1
|
Costanza G, Felici E, Velluso F, Grelli S, Paba P. "Evaluation of ELITE InGenius® integrative system for detection, quantification and monitoring of HIV-1 RNA in Cerebrospinal Fluid.". J Virol Methods 2024; 329:114996. [PMID: 39074515 DOI: 10.1016/j.jviromet.2024.114996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Human Immunodeficiency virus (HIV) is effectively suppressed in the blood by the Antiretroviral Therapy in people living with HIV, but in rare cases can be present in some tissues and body fluids. In recent years, integrated systems were validated for detecting HIV-1 in plasma or serum. but not in cerebrospinal fluid (CSF). We evaluated the performance of ELITE InGenius® in comparison with the cobas® in this area. METHODS To test the diagnostic accuracy of the HIV-1 ELITe MGB® kit on CSF samples, we tested CSF samples previously characterised with the cobras® HIV1 test. Archived CSF samples were also spiked with serial dilutions of the 4th WHO International Standard for HIV-1 NAT and assays and tested to assess the repeatability and reproducibility of the ELITechGroup assay. RESULTS The HIV-1 ELITe MGB® Kit confirmed all the HIV-1 negative CSF samples from patients HIV positive in plasma and from non-HIV1 patients. All the CSF samples that were HIV-1 positive by the cobas®, were confirmed positive by the ELITe InGenius®. Concordance across the methods was also observed when processing the CSF dilutions spiked at medium-low titre, mimicking HIV-1 low-load infections. CONCLUSIONS The two systems were equivalent in the detection and quantification of HIV-1 RNA in CSF samples.
Collapse
Affiliation(s)
| | | | - Fabio Velluso
- Unit of Virology, Policlinic of Tor Vergata, Rome, Italy.
| | - Sandro Grelli
- Unit of Virology, Policlinic of Tor Vergata, Rome, Italy; Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Pierpaolo Paba
- Unit of Virology, Policlinic of Tor Vergata, Rome, Italy.
| |
Collapse
|
2
|
Balli Turhan FN, Kara E, Uyaroğlu OA, Çalık Başaran N, Demirkan K, Ünal S, İnkaya AÇ. Evaluation of infectious diseases physicians' attitudes to dyslipidemia management in PLWH. Postgrad Med 2024:1-6. [PMID: 39175150 DOI: 10.1080/00325481.2024.2394015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Dyslipidemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). ASCVD prevalence among people living with HIV (PLWH) is twice that of the general population. This study aimed to evaluate the infectious diseases (ID) physicians' attitudes on dyslipidemia management in PLWH. METHODS This observational, cross-sectional study was conducted as online survey among ID physicians between November 2023 and February 2024. An e-mail with the survey link, title and purpose of the study was sent to physicians through the local ID societies. The survey included questions about physicians' demographic characteristics and their attitudes toward treating dyslipidemia in PLWH. RESULTS A total of 242 physicians responded to the survey, of whom 59.9% (n = 145) were ID specialists and 40.1% (n = 97) were ID residents. Forty-one percent (n = 100) of physicians reported that they did not follow a guideline, and 26% of physicians reported that they did not use a cardiovascular risk calculator in their clinical practice. Specialists (69%) were more likely than residents (43.3%) to follow clinical guidelines for dyslipidemia management (p < 0.001). Seventy-two percent (n = 174) of physicians doubted the need to treat dyslipidemia, and 73% (n = 177) of physicians were affected by the patient skepticism. Workload and lack of time were identified by 68.6% of physicians as barriers to implementing dyslipidemia guideline recommendations. CONCLUSION A considerable number of Turkish ID physicians did not prefer using clinical guidelines for dyslipidemia and ASCVD risk calculators. Statin prescribing of physicians was influenced by workload, lack of time, patient skepticism, and lack of knowledge. Training ID physicians in primary prevention of ASCVD and management of dyslipidemia in PLWH is paramount.
Collapse
Affiliation(s)
- Fatma Nisa Balli Turhan
- Department of Clinical Pharmacy, Gazi University Faculty of Pharmacy, Ankara, Türkiye
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Emre Kara
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Oğuz Abdullah Uyaroğlu
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| |
Collapse
|
3
|
Chivite I, Berrocal L, de Lazzari E, Navadeh S, Lluis-Ganella C, Inciarte A, de la Mora L, González-Cordón A, Martínez-Rebollar M, Laguno M, Torres B, Blanco JL, Martínez E, Mallolas J, Ambrosioni J. Effectiveness, safety and discontinuation rates of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with HIV using real-world data: a systematic review and meta-analysis. J Antimicrob Chemother 2024; 79:1775-1783. [PMID: 38758191 DOI: 10.1093/jac/dkae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is based on the results of robust clinical trials. OBJECTIVES To assess the effectiveness and safety of BIC/FTC/TAF in treatment-naïve (TN) and treatment-experienced (TE) people with HIV using available real-world cohort studies. METHODS Systematic review and meta-analysis of publications and communications identified via Boolean search in Medline, PubMed and Embase, and conference abstracts reporting retrospective real-world use of BIC/FTC/TAF, published until 31 January 2024. The primary endpoint was the proportion of TN and TE people with HIV with viral load (VL) < 50 copies/mL at 48 weeks while on treatment. RESULTS Of the 38 identified publications and conference abstracts, for the present analysis we included 12 publications (comprising 792 TN and 6732 TE individuals). For the three publications including 507 TN participants reporting the primary outcome, VL suppression was 97% [95% confidence intervals (CI): 89-100]. For the nine publications including 4946 TE participants reporting the primary outcome, VL suppression was 95% (95% CI: 94-96), with suppression >93% in all studies. Total discontinuations at 48 weeks in TE individuals were 3% (95% CI: 2-5), 1% (95% CI: 0-2) due to side effects. A total of four publications with 151 TE individuals with previous presence of M184V substitution were identified, reporting a suppression rate at 48 weeks of 95% (95% CI: 88-100). CONCLUSIONS Real-world studies demonstrate low discontinuation rates and high rates of virologic suppression in individuals treated with BIC/FTC/TAF, both TN and TE with and without previous detection of M184V substitution.
Collapse
Affiliation(s)
- Iván Chivite
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Leire Berrocal
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Elisa de Lazzari
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Alexy Inciarte
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorena de la Mora
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Maria Martínez-Rebollar
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Berta Torres
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Disease Service, Hospital Clinic- Fundacio de Recerca Clinic Barcelona-Institut d'nvestigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Le Guillou-Guillemette H, Pivert A, ElBara A, Vall M, Sang CNW, Veillon P, Ducancelle A, Bollahi MA, Mohamed MS, Lunel-Fabiani F. Prevalence, clinical and virological characteristics and short-term prognosis of hepatitis delta infection among patients with HIV/HBV in Nouakchott, Mauritania. J Viral Hepat 2024; 31:457-465. [PMID: 38771311 DOI: 10.1111/jvh.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.
Collapse
Affiliation(s)
- Hélène Le Guillou-Guillemette
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | - Adeline Pivert
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | | | - Pascal Veillon
- Virology Department, Angers University Hospital, Angers, France
| | - Alexandra Ducancelle
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | - Françoise Lunel-Fabiani
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| |
Collapse
|
5
|
Mazzitelli M, Avolio A, Carandina R, Parisi S, Wensing A, Cattelan A. Characterization of a case of virological failure after switch to long-acting cabotegravir and rilpivirine. J Antimicrob Chemother 2024; 79:2074-2076. [PMID: 38905150 DOI: 10.1093/jac/dkae187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Antonio Avolio
- Laboratory and Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Saverio Parisi
- Department of Molecular Medicine, Padua University Hospital, 35128 Padua, Italy
| | - Annemarie Wensing
- Translational Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| |
Collapse
|
6
|
Barroso S, Guitart-Mampel M, García-García FJ, Cantó-Santos J, Valls-Roca L, Andújar-Sánchez F, Vilaseca-Capel A, Tobías E, Arias-Dimas A, Quesada-López T, Artuch R, Villarroya F, Giralt M, Martínez E, Lozano E, Garrabou G. Metabolic, Mitochondrial, and Inflammatory Effects of Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate in Asymptomatic Antiretroviral-Naïve People with HIV. Int J Mol Sci 2024; 25:8418. [PMID: 39125986 PMCID: PMC11313075 DOI: 10.3390/ijms25158418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
This study aimed to comprehensively assess the metabolic, mitochondrial, and inflammatory effects of first-line efavirenz, emtricitabine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) single-tablet regimen (STR) relative to untreated asymptomatic HIV infection. To this end, we analyzed 29 people with HIV (PWH) treated for at least one year with this regimen vs. 33 antiretroviral-naïve PWH. Excellent therapeutic activity was accompanied by significant alterations in metabolic parameters. The treatment group showed increased plasmatic levels of glucose, total cholesterol and its fractions (LDL and HDL), triglycerides, and hepatic enzymes (GGT, ALP); conversely, bilirubin levels (total and indirect fraction) decreased in the treated cohort. Mitochondrial performance was preserved overall and treatment administration even promoted the recovery of mitochondrial DNA (mtDNA) content depleted by the virus, although this was not accompanied by the recovery in some of their encoded proteins (since cytochrome c oxidase II was significantly decreased). Inflammatory profile (TNFα, IL-6), ameliorated after treatment in accordance with viral reduction and the recovery of TNFα levels correlated to mtDNA cell restoration. Thus, although this regimen causes subclinical metabolic alterations, its antiviral and anti-inflammatory properties may be associated with partial improvement in mitochondrial function.
Collapse
Affiliation(s)
- Sergio Barroso
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Mariona Guitart-Mampel
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Francesc Josep García-García
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Judith Cantó-Santos
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Laura Valls-Roca
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Félix Andújar-Sánchez
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Adrià Vilaseca-Capel
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Ester Tobías
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| | - Angela Arias-Dimas
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain;
| | - Tania Quesada-López
- Biochemistry and Molecular Biomedicine Department, Biomedicine Institute (IBUB), University of Barcelona (UB), 08014 Barcelona, Spain; (T.Q.-L.); (F.V.); (M.G.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Rafael Artuch
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain;
| | - Francesc Villarroya
- Biochemistry and Molecular Biomedicine Department, Biomedicine Institute (IBUB), University of Barcelona (UB), 08014 Barcelona, Spain; (T.Q.-L.); (F.V.); (M.G.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Marta Giralt
- Biochemistry and Molecular Biomedicine Department, Biomedicine Institute (IBUB), University of Barcelona (UB), 08014 Barcelona, Spain; (T.Q.-L.); (F.V.); (M.G.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Esteban Martínez
- Infectious Diseases Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
- CIBER of Infectious Diseases (CIBERINFEC), Carlos III Health Institute, 28029 Madrid, Spain
| | - Ester Lozano
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona (UB), 08028 Barcelona, Spain
| | - Glòria Garrabou
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain; (S.B.); (M.G.-M.); (F.J.G.-G.); (J.C.-S.); (L.V.-R.); (F.A.-S.); (A.V.-C.); (E.T.)
- Department of Internal Medicine, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Carlos III Health Institute, 28029 Madrid, Spain;
| |
Collapse
|
7
|
Jadzic J, Dragovic G, Lukic R, Obradovic B, Djuric M. Bone Tissue Changes in Individuals Living with HIV/AIDS: The Importance of a Hierarchical Approach in Investigating Bone Fragility. J Pers Med 2024; 14:791. [PMID: 39201983 PMCID: PMC11355540 DOI: 10.3390/jpm14080791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024] Open
Abstract
Skeletal alterations and their complications can significantly impact the quality of life and overall prognosis of patients living with HIV (PLWHIV). Considering skeletal alterations are often asymptomatic and unapparent during routine clinical evaluation, these conditions are frequently overlooked in the clinical management of PLWHIV. However, since the use of combined antiretroviral therapy (cART) has increased life expectancy in PLWHIV effectively, osteopenia, osteoporosis, and bone fragility are now considered to have a major health impact, with a substantial increase in healthcare costs. This narrative literature review aimed to provide a comprehensive overview of the contemporary literature related to bone changes in PLWHIV, focusing on the importance of taking a multi-scale approach in the assessment of bone hierarchical organization. Even though a low bone mineral density is frequently reported in PLWHIV, numerous ambiguities still remain to be solved. Recent data suggest that assessment of other bone properties (on various levels of the bone structure) could contribute to our understanding of bone fragility determinants in these individuals. Special attention is needed for women living with HIV/AIDS since a postmenopausal status was described as an important factor that contributes to skeletal alterations in this population. Further research on complex etiopathogenetic mechanisms underlying bone alterations in PLWHIV may lead to the development of new therapeutic approaches specifically designed to reduce the health burden associated with skeletal disorders in this population. A major challenge in the clinical management of PLWHIV lies in the adverse skeletal effects of some frequently prescribed cART regimens (e.g., regimens containing tenofovir disoproxil fumarate), which may require a switch to other pharmacological approaches for maintained HIV infection (e.g., regimens containing tenofovir alafenamide). Taken together, the findings are indicative that the HIV/AIDS status should be taken into consideration when designing new guidelines and strategies for individualized prevention, diagnosis, and treatment of increased bone fragility.
Collapse
Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (G.D.); (B.O.)
| | - Relja Lukic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Obstetrics and Gynecology Clinic “Narodni Front”, 11000 Belgrade, Serbia
| | - Bozana Obradovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (G.D.); (B.O.)
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| |
Collapse
|
8
|
Wagner L, Boesecke C, Baumgarten A, Scholten S, Schellberg S, Hoffmann C, Audebert F, Noe S, Erber J, Lee M, Triebelhorn J, Schneider J, Spinner CD, Voit F. Is doxycycline post-exposure prophylaxis being utilised in Germany? Insights from an online survey among German men who have sex with men. Infection 2024:10.1007/s15010-024-02321-x. [PMID: 39042326 DOI: 10.1007/s15010-024-02321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/08/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces the likelihood of Chlamydia and early syphilis by approximately two-thirds. Currently, data on the frequency of Doxy-PEP use in men who have sex with men (MSM) are limited. This study aimed to assess knowledge, attitude towards, and frequency of Doxy-PEP use among MSM in Germany. METHODS We conducted a national online survey in Germany from summer to fall 2023, recruiting MSM and transgender women. Participants were invited to complete the online survey through social media, online dating platforms, and print media advertisements with active recruitment and poster advertising in private practices, tertiary outpatient clinics, and MSM community events in Germany. RESULTS In total, 438 participants completed the survey and were included in the analysis, and 285 (65.1%) were living with the human immunodeficiency virus (HIV) or taking HIV-pre-exposure prophylaxis (PrEP). Overall, 170 participants (38.8%) had heard of Doxy-PEP, and 275 (62.8%) would consider taking it, but only 32 (7.3%) reported having ever taken Doxy-PEP. The most common reason for a negative attitude towards Doxy-PEP were apprehension about insufficient detailed information, and concerns about antibiotic resistance. Doxy-PEP users were more likely to be on HIV-PrEP, had a higher self-reported risk of bacterial sexually transmitted infections (STIs), and often had a history of bacterial STIs. CONCLUSION The study demonstrated high awareness and strong interest in Doxy-PEP among MSM in Germany, most of whom were living with HIV or taking HIV-PrEP; however, the actual usage of Doxy-PEP remains low in the summer and fall of 2023.
Collapse
Affiliation(s)
- Laura Wagner
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany.
| | - Christoph Boesecke
- University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-Site Cologne-Bonn, Bonn, Germany
| | | | | | | | | | | | | | - Johanna Erber
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Marcel Lee
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Julian Triebelhorn
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Jochen Schneider
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Christoph D Spinner
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Florian Voit
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| |
Collapse
|
9
|
van Welzen BJ, Van Lelyveld SFL, Ter Beest G, Gisolf JH, Geerlings SE, Prins JM, Van Twillert G, Van Nieuwkoop C, Van der Valk M, Burger D, Wensing AMJ. Virological Failure After Switch to Long-Acting Cabotegravir and Rilpivirine Injectable Therapy: An In-depth Analysis. Clin Infect Dis 2024; 79:189-195. [PMID: 38207125 PMCID: PMC11259215 DOI: 10.1093/cid/ciae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Long-acting (LA) injectable therapy with cabotegravir (CAB) and rilpivirine (RPV) is currently used as maintenance treatment for human immunodeficiency virus type 1, and has a low risk for virological failure (VF). Although the risk is low, the circumstances and impact of VF in the real-world setting merit further evaluation. METHODS We performed an in-depth clinical, virological, and pharmacokinetic analysis on the reasons behind and the impact of VF during LA CAB/RPV therapy in 5 cases from the Netherlands. Genotypic resistance testing was performed after the occurrence of VF, and drug plasma (trough) concentrations were measured after VF was established and on any other samples to assess on-treatment drug levels. CAB and RPV drug levels that were below the first quartile of the population cutoff (≤Q1) were considered to be low. RESULTS Five cases who were eligible for LA CAB/RPV experienced VF despite a low predicted risk at baseline. Genotypic resistance testing revealed extensive selection of nonnucleoside reverse transcriptase inhibitor-associated mutations in all cases, and integrase strand transfer inhibitor mutations in 4 cases. All cases displayed low drug levels of either CAB, RPV, or both during the treatment course, likely contributing to the occurrence of VF. In 3 cases, we were able to identify the potential mechanisms behind these low drug levels. CONCLUSIONS This is the first in-depth multiple case analysis of VF on LA CAB/RPV therapy in a real-world setting. Our observations stress the need to be aware for (evolving) risk factors and the yield of a comprehensive clinical, virological, and pharmacokinetic approach in case of failure.
Collapse
Affiliation(s)
- Berend J van Welzen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gerjanne Ter Beest
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jet H Gisolf
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gitte Van Twillert
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Cees Van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Marc Van der Valk
- Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Stichting hiv Monitoring, Amsterdam, The Netherlands
| | - David Burger
- Department of Pharmacy, Institute of Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemarie M J Wensing
- Translational Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ezintsha, Department of Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
10
|
Guaraldi G, Milic J, Renzetti S, Motta F, Cinque F, Bischoff J, Desilani A, Conti J, Medioli F, del Monte M, Kablawi D, Elgretli W, Calza S, Mussini C, Rockstroh JK, Sebastiani G. The effect of weight gain and metabolic dysfunction-associated steatotic liver disease on liver fibrosis progression and regression in people with HIV. AIDS 2024; 38:1323-1332. [PMID: 38597416 PMCID: PMC11216384 DOI: 10.1097/qad.0000000000003903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE People with HIV (PWH) have high risk of liver fibrosis. We investigated the effect of weight gain and metabolic dysfunction-associated steatotic liver disease (MASLD) on liver fibrosis dynamics. DESIGN Multicenter cohort study. METHODS Fibrosis progression was defined as development of significant fibrosis [liver stiffness measurement (LSM) ≥8 kPa], or transition to cirrhosis (LSM ≥13 kPa), for those with significant fibrosis at baseline. Fibrosis regression was defined as transition to LSM less than 8 kPa, or to LSM less than 13 kPa for those with cirrhosis at baseline. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) with at least one metabolic abnormality. A continuous-time multistate Markov model was used to describe transitions across fibrosis states. RESULTS Among 1183 PWH included from three centers (25.2% with viral hepatitis coinfection), baseline prevalence of significant fibrosis and MASLD was 14.4 and 46.8%, respectively. During a median follow-up of 2.5 years (interquartile range 1.9-3.5), the incidence rate of fibrosis progression and regression was 2.8 [95% confidence interval (CI) 2.3-3.4] and 2.2 (95% CI 1.9-2.6) per 100 person-years, respectively. In Markov model, weight gain increased the odds of fibrosis progression [odds ratio (OR) 3.11, 95% CI 1.59-6.08], whereas weight gain (OR 0.30, 95% CI 0.10-0.84) and male sex (OR 0.32, 95% CI 0.14-0.75) decreased the odds of fibrosis regression. On multivariable Cox regression analysis, predictors of fibrosis progression were weight gain [adjusted hazard ratio (aHR) 3.12, 95% CI 1.41-6.90] and MASLD (aHR 2.72, 95% CI 1.05-7.02). CONCLUSION Fibrosis transitions are driven by metabolic health variables in PWH, independently of viral hepatitis coinfection and antiretroviral class therapy.
Collapse
Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena
| | - Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Federico Motta
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Felice Cinque
- Division of Gastroenterology and Hepatology, McGill University Health Centre
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Jenny Bischoff
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, Bonn Germany
| | - Andrea Desilani
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Jacopo Conti
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Filippo Medioli
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Martina del Monte
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Dana Kablawi
- Division of Gastroenterology and Hepatology, McGill University Health Centre
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena
| | - Juergen K. Rockstroh
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, Bonn Germany
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Division of Experimental Medicine, McGill University, Montreal, Canada
| |
Collapse
|
11
|
Dinh DA, Tan Y, Saeed S. Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review. AIDS Behav 2024:10.1007/s10461-024-04436-6. [PMID: 38992228 DOI: 10.1007/s10461-024-04436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Disengagement from care among people with HIV (PWH) and hepatitis C (HCV) increases the risks of adverse health outcomes and poses significant barriers to achieving global HIV and HCV elimination goals. In accordance with the Joanna Briggs Institute framework, a scoping review was conducted to synthesize and highlight existing gaps in the literature on (dis)engagement in care among PWH and HCV. We searched for original studies on (dis)engagement in care among PWH and HCV in high-income countries using eight electronic databases from inception to May 2023. Our search yielded 4462 non-duplicated records, which were scoped to 27 studies. Definitions of (dis)engagement in care were diverse, with considerable heterogeneity in how retention was operationalized and temporally measured. Studies identified predictors of (dis)engagement to be related to drug and substance use (n = 5 articles), clinical factors (n = 5), social and welfare (n = 4), and demographic characteristics (n = 2). When engagement in care was treated as an exposure, it was associated with HCV treatment initiation (n = 3), achieving sustained virological response (n = 2), and maintaining HIV viral suppression (n = 1). Interventions to improve care engagement among PWH and HCV were limited to five studies using cash incentives (n = 1) and individual case management (n = 4). (Dis)engagement in care is a dynamic process influenced by shifting priorities that may 'tip the balance' towards or away from regularly interacting with healthcare professionals. However, inconsistent definitions render cross-study comparisons and meta-analyses virtually impossible. Further research needs to establish a standardized definition to identify patients at high risk of disengagement and develop interventions that leverage the nested HIV/HCV care cascades to retain and recover patients lost from care.
Collapse
Affiliation(s)
- Duy A Dinh
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yvonne Tan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, 203 Carruthers Hall 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
| |
Collapse
|
12
|
Prosty C, Katergi K, Sorin M, Rjeily MB, Butler-Laporte G, McDonald EG, Lee TC. Comparative efficacy and safety of Pneumocystis jirovecii pneumonia prophylaxis regimens for people living with HIV: a systematic review and network meta-analysis of randomized controlled trials. Clin Microbiol Infect 2024; 30:866-876. [PMID: 38583518 DOI: 10.1016/j.cmi.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection among people living with HIV (PWH), particularly among new and untreated cases. Several regimens are available for the prophylaxis of PCP, including trimethoprim-sulfamethoxazole (TMP-SMX), dapsone-based regimens (DBRs), aerosolized pentamidine (AP), and atovaquone. OBJECTIVES To compare the efficacy and safety of PCP prophylaxis regimens in PWH by network meta-analysis. METHODS DATA SOURCES: Embase, MEDLINE, and CENTRAL from inception to June 21, 2023. STUDY ELIGIBILITY CRITERIA Comparative randomized controlled trials (RCTs). PARTICIPANTS PWH. INTERVENTIONS Regimens for PCP prophylaxis either compared head-to-head or versus no treatment/placebo. ASSESSMENT OF RISK OF BIAS Cochrane risk-of-bias tool for RCTs 2. METHODS OF DATA SYNTHESIS Title or abstract and full-text screening and data extraction were performed in duplicate by two independent reviewers. Data on PCP incidence, all-cause mortality, and discontinuation due to toxicity were pooled and ranked by network meta-analysis. Subgroup analyses of primary versus secondary prophylaxis, by year, and by dosage were performed. RESULTS A total of 26 RCTs, comprising 55 treatment arms involving 7516 PWH were included. For the prevention of PCP, TMP-SMX was ranked the most favourable agent and was superior to DBRs (risk ratio [RR] = 0.54; 95% CI, 0.36-0.83) and AP (RR = 0.53; 95% CI, 0.36-0.77). TMP-SMX was also the only agent with a mortality benefit compared with no treatment/placebo (RR = 0.79; 95% CI, 0.64-0.98). However, TMP-SMX was also ranked as the most toxic agent with a greater risk of discontinuation than DBRs (RR = 1.25; 95% CI, 1.01-1.54) and AP (7.20; 95% CI, 5.37-9.66). No significant differences in PCP prevention or mortality were detected among the other regimens. The findings remained consistent within subgroups. CONCLUSIONS TMP-SMX is the most effective agent for PCP prophylaxis in PWH and the only agent to confer a mortality benefit; consequently, it should continue to be recommended as the first-line agent. Further studies are necessary to determine the optimal dosing of TMP-SMX to maximize efficacy and minimize toxicity.
Collapse
Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Khaled Katergi
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Mark Sorin
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Guillaume Butler-Laporte
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, QC, Montréal, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada; Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, QC, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, QC, Montréal, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada; Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, QC, Canada
| |
Collapse
|
13
|
García-Ruiz de Morales AG, Vivancos MJ, de Lagarde M, Ramírez Schacke M, Del Mar Arcos Rueda M, Orviz E, Curran A, Carmona-Torre F, Moreno S, Pérez-Elías MJ, Martínez-Sanz J. Transition times across the HIV care continuum in Spain from 2005 to 2022: a longitudinal cohort study. Lancet HIV 2024; 11:e470-e478. [PMID: 38824937 DOI: 10.1016/s2352-3018(24)00118-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Ending AIDS by 2030 requires improvements across all stages of the HIV care continuum. We used a longitudinal approach to assess changes in the HIV care continuum in Spain and transition probabilities across different stages. METHODS We used data from the prospective Cohort of the Spanish HIV/AIDS Research Network to analyse the time from diagnosis to linkage to care, linkage to care to antiretroviral therapy (ART), and ART to viral suppression in five calendar periods defined by milestones in ART, from 2005 to 2022. We used the Kaplan-Meier method and Cox proportional hazard models to estimate cumulative probabilities of stage transition within 1, 3, 6, and 12 months of stage eligibility, by period. FINDINGS We included 18 529 participants. Comparing the initial (2005-09) and final (2020-22) periods, time to linkage to care decreased from a median of 6·0 weeks to 1·3 weeks, time to ART initiation from 15·9 weeks to 0·4 weeks, and time to viral suppression from 13·3 weeks to 7·1 weeks. Adjusted hazard ratios for the comparison between the last period and the initial period were 3·1 (95% CI 2·8-3·4) for linkage to care within 1 month, 11·4 (10·1-12·3) for ART initiation within 1 month, and 2·2 (1·2-2·4) for viral suppression within 3 months. The aggregate proportion of late diagnoses was 38·6%, increasing after 2012 to 46·4% in the 2020-22 period. Same-day ART initiation increased from 18% to 39% from 2005 to 2022. The overall incidence rate of virological failure was 1·05 failures per 1000 person-years and showed a non-significant decline throughout the study. INTERPRETATION The great improvement in transition times through the HIV care cascade might put Spain on the verge of achieving the UNAIDS targets for HIV elimination. However, late diagnosis remains a challenge that should be addressed. FUNDING Instituto de Salud Carlos III and Spanish AIDS Research Network.
Collapse
Affiliation(s)
- Alejandro G García-Ruiz de Morales
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Jesús Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - María de Lagarde
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Margarita Ramírez Schacke
- Department of Infectious Diseases, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid, Spain
| | - Adrian Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Francisco Carmona-Torre
- Biogipuzkoa Health Research Institute, Osakidetza Basque Health Service, Donostia University Hospital, Infectious Diseases Service, San Sebastián, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
14
|
Sebastiani G, Cinque F, Cascio A, Rockstroh JK, Guaraldi G. Inclusive healthcare in light of the new MASLD guidelines: Should people living with HIV be screened for liver fibrosis? J Hepatol 2024:S0168-8278(24)02332-8. [PMID: 38925269 DOI: 10.1016/j.jhep.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada.
| | - Felice Cinque
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada; SC Medicina Indirizzo Metabolico, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", Palermo, Italy
| | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
15
|
Antonopoulou N, Schinas G, Kotsiri Z, Tsachouridou O, Protopapas K, Petrakis V, Petrakis EC, Papageorgiou D, Tzimotoudis D, Metallidis S, Papadopoulos A, Marangos M, Barbounakis E, Kofteridis DP, Panagopoulos P, Gogos C, Vantarakis A, Akinosoglou K. Testing Hepatitis E Seroprevalence among HIV-Infected Patients in Greece: The SHIP Study. Pathogens 2024; 13:536. [PMID: 39057763 PMCID: PMC11280285 DOI: 10.3390/pathogens13070536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/26/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Hepatitis E virus (HEV) poses significant health concerns worldwide, particularly among people living with HIV (PLWHIV), due to an increased risk of chronic infection and progression to cirrhosis in individuals with low CD4 cell counts. This study aimed to investigate the prevalence, chronicity potential, and risk factors of HEV infection among PLWHIV in Greece, where data are currently absent. A synchronic multicentric study encompassing five major Greek university hospitals was executed over 24 months, recruiting 696 PLWHIV participants. The prevalence of HEV IgG antibodies was 16.5%, with 8.6% showing evidence of acute HEV infection (HEV IgM). Active viral replication (HEV RNA) was present in 2.3% of the study population. Longitudinal analysis revealed that of the 25 initially anti-HEV IgM-positive individuals, only 3 seroconverted to IgG positivity, and among those with prior HEV RNA positivity (16), none showed evidence of active replication in subsequent tests. Comparative subgroup analysis highlighted the lack of significant differences in HIV-related parameters between HEV seropositive and seronegative individuals. Laboratory evaluations generally showed no significant disparities across most parameters; however, a higher seropositivity for Hepatitis A was observed in the HEV-positive subgroup. Our findings highlight a considerable prevalence of HEV among PLWHIV in Greece, with no observed cases of chronicity.
Collapse
Affiliation(s)
- Nikolina Antonopoulou
- Department of Internal Medicine and Infectious Diseases, University of Patras, 26504 Patras, Greece; (N.A.); (M.M.)
| | - Georgios Schinas
- School of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (D.P.); (C.G.)
| | - Zoi Kotsiri
- Department of Public Health, University of Patras, 26504 Patras, Greece; (Z.K.); (D.T.); (A.V.)
| | - Olga Tsachouridou
- Department of Internal Medicine and Infectious Diseases AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (O.T.); (S.M.)
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (K.P.); (A.P.)
| | - Vasileios Petrakis
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (P.P.)
| | - Emmanouil C. Petrakis
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, University of Crete, 71500 Heraklion, Greece; (E.C.P.); (E.B.); (D.P.K.)
| | - Despoina Papageorgiou
- School of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (D.P.); (C.G.)
| | - Dimosthenis Tzimotoudis
- Department of Public Health, University of Patras, 26504 Patras, Greece; (Z.K.); (D.T.); (A.V.)
| | - Simeon Metallidis
- Department of Internal Medicine and Infectious Diseases AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (O.T.); (S.M.)
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (K.P.); (A.P.)
| | - Markos Marangos
- Department of Internal Medicine and Infectious Diseases, University of Patras, 26504 Patras, Greece; (N.A.); (M.M.)
- School of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (D.P.); (C.G.)
| | - Emmanouil Barbounakis
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, University of Crete, 71500 Heraklion, Greece; (E.C.P.); (E.B.); (D.P.K.)
| | - Diamantis P. Kofteridis
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, University of Crete, 71500 Heraklion, Greece; (E.C.P.); (E.B.); (D.P.K.)
| | - Periklis Panagopoulos
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (P.P.)
| | - Charalambos Gogos
- School of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (D.P.); (C.G.)
| | - Apostolos Vantarakis
- Department of Public Health, University of Patras, 26504 Patras, Greece; (Z.K.); (D.T.); (A.V.)
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University of Patras, 26504 Patras, Greece; (N.A.); (M.M.)
- School of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (D.P.); (C.G.)
| |
Collapse
|
16
|
Xiao R, Fu Q, Chen L, Li T, Du X. Development and Validation of a High-Performance Liquid Chromatography Coupled With Ultraviolet Detection Method for Quantification of Bictegravir in Human Plasma. Ther Drug Monit 2024:00007691-990000000-00242. [PMID: 38917376 DOI: 10.1097/ftd.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/01/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND To establish a method for determining the bictegravir (BIC) concentration in human plasma using high-performance liquid chromatography coupled with ultraviolet detection. METHODS The analysis was performed on a CLC-octadecylsilane column (150 × 6.0 mm, 5 μm) using a mixture of phosphate buffer and acetonitrile (62:38, v/v) as the mobile phase at the flow rate of 1.4 mL/min. The column temperature was maintained at 40°C. Using triamcinolone acetonide as the internal standard, 100 μL of plasma sample was extracted by methyl tert-butyl ether, followed by evaporating under nitrogen stream, redissolving with 100 μL mobile phase, and injection of 20-40 μL of supernatant into the chromatographic system. Ultraviolet detection was performed at 260 nm, and the total run time for each sample was 14 minutes. RESULTS The method exhibited good linearity within the range from 0.10 to 10.0 mcg/mL (r = 0.9995, n = 5). The intraday and interday relative standard deviations for low-, medium-, and high-concentration quality control samples (0.20, 4.00, 8.00 mcg/mL) and the lower limit of quantification (0.10 mcg/mL) were 1.31%-6.20% (n = 10) and 1.18%-2.87% (n = 5), respectively. The intraday and interday accuracies were 100.53%-102.32% and 97.96%-103.84%, respectively. The extraction recovery rates ranged from 80.00% to 88.09% (n = 3). The stability tests showed that the BIC concentration changed by <15%. CONCLUSIONS This study successfully established a high-performance liquid chromatography coupled with ultraviolet detection method for determining plasma BIC concentrations. This method is simple, selective, sensitive, and accurate, making it suitable for clinical monitoring and pharmacokinetic studies of BIC.
Collapse
Affiliation(s)
- Ran Xiao
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiang Fu
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ling Chen
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China; and
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoli Du
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
17
|
de la Mora L, Mallolas J, Ambrosioni J. [Epidemiology, treatment and prognosis of HIV infection in 2024: A practical review]. Med Clin (Barc) 2024; 162:535-541. [PMID: 38383266 DOI: 10.1016/j.medcli.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/23/2024]
Abstract
In recent years, the epidemiology and prognosis of HIV infection have undergone significant changes thanks to the recommendation of antiretroviral therapy (ART) for all infected persons, the development of more effective and better tolerated drugs, and preventive measures such as pre-exposure prophylaxis (PrEP). The evolution of ART, now with simple oral and injectable options, has also contributed to improvements in comprehensive HIV treatment and care. With early diagnosis and early initiation of ART, the life expectancy of people with HIV has reached the same as the general population. However, many people with HIV remain undiagnosed or are diagnosed late, and some population groups experience greater vulnerability, affecting individual and collective health. In this review we review the current epidemiology, treatment and prognosis of HIV infection.
Collapse
Affiliation(s)
- Lorena de la Mora
- Unitat de VIH-sida, Servei de Malalties Infeccioses, Hospital Clínic-Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, España.
| | - Josep Mallolas
- Unitat de VIH-sida, Servei de Malalties Infeccioses, Hospital Clínic-Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, España
| | - Juan Ambrosioni
- Unitat de VIH-sida, Servei de Malalties Infeccioses, Hospital Clínic-Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, España
| |
Collapse
|
18
|
Senneker T. Drug-drug interactions between gender-affirming hormone therapy and antiretrovirals for treatment/prevention of HIV. Br J Clin Pharmacol 2024. [PMID: 38866600 DOI: 10.1111/bcp.16097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 06/14/2024] Open
Abstract
Transgender persons face a greater burden of HIV compared to cisgender counterparts. Concerns around drug-drug interactions (DDIs) have been cited as reasons for lower engagement in HIV care and lower pre-exposure prophylaxis (PrEP) uptake among transgender populations. It is therefore imperative for hormone therapy, PrEP and antiretroviral therapy providers to understand the DDI potential between these therapies. Studies of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) PrEP with feminizing hormone therapies (FHTs) show reduced plasma tenofovir concentrations, but intracellular concentrations of tenofovir-diphosphate are not reduced. Efficacy of PrEP is expected to be maintained despite this interaction. Masculinizing hormone therapies have no effect on tenofovir concentrations but may increase FTC to a nonclinically relevant extent. No interactions between FHT and cabotegravir or tenofovir alafenamide have been demonstrated. Administration of TDF/FTC PrEP has no effect on hormone levels in transmen or transwomen. PrEP is expected to be effective and safe in transpersons and should be provided to high-risk individuals regardless of gender affirming hormone use. Enzyme inducing/inhibiting antiretroviral therapy may decrease or increase, respectively, the concentrations of FHT and masculinizing hormone therapy. Unboosted integrase inhibitors or enzyme neutral non-nucleoside reverse transcriptase inhibitors are not expected to affect and are not affected by gender affirming hormones and can be considered in transmen and transwomen. Overlapping toxicities including weight gain, dyslipidaemia, cardiovascular disease and bone density effects should be considered, and antiretroviral modifications can be made to minimize toxicities. Interactions between supportive care medications should be assessed to avoid chelation interactions and hyperkalaemia.
Collapse
Affiliation(s)
- Tessa Senneker
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| |
Collapse
|
19
|
Boschloo WJ, van Welzen BJ. Clinical Outcomes of Integrase Strand Transfer Inhibitors Containing Antiretroviral Therapy in HIV-2: A Narrative Review. Infect Dis Ther 2024; 13:1161-1175. [PMID: 38722462 PMCID: PMC11128418 DOI: 10.1007/s40121-024-00982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 05/28/2024] Open
Abstract
The human immunodeficiency virus type 2 (HIV-2) is a particular subtype of HIV, which is endemic in West Africa and is characterized by a more indolent course than HIV-1. As people living with HIV-2 (PWH-2) are at risk for the development of acquired immunodeficiency syndrome and can transmit the virus, antiretroviral therapy is usually indicated. However, the optimal treatment of HIV-2 is unknown and historically the protease inhibitors (PIs) were a regular part of therapy. Nowadays, the use of integrase strand transfer inhibitors (INSTIs) in HIV-2 is increasing but the evidence supporting this approach is limited. In this narrative review, we outline the clinical data on the use of INSTI-containing antiretroviral therapy in HIV-2. We found that in the setting of treatment-naïve PWH-2, the use of INSTIs is successful, but also noted large heterogeneity in reported outcomes and that most cohorts are small with limited follow-up time. There is a lack of studies comparing the efficacy of INSTIs to other first-line options. For treatment-experienced PWH-2, the efficacy of INSTI is highly variable.
Collapse
Affiliation(s)
- Wendy J Boschloo
- Department of Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Berend J van Welzen
- Department of Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| |
Collapse
|
20
|
Orkin C, Ring K. Implementing long-acting injectable cabotegravir and rilpivirine in Africa. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00296-2. [PMID: 38821072 DOI: 10.1016/s1473-3099(24)00296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Chloe Orkin
- Centre of Immunobiology, Queen Mary University of London, London E1 2AT, UK; Barts Health NHS Trust, London, UK.
| | - Kyle Ring
- Centre of Immunobiology, Queen Mary University of London, London E1 2AT, UK; Barts Health NHS Trust, London, UK
| |
Collapse
|
21
|
Bailón L, Sábato S, Coll J, Santos JR, Miranda C, Puig T, D Avolio A, Paredes R, Moltó J, Negredo E. Early virological failure with cabotegravir/rilpivirine. J Antimicrob Chemother 2024; 79:1193-1194. [PMID: 38385520 DOI: 10.1093/jac/dkae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- L Bailón
- HIV-Unit Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Catalonia, Spain
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| | - S Sábato
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| | - J Coll
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Projecte dels Noms-Hispanosida, BCN-Checkpoint, Barcelona, Spain
| | - J R Santos
- HIV-Unit Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| | - C Miranda
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| | - T Puig
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - A D Avolio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - R Paredes
- HIV-Unit Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| | - J Moltó
- HIV-Unit Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - E Negredo
- HIV-Unit Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Badalona, Barcelona, Spain
| |
Collapse
|
22
|
Scofield D, Moseholm E, Aebi-Popp K, Hachfeld A. Management of menopause in women living with HIV - A comparative guideline review. Maturitas 2024; 183:107937. [PMID: 38367364 DOI: 10.1016/j.maturitas.2024.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
Women living with human immunodeficiency virus (HIV) today have life expectancies comparable to the general female population, leading to a growing number transitioning through menopause. Recent studies have highlighted healthcare professionals' lack of confidence in managing menopause in women with HIV, raising concerns about potential mismanagement. This review explores and compares information on menopause management in HIV-specific and general guidelines, with the aim of identifying disparities and assessing the comprehensiveness of HIV guidelines. The focus is on three key areas: the diagnosis of menopause, and the assessment and treatment of menopausal symptoms. Additionally, the review evaluates the usage and characteristics of menopausal symptom assessment scales known to have been used in studies involving women living with HIV. In total, five HIV and six general menopause management guidelines, published between 2015 and 2023, were identified through medical databases, internet search engines and searches of reference lists. Five menopausal symptom assessment scales were also included for review. The findings suggest minimal differences in recommendations for treating menopausal symptoms. The HIV guidelines include recommendations on screening for menopause, and some raise awareness of the possibility of drug-to-drug interactions, but none offers guidance on how to diagnose menopause or how to differentiate between HIV-related and menopause-related symptoms. Upon examining the characteristics of the menopausal symptom assessment scales, we found that none had been validated specifically for women with HIV. In conclusion, this review advocates for the development of a comprehensive guideline that addresses all relevant factors in managing menopause in women with HIV.
Collapse
Affiliation(s)
- Ditte Scofield
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Karoline Aebi-Popp
- Department of Obstetrics and Gynaecology, Lindenhofspital, Bremgartenstrasse 117, 3001 Bern, Switzerland; Department of Infectious Diseases, University Hospital Bern, University of Bern, Freiburgstrasse 20, 3010 Bern, Switzerland.
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Freiburgstrasse 20, 3010 Bern, Switzerland.
| |
Collapse
|
23
|
Papantoniou E, Arvanitakis K, Markakis K, Papadakos SP, Tsachouridou O, Popovic DS, Germanidis G, Koufakis T, Kotsa K. Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas. Life (Basel) 2024; 14:449. [PMID: 38672720 PMCID: PMC11051320 DOI: 10.3390/life14040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Infections with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) represent one of the greatest health burdens worldwide. The complex pathophysiological pathways that link highly active antiretroviral therapy (HAART) and HIV infection per se with dyslipidemia make the management of lipid disorders and the subsequent increase in cardiovascular risk essential for the treatment of people living with HIV (PLHIV). Amongst HAART regimens, darunavir and atazanavir, tenofovir disoproxil fumarate, nevirapine, rilpivirine, and especially integrase inhibitors have demonstrated the most favorable lipid profile, emerging as sustainable options in HAART substitution. To this day, statins remain the cornerstone pharmacotherapy for dyslipidemia in PLHIV, although important drug-drug interactions with different HAART agents should be taken into account upon treatment initiation. For those intolerant or not meeting therapeutic goals, the addition of ezetimibe, PCSK9, bempedoic acid, fibrates, or fish oils should also be considered. This review summarizes the current literature on the multifactorial etiology and intricate pathophysiology of hyperlipidemia in PLHIV, with an emphasis on the role of different HAART agents, while also providing valuable insights into potential switching strategies and therapeutic options.
Collapse
Affiliation(s)
- Eleni Papantoniou
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Konstantinos Arvanitakis
- Division of Gastroenterology and Hepatology, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.A.); (G.G.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Konstantinos Markakis
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Stavros P. Papadakos
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Olga Tsachouridou
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Djordje S. Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, 21137 Novi Sad, Serbia;
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.A.); (G.G.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theocharis Koufakis
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 St. Kiriakidi Street, 54636 Thessaloniki, Greece
| |
Collapse
|
24
|
Xie M, Wang A, Zhang Z, Wang K, Yu Y, Ma X, Lin Z, Yu Z, Ke J. Development and validation of the perceived symptom manageability scale among people living with the human immunodeficiency virus. BMC Psychol 2024; 12:172. [PMID: 38528643 DOI: 10.1186/s40359-024-01658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND "Perceived Symptom Manageability (PSM)" is essential in symptom management among people living with HIV. As a standardized assessment instrument was lacking, we developed a PSM scale for people living with human immunodeficiency virus (PSM-HIV). METHODS Data analysis was performed using the sample from HIV-designated medical institutions (N = 540). Psychometric testing, namely reliability and validity, is assessed by unidimensionality, internal consistency, exploratory and confirmatory factor analysis, and structural equation modeling. RESULTS The final version of the PSM- HIV scale contained 15 items. This scale was submitted to a principal components analysis with varimax rotation, and three factors were obtained, explained by a total variance of 63.10%. The three factors were named Cognitive-Behavioral, Affective Interaction, and Self-Attitude. The results show that the scale had high reliability, Cronbach's α of the scale ranged from 0.71 to 0.92, and the Intraclass Correlation Coefficient was 0.88. The structural equation model supports a factor model with the acceptable fit (χ2/df (CMIN/DF) = 2.50, Root Mean square Residual (RMR) = 0.03, Goodness-of-Fit Index (GFI) = 0.93, Adjusted Goodness of Fit Index (AGFI) = 0.90, Normed Fit Index (NFI) = 0.93, Incremental Fit Index (IFI) = 0.96, Comparative Fit Index (CFI) = 0.96). The average variance extracted was 0.38 ∼ 0.59, and the composite reliability was 0.70 ∼ 0.91, indicating that the convergent validity of the scale is acceptable. Subjects with different stages of the disease reached significance(χ2 = 9.02; df = 2, P<0.05), meaning moderate Known-Groups Comparison Validation. CONCLUSIONS The PSM-HIV scale is a valid instrument that measures overall attitude and belief about controlling or coping with HIV-relevant symptoms.
Collapse
Affiliation(s)
- Meilian Xie
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Public Service, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Zhiyun Zhang
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Kerong Wang
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Xiaojing Ma
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhaoxia Lin
- Department of Quality Control, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhengli Yu
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Jianxue Ke
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, China
| |
Collapse
|
25
|
Lam K, Kraft WK, Zhan T, Lam E. Bidirectional pharmacokinetics of doravirine, tenofovir, and feminizing hormones in transgender women (IDentify): A randomized crossover trial. Clin Transl Sci 2024; 17:e13721. [PMID: 38421210 PMCID: PMC10903328 DOI: 10.1111/cts.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024] Open
Abstract
Transgender women may have concerns of drug interactions between feminizing hormone therapy (FHT) and antiretrovirals, leading to nonadherence. This randomized, three-period crossover, open-label, phase I trial assessed the effects of doravirine (DOR) and tenofovir disoproxil fumarate (TDF) on the pharmacokinetics (PKs) of estradiol, spironolactone, and total testosterone and vice versa in healthy transgender women. Volunteers were randomized 1:1 into two sequences containing three treatment groups (DOR, lamivudine [3TC], and TDF alone; estradiol, spironolactone, and placebo; and DOR/3TC/TDF, estradiol, and spironolactone). Eight subjects enrolled in the study and six had completed all study periods. The geometric mean ratios for DOR area under the concentration-time curve from zero to last measured concentration (AUC0-last ), maximum concentration (Cmax ), and concentration at 24 h (C24 ) were similar. However, tenofovir (TFV) AUC0-last , Cmax , and C24 moderately increased by 14%-38%. Last, estradiol AUC0-last , Cmax , and C24 were increased by 10%-13%. Whereas most 90% confidence intervals did not meet the bioequivalence bounds of 80%-125%, the point estimates fell within the intervals. Log-transformed DOR, TFV, and estradiol PK parameters computed with and without co-administration were not statistically different (p > 0.05). There were no serious adverse events. There is not a clinically significant impact of FHT on DOR/TFV PKs. Similarly, there is no observed impact on estradiol PKs and total testosterone following use of DOR/3TC/TDF.
Collapse
Affiliation(s)
- Kevin Lam
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Walter K. Kraft
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Tingting Zhan
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Edwin Lam
- Clinical Pharmacokinetics Research LabNational Institutes of HealthBethesdaMarylandUSA
| |
Collapse
|
26
|
Celik D, van Bremen K, Breitschwerdt S, Elamouri F, Swan T, Boesecke C, Rockstroh JK, Ingiliz P. Hepatitis delta in HIV/hepatitis B coinfection: A call for action. HIV Med 2024; 25:319-321. [PMID: 37968830 DOI: 10.1111/hiv.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Didem Celik
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Education and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Kathrin van Bremen
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Sven Breitschwerdt
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | | | - Tracy Swan
- GlobalHealth Consultant, Barcelona, Spain
| | - Christoph Boesecke
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Jürgen K Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Patrick Ingiliz
- Hepatology Department, Henri-Mondor University Hospital, Créteil, France
| |
Collapse
|
27
|
Ambrosioni J, Díaz NA, Marzolini C, Dragovic G, Imaz A, Calcagno A, Luque S, Curran A, Troya J, Tuset M, Khoo S, Burger D, Cortés CP, Naous N, Molto J. Outcomes of Drug Interactions Between Antiretrovirals and Co-Medications, Including Over-the-Counter Drugs: A Real-World Study. Infect Dis Ther 2024; 13:609-617. [PMID: 38372897 DOI: 10.1007/s40121-024-00935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION The objective was to characterize real-world outcomes of drug-drug interactions (DDIs) between antiretrovirals (ARVs) and other drugs, including over-the-counter medications (OTC), and treatment outcomes in clinical practice. METHODS www.clinicalcasesDDIs.com is an open-access website for healthcare providers to consult and briefly describe real-world clinical cases on DDI with ARVs. We reviewed all the clinical cases reported to the website between March 2019 and May 2023. RESULTS A total of 139 cases were reported, mostly involving ritonavir or cobicistat (boosters; 74 cases), unboosted integrase inhibitors (InSTI; 29 cases), and non-nucleoside reverse transcriptase inhibitors (NNRTI; 23 cases). Central nervous system drugs (29 cases) and cardiovascular drugs (19 cases) were the most frequently described co-medications. Notably, OTC medications were implicated in 27 cases, including mineral supplements (11 cases), herbals (8 cases), weight loss drugs (4 cases), anabolic steroids (3 cases), and recreational drugs (1 case). OTC acted as the perpetrator drug in 21 cases, leading to loss of ARV efficacy in 17 instances (mineral supplements in 10 cases, weight loss drugs in 4 cases, herbals in 3 cases). Additionally, toxicity was reported in 4 out of 6 cases where OTC was considered the victim drug of the DDI (anabolic steroids in 3 cases, MDMA in 1 case). CONCLUSIONS Frequent unwanted outcomes resulting from DDIs between ARVs and OTC medications underscore the importance of integrating non-prescription drugs into medication reconciliation. The real-world data available through www.clinicalcasesDDIs.com serves as a valuable resource for assessing the clinical relevance of DDIs.
Collapse
Affiliation(s)
- Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic- Fundacio de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Natalia Anahí Díaz
- Infectious Diseases Service, Hospital Cuenca Alta, Cañuelas, Argentina
- Infectious Diseases Service, Hospital Mariano y Luciano de La Vega, Moreno, Argentina
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland
- Service of Clinical Pharmacology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo Di Savoia Hospital, University of Turin, 10149, Turin, Italy
| | - Sonia Luque
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Adrian Curran
- University Hospital Vall D'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jesus Troya
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Montse Tuset
- Department of Pharmacy, Hospital Clínic Barcelona, Barcelona, Spain
| | - Saye Khoo
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - David Burger
- Department of Pharmacy, Radboud Institute for Medical Innovation (RIMI), RadboudUMC, Nijmegen, The Netherlands
| | | | - Nadia Naous
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jose Molto
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
- Fundació Lluita Contra Les Infeccions. Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
28
|
Mussini C, Guaraldi G. The best place for doravirine. Lancet HIV 2024; 11:e64-e65. [PMID: 38141640 DOI: 10.1016/s2352-3018(23)00326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Cristina Mussini
- Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena 41124, Italy; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy.
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena 41124, Italy; Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena 41124, Italy; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| |
Collapse
|
29
|
Bamford A, Foster C, Lyall H. Infant feeding: emerging concepts to prevent HIV transmission. Curr Opin Infect Dis 2024; 37:8-16. [PMID: 37889586 PMCID: PMC10734781 DOI: 10.1097/qco.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE OF REVIEW HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. RECENT FINDINGS Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. SUMMARY Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
Collapse
Affiliation(s)
- Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust
- UCL Great Ormond Street Institute of Child Health
- MRC Clinical Trials Unit at UCL
| | - Caroline Foster
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Hermione Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| |
Collapse
|
30
|
Zanrè V, Bellinato F, Cardile A, Passarini C, Monticelli J, Di Bella S, Menegazzi M. Lamivudine, Doravirine, and Cabotegravir Downregulate the Expression of Human Endogenous Retroviruses (HERVs), Inhibit Cell Growth, and Reduce Invasive Capability in Melanoma Cell Lines. Int J Mol Sci 2024; 25:1615. [PMID: 38338893 PMCID: PMC10855363 DOI: 10.3390/ijms25031615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
This study explores the impact of antiretroviral administration on the expression of human endogenous retroviruses (HERVs), cell growth, and invasive capability of human melanoma cell lines in culture. We investigated three antiretrovirals-lamivudine, doravirine, and cabotegravir-in A375, FO-1, and SK-Mel-28, BRAF-mutated, and in MeWo, P53-mutated, melanoma cell lines. The findings indicate a general capability of these drugs to downregulate the expression of HERV-K Pol and Env genes and hinder cell viability, mobility, and colony formation capacity of melanoma cells. The antiretroviral drugs also demonstrate selectivity against malignant cells, sparing normal human epithelial melanocytes. The study reveals that the integrase inhibitor cabotegravir is particularly effective in inhibiting cell growth and invasion across different cell lines in comparison with lamivudine and doravirine, which are inhibitors of the viral reverse transcriptase enzyme. The investigation further delves into the molecular mechanisms underlying the observed effects, highlighting the potential induction of ferroptosis, apoptosis, and alterations in cell cycle regulatory proteins. Our findings showed cytostatic effects principally revealed in A375, and SK-Mel-28 cell lines through a downregulation of retinoblastoma protein phosphorylation and/or cyclin D1 expression. Signs of ferroptosis were detected in both A375 cells and FO-1 cells by a decrease in glutathione peroxidase 4 and ferritin expression, as well as by an increase in transferrin protein levels. Apoptosis was also detected in FO-1 and SK-Mel-28, but only with cabotegravir treatment. Moreover, we explored the expression and activity of the stimulator of interferon genes (STING) protein and its correlation with programmed death-ligand 1 (PD-L1) expression. Both the STING activity and PD-L1 expression were decreased, suggesting that the antiretroviral treatments may counteract the detrimental effects of PD-L1 expression activation through the STING/interferon pathway triggered by HERV-K. Finally, this study underscores the potential therapeutic significance of cabotegravir in melanoma treatment. The findings also raise the prospect of using antiretroviral drugs to downregulate PD-L1 expression, potentially enhancing the therapeutic responses of immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Valentina Zanrè
- Section of Biochemistry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada Le Grazie, 8, 37134 Verona, Italy; (V.Z.); (A.C.); (C.P.)
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy;
| | - Alessia Cardile
- Section of Biochemistry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada Le Grazie, 8, 37134 Verona, Italy; (V.Z.); (A.C.); (C.P.)
| | - Carlotta Passarini
- Section of Biochemistry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada Le Grazie, 8, 37134 Verona, Italy; (V.Z.); (A.C.); (C.P.)
| | - Jacopo Monticelli
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34129 Trieste, Italy;
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy;
| | - Marta Menegazzi
- Section of Biochemistry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada Le Grazie, 8, 37134 Verona, Italy; (V.Z.); (A.C.); (C.P.)
| |
Collapse
|
31
|
Loghin II, Vâță A, Miftode EG, Cobaschi M, Rusu ȘA, Silvaș G, Frăsinariu OE, Dorobăț CM. Characteristics of Tuberculous Meningitis in HIV-Positive Patients from Northeast Romania. Clin Pract 2023; 13:1488-1500. [PMID: 38131680 PMCID: PMC10742667 DOI: 10.3390/clinpract13060131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES One of the most severe forms of extrapulmonary tuberculosis (EPTB) is tuberculous meningitis (TBM), which is linked to significant morbidity and high mortality. It is well recognized that human immunodeficiency virus (HIV)-positive people are more likely to develop EPTB, including TBM, especially if they have severe immunodeficiencies. We aim to highlight the profile and the characteristics of TBM in HIV-infected patients. MATERIAL AND METHODS We conducted a retrospective clinical study based on hospital medical records of patients diagnosed with HIV/AIDS (acquired immunodeficiency syndrome) and TBM in Northeast Romania, hospitalized at "St. Parascheva" Clinical Hospital of Infectious Diseases of Iasi from 1 January 2010 to 1 December 2022. RESULTS From a total number of 1692 patients on record in our center, 195 had a HIV-tuberculosis (TB) coinfection, and 19 cases were HIV-TBM coinfected. Six cases were newly HIV-diagnosed late presenters, and thirteen patients' names were already found in the center's records with deficient immunological viral status (median CD4 lymphocyte level 47/mm3). The average age in the study group was 27 years old. The clinical manifestations and cerebrospinal fluid (CSF) variables were typical in most cases, despite the severe immunodepression of the patients. The Thwaites scoring system correctly identified 89.5% of the patients. The median admission period was 18 days; the lethality rate was 31.6%, despite access to ART and anti-TB drugs, and was associated with a more severe immunosuppression. No rifampicin resistance was detected. CONCLUSIONS TBM appeared in a minority of our HIV cohort and affected severely immunodepressed patients; the clinical and CSF variables had a typical aspect in most cases, and the Thwaites scoring system performed well for this type of patient. The lethality rate was high and was correlated with a more severe immunodepression.
Collapse
Affiliation(s)
- Isabela Ioana Loghin
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (A.V.); (E.G.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| | - Andrei Vâță
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (A.V.); (E.G.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (A.V.); (E.G.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| | - Mihaela Cobaschi
- Faculty of Medicine/Clinical II Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Șerban Alin Rusu
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| | - George Silvaș
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| | - Otilia Elena Frăsinariu
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (A.V.); (E.G.M.)
- Emergency Clinical Hospital for Children “St. Maria”, 700309 Iasi, Romania
| | - Carmen Mihaela Dorobăț
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (G.S.); (C.M.D.)
| |
Collapse
|