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Malagnino V, Mulas T, Teti E, Basso M, Giobbia M, Geremia N, Battagin G, Abi Aad Y, Vincensini JP, Iannetta M, Parisi SG, Sarmati L, Lacombe K. HBcAb Positivity as a Risk Factor for Missing HIV RNA Undetectability after the 3TC+DTG Switch. Viruses 2024; 16:348. [PMID: 38543714 PMCID: PMC10974397 DOI: 10.3390/v16030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
Hepatitis B Core antibody (HBcAb) positivity is the surrogate marker of hepatitis B occult infection. This condition is not a contraindication for switching to two-drug (2DR) antiretroviral therapy; however, the removal of tenofovir may contribute to poor control of HBV replication. A multicentre retrospective cohort study investigated the impact of HBcAb positivity on HIV control in patients switching to a 2DR with Lamivudine and Dolutegravir (3TC-DTG). In this study, a comparison analysis was conducted between HBcAb-positive and -negative PLWH regarding HIV-RNA suppression, considering: (1): Target Not Detected (TND) < 20 cp/mL; (2) Target Detected (TD) < 20 cp/mL; and (3) Detectable > 20 cp/mL and <50 cp/mL and >50 copies/mL. A total of 267 patients on 2DR with 3TC-DTG were included. In comparison to HBcAb-negative, HBcAb-positive patients were older (45 years [35-54]) and had a lower CD4+ nadir (248 vs. 349 cells/mmc, p = 0.007). No difference in the maintenance of virological suppression was present in the two groups of patients before the switch. Although no patient had an HIV-RNA > 20 cp/mL after the switch, significantly fewer HBcAb-positive compared with -negative subjects resulted in TND at 12, 24, and 36 months after the switch: 52 (69.3%) versus 164 (85.4%), p = 0.004, 50 [72.5%] versus 143 [89.9%], p = 0.001, and 30 [66.7%] versus 90 [92.8%], p = 0.001, respectively. HBcAb positivity is associated with an increased risk of suboptimal HIV suppression during the 36 months after 3TC/DTG simplification. This finding reinforces the relevance of the OBI condition in PLWH and raises the issue of careful virological monitoring of such cases.
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Affiliation(s)
- Vincenzo Malagnino
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Tiziana Mulas
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
| | - Elisabetta Teti
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, 35128 Padova, Italy; (M.B.); (S.G.P.)
| | - Mario Giobbia
- Infectious Disease Unit, Ospedale di Treviso, 31100 Treviso, Italy;
| | - Nicholas Geremia
- Infectious Disease Unit, Ospedale di Venezia, 30122 Venezia, Italy;
| | | | - Yasmine Abi Aad
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
| | - Jean-Paul Vincensini
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
| | - Marco Iannetta
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, 35128 Padova, Italy; (M.B.); (S.G.P.)
| | - Loredana Sarmati
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Karine Lacombe
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
- INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University, 75646 Paris, France
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Ding L, Chen X, He J, Zheng J, Wei X, Qin B, Li X. Analysis of virologic outcome in low-level HIV-1 viremia patients in a small cohort. Future Virol 2022. [DOI: 10.2217/fvl-2021-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: It is unclear whether a low-level viremia (LLV) status is maintained in HIV-infected patients. Materials & methods: HIV-infected patients with LLV were enrolled and followed up for 5 years. Factors associated with virological outcomes were assessed via regression analyses. Results: A total of 39 patients maintained an LLV status, whereas 19 had disease progression with a viral load of ≥1000 copies/ml. LLV duration and drug resistance (DR) were associated with virological failure. Among the DR cases, the most frequent mutations were M184V/I (70.4%) and K103N (40.7%). Protease inhibitor (PI) mutations were rare. Conclusion: There is an increased risk for virologic failure in HIV-1-infected patients maintaining LLV for a long time. DR was not a rare phenomenon in LLV patients.
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Affiliation(s)
- Lisha Ding
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Xi Chen
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Jianmei He
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Jun Zheng
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Xiuqing Wei
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Biyun Qin
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
| | - Xiangzhong Li
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha, 410005, China
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Suzuki K, Levert A, Yeung J, Starr M, Cameron J, Williams R, Rismanto N, Stark T, Druery D, Prasad S, Ferrarini C, Hanafi I, McNally LP, Cunningham P, Liu Z, Ishida T, Huang CS, Oswald V, Evans L, Symonds G, Brew BJ, Zaunders J. HIV-1 viral blips are associated with repeated and increasingly high levels of cell-associated HIV-1 RNA transcriptional activity. AIDS 2021; 35:2095-2103. [PMID: 34148986 PMCID: PMC8505147 DOI: 10.1097/qad.0000000000003001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Some HIV+ patients, virally suppressed on ART, show occasional 'blips' of detectable HIV-1 plasma RNA. We used a new highly sensitive assay of cell-associated HIV-1 RNA to measure transcriptional activity in PBMCs and production of infectious virus from the viral reservoir, in patients with and without 'blips'. DESIGN/METHODS RNA and DNA extracted from cells in 6 ml of peripheral blood, from suppressed patients with one to two 'blip' episodes over the past 2 years of ART (n = 55), or no 'blips' (n = 52), were assayed for HIV-1 RNA transcripts and proviral DNA targeting the highly conserved 'R' region of the LTR. Follow-up samples were also collected. Purified CD4+ T cells were cultured with anti-CD3/CD28/CD2 T-cell activator to amplify transcription and measure replication competent virus. RESULTS HIV-1 RNA transcripts ranged from 1.3 to 5415 copies/106 white blood cells. 'Blip' patients had significantly higher levels vs. without blips (median 192 vs. 49; P = 0.0007), which correlated with: higher levels of inducible transcripts after activation in vitro, sustained higher HIV-1 transcription levels in follow-up samples along with increasing HIV-1 DNA in some, and production of replication-competent HIV-1. CONCLUSION Viral 'blips' are significant reflecting higher transcriptional activity from the reservoir and contribute to the reservoir over time. This sensitive assay can be used in monitoring the size and activity of the HIV-1 reservoir and will be useful in HIV-1 cure strategies.
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Affiliation(s)
- Kazuo Suzuki
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Angelique Levert
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Julie Yeung
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Mitchell Starr
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Jane Cameron
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Raffaella Williams
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Nikolas Rismanto
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Tayla Stark
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Dylan Druery
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Salzeena Prasad
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Cristina Ferrarini
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Imelda Hanafi
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Leon Patrick McNally
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Philip Cunningham
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
| | - Zhixin Liu
- Stats Central, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Velma Oswald
- Clinical Immunology and HIV Medicine, Liverpool Hospital
| | - Louise Evans
- Clinical Immunology and HIV Medicine, Liverpool Hospital
- University of New South Wales
| | | | - Bruce James Brew
- Departments of Neurology and Immunology
- Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, and University of Notre Dame
- Department of HIV Medicine, St Vincent's Hospital
- St Vincent's Clinical School, Delacy Building, University of New South Wales, Sydney, NSW, Australia
| | - John Zaunders
- St Vincent's Centre for Applied Medical Research, NSW State Reference laboratory for HIV
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Ding L, Chen X, He J, Zheng J, Wei X. A retrospective analysis of neglected HIV-1 patients with middle-level viremia in Central China based on current policy. Future Virol 2021. [DOI: 10.2217/fvl-2020-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Due to the conflict of policies, HIV-1 middle-level viremia during antiretroviral therapy is neglected in China, so its clinical management was retrospectively investigated. Materials & methods: The characteristics and clinical indicators of HIV-1 patients treated in 2016 were analyzed. Results: Of 4370 cases, 1.2% progressed to middle-level viremia and 5.4% had persistent viral loads of ≥1000 copies/ml. Age, transmission mode and the ‘test and treat’ ratio among the three groups were significantly different (p < 0.05). Ordinal regression analysis showed that younger patients with higher CD4 count at baseline achieved better viral suppression if they had treatment as soon as possible. Conclusion: The results supported the ‘test and treat’ policy and suggested that the current treatment standard and testing policies should be adjusted.
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Affiliation(s)
- Lisha Ding
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha 410005, China
| | - Xi Chen
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha 410005, China
| | - Jianmei He
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha 410005, China
| | - Jun Zheng
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha 410005, China
| | - Xiuqing Wei
- Hunan Provincial Center for Diseases Control & Prevention, 450 Furongzhong Rd sec 1, Changsha 410005, China
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Aylie NS, Dadi LS, Alemayehu E, Mekonn MA. Determinants of Fertility Desire among Women Living with HIV in the Childbearing Age Attending Antiretroviral Therapy Clinic at Jimma University Medical Center, Southwest Ethiopia: A Facility-Based Case-Control Study. Int J Reprod Med 2020; 2020:6504567. [PMID: 32851055 PMCID: PMC7441441 DOI: 10.1155/2020/6504567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND High fertility and aspiration to have more children are a normal phenomenon in many developing countries including Ethiopia. The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Despite the growing number of women living with HIV/AIDS, the issues of fertility and childbearing intention have not been widely studied in Ethiopia. OBJECTIVE To identify determinants of fertility desire among women living with HIV in the childbearing age attending antiretroviral therapy clinic at Jimma University Medical Center, Southwest Ethiopia. METHODS A facility-based case-control study was conducted in March 2019. Cases were women living with HIV who had fertility desire, and controls were those who had not. Data was collected using a face-to-face interview using a pretested questionnaire. The data was entered into EpiData 3.1 and exported to SPSS Version 24 for analysis. Bivariate and multivariable logistic regression analyses were used to identify candidate and independent determinants of fertility desire, respectively. Independent determinants associated with fertility desire were assessed using AORs with their corresponding 95% CIs at P value < 0.05 cutoff point. Results. Three hundred forty-four (115 cases and 229 controls) were included into the study with a 100% response rate. Age categories 15-24 (AOR: 4.1; 95% CI: 2.0, 8.4) and 25-34 (AOR: 2.3; 95% CI: 1.3, 4.2) years, not using family planning (AOR: 2.3; 95% CI: 1.4, 4.0), and having a sexual partner (AOR: 1.9; 95% CI: 1.1, 3.2) were independent predictors of fertility desire. CONCLUSIONS Age of women, family planning, and sexual partner were found to be the independent predictors of fertility desire among women living with HIV/AIDS. Policymakers and health care providers who are working on an ART clinic should try to consider the effects of these factors for women living with HIV while developing HIV/AIDS interventions and discussing on sexual and reproductive health issues with their clients, respectively.
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Affiliation(s)
- Nigusie Shifera Aylie
- Nursing Department, College of Health Science Mizan-Tepi Unversity, Mizan-Aman, Ethiopia
| | - Lelisa Sena Dadi
- Epidemiology Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Eshetu Alemayehu
- Epidemiology Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mengistu Ayenew Mekonn
- Epidemiology Department, College of Health Science Mizan-Tepi Unversity, Mizan-Aman, Ethiopia
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Cento V, Perno CF. Two-drug regimens with dolutegravir plus rilpivirine or lamivudine in HIV-1 treatment-naïve, virologically-suppressed patients: Latest evidence from the literature on their efficacy and safety. J Glob Antimicrob Resist 2019; 20:228-237. [PMID: 31446092 DOI: 10.1016/j.jgar.2019.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES In the HIV-1-positive population, a paradigm shift from three-drug regimens (3DRs) to dolutegravir-based two-drug regimens (2DRs) both as initial and switch treatment is beginning to take place, supported virologically by the availability of new potent drugs with high genetic barrier to overcome, at least in certain conditions, the dogma of 3DRs in effective HIV-1 therapy. This manuscript reviews the increasing evidence on their excellent and sustained long-term effectiveness and safety. METHODS This review includes the most recent results on dolutegravir plus rilpivirine or lamivudine 2DRs from randomised clinical trials, meta-analyses and real-life studies, including relevant data presented at international conferences up to August 2019. RESULTS As an initial treatment strategy, dolutegravir plus lamivudine showed high efficacy and safety over 96 weeks in 1441 patients from the GEMINI-1&2 phase III non-inferiority trials. In the SWORD 1&2 trials in virologically-suppressed patients, switching to once-daily dolutegravir plus rilpivirine maintained efficacy over 148 weeks. Similarly, in the TANGO trial, no confirmed virological withdrawals were observed with dolutegravir/lamivudine through Week 48. Consistent results were observed in real-life cohorts. No emergent dolutegravir-resistant virus has ever been reported in a patient in whom dolutegravir was prescribed in the context of such 2DRs. Switching to once-daily dolutegravir plus rilpivirine or lamivudine was generally well tolerated and was associated with favourable renal and bone safety. CONCLUSION The results available so far support dolutegravir-based 2DRs as excellent treatment options for adults with HIV-1 infection, either naïve or already virologically suppressed on their current antiretroviral regimen.
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Affiliation(s)
- Valeria Cento
- Residency in Microbiology and Virology, Università degli Studi di Milano, Milan, Italy
| | - Carlo Federico Perno
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.
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