Population Of HIV-infected Patients Research Articles

CHARACTERISTICS OF DERMATOMYCOSIS AGAINST THE BACKGROUND OF HIV INFECTION

Background. In the population of HIV-infected patients, superficial mycoses may have different clinical manifestations, evolution, and etiology, in contrast to those found in the population of people not infected with HIV. Aim: to describe superficial lesions of fungal etiology in HIV-infected patients and to compare them with a group of patients with onychomycosis of the feet who did not have HIV infection and concomitant diseases. Materials and methods. 63 patients with lesions of the skin and its appendages of fungal etiology were examined (30 HIV-positive patients and 33 individuals who made up the control group). We analyzed the location of the lesion, the time of development, and performed a mycological examination of skin samples with suspected fungal etiology of the lesion. Results. A statistically significant difference was found between HIV-infected patients and examined individuals of the control group in terms of the number of cases of Tinea unguium. The clinical picture of bedwetting was brighter in the group of HIV-positive patients. In HIV-infected patients, dermatophyte infection of the foot (Tinea pedis) and intertrigo of the feet (ringworm) are diagnosed significantly more often, compared to the group of patients with onychomycosis of the feet who did not have HIV infection and concomitant diseases (p<0.05-0.01 ). It is noteworthy that sedation always occurred under conditions of HIV load ≥50 copies/ml and the number of CD4+-lymphocytes <500 cells in 1 mm3 of blood serum. The clinical picture of onychomycosis in the compared groups also has differences. Thus, onycholysis and hyperkeratosis are statistically more common in HIV-infected persons (p<0.001). Onychodystrophy was characteristic only for patients with onychomycosis of the feet who did not have HIV infection and concomitant diseases (p<0.01). Distal-lateral subungual onychomycosis and white superficial onychomycosis were mainly caused by dermatomycetes, proximal subungual onychomycosis by yeast and mixed infection, and total dystrophic onychomycosis was usually caused by filamentous non-dermatomycetes. Conclusion. A relationship was established between the clinical forms of onychomycosis of the feet of HIV-infected patients and the types of the pathogen (χ2=6.483; df=2; p<0.05).

Diabetes mellitus and associated risk factors among HIV infected patients on HAART

BackgroundUnderstanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

Aflatoxin exposure in a population of HIV patients at risk of hepatocellular carcinoma North-Central, Nigeria.

Aflatoxin B1causes damage to the DNA by the alkylation of bases and P53 mutation. Exposure to this mycotoxin is associated with the development of liver cancer. Measures to reduce grain and cereal contamination have been a focus however, the effects of these measures are still lagging behind and exposure continues to occur even in populations at risk of developing liver cancer. To quantify aflatoxin B1 exposure in a population of HIV infected patients with and without HCC. This was a cross-sectional study among 196 patients with HIV and or HCC. We evaluated the exposure to aflatoxin B1 using the Aflatoxin M1 metabolite by ELISA on urine samples. A total of 196 participants consisting of 163 (83.2%) HIV positive and 28 (14.3%) HCC. Mean age is 46.64±10.8 years. The median aflatoxin (IQR) aflatoxin M1level is 177.3(112.5-272) pg/ml. Only 8(4.1%) of the participant had no exposure to aflatoxin B1. The median (IQR) aflatoxin for fibrosis score ≥ 13kpa (178.7(112.9-286.8) pg/ml) VS < 13kpa (173.5(107.9-250.4)), p = 0.046. There is high prevalence of aflatoxin B1 exposure in this population. Concerted efforts must be put in place to mitigate exposure because of the potential effects of short- and long-term exposure to aflatoxin.

Safety and Immunogenicity of Inactivated COVID-19 Vaccines Among People Living with HIV in China.

PurposeVaccination reduces the incidence of severe COVID-19 and death and effectively limits viral spread. Concerns have been raised about COVID-19 vaccine responses in the large population of HIV-infected patients. This study aims to explore the safety and immunogenicity of the inactivated COVID-19 vaccine in people living with HIV (PLWH).Patients and MethodsAll participants in this study already had their second dose of an inactivated COVID-19 vaccine at least 14 days earlier, without a history of SARS-CoV-2 infection. The primary safety outcomes were the incidence of adverse reactions and changes in CD4+ T-cell counts. SARS-CoV-2 IgG and neutralizing antibody responses to the D614G variant and delta variant were measured for immune response assessment.ResultsForty-seven HIV-infected patients and 18 healthy donors (HDs) were enrolled in this study. Adverse reactions were mild or self-limiting and were reported in 19.1% of HIV-infected patients. Most PLWH developed antibody responses against the inactivated COVID-19 vaccine. The longitudinal analysis of antibody responses in PLWH (median interval between detection and complete vaccination, 59 days) showed that antibodies were maintained for at least three months, though their titers were reduced. However, the antibody-positive rates in PLWH were significantly lower than those in HDs. Additionally, compared to HDs (Geomean titers (GMT) of 165 for D614G and GMT of 72 for delta), the neutralizing antibody titers against the two variants in PLWH (GMT of 43 for D614G and GMT 13 for delta) were decreased significantly (p = 0.018 and p < 0.001, respectively). HIV-infected patients with CD4+T-cell counts ≤350 cells/μL appeared to exhibit a poor antibody response to inactivated vaccination.ConclusionInactivated COVID-19 vaccines appear to be efficacious in PLWH. However, antibody responses in HIV-infected patients are inferior to those in healthy individuals, especially PLWH with lower CD4+T-cell counts.

Impact of acquired immunodeficiency in dermatomycosis. Cases and controls study

Background: In the population of HIV-infected patients, superficial mycoses may have different clinical manifestations, evolution and etiology from those found in the non-HIV population. Objectives: To describe superficial lesions of fungal etiology in HIV-infected patients and compare them with a control group. Materials and methods: 79 patients (25 HIV positive and 54 controls) were evaluated. A card was prepared with data: age, sex, description and location of the lesion, evolution time and previous treatment. Samples of skin and lines of lesions with suspected fungal etiology were taken and a mycological study was performed. Results: A slightly significant difference was observed between HIV reactive patients with respect to the control group in the number of cases of foot Tinea unguium. The clinical presentation of intertrigo was more observed in the group of HIV positive patients. Conclusions: Superficial mycoses are more common infections in HIV reactive patients, with mixed clinical presentations and the difference in CD4 count between the HIV population in successful ARV treatment does not modify the clinical presentation of dermatophytosis

Socio-demographic features of HIV infection in Primorsky Territory

The article presents an analysis of the socio-demographic characteristics of HIV infection in the Primorsky Territory. The data for analysis were taken from the reporting forms of statistical data (information on the results of blood tests for antibodies to HIV, information on the disease caused by the human immunodeficiency virus) GBUZ «Regional Clinical Hospital No. 2» Center for the Prevention and Control of AIDS and Infectious Diseases for the period of 2018–2020. In recent years, the disease has been diagnosed in older age groups. In the general structure of newly diagnosed persons with HIV infection, there remain a consistently high proportion of adults who are the most able-bodied and sexually active. There is a stable increase in the proportion of morbidity and mortality among men in the general structure of patients diagnosed for the first time in the Primorsky Territory. In the total population of HIV-infected patients, the dominant route of HIV transmission is still parenteral (with intravenous drug use), although there is an annual stable decrease in its share in the total number of newly diagnosed patients. Mortality due to the parenteral (narcotic) route of HIV transmission among HIV-positive men is significantly higher in the general structure of HIV-infected. Among the population of Primorsky Krai, the largest number of HIV-infected people are unemployed patients. The proportion of women of reproductive age is increasing, but the detection rate of HIV infection among pregnant women is decreasing. HIV infection affects the most working-age population, affecting demographic indicators. Despite the efforts aimed at combating the epidemic, HIV infection still remains one of the main socially significant threats to the health of all mankind.

Is age and not antiretroviral therapy the strongest risk factor for chronic pain in HIV-infected population?

BackgroundChronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.MethodsWe conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.ResultsIn total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17–1.58]), time under specialist care (OR 2.25 [95%CI:1.42–35.7]), time on ART (OR2.96 [95%CI:1.60–5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06–1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92–8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014–0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06–1.55]).ConclusionsThe prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.

The Analysis of Urological Morbidity in HIV-Infected Patients of the Vladivostok City District

Introduction: HIV infection, the disease that develops as a result of infection with the human immunodeficiency virus, has moved from the category of fatal diseases to indolent manageable infections. Urologic diseases are a common complication observed already in the early stages of HIV infection, and the prevalence of kidney disease in HIV patients ranges from 5% to 30%. Our objective was to analyze urological morbidity in HIV-infected patients hospitalized for emergency and planned indications in the Urology Department of Vladivostok Clinical Hospital No. 2 (VCB No. 2) and to identify the main nosological forms of urological pathology in this cohort. Methods: For the analysis of epidemiological, immunological and virological characteristics of 91 HIV-infected patients admitted to the Urology Department from June 2016 to December 2019 we reviewed inpatient and outpatient medical histories, structured HIV-infected patients by urological nosologies, assessed stages of HIV infection and values of viral load and CD4+ T-lymphocytes, and established the presence of coinfections. Results: The analysis revealed the prevalence of acute infectious and inflammatory diseases of the urinary system (pyelonephritis, prostatitis, orchiepidymitis, kidney abscess) and urolithiasis, which in some cases required the immediate initiation of empirical antibiotic therapy and emergency drainage of the renal cavity system. Our findings are consistent with the results of studies previously conducted on a different population of HIV-infected patients. Conclusions: Since the Urology Department of Vladivostok Clinical Hospital No. 2 is the main hospital that provides both emergency and planned urology care, our data fully reflect urological morbidity of HIV-infected patients in the city district and can be used for optimization of medical care for this cohort of patients.

Regulatory T Cell Counts and Development of Malignancy in Patients with HIV Infection.

T-regulatory cells (Tregs) play an important role in maintaining homeostasis by attenuating the cytokine response to T-cell receptor (TCR) stimulation and by suppressing the functioning of neighboring immune cells. In Human Immunodeficiency Virus (HIV) infection, Tregs can be either beneficial, by suppressing generalized T-cell activation, or detrimental, by suppressing protective anti-HIV cell-mediated immunity. An imbalance of Tregs and effector T-cells can blunt immune responses to malignant cells or facilitate inflammation-mediated pathologies. The purpose of our study was to explore the possible correlation between Tregs' concentration and HIV infection's parameters as well as the development of hematological and solid malignancies. In a longitudinal prospective study, ex vivo phenotyping of fresh peripheral blood mononuclear cells from patients with primary HIV infection was performed at baseline. All patients were then followed up every 3 months and the development of solid or hematological malignancies was noted. A total of 155 patients were included in the study and the median follow-up period was 64 months. Treg counts were significantly higher among males, patients with high viral load (>350 copies/ml) and patients with virological failure to antiretroviral treatment (ART). Linear regression analysis showed a significant negative correlation between Treg levels and CD4 (+) T-cell counts. Patients with neoplasia had lower levels of Tregs while increasing levels showed a negative correlation with the development of neoplasia. In our population of HIV-infected patients, high levels of Tregs were associated with disease progression, and low baseline levels were associated with a higher probability of developing neoplasia.

Polyfunctional CD8+ T-Cell Response to Autologous Peptides from Protease and Reverse Transcriptase of HIV-1 Clade B.

The diversity of the HIV proteome influences the cellular response and development of an effective vaccine, particularly due to the generation of viral variants with mutations located within CD8+ T-cell epitopes. These mutations can affect the recognition of the epitopes, that may result in the selection of HIV variants with mutated epitopes (autologous epitopes) and different CD8+ T-cell functional profiles. To determine the phenotype and functionality of CD8+ T-cell from HIV-infected Colombian patients in response to autologous and consensus peptides derived from HIV-1 clade B protease and reverse transcriptase (RT). By flow cytometry, we compared the ex vivo CD8+ T-cell responses from HIV-infected patients to autologous and consensus peptides derived from HIV-1 clade B protease and RT, restricted by HLA-B*35, HLA-B*44 and HLA-B*51 alleles. Although autologous peptides restricted by HLA-B*35 and HLA-B*44 did not show any differences compared with consensus peptides, we observed the induction of a higher polyfunctional profile of CD8+ T-cells by autologous peptides restricted by HLA-B*51, particularly by the production of interferon-γ and macrophage inflammatory protein-1β. The response by different memory CD8+ T-cell populations was comparable between autologous vs. consensus peptides. In addition, the magnitude of the polyfunctional response induced by the HLA-B*51-restricted QRPLVTIRI autologous epitope correlated with low viremia. Autologous peptides should be considered for the evaluation of HIV-specific CD8+ Tcell responses and to reveal some relevant epitopes that could be useful for therapeutic strategies aiming to promote polyfunctional CD8+ T-cell responses in a specific population of HIV-infected patients.

Beneficial and Adverse Effects of cART Affect Neurocognitive Function in HIV-1 Infection: Balancing Viral Suppression against Neuronal Stress and Injury.

HIV-associated neurocognitive disorders (HAND) persist despite the successful introduction of combination antiretroviral therapy (cART). While insufficient concentration of certain antiretrovirals (ARV) may lead to incomplete viral suppression in the brain, many ARVs are found to cause neuropsychiatric adverse effects, indicating their penetration into the central nervous system (CNS). Several lines of evidence suggest shared critical roles of oxidative and endoplasmic reticulum stress, compromised neuronal energy homeostasis, and autophagy in the promotion of neuronal dysfunction associated with both HIV-1 infection and long-term cART or ARV use. As the lifespans of HIV patients are increased, unique challenges have surfaced. Longer lives convey prolonged exposure of the CNS to viral toxins, neurotoxic ARVs, polypharmacy with prescribed or illicit drug use, and age-related diseases. All of these factors can contribute to increased risks for the development of neuropsychiatric conditions and cognitive impairment, which can significantly impact patient well-being, cART adherence, and overall health outcome. Strategies to increase the penetration of cART into the brain to lower viral toxicity may detrimentally increase ARV neurotoxicity and neuropsychiatric adverse effects. As clinicians attempt to control peripheral viremia in an aging population of HIV-infected patients, they must navigate an increasingly complex myriad of comorbidities, pharmacogenetics, drug-drug interactions, and psychiatric and cognitive dysfunction. Here we review in comparison to the neuropathological effects of HIV-1 the available information on neuropsychiatric adverse effects and neurotoxicity of clinically used ARV and cART. It appears altogether that future cART aiming at controlling HIV-1 in the CNS and preventing HAND will require an intricate balancing act of suppressing viral replication while minimizing neurotoxicity, impairment of neurocognition, and neuropsychiatric adverse effects. Graphical abstract Schematic summary of the effects exerted on the brain and neurocognitive function by HIV-1 infection, comorbidities, psychostimulatory, illicit drugs, therapeutic drugs, such as antiretrovirals, the resulting polypharmacy and aging, as well as the potential interactions of all these factors.

Variability in the UDP-glucuronosyltransferase 1A1 (UGT1A1) promotor in a HIV-infected Portuguese population

Introduction: Dolutegravir is an HIV-1 integrase inhibitor (INI) recently approved for the treatment of HIV infection and is metabolized by UGT1A1 [1]. This protein is responsible for the glucuronidation of many compounds, and some functional polymorphisms in the UGT1A1 gene results in a decrease of enzyme activity [2]. The polymorphism (rs8175347) is associated with thymine-adenine (TA) repeats located in the TATA box in the promoter region of the UGT1A1 gene. The increasing number of TA repeats is inversely associated with UGT1A1 transcription, with 6 repeats (allele*1) being associated with normal UGT1A1 activity phenotype. 7 and 8 TA repeats (alleles *28 and *37, respectively) with low UGT1A1 activity phenotype [1]. Knowledge of the frequency distribution of functional polymorphisms in a HIV-infected population may improve therapeutic options. The present study aims to identify the frequency of UGT1A1 (rs8175347) gene polymorphism in a population of Portuguese HIV-infected patients and compare with other ethnic groups. Materials and methods: The study includes 74 Portuguese HIV-infected adult patients receiving ARV therapy. The informed consent and the study protocol were approved by ethics committee. Genotyping the (TA) insertion in the TATA box region of UGT1A1 gene was performed by PCR amplification followed by direct sequencing. The allelic and genotype frequencies were tested for Hardy-Weinberg equilibrium by goodness off fit χ2 test with a 95% CI, using The R Project for Statistical Computing. Obtained frequencies were then compared with 219 unrelated individuals collected from the database Pharmgkb using a χ2 test. Results: All frequencies in our study group were in Hardy-Weinberg equilibrium (p = 0.4016). In this study the allelic frequencies for UGT1A1 *1, *28 and * 37 alleles were 61.49%, 30.41% and 8.11%, respectively, being significantly different from African, Asian and European (p < 0.001) ethnic groups. The genotype frequencies for UGT1A 1*1/*1, *1/*28, *1/*37, *28/*28 and *28/*37 were 32.43%, 44.59%, 13.51%, 6.76% and 2.70%, respectively. In our sample a total of 67.56% patients have UGT1A1 * 28 or * 37 alleles which was significantly associated with lower UGT1A1 activity phenotype. Discussion and conclusions: Obtained UGT1A1*28 and *37 frequencies were similar to the ones observed in African population and different from those of European and Asian origin. Patients with UGT1A1*28 and *37 alleles in our study may be at risk of dolutegravir therapeutic failure, consequently drug monitoring is recommended to guide dose adjustment. Our study contributes for personalized medicine optimization, indicating the individual differences in genetic characteristics.

EPIDEMOILOGY, DIAGNOSIS, AND TREATMENT OF HIV-ASSOCIATED NON-HODGKIN LYMPHPOMAS

The objective of the study was to analyze clinical, immunological and morphological features of malignant non-Hodgkin lymphpomas (MNHL) in HIV-infected patients, evaluate the options and the results of the treatment for the patients in oncohematological hospital environment. Materials and methods. The study evaluated the data from Original Medical Records of 185 HIVinfected patients (mean age 36–40 years) with MNHL that was detected during the period from 1994 to 2017. The results of clinical, laboratory, morphological and immunohistochemical methods used for the study in HIV-infected patients with MNHL were represented. Results. During the period from 1994 to 2017, increasing in the number of HIV-infected patients with MNL, mean age of which was less than 40 years, had been marked. Duration of HIV-infection up to the time of detection the MNHL was 7 years but in 23% of cases the HIV-infection and tumor disease were diagnosed at the same time. Low number of CD4 lymphocyte cells (132 cells/μL) and high number of RNA HIV (more than 550 000 copies/μL) were detected in the blood of the patients. The following distribution was among morphological types of MNHL: diffuse large B-cell lymphoma (DLBCL) — 42%, Burkitt's lymphomas — 32%, plasmablastic lymphomas — 26%. Clinical lymphomas with the extranodal manifestations accompanied with large quantity of complications and opportunistic infections directly resulted from immunosuppression severity (p&lt;0,05) were predominant (76%). Evaluation of combined chemoimmunotherapy effectiveness in HIV-infected patients and in the patients with MNHL showed comparable results in contrast with the population of seronegative HIV-infected patients under using standard polychemotherapy regimens with rituximab, antiretroviral therapy, prevention of infectious complications and immune reconstitution syndrome. Conclusion. Malignant non-Hodgkin lymphpomas represent the group of oncological diseases, which is predominant in HIV-infected patients. These diseases require team approach in early detection, current treatment, prevention of complications in the multidisciplinary team that will significantly improve disease outcome.

Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test \u2013 which method to choose for the diagnosis?

BackgroundAntiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors and pathologies. The optimal diagnostic protocol for Diabetes Mellitus in these patients is still controversial. Haemoglobin A1c (HbA1c) has been shown to underestimate glycaemia levels and the oral glucose tolerance test (OGTT) has been shown to reveal cases of glucose metabolism disturbances in patients with normal fasting glucose. Thus, this study aimed to determine the prevalence of prediabetes and diabetes in a population of HIV-infected patients undergoing combined antiretroviral therapy, using three different diagnostic methods (fasting glucose, OGTT and HbA1c), to determine the agreement between the different methods and the characteristics associated with each one.MethodsThis study analyzed 220 HIV-infected patients on antiretroviral therapy. Patient characteristics were collected using a standardized protocol. Disturbances of glucose homeostasis were defined by the ADA 2017 criteria. Patients were characterized according to the presence or absence of clinical lipodystrophy, and distributed into four different categories, according to the presence, or absence of either clinical lipoatrophy, or abdominal prominence. Insulin resistance was assessed by HOMA-IR and QUICKI indexes. Agreement between the diagnostic methods was assessed by Cohen’s kappa coefficient.ResultsThere were no patients diagnosed with diabetes with HbA1c. 5.9% prevalence was obtained when OGTT was used, and 3.2% prevalence when fasting glucose was used. Prediabetes had a prevalence of 14.1% when using HbA1c, 24.1% when using OGTT, and 20% when using fasting glucose. In all three methods, glucose homeostasis disturbances were associated with older age and higher resistance to insulin. Regarding other characteristics, associations varied between the three methods. The agreement between them was fair, or slight.ConclusionsWe observed that HbA1c was the method that diagnosed the least amount of cases and that OGTT was the one that diagnosed the most cases. Accordingly, our results indicate that HbA1c underestimated glycaemia levels in this population and that the use of OGTT might allow an earlier diagnosis of glucose homeostasis disturbances, potentially making it possible to avoid severe complications of DM.

Analysis of drug-drug interactions among patients receiving antiretroviral regimens using data from a large open-source prescription database.

Results of a study of contraindicated concomitant medication use among recipients of preferred antiretroviral therapy (ART) regimens are reported. A retrospective study was conducted to evaluate concomitant medication use in a cohort of previously treatment-naive, human immunodeficiency virus (HIV)-infected U.S. patients prescribed preferred ART regimens during the period April 2014-March 2015. Data were obtained from a proprietary longitudinal prescription database; elements retrieved included age, sex, and prescription data. The outcome of interest was the frequency of drug-drug interactions (DDIs) associated with concomitant use of contraindicated medications. Data on 25,919 unique treatment-naive patients who used a preferred ART regimen were collected. Overall, there were 384 instances in which a contraindicated medication was dispensed for concurrent use with a recommended ART regimen. Rates of contraindicated concomitant medication use differed significantly by ART regimen; the highest rate (3.2%) was for darunavir plus ritonavir plus emtricitabine-tenofovir disoproxil fumarate (DRV plus RTV plus FTC/TDF), followed by elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate (EVG/c/FTC/TDF)(2.8%). The highest frequencies of DDIs were associated with ART regimens that included a pharmacoenhancing agent: DRV plus RTV plus FTC/TDF (3.2%) and EVG/c/FTC/TDF (2.8%). In a large population of treatment-naive HIV-infected patients, ART regimens that contained a pharmacoenhancing agent were involved most frequently in contraindicated medication-related DDIs. All of the DDIs could have been avoided by using therapeutic alternatives within the same class not associated with a DDI.

Country of infection among HIV-infected patients born abroad living in French Guiana.

BackgroundOver 75% of patients in the HIV cohort in French Guiana are of foreign origin. Our objective was to estimate what proportion of the migrant population of HIV-infected patients in Cayenne had been infected in French Guiana.MethodsWe included patients of known foreign origin who were followed in Cayenne, for whom the year of arrival in French Guiana was known and the initial CD4 count at the time of diagnosis was available. The time between seroconversion and time at diagnosis was estimated using the formula [square root (CD4 at seroconversion)-square root(CD4 at HIV diagnosis)] / slope of CD4 decline.CD4 counts at the time of infection and the slope were computed in an age and ethnicity-dependent variable.ResultsThe median estimated time between infection and diagnosis was 4.5 years (IQR = 0.2–9.2). Overall, using a median estimate of CD4 count at the time of infection, it was estimated that 53.2% (95% CI = 48.3–58%) of HIV infected foreign patients had acquired HIV after having arrived in French Guiana. Patients having arrived in French Guiana before and during the 1990s and those receiving their HIV diagnosis before 2010 were more likely to have been infected in French Guiana.ConclusionsContrary to widespread belief suggesting that most migrants are already HIV-infected when they arrive in French Guiana, a large proportion of foreign HIV patients seem acquire the virus in French Guiana.There is still much to do in terms of primary prevention and testing among migrants.

Barriers to listing for HIV-infected patients being evaluated for kidney transplantation.

Human immunodeficiency virus (HIV)-infected patients have excellent outcomes following kidney transplantation (KT) but still might face barriers in the evaluation and listing process. The aim of this study was to characterize the patient population, referral patterns, and outcomes of HIV-infected patients who present for KT evaluation. We performed a single-center retrospective cohort study of HIV-infected patients who were evaluated for KT. The primary outcome was time to determination of eligibility for KT. Between 2011 and 2015, 105 HIV-infected patients were evaluated for KT. Of the 105 patients, 73 were listed for transplantation by the end of the study period. For those who were deemed ineligible, the most common reasons cited were active substance abuse (n=7, 22%) and failure to complete the full transplant evaluation (n=7, 22%). Our cohort demonstrated a higher proportion of HIV-infected patients eligible for KT than in previous studies, likely secondary to advances in HIV management. Among those who were denied access to transplantation, we identified that many were unable to complete the evaluation process, and that active substance abuse was common. Future prospective studies should examine reasons and potential interventions for the lack of follow-through and drug use we observed in this population.

Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study.

BackgroundHIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects.MethodsA cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis.ResultsOverall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained of ARVs related side-effects. Forty-five percent of those with side-effects (141/311, 45.34%) reported taking various types of medicines for treating side-effects, with 90.07% of them (127/141) using medicines prescribed by biomedically trained doctors or by pharmacy personnel as over-the -counter medicines, p <0. 001. Very few participants (14/141, 9.93%) resorted to the use of traditional medicine for treating side effects associated with antiretroviral therapy with no significant difference (p=0.293). In a multiple logistic regression, after adjusting for age, gender, race and side-effects due to antiretroviral therapy, odds for using traditional medicine were almost two times higher [odds ratio = 1.884, 95% Confidence Interval 1.317–2.695] with those participants having comorbidities and co-infections, with a significant difference p-value< 0.001.ConclusionsComorbidities, co-infections and side effects are prevalent among HIV-infected patients attending public sector healthcare facilities. Odds of using traditional medicine were almost two times higher and significantly associated with the presence of comorbidities and co-infections than for other factors. The presence of such comorbid health problems does not explain the increased use of traditional medicine among HIV-infected patients on antiretroviral therapy. Findings from this study should be interpreted cautiously as they cannot be generalized to the entire population of HIV-infected patients in KwaZulu-Natal. Studies on safety and efficacy of herbal traditional medicines are needed for beneficiation of the minority of patients who still resort to them for co-treatment with combination antiretroviral therapy.

Performance of Early-Warning Scores in Predicting Mortality in an HIV-Infected Population with Sepsis in Uganda

Background Early-warning scores (EWS) have the potential to improve resource allocation and hasten care in sub-Saharan Africa (SSA). Despite the high prevalence of HIV infection in SSA, current EWS do not take into account HIV serostatus.Methods We conducted a retrospective study at Mbarara Regional Referral Hospital (MRRH) in Uganda to evaluate the performance of CRB-65, modified early-warning score (MEWS), quick sepsis-related organ failure assessment (qSOFA), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), South African triage scale (SATS), and shock index (SI) in predicting mortality among HIV-infected patients presenting with sepsis. We included patients admitted with sepsis to MRRH between January 2014 and December 2015 that had an HIV-positive serostatus and at least one valid heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, temperature, and oxygen saturation. Glasgow coma scale was imputed with the median. We used the area under the receiver operating curve (AUC) with tenfold cross-validation to assess the performance of each EWS.ResultsOf the 193 patients, the median (interquartile range) age was 34 (27, 42) years, 87 (45.0%) were female and 65 (44.6%) died. The AUC (95% confidence interval) was 0.53 (0.43, 0.62) for CRB65, 0.53 (0.44, 0.62) for MEWS, 0.57 (0.46, 0.68), for qSOFA, 0.60 (0.51, 0.69) for RAPS, 0.55 (0.46, 0.63) for REMS, 0.53 (0.45, 0.62) for SATS, and 0.54 (0.46, 0.63) for SI.Conclusion The ability of EWS to predict mortality in an HIV-infected patient population with sepsis in Uganda was poor. EWS used in SSA should be derived from African patient populations and adjust for HIV serostatus.Disclosures All authors: No reported disclosures.

Association of HIV infection with extrapulmonary tuberculosis: a systematic review.

HIV/AIDS is a known risk factor for the development of pulmonary tuberculosis (PTB). However, the association is less clear between HIV and extrapulmonary tuberculosis (EPTB). We conducted a systematic review to determine the association between HIV and EPTB. We searched the electronic databases Medline, Embase, and relevant conference literature using defined search terms for EPTB and HIV. Only publications in English and only studies reporting adjusted estimates were included, while our search criteria did not include restriction by age or geographic location of study participants. Qualitative and quantitative analyses (including I 2 test for heterogeneity) were performed. Sixteen studies (15 cross-sectional and 1 case-control) conducted from 1984 to 2016 were included in the final analyses after screening 5163 articles and conference abstracts. Our qualitative analysis showed heterogeneity in study design and study population characteristics along with a medium/high risk of bias in the majority of studies. While most of the individual studies showed increased odds of EPTB compared with PTB among HIV-infected individuals, we did not provide an overall pooled estimate, as the I 2 value was high at 93% for the cross-sectional studies. While an association between HIV and EPTB is observed in most individual studies, the high heterogeneity and risk of bias in these studies highlight the need for further well-designed prospective cohort studies to assess the true risk of EPTB in the HIV-infected patient population.