Highly Active Antiretroviral Therapy Regimen Research Articles

The reasons for regimen shift among people living with HIV/AIDS in Asella Referral Hospital

Highly active antiretroviral therapy (HAART) is the base for management of patients with HIV infection. On the other hand, a switch in the antiretroviral regimen could be compulsory because of various reasons. Therefore, the aim of this study was to determine the causes for initial antiretroviral regimen switch among adult HIV/ADIS patients. A retrospective cross-sectional study was conducted on patient information records of those visited the ART clinic since February 2013 to January 2015 in Asella Referral Hospital. Results: From 1468 patientsÂ’ medical information reviewed, 221 of them changed their initial HAART regimens. Among these patients, 38% of them changed their first medications as a consequence of drug toxicity which was mainly triggered by AZT/3TC/NVP. The major cause for changing AZT/3TC/NVP treatment regimen associated with drug toxicity was anemia (17.85%). Other reasons stated for medication shift were co-morbidity, treatment failure, poor adherence and pregnancy. Since most of regimen modifications were in consequence of drug toxicity, these medication shifts require careful patient follow up; frequent laboratory result monitoring and selection of the right antiretroviral regimens.

Kaposi Sarcoma: Clinical Indices and Diagnosis

Any type of cancer that originate from the connective tissues are termed Sarcomas. The name Kaposi in relation to Kaposi sarcoma was derived from a Hungarian Dermatologist, Dr. Moritz Kaposi who is the first to describe this kind of tumor. KS is caused by a Herpes virus called HHV-8 or KSHV which is transmitted through unprotected sexual intercourse (higher in MSM), sharing of used needles, blood transfusion and organ transplant. There are five (5) epidemiological types of KS; Classic, Transplant, African, AIDS-related and Non-epidemic gay related. KS is the commonest symptom of an advanced HIV infected patient and its proliferation is faster due to the weakened immune system. Awareness about this sarcoma is poor. This disease is generally diagnosed as brown, red or purple patches/plagues/nodules on the skin, mucosal cavity of the GIT, Lungs and the oral cavity. There are also immunohistochemical staining endothelial markers that are used to differentiate KS from other types of sarcomas. CD31 is best used as an endothelial marker for lesions from HIV+ patients. Some other common markers include CD4, LNA-1, BCL-2 and VEGFR-3. Other symptoms of KS are shortness of breath, internal bleeding Anemia and Fatigue. Highly Active Antiretroviral Therapy (HAART) is believed to be the most efficient treatment for AIDS-related KS. Other soothing treatments available are chemotherapy, topical ointments, cryotherapy, photodynamic therapy, laser therapy and a times excisional surgery. There are active clinical trials towards treatment of KS. Some of which are done by combining different doses of HAART regimen with other therapeutic agents. One of the CTs been conducted by the National Cancer Institute in the U.S is the Phase II/ Phase I study using Pomalidomide in treating HIV and Non-HIV patients with Kaposi Sarcoma.

Study to monitor the adverse effects by different HAART regimens in HIV patients with tuberculosis

Background: In the modern era, AIDS is not less than a disaster for the human race. More than two-third of HIV-infected individuals have an associated infectious pulmonary disease. Mycobacterium tuberculosis is more virulent than most of other opportunistic pathogen causing latent infection. HIV is characterized by a profound immunodeficiency resulting from a progressive, quantitative and qualitative deficiency of the subset of CD4 T lymphocytes referred to as helper T cells leading to the patient at high risk of developing a variety of opportunistic infections. At present AIDS is incurable but some of the drugs have shown to decrease the mortality and morbidity of the disease. These are called as Highly Active Anti-Retroviral Therapy (HAART). However, these drugs are associated with a significant number of side effects. This work has been conducted in order to study the demographic profile of HIV patients with TB and monitor the adverse effects of different HAART regimens among them.Methods: A total of 3078 patients screened for the study. Those who were diagnosed with HIV were enrolled. Pretreatment parameters like, CD4, CD8 + lymphocyte count and their ratio, haemogram etc. were recorded. Patients were divided into four groups and were started with different HAART regimens. They were monitored regularly for the appearance of any adverse effects.Results: The prevalence of HIV sero-positivity was found to be 3.60%. Out of them, 71.18% were males and 28.82% were females. The highest prevalence (43.29%) was in the age group of 21-50 years. The sero-positive rate was found more in married males as compared to married females and unmarried cases. Side effects were present in all the groups. The most common side effect was GI intolerance and was most frequent in Group I. Anemia and neutropenia occurred in the Zidovudine containing groups (group I, III and IV). Peripheral neuropathy occurred most commonly in cases of Group II. Rashes occurred in nevirapine containing groups. Liver function derangement was noticed more in group I and II. 71.4% of patients on HAART regimen showed improvement in symptoms while 28.57% did not show any improvement.Conclusions: The prevalence of HIV sero-positivity in our study was 3.60%. The rate of sero-positivity was more in males as compared to females while it was highest in the individuals of 21-50 years of age. The most common side effect was GI intolerance and was most frequent in Group I. Anemia and neutropenia occurred most frequently in Zidovudine containing groups. Peripheral neuropathy occurred most commonly in cases of Group II (Stavudine + Lamivudine + Nevirapine). Deranged lipid profile was found to occur due to indinavir in patients of Group IV. After starting on HAART regimens, 74.4% showed significant improvement in symptoms.

Disseminated MAC: Broadening the Differential for Diarrhea in a Patient with Advanced AIDS

Diarrhea is a common problem in acquired immunodeficiency syndrome (AIDS). Aside from noninfectious causes, such as AIDS enteropathy and drug-induced diarrhea, the most common causes are opportunistic infections (OI). Disseminated Mycobacterium avium complex (MAC) is the most common OI with an incidence of 20% per year. There has been a dramatic decline in the incidence of disseminated MAC since the advent of highly active antiretroviral therapy (HAART). Clinicians must be familiar with the causes of diarrhea in AIDS to ensure timely institution of appropriate interventions. A fifty year old male with AIDS and CD4 count of three presented to the hospital with fever, encephalopathy, and failure to thrive. He was found to be septic with a urinary tract infection and bacteremia secondary to Escherichia coli, as well as Epstein-Barr virus (EBV) encephalitis. His hospital course was complicated by pancytopenia, and a bone marrow (BM) biopsy was performed due to concern for lymphoma in the setting of a positive EBV serology. Two weeks into hospitalization, he was resumed on his prior regimen of HAART, which included Ritonavir, Atazanavir, Emtricitabine and Tenofovir. One week later, he developed profuse, watery diarrhea. Stool studies were sent and while initially only positive for norovirus, two days later, acid-fast bacilli was also isolated. He began a regimen of Azithromycin, Isoniazid, Moxifloxacin, and Ethambutol to cover for both MAC and M. tuberculosis. His BM biopsy and blood cultures later resulted and were positive for MAC, confirming the diagnosis of disseminated MAC. Before HAART, diarrhea, which increases in frequency and severity as immune function declines, afflicted 40% to 80% of AIDS patients. With the initiation of HAART in a person with severe AIDS however, the risk of immune reconstitution inflammatory syndrome (IRIS) is significant and needs to be considered. Given the timing of this patient's diarrhea after resuming HAART, he most likely developed disseminated MAC secondary to IRIS. Although this patient initially tested positive for norovirus, which by itself would explain his diarrhea, comprehensive work-up led to the diagnosis of diarrhea secondary to disseminated MAC, and in turn, appropriate treatment. In an immunocompromised patient, multiple pathogens may be playing a role, and concomitant disease must always be considered.

Association Between the Occurrence of Adverse Drug Events and Modification of First-Line Highly Active Antiretroviral Therapy in Ghanaian HIV Patients.

IntroductionPatients initiated on highly active antiretroviral therapy (HAART) generally remain on medication indefinitely. A modification in the HAART regimen may become necessary because of possible acute or chronic toxicities, concomitant clinical conditions, development of virological failure or the advent of adverse drug events. The study documents adverse drug events of HIV-positive Ghanaian patients with HAART modifications. It also investigates the association between documented adverse drug events and HAART modification using an unmatched case–control study design.MethodThe study was conducted in the Fevers Unit of the Korle Bu Teaching Hospital and involved patients who attended the HIV Care Clinic between January 2004 and December 2009. Data from 298 modified therapy patients (cases) were compared with 298 continuing therapy patients (controls) who had been on treatment for at least 1 month before the end of study. Controls were sampled from the same database of a cohort of HIV-positive patients on HAART, at the time a case occurred, in terms of treatment initiation ±1 month. Data were obtained from patients’ clinical folders and the HIV clinic database linked to the pharmacy database. The nature of the documented adverse drug events of the cases was described and the association between the documented adverse drug events and HAART modification was determined by logistic regression with reported odds ratios (ORs) and their 95 % confidence interval (CI).ResultsAmong the 298 modified therapy patients sampled in this study, 52.7 % of them had at least one documented adverse drug event. The most documented adverse drug event was anaemia, recorded in 18.5 % of modified therapy patients, all of whom were on a zidovudine-based regimen. The presence of documented adverse drug events was significantly associated with HAART modification [adjusted OR = 2.71 (95 % CI 2.11–3.48), p < 0.001].ConclusionAmong HIV patients on HAART, adverse drug events play a major role in treatment modification. Occurrence of adverse drug events may be used as a predictor for possible therapy modification. We recommend the institution of active pharmacovigilance in HIV treatment programmes as it permits the proper identification and characterisation of drug-related adverse events. This can help develop approaches towards their management and also justify therapy modifications.

A single untimed plasma drug concentration measurement during low-level HIV viremia predicts virologic failure

Suboptimal untimed plasma drug levels (UDL) have been associated with lower rates of virologic suppression and the emergence of drug resistance. Our aim was to evaluate whether UDL among patients with low-level viremia (LLV) while receiving highly active antiretroviral therapy (HAART) can predict subsequent virologic failure (plasma viral load ≥1000 copies/mL) and emergence of resistance.The first documented LLV episode of 328 consenting patients was analysed in terms of drug levels, viral load and resistance, which were monitored while patients were on a consistent HAART regimen. UDL of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), were categorized as ‘therapeutic’ or ‘subtherapeutic’ based on predefined target trough concentrations. Drug resistance genotype was assessed using the Stanford algorithm. Time to virologic failure was evaluated by Kaplan–Meier analysis and Cox proportional hazards regression.We found 78 of 328 patients (24%) with subtherapeutic drug levels at time of first detectable LLV, while 19% harboured drug-resistant virus. Both subtherapeutic UDL and drug resistance independently increased the risk of subsequent virologic failure (p <0.001 and p 0.04, respectively). In a multivariable model, variables associated with LLV and virologic failure included subtherapeutic UDL, elevated plasma viral load, and drug resistance. Patients with subtherapeutic UDL accumulated further drug resistance faster during follow-up (p 0.03).Together, resistance and UDL variables can explain a higher proportion of virologic failure than either measure alone. Our results support further prospective evaluation of UDL in the management of low-level viremia.

Antiretroviral therapy does not affect response to chronic hepatitis C therapy in HIV-coinfected patients.

Many patients coinfected with the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are using highly active antiretroviral therapy (HAART) and HCV therapy with peginterferon (PEG-IFN) and ribavirina (RBV) because the use of direct-acting antivirals is not a reality in some countries. To know the impact of such medications in the sustained virological response (SVR) during HCV treatment is of great importance. This was a retrospective cohort study of 215 coinfected HIV/HCV patients. The patients were treated with PEG-IFN and RBV between 2007 and 2013 and analyzed by intention to treat. Treatment-experienced patients to HCV and carriers of hepatitis B were excluded. Demographic data (gender, age), mode of infection, HCV genotype, HCV viral load, hepatic fibrosis, HIV status, and type of PEG were evaluated. One hundred eighty-eight (87.4%) patients were using HAART. SVR was achieved in 55 (29.3%) patients using HAART and in 9 (33.3%) patients not using HAART (p = 0.86). There was no difference in SVR between different HAART medications and regimens using two reverse transcriptase inhibitor nucleosides (NRTIs) or the use of protease inhibitors and non-NRTIs (27.1% versus 31.5%; p = 0.61). The predictive factors for obtaining SVR were low HCV viral load, non-1 genotype, and the use of peginterferon-α2a. The use of HAART does not influence the SVR of HCV under PEG-IFN and RBV therapy in HIV/HCV coinfected patients.

Efavirenz and ritonavir-boosted lopinavir use exhibited elevated markers of atherosclerosis across age groups in people living with HIV in Ethiopia

BackgroundHIV patients on highly-active antiretroviral therapy (HAART) have shown elevated incidence of dyslipidemia, lipodystrophy, and markers of cardiovascular disease. Evidence is beginning to emerge that implicates efavirenz (EFV) as a potential mediator of early on-set cardiovascular disease. MethodsPediatric and adult HIV-infected HAART-naïve, EFV-treated, nevirapine (NVP)-treated, and ritonavir-boosted lopinavir (LPV/r)-treated subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Pulse wave velocity (PWV), carotid intima-media thickness (cIMT), carotid arterial stiffness, brachial artery flow-mediated dilation (FMD), body mass index, waist-to-hip circumference ratio, and skinfold thickness were measured. CD4+ cell count, fasting glucose, lipoprotein profiles and triglycerides were also determined. Results were segmented into pediatric (6–17 years of age), young adults (25–39 years old) and older adults (40–60 years old). ResultsPWV was generally elevated in EFV- and LPV/r-treated subjects compared to NVP-treated subjects across age groups. cIMT was elevated in EFV- and LPV/r-treated compared to NVP-treated older adults and in EFV-treated compared to HAART-naïve older adults. FMD was impaired in EFV- and LPV/r-treated compared to HAART-naïve younger adults, in EFV-treated compared to NVP-treated young and older adults, and in LPV/r-treated compared to NVP-treated older adults. Differences in lipoprotein profiles and skinfold thickness with HAART regimen were observed in pediatric and young adults, but less so in older adults. ConclusionsWhereas LPV/r and other protease inhibitors have long been recognized as mediators of HIV/HAART-associated atherosclerosis, this report supports the emerging evidence that EFV may also mediate cardiovascular disease in people living with HIV on HAART.

Analysis on antiretroviral therapy efficacy for HIV/AIDS in Zhejiang province, 2009-2014

To analyze the efficacy of highly active antiretroviral therapy(HAART)for HIV/AIDS in Zhejiang province from 2009 to 2014. A retrospective cohort study was conducted among patients with access to HAART aged <15 years from 2009 to 2014 through descriptive epidemiological analysis on the patients' demographic characteristics, HAART efficacy. The immune recovery Kaplan-Meier curves were drawn by using baseline CD(4) T lymphocytes cell(CD(4))data. The influencing factors for virus suppression were analyzed by using logistic regression model. There were 9 594 patients with access to HAART in Zhejiang from 2009 to 2014. The' average age of the patients was 38.7 years old, the male to female ratio was 4.11∶1. Heterosexual(55.9%)and homosexual(40.0%)contacts were the main transmission routes. Baseline CD(4) count 200-349 cells/μl was found in 45.4% of the patients, the median of the CD(4) count was 221(IQR: 123-298). The median of time for CD(4) recovery in patients with baseline CD(4) count <200 cells/μl was 3.48 and 11.58 times higher than the patients with baseline CD(4) count 200-349 cells/μl and baseline CD(4) count ≥350 cells/μl. Univariate and multivariate logistic regression analyses showed that marital status, HAART regimen, treatment miss in last week and CD(4) recovery were major influencing factors for HAART efficacy. HAART had good treatment effecacy in HIV/AIDS patients in Zhejiang. The baseline CD(4) count and adherence to HAART were the most important influencing factors. It is recommended to take measures to expand HIV screening and HAART coverage, conduct HAART adherence education, and strengthen the special care for high-risk groups to improve the HAART efficacy in Zhejiang province.

Rate of initial highly active anti-retroviral therapy regimen change and its predictors among adult HIV patients at University of Gondar Referral Hospital, Northwest Ethiopia: a retrospective follow up study.

BackgroundRegimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. In a resource limited setting where treatment options are limited, designing strategies to increase the durability of original regimen are essential. However, information’s on rate of initial regimen change and its predictors is scarce in Ethiopia. Therefore, the purpose of this study was to assess the rate of initial highly active anti retroviral therapy (HAART) regimen change and its predictors among adult HIV patients at the University of Gondar Referral Hospital, Northwest Ethiopia.MethodsAn institutional based retrospective follow up study was conducted among 410 adult HIV patients started HAART from January 2010 to December 2014. Simple random sampling technique was used to select patient records using computer generated random number. Data were collected from patient chart using data extraction tool. The Kaplan–Meier curve was used to estimate the median duration of regimen change. Life table was used to estimate the cumulative survival for initial regimen change and log rank test to compare regimen change survival curves between the different categories of explanatory variables. Bivariate and multivariate Cox proportional hazard model were used to identify predictors of initial regimen change.ResultsThe overall incidence rate of initial regimen change was 10.11 (95 % CI 8.29, 12.6) per 100 person years (PY). Baseline WHO clinical stage III (AHR = 1.92, 95 % CI 1.12–3.35), occurrence of tuberculosis (TB) on the initial regimen (AHR = 8.33, 95 % CI 4.47–15.53), side effect on the initial regimen (AHR = 25.27, 95 % CI 15.12–42.00) and co-medication with ART (AHR = 2.5, 95 % CI 1.46–4.34) were significant predictors of initial regimen change.ConclusionsThe rate of initial HAART regimen change was found to be high. Having WHO clinical stage III, co-medication with ART, occurrence of tuberculosis and side effect on initial regimen were independent predictors of regimen change. Hence, close follow-up and screening of patient for side effect and tuberculosis is important.

Prevalence of Hypertension in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) Compared with HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon

BackgroundHighly active antiretroviral therapy (HAART) has greatly reduced the morbidity and mortality of HIV/AIDS patients but has also been associated with increased metabolic complications and cardiovascular diseases. Data on the association between HAART and hypertension (HTN) in Africa are scarce.ObjectivesPrimarily to compare the prevalence of HTN in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to assess other socio-demographic and clinical factors associated with HTN in this population.MethodsA cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and sex to 100 HAART-naïve patients). HTN was defined as a systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg.ResultsThe prevalence of HTN in patients on HAART was twice (38%; 95% CI: 28.5–48.3) that of the HAART-naïve patients (19%; 95% CI, 11.8–28.1), p = 0.003. In multivariate analyses adjusted for age, gender, smoking, family history of HTN, and BMI-defined overweight, HAART was associated with HTN, the adjusted odds ratio of the HAART-treated versus HAART-naïve group was 2.20 (95% CI: 1.07–4.52), p = 0.032. HTN was associated with older age and male gender, in the HAART group and with BMI-defined overweight in the HAART-naïve group.ConclusionThe prevalence of hypertension in HIV/AIDS patients in Limbe stands out to be elevated, higher in patients on HAART compared to those not on treatment. Blood pressure and cardiovascular risk factors should be routinely monitored. Other factors such as diet, weight control and physical exercise should also be considered.

Acute Pancreatitis in Patients Living with HIV

Background: Acute pancreatitis in HIV positive patients remains a management challenge even with a Highly Active Antiretroviral Therapy (HAART) era. Objective: Report the prevalence, clinical and radiological features of acute pancreatitis associated with HIV. Patients and methods: Retrospective study conducted from January 1999 to June 2015 in HIV positive patients admitted with acute pancreatitis in the Infectious Disease Unit, Ibn Rochd, Casablanca. The Balthazar Grade score was used to assess radiological severity of the disease. Results: During this period, 39 patients had an acute pancreatitis or an incidence of 0.6/1000 inhabitant/year. The mean age was 33.72 years (range: 18 to 48 years), mostly represented by females (68% to 32% male).The known risk factors included an alcohol abuse in 15 patients (52%), a history of pancreatitis in two patients (5%), cholecystitis in four patients (14%), and intravenous drug abuse in two patients (5%). Nineteen patients (65%) were on HAART regimen and only nine patients (31%) were receiving cotrimoxazole as prophylaxis. Twenty-two patients (76%) were in stage C of CDC. Twenty-one (72%) patients had a mean CD4 count below 200/mm³ and a HIV viral load above 1000 copies/ml in seventy nineteen (65%) patients. Pancreatitis was symptomatic in all cases. The median amylasemia level was 120 IU/L, serum lipase 672.7 IU/L and 1,23 mg/dl triglycerides. All patients had an abnormal pancreas CT scan of which twelve (41%) patients were in stage A of AP. The main causes found were drug toxicity of which 6 cases were due to stavudine, meglumine antimony in 3 cases, didanosine in 1 case, anti-tuberculous treatment in 1 case and opportunistic infections of which 4 cases were tuberculosis, 4 cases of cytomegalovirus disease and cryptosporidiosis in 2 cases respectively. The main complications were: shock in 9 cases, 2 cases of diabetes and pancreatic pseudocysts in 2 cases. The evolution was fatal in 45% of cases. The median duration for hospital course was 10 days (range 6-50 days). Conclusion: Acute pancreatitis is a serious condition in HIV-positive patients. Drug toxicity and opportunistic infections represented the most frequent causes.

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.

Dysregulated Immune Activation in Second-Line HAART HIV+ Patients Is Similar to That of Untreated Patients.

BackgroundSuccessful highly active antiretroviral therapy (HAART) has changed the outcome of AIDS patients worldwide because the complete suppression of viremia improves health and prolongs life expectancy of HIV-1+ patients. However, little attention has been given to the immunological profile of patients under distinct HAART regimens. This work aimed to investigate the differences in the immunological pattern of HIV-1+ patients under the first- or second-line HAART in Brazil.MethodsCD4+ T cell counts, Viral load, and plasma concentration of sCD14, sCD163, MCP-1, RANTES, IP-10, IL-1β, IL-6, TNF-α, IL-12, IFN-α, IFN-γ, IL-4, IL-5, and IL-10 were assessed for immunological characterization of the following clinical groups: Non-infected individuals (NI; n = 66), HIV-1+ untreated (HIV; n = 46), HIV-1+ treated with first-line HAART (HAART 1; n = 15); and HIV-1+ treated with second-line HAART (HAART 2; n = 15).ResultsWe found that the immunological biosignature pattern of HAART 1 is similar to that of NI individuals, especially in patients presenting slow progression of the disease, while patients under HAART 2 remain in a moderate inflammatory state, which is similar to that of untreated HIV patients pattern. Network correlations revealed that differences in IP-10, TNF-α, IL-6, IFN-α, and IL-10 interactions were primordial in HIV disease and treatment. Heat map and decision tree analysis identified that IP-10>TNF-α>IFN-α were the best respective HAART segregation biomarkers.ConclusionHIV patients in different HAART regimens develop distinct immunological biosignature, introducing a novel perspective into disease outcome and potential new therapies that consider HAART patients as a heterogeneous group.

A Reduction Grade of Lipodystrophy and Limited Side Effects after HAART Regimen with Raltegravir, Lamivudine, Darunavir and Ritonavir in an HIV-1 Infected Patient after Six Years of Antiretroviral Therapy.

HIV-associated lipodystrophy commonly presents with fat loss in the face, buttocks, arms and legs, hypocomplementaemia, glomerulonephritis, and autoimmune disorders. The exact mechanism of HIV-associated lipodystrophy is not fully elucidated. There is evidence indicating that it can be caused by both antiretroviral medications and HIV infection in the absence of antiretroviral medication. Lipodystrophy seems to be mainly due to HIV-1 protease inhibitors. Interference with lipid metabolism is postulated as pathophysiology. Also, the development of lipodystrophy is associated with specific nucleoside reverse transcriptase inhibitors (NRTI). Mitochondrial toxicity is postulated to be involved in the pathogenesis associated with NRTI. Here, we analyse the side effects and examine the impact of the highly active antiretroviral therapy (HAART) regimen including raltegravir, lamivudine, darunavir and ritonavir in an HIV-1 infected patient with severe lipodystrophy after six years of antiretroviral therapy.

Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.

We examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression and estimated the minimum cutoff of adherence to newer HAART formulations needed for HIV RNA suppression by regimen type. We used Veterans Affairs pharmacy dispensing data from the Veterans Aging Cohort Study Virtual Cohort between October 2000 and September 2010 and defined adherence as the duration of time the patient had the medications available, relative to the total number of days between refills for all antiretrovirals in a year. Temporal trends in adherence and viral load suppression were examined by the patient's most frequently used HAART regimen in the year. The minimum needed adherence was defined as the level at which the odds of suppression was not significantly different than that observed with ≥ 95% adherence using repeated-measures logistic regression. A total of 21,865 HAART users contributed 82,217 person-years of follow-up. There was a significant increase (P(trend) < 0.001) in the proportion virally suppressed even among those with <95% adherence (2001: 38% to 2010: 84%), and the trend was similar when restricting to their first HAART regimen. For nonnucleoside reverse transcriptase inhibitor multi-pill users, the odds of suppression did not differ for 85%-89% adherence compared to those with ≥ 95% adherence [odds ratios: 0.82 (0.64-1.04)], but for protease inhibitor users, the odds of suppression significantly differed if adherence levels were <95% compared to ≥ 95% adherence. Although all HIV-infected persons should be instructed to achieve perfect adherence, concerns of slightly lower adherence should not hinder prescribing new HAART regimens early in HIV infection.

A narrative review of cost-effectiveness analysis of people living with HIV treated with HAART: from interventions to outcomes.

BackgroundSince its introduction in 1996, highly active antiretroviral therapy (HAART), which involves the combination of antiretroviral drugs, has resulted in significant improvements in the morbidity, mortality, and life expectancy of HIV-infected patients. Numerous studies of the cost-effectiveness of HAART from different perspectives in HIV have been reported.AimTo investigate the economic outcomes and relevance of HAART for people living with HIV.Materials and methodsA narrative literature review was conducted on 22 peer-reviewed full economic evaluations of people living with HIV treated with different HAART regimens and published in English between January 2005 and December 2014. Information regarding study details, such as interventions, outcomes, and modeling methods, was extracted. The high heterogeneity of the included studies rendered a meta-analysis inappropriate; therefore, we conducted a comparative analysis of studies grouped according to the similarity of the different intervention types and outcomes.ResultsMost of the economic evaluations of HAART focused on comparisons between the specific HAART regimens and others from the following perspectives: injecting drug users versus noninjecting drug users, HIV-infected adults without AIDS versus those with AIDS, regimens based on developed world guidelines versus those based on developing world guidelines, self-administered HAART versus directly observed HAART, and “ideal” versus “typical” regimens.ConclusionIn general, HAART is more cost-effective than other therapeutic regimens adopted so far. Further investigations, especially head-to-head comparisons of “ideal” and “typical” trials of different regimen combinations, are required to identify the optimal HAART regimens.

Cardiovascular disease associated with human immunodeficiency virus: A review

The cardiovascular manifestations of human immunodeficiency virus (HIV) infection have changed significantly following the introduction of highly active antiretroviral therapy (HAART) regimens. On one hand, HAART has altered the course of HIV disease, with longer survival of HIV-infected patients, and cardiovascular complications of HIV infection such as myocarditis have been reduced. On the other hand, HAART is associated with an increase in the prevalence of both peripheral and coronary arterial disease. As longevity increases in HIV-infected individuals, long-term effects, such as cardiovascular disease, are emerging as leading health issues in this population. In the present review article, we discuss HIV-associated cardiovascular disease, focusing on epidemiology, etiopathogenesis, diagnosis, prognosis, management and therapy. Cardiovascular involvement in treatment-naive patients is still important in situations such as non-adherence to treatment, late initiation of treatment, and/or limited access to HAART in developing countries. We therefore describe the cardiovascular consequences in treatment-naive patients and the potential effect of antiretroviral treatment on their regression, as well as the metabolic and cardiovascular implications of HAART regimens in HIV-infected individuals.

Patologia cardiovascular associada ao vírus da imunodeficiência humana

The cardiovascular manifestations of human immunodeficiency virus (HIV) infection have changed significantly following the introduction of highly active antiretroviral therapy (HAART) regimens. On one hand, HAART has altered the course of HIV disease, with longer survival of HIV‐infected patients, and cardiovascular complications of HIV infection such as myocarditis have been reduced. On the other hand, HAART is associated with an increase in the prevalence of both peripheral and coronary arterial disease. As longevity increases in HIV‐infected individuals, long‐term effects, such as cardiovascular disease, are emerging as leading health issues in this population. In the present review article, we discuss HIV‐associated cardiovascular disease, focusing on epidemiology, etiopathogenesis, diagnosis, prognosis, management and therapy. Cardiovascular involvement in treatment‐naive patients is still important in situations such as non‐adherence to treatment, late initiation of treatment, and/or limited access to HAART in developing countries. We therefore describe the cardiovascular consequences in treatment‐naive patients and the potential effect of antiretroviral treatment on their regression, as well as the metabolic and cardiovascular implications of HAART regimens in HIV‐infected individuals.

Insulin resistance by homeostasis model assessment in HIV-infected patients on highly active antiretroviral therapy: cross-sectional study.

BackgroundThe highly active antiretroviral therapy (HAART) has altered the course of HIV infection, transforming it from a fatal illness to a chronic condition, reducing morbidity and mortality. However, this therapy has led to an increased incidence of metabolic problems such as insulin resistance, dyslipidemia, lipodystrophy and impaired glucose metabolism.The objectives of this study are to determine the prevalence of insulin resistance (IR) in a cohort of human immunodeficiency virus (HIV)-infected patients on highly active antiretroviral therapy (HAART) and to investigate the potentially associated factors.MethodsWe conducted a cross-sectional study including 219 adult patients with HIV on HAART. IR was determined through the homeostasis model assessment (HOMA-IR) mathematical model, using fasting plasma glucose (FPG) and insulin. Bivariate and multivariate analyses were performed to assess the association between demographic information, clinical characteristics and laboratory results, and IR.Results75 (34.2 %) [95 % confidence interval (CI) 28.9–40.9] HIV-patients on HAART showed IR. 61 (81 %) of these patients were on HAART for more than one year, which was mainly composed by non-protease inhibitors drugs (88 %). Metabolic syndrome (MS) was found in 59 (26.9 %) subjects. In the multivariate analysis, the factors associated with IR were age ≥ 46 years (Prevalence ratio = 2.767, 95 % CI 1.325 to 5.780) and greater body mass index (BMI) (Prevalence ratio = 1.148, 95 % CI 1.054 to 1.250).ConclusionsThe prevalence of IR was 34.2 %. Factors associated with IR were age and BMI. We did not find any significant association between IR and protease inhibitors (PI), which may be explained by the small number of patients using PI as part of their HAART regimen included in our study.