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Vallée A, Majerholc C, Zucman D, Livrozet JM, Laurendeau C, Bouée S, Prevoteau du Clary F. Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18. Eur J Public Health 2024; 34:879-884. [PMID: 38409963 PMCID: PMC11430913 DOI: 10.1093/eurpub/ckae031] [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] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. METHODS Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. RESULTS During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. CONCLUSION Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Jean-Michel Livrozet
- Department of Infectious and Tropical Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Byrne ME, Resnik JB, Horberg MA, Greenberg AE, Castel AD, Monroe AK. Factors Associated with Time to Initial Antiretroviral Therapy Discontinuation in the DC Cohort. AIDS Res Hum Retroviruses 2024. [PMID: 38959120 DOI: 10.1089/aid.2024.0002] [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] [Indexed: 07/05/2024] Open
Abstract
When an initial antiretroviral therapy (ART) regimen is effective and well-tolerated, it can be maintained for years as long as the patient adheres. Prior research has revealed that shorter initial ART duration is associated with regimen type, female sex, injection drug use as the HIV transmission category, and lower baseline CD4 count. We examined potential factors associated with initial regimen discontinuation among a subset of newly diagnosed virally unsuppressed PWH in the DC Cohort, an ongoing prospective observation study that uses electronic health record data from clinic sites to collect relevant information, including demographic and clinical information. Participants were excluded from the analysis if they had less than 6 months of follow-up and were virally suppressed at enrollment. There were 479 individuals included in the study. The median age of participants was 33.9 years [interquartile range (IQR) 26-43.9]. The sample was predominantly male (79.1%) and of Black race (70.8%). Over half of the study participants (56.4%) attended community-based clinic sites. The median time to the discontinuation of initial ART was 2.7 years [95% confidence interval (CI): 2.3, 3.4]. Females had a shorter time to ART discontinuation [adjusted hazard ratio (aHR) 1.55, 95% CI: 1.14, 2.11] as did individuals who started on a protease inhibitor-based regimen versus integrase strand transfer inhibitors (aHR 1.87, 95% CI: 1.34, 2.61) and those receiving HIV care at a community-based site (aHR 1.46, 95% CI: 1.11,1.93). Although limited by lack of reason for discontinuation, we demonstrated that ART-naïve women, community clinic attendees, and patients starting on PIs had a shorter duration of initial ART. More anticipatory guidance may be needed to help patients stay on their initial therapy and manage the side effects or to be flexible in trying different regimens.
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Affiliation(s)
- Morgan E Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jenna B Resnik
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Oakland, California, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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Ramos-Ruperto L, Arcos-Rueda MDM, de Miguel-Buckley R, Busca-Arenzana C, Mican R, Montejano R, Delgado-Hierro A, Montes ML, Valencia ME, Serrano L, Arribas JR, González J, Bernardino JI, Martín-Carbonero L. Sex differences in the effectiveness and tolerability of dolutegravir plus rilpivirine as a switch strategy in people living with HIV. HIV Med 2024; 25:684-691. [PMID: 38379338 DOI: 10.1111/hiv.13617] [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: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Dolutegravir + rilpivirine (DTG + RPV) is an effective antiretroviral therapy regimen approved in clinical guidelines as a switch therapy for virologically suppressed people with HIV. Our study aimed to compare the effectiveness and tolerability of DTG + RPV in women and men in real-world clinical practice. METHODS This was a retrospective analysis of treatment-experienced people with HIV from a large HIV unit who switched to DTG + RPV. We analysed treatment effectiveness, rates of adverse events and discontinuation, and metabolic changes after 48 weeks of treatment. HIV-RNA levels <50 copies/mL were analysed at 48 weeks using both intention-to treat analysis (where missing data were interpreted as failures) and per-protocol analysis (excluding those with missing data or changes due to reasons other than virological failure). Outcomes were compared between women and men based on sex at birth. RESULTS A total of 307 patients were selected (71 women and 236 men). No transgender people were included. At baseline, women had lived with HIV infection and received antiretroviral therapy for longer than men (23.2 vs 17.4 years and 18.9 vs 14.2 years, respectively). In the intention-to-treat analysis, 74.6% (95% confidence interval [CI] 63.4-83.3%) of women and 83.5% (95% CI 78.2-87.7) of men had HIV-RNA <50 copies/mL. In the per-protocol analysis, 96.4% (95% CI 87.7-99) of women and 99% (95% CI 98.9-99.7) of men had HIV-RNA levels <50 copies/mL. Two women and two men had HIV-RNA >50 copies/mL at 48 weeks. Discontinuation due to adverse events was more frequent in women than in men: 12.7% vs 7.2% (p < 0.02). Neuropsychiatric and gastrointestinal events were the most frequently reported. A median (interquartile range) weight gain of 1.9 kg (0-4.2) in women and 1.2 kg (-1-3.1) in men was reported (median of differences between baseline visit and week 48); the remaining changes in metabolic parameters were neutral. CONCLUSIONS DTG + RPV exhibited good and similar virological effectiveness in women and men in real-world settings. However, poorer tolerability and more treatment interruptions were observed in women.
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Affiliation(s)
- Luis Ramos-Ruperto
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
| | - Maria Del Mar Arcos-Rueda
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
| | - Rosa de Miguel-Buckley
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Busca-Arenzana
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Mican
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Montejano
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Delgado-Hierro
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
| | - María Luisa Montes
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - María Eulalia Valencia
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
| | - Lucía Serrano
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
| | - José Ramon Arribas
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan González
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Ignacio Bernardino
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
| | - Luz Martín-Carbonero
- HIV Unit, Internal Medicine Department, La Paz-Carlos III University Hospital, IdiPaz, Madrid, Spain
- CIBER de Enfermedades Infecciosas CIBER INFECC, Instituto de Salud Carlos III, Madrid, Spain
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Shelton BA, Sawinski D, MacLennan PA, Lee W, Wyatt C, Nadkarni G, Fatima H, Mehta S, Crane HM, Porrett P, Julian B, Moore RD, Christopoulos K, Jacobson JM, Muller E, Eron JJ, Saag M, Peter I, Locke JE. Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study. EClinicalMedicine 2022; 53:101653. [PMID: 36159042 PMCID: PMC9489495 DOI: 10.1016/j.eclinm.2022.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Abstract
Background Women represent a meaningful proportion of new HIV diagnoses, with Black women comprising 58% of new diagnoses among women. As HIV infection also increases risk of chronic kidney disease (CKD), understanding CKD risk among women with HIV (WWH), particularly Black women, is critical. Methods In this longitudinal cohort study of people with HIV (PWH) enrolled in CFAR Network of Integrated Clinical Systems (CNICS), a multicentre study comprised of eight academic medical centres across the United States from Jan 01, 1996 and Nov 01, 2019, adult PWH were excluded if they had ≤2 serum creatinine measurements, developed CKD prior to enrollment, or identified as intersex or transgendered, leaving a final cohort of 33,998 PWH. The outcome was CKD development, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1·73 m2 calculated using the CKD-EPI equation, for ≥90 days with no intervening higher values. Findings Adjusting for demographic and clinical characteristics, WWH were 61% more likely to develop CKD than men (adjusted hazard ratio [aHR]: 1·61, 95% CI: 1·46-1·78, p<0·001). This difference persisted after further adjustment for APOL1 risk variants (aHR female sex: 1·92, 95% CI: 1·63-2·26, p<0·001) and substance abuse (aHR female sex: 1·70, 95% CI: 1·54-1·87, p<0·001). Interpretation WWH experienced increased risk of CKD. Given disparities in care among patients with end-stage kidney disease, efforts to engage WWH in nephrology care to improve chronic disease management are critical. Funding US National Institutes of Health.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
| | | | - Paul A. MacLennan
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Wonjun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Girish Nadkarni
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Huma Fatima
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Shikha Mehta
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Heidi M. Crane
- University of Washington School of Medicine, United States
| | - Paige Porrett
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Bruce Julian
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | | | | | | | - Elmi Muller
- Stellenbosch University, Medicine and Health Sciences, South Africa
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill School of Medicine, United States
| | - Michael Saag
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Heersink School of Medicine, United States
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Park B, Choi Y, Kim JH, Seong H, Kim YJ, Lee M, Seong J, Kim SW, Song JY, Choi HJ, Park DW, Kim HY, Choi JY, Kim SI, Choi BY. Mortality and Causes of Death among Individuals Diagnosed with Human Immunodeficiency Virus in Korea, 2004-2018: An Analysis of a Nationwide Population-Based Claims Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11788. [PMID: 36142061 PMCID: PMC9517230 DOI: 10.3390/ijerph191811788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
The mortality rate and causes of death among individuals diagnosed with human immunodeficiency virus (HIV) infection in Korea were described and compared to those of the general population of Korea using a nationwide population-based claims database. We included 13,919 individuals aged 20-79 years newly diagnosed with HIV between 2004 and 2018. The patients' vital status and cause of death were linked until 31 December 2019. Standardized mortality ratios (SMRs) for all-cause death and specific causes of death were calculated. By the end of 2019, 1669 (12.0%) of the 13,919 HIV-infected participants had died. The survival probabilities of HIV-infected individuals at 1, 5, 10, and 15 years after diagnosis in Korea were 96.2%, 91.6%, 85.9%, and 79.6%, respectively. The main causes of death during the study period were acquired immunodeficiency syndrome (AIDS; 59.0%), non-AIDS-defining cancer (8.2%), suicide (7.4%), cardiovascular disease (4.9%), and liver disease (2.7%). The mortality rate of men and women infected with HIV was 5.60-fold (95% CI = 5.32-5.89) and 6.18-fold (95% CI = 5.30-7.09) that of men and women in the general population, respectively. After excluding deaths due to HIV, the mortality remained significantly higher, with an SMR of 2.16 (95% CI = 1.99-3.24) in men and 3.77 (95% CI = 3.06-4.48) in women. HIV-infected individuals had a higher overall mortality than the general population, with AIDS the leading cause of mortality. Additionally, mortality due to non-AIDS-related causes was higher in HIV-infected individuals.
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Affiliation(s)
- Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- AIDS Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro Bupyeong-gu, Incheon 21431, Korea
| | - Myungsun Lee
- Division of Clinical Research, Center for Emerging Virus Research, National Institute of Infectious Diseases, Korea National Institute of Health, Osong Health Technology Administration Complex, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28159, Korea
| | - Jaehyun Seong
- Division of Clinical Research, Center for Emerging Virus Research, National Institute of Infectious Diseases, Korea National Institute of Health, Osong Health Technology Administration Complex, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28159, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Deagu 41944, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 26426, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- AIDS Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Bo-Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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Moran JA, Turner SR, Marsden MD. Contribution of Sex Differences to HIV Immunology, Pathogenesis, and Cure Approaches. Front Immunol 2022; 13:905773. [PMID: 35693831 PMCID: PMC9174895 DOI: 10.3389/fimmu.2022.905773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
Approximately 38 million people were living with human immunodeficiency virus (HIV) in 2020 and 53% of those infected were female. A variety of virological and immunological sex-associated differences (sexual dimorphism) in HIV infection have been recognized in males versus females. Social, behavioral, and societal influences play an important role in how the HIV pandemic has affected men and women differently. However, biological factors including anatomical, physiologic, hormonal, and genetic differences in sex chromosomes can each contribute to the distinct characteristics of HIV infection observed in males versus females. One striking example of this is the tendency for women to have lower HIV plasma viral loads than their male counterparts early in infection, though both progress to AIDS at similar rates. Sex differences in acquisition of HIV, innate and adaptive anti-HIV immune responses, efficacy/suitability of specific antiretroviral drugs, and viral pathogenesis have all been identified. Sex differences also have the potential to affect viral persistence, latency, and cure approaches. In this brief review, we summarize the major biological male/female sex differences in HIV infection and their importance to viral acquisition, pathogenesis, treatment, and cure efforts.
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Affiliation(s)
- Jose A. Moran
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA, United States
| | - Shireen R. Turner
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA, United States
| | - Matthew D. Marsden
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA, United States
- Department of Medicine (Division of Infectious Diseases), School of Medicine, University of California, Irvine, CA, United States
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Pond RA, Collins LF, Lahiri CD. Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus. Open Forum Infect Dis 2021; 8:ofab558. [PMID: 34888399 PMCID: PMC8651163 DOI: 10.1093/ofid/ofab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
Women are grossly underrepresented in human immunodeficiency virus (HIV) clinical and translational research. This is concerning given that people with HIV (PWH) are living longer, and thus accumulating aging-related non-AIDS comorbidities (NACMs); emerging evidence suggests that women are at higher risk of NACM development and progression compared with men. It is widely recognized that women vs men have greater immune activation in response to many viruses, including HIV-1; this likely influences sex-differential NACM development related to differences in HIV-associated chronic inflammation. Furthermore, many sociobehavioral factors that contribute to aging-related NACMs are known to differ by sex. The objectives of this review were to (1) synthesize sex-stratified data on 4 NACMs among PWH: bone disease, cardiovascular disease, metabolic dysfunction, and neurocognitive impairment; (2) evaluate the characteristics of key studies assessing sex differences in NACMs; and (3) introduce potential biological and psychosocial mechanisms contributing to emerging trends in sex-differential NACM risk and outcomes among PWH.
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Affiliation(s)
- Renee A Pond
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Abstract
OBJECTIVE Hepatitis C virus (HCV), cirrhosis, and HCV medications including direct-acting antivirals (DAAs) ±ribavirin may all influence the metabolic milieu. While interferon-based regimens improve glucose tolerance, evidence is limited on DAAs. Cases of elevated lactate have recently been reported in patients treated with DAAs, and lactic acidosis is a known complication of antivirals used to treat hepatitis B virus and HIV. PATIENTS AND METHODS Measures were evaluated at baseline, week 4, end of treatment, and 12-24 weeks after treatment. Mixed-effects modeling was used to determine factors influencing glucose and lactate over time. RESULTS In total, 442 patients were treated (mean age 56, 65% male, 72% genotype 1, 48% cirrhotic). Glucose did not change on or after DAA treatment from baseline (P=0.51) aside from those with untreated diabetes, which declined (P=0.02). Overall, there was a decline in lactate following HCV treatment (mean 2.4-2.1 mmol/l; P<0.001). Lactate initially increased on treatment and then decreased after treatment completion in male patients treated with ribavirin. This pattern was not observed in other groups. There was no evidence of lactic acidosis with HCV nucleotide use. CONCLUSION Distinct glucose and lactate trajectories were identified without evidence of DAA metabolic toxicity. HCV treatment does not improve random glucose levels aside from perhaps in untreated diabetic patients.
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Wessman M, Thorsteinsson K, Storgaard M, Rönsholt FF, Johansen IS, Pedersen G, Nielsen LN, Wies N, Katzenstein TL, Lebech AM. HIV disclosure and stigma among women living with HIV in Denmark. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30332-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Squires K, Bekker LG, Katlama C, Yazdanpanah Y, Zhou Y, Rodgers AJ, DiNubile MJ, Sklar PA, Leavitt RY, Teppler H. Influence of Sex/Gender and Race on Responses to Raltegravir Combined With Tenofovir-Emtricitabine in Treatment-Naive Human Immunodeficiency Virus-1 Infected Patients: Pooled Analyses of the STARTMRK and QDMRK Studies. Open Forum Infect Dis 2017; 4:ofw047. [PMID: 28480227 PMCID: PMC5414081 DOI: 10.1093/ofid/ofw047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/22/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Antiretroviral therapy in human immunodeficiency virus (HIV)-infected women and blacks merits particular scrutiny because these groups have been underrepresented in clinical trials. METHODS To document the effects of raltegravir across sex and racial lines, we conducted a pooled subgroup analysis of the efficacy and safety of raltegravir 400 mg BID plus tenofovir-emtricitabine by sex (women vs men) and self-identified race (black vs non-black) using phase 3 studies in treatment-naive patients. RESULTS Study participants included 42 black women, 102 non-black women, 48 black men, and 477 non-black men. Clade B infections were less common in women (43.8%) than men (84.6%) and in blacks (45.6%) than non-blacks (80.5%). Baseline CD4 counts were ≤200 cells/µL in 52.2% of blacks and 31.6% of non-blacks. Black men had the largest proportion of patients with baseline CD4 counts <50 cells/µL and the highest nontreatment-related discontinuation rate among the 4 sex-by-race subgroups. Human immunodeficiency virus-ribonucleic acid levels <50 copies/mL were achieved at week 48 in 92.7% (95% confidence interval [CI], 80.1-98.5) of black women, 93.6% (95% CI, 86.6-97.6) of non-black women, 82.9% (95% CI, 67.9-92.8) of black men, and 91.4% (95% CI, 88.4-93.8) of non-black men. Serious clinical adverse events were reported in 9.0% of women versus 8.8% of men and in 11.1% of blacks versus 8.5% of non-blacks. CONCLUSIONS In this post hoc analysis of patients with previously untreated HIV-1 infection receiving raltegravir plus tenofovir-emtricitabine, generally comparable results were achieved across sex and racial subgroups. However, black men had a lower response rate than either black women or non-black men, partially attributable to lower baseline CD4 counts and higher discontinuation rates.
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Affiliation(s)
- Kathleen Squires
- Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Linda-Gail Bekker
- Department of Medicine, The Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | | | - Yazdan Yazdanpanah
- Department of Infectious and Tropical Diseases, Hopital Bichat-Claude Bernard, Paris, France
| | - Yan Zhou
- Merck & Co., Inc., Kenilworth, New Jersey
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Treskova M, Kuhlmann A, Bogner J, Hower M, Heiken H, Stellbrink HJ, Mahlich J, von der Schulenburg JMG, Stoll M. Analysis of contemporary HIV/AIDS health care costs in Germany: Driving factors and distribution across antiretroviral therapy lines. Medicine (Baltimore) 2016; 95:e3961. [PMID: 27367993 PMCID: PMC4937907 DOI: 10.1097/md.0000000000003961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To analyze contemporary costs of HIV health care and the cost distribution across lines of combination antiretroviral therapy (cART). To identify variations in expenditures with patient characteristics and to identify main cost determinants. To compute cost ratios between patients with varying characteristics.Empirical data on costs are collected in Germany within a 2-year prospective observational noninterventional multicenter study. The database contains information for 1154 HIV-infected patients from 8 medical centers.Means and standard deviations of the total costs are estimated for each cost fraction and across cART lines and regimens. The costs are regressed against various patient characteristics using a generalized linear model. Relative costs are calculated using the resultant coefficients.The average annual total costs (SD) per patient are &OV0556;22,231.03 (8786.13) with a maximum of &OV0556;83,970. cART medication is the major cost fraction (83.8%) with a mean of &OV0556;18,688.62 (5289.48). The major cost-driving factors are cART regimen, CD4-T cell count, cART drug resistance, and concomitant diseases. Viral load, pathology tests, and demographics have no significant impact. Standard non-nucleoside reverse transcriptase inhibitor-based regimens induce 28% lower total costs compared with standard PI/r regimens. Resistance to 3 or more antiretroviral classes induces a significant increase in costs.HIV treatment in Germany continues to be expensive. Majority of costs are attributable to cART. Main cost determinants are CD4-T cells count, comorbidity, genotypic antiviral resistance, and therapy regimen. Combinations of characteristics associated with higher expenditures enhance the increasing effect on the costs and induce high cost cases.
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Affiliation(s)
- Marina Treskova
- Center for Health Economics Research Hannover, Hannover
- Correspondence: Marina Treskova, Gottfried Wilhelm Leibniz Universität Hannover, Center for Health Economics Research Hannover Institut für Versicherungsbetriebslehre Otto-Brenner-Str. 1, 30159 Hannover, Germany (e-mail: )
| | | | - Johannes Bogner
- Sektion Klinische Infektiologie, Med IV, Klinikum der Universität München, Munich
| | - Martin Hower
- ID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund
| | - Hans Heiken
- Innere Medizin, Praxis Georgstraße, Hannover
| | | | - Jörg Mahlich
- Health Economics & Pricing, Janssen-Cilag GmbH, Neuss
| | | | - Matthias Stoll
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Germany
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Adverse Drug Reactions and Clinical Outcomes in Patients Initiated on Antiretroviral Therapy: A Prospective Cohort Study From Ethiopia. Drug Saf 2016; 38:629-39. [PMID: 26008986 DOI: 10.1007/s40264-015-0295-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In Ethiopia, the use of antiretroviral therapy (ART) has been scaled up for HIV/AIDS over the past decade. Adverse drug reactions (ADRs) associated with ART pose a unique challenge in the treatment of the infection in this resource-limited setting. OBJECTIVES The aims of this study were to examine the incidence and nature of ADRs, identify the risk factors associated with the development of ADRs, and assess their impact on treatment outcomes. METHODS A prospective cohort study was conducted in adult patients (≥18 years of age) with HIV/AIDS who commenced ART. All ADRs in the first 12 months of therapy were recorded, and the severity, causality, and preventability assessed. The impact of severe ADRs on self-reported adherence, immunological, and body mass index (BMI) outcomes were assessed. RESULTS Of the 211 patients included in the analysis, 181 (85.7 %) experienced at least one ADR and 66 (31.3 %) experienced at least one severe ADR within 12 months of commencing ART (incidence rates for any ADR and severe ADR of 14.8 and 3.2 per 100 person-months, respectively). Logistic regression analysis indicated that taking zidovudine-containing regimens (odds ratio [OR] 4.2, 95 % confidence interval [CI] 2.1-8.4) or being unemployed (OR 2.2, 95 % CI 1.1-4.3) were independent predictors of experiencing severe ADRs. Patients who experienced a severe ADR were less likely (OR 0.4, 95 % CI 0.2-0.9) to be ≥90 % adherent to ART. The mean gain in BMI was significantly lower in patients with severe ADRs after 3 and 12 months of therapy. CONCLUSIONS ADRs were common within the first 3 months in patients initiated on ART. Severe ADRs were negatively associated with self-reported adherence and gain in BMI. Measures need to be implemented to routinely monitor for severe ADRs to improve ART adherence and treatment outcomes.
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Rollet-Kurhajec KC, Moodie EEM, Walmsley S, Cooper C, Pick N, Klein MB. Hepatic Fibrosis Progression in HIV-Hepatitis C Virus Co-Infection--The Effect of Sex on Risk of Significant Fibrosis Measured by Aspartate-to-Platelet Ratio Index. PLoS One 2015; 10:e0129868. [PMID: 26090666 PMCID: PMC4474689 DOI: 10.1371/journal.pone.0129868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/13/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In Hepatitis C virus (HCV) mono-infection, male sex is associated with faster liver fibrosis progression but the effects of sex have not been well studied in HIV-HCV co-infected patients. We examined the influence of sex on progression to significant liver fibrosis in HIV-HCV co-infected adults receiving antiretroviral therapy (ART) using the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate biomarker of liver fibrosis. METHODS We evaluated 308 HIV infected, HCV RNA positive participants of a Canadian multicentre prospective cohort receiving antiretrovirals and without significant liver fibrosis or end-stage liver disease at baseline. We used multivariate discrete-time proportional hazards models to assess the effect of sex on time to significant fibrosis (APRI≥1.5) adjusting for baseline age, alcohol use, cigarette smoking, HCV duration, and APRI and time-updated CD4 count and HIV RNA. RESULTS Overall, 55 (18%) participants developed an APRI ≥ 1.5 over 544 person-years of at-risk follow-up time; 18 (21%) women (incidence rate (IR)=14.0/100 PY; 7.5-20.4) and 37 (17%) men (IR=8.9/100 PY; 6.0-11.8). Women had more favourable profiles with respect to traditional risk factors for liver disease progression (younger, shorter duration of HCV infection and less alcohol use). Despite this, female sex was associated with a greater than two-fold increased risk of fibrosis progression (adjusted hazard rate (HR) =2.23; 1.22-4.08). CONCLUSIONS HIV-HCV co-infected women receiving antiretroviral therapy were at significantly greater risk of progressing to liver fibrosis as measured by APRI compared with men. Enhanced efforts to engage and treat co-infected women for HCV are needed.
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Affiliation(s)
- Kathleen C. Rollet-Kurhajec
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Erica E. M. Moodie
- Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada
| | - Sharon Walmsley
- University Health Network, Toronto, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Curtis Cooper
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Divisions of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Marina B. Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- * E-mail:
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14
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Lee MP, Zhou J, Messerschmidt L, Honda M, Ditangco R, Sirisanthana T, Kumarasamy N, Phanuphak P, Chen YMA, Zhang F, Saphonn V, Kiertiburanakul S, Lee CKC, Pujari S, Choi JY, Kamarulzaman A, Yunihastuti E, Merati TP, Lim PL, Li PCK. Impact of Gender on Long-Term Treatment Outcomes of Highly Active Antiretroviral Therapy (HAART) in the TREAT Asia HIV Observational Database. AIDS Patient Care STDS 2015; 29:229-31. [PMID: 25774867 DOI: 10.1089/apc.2014.0232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Jialun Zhou
- The Kirby Institute, University of New South Wales, Sydney, Australia; (current affiliation: Roche Product Development in Asia Pacific, Shanghai, China)
| | - Liesl Messerschmidt
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand [current affiliation: Health and Development Consulting international (HDCi) LLC, USA]
| | - Miwako Honda
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | | | - Yi-Ming Arthur Chen
- Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan; (current affiliation: Kaohsiung Medical University, Kaohsiung, Taiwan)
| | | | - Vonthanak Saphonn
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | | | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Evy Yunihastuti
- Working Group on AIDS Faculty of Medicine, University of Indonesia/ Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Tuti Parwati Merati
- Faculty of Medicine Udayana University and Sanglah Hospital, Bali, Indonesia
| | - Poh-Lian Lim
- Department of Infectious Diseases, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore
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Firnhaber C, Smeaton LM, Grinsztejn B, Lalloo U, Faesen S, Samaneka W, Infante R, Rana A, Kumarasamy N, Hakim J, Campbell TB. Differences in antiretroviral safety and efficacy by sex in a multinational randomized clinical trial. HIV CLINICAL TRIALS 2015; 16:89-99. [PMID: 25979186 PMCID: PMC4604209 DOI: 10.1179/1528433614z.0000000013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Worldwide, 50% of human immunodeficiency virus (HIV)-infected people are women. This study was to evaluate whether the safety and efficacy outcomes of three initial antiretroviral regimens (ARVs) differed by sex. METHODS Antiretroviral regimen naive participants from nine countries in four continents were assigned to ARVs with efavirenz (EFV) plus lamivudine-zidovudine, atazanavir (ATV) plus didanosine (ddI)-EC/emtricitabine (FTC) or EFV plus FTC-tenofovir-DF. The primary objective was to estimate the sex difference on efficacy outcome of treatment failure defined as one of the following: 1. Time to 1st of confirmed virologic failure, 2. WHO Stage 4 progression or 3. death with hazard ratio (HR) and 95% confidence interval (CI) from adjusted Cox regression models. RESULTS In all, 739 (47%) women and 832 (53%) men with HIV were evaluated. Women had higher pretreatment CD4+(182 vs 165 cells/mm(3); P < 0.001) and lower HIV-1 RNA (4.9 log10 vs 5.2 log10 copies/ml; P < 0.001) compared to men. Association of sex with time to regimen failure differed by treatment arm (P = 0.018). For atazanavir plus didanosine-EC plus emtricitabine, women had a longer time to treatment failure compared to men [adjusted HR (aHR) = 0.59; 95% CI 0.40-0.87]. Women were less likely to prematurely discontinue treatment prematurely (aHR = 0.74; 95% CI 0.56-0.98). Women assigned to efavirenz plus lamivudine-zidovudine were more likely to have a primary safety event compared to men (aHR = 1.49; 95% CI 1.18-1.88). CONCLUSION Antiretroviral efficacy and safety differed by sex in this study. Consideration of potential effects of sex on antiretroviral outcomes is important for the design of future clinical trials and for HIV treatment guidelines.
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Affiliation(s)
- Cynthia Firnhaber
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care Johannesburg, South Africa
| | - Laura M. Smeaton
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, United States of America
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Umesh Lalloo
- Durban University of technology, Durban, South Africa
| | - Sharla Faesen
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Aadia Rana
- Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | - James Hakim
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Thomas B. Campbell
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America
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Hughes AJ, Mattson CL, Scheer S, Beer L, Skarbinski J. Discontinuation of antiretroviral therapy among adults receiving HIV care in the United States. J Acquir Immune Defic Syndr 2014; 66:80-9. [PMID: 24326608 PMCID: PMC5091800 DOI: 10.1097/qai.0000000000000084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous antiretroviral therapy (ART) is important for maintaining viral suppression. This analysis estimates prevalence of and reason for ART discontinuation. METHODS Three-stage sampling was used to obtain a nationally representative, cross-sectional sample of HIV-infected adults receiving HIV care. Face-to-face interviews and medical record abstractions were collected from June 2009 to May 2010. Data were weighted based on known probabilities of selection and adjusted for nonresponse. Patient characteristics of ART discontinuation, defined as not currently taking ART, stratified by provider-initiated versus non-provider-initiated discontinuation, were examined. Weighted logistic regression models predicted factors associated with ART discontinuation. RESULTS Of adults receiving HIV care in the United States who reported ever initiating ART, 5.6% discontinued treatment. Half of those who discontinued treatment reported provider-initiated discontinuation. Provider-initiated ART discontinuation patients were more likely to have a nadir CD4 ≥ 200 cells per cubic millimeter. Non-provider-initiated ART discontinuation patients were more likely to have unmet need for supportive services and to have not received HIV care in the past 3 months. Among all patients who discontinued, younger age, female gender, not having continuous health insurance, incarceration, injection drug use, nadir CD4 count ≥ 2 00 cells per cubic millimeter, unmet need for supportive services, no care in the past 3 months and HIV diagnosis ≥ 5 years before interview were independently associated with ART discontinuation. CONCLUSIONS These findings inform development of interventions to increase ART persistence by identifying groups at increased risk of ART discontinuation. Evidence-based interventions targeting vulnerable populations are needed and are increasingly important as recent HIV treatment guidelines have recommended universal ART.
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Affiliation(s)
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
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Marconi VC, Wu B, Hampton J, Ordóñez CE, Johnson BA, Singh D, John S, Gordon M, Hare A, Murphy R, Nachega J, Kuritzkes DR, del Rio C, Sunpath, and South Africa Resistanc H. Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic. AIDS Patient Care STDS 2013; 27:657-68. [PMID: 24320011 DOI: 10.1089/apc.2013.0263] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ≥ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL ≤ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.
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Affiliation(s)
- Vincent C. Marconi
- Department of Medicine/Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Baohua Wu
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Brent A. Johnson
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | | | - Anna Hare
- Department of Medicine/Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia
| | - Richard Murphy
- Albert Einstein College of Medicine and Medical Unit, Doctors Without Borders, New York, New York
| | - Jean Nachega
- Department of Epidemiology, Pittsburgh University Graduate School of Public Health, Pittsburgh, Pennsylvania
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Faculty of Medicine & Health Sciences, Cape Town, South Africa
| | - Daniel R. Kuritzkes
- Section of Retroviral Therapeutics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carlos del Rio
- Department of Medicine/Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Henry Sunpath, and South Africa Resistanc
- McCord Hospital, Durban, South Africa
- Nelson Mandela School of Medicine, Durban, South Africa
- South Africa Resistance Cohort Study Team Group Authors included Helga Holst and Phacia Ngubane,4 and Rachel Kearns and Peng Wu.2
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Mostardt S, Hanhoff N, Wasem J, Goetzenich A, Schewe K, Wolf E, Mayr C, Jaeger H, Pfaff H, Dupke S, Neumann A. Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:799-808. [PMID: 22990377 DOI: 10.1007/s10198-012-0425-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 08/16/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aims of this study were to estimate the expenditure for HIV-care in Germany and to identify variables associated with resource use. DESIGN/SETTING We performed an 18-month prospective multi-center study in an HIV specialized ambulatory care setting from 2006 to 2009. SUBJECTS, PARTICIPANTS Patients were eligible for study participation if they (1) were HIV-positive, (2) were ≥ 18 years of age, (3) provided written consent and (4) were not enrolled in another clinical study; 518 patients from 17 centers were included. MAIN OUTCOME MEASURES Health care costs were estimated following a micro-costing approach from two perspectives: (1) costs incurred to society in general, and (2) costs incurred to statutory health insurance. Data were obtained using questionnaires. Several empirical models for identifying the relationship between health care costs and independent variables, including age, gender, route of transmission and CD4 cell count at baseline, were developed. RESULTS Average annual health care costs were <euro>23,298 per patient from the societal perspective and <euro>19,103 from the statutory health insurance perspective. Most expenses are caused by antiretroviral medication (80 % of the total and 89 % of direct costs), while hospital costs represented 7 % of total expenditure. A statistically significant association was found between health care costs and clinical variables, with higher CD4 count and female gender generating lower costs, while increased antiretroviral experience and injection drug use led to higher expenditures (P < 0.05). CONCLUSIONS Expenditures for HIV-infection are driven mainly by drug costs. We identified several clinical variables influencing the costs of HIV-treatment. This information could assist policymakers when allocating limited health care resources to HIV care.
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Affiliation(s)
- Sarah Mostardt
- Institute for Health Care Management and Research, University of Duisburg-Essen, Schützenbahn 70, 45127, Essen, Germany.
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Caring for women living with HIV: gaps in the evidence. J Int AIDS Soc 2013; 16:18509. [PMID: 24088395 PMCID: PMC3789211 DOI: 10.7448/ias.16.1.18509] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health. Methods Using scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed. Results This review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH. Conclusions Based on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.
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Blackstock OJ, Tate JP, Akgün KM, Crystal S, Duggal M, Edelman EJ, Gibert CL, Gordon KS, Rimland D, Rodriguez-Barradas MC, Wang EA, Fiellin DA, Justice AC. Sex disparities in overall burden of disease among HIV-infected individuals in the Veterans Affairs healthcare system. J Gen Intern Med 2013; 28 Suppl 2:S577-82. [PMID: 23807068 PMCID: PMC3695278 DOI: 10.1007/s11606-013-2346-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Whether sex disparities exist in overall burden of disease among human immunodeficiency virus (HIV)-infected individuals in the Veterans Affairs healthcare system (VA) is unknown. OBJECTIVE To determine whether sex differences exist in overall burden of disease after 1 year of combined antiretroviral therapy (ART) among HIV-infected individuals in VA. DESIGN Retrospective cohort study. PARTICIPANTS Among patients in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC), all ART-naïve HIV-infected Veterans who received VA-based HIV care between 1996 and 2009. MAIN MEASURES Overall burden of disease was measured using the VACS Index, an index that incorporates HIV (e.g. CD4 cell count) and non-HIV biomarkers (e.g. hemoglobin) and is highly predictive of all-cause mortality. Possible scores range from 0 to 164, although scores typically range from 0 to 50 for 80 % of patients in VACS-VC. A higher score indicates greater burden of disease (each additional five points indicates approximately 20 % increased 5-year mortality risk). ART adherence was measured using pharmacy data. KEY RESULTS Complete data were available for 227 women and 8,073 men. At ART initiation, compared with men, women were younger and more likely to be Black, less likely to have liver dysfunction, but more likely to have lower hemoglobin levels. Median VACS Index scores changed from ART initiation to 1 year after ART initiation: women's scores went from 41 to 28 for women (13 point improvement) and men's from 42 to 27 for men (15 point improvement). In multivariable regression, women had 3.6 point worse scores than men after 1 year on ART (p = 0.002); this difference decreased to 3.2 points after adjusting for adherence (p = 0.004). CONCLUSIONS In VA, compared to men, women experienced less improvement in overall burden of disease after 1 year of HIV treatment. Further study is needed to elucidate the modifiable factors that may explain this disparity.
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Affiliation(s)
- Oni J Blackstock
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
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Factors affecting antiretroviral pharmacokinetics in HIV-infected women with virologic suppression on combination antiretroviral therapy: a cross-sectional study. BMC Infect Dis 2013; 13:256. [PMID: 23732043 PMCID: PMC3679788 DOI: 10.1186/1471-2334-13-256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/16/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although some studies show higher antiretroviral concentrations in women compared to men, data are limited. We conducted a cross-sectional study of HIV-positive women to determine if protease inhibitor (PI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) C(min) and Cmax values were significantly different than historical general population (predominantly male) averages and to evaluate correlates of higher concentrations. METHODS HIV-positive women with virologic suppression (viral load < 50copies/mL) on their first antiretroviral regimen were enrolled. Timed blood samples for C(min) and Cmax were drawn weekly for 3 weeks. The ratio of each individual's median C(min) and Cmax to the published population mean values for their PI or NNRTI was calculated and assessed using Wilcoxon sign-rank. Intra- and inter-patient variability of antiretroviral drug levels was assessed using coefficient of variation and intra-class correlation. Linear regression was used to identify correlates of the square root-transformed C(min) and Cmax ratios. RESULTS Data from 82 women were analyzed. Their median age was 41 years (IQR=36-48) and duration of antiretrovirals was 20 months (IQR=9-45). Median antiretroviral C(min) and Cmax ratios were 1.21 (IQR=0.72-1.89, p=0.003) (highest ratios for nevirapine and lopinavir) and 0.82 (IQR=0.59-1.14, p=0.004), respectively. Nevirapine and efavirenz showed the least and unboosted atazanavir showed the most intra- and inter-patient variability. Higher CD4+ count correlated with higher C(min). No significant correlates for Cmax were found. CONCLUSIONS Compared to historical control data, C(min) in the women enrolled was significantly higher whereas Cmax was significantly lower. Antiretroviral C(min) ratios were highly variable within and between participants. There were no clinically relevant correlates of drug concentrations. TRIAL REGISTRATION NCT00433979.
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King JR, Kakuda TN, Paul S, Tse MM, Acosta EP, Becker SL. Pharmacokinetics of Saquinavir With Atazanavir or Low-Dose Ritonavir Administered Once Daily (ASPIRE I) or Twice Daily (ASPIRE II) in Seronegative Volunteers. J Clin Pharmacol 2013; 47:201-8. [PMID: 17244771 DOI: 10.1177/0091270006296763] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ASPIRE I and II were prospective, 3-way sequential crossover studies in healthy volunteers to compare the safety and pharmacokinetics of saquinavir/ritonavir (SQV/RTV) with saquinavir/atazanavir (SQV/ATV) administered either once daily (QD, ASPIRE I) or twice daily (BID, ASPIRE II). Treatments were separated by 10 days, and pharmacokinetic analyses were performed on days 11, 32, and 53. SQV pharmacokinetics were significantly higher when dosed with RTV compared to ATV (P < .05 for all comparisons). ATV pharmacokinetics were similar within treatment arms. ATV Cmin increased approximately 60%, and Cmax decreased approximately 35% with BID dosing compared with QD dosing. Women had higher exposure for all 3 protease inhibitors (PIs) compared with men after adjusting for weight. Adverse effects were primarily gastrointestinal-related with SQV/RTV and hyperbilirubinemia with SQV/ATV. Although SQV plasma concentrations were higher when coadministered with RTV, a combination of SQV/ATV administered BID may be a viable alternative in HIV-infected, PI-naive subjects intolerant to RTV.
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Affiliation(s)
- Jennifer R King
- PharmD, University of Alabama at Birmingham, Division of Clinical Pharmacology, 1530 3rd Avenue South, VH 116, Birmingham, AL 35294-0019, USA
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Campbell TB, Smeaton LM, Kumarasamy N, Flanigan T, Klingman KL, Firnhaber C, Grinsztejn B, Hosseinipour MC, Kumwenda J, Lalloo U, Riviere C, Sanchez J, Melo M, Supparatpinyo K, Tripathy S, Martinez AI, Nair A, Walawander A, Moran L, Chen Y, Snowden W, Rooney JF, Uy J, Schooley RT, De Gruttola V, Hakim JG. Efficacy and safety of three antiretroviral regimens for initial treatment of HIV-1: a randomized clinical trial in diverse multinational settings. PLoS Med 2012; 9:e1001290. [PMID: 22936892 PMCID: PMC3419182 DOI: 10.1371/journal.pmed.1001290] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 07/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world. METHODS AND FINDINGS 1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure. An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72-1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54-0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39-0.64 for women; HR 0.79, CI 0.62-1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12-2.04; p = 0.007). CONCLUSION EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00084136. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Thomas B Campbell
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America.
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Hodder S, Jayaweera D, Mrus J, Ryan R, Witek, on behalf of the GRACE Study J. Efficacy and safety outcomes among treatment-experienced women and men treated with etravirine in gender, race and clinical experience. AIDS Res Hum Retroviruses 2012; 28:544-51. [PMID: 22206504 DOI: 10.1089/aid.2011.0118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The GRACE (Gender, Race and Clinical Experience) trial enrolled treatment-experienced, HIV-1-infected patients, mainly women, in North America, to assess outcomes with a darunavir/ritonavir-based regimen, which could include etravirine (ETR). We present outcomes at week 48 for men and women receiving ETR. Virologic response (HIV-1 RNA <50 copies/ml) and safety were assessed; descriptive statistics are reported. To evaluate the independent contribution of ETR treatment, a post hoc analysis including a multivariate model assessed factors predictive of virologic response for the entire GRACE population (429 patients). Of 207 patients who received ETR (women, 57.5%; black or Hispanic, 81.7%), 71.4% of women and 79.5% of men completed the study. Week 48 virologic response rates in women and men (intent-to-treat population) were 58.0% and 61.4%, respectively. After censoring patients who discontinued treatment for reasons other than virologic failure, response rates were 79.3% and 73.0%, respectively. Overall, ETR was well tolerated. Women experienced more nausea (24.4% vs. 11.4%) and rash-related events (21.0% vs. 15.9%), but less diarrhea (15.1% vs. 21.6%), compared with men. Grade 3-4 hypertriglyceridemia was more common in men (9.3%) than women (1.1%). In total, 11 (9.2%) women and 7 (8.0%) men discontinued ETR due to adverse events. In the multivariate model of the entire GRACE population, ETR use was independently associated with improved virologic response. ETR is effective and well tolerated in treatment-experienced patients with HIV-1, with similar outcomes among women and men.
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Affiliation(s)
- Sally Hodder
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | | | - Joseph Mrus
- Janssen Global Services, Titusville, New Jersey
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Dragovic G, Jevtovic D. The role of nucleoside reverse transcriptase inhibitors usage in the incidence of hyperlactatemia and lactic acidosis in HIV/AIDS patients. Biomed Pharmacother 2012; 66:308-11. [PMID: 22658063 DOI: 10.1016/j.biopha.2011.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/28/2011] [Indexed: 12/25/2022] Open
Abstract
Hyperlactatemia and lactic acidosis (LA) are among the most dangerous and life-threatening side effect that occurs during therapy with some nucleoside reverse transcriptase inhibitors (NRTIs), mainly didanosine (ddI) and stavudine (d4T), also known as d-drugs. Therefore, we performed a prospective, follow-up study and aimed to examine the incidence rates (IR) and rate ratios (RR) of hyperlactatemia and LA for each NRTI. Three hundred and ninety-six HIV-patients were included in final analysis comprising 783.8 person-years of follow-up. Between 1st January 2000 and 1st January 2008, 19 cases of hyperlactatemia and 15 cases of LA were recorded. Between regimens with the significant impact for developing hyperlactatemia and LA the lowest IR was for didanosine (IR=2.87 per 100 person-years, 95%CI=0.45-9.25 and IR=4.31 per 100 person-years, 95%CI=1.07-13.91, respectively), and the highest for didanosine+stavudine (IR=10.17 per 100 person-years, 95%CI=1.02-19.76 and IR=7.39 per 100 person-years, 95%CI=1.02-13.05, respectively). Compared to didanosine alone the RR of hyperlactatemia was 2.67 (95%CI=1.11-12.52) for stavudine, and 4.06 (95%CI=1.31-15.48) for didanosine+stavudine. The RR of LA was 3.12 (95%CI=1.13-10.65) for stavudine, and 5.13 (95%CI=1.54-13.37) for didanosine+stavudine in comparison with didanosine alone. Other risk factors for AP were CD4 cell count less than 200 cells/mm³ and female sex. Our results suggest that the use of stavudine alone or in combination with didanosine should not be used as first-line therapy, especially in patients with CD4 cell count less than 200 cells/mm³ and females if other treatment options are available.
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Affiliation(s)
- Gordana Dragovic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Dr Subotica 1/III, School of Medicine, University of Belgrade, Belgrade, Serbia.
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Hodder S, Arasteh K, De Wet J, Gathe J, Gold J, Kumar P, Mohapi L, Short W, Crauwels H, Vanveggel S, Boven K. Effect of gender and race on the week 48 findings in treatment-naïve, HIV-1-infected patients enrolled in the randomized, phase III trials ECHO and THRIVE. HIV Med 2012; 13:406-15. [PMID: 22416849 DOI: 10.1111/j.1468-1293.2012.00991.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A week 48 efficacy and safety analysis with respect to gender and race was conducted using pooled data from the phase III, double-blind, double-dummy efficacy comparison in treatment-naïve, HIV-infected subjects of TMC278 and efavirenz (ECHO) and TMC278 against HIV, in a once-daily regimen versus efavirenz (THRIVE) trials. METHODS Treatment-naïve, HIV-1-infected adults were randomized to receive rilpivirine (RPV; TMC278) 25 mg once a day (qd), or efavirenz (EFV) 600 mg qd, plus tenofovir/emtricitabine (ECHO) or tenofovir/emtricitabine, zidovudine/lamivudine or abacavir/lamivudine (THRIVE). RESULTS A total of 1368 participants (76% male and 61% White, of those with available race data) were randomized and treated. No gender-related differences in response rate (percentage of patients with HIV-1 viral load < 50 HIV-1 RNA copies/mL, using an intent-to-treat, time-to-loss-of-virological-response algorithm) were observed (RPV: men, 85%; women, 83%; EFV: men, 82%; women, 83%). Response rates were lower in Black compared with Asian and White participants (RPV: 75% vs. 95% and 85%, respectively; EFV: 74% vs. 93% and 83%, respectively); this finding was mostly a result of higher discontinuation and virological failure rates in Black patients. Safety findings were generally similar across race and gender subgroups. However, nausea occurred more commonly in women than in men in both treatment groups. In men, diarrhoea was more frequent in the EFV group, and abnormal dreams/nightmares were more frequent in men in both the EFV and RPV groups. CONCLUSIONS Overall response rates were high for both RPV and EFV. No gender differences were observed. However, response rates were lower among Black patients, regardless of treatment group. Gender appeared to influence the incidence of gastrointestinal adverse events and abnormal dreams/nightmares for both treatments.
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Affiliation(s)
- S Hodder
- UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA
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Falcon R, Bridge DA, Currier J, Squires K, Hagins D, Schaible D, Ryan R, Mrus J. Recruitment and retention of diverse populations in antiretroviral clinical trials: practical applications from the gender, race and clinical experience study. J Womens Health (Larchmt) 2011; 20:1043-50. [PMID: 21663416 PMCID: PMC3130514 DOI: 10.1089/jwh.2010.2504] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Women, particularly women of color, remain underrepresented in antiretroviral (ARV) clinical trials. To evaluate sex-based differences in darunavir/ritonavir-based therapy, the Gender, Race And Clinical Experience (GRACE) study was designed to enroll and retain a high proportion of women representative of the racial/ethnic demographics of women with HIV/AIDS in the United States. The recruitment and retention strategies used in GRACE are described in this article. METHODS Recruitment and retention strategies targeting women included selecting study sites that focused on women, involving community consultants, site-specific enrollment plans, access to other ARV drugs, study branding, site and patient toolkits, targeted public relations, site grants for patient support, and subsidized child care and transportation. RESULTS The recruitment strategies were successful; 287 (67%) women were enrolled, primarily women of color (black, n=191 [67%], Hispanic, n=60 [21%]). Despite the focus on retention, a greater proportion of women (32.8%) discontinued compared with men (23.2%). CONCLUSIONS The successes of GRACE in enrolling a representative population of women were rooted in pretrial preparation, engagement of community advisors, enrollment quotas, choice of study sites and site support. Lessons learned from GRACE may be applied to future study design. Further focus on factors that influence discontinuation is warranted.
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Affiliation(s)
- Ron Falcon
- Tibotec Therapeutics, Titusville, NJ 08560, USA.
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Mariana B, Adrián L, Guillermo V, Juan S, Laura M, Carlos L. Gender-related differences on P-glycoprotein-mediated drug intestinal transport in rats. J Pharm Pharmacol 2011; 63:619-26. [DOI: 10.1111/j.2042-7158.2010.01230.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
Evidence of sex-related differences on drug pharmacokinetics and pharmacodynamics are markedly increasing. The aim of this study was to characterize the influence of gender on P-glycoprotein (P-gp)-mediated drug intestinal transport using two ex-vivo methodological approaches.
Methods
To study the comparative tissue uptake of ivermectin, intestinal sacs (distal jejunum/ileum) of male and female Wistar rats were incubated with ivermectin (0.5 µm) (a P-gp substrate) in the presence or absence of PSC833 (10 µm) (a P-gp inhibitor). Additionally, sex-based differences in the bidirectional transport of Rhodamine 123 (Rho 123; 5 µm) incubated either alone or with PSC833 (10 µm) were examined in diffusion chambers.
Key findings
The ivermectin accumulation in the everted gut sacs was higher in female compared with male intestine. The presence of PSC833 increased ivermectin accumulation profiles both in male and female rats. However, a greater response to transport modulation was observed in male compared with female animals. Similar results were obtained for Rho 123, where a higher absorption was measured in the intestine of females. PSC833 decreased Rho 123 intestinal secretion in animals of both sexes with a greater inhibition in male.
Conclusions
Substantial sex-related differences were observed on the ivermectin and Rho 123 active intestinal transport. Likewise, the PSC833-mediated modulation had a differential impact between male and female animals. Further work is needed to clarify the mechanisms underlying this phenomenon, which may have considerable pharmacological and clinical relevance.
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Affiliation(s)
- Ballent Mariana
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
| | - Lifschitz Adrián
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
| | - Virkel Guillermo
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
| | - Sallovitz Juan
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
| | - Maté Laura
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
| | - Lanusse Carlos
- Laboratorio de Farmacología Veterinaria, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Campus Universitario, Tandil, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Tandil, Argentina
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Oliva-Moreno J, López-Bastida J, Serrano-Aguilar P, Perestelo-Pérez L. Determinants of health care costs of HIV-positive patients in the Canary Islands, Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:405-412. [PMID: 20049503 DOI: 10.1007/s10198-009-0212-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 12/09/2009] [Indexed: 05/28/2023]
Abstract
The aims of this study were to estimate medical expenditures on human immunodeficiency virus (HIV) treatment and to identify significant associated variables. We performed a retrospective multi-centre study in the Canary Islands using a sample of 569 patients recruited at outpatient visits. The study examined demographic and clinical variables, health-related quality of life (HRQOL), and health care resources. Clinical data was obtained from medical records and patient interviews. Several empirical models for identifying the relationship between health care costs and independent variables were developed. The greatest expense came from pharmaceutical expenditure (82.1% of direct costs), while hospital costs only represented 4.6% of total expenditure. The data showed a statistically significant association between health care costs and the CD4 count of the previous year. HRQOL was also a significant variable. Therefore, CD4 cell count can be used to predict health care costs in patients. Policymakers could use this information to help guide their decisions in allocating limited health care resources to HIV treatments.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finances, University of Castilla la Mancha, Toledo, Spain.
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Grinsztejn B, Di Perri G, Towner W, Woodfall B, De Smedt G, Peeters M. A review of the safety and tolerability profile of the next-generation NNRTI etravirine. AIDS Res Hum Retroviruses 2010; 26:725-33. [PMID: 20624073 DOI: 10.1089/aid.2009.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The next-generation nonnucleoside reverse transcriptase inhibitor (NNRTI) etravirine (TMC125) has demonstrated durable virologic efficacy in clinical trials involving >1000 treatment-experienced, NNRTI-resistant, HIV-1-infected patients. In this clinical safety review, we show etravirine to be well tolerated with a proven safety record. The nature and magnitude of adverse events observed during treatment suggest that etravirine may offer improved tolerability over existing antiretrovirals, including NNRTIs. Notably, adverse events reported with etravirine treatment are generally mild to moderate in severity. Rash has been shown to occur with a higher incidence in etravirine-treated patients versus placebo, but cases are generally mild to moderate, occur within the first few weeks, and resolve with continued use. In addition, the rate of adverse event-related discontinuations is low with etravirine. In summary, the safety and tolerability profile of etravirine, combined with its virologic efficacy, suggest that the drug may be a valuable option for treatment-experienced patients with HIV-1 infection.
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Affiliation(s)
- Beatriz Grinsztejn
- Instituto de Pesquisa Clinica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
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Katz IT, Shapiro R, Li D, Govindarajulu U, Thompson B, Watts DH, Hughes MD, Tuomala R. Risk factors for detectable HIV-1 RNA at delivery among women receiving highly active antiretroviral therapy in the women and infants transmission study. J Acquir Immune Defic Syndr 2010; 54:27-34. [PMID: 20065861 PMCID: PMC2860013 DOI: 10.1097/qai.0b013e3181caea89] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Detectable HIV-1 RNA at delivery is the strongest predictor of mother-to-child transmission. The risk factors for detectable HIV, including type of regimen, are unknown. We evaluated factors, including highly active antiretroviral (HAART) regimen, associated with detectable HIV-1 RNA at delivery in the Women and Infants Transmission Study (WITS). METHODS Data from 630 HIV-1-infected women who enrolled from 1998 to 2005 and received HAART during pregnancy were analyzed. Multivariable analyses examined associations between regimens, demographic factors, and detectable HIV-1 RNA (>400 copies/milliliter) at delivery. RESULTS Overall, 32% of the women in the cohort had detectable HIV-1 RNA at delivery. Among the subset of 364 HAART-experienced women, a lower CD4 cell count at enrollment [adjusted odds ratio (AOR) = 1.20 per 100 cells/microL, confidence interval (CI) 1.04 to 1.37] and higher HIV-1 RNA at enrollment (AOR = 1.52 per log10 copies/milliliter, CI 1.32 to 1.75) were significantly associated with detectable HIV-1 RNA levels at delivery. For the 266 HAART-naive women, both lower CD4 cell count at enrollment (AOR = 1.24 per 100 cells/microL, CI 1.05 to 1.48) and higher HIV-1 RNA at enrollment (AOR = 1.35 per log10 copies/milliliter, CI 1.12 to 1.63) were associated with detectable HIV-1 RNA at delivery. In addition, age at delivery (AOR = 0.92 per 10 years older, CI 0.86 to 0.99) and maternal illicit drug use (AOR = 3.15, CI 1.34 to 7.41) were significantly associated with detectable HIV-1 RNA at delivery among HAART-naive women. Type of HAART regimen was not significant in either group. CONCLUSIONS Lack of viral suppression at delivery was common in the WITS cohort, but differences by antiretroviral regimen were not identified. Despite a transmission rate below 1% in the last 5 years of the WITS cohort, improved measures to maximize HIV-1 RNA suppression at term among high-risk women are warranted.
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Epidemic Stevens-Johnson syndrome in HIV patients in Guinea-Bissau: a side effect of the drug-supply policy? AIDS 2010; 24:783-5. [PMID: 20215883 DOI: 10.1097/qad.0b013e328335cead] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kiertiburanakul S, Sungkanuparph S, Malathum K, Watcharananan S, Sathapatayavongs B, Charoenyingwattana A, Mahasirimongkol S, Chantratita W. A model and risk score for predicting nevirapine-associated rash among HIV-infected patients: in settings of low CD4 cell counts and resource limitation. Open AIDS J 2009; 3:24-30. [PMID: 19639037 PMCID: PMC2714560 DOI: 10.2174/1874613600903010024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Rash is the most common adverse effect associated with nevirapine (NVP). We aimed to develop a model and risk score for predicting NVP-associated rash among HIV-infected patients with low CD4 cell counts. METHODS Cross-sectional study was conducted and 383 HIV-infected patients consecutively enrolled in the study. RESULTS Of 222 patients in the training set, 116 (52.2%) were males and median (IQR) age was 35.2 (31.1-42.0) years. Median (IQR) CD4 cell count was 104 (35-225) cells/mm(3). Of these, 72 and 150 patients were in "rash" and "no rash" group, respectively. Four factors were independently associated with rash: a history of drug allergy (odds ratio (OR) 4.01, 95% confidence interval (CI), 1.75-9.20, P = 0.001), body weight <55 kg. (OR 2.02, 95% CI, 1.09-3.76, p = 0.026), not receiving slow dose escalation (OR 2.00, 95% CI, 1.06-3.77, p = 0.032), and no concomitant drug(s) (OR 2.48, 95% CI, 1.32-4.64, p = 0.005). Receiver-operator characteristic analysis yielded area under the curve of 71% and the goodness-of-fit statistics was 6.48 (p = 0.840). The variables were given scores of 14, 7, 7 and 9, respectively. A cutoff >21 points defined the high risk individuals which yielded specificity and positive predictive value of 99% and 69%, respectively, with OR of 3.96 (95% CI, 1.79-8.86, p = 0.001). CONCLUSIONS A model and risk score for predicting NVP-associated rash performed well in this study population. It might be useful for predicting the risk of rash before NVP initiation among HIV-infected patients with low CD4 cell counts.
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Kremer H, Sonnenberg-Schwan U, Arendt G, Brockmeyer NH, Potthoff A, Ulmer A, Graefe K, Lorenzen T, Starke W, Walker UA. HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV. Eur J Med Res 2009; 14:139-46. [PMID: 19380286 PMCID: PMC3401004 DOI: 10.1186/2047-783x-14-4-139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 03/04/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences. METHODS HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities. RESULTS Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01). CONCLUSIONS Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.
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Affiliation(s)
- H Kremer
- All Around Women Special, German AIDS Society, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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Carosi G, Nasta P, Fiore S, Matteelli A, Cauda R, Ferrazzi E, Tamburrini E, Savasi V, Bini T, Ravizza M, Bucceri A, Vichi F, Murri R, Mazzotta F, d'Arminio Monforte A. Women facing HIV. Key question on women with HIV infection: Italian consensus workshop. Infection 2009; 37:168-78. [PMID: 19308320 DOI: 10.1007/s15010-008-7361-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 10/06/2008] [Indexed: 01/13/2023]
Abstract
A panel of leading Italian specialists in infectious diseases, obstetrics and gynaecology met in a national consensus workshop on women facing HIV to review critical aspects and discuss recommendations for selected key questions on four issues: (1) women and highly active antiretroviral therapy (HAART): access to care and adherence to therapy, side effects and drug-drug interaction; (2) HIV-infected pregnant women: prevention of mother to child transmission; (3) desire for children among women living with HIV: assisted reproduction; (4) sexually transmitted diseases and genital disturbances. The method of a nominal group meeting was used, and recommendations were graded for their strength and quality of evidence using a system based on the one adopted by the Infectious Diseases Society of America. Main conclusions are summarized and critically discussed, and some of the most recent data supporting recommendations are provided.
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Affiliation(s)
- G Carosi
- Institute of Infectious and Tropical Diseases, University of Brescia, Italy
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Abstract
Clinicians should be familiar with sex-specific considerations when managing antiretroviral (ARV) treatment among women. Pregnancy is a critical influence on when to start treatment and what ARVs should be included in a regimen. Sex, pregnancy and hormonal contraceptive therapies can each influence ARV pharmacokinetic profiles. Women may be prone to have higher serum levels with selected ARV treatments, which may improve potency but also increase the risk for toxicities. Several studies have demonstrated that women do have higher frequencies of selected ARV-associated adverse events when compared with men. Although HIV treatment guidelines for nonpregnant women do not differ from men, clinicians should be aware of the high potential for certain ARV-related toxicities and follow suggestions in order to decrease the risk of side effects.
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Affiliation(s)
- Rebecca Clark
- Louisiana State University Health Science Center, HIV Outpatient Program, 136 S. Roman St, New Orleans, LA 70112, USA.
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Cuzin L, Flandre P, Pugliese P, Duvivier C, Yazdanpanah Y, Billaud E, Poizot-Martin I, Katlama C. Atazanavir in patients with persistent viral replication despite HAART: results from the French prospective NADIS cohort. HIV CLINICAL TRIALS 2008; 9:147-51. [PMID: 18547901 DOI: 10.1310/hct0903-147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess virological efficacy of a ritonavir-boosted atazanavir (ATV/r)-containing regimen in patients with persistent viral replication despite HAART. PATIENTS AND METHOD Prospective cohort of French HIV-infected patients. Patients were included if pretreated and viral load (VL) >400 copies/mL at the time of ATV/r first prescription (baseline). Demographic and epidemiologic data, therapeutic history, and clinical and biological values at baseline and during follow-up were analyzed. Primary endpoint was failure of the regimen defined as either VL>400 copies/mL at Week 24 or treatment interruption before Week 24. Multivariate analysis was performed of baseline characteristics related with treatment failure. RESULTS There were 424 patients with available data. Primary endpoint was met by 36%: 24% VL>400 copies/mL and 12% treatment interruption. Treatment interruption due to drug-related toxicity was significantly more frequent in women (20.5% vs. 8.8%, p= .001). Female gender (adjusted odds ratio [OR]=1.91), previous use of lopinavir (LPV; OR=2.76), number of new drugs and of active drugs in the regimen (OR=0.48 and 0.3, respectively), and baseline VL (OR=1.75) were independently related with treatment failure. CONCLUSION ATV/r-containing regimens, because of low pill burden and good tolerance, can be a useful strategy as long as the patients did not suffer previous LPV failures. The issue of gender deserves further studies in larger populations.
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Affiliation(s)
- L Cuzin
- CISIH-Hôpital Purpan, Toulouse, France.
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von Hentig N, Babacan E, Lennemann T, Knecht G, Carlebach A, Harder S, Staszewski S, Haberl A. The steady-state pharmacokinetics of atazanavir/ritonavir in HIV-1-infected adult outpatients is not affected by gender-related co-factors. J Antimicrob Chemother 2008; 62:579-82. [PMID: 18477709 DOI: 10.1093/jac/dkn204] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pharmacokinetic differences, contributing to drug-related side effects, between men and women have been reported for HIV protease inhibitors. As only limited and inconclusive data on ritonavir-boosted atazanavir are available, we evaluated the respective steady-state pharmacokinetics in 48 male and 26 female HIV-1-infected adults receiving atazanavir/ritonavir 300/100 mg once-daily as part of their antiretroviral therapy. METHODS Pharmacokinetic profiles (24 h) of atazanavir/ritonavir were assessed and measured by HPLC/tandem mass spectrometry. Geometric mean (GM; ANOVA) of minimum and maximum plasma drug concentrations (C(min) and C(max)), area under the concentration-time curve (AUC) and total clearance (CL(total)) were compared between the sexes and correlated to demographic (age, gender and ethnicity), physiological (weight and body mass index) and clinical (CD4+ cell count, HIV-RNA, co-medication and hepatitis serology) co-factors. RESULTS The GM of the atazanavir AUC, C(max) and C(min) of men versus women were 32 643 versus 36 232 ng.h/mL [GM ratio (GMR) = 1.11, P = 0.435], 2802 versus 3211 ng/mL (GMR = 1.15, P = 0.305) and 398 versus 470 ng/mL (GMR = 1.18, P = 0.406), respectively. Although weight (80.6 versus 63.9 kg, P = 0.001) and body weight-adjusted atazanavir dose (3.84 versus 4.60 mg/kg, P = 0.013) were different between the sexes, no significant correlation to atazanavir pharmacokinetics was observed. A linear regression analysis detected significant correlations of atazanavir C(min) with ritonavir AUC (P < 0.001) and the co-administration of methadone oral solution (P = 0.032), and inverse correlations with the time since the first HIV infection diagnosis (P = 0.003) and the number of previous antiretroviral treatments (P = 0.022). CONCLUSIONS Atazanavir/ritonavir steady-state pharmacokinetics was comparable in men and women, despite gender-related significant differences in atazanavir dose/body weight. The administration of atazanavir/ritonavir is pharmacokinetically safe; 95% of all trough samples were above the recommended plasma concentration of 150 ng/mL.
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Affiliation(s)
- Nils von Hentig
- Pharmazentrum Frankfurt, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Frankfurt, Germany.
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Torti C, Costarelli S, De Silvestri A, Quiros-Roldan E, Lapadula G, Cologni G, Paraninfo G, Castelnuovo F, Puoti M, Carosi G. Analysis of severe hepatic events associated with nevirapine-containing regimens: CD4+ T-cell count and gender in hepatitis C seropositive and seronegative patients. Drug Saf 2008; 30:1161-9. [PMID: 18035868 DOI: 10.2165/00002018-200730120-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Nevirapine-containing regimens have been associated with a risk of significant elevations of liver transaminase levels. Higher risk in antiretroviral-naive populations has been related to gender and CD4+ T-cell count (women with CD4+ T-cell counts of > or =250/mm(3) or men with CD4+ T-cell counts of > or =400/mm(3), i.e. group at risk). However, recent studies do not confirm this association in HIV populations comprising patients who are antiretroviral-experienced. Moreover, the predictive value of gender and CD4+ T-cell count on the risk of raised transaminase levels has been poorly investigated in populations of patients co-infected with hepatitis C virus (HCV). METHODS Analysis of HIV-positive patients receiving nevirapine-containing regimens for the first time was conducted. Grade > or =III hepatotoxicity (i.e. > or =5 x upper limit of normal in alanine aminotranferase or aspartate aminotransferase levels) was the primary endpoint. Univariate and multivariable Cox proportional hazard regression models were separately conducted among HCV-antibody (Ab)-positive and HCV-Ab-negative patients. RESULTS Amongst 905 patients, 49% were HCV-Ab-positive and 79% were antiretroviral-experienced. Grade > or =III liver transaminase elevations developed in 7.1% of patients, accounting for an incidence of 2.47 (95% CI 1.97, 3.09) per 100 patient-years of follow-up. HCV-Ab reactivity was associated with a 3-fold increase in risk of developing relevant liver transaminase elevations (95% CI 1.75, 5.3; p < 0.001), whereas gender and CD4+ T-cell count did not impact significantly. When analysis was performed in HCV-Ab-negative patients, the outcome was independently correlated with the group at risk (hazard ratio [HR] 3.66; 95% CI 1.20, 11.14; p = 0.022). By contrast, in HCV-Ab-positive patients, the group at risk was not significantly associated with the outcome. CONCLUSIONS Most of the excess rates of relevant raised transaminase levels in patients prescribed nevirapine-containing regimens could be attributed to HCV co-infection. Gender and CD4+ T-cell count appeared to have a statistically significant impact on the risk of relevant transaminase level elevations in HCV-negative, but not in HCV-positive patients, probably due to a diluting effect of HCV. Incidence of hepatic events after nevirapine-containing regimens did not appear to be a major concern in our cohort of patients who were mainly antiretroviral-experienced and negative for HCV-Ab. Preferably, nevirapine should be avoided in HCV co-infected patients and in males with CD4+ T-cell counts of > or =400/mm(3) or females with CD4+ T-cell counts of > or =250/mm(3).
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Affiliation(s)
- Carlo Torti
- School of Medicine, Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Risk factors for lactic acidosis and severe hyperlactataemia in HIV-1-infected adults exposed to antiretroviral therapy. AIDS 2007; 21:2455-64. [PMID: 18025882 DOI: 10.1097/qad.0b013e3282f08cdc] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe hyperlactataemia and lactic acidosis are rare serious complications of antiretroviral therapy (ART). METHODS Lactic acidosis was defined as pH < 7.35, bicarbonate < 20 mmol/l and raised lactate; hyperlactataemia as two consecutive lactates > 5 mmol/l. The case-control study of 110 cases and 220 controls(two randomly selected from treated patients by centre and calendar year) from centres in 10 countries included 40 (36.4%) female cases and 40 female controls (18.2%) (P < 0.001). Median age was 42.4 years [interquartile range (IQR, 36.0-52.5] for cases and 40 (IQR, 35.0-47.1) for controls (P = 0.013). More cases were nonwhite (41.9%) than controls (31.2%) (P = 0.032). Cases had a shorter duration of exposure to dideoxynucleosides. RESULTS After adjusting for age, gender and current CD4 cell count, hyperlactataemia/lactic acidosis remained associated with exposure to didanosine in every category of exposure duration but was most strongly associated with exposure < 12 months. In a separate multivariable model, apart from exposure to stavudine, didanosine, or even more strongly both, age above 40 years [odds ratio (OR), 2.6; 95% confidence interval (CI), 1.08-6.29], female gender (OR, 5.97; 95% CI, 1.92-18.5) and advanced immunosuppression were independent associations (CD4 cell count 200-349, 100-199 and < 100 cells/mul: OR, 3.89, 7.58 and 8.11, respectively). INTERPRETATION Hyperlactataemia/lactic acidosis was associated with exposure to dideoxynucleosides, female gender, advanced immunosuppression and possibly ethnicity. This has important consequences for choice of ART in resource-limited settings. The association with shorter duration of exposure may support the hypothesis of susceptibility in a small proportion of patients.
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Abstract
Many HIV-infected women are benefiting from highly active antiretroviral therapy and living longer. Their reproductive choices vary over the life cycle, and there is a need to understand the appropriate contraceptives for those not intending pregnancy. There are specific gynecologic issues relevant to HIV-infected women, such as genital tract infections, risk for cervical cancer, and menstrual irregularities. More women are expected to reach menopause. Health care providers should be aware of these unique needs of HIV-infected women.
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Affiliation(s)
- Erna Milunka Kojic
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02806, USA.
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Manfredi R, Calza L. Safety Issues About Nevirapine Administration in HIV-Infected Pregnant Women. J Acquir Immune Defic Syndr 2007; 45:365-8. [PMID: 17592340 DOI: 10.1097/qai.0b013e318050d879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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&NA;. Potential for modest differences between sexes in antiretroviral therapy pharmacokinetics and adverse events. DRUGS & THERAPY PERSPECTIVES 2006. [DOI: 10.2165/00042310-200622110-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jaquenoud Sirot E, van der Velden JW, Rentsch K, Eap CB, Baumann P. Therapeutic Drug Monitoring and Pharmacogenetic Tests as Tools in Pharmacovigilance. Drug Saf 2006; 29:735-68. [PMID: 16944962 DOI: 10.2165/00002018-200629090-00001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Therapeutic drug monitoring (TDM) and pharmacogenetic tests play a major role in minimising adverse drug reactions and enhancing optimal therapeutic response. The response to medication varies greatly between individuals, according to genetic constitution, age, sex, co-morbidities, environmental factors including diet and lifestyle (e.g. smoking and alcohol intake), and drug-related factors such as pharmacokinetic or pharmacodynamic drug-drug interactions. Most adverse drug reactions are type A reactions, i.e. plasma-level dependent, and represent one of the major causes of hospitalisation, in some cases leading to death. However, they may be avoidable to some extent if pharmacokinetic and pharmacogenetic factors are taken into consideration. This article provides a review of the literature and describes how to apply and interpret TDM and certain pharmacogenetic tests and is illustrated by case reports. An algorithm on the use of TDM and pharmacogenetic tests to help characterise adverse drug reactions is also presented. Although, in the scientific community, differences in drug response are increasingly recognised, there is an urgent need to translate this knowledge into clinical recommendations. Databases on drug-drug interactions and the impact of pharmacogenetic polymorphisms and adverse drug reaction information systems will be helpful to guide clinicians in individualised treatment choices.
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Hellinger FJ. Economic models of antiretroviral therapy: searching for the optimal strategy. PHARMACOECONOMICS 2006; 24:631-42. [PMID: 16802839 DOI: 10.2165/00019053-200624070-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The diffusion of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in the US in 1996 and 1997 reduced the number of deaths attributable to HIV disease and changed the way we think about the illness. Today, HIV disease may be deemed a fairly expensive chronic condition rather than an intolerably expensive fatal illness. Although most studies have found that patients receiving new drug therapies are hospitalised less frequently than patients who received early drug therapies, it is unclear whether the diffusion of new drug therapies has increased or decreased the annual cost of care. However, it is evident that the diffusion of new drug therapies has increased the lifetime cost of care. Analysts rely on models to simulate the course and cost of HIV disease. This study reviews the evolution of these models, paying particular attention to how these models estimate the cost of care. The primary findings of this review are that the economic data used in these models are often too imprecise to accurately identify the cost of each disease stage and are almost always outdated. Moreover, it was found that estimates of drug costs in these models may not accurately reflect actual expenditures.
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Affiliation(s)
- Fred J Hellinger
- Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland 20850, USA.
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