and the controls (49.97 ± 13.58 kg) was statistically significant (t = 2.88, p = 0.004). Similarly, the difference between the mean BMI Z-scores of the subjects (-0.96 ± 1.95) and the controls (-0.10 ± 0.86) was statistically significant (t = 4.10, p = < 0.001). The subjects showed a delay in pubic hair and testicular development for Stages 1, 2, and 3. Duration of HAART did not significantly affect the BMI of subjects who were in three groups: undernutrition, normal nutrition, and overnutrition (Kruskal-Wallis test, p = 0.30).ConclusionPerinatal HIV infection negatively affects physical growth and the onset of pubic-hair development (PH 2) despite the duration of HAART. We recommend that screening for weight deficit or pubertal delay should form part of the management protocol for HIV-infected male children on HAART.

Dyslipidemia and associated risk factors among HIV/AIDS patients on HAART in Asmara, Eritrea.

Though the initiation of Highly Active Antiretroviral Therapy (HAART) has led to decreased HIV/AIDS related mortality, the regimen has been reported to be associated with lipid toxicities. Baseline data on such disturbances are required to induce countrywide interventional HIV/AIDS programs. The aim of this study was to determine the frequency and risks of dyslipidemia in HIV patients on HAART medication in Eritrea. A cross sectional study was conducted on HIV/AIDS patients in two national referral hospitals in Asmara, Eritrea. A structured questionnaire was used to collect demographic data and blood sample was taken for analyses of lipid profile tests. Data was analyzed using chi-square test, Post Hoc and logistic regression in SPSS software. The study included 382 participants of whom 256(67%) were females. Their median age, CD4+ T cell count (cell/microliter) and duration of HAART (years) was 45(IQR: 38-51), 434(IQR: 294-583) & 5(IQR: 3-5) respectively. The prevalence of dyslipidemia was 331(86.6%). Increased Low Density Lipoprotein-C (LDL-C) 213(55.8%) was the predominant abnormality. Abacavir was significantly related with highest means of triglycerides (TG) (228.17 ± 193.81) and lowest means of High Density Lipoprotein (HDL-C) (46.94 ± 12.02). Females had substantially higher proportions of TG (aOR = 2.89, 95% CI: 1.65-5.05) and TC/HDL ratio (aOR = 2.33, 95% CI: 1.40-3.87) and low HDL-C (aOR = 2.16, 95% CI: 1.34-3.48). Increased age was related with increased pro-atherogenic lipid parameters. High LDL-C was more infrequent in non-smokers (aOR = 0.028, 95% CI: 0.12-0.69). The study showed a high prevalence of dyslipidemia in HIV-patients receiving HAART in Eritrea. Sex, age and smoking practice were among key factors associated with dyslipidemia. The necessity to assess lipid profiles and other cardiovascular risk factors before initiation of HAART treatment and continuous monitoring during therapy is mandatory.

The Effect of Highly Active Antiretroviral Therapy (HAART) on Accommodative-Convergence Mechanism among HIV/AIDS Patients in North-Western Nigeria.

The introduction of Highly Active Anti-Retroviral Therapy (HAART) has led to a dramatic decrease in Human Immune Deficiency Virus (HIV) related morbidity and mortality in the developed as well as developing world. Whilst HAART has been effective in reducing rapidly progressive retinopathies, there are other ocular manifestations of HIV which are yet to be determined, characterised and addressed. The aim of the study was to determine the effect of HAART on Accommodative-Convergence mechanism among HIV/AIDS patients in Northwestern, Nigeria. This was hospital-based cohort study carried out from April 2019 to November 2019. Participants that met the inclusion criteria were recruited and were separated into two groups A and B. Group A were those about to commence HAART referred to as HAART naive, while group B were subdivided into four groups; comprising of B1: those that had been on HAART for 0 - 2½ years, group B2: >2½ - 5 years, group B3: >5 - 7½ years, and group B4: >7½ - 10 years, termed as HAART experience. Information obtained from the patients included sex, age, marital status, Near Point of Convergence (NPC), Amplitude of Accommodation (AA), Presbyopic reading Addition (ADD), CD4+ T cell count, HAART regimen and duration on HAART therapy. There were 400 participants aged 25 - 55years with a mean age of 37.86 ± 7.5years. The participant's NPC mean was 6.4 ± 1.47cm with a range of 2 - 18cm. Most of the participants 336 (84.0%) had an abnormal Near Point of Convergence compared to 64 (16%) with normal NPC values. The mean AA was 4.18± 1.34DS, ranging from 0.75 to 10.0DS and about 273 (68.2%) of the participant's AA was within 3 to 5DS. The mean presbyopic addition was 1.39± 0.98 DS ranging from 1.00 to 3.50DS whilst majority of the participants, 305 (76.2%) had an abnormal Reading Addition. The study showed that the HIV/AIDS patients on HAART exhibit an abnormally low AA, receded NPC and High presbyopic reading addition as compared to age matched HAART naïve. There was a statistically significant association between AA and HAART (p = 0.002) and HAART duration (p = 0.00), but there was no association with their CD4+ T cell levels and HAART regimen (p = 0.12, p = 0.08). There was no statistically significant association between Abnormal reading addition and HAART (p= 0.46), CD4+4 T cell levels and HAART regimen (p=0.53 and p= 0.59), but there was a statistically significant association with HAART duration (p= 0.00).

A Real-world Evidence-based Management of HIV by Differential Duration HAART Treatment and its Association with Incidence of Oral Lesions.

BackgroundThe efficacy of highly active antiretroviral therapy (HAART) can be estimated by the immunological response and the incidence of opportunistic infections.ObjectiveThis study aimed at evaluating the effectiveness of different durations of HAART in terms of immunological response markers (CD4 count and CD4/CD8 ratio) along with disease progression markers (incidence of oral lesions) in Chinese patients with HIV.MethodsThis single-center, retrospective, and real-world study included patients with HIV, grouped into a treatment group and treatment-naïve group, of which the former was further divided into 6, 12, and 18 months based on the treatment duration. The CD4 and CD8 cell counts were analyzed by the FACSCalibur flow cytometry. Kruskal-Wallis test was applied to determine the outcome of different duration of HAART. Oral examination was carried out according to the WHO type IV examination.ResultsIn 246 patients with HIV, CD4 counts increased significantly post-HAART compared to pre-HAART in all three treatment groups (P<.001), while CD8 count decreased significantly (P<.05) in all three treated groups. A significant association of HAART with the CD4/CD8 ratio was observed (P<.001). A significant increase in CD4 count was observed between 12-months and 18-months treatment groups (P<.05). The occurrence of oral lesions reduced significantly in the treatment group.ConclusionWe observed a better response to the HAART regimen with 18-months of duration than 12-months and 6-months therapies and reduction in oral lesions.

Manifestation of cardiopulmonary exercise testing in an HIV-infected patient with highly active anti-retroviral therapy: A Case Report

Background: Human immunodeficiency virus (HIV) is a retrovirus that causes severe immunodeficiency syndrome in most patients if left untreated. It has been a reportable disease in Taiwan since 1984, and was diagnosed in 41,679 patients until June 2020. However, there is no previous study evaluating aerobic capacity in HIV-infected patient in Taiwan. Case report: A 50-year-old male with HIV infection visited our rehabilitation center for cardiopulmonary exercise testing (CPET) due to dyspnea on exertion sometimes. He received a highly active antiretroviral therapy (HAART) regimen since 2015. He could achieve VO2max during CPET. The maximal aerobic ability was about 91.95% of the predicted, and functional aerobic impairment (FAI) was within normal limit. His VO2 peak was 8.3 MET, equal to 29.05 mL/kg/min. Additionally, VO2 AT was 4.5 MET, equal to 15.75 mL/kg/min. We make recommendations of physical exercise training program according to CPET results. Conclusion: The difference of disease duration, HAART regimen and time of HAART will affect the cardiopulmonary fitness results. However, our HIV-infected patient showed normal aerobic fitness following the CPET, and aerobic capacity did not impair in HIV-infected patient receiving HAART due to personalized life-style modification.

Prevalence and predictors of Kaposi’s sarcoma among HIV patients receiving care at a tertiary hospital in Jos, Nigeria

Background Kaposi’s sarcoma became prevalent with the appearance of human immune deficiency virus (HIV) in the 1980s. However, the widespread use of the highly active antiretroviral therapy (HAART) reduced its prevalence in communities with good access to the antiretroviral drugs. The objective of this study was to determine the prevalence and predictors of Kaposi’s sarcoma among persons receiving HIV care at a tertiary hospital in Jos, Nigeria. Methods The study used a cross-sectional study design, based on secondary data related to patients who had received HIV care between January 2004 and December 2017. Logistic regression was then used to determine the variables that were predictors of Kaposi’s sarcoma risk. Results The prevalence of Kaposi’s sarcoma among the patients was 1.2% (95% confidence interval, CI=1.06-1.34). Patients whose baseline viral loads were higher than 10,000 copies/mm3 were three times more likely to develop Kaposi’s sarcoma than those with lesser viral load (OR: 3.13, CI: 2.19-4.47). Gender, duration of HAART and education had modifying effect on the Kaposi’s sarcoma risk. Conclusions Kaposi’s sarcoma is a substantial public health problem among the HIV population in Jos. Universal access to HAART by the Federal Government of Nigeria and its partners is recommended to reduce its prevalence. In addition, education, skill acquisition and income generating programs should be targeted at girls and women by governments and other stakeholders in order to reduce the inequality that worsens their vulnerability to HIV infection and Kaposi’s sarcoma.

Prevalence of protein energy malnutrition in HIV-infected under five children and the effects of highly active antiretroviral therapy on their nutritional status in Nigeria

Aim: To determine the prevalence of malnutrition among HIV- infected under-five children and effect of highly active antiretroviral therapy (HAART) on the nutritional status. Method: This cross-sectional and descriptive study was conducted among under-fives presenting at the Paediatric HIV clinic in a tertiary centre in Nigeria. HIV positive children aged less than five years, who were on HAART and whose parents/caregivers gave consent were included. Odds ratios (ORs) and their 95% confidence intervals (CIs) were determined in a multivariate logistic regression analysis and p-values of &lt;0.05 were considered significant. Result: A total of 92 HIV positive children comprising 52 (56.5%) males and 40 (43.5%) females were recruited, giving a ratio of 1.3:1. Children who were more than 48 months of age were (46.7%), while (9.8%) were aged 24 months or less. The mean age of the children was 44.5+12.9 months, while that of the male and female children were 43.9 +13.1 months and 45.2+12.6 months, respectively, and their age difference was statistically insignificant. The prevalence of undernutrition was 40.2% with a significantly higher proportion of them being male children (P= 0.02) while 1.1% of the children was overweight. The prevalence of severe wasting, severe underweight and severe stunting were 2.1, 3.3 and 17.4% respectively. A total of 12 (13.0%) were wasted, 14 (15.2%) were underweight, and 26 (28.3%) were stunted. Children who received HAART for more than 12 months were less likely to be wasted (P=0.02). Multivariate logistic regression also showed that being a male increased the risk of being underweight (OR=2.55, 95%CL=1.06-6.16) and stunted (OR=2.67, 95%CL=1.32-5.40). Conclusion: Malnutrition remains a problem of children living with HIV even while they are on HAART. The longer duration of HAART is significantly associated with better nutritional status.

Antifungal drug susceptibility of fungal isolates in patients with human immunodeficiency virus receiving highly active antiretroviral therapy

<h3>Objectives</h3> Given the evolving drug therapy options and consequent opportunistic infections, antifungal drug resistance is a major concern in patients with human immunodeficiency virus (HIV) undergoing highly active antiretroviral therapy (HAART), prompting the need for clinically relevant antifungal susceptibility testing. The goals of the present study were to determine the asymptomatic oral fungal carriage and species distribution in patients with HIV infection receiving HAART in Kerala State, India, and to evaluate the antifungal susceptibility/resistance profile of these oral fungal isolates. We also sought to identify any correlation between antifungal susceptibility/resistance with respect to the duration of HAART therapy and if there was an association between oral fungal colonization, CD4 counts, and risk factors. <h3>Methods</h3> Thirty HIV-positive patients receiving HAART were divided into 2 groups based on duration of HAART (group 1, <2 years; group 2, >2 years). A detailed history, including demographic characteristics, treatment details, and presence of any risk factors for candidiasis, was taken before saliva sample collection by the oral rinse method. Candidal growth and colonies were evaluated on the Sabouraud slope. Germ tube, sugar assimilation, and fermentation tests were used for identification of species. When conventional methods failed to identify any fungal isolates, they were verified using the automated VITEK-2 YST system (bioMérieux, Marcy l'Etoile, France). The Wilcoxon signed-rank test was used to compare the CD4⁺ lymphocyte count before and after initiation of HAART. The association of risk factors with candidiasis was analyzed using the chi-square test. <h3>Results</h3> Overall culture positivity was 83.3%. <i>Candida albicans</i> was the most prevalent species (57.7%), followed by <i>Candida tropicalis</i> (26.9%). All except for 1 patient had a single fungal isolate. In vitro antifungal susceptibility testing of the isolates revealed that all candidal species were sensitive to amphotericin B. <i>Candida krusei</i> showed 100% resistance to fluconazole. All candidal species except <i>Geotrichum klebahnii</i> showed increased resistance to itraconazole. Comparison between initial and recent CD4⁺ counts revealed improvement in the CD4⁺ count after HAART, but no change in fungal population. Of the study sample, 63.3% had risk factors for candidiasis other than being immunocompromised, and colonization was increased in those with risk factors compared with those without risk factors. <h3>Conclusions</h3> The present study showed the distribution of yeast species and the antifungal drug susceptibility of fungal isolates in patients with receiving HAART.

Evaluating the effect of highly active antiretroviral therapy on visual acuity and intraocular pressure among HIV/AIDS patients in Kano State, Nigeria

Highly Active Anti-Retroviral Therapy (HAART) has been effective in reducing rapidly progressive retinopathies, there are other ocular manifestations of HIV and ocular side effects of HAART which are yet to be determined and evaluated. The aim of this study was to investigate and evaluate the effect of HAART on Visual Acuity (VA) and Intraocular Pressure (IOP) among HIV/AIDS patients in Kano State, Nigeria. This was a prospective hospital based cross-sectional study; consented patients that fulfilled the inclusion criteria were recruited and grouped into two groups A and B. Group A was those scheduled to commence HAART referred to as HAART naive, while group B was subdivided into four groups, comprising B1, B2, B3, B4, termed as HAART experience. There were 400 participants aged 25 to 55 years with mean age of 37.86 ± 7.5 years. Their mean CD4+ T cell count was 476.94 ± 272.3 cells/mm3. The mean IOP was 14.14 ± 2.65 mmHg and analysis of variance showed that there was no correlation of HAART on IOP. About 370 (92.5%) had the best corrected distance visual acuity (BCDVA) on OU of 6/6, while 30 (7.5%) had BCDVA of less than 6/6 or worse and there was a correlation between HAART and VA (p < 0.01), but statistically insignificant on CD4+ T-cells counts, HAART regimen and its durations. There was a correlation between VA and HAART among HIV/AIDS patients, but it showed no association with CD4+ T cell counts, HAART regimen and HAART duration. There was no correlation of HAART on IOP of the patients. Key words: Highly active antiretroviral therapy (HAART), visual acuity, intraocular pressure (IOP), CD4+ T cell counts.

Diffusion tensor magnetic resonance imaging of white matter integrity in patients with HIV-associated neurocognitive disorders.

BackgroundThis study investigated the efficacy and neurotoxicity of highly active antiretroviral therapy (HAART) by evaluating white matter (WM) injury using diffusion tensor magnetic resonance imaging (DTI) in patients with human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND).MethodsForty-six patients with HAND underwent DTI before and every six months during HAART treatment. DTI data, including fractional anisotropy (FA) and mean diffusivity (MD) values of structural WM before and after HAART, were compared. The relationship between DTI values and plasma viral loads was tested. MD was more sensitive than FA for evaluating WM injury in HAND-positive patients.ResultsFollowing 12 months of HAART, increased MD values (compared to 6 months of HAART) were observed in the right temporal lobe, right parietal lobe, right occipital lobe, right anterior limb of the internal capsule, right lenticular nucleus, the right cerebral peduncle, left caudate nucleus, left dorsal thalamus, and left posterior limb of the internal capsule. MD values in the left genu of the internal capsule (r=0.350, P=0.017) and left corona radiata (r=0.338, P=0.021) were positively correlated with plasma viral loads.ConclusionsDTI may be useful for assessing the efficacy and neurotoxicity of HAART in HAND-positive patients. Starting HAART may halt WM injury; however, prolonged HAART could worsen WM injury, highlighting the importance of optimal HAART duration.

The impact of the duration of HAART on cytokine profiles in pregnancy.

To determine the cytokine profile of HIV infected women treated with highly active anti-retroviral therapy (HAART) of variable duration in pregnancy. HIV infected women were enrolled at a large tertiary hospital in Durban, South Africa in their antenatal period and stratified into those that initiated HAART before pregnancy (pre-pregnancy HAART or PPH group) and those who initiated HAART during pregnancy (in-pregnancy HAART or IPH group). These were compared with HIV negative women (HN group), matched for gestational age at the time of enrolment. Serum was obtained and Th1 and Th2 cytokines expression determined using the Bio-Plex Pro™ Human Cytokine Treg Panels. The overall cytokine profile of the cohort was pro-inflammatory as a result of significant IL-6 and TNF alpha expression. The anti-inflammatory markers (i.e. Th2 cytokines, namely IL4 and IL10) were poorly expressed by the whole cohort, with IL 4 seen almost exclusively in the IPH group, thus counter-balancing the predominantly pro-inflammatory milieu only in this group. PPH group had a pro-inflammatory milieu comparable to the HN control. IL 6 was the predominant cytokine in all groups, and as expected, it increased with advancing gestation in all the groups. This highly pro-inflammatory milieu was unexpected and needs further review CONCLUSION: Long use of HAART suppresses the anti-inflammatory markers previously reported to be conducive for the wellbeing of pregnancy. This effect needs further review as it was similarly observed in our HIV uninfected controls.

Immunological Response During HAART and Determinants of Current CD4+ T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia.

PurposeAfter the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4+ count. Several factors affect the CD4+ T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4+ T-cell count among HIV/AIDS patients on HAART.Patients and MethodsA hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p-value <0.2 in the bivariate analysis were entered in the multiple regression models. p-Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4+ T-cell count.ResultsThe mean CD4+ T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4+ T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [β=185.5, 95% CI (8.8, 362.2)] (p=0.040), with increased baseline CD4+ T-cell count [β=0.468, 95% CI (0.342, 0.594)] (p<0.0001), and with long duration on HAART [β=18.0, 95% CI (9.9, 26.1)] (p<0.0001), whereas a decreased level of current CD4+ T-cell count was observed among males [β=−72.7, 95% CI (−114.5, –30.9)]) (p<0.0001) and those with poor baseline adherence [β=−108.9, 95% CI (−210.9, −7.0)] (p=0.036) and viral load >1000 copies [β=−189.2, 95% CI (−243.5, −134.9)] (p<0.0001).ConclusionThe trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4+ count, viral load, and duration on HAART were independent determinants of current CD4+ count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.

The Role of Highly Active Antiretroviral Therapy (HAART) on Interleukin 17A (IL-17A) in Normotensive and Preeclamptic Black South African Women.

Introduction Interleukin 17A has been implicated in the pathophysiology of both human immune deficiency virus and preeclampsia. This study evaluated serum levels of IL-17A based on pregnancy type, gestational age, HIV status, and duration of HAART. Material and Methods. A sample size of 250 was analysed: normotensives (n = 150; N) and preeclamptics (n = 100; PE). Normotensives were further stratified into HIV negative (n = 90), HAART-acute (n = 30), and HAART-chronic (n = 30). The PE group was divided into early onset (n = 50; EOPE) and late onset (n = 50; LOPE). The EOPE and LOPE groups were subdivided into HIV negative (n = 30), HAART-acute (n = 10), and HAART-chronic (n = 10). Analysis of IL-17A was performed using a multiple Bio-Plex immunoassay method. Results Pregnancy type: the levels of IL-17A were increased in PE compared to N (P = 0.0014). Gestational age: the levels of IL-17A were increased in EOPE compared to N group (P = 0.0113). A significant increase in the levels of IL-17A in LOPE compared to N was observed (P = 0.0063). HIV status: the levels of IL-17A were increased in PE compared to N (P = 0.0114) and in EOPE compared to N groups (P = 0.0071). HAART duration: the concentration of IL-17A was increased in HAART-chronic PE compared to N groups (P = 0.0062). There was also an increase in the levels of IL-17A in EOPE compared to N (P = 0.0029). Conclusion The study demonstrates that IL-17A is involved in the pathophysiology of PE and that in the presence of HIV infection, chronic HAART administration predisposes women to the development of EOPE.

The clinical significance of serum autoantibodies and HLA-B(27) molecule testing in Uygur patients with human immunodeficiency virus infection

Objective: To explore the clinical value of serum autoantibodies and human leukocyte antigen (HLA-B(27)) molecular testing in Uygur patients with human immunodeficiency virus (HIV) infection. Method: A total of 727 HIV-infected Uygur patients who visited Kuche infectious diseases hospital during May 2016 to March 2017 were include in this study. The other 390 healthy people were enrolled as controls. Serum antinuclear antibodies (ANA), anti-cyclic citrullinated peptide (CCP) antibody, anti-extractable nuclear antigen (ENAs) antibody and HLA-B(27) molecule were tested. Result: Among 727 HIV-infected Uygur patients, 317 were males and 410 were females with mean age (35.52±13.44) years old. The mean duration of disease was (6.34±3.05) years. There were 697 (95.87%) patients receiving highly active antiretroviral therapy (HAART) with mean duration of treatment (5.52±3.47) years. The mean CD4(+)T cell count was (520±271) cells/μl in 202 HIV-infected patients, and mean virus load was (108 139±20 498) copies/ml in 20 HIV-infected patients. Rheumatic manifestations were recorded in 238 (32.74%) HIV-infected Uygur patients, mainly with dry mouth and dry eye (15.41%) , alopecia (9.90%) , arthralgia (8.94%) , ect. Compared with the health controls, positive ANA was more common in HIV infected Uygur patients (33.43% vs. 17.43%, P<0.001) with low titers (ANA titer:1∶100) . HIV-infected Uygur patients had higher positive anti-u1-RNP antibodies positive rate (1.10%), but lower anti-SSA antibodies positive rate (0.14%) and anti-CCP antibodies positive rate (0.28%). Patients with positive ANA in HAART group were significantly less than that in non-treatment group (32.71% vs. 50.00%, P=0.049). There were no correlations between ANA and duration of HAART, CD4(+)T cell counts and virus load (r values 0.061, 0.047, 0.121, respectively. P>0.05). Only one female patient was HLA-B(27) positive (0.14%), which was significantly lower than that in healthy controls (3.08%) (P<0.001). Also, only one patient was diagnosed with rheumatoid arthritis (RA). Conclusion: Autoimmune manifestations are common in HIV-infected Uygur patients. Several autoantibodies are positive, but the coincidence of rheumatic diseases is rare. It's noted that patients with autoimmune manifestations should be considered as a differential diagnosis of HIV infection.

Study of self-reported adverse drug reactions and factors influencing it among human immunodeficiency virus/acquired immunodeficiency syndrome patients on antiretroviral therapy

Background: Human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS). HIV/AIDS is a significant worldwide medical issue. Patients on highly active antiretroviral therapy (HAART) generally encounter adverse drug reactions (ADRs). Various aspects of HAART such as adherence of the patient to the therapy, results of the therapy, and their treatment alternatives are considerably influenced by the presence of ADRs. Aim and Objectives: To estimate the commonly encountered self-reported ADRs among the patient on HAART, to know the various factors which influence the ADRs, the reasons behind missing ART doses and to know the relationship among ADRs and different factors to HAART. Materials and Methods: The present study was conducted in HIV/AIDS patients on HAART attending ART center at Raichur Institute of Medical Sciences, Raichur, after getting the ethical clearance. This was a cross-sectional, observational study conducted among the two hundred and seventy HIV/AIDS patients on HAART during the 12-month study period from December 2013 to November 2014. After obtaining the informed consent, the information pertaining to the sociodemographic profile of the patient, ADRs to HAART, and explanations behind missing ART dose were collected using a semi-structured interview questionnaire. The patient treatment record was used to collect the information regarding variables related to HAART and the laboratory values. Data were interpreted by applying descriptive analysis after collecting in Microsoft Excel sheet. The relationships of dependent variables to ADRs were determined by logistic regression analysis. Results: Of 270 enrolled patients, 135 (50%) patients aged less than 40 years, 190 (70.4%) were literate, 142 (52.6%) were male, and 194 (71.9%) were from rural background. Zidovudine based regimens 117 (43.3%) were the most commonly prescribed regimen in this study. The most frequently self-reported ADRs were burning sensation in stomach 40 (14.8%). The two most normal explanations behind missing ART dosages were simply forgot 35 (70%) trailed by ADRs 17 (34%) to HAART. Two variables were found to have a significant relationship to the self-reported ADRs on bivariate analysis. These were patients on HAART who aged more than or equal to 40 years (24.4%, P = 0.04) and when the duration of HAART was under 2 years (17.8%, P = 0.028). Conclusions: The most common self-reported ADR was a burning sensation in stomach. The ADR encounter was more common when the duration of HAART was lesser than 2 years. Aside from the age of the patient, no other sociodemographic variable has an impact on ADR occurrence. Therefore, it is the responsibility of the health care service providers to have the knowledge of frequently occurring ADRs and the factors influencing it to enhance the effectiveness of HAART.

Assessment of liver and renal functions in human immunodeficiency virus-infected persons on highly active antiretroviral therapy: A mixed cohort study.

Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2-84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02-3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.

Angiogenesis, Lymphangiogenesis, and the Immune Response in South African Preeclamptic Women Receiving HAART.

Purpose of the review: This review highlights the role of angiogenesis, lymphangiogenesis, and immune markers in human immunodeficiency virus (HIV)-associated preeclamptic (PE) pregnancies in an attempt to unravel the mysteries underlying the duality of both conditions in South Africa. Recent findings: Studies demonstrate that HIV-infected pregnant women develop PE at a lower frequency than uninfected women. In contrast, women receiving highly active anti-retroviral therapy (HAART) are more inclined to develop PE, stemming from an imbalance of angiogenesis, lymphangiogenesis, and immune response. Summary: In view of the paradoxical effect of HIV infection on PE development, this study examines angiogenesis, lymphangiogenesis, and immune markers in the highly HIV endemic area of KwaZulu-Natal. We believe that HAART re-constitutes the immune response in PE, thereby predisposing women to PE development. This susceptibility is due to an imbalance in the angiogenic/lymphangiogenic/immune response as compared to normotensive pregnant women. Further large-scale studies are urgently required to investigate the effect of the duration of HAART on PE development.

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic.&#x0D; Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. &#x0D; Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results.&#x0D; Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82).&#x0D; Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Diffusion Tensor MR Imaging of White Matter Integrity in Patients with HIV-Associated Neurocognitive Disorders

Background: Effective highly active antiretroviral therapy (HAART) could prevent progression of white matter (WM) injury. However, prolonged use of HAART may induce neurotoxicity. This study investigated the efficacy and neurotoxicity of HAART by evaluating WM injury using diffusion tensor magnetic resonance imaging (DTI) in patients with HIV-associated neurocognitive disorders (HAND). Methods: Forty-six patients with HAND underwent DTI before and every six months during HAART treatment. DTI data, including fractional anisotropy (FA) and mean diffusivity (MD) values of structural WM before and after HAART, were compared. The relationship between DTI values and plasma viral loads was also evaluated. Findings: MD was more sensitive than FA for evaluating WM injury in HAND-positive patients. Following 12 months of HAART, increased MD values (compared to 6 months of HAART) were observed in the right temporal lobe, right parietal lobe, right occipital lobe, right anterior limb of the internal capsule, right lenticular nucleus, right cerebral pedunculus, left caudate nucleus, left dorsal thalamus, and left posterior limb of the internal capsule. MD values in the left genu of the internal capsule (r = 0.350, P < 0.05) and left corona radiata (r = 0.338, P < 0.05) were positively correlated with plasma viral loads. Interpretation: DTI may be useful for assessing efficacy and neurotoxicity of HAART in HAND-positive patients. Initiating HAART may halt WM injury; however, prolonged HAART could worsen WM injury, highlighting the importance of optimal HAART duration. Funding: Guangxi Science and Technology Department Key Research and Development Programs, Youth Science Foundation of Guangxi Medical University and International Communication of Guangxi Medical University Graduate Education. Declaration of Interest: None. Ethical Approval: All experiments performed are endorsed by the Ethics Committee of Guangxi Medical University and complied with the Declaration of Helsinki.