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Saadouli D, Ammari L, Ben Mansour K, Yahyaoui Y, Aissa S, Mohamed Ali EA, Yahyaoui S, Tiouri H. Ocular manifestations of people living with HIV in Tunisia. South Afr J HIV Med 2021; 22:1193. [PMID: 33824735 PMCID: PMC8008002 DOI: 10.4102/sajhivmed.v22i1.1193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 11/03/2022] Open
Abstract
Background Ocular involvement is a common complication of human immunodeficiency virus (HIV). Knowledge about this topic in Tunisia is limited. Objective To investigate ophthalmic manifestations in patients living with HIV in Tunisia. Method This was an observational study, performed between January 2007 and December 2016. We included patients with ocular disorders related to HIV. The data were recorded retrospectively from chart review. Results Amongst 98 people living with HIV (PLWH), 36 participants (55 eyes) had ocular manifestations. The mean age was 32.2 ± 5.6 years. Twenty-four patients were men and 12 were women. The mean value of CD4+ T-cell count was 156.5 ± 4.2 cells/µL. Bilateral lesions were found in 19 eyes. Best corrected visual acuity was better than 6/12 in 36 eyes. The most common ocular finding was dry eye syndrome (22%), cotton-wool spots (20%) and retinal haemorrhage (16%) followed by cytomegalovirus (CMV) retinitis (9%), anterior uveitis (7%), toxoplasmosis (4%) and tuberculosis retinochoroiditis (7%) Herpetic keratitis (5%), Herpes zoster ophthalmicus (2%) and syphilitic chorioretinitis (2%). Papilledema was found in three eyes (5%). Panuveitis was observed in four eyes (7%): three of them were associated with chorioretinal toxoplasmosis, syphilitic chorioretinitis and CMV retinitis. The fourth was attributable to immune recovery uveitis. A CD4+ T-cell count of ≤ 200 cells/µL was found to be an independent risk factor for developing posterior segment manifestations. Conclusion Various ophthalmic manifestations were observed in PLWH. The most common lesion was retinopathy. Ocular involvement can be serious leading to poor visual prognosis, which requires close collaboration between the ophthalmologist and infectious disease physician.
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Affiliation(s)
- Dorsaf Saadouli
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Lamia Ammari
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khaoula Ben Mansour
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Yahyaoui
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sameh Aissa
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - El Afrit Mohamed Ali
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salem Yahyaoui
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hanene Tiouri
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Sherbuk JE, Barakat LA. Training the next generation of HIV providers: impact of trainees on patient satisfaction in an urban HIV clinic. AIDS Care 2018; 31:41-44. [PMID: 29779395 DOI: 10.1080/09540121.2018.1476663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
For persons living with HIV and AIDS (PLWHA), care by an HIV-specialist improves outcomes and satisfaction with one's HIV primary care provider (PCP) promotes engagement with care. In the United States, we are facing a workforce shortage of HIV providers. As we aim to train a new generation of HIV providers, it is unclear how PLWHA perceive their experience when cared for by trainees compared to experienced providers. Therefore we assessed patient satisfaction with HIV providers, both trainees in an HIV Primary Care residency program and HIV-specialists. A secondary objective was to evaluate providers' performance in adhering to standard management guidelines for HIV-associated and non-HIV-associated conditions. We surveyed 75 PLWHA, including 51 (68%) assigned to an HIV-specialist PCP and 24 (32%) to a trainee PCP. Overall patient satisfaction on a 10-point scale was similar (mean 9.6 HIV-specialist vs 9.7 trainee, p = 0.71) and remained similar in multivariate logistic regression analysis when controlling for patient age, gender, race, and recently establishing care (Odds Ratio 1.1, 95% Confidence Interval 0.3-5.0). Participants in the trainee group were more likely to feel their provider "always" spent enough time with them (100% vs 81%, p = 0.03). Adherence to HIV guidelines was similar, though trainees were more likely to document counseling on risk reduction (83% vs 47%, p = 0.005) and adherence to antiretroviral therapy (100% vs 66%, p = 0.001). In conclusion, in a structured HIV-training program, residents can provide subspecialty level care in an HIV continuity clinic with levels of performance and patient satisfaction equivalent to those of experienced specialists.
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Affiliation(s)
- Jacqueline E Sherbuk
- a Department of Medicine, Internal Medicine Residency , Yale University School of Medicine , New Haven , USA
| | - Lydia Aoun Barakat
- b Department of Medicine, Division of Infectious Diseases , Yale University School of Medicine , New Haven , USA
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An Enhanced Emtricitabine-Loaded Long-Acting Nanoformulation for Prevention or Treatment of HIV Infection. Antimicrob Agents Chemother 2016; 61:AAC.01475-16. [PMID: 27821449 DOI: 10.1128/aac.01475-16] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023] Open
Abstract
Among various FDA-approved combination antiretroviral drugs (cARVs), emtricitabine (FTC) has been a very effective nucleoside reverse transcriptase inhibitor. Thus far, FTC is the only deoxycytidine nucleoside analog. However, a major drawback of FTC is its large volume distribution (averaging 1.4 liters/kg) and short plasma half-life (8 to 10 h), necessitating a high daily dosage. Thus, we propose an innovative fabrication method of loading FTC in poly(lactic-co-glycolic acid) polymeric nanoparticles (FTC-NPs), potentially overcoming these drawbacks. Our nanoformulation demonstrated enhanced FTC loading (size of <200 nm and surface charge of -23 mV) and no to low cytotoxicity with improved biocompatibility compared to those with FTC solution. An ex vivo endosomal release assay illustrated that NP entrapment prolongs FTC release over a month. Intracellular retention studies demonstrate sustained FTC retention over time, with approximately 8% (24 h) to 68% (96 h) release with a mean retention of ∼0.74 μg of FTC/105 cells after 4 days. An in vitro HIV-1 inhibition study demonstrated that FTC-NP treatment results in a 50% inhibitory concentration (IC50) ∼43 times lower in TZM-bl cells (0.00043 μg/ml) and ∼3.7 times lower (0.009 μg/ml) in peripheral blood mononuclear cells (PBMCs) than with FTC solution (TZM-bl cells, 0.01861, and PBMCs, 0.033 μg/ml). Further, on primary PBMCs, FTC-NPs also illustrate an HIV-1 infection blocking efficacy comparable to that of FTC solution. All the above-described studies substantiate that FTC nanoformulation prolongs intracellular FTC concentration and inhibition of HIV infection. Therefore, FTC-NPs potentially could be a long-acting, stable formulation to ensure once-biweekly dosing to prevent or treat HIV infection.
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Mendes-Bastos P, Brasileiro A, Matos-Pires E, Rodrigues I, Marques C, Coelho-Macias V, Fernandes C. De novo HIV infection diagnoses in a Department of Dermatology and Venereology in Lisbon, Portugal. Int J STD AIDS 2016; 28:887-892. [PMID: 27815548 DOI: 10.1177/0956462416679279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. Objective A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. Methods Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. Results During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI ( p < 0.01). Basal viral load was also lower in this group of patients ( p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. Conclusion This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice.
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Affiliation(s)
- Pedro Mendes-Bastos
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ana Brasileiro
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Eugénia Matos-Pires
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Isaura Rodrigues
- 2 Department of Laboratory Medicine/Clinical Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Cristina Marques
- 2 Department of Laboratory Medicine/Clinical Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Vasco Coelho-Macias
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Cândida Fernandes
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Pfaender S, von Hahn T, Steinmann J, Ciesek S, Steinmann E. Prevention strategies for blood-borne viruses-in the Era of vaccines, direct acting antivirals and antiretroviral therapy. Rev Med Virol 2016; 26:330-9. [PMID: 27185010 PMCID: PMC5084801 DOI: 10.1002/rmv.1890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022]
Abstract
Blood-borne viruses, such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and the facultative blood-borne hepatitis E virus, are considered a major public health problem given that they are accountable for millions of deaths each year. Treatment options, including effective vaccine design, development of antiviral strategies and the implementation of antiretroviral therapy have improved substantially over the last couple of years and contribute to successful treatment and prevention of these infectious diseases. In this review, we summarise the current knowledge and concepts in prevention of transmission of these blood-borne viruses.
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Affiliation(s)
- Stephanie Pfaender
- Institute for Experimental Virology, Twincore, and Hannover Medical School Hannover, Germany, and Helmholtz Centre for Infection Research, Braunschweig, Germany
- Department of Infectious Diseases and Pathobiology, University of Bern, 3012 Bern, Switzerland, Federal Department of Home Affairs, Institute of Virology and Immunology, 3012 Bern and 3147, Mittelhäusern, Switzerland
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
- German Center for Infection Research (DZIF) - Hannover-Braunschweig Site
- Institute for Molecular Biology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Sandra Ciesek
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eike Steinmann
- Institute for Experimental Virology, Twincore, and Hannover Medical School Hannover, Germany, and Helmholtz Centre for Infection Research, Braunschweig, Germany.
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Kalapila AG, Marrazzo J. Antiretroviral Therapy for Prevention of Human Immunodeficiency Virus Infection. Med Clin North Am 2016; 100:927-50. [PMID: 27235622 DOI: 10.1016/j.mcna.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Human immunodeficiency virus (HIV) infection is considered a chronic medical condition. Several new drugs are available, including fixed-dose combination tablets, that have greatly simplified combination antiretroviral therapy (ART) regimens to treat HIV, while increasing the life-expectancy of infected individuals. In the last decade, multiple well-regarded studies have established the benefits of using ART in high-risk, HIV-negative persons to prevent HIV acquisition. The primary care provider must not only understand commonly encountered issues pertaining to ART, such as toxicities and drug interactions, but also needs to be aware of using ART for HIV prevention.
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Affiliation(s)
- Aley G Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jeanne Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Cole AL, Hossain S, Cole AM, Phanstiel O. Synthesis and bioevaluation of substituted chalcones, coumaranones and other flavonoids as anti-HIV agents. Bioorg Med Chem 2016; 24:2768-76. [PMID: 27161874 DOI: 10.1016/j.bmc.2016.04.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/15/2016] [Accepted: 04/21/2016] [Indexed: 01/26/2023]
Abstract
A series of chalcone, flavone, coumaranone and other flavonoid compounds were screened for their anti HIV-1 activity in two cell culture models using TZM-bl and PM1 cells. Within the systems evaluated, the most promising compounds contained either an α- or β-hydroxy-carbonyl motif within their structure (e.g., 8 and 9). Efficacious substituents were identified and used to design new HIV inhibitors with increased potency and lower cytotoxicity. Of the scaffolds evaluated, specific chalcones were found to provide the best balance between anti-HIV potency and low host cell toxicity. Chalcone 8l was shown to inhibit different clinical isolates of HIV in a dose-dependent manner (e.g., IC50 typically⩽5μM). Inhibition of HIV infection experiments using TZM-bl cells demonstrated that chalcone 8l and flavonol 9c had IC50 values of 4.7μM and 10.4μM, respectively. These insights were used to design new chalcones 8o and 8p. Rewardingly, chalcones 8o and 8p (at 10μM) each gave >92% inhibition of viral propagation without impacting PM1 host cell viability. Inhibition of viral propagation significantly increased (60-90%) when PM1 cells were pre-incubated with chalcone 8o, but not with the related flavonol 9c. These results suggested that chalcone 8o may be of value as both a HIV prophylactic and therapy. In summary, O-benzyl-substituted chalcones were identified as promising anti-HIV agents for future investigation.
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Affiliation(s)
- Amy L Cole
- Burnett School for Biomedical Sciences, College of Medicine, University of Central Florida, 12722 Research Parkway, Orlando, FL 32826-3227, United States
| | - Sandra Hossain
- Department of Medical Education, College of Medicine, University of Central Florida, 12722 Research Parkway, Orlando, FL 32826-3227, United States
| | - Alex M Cole
- Burnett School for Biomedical Sciences, College of Medicine, University of Central Florida, 12722 Research Parkway, Orlando, FL 32826-3227, United States
| | - Otto Phanstiel
- Department of Medical Education, College of Medicine, University of Central Florida, 12722 Research Parkway, Orlando, FL 32826-3227, United States.
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