601
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Rubin LH, Sundermann EE, Moore DJ. The current understanding of overlap between characteristics of HIV-associated neurocognitive disorders and Alzheimer's disease. J Neurovirol 2019; 25:661-672. [PMID: 30671777 DOI: 10.1007/s13365-018-0702-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022]
Abstract
The advent of effective antiretroviral medications (ARVs) has led to an aging of the HIV population with approximately 50% of people with HIV (PWH) being over the age of 50 years. Neurocognitive complications, typically known as HIV-associated neurocognitive disorders (HAND), persist in the era of ARVs and, in addition to risk of HAND, older PWH are also at risk for age-associated, neurodegenerative disorders including Alzheimer's disease (AD). It has been postulated that risk for AD may be greater among PWH due to potential compounding effects of HIV and aging on mechanisms of neural insult. We are now faced with the challenge of disentangling AD from HAND, which has important prognostic and treatment implications given the more rapidly debilitating trajectory of AD. Herein, we review the evidence to date demonstrating both parallels and differences in the profiles of HAND and AD. We specifically address similarities and difference of AD and HAND as it relates to (1) neuropsychological profiles (cross-sectional/longitudinal), (2) AD-associated neuropathological features as evidenced from neuropathological, cerebrospinal fluid and neuroimaging assessments, (3) biological mechanisms underlying cortical amyloid deposition, (4) parallels in mechanisms of neural insult, and (5) common risk factors. Our current understanding of the similarities and dissimilarities of AD and HAND should be further delineated and leveraged in the development of differential diagnostic methods that will allow for the early identification of AD and more suitable and effective treatment interventions among graying PWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego (UCSD) School of Medicine, La Jolla, CA, USA.
| | - David J Moore
- Department of Psychiatry, University of California, San Diego (UCSD) School of Medicine, La Jolla, CA, USA
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602
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Kiragga AN, Mubiru F, Kambugu AD, Kamya MR, Castelnuovo B. A decade of antiretroviral therapy in Uganda: what are the emerging causes of death? BMC Infect Dis 2019; 19:77. [PMID: 30665434 PMCID: PMC6341568 DOI: 10.1186/s12879-019-3724-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa. METHODS We used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death. RESULTS Of the 559, (386, 69%) were female, median age 36 years (IQR: 21-44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/μL (IQR: 21-163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi's Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%). CONCLUSION Despite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases.
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Affiliation(s)
- Agnes N. Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Frank Mubiru
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew D. Kambugu
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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603
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Hartnell F, Brown A, Capone S, Kopycinski J, Bliss C, Makvandi-Nejad S, Swadling L, Ghaffari E, Cicconi P, Del Sorbo M, Sbrocchi R, Esposito I, Vassilev V, Marriott P, Gardiner CM, Bannan C, Bergin C, Hoffmann M, Turner B, Nicosia A, Folgori A, Hanke T, Barnes E, Dorrell L. A Novel Vaccine Strategy Employing Serologically Different Chimpanzee Adenoviral Vectors for the Prevention of HIV-1 and HCV Coinfection. Front Immunol 2019; 9:3175. [PMID: 30713538 PMCID: PMC6346592 DOI: 10.3389/fimmu.2018.03175] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Nearly 3 million people worldwide are coinfected with HIV and HCV. Affordable strategies for prevention are needed. We developed a novel vaccination regimen involving replication-defective and serologically distinct chimpanzee adenovirus (ChAd3, ChAd63) vector priming followed by modified vaccinia Ankara (MVA) boosts, for simultaneous delivery of HCV non-structural (NSmut) and HIV-1 conserved (HIVconsv) region immunogens. Methods: We conducted a phase I trial in which 33 healthy volunteers were sequentially enrolled and vaccinated via the intramuscular route as follows: 9 received ChAd3-NSmut [2.5 × 1010 vp] and MVA-NSmut [2 × 108 pfu] at weeks 0 and 8, respectively; 8 received ChAdV63.HIVconsv [5 × 1010 vp] and MVA.HIVconsv [2 × 108 pfu] at the same interval; 16 were co-primed with ChAd3-NSmut [2.5 × 1010 vp] and ChAdV63.HIVconsv [5 × 1010 vp] followed at week 8 by MVA-NSmut and MVA.HIVconsv [both 1 × 108 pfu]. Immunogenicity was assessed using peptide pools in ex vivo ELISpot and intracellular cytokine assays. Vaccine-induced whole blood transcriptome changes were assessed by microarray analysis. Results: All vaccines were well tolerated and no vaccine-related serious adverse events occurred. Co-administration of the prime-boost vaccine regimens induced high magnitude and broad T cell responses that were similar to those observed following immunization with either regimen alone. Median (interquartile range, IQR) peak responses to NSmut were 3,480 (2,728–4,464) and 3,405 (2,307–7,804) spot-forming cells (SFC)/106 PBMC for single and combined HCV vaccinations, respectively (p = 0.8). Median (IQR) peak responses to HIVconsv were 1,305 (1,095–4,967) and 1,005 (169–2,482) SFC/106 PBMC for single and combined HIV-1 vaccinations, respectively (p = 0.5). Responses were maintained above baseline to 34 weeks post-vaccination. Intracellular cytokine analysis indicated that the responding populations comprised polyfunctional CD4+ and CD8+ T cells. Canonical pathway analysis showed that in the single and combined vaccination groups, pathways associated with antiviral and innate immune responses were enriched for upregulated interferon-stimulated genes 24 h after priming and boosting vaccinations. Conclusions: Serologically distinct adenoviral vectors encoding HCV and HIV-1 immunogens can be safely co-administered without reducing the immunogenicity of either vaccine. This provides a novel strategy for targeting these viruses simultaneously and for other pathogens that affect the same populations. Clinical trial registration:https://clinicaltrials.gov, identifier: NCT02362217
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Affiliation(s)
- Felicity Hartnell
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Anthony Brown
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Jakub Kopycinski
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Carly Bliss
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Leo Swadling
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Emma Ghaffari
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paola Cicconi
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Ilaria Esposito
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Paula Marriott
- Centre for Clinical Vaccinology and Tropical Medicine, Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Clair M Gardiner
- School of Biochemistry and Immunology, Trinity College, Dublin, Ireland
| | | | | | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Bethany Turner
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alfredo Nicosia
- Keires AG, Basel, Switzerland.,Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | | | - Tomáš Hanke
- Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom.,International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford NIHR Biomedical Research Centre, Headington, United Kingdom
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford NIHR Biomedical Research Centre, Headington, United Kingdom
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604
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Pastori D, Mezzaroma I, Pignatelli P, Violi F, Lip GYH. Atrial fibrillation and human immunodeficiency virus type-1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy. Br J Clin Pharmacol 2019; 85:508-515. [PMID: 30575989 DOI: 10.1111/bcp.13837] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence and incidence of atrial fibrillation/flutter (AF/AFL) in patients with human immunodeficiency virus type-1 (HIV-1) infection have been poorly investigated. We performed a systematic review using PubMed and Cochrane Database of Systematic Reviews, and screening of references, searching for clinical studies reporting on the association between HIV-1 infection and AF/AFL. We also summarized the main interactions of antiretroviral agents with antithrombotic and antiarrhythmic drugs. We found a prevalence of AF/AFL ranging from 2.0% to 5.13% in patients with HIV-1, with an incidence rate of 3.6/1000 person-years. Low CD4+ count (<200-250 cells ml-1 ) and high viral load were predictors of AF/AFL. Regarding drugs interactions, nucleoside reverse transcriptase inhibitors, integrase inhibitor and maraviroc have the lowest interactions with oral anticoagulants. Among anticoagulants, dabigatran presents the most favourable profile. Most of antiarrhythmic drugs interact with protease inhibitors, with beta blockers and diltiazem having fewer interactions. The few studies available suggest a non-negligible prevalence of AF/AFL in patients with HIV-1 infection. Awareness of potential interactions with anticoagulation and antiarrhythmic drugs is needed to offer optimal management in this population.
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Affiliation(s)
- Daniele Pastori
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Francesco Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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605
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Krentz HB, Campbell S, Lahl M, Gill MJ. De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings. HIV Med 2019; 20:214-221. [PMID: 30632660 DOI: 10.1111/hiv.12701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES As more HIV-positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De-simplifying a single-tablet co-formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de-simplification of one STF could be utilized as a cost-saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. METHODS Patients stable on the most commonly used STF (Triumeq® ) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay® . No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. RESULTS Of 626 patients receiving Triumeq® , 321 were approached; 177 (55.1%) agreed to de-simplify. Of patients initiating ART, 62.7% chose the generic co-formulation. Patients switching to or starting on the generic co-formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV-experienced, and to have more comorbidities (all P < 0.05). Preference for STF was cited for declining de-simplification. No concern about generic ARVs was expressed. The rate of viral load > 500 HIV-1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. CONCLUSIONS Reliance on altruism, while respecting patient autonomy, achieved de-simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M Lahl
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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606
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Bijker R, Jiamsakul A, Uy E, Kumarasamy N, Ditango R, Chaiwarith R, Wong WW, Avihingsanon A, Sun LP, Yunihastuti E, Pujari S, Do CD, Merati TP, Kantipong P, Nguyen KV, Kamarulzaman A, Zhang F, Lee MP, Choi JY, Tanuma J, Ng OT, Sim B, Ross J, Kiertiburanakul S. Cardiovascular disease-related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD). HIV Med 2019; 20:183-191. [PMID: 30620108 DOI: 10.1111/hiv.12687] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES With aging of the HIV-positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD-related and other causes of death (CODs) and factors associated with CVD in a multi-country Asian HIV-positive cohort. METHODS Patient data from 2003-2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow-up. Cumulative incidences were plotted for CVD-related, AIDS-related, non-AIDS-related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. RESULTS Of 8069 patients with a median follow-up of 7.3 years [interquartile range (IQR) 4.4-10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person-years (PY)], and this total included 22 CVD-related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub-hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36-3.58 for age 41-50 years; sHR 5.52; 95% CI 3.43-8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04-2.52), high total cholesterol (sHR 1.89; 95% CI 1.27-2.82), high triglycerides (sHR 1.55; 95% CI 1.02-2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12-2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle- and upper middle-income countries. CONCLUSIONS The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle-income countries may indicate under-diagnosis of CVD in Asian-Pacific resource-limited settings.
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Affiliation(s)
- R Bijker
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E Uy
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - R Ditango
- Research Institute for Tropical Medicine, Manila, Philippines
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - A Avihingsanon
- HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - L P Sun
- National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/CiptoMangunkusumo Hospital, Jakarta, Indonesia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine, Sanglah Hospital, Udayana University, Bali, Indonesia
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Bejing, China
| | - M P Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Blh Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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607
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Sovershaeva E, Shamu T, Wilsgaard T, Bandason T, Flægstad T, Katzenstein D, Ferrand RA, Odland J. Patterns of detectable viraemia among children and adults with HIV infection taking antiretroviral therapy in Zimbabwe. Int J Infect Dis 2019; 78:65-71. [PMID: 30391420 PMCID: PMC7614873 DOI: 10.1016/j.ijid.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the incidence and predictors of viraemia among individuals on antiretroviral therapy (ART) in Harare, Zimbabwe. METHODS Children (0-19 years) and adults (>19 years) starting ART between 2013 and 2015 were followed for a median of 2.8 and 2.7 years, respectively. The incidence rates of virological failure (VF), low-level viraemia (LLV), and viral blips were assessed and the predictors of viraemia were determined using logistic and parametric survival regression analyses. RESULTS A total of 630 individuals initiated ART, and 19.7% of children and 5.6% of adults did not achieve viral suppression by 12 months. Younger age and CD4 count ≤200 cells/mm3 at baseline were associated with not being virally suppressed at 12 months in adults. Among those who achieved viral suppression during the follow-up period, the incidence of VF was higher in children (4.0/100 person-years vs. 0.4/100 person-years in adults; p<0.001), as was the incidence of LLV (1.9/100 person-years vs. 0.3/100 person-years in adults; p=0.03). The incidence rate of blips was 10.9 per 100 person-years in children and 4.0 per 100 person-years in adults. CONCLUSIONS Children are less likely to reach viral suppression and are at higher risk of viraemia while on ART than adults. The significance of LLV and blips needs further study.
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Affiliation(s)
- Evgeniya Sovershaeva
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| | | | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Trond Flægstad
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - David Katzenstein
- Division of Infectious Diseases, Stanford University, California, USA
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Jon Odland
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU The Norwegian University of Science and Technology, Trondheim, Norway
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608
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Conley TD, Perry M, Gusakova S, Piemonte JL. Monogamous Halo Effects: The Stigma of Non-Monogamy within Collective Sex Environments. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:31-34. [PMID: 29796718 DOI: 10.1007/s10508-018-1213-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/03/2018] [Indexed: 05/25/2023]
Affiliation(s)
- Terri D Conley
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Morgan Perry
- Department of Psychology, University of Michigan-Flint, Flint, MI, USA
| | - Staci Gusakova
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
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609
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Serrano-Villar S, de Lagarde M, Vázquez-Castellanos J, Vallejo A, Bernadino JI, Madrid N, Matarranz M, Díaz-Santiago A, Gutiérrez C, Cabello A, Villar-García J, Blanco JR, Bisbal O, Sainz T, Moya A, Moreno S, Gosalbes MJ, Estrada V. Effects of Immunonutrition in Advanced Human Immunodeficiency Virus Disease: A Randomized Placebo-controlled Clinical Trial (Promaltia Study). Clin Infect Dis 2019; 68:120-130. [PMID: 29788075 DOI: 10.1093/cid/ciy414] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While nutritional interventions with prebiotics and probiotics seem to exert immunological effects, their clinical implications in human immunodeficiency virus (HIV)-infected subjects initiating antiretroviral therapy (ART) at advanced HIV disease remain unclear. METHODS This was a pilot multicenter randomized, placebo-controlled, double-blind study in which 78 HIV-infected, ART-naive subjects with <350 CD4 T cells/μL or AIDS were randomized to either daily PMT25341 (a mixture of synbiotics, omega-3/6 fatty acids and amino acids) or placebo for 48 weeks, each in combination with first-line ART. Primary endpoints were changes in CD4 T-cell counts and CD4/CD8 ratio from baseline to week 48 and safety. Secondary endpoints were changes in markers of T-cell activation, bacterial translocation, inflammation, and α and β microbiota diversity. RESULTS Fifty-nine participants completed the follow-up with a mean CD4+ T-cell count of 221 ± 108 cells/μL and mean CD4/CD8 ratio of 0.26 ± 0.19. PMT25341 was well tolerated, without grade 3-4 adverse effects attributable to the intervention. While most of the assessed biomarkers improved during the follow-up in both arms, PMT25341-treated subjects did not experience any significant change, compared to placebo-treated subjects, in mean CD4+ T-cell count change (278 vs 250 cells/μL, P = .474) or CD4/CD8 ratio change (0.30 vs 0.32, P = .854). Similarly, we did not detect differences between treatment arms in secondary endpoints. CONCLUSIONS In HIV-infected patients initiating ART at advanced disease, the clear immunological benefits of ART were not enhanced by this nutritional intervention targeting the gut-associated lymphoid tissue and microbiota. CLINICAL TRIALS REGISTRATION NCT00870363.
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid
| | | | | | - Alejandro Vallejo
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid
| | - José I Bernadino
- HIV Unit, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid
| | - Nadia Madrid
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid
| | | | - Alberto Díaz-Santiago
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid
| | - Carolina Gutiérrez
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid
| | - Alfonso Cabello
- Infectious Diseases Division, Hospital Universitario Fundación Jiménez Díaz, Madrid
| | - Judit Villar-García
- Infectious Diseases Department, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona
| | - José Ramón Blanco
- Department of Infectious Diseases, Hospital San Pedro - Centro de Investigación Biomédica de la Rioja (CIBIR), Logroño
| | - Otilia Bisbal
- HIV Unit, Hospital Universitario Doce de Octubre, Madrid
| | - Talía Sainz
- Pediatric Tropical and Infectious Diseases Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Valencia
| | - Andrés Moya
- Area of Genomics and Health, FISABIO-Salud Pública, Valencia
- Institute of Integrative Systems Biology, University of Valencia and CSIC, Valencia
- CIBER in Epidemiology and Public Health, Madrid
| | | | - María José Gosalbes
- Area of Genomics and Health, FISABIO-Salud Pública, Valencia
- CIBER in Epidemiology and Public Health, Madrid
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610
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Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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611
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Scott-Sheldon LAJ, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Salmoirago-Blotcher E, Wing RR, Carey MP. Mindfulness-Based Interventions for Adults Living with HIV/AIDS: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:60-75. [PMID: 30054765 PMCID: PMC6344266 DOI: 10.1007/s10461-018-2236-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This meta-analysis examined the effects of mindfulness-based interventions (MBIs) on stress, psychological symptoms, and biomarkers of disease among people living with HIV/AIDS (PLWHA). Comprehensive searches identified 16 studies that met the inclusion criteria (N = 1059; M age = 42 years; 20% women). Participants had been living with HIV for an average of 8 years (range = < 1-20 years); 65% were currently on antiretroviral therapy. Between-group analyses indicated that depressive symptoms were reduced among participants receiving the MBIs compared to controls (d+ = 0.37, 95% CI 0.03, 0.71). Within-group analyses showed reductions in psychological symptoms (i.e., less anxiety, fewer depressive symptoms) and improved quality of life over time among MBI participants (d+s = 0.40-0.85). No significant changes were observed for immunological outcomes (i.e., CD4 counts) between- or within-groups. MBIs may be a promising approach for reducing psychological symptoms and improving quality of life among PLWHA. Studies using stronger designs (i.e., randomized controlled trials) with larger sample sizes and longer follow-ups are needed to clarify the potential benefits of MBIs for PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rena R Wing
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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612
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Benzekri NA, Seydi M, N. Doye I, Toure M, Sy MP, Kiviat NB, Sow PS, Gottlieb GS, Hawes SE. Increasing prevalence of hypertension among HIV-positive and negative adults in Senegal, West Africa, 1994-2015. PLoS One 2018; 13:e0208635. [PMID: 30596667 PMCID: PMC6312281 DOI: 10.1371/journal.pone.0208635] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Non-communicable diseases, including hypertension (HTN), are increasingly recognized as important causes of morbidity and mortality among people living with HIV (PLHIV) in resource-limited settings. The goals of this study were to determine the prevalence of HTN among PLHIV in Senegal over time and to identify predictors of HTN among HIV-positive versus HIV-negative adults. METHODS We conducted a retrospective study using data from individuals enrolled in previous studies in Senegal from 1994-2015. Blood pressure (BP) measurements taken during study visits were used for analysis. HTN was defined as systolic BP≥140 or diastolic BP≥90. We used logistic regression to identify predictors of HTN. RESULTS We analyzed data from 2848 adults (1687 HIV-positive, 1161 HIV-negative). Among PLHIV, the prevalence of HTN increased from 11% during 1994-1999 to 22% during 2010-2015. Among HIV-negative individuals, the prevalence of HTN increased from 16% to 32%. Among both groups, the odds of HTN more than doubled from 1994-1999 to 2010-2015 (HIV-positive OR 2·4, 95% CI 1·1-5·0; HIV-negative OR 2·6, 95% CI 1·5-4·6). One quarter of all individuals with HTN had stage 2 HTN. The strongest risk factor for HTN was obesity (HIV-positive OR 3·2, 95% CI 1·7-5·8; p<0·01; HIV-negative OR 7·8, 95% CI 4·5-13·6; p<0·01). Male sex and age ≥50 were also predictive of HTN among both groups. Among HIV-positive subjects, WHO stage 1 or 2 disease was predictive of HTN and among HIV-negative subjects, having no formal education was predictive. CONCLUSION Over the past 20 years, the prevalence of HTN has doubled among both HIV-positive and HIV-negative adults in Senegal. Our study indicates that there is an increasing need for the integration of chronic disease management into HIV programs in Senegal. Furthermore, our findings highlight the need for enhanced prevention, recognition, and management of non-communicable diseases, including hypertension and obesity, among both HIV-positive and HIV-negative individuals in Senegal.
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Affiliation(s)
- Noelle A. Benzekri
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | | | - Macoumba Toure
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Marie Pierre Sy
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Nancy B. Kiviat
- Department of Pathology, University of Washington, Seattle, WA, United States of America
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Stephen E. Hawes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
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613
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Giguère P, Nhean S, Tseng AL, Hughes CA, Angel JB. Getting to the Heart of the Matter: A Review of Drug Interactions Between HIV Antiretrovirals and Cardiology Medications. Can J Cardiol 2018; 35:326-340. [PMID: 30825953 DOI: 10.1016/j.cjca.2018.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 01/28/2023] Open
Abstract
The past 20 years have seen remarkable advances in the treatment of HIV such that most people diagnosed with HIV today can live long, healthy lives by taking antiretrovirals which are usually life-long. Advancements in antiretroviral therapy include the availability of well tolerated, single tablet regimens that are associated with a lower risk of drug-drug interactions. Despite this, many people living with HIV infection might be taking antiretroviral agents that are associated with significant drug-drug interactions. Because HIV infection itself is associated with cardiovascular complications and this population is living longer, concomitant use of antiretrovirals and medications to treat cardiovascular-related diseases is often required. For this reason, it is imperative that clinicians are aware of the potential for clinically significant drug-drug interactions between antiretroviral agents and cardiac medications as well as the useful HIV drug interaction resources that might provide guidance. Available data on significant interactions are summarized and suggested guidance regarding management is discussed.
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Affiliation(s)
- Pierre Giguère
- Department of Pharmacy, The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Salin Nhean
- University Health Network, Toronto, Ontario, and McGill University Health Centre, Montréal, Quebec, Canada
| | - Alice L Tseng
- University of Health Network, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan B Angel
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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614
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Sánchez-Conde M, Díaz-Alvarez J, Dronda F, Brañas F. Why are people with HIV considered “older adults” in their fifties? Eur Geriatr Med 2018; 10:183-188. [DOI: 10.1007/s41999-018-0148-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
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615
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Freedman SF, Johnston C, Faragon JJ, Siegler EL, Del Carmen T. Older HIV-infected adults. Complex patients (III): Polypharmacy. Eur Geriatr Med 2018; 10:199-211. [PMID: 31983932 DOI: 10.1007/s41999-018-0139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities. Even when excluding ARVs, the prevalence of polypharmacy in PLWH is higher than the general population, and not just in resource-rich countries. Using a more nuanced approach with "appropriate" or "safer" polypharmacy allows for a better framework for discussing how to mitigate the associated risks. Some of the consequences of polypharmacy include adverse effects of medications including the risk of geriatric syndromes, drug-drug interactions, decreased adherence, and over- and undertreatment of medical comorbidities. Interventions to combat polypharmacy include decreasing pill burden-specifically with fixed-dose combination (FDC) tablets- and medication reconciliation/deprescription using established criteria. The goal of these interventions is to decrease drug interactions and improve quality of life and outcomes. Some special populations of interest within the community of PLWH include those with chronic pain, substance abuse, or requiring end of life care. A final look into the future of antiretroviral therapy (ART) shows the promise of possible two-drug regimens, which can help reduce the above risks of polypharmacy.
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Affiliation(s)
- Samuel F Freedman
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Carrie Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | | | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tessa Del Carmen
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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616
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Groenewegen H, Bierman WFW, Delli K, Dijkstra PU, Nesse W, Vissink A, Spijkervet FKL. Severe periodontitis is more common in HIV- infected patients. J Infect 2018; 78:171-177. [PMID: 30528870 DOI: 10.1016/j.jinf.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis. DESIGN cross-sectional controlled study. METHODS We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires. RESULTS Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p = 0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists. CONCLUSIONS Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients.
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Affiliation(s)
- Hester Groenewegen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Wouter F W Bierman
- Department of Internal Medicine, Division of Infectious Diseases, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery and Department Rehabilitation, Center of Rehabilitation, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Willem Nesse
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, Wilhelmina Hospital Assen, Postbus 30001, 9400 RA Assen, The Netherlands.
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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617
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Slawek DE, Lu TY, Hayes B, Fox AD. Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2018. [PMCID: PMC9175890 DOI: 10.1176/appi.prcp.20180005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Opioid use disorder (OUD) is a growing problem, with opioid‐involved overdose deaths quadrupling since 1999 in the United States. This article reviews comorbid medical conditions related to OUD, starting with complications of behaviors associated with opioid use (e.g., injection drug use), followed by conditions stemming from the direct effects of opioids (e.g., hypogonadism). HIV and hepatitis C virus (HCV) are common infections in people with OUD, and treatment for these conditions can be safely provided regardless of ongoing substance use. Complications of drug injection, such as HIV, HCV, skin and soft tissue infections, and infective endocarditis, may be prevented through provision of sterile syringes and supervised injection facilities. Rare, life‐threatening bacterial infections may present with signs and symptoms that mimic intoxication, such as malaise or stupor, and should be assessed in patients with fever or positive blood cultures. In addition, chronic opioid exposure can lead to hypogonadism, opioid‐induced hyperalgesia, sleep‐disordered breathing, and potentially increased risk of cardiovascular disease and neurocognitive impairment. Pharmacotherapies for OUD (buprenorphine, methadone, and naltrexone) are safe and effective and their adverse opioid effects can be managed in clinical practice. Awareness of OUD‐associated medical conditions and their treatments is an important step in improving the health and wellness of people with OUD.
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Affiliation(s)
| | - Tiffany Y. Lu
- Department of MedicineAlbert Einstein College of MedicineBronxNY
| | - Benjamin Hayes
- Department of MedicineAlbert Einstein College of MedicineBronxNY
| | - Aaron D. Fox
- Department of MedicineAlbert Einstein College of MedicineBronxNY
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618
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A Review of Infections in People Who Use Nonprescription Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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619
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Stecher M, Schommers P, Schmidt D, Kollan C, Gunsenheimer-Bartmeyer B, Lehmann C, Platten M, Fätkenheuer G, Vehreschild JJ. Antiretroviral treatment indications and adherence to the German-Austrian treatment initiation guidelines in the German ClinSurv HIV Cohort between 1999 and 2016. Infection 2018; 47:247-255. [PMID: 30414065 DOI: 10.1007/s15010-018-1248-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of the study was to assess guideline adherence to combined antiretroviral therapy (ART) in the German ClinSurv HIV Cohort and the real-life impact of the Strategic Timing of Antiretroviral Therapy (START) study, to identify patients not treated as recommended by new guidelines. METHODS We used data from the multicenter ClinSurv cohort of the Robert-Koch-Institute (RKI) between 1999 and 2016. Inclusion criteria were people living with HIV/AIDS, ≥ 18 years of age and cART naïve at the first visit (FV). Adherence was defined as starting cART within 6 months of crossing the CD4+ T cell threshold as suggested by the German-Austrian treatment guidelines. Logistic regression was used to identify factors associated with non-adherence. RESULTS 11,817 patients met the inclusion criteria. We observed an overall adherence rate of 60%, in patients with treatment indication who started cART timely between 2002 and 2015. Adherence rate increased constantly, demonstrating a potential increase in patients, with treatment indication, starting cART within 6 months of presentation from 55% in 2008 to 94% in 2015. Patients reporting injection drug use (OR 2.18, 95% CI 1.70-2.95) and patients between 18 years and 39 years of age at the time of their first visit (OR 2.89, 95% CI 1.35-6.18) were identified as risk groups associated with non-adherence. CONCLUSION The majority of patients below the CD4+ T cell count threshold of applicable guidelines initiated treatment within 6 months. We observed a slowly diminishing proportion of patients not starting cART timely. Delayed treatment was more frequent in patients reporting injection drug use.
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Affiliation(s)
- Melanie Stecher
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany.
| | - Philipp Schommers
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Charité - University Medicine Berlin, Berlin, Germany
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Clara Lehmann
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany
| | - Martin Platten
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany
| | - Jörg Janne Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany.
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620
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Safeek RH, Hall KS, Lobelo F, del Rio C, Khoury AL, Wong T, Morey MC, McKellar MS. Low Levels of Physical Activity Among Older Persons Living with HIV/AIDS Are Associated with Poor Physical Function. AIDS Res Hum Retroviruses 2018; 34:929-935. [PMID: 29984584 PMCID: PMC6909688 DOI: 10.1089/aid.2017.0309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antiretroviral therapy (ART) has prolonged lives of persons living with HIV/AIDS (PLWHA), resulting in greater incidence of aging-related diseases and disability. Physical activity (PA) is recommended for healthy aging, but little is known about PA in older PLWHA. The purpose of this study was to objectively assess PA levels in older PLWHA and the associations with physical function. Twenty-one PLWHA, ≥50 years old, on ART with undetectable HIV-1 viral loads, wore an accelerometer to assess PA, including number of steps, activity intensity, and energy expenditure over 7 days. A physical function performance battery assessing aerobic capacity, strength, and gait speed was also completed. Average age was 66, and 67% were male. An average of 3,442 (interquartile range: 4,613) steps were walked daily, with 254.9 kcals expended. Participants spent most waking hours (75%) sedentary, with minimal hours (24%) in light-intensity activity. Only 5 min per day (35 min per week), on average, were spent in moderate-to-vigorous physical activity (MVPA). Maximal gait speed and 6-min walk test significantly correlated (p < .05) with all PA outcomes. Usual gait speed significantly correlated with all PA outcomes, except for daily kcals and light-intensity activity. Greater PA was associated with better physical performance, while high sedentary time was associated with poorer performance. To our knowledge, this is the first study to objectively measure PA in older PLWHA. Our findings indicate that older PLWHA accumulate substantial sedentary time. Most (86%) do not achieve recommended MVPA levels. This activity profile was associated with poor physical function. Providers should promote PA among PLWHA.
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Affiliation(s)
- Rachel H. Safeek
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine S. Hall
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Felipe Lobelo
- Exercise is Medicine Global Research and Collaboration Center, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carlos del Rio
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Audrey L. Khoury
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tammy Wong
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Miriam C. Morey
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Mehri S. McKellar
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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621
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Joshi K, Boettiger D, Kerr S, Nishijima T, Van Nguyen K, Ly PS, Lee MP, Kumarasamy N, Wong W, Kantipong P, Cuong DD, Kamarulzaman A, Choi JY, Zhang F, Chaiwarith R, Ng OT, Kiertiburanakul S, Sim BLH, Merati TP, Yunihastuti E, Ditangco R, Ross J, Pujari S. Changes in renal function with long-term exposure to antiretroviral therapy in HIV-infected adults in Asia. Pharmacoepidemiol Drug Saf 2018; 27:1209-1216. [PMID: 30246898 PMCID: PMC6218305 DOI: 10.1002/pds.4657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Renal disease is common among people living with human immunodeficiency virus (HIV). However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia. METHODS We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy during or after 2003, had a serum creatinine measurement at antiretroviral therapy initiation (baseline), and had at least 2 follow-up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 were excluded. Chronic kidney disease was defined as 2 consecutive eGFR values ≤60 mL/min/1.73 m2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative incidence plots were used to evaluate factors associated with chronic kidney disease (CKD). RESULTS Of 2547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage, and low nadir CD4 were associated with a decrease in eGFR during follow-up. Chronic kidney disease occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use. CONCLUSIONS There is an urgent need to enhance renal monitoring and management capacity among at-risk groups in Asia and improve access to less nephrotoxic antiretrovirals.
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Affiliation(s)
- Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | | | - Stephen Kerr
- HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - Wingwai Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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622
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Mwamba C, Sharma A, Mukamba N, Beres L, Geng E, Holmes CB, Sikazwe I, Topp SM. 'They care rudely!': resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia. BMJ Glob Health 2018; 3:e001007. [PMID: 30483408 PMCID: PMC6231098 DOI: 10.1136/bmjgh-2018-001007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/08/2018] [Accepted: 08/31/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Despite access to free antiretroviral therapy (ART), many HIV-positive Zambians disengage from HIV care. We sought to understand how Zambian health system 'hardware' (tangible components) and 'software' (work practices and behaviour) influenced decisions to disengage from care among 'lost-to-follow-up' patients traced by a larger study on their current health status. METHODS We purposively selected 12 facilities, from 4 provinces. Indepth interviews were conducted with 69 patients across four categories: engaged in HIV care, disengaged from care, transferred to another facility and next of kin if deceased. We also conducted 24 focus group discussions with 158 lay and professional healthcare workers (HCWs). These data were triangulated against two consecutive days of observation conducted in each facility. We conducted iterative multilevel analysis using inductive and deductive reasoning. RESULTS Health system 'hardware' factors influencing patients' disengagement included inadequate infrastructure to protect privacy; distance to health facilities which costs patients time and money; and chronic understaffing which increased wait times. Health system 'software' factors related to HCWs' work practices and clinical decisions, including delayed opening times, file mismanagement, drug rationing and inflexibility in visit schedules, increased wait times, number of clinic visits, and frustrated access to care. While patients considered HCWs as 'mentors' and trusted sources of information, many also described them as rude, tardy, careless with details and confidentiality, and favouring relatives. Nonetheless, unlike previously reported, many patients preferred ART over alternative treatment (eg, traditional medicine) for its perceived efficacy, cost-free availability and accompanying clinical monitoring. CONCLUSION Findings demonstrate the dynamic effect of health system 'hardware' and 'software' factors on decisions to disengage. Our findings suggest a need for improved: physical resourcing and structuring of HIV services, preservice and inservice HCWs and management training and mentorship programmes to encourage HCWs to provide 'patient-centered' care and exercise 'flexibility' to meet patients' varying needs and circumstances.
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Affiliation(s)
- Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura Beres
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elvin Geng
- School of Medicine, University of California, San Francisco, California, USA
| | - Charles B Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Abstract
OBJECTIVES To describe changes in the prevalence of comorbidities and risk factors among HIV-positive individuals in the EuroSIDA study. DESIGN Comparison of two cross-sectional cohorts of HIV-positive adults under active follow-up in 2006 and 2014. METHODS Baseline demographics and prevalence of comorbidities were described. Factors associated with the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD) were assessed by logistic regression modelling using generalized estimating equations. RESULTS Nine thousand, seven hundred and ninety-eight individuals were under active follow-up in EuroSIDA during 2006 and 12 882 during 2014. Compared with study participants in 2006, those in 2014 were older [median age 48.6 years (IQR 40.3-55.1) vs. 43.1 years (37.2-50.0) in 2006] and had higher prevalence of hypertension (59.6 vs. 47% in 2006), diabetes (6.3 vs. 5.4%), CKD (6.9 vs. 4.1%) and CVD (5.0 vs. 3.7%). Individuals in the 2014 cohort had higher odds for CKD (unadjusted OR 2.62, 95% CI 2.30-2.99, P < 0.0001) and CVD (OR 1.88, CI 1.68-2.10, P < 0.0001), but after multivariable adjustment for age group, comorbidities and other factors, year of cohort was no longer significantly associated with the odds of CKD [adjusted OR (aOR) 0.97, CI 0.52-1.82, P = 0.92) or of CVD (aOR 0.94, CI 0.54-1.63, P = 0.82). CONCLUSION Between 2006 and 2014, the population aged and experienced an overall higher prevalence of non-AIDS comorbidities, including CKD and CVD. The increase in CVD could be explained by the aging population, and the increase in CKD by aging and changes in other factors. Treatment strategies balancing HIV outcomes with long-term management of comorbidities remain a priority.
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624
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Ke R, Conway JM, Margolis DM, Perelson AS. Determinants of the efficacy of HIV latency-reversing agents and implications for drug and treatment design. JCI Insight 2018; 3:123052. [PMID: 30333308 DOI: 10.1172/jci.insight.123052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
HIV eradication studies have focused on developing latency-reversing agents (LRAs). However, it is not understood how the rate of latent reservoir reduction is affected by different steps in the process of latency reversal. Furthermore, as current LRAs are host-directed, LRA treatment is likely to be intermittent to avoid host toxicities. Few careful studies of the serial effects of pulsatile LRA treatment have yet been done. This lack of clarity makes it difficult to evaluate the efficacy of candidate LRAs or predict long-term treatment outcomes. We constructed a mathematical model that describes the dynamics of latently infected cells under LRA treatment. Model analysis showed that, in addition to increasing the immune recognition and clearance of infected cells, the duration of HIV antigen expression (i.e., the period of vulnerability) plays an important role in determining the efficacy of LRAs, especially if effective clearance is achieved. Patients may benefit from pulsatile LRA exposures compared with continuous LRA exposures if the period of vulnerability is long and the clearance rate is high, both in the presence and absence of an LRA. Overall, the model framework serves as a useful tool to evaluate the efficacy and the rational design of LRAs and combination strategies.
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Affiliation(s)
- Ruian Ke
- Department of Mathematics, North Carolina State University, Raleigh, North Carolina, USA.,Theoretical Biology and Biophysics Group, MS-K710, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Jessica M Conway
- Department of Mathematics and Center for Infectious Disease Dynamics, Pennsylvania State University, State College, Pennsylvania, USA
| | - David M Margolis
- University of North Carolina (UNC) HIV Cure Center, UNC Institute of Global Health and Infectious Diseases.,Departments of Medicine, Microbiology and Immunology, UNC Chapel Hill School of Medicine, and.,Department of Epidemiology, UNC Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, MS-K710, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
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625
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Quaife M, Vickerman P, Manian S, Eakle R, Cabrera‐Escobar MA, Delany‐Moretlwe S, Terris‐Prestholt F. The effect of HIV prevention products on incentives to supply condomless commercial sex among female sex workers in South Africa. HEALTH ECONOMICS 2018; 27:1550-1566. [PMID: 29926508 PMCID: PMC6175015 DOI: 10.1002/hec.3784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/02/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
Evidence suggests that economic factors play an important role in commercial sex work, in particular that condomless sex commands a price premium relative to condom-protected sex. This paper explores whether the use of a new HIV prevention product, with 100% efficacy but modeled after pre-exposure prophylaxis (PrEP), could change the price and quantity of condomless commercial sex supplied. We collected stated preference data from 122 HIV-negative female sex workers in urban South Africa, using a repeated choice experiment to simulate the impact of using PrEP on choices. Results suggest that the price premium for condomless sex would decrease by 73% with PrEP use and the quantity of condomless sex is predicted to increase by a factor of 2.27. Act price does not significantly affect choices without protection but strongly influences choices under full HIV protection. The utility offered by condoms reduces by around 15% under PrEP use. Because new HIV prevention products do not protect against other STIs or pregnancy, the unintended consequences of introducing HIV prevention products should be closely monitored, whereas users should not face stigma or blame for reacting rationally to exogenous changes to market conditions.
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Affiliation(s)
- Matthew Quaife
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Peter Vickerman
- School of Social and Community MedicineUniversity of BristolBristolUK
| | | | - Robyn Eakle
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | - Fern Terris‐Prestholt
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
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626
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Nkhoma K, Norton C, Sabin C, Winston A, Merlin J, Harding R. Self-management Interventions for Pain and Physical Symptoms Among People Living With HIV: A Systematic Review of the Evidence. J Acquir Immune Defic Syndr 2018; 79:206-225. [DOI: 10.1097/qai.0000000000001785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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627
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Jacobson K, Ogbuagu O. Integrase inhibitor-based regimens result in more rapid virologic suppression rates among treatment-naïve human immunodeficiency virus-infected patients compared to non-nucleoside and protease inhibitor-based regimens in a real-world clinical setting: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e13016. [PMID: 30412140 PMCID: PMC6221636 DOI: 10.1097/md.0000000000013016] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The integrase strand transfer inhibitor (INSTI) class of antiretroviral therapy (ART) may result in faster time to virologic suppression compared with regimens that contain protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, differences in time to achieve virologic suppression are not well-defined in routine clinical settings with contemporary antiretroviral agents.Study was a retrospective single-center study of treatment-naïve human immunodeficiency virus (HIV) patients initiating ART between 2013 and 2016. Among patients on different ART regimen types, we compared rates of and median time to virologic suppression [viral load (VL) <50 copies/mL].A total of 155 patients-45 (29%) female and 110 (71%) male-met study inclusion criteria. Median age was 42 years (interquartile range 31-52), and median baseline CD4 count was 288 cells/μL and VL was 60,000 copies/mL. Seventy-one (46%) initiated an INSTI-based regimen, 58 (37%) were on NNRTI-based regimens, and 26 (17%) on PI-based regimens. In total, 112 (72%) patients achieved virologic suppression at 12 months. Patients on INSTI-based regimens were more likely to achieve virologic suppression by 3, 6, and 12 months (P < .01), and had lower median time to suppression (60 vs 137 days on NNRTI-based regimens and 147 days on PI-based regimens, P < .01).Patients on INSTI-based ART regimens in a real-world setting experienced higher rates of virologic suppression and shorter time from ART initiation to virologic suppression. For HIV patients on INSTI-based ART regimens, virologic failure should be suspected in those with VLs >50 copies/mL before the current recommendation of 48 weeks.
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Affiliation(s)
| | - Onyema Ogbuagu
- Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT
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628
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Yanagisawa N, Muramatsu T, Koibuchi T, Inui A, Ainoda Y, Naito T, Nitta K, Ajisawa A, Fukutake K, Iwamoto A, Ando M. Prevalence of Chronic Kidney Disease and Poor Diagnostic Accuracy of Dipstick Proteinuria in Human Immunodeficiency Virus-Infected Individuals: A Multicenter Study in Japan. Open Forum Infect Dis 2018; 5:ofy216. [PMID: 30320149 PMCID: PMC6176335 DOI: 10.1093/ofid/ofy216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has become one of the common comorbid conditions affecting the human immunodeficiency virus (HIV) population. Human immunodeficiency virus-infected individuals are at increased risk of developing CKD, and they are likely to experience faster progression of renal dysfunction compared with HIV-uninfected individuals. Albuminuria represents not only kidney damage but also manifests metabolic syndrome and vascular dysfunction. METHODS We conducted a multicenter, cross-sectional study involving 2135 HIV-infected individuals in Japan to test the prevalence of CKD and proteinuria/albuminuria. Urine sample was analyzed by both dipstick test and albumin-to-creatinine ratio (ACR) assay. Chronic kidney disease was classified according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The diagnostic performance of dipstick test to detect albuminuria (ACR ≥30 mg/g) was evaluated. RESULTS The prevalence of CKD, evaluated by K/DOQI and KDIGO guidelines, was 15.8% and 20.4%, respectively. Age, total cholesterol level, prevalence of hypertension, diabetes mellitus, and hepatitis C infection tended to increase, whereas levels of hemoglobin, serum albumin, and CD4 cell count tended to decrease as CKD risk grades progressed. Proteinuria and albuminuria were present in 8.9% and 14.5% of individuals, respectively. Dipstick test ≥1+ to detect albuminuria had an overall sensitivity of 44.9% and specificity of 97.2%. CONCLUSIONS The KDIGO guideline may enable physicians to capture HIV-infected patients at increased risk more effectively. The sensitivity of dipstick proteinuria to detect albuminuria is so poor that it may not serve as an alternative in HIV-infected individuals.
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Affiliation(s)
- Naoki Yanagisawa
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takashi Muramatsu
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Tomohiko Koibuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Akihiro Inui
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Ainoda
- Division of Infection Control and Infectious Diseases, Mitsui Memorial Hospital, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- Department IV of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
- Department of Medicine, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan
| | - Katsuyuki Fukutake
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Aikichi Iwamoto
- Division of Infectious Diseases, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Minoru Ando
- Department IV of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Medicine, Jiseikai Memorial Hospital, Tokyo, Japan
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629
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Lédo AP, Rodriguez-Prieto I, Lins L, Neto MG, Brites C. Association Between Health-Related Quality of Life and Physical Functioning in Antiretroviral-Naive HIV-Infected Patients. Open AIDS J 2018; 12:117-125. [PMID: 30369996 PMCID: PMC6182873 DOI: 10.2174/1874613601812010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/24/2018] [Accepted: 09/06/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Poor functional status can significantly affect Health-Related Quality of Life (HRQoL) of HIV patients. However, there is scarce information on the functional profile of such patients before starting antiretroviral therapy (ART). Objective: To estimate the association between health-related quality of life and physical functioning in Antiretroviral-Naive HIV-infected patients. Methods: We conducted a cross-sectional study with HIV-infected patients older than 18 years, and naïve to antiretroviral therapy. The patients were evaluated for functional profile by pulmonary function (forced vital capacity, forced expiratory volume at one second, and Tiffeneau index), handgrip strength, and six-minute walk test in a cross-sectional study. HRQoL was evaluated by the 36-Item Short-Form Health Survey and its Physical (PCS) and Mental (MCS) Component Summaries. Multiple linear regression analyses were used to evaluate the association of predictor variables with PCS and MCS scores. Results: We found lower HRQoL among females patients, with far below average impairment of mental health component. Both male and female patients presented lower 6MWD function test values. Patients with dynapenia were older than patients without it, presented lower PCS mean score, lower family income, poor 6 MWD function test, lower FVC, and lower FEV1 t. Multivariable logistic regression analyses showed that Grip Strength, age and family income were predictor variables for Physical component of HRQoL. Female gender and smoking habit were predictive for the mental component of HRQoL. Conclusion: HRQoL in HIV, drug-naïve patients is predicted by level of dynapenia, smoking, income and gender. Therefore, lifestyle changes and active exercising can help to improve HRQoL in such patients.
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Affiliation(s)
- Ana Paula Lédo
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Liliane Lins
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Carlos Brites
- Research Laboratory of Infectious Diseases, Edgard Santos Federal University Hospital, Salvador, Bahia, Brazil
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630
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Lupo J, Germi R, Costagliola D, Morand P, Besson C. Utility of Epstein-Barr Virus Biomarkers in Human Immunodeficiency Virus–related Lymphomas in the Modern Combined Antiretroviral Therapy Era. Clin Infect Dis 2018; 68:891-892. [DOI: 10.1093/cid/ciy786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julien Lupo
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Raphaële Germi
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Dominique Costagliola
- Institut national de la santé et de la recherche médicale (INSERM), Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris
| | - Patrice Morand
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Caroline Besson
- Unité d’Hémato-Oncologie, Centre Hospitalier de Versailles, Le Chesnay
- Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay
- Centre for Research in Epidemiology and Population Health, INSERM Unit 1018, Villejuif, France
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631
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Pitman MC, Lewin SR. Towards a cure for human immunodeficiency virus. Intern Med J 2018; 48:12-15. [PMID: 29314511 DOI: 10.1111/imj.13673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Matthew C Pitman
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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632
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Rai T, Bruton J, Day S, Ward H. From activism to secrecy: Contemporary experiences of living with HIV in London in people diagnosed from 1986 to 2014. Health Expect 2018; 21:1134-1141. [PMID: 30168239 PMCID: PMC6250870 DOI: 10.1111/hex.12816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Successes in biomedicine have transformed HIV from a debilitating and frequently fatal infection to a chronic, manageable condition. Objective To explore how the contemporary metanarrative of HIV as a chronic condition is understood by patients and how it varies depending on when they were diagnosed. Design Qualitative interviews with 52 people living with HIV who were diagnosed during different phases in the history of the epidemic. Setting and participants Participants were recruited from two HIV clinics in London to include four “HIV generations”: generation 1 were those who had been diagnosed pre‐1997 (pre‐ART), generation 2 from 1997 to 2005 (complex ART), generation 3 from 2006 to 2012 (simpler ART) and generation 4 diagnosed in the year before the study (2013‐2014). Results Participants in all HIV generations took their medication as prescribed, attended clinic appointments and were well informed about their immunological biomarkers. While the pre‐treatment generation had been engaged in community endeavours such as activism, public education and use of support groups, those more recently diagnosed had little experience of collective activities and their HIV was essentially a private matter, separate from their social identity. These strategies worked for some; however, those experiencing clinical or social problems related to HIV or wider issues often relied exclusively on their HIV clinic for wider support. Conclusion The loss of public conversation around HIV, the imperative for patients to take on greater individual responsibility for HIV management and the streamlining of HIV services alongside reductions in ancillary support services may expose some people to suboptimal health outcomes.
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Affiliation(s)
- Tanvi Rai
- School of Public Health, Imperial College London, London, UK
| | - Jane Bruton
- School of Public Health, Imperial College London, London, UK
| | - Sophie Day
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
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633
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Abstract
The benefits of combination antiretroviral therapy (cART) for HIV replication and transmission control have led to its universal recommendation. Many people living with HIV are, however, still undiagnosed or diagnosed late, especially in sub-Saharan Africa, where the HIV disease burden is highest. Further expansion in HIV treatment options, incorporating women-centred approaches, is essential to make individualised care a reality. With a longer life expectancy than before, people living with HIV are at an increased risk of developing non-AIDS comorbidities, such as cardiovascular diseases and cancers. Antiretroviral strategies are evolving towards a decrease in drug burden, and some two-drug combinations have proven efficacy for maintenance therapy. Investigational immune checkpoint inhibitors and broadly neutralising antibodies with effector functions have energised the HIV cure research field as the search for an effective vaccine continues. In this Seminar, we review advances and challenges relating to the goal of an AIDS-free world.
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Affiliation(s)
- Jade Ghosn
- Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Babafemi Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brigitte Autran
- Inserm UMR-S 1135, Centre de Recherches en Immunologie et Maladies Infectieus, CIMI-Paris, Université Pierre et Marie Curie, Paris, France
| | - Christine Katlama
- Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Paris-Sorbonne University, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Infectious Diseases, Hôpital Pitié Salpêtrière, Paris, France.
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634
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Lamb CA, O'Byrne S, Keir ME, Butcher EC. Gut-Selective Integrin-Targeted Therapies for Inflammatory Bowel Disease. J Crohns Colitis 2018; 12:S653-S668. [PMID: 29767705 DOI: 10.1093/ecco-jcc/jjy060] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Integrins are cell surface receptors with bidirectional signalling capabilities that can bind to adhesion molecules in order to mediate homing of leukocytes to peripheral tissues. Gut-selective leukocyte homing is facilitated by interactions between α4β7 and its ligand, mucosal addressin cellular adhesion molecule-1 [MAdCAM-1], while retention of lymphocytes in mucosal tissues is mediated by αEβ7 binding to its ligand E-cadherin. Therapies targeting gut-selective trafficking have shown efficacy in inflammatory bowel disease [IBD], confirming the importance of leukocyte trafficking in disease pathobiology. This review will provide an overview of integrin structure, function and signalling, and highlight the role that these molecules play in leukocyte homing and retention. Anti-integrin therapeutics, including gut-selective antibodies against the β7 integrin subunit [etrolizumab] and the α4β7 integrin heterodimer [vedolizumab and abrilumab], and the non-gut selective anti-α4 integrin [natalizumab], will be discussed, as well as novel targeting approaches using small molecules.
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Affiliation(s)
- Christopher A Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sharon O'Byrne
- Global Medical Affairs, Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Mary E Keir
- Genentech Research & Early Development, South San Francisco, CA, USA
| | - Eugene C Butcher
- Laboratory of Immunology and Vascular Biology, Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System and The Palo Alto Veterans Institute for Research, Palo Alto, CA, USA
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635
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Lin TC, Burton BN, Barleben A, Hoenigl M, Gabriel RA. Association of HIV infection with age and symptomatic carotid atherosclerotic disease at the time of carotid intervention in the United States. Vasc Med 2018; 23:467-475. [PMID: 30101684 DOI: 10.1177/1358863x18789783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The primary objectives of this work were: (1) to describe trends in HIV prevalence among those undergoing carotid intervention (carotid endarterectomy or carotid artery stenting) in the United States; and (2) to determine if HIV infection is independently associated with symptomatic carotid atherosclerotic disease or age at the time of carotid intervention. In a nationally representative inpatient database from 2004 to 2014, HIV infection was associated with younger age at the time of carotid intervention (59 years [SE 0.2] vs 71 years [SE 0.01], p < 0.001), male sex (83% vs 58%, p < 0.001), black race (21% vs 4%, p < 0.001), and symptomatic carotid atherosclerotic disease (18.8% vs 11.0%, p < 0.001). Among those undergoing carotid intervention, there was a significant increase in the prevalence of HIV from 0.08% in 2004 to 0.17% in 2014 ( p < 0.001). After adjustment for patient demographics, comorbidities and other covariates, HIV infection remained significantly associated with younger age (-8.9 years; 95% CI: -9.7 to -8.1; p < 0.001) at the time of carotid intervention, but HIV infection was not independently associated with symptomatic carotid atherosclerotic disease.
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Affiliation(s)
- Timothy C Lin
- 1 UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Andrew Barleben
- 2 Department of Surgery, Division of Vascular and Endovascular Surgery, UC San Diego, San Diego, CA, USA
| | - Martin Hoenigl
- 3 Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA, USA.,4 Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Rodney A Gabriel
- 5 Department of Anesthesiology, Division of Regional Anesthesia, UC San Diego, San Diego, CA, USA.,6 Department of Medicine, Division of Biomedical Informatics, UC San Diego, San Diego, CA, USA
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636
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Rajasuriar R, Hearps AC, Crowe SM, Anzinger JJ, Palmer CS. Suppression of monocyte inflammatory and coagulopathy responses in HIV infection. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:277. [PMID: 30094263 DOI: 10.21037/atm.2018.06.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Anna C Hearps
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Suzanne M Crowe
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joshua J Anzinger
- Department of Microbiology, University of the West Indies, Mona, Kingston, Jamaica
| | - Clovis S Palmer
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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637
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Abstract
OBJECTIVE To review the pharmacokinetics, safety, common drug-drug interactions (DDIs), and advantages and disadvantages of new single-tablet regimens (STRs) approved since September 2016 for HIV-1 infection. DATA SOURCES A search using PubMed was conducted (2004 through May 2018) using the following keywords: single tablet regimen AND HIV. Additionally, a PubMed search was conducted for each individual STR using the generic names of the agents. For specific STRs, additional search terms were added to narrow results. Articles were evaluated for content, and additional references were identified from a review of literature citations. Conference abstracts from national and international HIV conferences were also searched. STUDY SELECTION AND DATA EXTRACTION Studies included were published randomized controlled trials and observational studies that evaluated STR approved since September 2016. Relevant conference abstracts were included if the study design was a randomized controlled trial or observational study pertaining to the STRs included. DATA SYNTHESIS Four new STRs are available, including the first dual antiretroviral therapy (ART) regimen for virologically suppressed patients. Of the STRs, only 1 is a new molecular entity, and others include new combinations of existing agents that result in distinct advantages and disadvantages. Relevance to Patient Care and Clinical Practice: The treatment of HIV-1 continues to improve with new agents developed rapidly. These agents should be analyzed in regard to efficacy, safety, DDIs, and appropriateness for specific patients on an individual basis. CONCLUSIONS STRs and agents in the pipeline continue to simplify ART regimens, increase medication adherence, and minimize toxicities.
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Affiliation(s)
| | - Denise Kelley
- 2 University of Florida, Health Jacksonville, Jacksonville, FL, USA
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638
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Rogers L, Obasa AE, Jacobs GB, Sarafianos SG, Sönnerborg A, Neogi U, Singh K. Structural Implications of Genotypic Variations in HIV-1 Integrase From Diverse Subtypes. Front Microbiol 2018; 9:1754. [PMID: 30116231 PMCID: PMC6083056 DOI: 10.3389/fmicb.2018.01754] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/13/2018] [Indexed: 01/02/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) integrase (IN) integrates viral DNA into the host genome using its 3′-end processing and strand-transfer activities. Due to the importance of HIV-1 IN, it is targeted by the newest class of approved drugs known as integrase strand transfer inhibitors (INSTIs). INSTIs are efficient in maintaining low viral load; however, as with other approved antivirals, resistance mutations emerge in patients receiving INSTI-containing therapy. As INSTIs are becoming increasingly accessible worldwide, it is important to understand the mechanism(s) of INSTI susceptibility. There is strong evidence suggesting differences in the patterns and mechanisms of drug resistance between HIV-1 subtype B, which dominates in United States, Western Europe and Australia, and non-B infections that are most prevalent in countries of Africa and Asia. IN polymorphisms and other genetic differences among diverse subtypes are likely responsible for these different patterns, but lack of a full-length high-resolution structure of HIV-1 IN has been a roadblock in understanding the molecular mechanisms of INSTI resistance and the impact of polymorphisms on therapy outcome. A recently reported full-length medium-resolution cryoEM structure of HIV-1 IN provides insights into understanding the mechanism of integrase function and the impact of genetic variation on the effectiveness of INSTIs. Here we use molecular modeling to explore the structural impact of IN polymorphisms on the IN reaction mechanism and INSTI susceptibility.
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Affiliation(s)
- Leonard Rogers
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, United States
| | - Adetayo E Obasa
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Graeme B Jacobs
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Stefan G Sarafianos
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Kamalendra Singh
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO, United States
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639
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de Coninck Z, Hussain-Alkhateeb L, Bratt G, Ekström AM, Gisslén M, Petzold M, Svedhem V. Non-AIDS Mortality Is Higher Among Successfully Treated People Living with HIV Compared with Matched HIV-Negative Control Persons: A 15-Year Follow-Up Cohort Study in Sweden. AIDS Patient Care STDS 2018; 32:297-305. [PMID: 30067408 PMCID: PMC6088250 DOI: 10.1089/apc.2018.0015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
There is an ongoing debate whether the life span of successfully treated people living with HIV (PLHIV) is comparable with that of the general population. The aim of this cohort study is to compare all-cause mortality between all PLHIV, successfully treated PLHIV, and HIV-negative control persons from the general population and to explore the impact of viral load (VL) at diagnosis. A total of 4066 PLHIV were matched against 8072 HIV-negative controls according to age, sex, and region of birth. Further, associations between VL at diagnosis, time on treatment, treatment outcome, and mortality were assessed over a 15-year period. Cox regression estimates were computed to compare the overall crude and adjusted hazard ratios (HRs) for mortality. After a 15-year follow-up period, successfully treated PLHIV were found to be three times more likely to die when compared with HIV-negative controls (HR 3.01, 95% CI 2.05–4.44, p < 0.001). The risk of mortality decreased from HR 6.02 after the first year of successful treatment. VL >30,000 c/mL at diagnosis was associated with an increased risk of mortality despite long-term antiretroviral therapy (ART) treatment. Although effective viral suppression has led to significant increases in longevity and quality of life, ART has not fully restored life expectancy to a level comparable with that found in HIV-negative persons. Even when PLHIV are successfully treated, there are several other important areas related to death, such as smoking and social factors, where data are still missing.
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Affiliation(s)
- Zaake de Coninck
- Department of Public Health Sciences, Centre for Global Health, HIV and SRHR, Karolinska Institutet, Stockholm, Sweden
| | - Laith Hussain-Alkhateeb
- Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bratt
- Department of Clinical Science and Education, Stockholm South General Hospital, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, Stockholm South General Hospital, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Public Health Sciences, Centre for Global Health, HIV and SRHR, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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640
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Mirza FS, Luthra P, Chirch L. Endocrinological aspects of HIV infection. J Endocrinol Invest 2018; 41:881-899. [PMID: 29313284 DOI: 10.1007/s40618-017-0812-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with human immunodeficiency virus (HIV) are living longer with effective antiretroviral therapies and are enjoying near normal life span. Therefore, they are encountering endocrine issues faced by the general population along with those specific to HIV infection. The purpose of this article is to review the common endocrine aspects of HIV infection, and the early detection and management strategies for these complications. METHODS Recent literature on HIV and endocrine disease was reviewed. RESULTS HIV can influence endocrine glands at several levels. Endocrine glandular function may be altered by the direct effect of HIV viral proteins, through generation of systemic and local cytokines and the inflammatory response and via glandular involvement with opportunistic infections and HIV-related malignancies. Endocrine disorders seen in people with HIV include metabolic issues related to obesity such as diabetes, hyperlipidemia, lipohypertrophy, lipoatrophy and lipodystrophy and contribute significantly to quality of life, morbidity and mortality. In addition, hypogonadism, osteopenia and osteoporosis are also more prevalent in the patients with HIV. Although disorders of hypothalamic-pituitary-adrenal axis resulting in adrenal insufficiency can be life threatening, these along with thyroid dysfunction are being seen less commonly in the antiretroviral therapy (ART) era. ARTs have greatly improved life expectancy in people living with HIV but can also have adverse endocrine effects. CONCLUSIONS Clinicians need to have a high index of suspicion for endocrine abnormalities in people with HIV as they can be potentially life threatening if untreated. Endocrine evaluation should be pursued as in the general population, with focus on prevention, early detection and treatment to improve quality of life and longevity.
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Affiliation(s)
- F S Mirza
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA.
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA.
| | - P Luthra
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
| | - L Chirch
- Division of Infectious Diseases, UConn Health, Farmington, CT, 06030, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
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641
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Nganou-Makamdop K, Billingsley JM, Yaffe Z, O’Connor G, Tharp GK, Ransier A, Laboune F, Matus-Nicodemos R, Lerner A, Gharu L, Robertson JM, Ford ML, Schlapschy M, Kuhn N, Lensch A, Lifson J, Nason M, Skerra A, Schreiber G, Bosinger SE, Douek DC. Type I IFN signaling blockade by a PASylated antagonist during chronic SIV infection suppresses specific inflammatory pathways but does not alter T cell activation or virus replication. PLoS Pathog 2018; 14:e1007246. [PMID: 30142226 PMCID: PMC6126880 DOI: 10.1371/journal.ppat.1007246] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/06/2018] [Accepted: 07/27/2018] [Indexed: 01/29/2023] Open
Abstract
Chronic activation of the immune system in HIV infection is one of the strongest predictors of morbidity and mortality. As such, approaches that reduce immune activation have received considerable interest. Previously, we demonstrated that administration of a type I interferon receptor antagonist (IFN-1ant) during acute SIV infection of rhesus macaques results in increased virus replication and accelerated disease progression. Here, we administered a long half-life PASylated IFN-1ant to ART-treated and ART-naïve macaques during chronic SIV infection and measured expression of interferon stimulated genes (ISG) by RNA sequencing, plasma viremia, plasma cytokines, T cell activation and exhaustion as well as cell-associated virus in CD4 T cell subsets sorted from peripheral blood and lymph nodes. Our study shows that IFN-1ant administration in both ART-suppressed and ART-untreated chronically SIV-infected animals successfully results in reduction of IFN-I-mediated inflammation as defined by reduced expression of ISGs but had no effect on plasma levels of IL-1β, IL-1ra, IL-6 and IL-8. Unlike in acute SIV infection, we observed no significant increase in plasma viremia up to 25 weeks after IFN-1ant administration or up to 15 weeks after ART interruption. Likewise, cell-associated virus measured by SIV gag DNA copies was similar between IFN-1ant and placebo groups. In addition, evaluation of T cell activation and exhaustion by surface expression of CD38, HLA-DR, Ki67, LAG-3, PD-1 and TIGIT, as well as transcriptome analysis showed no effect of IFN-I blockade. Thus, our data show that blocking IFN-I signaling during chronic SIV infection suppresses IFN-I-related inflammatory pathways without increasing virus replication, and thus may constitute a safe therapeutic intervention in chronic HIV infection.
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Affiliation(s)
- Krystelle Nganou-Makamdop
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James M. Billingsley
- Division of Microbiology and Immunology, Emory Vaccine Center, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
| | - Zachary Yaffe
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Gregory O’Connor
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Gregory K. Tharp
- Division of Microbiology and Immunology, Emory Vaccine Center, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
| | - Amy Ransier
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Farida Laboune
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Rodrigo Matus-Nicodemos
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Andrea Lerner
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Lavina Gharu
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jennifer M. Robertson
- Department of Surgery and Emory Transplant Center, Emory University School of Medicine and Emory Healthcare, Atlanta, GA
| | - Mandy L. Ford
- Department of Surgery and Emory Transplant Center, Emory University School of Medicine and Emory Healthcare, Atlanta, GA
| | - Martin Schlapschy
- Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
| | - Nadine Kuhn
- Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
| | - Alexandra Lensch
- Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
| | - Jeffrey Lifson
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Martha Nason
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Arne Skerra
- Lehrstuhl für Biologische Chemie, Technische Universität München, Freising (Weihenstephan), Germany
- XL-protein GmbH, Freising, Germany
| | - Gideon Schreiber
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Steven E. Bosinger
- Division of Microbiology and Immunology, Emory Vaccine Center, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
- Department of Pathology & Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Daniel C. Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
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642
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643
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Dearborn AD, Eren E, Watts NR, Palmer IW, Kaufman JD, Steven AC, Wingfield PT. Structure of an RNA Aptamer that Can Inhibit HIV-1 by Blocking Rev-Cognate RNA (RRE) Binding and Rev-Rev Association. Structure 2018; 26:1187-1195.e4. [PMID: 30017564 DOI: 10.1016/j.str.2018.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/24/2018] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Abstract
HIV-1 Rev protein mediates nuclear export of unspliced and partially spliced viral RNAs for production of viral genomes and structural proteins. Rev assembles on a 351-nt Rev response element (RRE) within viral transcripts and recruits host export machinery. Small (<40-nt) RNA aptamers that compete with the RRE for Rev binding inhibit HIV-1 viral replication. We determined the X-ray crystal structure of a potential anti-HIV-1 aptamer that binds Rev with high affinity (Kd = 5.9 nM). The aptamer is structurally similar to the RRE high-affinity site but forms additional contacts with Rev unique to its sequence. Exposed bases of the aptamer interleave with the guanidinium groups of two arginines of Rev, forming stacking interactions and hydrogen bonds. The aptamer also obstructs an oligomerization interface of Rev, blocking Rev self-assembly. We propose that this aptamer can inhibit HIV-1 replication by interfering with Rev-RRE, Rev-Rev, and possibly Rev-host protein interactions.
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Affiliation(s)
- Altaira D Dearborn
- The Protein Expression Laboratory, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Elif Eren
- The Laboratory of Structural Biology Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Norman R Watts
- The Protein Expression Laboratory, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Ira W Palmer
- The Protein Expression Laboratory, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Joshua D Kaufman
- The Protein Expression Laboratory, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Alasdair C Steven
- The Laboratory of Structural Biology Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
| | - Paul T Wingfield
- The Protein Expression Laboratory, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA.
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644
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Aging and Apolipoprotein E in HIV Infection. J Neurovirol 2018; 24:529-548. [PMID: 29987582 PMCID: PMC6244718 DOI: 10.1007/s13365-018-0660-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/23/2018] [Accepted: 06/25/2018] [Indexed: 01/21/2023]
Abstract
With the implementation of increasingly effective antiretroviral therapy (ART) over the past three decades, individuals infected with HIV live a much longer life. HIV infection is no longer a terminal but rather a chronic disease. However, the lifespan of infected individuals remains shorter than that of their uninfected peers. Even with ART, HIV infection may potentiate “premature” aging. Organ-associated disease and systemic syndromes that occur in treated HIV-infection are like that of older, uninfected individuals. Brain aging may manifest as structural changes or neurocognitive impairment that are beyond the chronological age. The spectrum of neurological, cognitive, and motor deficiencies, currently described as HIV-associated neurocognitive disorders (HAND), may reflect earlier onset of mechanisms common to HIV infection and aging (accelerated aging). HAND could also reflect the neurological impact of HIV infection superimposed on comorbidities linked to age and chronic inflammation, leading to a higher prevalence of neurocognitive impairment across the age span (accentuated aging). In addition, apolipoprotein E (ApoE), one of the most influential host risk factors for developing Alzheimer’s disease, has been implicated in the development of HAND. But studies differ as to whether ApoE is relevant, and whether age and ApoE interact to impair brain function in the HIV-infected patient. What is clear is that HIV-infected individuals are living longer with HIV, and therefore factors related to aging and health need to be examined in the context of current, effective ART. This review addresses the recent evidence for the influence of aging and ApoE on HIV-associated neurocognitive impairment.
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645
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Moysi E, Pallikkuth S, De Armas LR, Gonzalez LE, Ambrozak D, George V, Huddleston D, Pahwa R, Koup RA, Petrovas C, Pahwa S. Altered immune cell follicular dynamics in HIV infection following influenza vaccination. J Clin Invest 2018; 128:3171-3185. [PMID: 29911996 PMCID: PMC6025971 DOI: 10.1172/jci99884] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/25/2018] [Indexed: 12/29/2022] Open
Abstract
HIV infection changes the lymph node (LN) tissue architecture, potentially impairing the immunologic response to antigenic challenge. The tissue-resident immune cell dynamics in virologically suppressed HIV+ patients on combination antiretroviral therapy (cART) are not clear. We obtained LN biopsies before and 10 to 14 days after trivalent seasonal influenza immunization from healthy controls (HCs) and HIV+ volunteers on cART to investigate CD4+ T follicular helper (Tfh) and B cell dynamics by flow cytometry and quantitative imaging analysis. Prior to vaccination, compared with those in HCs, HIV+ LNs exhibited an altered follicular architecture, but harbored higher numbers of Tfh cells and increased IgG+ follicular memory B cells. Moreover, Tfh cell numbers were dependent upon preservation of the follicular dendritic cell (FDC) network and were predictive of the magnitude of the vaccine-induced IgG responses. Interestingly, postvaccination LN samples in HIV+ participants had significantly (P = 0.0179) reduced Tfh cell numbers compared with prevaccination samples, without evidence for peripheral Tfh (pTfh) cell reduction. We conclude that influenza vaccination alters the cellularity of draining LNs of HIV+ persons in conjunction with development of antigen-specific humoral responses. The underlying mechanism of Tfh cell decline warrants further investigation, as it could bear implications for the rational design of HIV vaccines.
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Affiliation(s)
- Eirini Moysi
- Tissue Analysis Core, Immunology Laboratory, Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lesley R. De Armas
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Louis E. Gonzalez
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Ambrozak
- Immunology Laboratory, VRC, NIAID, NIH, Bethesda, Maryland, USA
| | - Varghese George
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Huddleston
- Department of Trauma Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rajendra Pahwa
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard A. Koup
- Immunology Laboratory, VRC, NIAID, NIH, Bethesda, Maryland, USA
| | - Constantinos Petrovas
- Tissue Analysis Core, Immunology Laboratory, Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Savita Pahwa
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
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646
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Fitzpatrick MC, Gray GE, Galvani AP. The Challenge of Vanquishing HIV for the Next Generation-Facing the Future. JAMA Pediatr 2018; 172:609-610. [PMID: 29800028 DOI: 10.1001/jamapediatrics.2018.0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore.,Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,South African Medical Research Council, Cape Town, South Africa
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut
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647
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Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs: lessons from Malawi, South Africa, Swaziland and Kenya. AIDS 2018; 32 Suppl 1:S21-S32. [PMID: 29952787 DOI: 10.1097/qad.0000000000001885] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Countries in sub-Saharan Africa (SSA) are recognizing the growing dual burden of HIV and noncommunicable diseases (NCDs). This article explores the availability, implementation processes, opportunities and challenges for policies and programs for HIV/NCD integration in four SSA countries: Malawi, Kenya, South Africa and Swaziland. METHODS We conducted a cross-sectional analysis of current policies and programs relating to HIV/NCD care integration from January to April 2017 using document review and expert opinions. The review focussed on availability and content of relevant policy documents and processes towards implementating national HIV/NCD integration policies. RESULTS All four case study countries had at least one policy document including aspects of HIV/NCD care integration. Apart from South Africa that had a phased nation-wide implementation of a comprehensive integrated chronic disease model, the three other countries - Malawi, Kenya and Swaziland, had either pilot implementations or nation-wide single-disease integration of NCDs and HIV. Opportunities for HIV/NCD integration policies included: presence of overarching health policy documents that recognize the need for integration, and coordinated action by policymakers, researchers and implementers. Evidence gaps for cost-effectiveness, effects of integration on key HIV and NCD outcomes and funding mechanisms for sustained implementation of integrated HIV/NCD care strategies, were among challenges identified. CONCLUSION Policymakers in Malawi, Kenya, South Africa and Swaziland have considered integration of NCD and HIV care but a lack of robust evidence hampers large-scale implementation of HIV/NCD integration. It is crucial for SSA Ministries of Health and throughout low-and-middle-income countries to utilize existing opportunities and advocate for evidence-informed HIV/NCD integration strategies.
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648
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Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
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Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
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649
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McGettrick PMC, Barco EA, Kaminskiy G, Mallon PWG. The immune profile in HIV: A useful signature in future HIV research? Germs 2018; 8:54-57. [PMID: 29951377 DOI: 10.18683/germs.2018.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Padraig M C McGettrick
- MB BCh BAO, MRCPI, HIV Molecular Research Group, UCD School of Medicine, Catherine McAuely Education and Research Centre, Nelson Street, Dublin 7, Dublin, Ireland, Department of Infectious Diseases, Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Elena Alvarez Barco
- BSc, PhD, HIV Molecular Research Group, UCD School of Medicine, Catherine McAuely Education and Research Centre, Nelson Street, Dublin 7, Dublin, Ireland
| | - Greg Kaminskiy
- MD, National Medical Research Centre of Phthisiopulmonology and Infectious Diseases, Moscow, Russian Federation
| | - Patrick W G Mallon
- BSc FRACP MB BCh BAO PhD, HIV Molecular Research Group, UCD School of Medicine, Catherine McAuely Education and Research Centre, Nelson Street, Dublin 7, Dublin, Ireland, Department of Infectious Diseases, Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland
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650
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Bastys T, Gapsys V, Doncheva NT, Kaiser R, de Groot BL, Kalinina OV. Consistent Prediction of Mutation Effect on Drug Binding in HIV-1 Protease Using Alchemical Calculations. J Chem Theory Comput 2018; 14:3397-3408. [PMID: 29847122 DOI: 10.1021/acs.jctc.7b01109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite a large number of antiretroviral drugs targeting HIV-1 protease for inhibition, mutations in this protein during the course of patient treatment can render them inefficient. This emerging resistance inspired numerous computational studies of the HIV-1 protease aimed at predicting the effect of mutations on drug binding in terms of free binding energy Δ G, as well as in mechanistic terms. In this study, we analyze ten different protease-inhibitor complexes carrying major resistance-associated mutations (RAMs) G48V, I50V, and L90M using molecular dynamics simulations. We demonstrate that alchemical free energy calculations can consistently predict the effect of mutations on drug binding. By explicitly probing different protonation states of the catalytic aspartic dyad, we reveal the importance of the correct choice of protonation state for the accuracy of the result. We also provide insight into how different mutations affect drug binding in their specific ways, with the unifying theme of how all of them affect the crucial drug binding regions of the protease.
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Affiliation(s)
- Tomas Bastys
- Department for Computational Biology and Applied Algorithmics , Max Planck Institute for Informatics , D-66123 Saarbrücken , Germany.,Saarbrücken Graduate School of Computer Science , University of Saarland , D-66123 Saarbrücken , Germany
| | - Vytautas Gapsys
- Computational Biomolecular Dynamics Group, Department of Theoretical and Computational Biophysics , Max Planck Institute for Biophysical Chemistry , D-37077 Göttingen , Germany
| | - Nadezhda T Doncheva
- Department for Computational Biology and Applied Algorithmics , Max Planck Institute for Informatics , D-66123 Saarbrücken , Germany.,Faculty of Health and Medical Sciences , University of Copenhagen , 2200 Copenhagen , Denmark
| | - Rolf Kaiser
- Institute for Virology , University Clinic of Cologne , D-50935 Köln , Germany
| | - Bert L de Groot
- Computational Biomolecular Dynamics Group, Department of Theoretical and Computational Biophysics , Max Planck Institute for Biophysical Chemistry , D-37077 Göttingen , Germany
| | - Olga V Kalinina
- Department for Computational Biology and Applied Algorithmics , Max Planck Institute for Informatics , D-66123 Saarbrücken , Germany
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