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Ayanaw MA, Yabeyu AB, Lenjiso G, Kifle ZD. Prevalence and predictors of thrombocytopenia among HAART naive HIV positive patients at Ambo University Referral Hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101049] [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] Open
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Talargia F, Getacher L. Thrombocytopenia and Associated Factors Among HIV Infected Patients in Pre- and Post-Anti-Retroviral Therapy, North East Ethiopia. J Blood Med 2021; 12:741-748. [PMID: 34429675 PMCID: PMC8380136 DOI: 10.2147/jbm.s323086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 12/23/2022] Open
Abstract
Background Thrombocytopenia is a common disorder of HIV (human immunodeficiency virus) infection. The magnitude of thrombocytopenia and associated factors among HIV-infected patients receiving ART (anti-retroviral treatment) are not studied well in this study area. The aim of this study was to determine the prevalence of thrombocytopenia and associated factors in pre- and post-ART patients who attended Debre Berhan Referral Hospital (DBRH) in North-East Ethiopia. Methods A hospital-based cross-sectional study was conducted from October to December 2020 in DBRH, North-East Ethiopia. From the total ART patients, 272 study participants were selected randomly. Socio-demographic variables and clinical characteristics of the patients were collected by standard questionnaires. Measurement of platelet count and CD4 count were made by Sysmex XT2000i hematology machine and BD FACS count analyzer, respectively. Data were analyzed with SPSS software version 23 and multivariate logistic regression was done. P-value less than 0.05 was taken as statistically significant. Results The prevalence of thrombocytopenia was 22.7% with 95% CI: 17.8-27.5 in pre-ART and 14.7% with 95% CI: 11.0-19.9 in post-ART HIV-infected patients with a significant difference at P <0.0001. HIV patients with CD4 counts <200 cells/µL were more likely to have thrombocytopenia (35.0%) than patients with CD4 counts ≥200 with a P <0.04 in pre-ART patients. Patients on zidovudine (AZT)-based therapy were more likely to have thrombocytopenia (16.3%) than patients on tenofovir (TDF)-based therapy (14.8%) with P<0.79; however, this did not show any significant association. Conclusion The prevalence of thrombocytopenia decreased significantly after the beginning of ART. HIV patients with low CD4 count and on AZT-based treatment showed high risk of thrombocytopenia. According to this study, thrombocytopenic patients were observed even after the initiation of ART. As a result, to decrease thrombocytopenic associated mortality and morbidity, there should be continuous screening for HIV-infected patients.
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Affiliation(s)
- Feredegn Talargia
- Department of Biomedical Science, College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Lemma Getacher
- Department of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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Moore CL, Stöhr W, Crook AM, Richert L, Leliévre JD, Pantaleo G, García F, Vella S, Lévy Y, Thiébaut R, McCormack S. Multi-arm, multi-stage randomised controlled trials for evaluating therapeutic HIV cure interventions. Lancet HIV 2020; 6:e334-e340. [PMID: 31047670 DOI: 10.1016/s2352-3018(19)30082-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 12/22/2022]
Abstract
The evaluation of immune-based approaches to achieve an antiretroviral therapy free remission of HIV infection requires proven efficacy through antiretroviral therapy interruption placebo-controlled trials. This approach is not without risk to participants and innovative trial designs need to be developed that minimise the number of participants treated with placebo and ineffective candidates. Multi-arm, multi-stage (MAMS) trial designs can be used in this context to accelerate the development of an immune-based therapeutic agent for HIV cure. Issues related to implementing a MAMS design within the planned EHVA T01 trial are considered here. EHVA T01 is a multicentre, MAMS, double-blind, phase 1 and 2 trial that aims to evaluate the effect of immune interventions on viral control in HIV-1 infected participants following analytic treatment interruption. The application of a MAMS design increases the likelihood that the EHVA T01 trial will identify a successful treatment and minimises the number of participants undergoing analytical treatment interruptions who have been treated with futile agents. The use of a MAMS design is a promising strategy to evaluate complex immune-based approaches aimed at curing HIV-infection, particularly relevant to the pipeline with multiple agents requiring examination.
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Affiliation(s)
- Cecilia L Moore
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Angela M Crook
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Laura Richert
- Vaccine Research Institute, Créteil, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team SISTM, UMR 1219, and Inria, Bordeaux, France; European Clinical Trials Platform and Development, and French Clinical Research Infrastructure Network, CIC 1401, University of Bordeaux, Inserm, CHU Bordeaux, Bordeaux, France
| | - Jean-Daniel Leliévre
- Vaccine Research Institute, Créteil, France; INSERM U955, Paris Est Créteil University, Créteil, France
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, and Swiss Vaccine Research Institute, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Felipe García
- Infectious Diseases Department, Hospital Clinic of Barcelona-HIVACAT, University of Barcelona, Barcelona, Spain; Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)-HIVACAT, Barcelona, Spain
| | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Yves Lévy
- Vaccine Research Institute, Créteil, France; INSERM U955, Paris Est Créteil University, Créteil, France; AP-HP, Hôpital Henri-Mondor Albert-Chenevier, Service d'Immunologie Clinique et Maladies Infectieuses, Créteil, France
| | - Rodolphe Thiébaut
- Vaccine Research Institute, Créteil, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team SISTM, UMR 1219, and Inria, Bordeaux, France; European Clinical Trials Platform and Development, and French Clinical Research Infrastructure Network, CIC 1401, University of Bordeaux, Inserm, CHU Bordeaux, Bordeaux, France
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
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Chronic Subdural Hematoma Associated with Thrombocytopenia in a Patient with Human Immunodeficiency Virus Infection in Cameroon. Case Rep Neurol Med 2017; 2017:5395829. [PMID: 28168070 PMCID: PMC5259660 DOI: 10.1155/2017/5395829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022] Open
Abstract
Hematological abnormalities including thrombocytopenia are common in patients living with HIV infection. Patients with HIV infection related thrombocytopenia present generally with only minor bleeding problems. But cases of subdural hematoma are very rare. A 61-year-old female with a history of HIV infection of 9 years' duration presented with a 3-month history of generalized headache associated with visual blurring and anterograde amnesia. There was no history of trauma or fever. She was treated empirically for cerebral toxoplasmosis for 6 weeks without any improvement of the symptoms. One week prior to admission, she developed weakness of the left side of the body. Clinical examination revealed left-sided hemiparesis. Computed tomography scan of the brain showed a 25 mm chronic right frontoparietotemporal subdural hematoma compressing the lateral ventricle with midline shift. There was no appreciable cerebral atrophy. A complete blood count showed leucopenia and thrombocytopenia at 92,000 cells/mm3. Her CD4-positive cell count was 48 cells/mm3 despite receiving combination antiretroviral therapy for 9 years. A complete blood count analysis suggestive of thrombocytopenia should raise suspicion of possibilities of noninfectious focal brain lesions like subdural hematoma amongst HIV infected patients presenting with nonspecific neurological symptoms. This will enable prompt diagnosis and allow early appropriate intervention.
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Graziani GM, Angel JB. Evaluating the efficacy of therapeutic HIV vaccines through analytical treatment interruptions. J Int AIDS Soc 2015; 18:20497. [PMID: 26561337 PMCID: PMC4641978 DOI: 10.7448/ias.18.1.20497] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/16/2015] [Accepted: 10/08/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The development of an effective therapeutic HIV vaccine that induces immunologic control of viral replication, thereby eliminating or reducing the need for antiretroviral therapy (ART), would be of great value. Besides the obvious challenges of developing a therapeutic vaccine that would generate effective, sustained anti-HIV immunity in infected individuals is the issue of how to best assess the efficacy of vaccine candidates. DISCUSSION This review discusses the various outcome measures assessed in therapeutic HIV vaccine clinical trials involving individuals receiving suppressive ART, with a particular focus on the role of analytical treatment interruption (ATI) as a way to assess the virologic control induced by an immunotherapy. This strategy is critical given that there are otherwise no readily available measures to determine the ability of a vaccine-induced immune response to effectively control HIV replication. The various outcome measures that have been used to assess vaccine efficacy in published therapeutic HIV vaccine clinical trials will also be discussed. Outcome measures have included the kinetics of viral rebound, the new viral set point and changes in the size of the viral reservoir. Clinically relevant outcomes such as the CD4 decline, the time to resume therapy or the time to meet the criterion to resume therapy, the proportion of participants who resume therapy and/or the development of clinical symptoms such as acute retroviral syndrome are also measures of vaccine efficacy. CONCLUSIONS Given the lack of consistency between therapeutic HIV vaccine trials in how efficacy is assessed, comparing vaccines has been difficult. It would, therefore, be beneficial to determine the most clinically relevant measure for use in future studies. Other recommendations for future clinical trials also include studying compartments in addition to blood and replacing ATIs with single-copy assays in situations in which the use of an ATI is not ideal.
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Affiliation(s)
| | - Jonathan B Angel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada;
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Nair M, Maria JM, Agudelo M, Yndart A, Vargas-Rivera ME. Platelets Contribute to BBB Disruption Induced by HIV and Alcohol. ACTA ACUST UNITED AC 2015; 3:182. [PMID: 26501067 PMCID: PMC4612493 DOI: 10.4172/2329-6488.1000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The role of platelets in the neurological diseases that underlie cognitive impairment has attracted increasing attention in recent years. Multiple pathways in platelets contribute to host defenses, as well as to CNS function. In the current study, we hypothesize that the Blood Brain Barrier (BBB) is disrupted when exposed to platelets from patients with triple Co-morbidity (hazardous alcohol users+ HIV+ thrombocytopenia), compared to those with dual, single or no morbidity (HIV only, alcohol only or healthy controls).
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Affiliation(s)
- Madhavan Nair
- Professor and Chair, Institute of Neuro-Immune Pharmacology, Department of Immunology, Florida International University, Miami, FL, USA
| | - Jose Mb Maria
- Professor, School of Integrated Health and Science, Department of Art and Science, Florida International University, Miami, FL, USA
| | - Marisela Agudelo
- Institute of Neuro-Immune Pharmacology, Department of Immunology, Florida International University, Miami, FL, USA
| | - Adriana Yndart
- Institute of Neuro-Immune Pharmacology, Department of Immunology, Florida International University, Miami, FL, USA
| | - Mayra E Vargas-Rivera
- School of Integrated Science and Humanity, College of Arts and Sciences, Florida International University, Miami, FL, USA
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Abstract
The lives of individuals infected with HIV who have access to combination antiretroviral therapy (cART) are substantially prolonged, which increases the risk of developing non-AIDS comorbidities, including coronary heart disease (CHD). In Europe and the USA, individuals with HIV infection have a ∼1.5-fold increased risk of myocardial infarction relative to uninfected individuals. In Africa, the relative risk of myocardial infarction is unknown, but broadened access to life-extending cART suggests that rates of CHD will rise in this and other resource-constrained regions. Atherogenesis in HIV is affected by complex interactions between traditional and immune risk factors. cART has varied, regimen-specific effects on metabolic risk factors. Overall, cART seems to lessen proatherogenic immune activation, but does not eliminate it even in patients in whom viraemia is suppressed. Current strategies to decrease the risk of CHD in individuals infected with HIV include early initiation of cART regimens with the fewest metabolic adverse effects, and careful management of traditional CHD risk factors throughout treatment. Future strategies to prevent CHD in patients with HIV infection might involve the use of HIV-tailored CHD risk-prediction paradigms and the administration of therapies alongside cART that will further decrease proatherogenic HIV-specific immune activation.
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Iordache L, Launay O, Bouchaud O, Jeantils V, Goujard C, Boue F, Cacoub P, Hanslik T, Mahr A, Lambotte O, Fain O. Autoimmune diseases in HIV-infected patients: 52 cases and literature review. Autoimmun Rev 2014; 13:850-7. [PMID: 24747058 DOI: 10.1016/j.autrev.2014.04.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES 1) To describe autoimmune diseases (AD) in HIV-infected people; and 2) to perform a literature review concerning this issue. DESIGN 52 HIV-infected patients that presented an AD in 14 medical departments in Paris and Ile-de-France area were retrospectively included in this study. RESULTS The ADs were vasculitis (11), immune cytopenias (8), rheumatic diseases (8), lupus (7), sarcoidosis (7), thyroid diseases (6), hepatic diseases (5), and antiphospholipid syndrome (4). Four patients presented 2 ADs. In 5 patients the AD preceded HIV infection, in 14 HIV infection was diagnosed at the same time as the AD and 34 were HIV-infected when they developed an AD. 40 ADs (80%) occurred in patients with a CD4 T lymphocyte count of more than 200/mm(3). Cases of autoimmune hemolytic anemia occurred only in patients severely immunodepressed. In five patients (a vasculitis case, a sarcoidosis case, three thyroid disease cases) the AD presented as a form of immune restoration inflammatory syndrome (IRIS). Some ADs allowed HIV-infection diagnosis at a stage of moderate immune deficiency (vasculitis, antiphospholipid syndrome, immune thrombocytopenia). 37 patients received immunosuppressant treatments with good tolerance. These results confirm in a large series of patients previous data concerning autoimmune diseases occurrence in HIV-infected people. CONCLUSION In the HAART era, when HIV-infected people are treated more and more early, autoimmune diseases can occur, mainly at the phase of immunological recovery. HIV infection should not limit immunosuppressant treatment use.
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Affiliation(s)
- Laura Iordache
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France.
| | - Odile Launay
- Clinical Investigation Centre, Cochin Hospital, 27 rue du Fbg St.-Jacques, 75014 Paris, France
| | - Olivier Bouchaud
- Infectious Diseases Department, Avicenne Hospital, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Vincent Jeantils
- Infectious Diseases Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
| | - Cécile Goujard
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Francois Boue
- Internal Medicine Department, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Patrice Cacoub
- Internal Medicine and Clinical Immunology Department, Pitié-Salpétrière Hospital, 47-83 bd de l'Hopital, 75013 Paris, France; Hospital-University Department I2B, Sorbonne Universités, UPMC Paris 6 University, UMR 7211, F-75005, Paris, France; INSERM, UMR S959, F-75013, Paris, France; CNRS, UMR 7211, F-75005, Paris, France
| | - Thomas Hanslik
- Internal Medicine Department, Ambroise Paré Hospital, 9 Avenue Charles-de-Gaulle, 92100 Boulogne Billancourt, France
| | - Alfred Mahr
- Internal Medicine Department, St. Louis Hospital, 1 Avenue Claude-Vellefaux, 75010 Paris, France
| | - Olivier Lambotte
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Olivier Fain
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
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Thrombocytopenia during primary HIV-1 infection predicts the risk of recurrence during chronic infection. J Acquir Immune Defic Syndr 2012; 60:e112-4. [PMID: 22772349 DOI: 10.1097/qai.0b013e31825b6fde] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Metcalf Pate KA, Mankowski JL. HIV and SIV Associated Thrombocytopenia: An Expanding Role for Platelets in the Pathogenesis of HIV. DRUG DISCOVERY TODAY. DISEASE MECHANISMS 2011; 8:e25-e32. [PMID: 22577463 PMCID: PMC3346281 DOI: 10.1016/j.ddmec.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Thrombocytopenia is common in HIV and SIV infection, and is often associated with disease progression. HIV and SIV-associated thrombocytopenia arise through multiple mechanisms, including decreased platelet production, increased platelet destruction due to HIV-mimetic anti-platelet antibodies, and increased use of activated platelets. Activated platelets have the potential to contribute to the pathogenesis of HIV and SIV by interacting directly with inflammatory cells and endothelium and by releasing soluble immunomodulatory cytokines.
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Affiliation(s)
- Kelly A Metcalf Pate
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore MD, 21205
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Nascimento FG, Tanaka PY. Thrombocytopenia in HIV-Infected Patients. Indian J Hematol Blood Transfus 2011; 28:109-11. [PMID: 23730018 DOI: 10.1007/s12288-011-0124-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 10/03/2011] [Indexed: 10/16/2022] Open
Abstract
Thrombocytopenia is a common feature among HIV-positive patients. However, there are few reports about this subject after highly active antiretroviral therapy (HAART) introduction. The authors show a retrospective description of epidemiology, clinical aspects, and treatment observed in 55 HIV-positive outpatients with thrombocytopenia treated in two reference centers for HIV treatment in São Paulo, Brazil. Thirty-four (62%) patients were male, 50 (91%) were Caucasian, with median of lymphocytes TCD4 of 394 cells/mm(3). In 63.6% patients, the cause of thrombocytopenia was classified as immune thrombocytopenic purpura and non immune in 25.5%. Regular use of HAART was present in 43.6% of the population studied. In 20% HAART was initiated for thrombocytopenia treatment with improvement in platelets count observed after 3 months. Platelet transfusion was needed in 23.7% of the patients and one patient died due to bleeding. Thrombocytopenia is still common among patients infected with HIV, considered a multifactor disorder, commonly due to immune mechanisms in our cases. In the clinical setting, a diagnostic approach related to the hematological consequences of HIV infection is needed for a better therapy option for this population.
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Affiliation(s)
- Francielle Garcia Nascimento
- Hematology Section, Instituto de Infectologia Emílio Ribas, Av. Dr. Arnaldo, 165, São Paulo, SP 01246-900 Brazil
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Leibowitch J, Mathez D, Truchis P, Perronne C, Melchior J. Short cycles of antiretroviral drugs provide intermittent yet effective therapy: a pilot study in 48 patients with chronic HIV infection. FASEB J 2010; 24:1649-55. [DOI: 10.1096/fj.09-148676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jacques Leibowitch
- Immunology and Virology Unit Raymond Poincaré Hospital, Assistance Publique–Hôpitaux de Paris Garches France
| | - Dominique Mathez
- Immunology and Virology Unit Raymond Poincaré Hospital, Assistance Publique–Hôpitaux de Paris Garches France
| | - Pierre Truchis
- Clinical Infectious Disease Unit Raymond Poincaré Hospital, Assistance Publique–Hôpitaux de Paris Garches France
| | - Christian Perronne
- Clinical Infectious Disease Unit Raymond Poincaré Hospital, Assistance Publique–Hôpitaux de Paris Garches France
| | - Jean‐Claude Melchior
- Clinical Nutrition and Infectious Disease Unit, Department of Internal Medicine and Infectious Diseases Raymond Poincaré Hospital, Assistance Publique–Hôpitaux de Paris Garches France
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Incidence and risk factors of thrombocytopenia in patients receiving intermittent antiretroviral therapy: a substudy of the ANRS 106-window trial. J Acquir Immune Defic Syndr 2009; 52:531-7. [PMID: 19855285 DOI: 10.1097/qai.0b013e3181be73e3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incidence and risk factors for thrombocytopenia in patients discontinuing highly active antiretroviral therapy (HAART) have not been fully investigated. METHODS Well-suppressed patients on HAART were randomized to continuous (CT) or intermittent therapy (IT) for 96 weeks. Incidence of thrombocytopenia (<150 x 10(3) platelets/mm(3)) was assessed and multivariate analysis performed to identify baseline predictors. Correlations were assessed between platelet, CD4, CD8 T-cell counts, and viral load after treatment interruption. RESULTS Three hundred ninety-one patients were included, with a median baseline platelet count of 243,000/mm(3). The incidence of thrombocytopenia at week 96 was significantly higher in the IT versus the CT arm (25.4% versus 9.8%, respectively, P < 0.001) and median time to thrombocytopenia was 9 weeks. In multivariate analysis, the IT strategy: odds ratio (OR) = 4.1 (2.1-7.9; P < 0.0001), a history of thrombocytopenia: OR = 11.9 (2.4-57.9; P = 0.002), and a low baseline platelet count: OR = 3.4 (2.3-5.1; P < 0.0001) were associated with an increased risk of thrombocytopenia. Also, after treatment interruption, changes from baseline in platelet counts were correlated with changes in CD4 T-cell counts and plasma HIV RNA levels (P < 0.001 for both). CONCLUSIONS Intermittent therapy is associated with a high incidence of thrombocytopenia, especially among patients with low platelet counts and a history of thrombocytopenia.
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Abstract
PURPOSE OF REVIEW This paper provides an overview of the current knowledge on virological rebound during treatment interruption and its consequences in patients with chronic HIV-1 infection. RECENT FINDINGS After interruption of antiretroviral therapy, plasma viremia inevitably returns to individual pretherapy set point levels in almost all patients with chronic HIV infection. This virological rebound leads to a state of massive immune activation and consequently an increased turnover of CD4+ and CD8+ T cells resulting in a biphasic decay of T-helper cell numbers. Rebound has been shown to be associated with an increased risk of clinical events by some (albeit not all) randomized trials published during the last few months. Secondary consequences of immunologic deterioration include worsening of comorbidity (e.g. hepatitis and renal impairment) and an increased risk of cardiovascular disease as well as an elevated HIV transmission risk during treatment interruption. The individual course after treatment interruption cannot be predicted by any of the known surrogate markers. SUMMARY Treatment interruptions cannot be recommended in HIV-infected patients outside clinical trials, especially when profound immune deficiency is found to be preexisting.
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Bunupuradah T, Puthanakit T, Pancharoen C, Butterworth O, Phanuphak P, Ananworanich J. Henoch–Schönlein purpura and thrombocytopenia after planned antiretroviral treatment interruption in a Thai girl with HIV infection. Int J Infect Dis 2009; 13:e31-3. [DOI: 10.1016/j.ijid.2008.05.1225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 05/13/2008] [Accepted: 05/19/2008] [Indexed: 11/28/2022] Open
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Pai NP, Tulsky JP, Lawrence J, Colford JM, Reingold AL. Structured treatment interruptions (STI) in chronic suppressed HIV infection in adults. Cochrane Database Syst Rev 2005:CD005482. [PMID: 16235406 DOI: 10.1002/14651858.cd005482] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although antiretroviral treatment (ART) has led to a decline in morbidity and mortality of HIV-infected patients in developed countries, it has also presented challenges. These challenges include increases in pill burden; adherence to treatment; development of resistance and treatment failure; development of drug toxicities; and increase in cost of HIV treatment and care. These issues stimulated interest in investigating the short-term and long-term consequences of discontinuing ART, thus providing support for research in structured treatment interruptions (STI). Structured treatment interruptions of antiretroviral treatment involve taking supervised breaks from ART. STI are defined as one or more planned, timing pre-specified, cyclical interruptions in ART. STI are attempted in monitored clinical settings in eligible participants. STI have generated hopes of reducing drug toxicities, decreasing costs and total time on treatment in HIV-positive patients. The first STI was attempted in the case of a patient in Germany, who later permanently discontinued treatment. This successful anecdotal case report led to several trials on STI worldwide. OBJECTIVES The objective of this systematic review was to assess the effects of structured treatment interruptions (STI) of antiretroviral therapy (ART) in the management of chronic suppressed HIV infection, using all available high-quality studies. SEARCH STRATEGY Nine databases covering the time period from January 1996 to March 2005 were searched. Bibliographies were scanned and experts contacted in the field to identify unpublished research and ongoing trials. Two reviewers independently extracted data, and evaluated study eligibility and quality. Disagreements were resolved in consultation with a third reviewer. Data from 33 studies were included in the review. SELECTION CRITERIA STI is a planned, timing pre-specified experimental intervention. In our review, we decided to include all available intervention trials in HIV-infected patients, with or without control groups. We reviewed evidence from 18 randomized and non-randomized controlled trials, and 15 single arm trials. Single arm trials were included because these pilot studies made significant contribution to the early development and refutation of hypotheses in STI. DATA COLLECTION AND ANALYSIS Trials included in this review varied in study participants, methodology and reported inconsistent measures of effect. Due to this heterogeneity, we did not attempt to meta-analyse them. Results were tabulated and a qualitative systematic review was done MAIN RESULTS For the purpose of this review, STI strategies were classified either as a timed-cycle STI strategy or a CD4-guided STI strategy. In timed-cycle STI strategy, a predetermined period of fixed duration (e.g. one week, one month) off ART was attempted followed by resumption of ART, while closely monitoring changes in CD4 levels and viral load levels. Predetermined criteria for interruption and resumption were laid out in this strategy. Timed-cycle STI fell out of favor due to reports of development of resistance in many studies. Moreover, there were no significant immunological and virological benefits, and no reduction in toxicities, reported in these studies. In CD4-guided STI strategy, ART was interrupted for variable durations guided by CD4 levels. Participants with high nadir CD4 levels qualified for this approach. A reduction in costs of ART, a reduction in mutation, and a better tolerability of this CD4-guided STI strategy was reported. However, concerns about long-term safety of this strategy on immunological, virological, and clinical outcomes were also raised. AUTHORS' CONCLUSIONS Timed-cycle STI have not been proven to be safe in the short term. Although CD4-guided STI strategy has reported favorable outcomes in the short term, the long-term safety, efficacy and tolerability of this strategy has not been fully investigated. Based on the studies we reviewed, the evidence to support the use of timed-cycle STI and CD4-guided STI cycles as a standard of care in the management of chronic suppressed HIV infection is inconclusive.
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Affiliation(s)
- N P Pai
- University of California at Berkeley, Division Of Epidemiology, School of Public Health, 140 Warren Hall, Division of Epidemiology, University of California at Berkeley, Berkeley, California 94720, USA.
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Maroto AAM, Cabrera MH, Pérez-Arellano JL. HIV-related thrombocytopenic purpura not relapsing during CD4 cell-guided treatment interruptions. AIDS 2005; 19:1111-2. [PMID: 15958847 DOI: 10.1097/01.aids.0000174462.08924.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pavie J, Porcher R, Fournier S, Furco A, Tournoux C, Palmer P, Rabian C, Molina JM. Interruptions du traitement antirétroviral chez 30 patients infectés par le VIH en succès virologique. Presse Med 2005. [DOI: 10.1016/s0755-4982(05)73403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ananworanich J, Hirschel B. Interrupting highly active antiretroviral therapy in patients with HIV. Expert Rev Anti Infect Ther 2005; 3:51-60. [PMID: 15757457 DOI: 10.1586/14787210.3.1.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Scheduled treatment interruptions are preplanned interruptions of antiretroviral treatment, which may be directed by time (e.g., cycles of 8 weeks on treatment and 8 weeks off treatment); the concentration of CD4+ lymphocytes (the CD4 count); HIV-1 RNA concentration (viral load); or other factors. This review covers the rationale of scheduled treatment interruptions and the different strategies that have been explored. It examines the issue of autovaccination, resistance and other risks and benefits. Scheduled-treatment-interruption studies in three populations are discussed: patients who initiated highly active antiretroviral therapy during acute HIV infection; patients with successfully treated chronic HIV infection; and patients with highly active antiretroviral therapy failure.
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Affiliation(s)
- Jintanat Ananworanich
- The HIV Netherlands, Australia, Thailand Research Collaboration (HIV-NAT) and The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
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Colebunders R, De Schacht C, Vanwolleghem T, Callens S. Lopinavir/ritonavir- and indinavir-induced thrombocytopenia in a patient with HIV infection. Int J Infect Dis 2004; 8:315-6. [PMID: 15325601 DOI: 10.1016/j.ijid.2004.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Indexed: 11/17/2022] Open
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