1
|
Allen Reeves A, Fuentes AV, Caballero J, Thomas JE, Mosley Ii JF, Harrington C. Neurotoxicities in the treatment of HIV between dolutegravir, rilpivirine and dolutegravir/rilpivirine: a meta-analysis. Sex Transm Infect 2021; 97:261-267. [PMID: 33782144 DOI: 10.1136/sextrans-2020-054821] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the risk of neuropsychiatric adverse effects (ie, depression, anxiety, insomnia, dizziness, suicidal behaviour) among patients treated with rilpivirine, dolutegravir and dolutegravir/rilpivirine. DESIGN This is a systematic review and meta-analysis of randomised controlled trials. Quality of evidence was assessed using Jadad scoring system. DATA SOURCES Three electronic databases were searched for available publications up to 1 May 2020. Searches included relevant studies, trial registers, conference proceeding abstracts and grey literature. INCLUSION CRITERIA Randomised controlled trials with data focused on adult participants (ie, 18 years of age or older) receiving dolutegravir 50 mg, rilpivirine 25 mg or combination of dolutegravir 50 mg/rilpivirine 25 mg once daily. RESULTS Twenty studies with a minimum duration of 48 weeks and average Jadad score of 4 were included (n=10 998). Primary objective demonstrated a relative risk (RR) synergistic effect on depressive symptoms for dolutegravir/rilpivirine (RR=2.82; 95% CI (1.12 to 7.10)) when compared with dolutegravir (RR=1.10; 95% CI (0.88 to 1.38)) and rilpivirine (RR=1.08; 95% CI (0.80 to 1.48)). Secondary objectives showed no difference between dolutegravir, rilpivirine and dolutegravir/rilpivirine to efavirenz. Additionally, excluding efavirenz studies, dolutegravir and dolutegravir/rilpivirine yielded increased depression (RR=1.34; 95% CI (1.04 to 1.74)). CONCLUSION The combination of dolutegravir/rilpivirine appears to increase the risk of depressive symptoms. Despite the increase, the clinical significance is unknown and needs further study. Additionally, neurotoxicity risk appears similar between dolutegravir, rilpivirine and dolutegravir/rilpivirine antiretroviral therapy when compared with efavirenz-based antiretroviral therapy.
Collapse
Affiliation(s)
- Anthony Allen Reeves
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, Florida, USA
| | - Andrea V Fuentes
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, Florida, USA
| | - Joshua Caballero
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, Florida, USA
| | - Jennifer E Thomas
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, Florida, USA
| | - Juan F Mosley Ii
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, Florida, USA
| | - Catherine Harrington
- Lloyd L Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| |
Collapse
|
2
|
Immunological and Virological Responses in Older HIV-Infected Adults Receiving Antiretroviral Therapy: An Evidence-Based Meta-Analysis. J Acquir Immune Defic Syndr 2020; 83:323-333. [PMID: 31913990 DOI: 10.1097/qai.0000000000002266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Millions of people living with the HIV have received antiretroviral therapy (ART). Older adults make up a significant portion of these individuals; however, the immunological and virological responses to ART for older patients still need to be clarified. DESIGN Meta-analysis. METHODS In this article, we systematically reviewed research articles published between 2001 and 2018 that reported immunological and virological responses and AIDS-related mortality among HIV- infected adults (including individuals aged 50 years and older) receiving ART, using meta-analysis. ART efficiency was measured using 3 outcomes: (1) immunological response, (2) virological response, and (3) mortality. RESULTS We identified 4937 citations, and 40 studies were eventually selected to investigate ART efficiency in older HIV-infected patients, comprising more than 888,151 patients initiating ART. We report that older patients showed poor immunological responses, with CD4 counts and the restoration of CD4 counts after ART initiation being significantly lower than seen in younger patients. However, older patients exhibited better viral suppression rates (risk ratio: 1.04; 95% confidence intervals: 1.01 to 1.08) after 36 months following ART initiation. In addition, older adults had a higher risk of AIDS-related death (adjusted hazard ratio: 1.44, 95% confidence interval: 1.30 to 1.60). CONCLUSIONS Older age after ART initiation was associated with a poorer immunological response and a higher risk of mortality, suggesting the need to increase early diagnosis and treatment among older HIV patients.
Collapse
|
3
|
Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol 2018; 11:1171-1181. [PMID: 30444968 DOI: 10.1080/17512433.2018.1549484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. Areas covered: This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. Expert commentary: Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
Collapse
Affiliation(s)
- Giovanni Guaraldi
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Ines Pintassilgo
- c Internal Medicine Department , Hospital Garcia de Orta , Almada , Portugal
| | - Jovana Milic
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy.,d Clinical and Experimental Medicine PhD Program , University of Modena and Reggio Emilia , Modena , Italy
| | - Cristina Mussini
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| |
Collapse
|
4
|
Nevedal A, Neufeld S, Luborsky M, Sankar A. Older and Younger African Americans' Story Schemas and Experiences of Living with HIV/AIDS. J Cross Cult Gerontol 2018; 32:171-189. [PMID: 28258333 DOI: 10.1007/s10823-016-9309-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This paper reports findings from a study that compared older (n = 21, ≥ age 50) and younger (n = 96, ≤ age 49) African Americans' stories (N = 117) of living with HIV/AIDS to determine how they make sense of the experience. The purpose was to: (1) identify and describe the cultural models African Americans use to inform their stories of living with HIV/AIDS, and (2) to compare older and younger adults' HIV stories. To characterize the cultural models engaged in the telling of these HIV stories, we conducted schema analysis. Analyses documented six diverse schemas, ranging from "Stages of Grief", "12 Steps", "Wake Up Call", "Continuity of Life", to "Angry and Fearful", "Shocked and Amazed". Comparison conducted by age group showed older adults more frequently expressed their story of living with HIV as "Stages of Grief" and "Continuity of Life", whereas younger adults expressed their stories as "12 Steps" and "Wake Up Call". Findings contribute by documenting African American stories of living with HIV/AIDS, important heterogeneity in cultural schemas for experiences of living with HIV and differences by age group. These findings may help by identifying the cultural resources as well as challenges experienced with aging while living with HIV/AIDS for African Americans.
Collapse
Affiliation(s)
- Andrea Nevedal
- Department of Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, CA, USA
| | - Stewart Neufeld
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Mark Luborsky
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
- Department of Anthropology, Wayne State University, 656 W. Kirby Street 3054 Faculty/Administration Building, Detroit, MI, 48202, USA
| | - Andrea Sankar
- Department of Anthropology, Wayne State University, 656 W. Kirby Street 3054 Faculty/Administration Building, Detroit, MI, 48202, USA.
| |
Collapse
|
5
|
Agaba PA, Meloni ST, Sule HM, Agbaji OO, Sagay AS, Okonkwo P, Idoko JA, Kanki PJ. Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria. Open Forum Infect Dis 2017; 4:ofx031. [PMID: 29497627 PMCID: PMC5780650 DOI: 10.1093/ofid/ofx031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m2, and having a gap in care independently predicted LTFU. Conclusions Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.
Collapse
Affiliation(s)
- Patricia A Agaba
- Departments of Family Medicine.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Seema T Meloni
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| | - Halima M Sule
- Departments of Family Medicine.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Oche O Agbaji
- Medicine, and.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Atiene S Sagay
- Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | | | | | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Bone health has become an increasingly important aspect of the care of HIV-infected patients as bone loss with antiretroviral therapy (ART) initiation is significant and osteopenia and osteoporosis are highly prevalent. Vitamin D is tightly linked to calcium balance and bone health, and vitamin D deficiency is common in HIV. This review outlines the epidemiology of vitamin D deficiency in HIV, summarizes our current understanding of the relationship between vitamin D and bone loss in HIV and the impact of vitamin D supplementation in this patient group. RECENT FINDINGS Although data are conflicting as to whether vitamin D deficiency is more prevalent among HIV-infected individuals than in the general population, there are several reasons for why this patient group may be at heightened risk. Studies linking vitamin D deficiency to bone loss in HIV are limited; however, data from randomized clinical trials suggest a benefit of vitamin D supplementation for the prevention of bone loss with ART initiation and for the treatment of bone loss with bisphosphonate therapy. SUMMARY There are too limited data to recommend universal screening of vitamin D status or supplementation to all HIV-infected individuals. However, testing 25-hydroxyvitamin D levels in those at risk for deficiency and treating patients found to be deficient or initiating ART or bisphosphonate therapy should be considered. Further study on vitamin D supplementation is needed regarding the potential benefit on immune activation and restoration in this patient group.
Collapse
|
7
|
Azzopardi E, Lloyd C, Teixeira SR, Conlan RS, Whitaker IS. Clinical applications of amylase: Novel perspectives. Surgery 2016; 160:26-37. [PMID: 27117578 DOI: 10.1016/j.surg.2016.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/20/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Amylase was the first enzyme to be characterized, and for the previous 200 years, its clinical role has been restricted to a diagnostic aid. Recent interface research has led to a substantial expansion of its role into novel, viable diagnostic, and therapeutic applications to cancer, infection, and wound healing. This review provides a concise "state-of-the-art" overview of the genetics, structure, distribution, and localization of amylase in humans. METHOD A first-generation literature search was performed with the MeSH search string "Amylase AND (diagnost∗ OR therapeut$)" on OVIDSP and PUBMED platforms. A second-generation search was then performed by forward and backward referencing on Web of Knowledge™ and manual indexing, limited to the English Language. RESULTS "State of the Art" in amylase genetics, structure, function distribution, localisation and detection of amylase in humans is provided. To the 4 classic patterns of hyperamylasemia (pancreatic, salivary, macroamylasemia, and combinations) a fifth, the localized targeting of amylase to specific foci of infection, is proposed. CONCLUSIONS The implications are directed at novel therapeutic and diagnostic clinical applications of amylase such as the novel therapeutic drug classes capable of targeted delivery and "smart release" in areas of clinical need. Future directions of research in areas of high clinical benefit are reported.
Collapse
Affiliation(s)
- Ernest Azzopardi
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; Centre for Nanohealth, Swansea University, Swansea, United Kingdom; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom.
| | - Catherine Lloyd
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; Centre for Nanohealth, Swansea University, Swansea, United Kingdom
| | | | - R Steven Conlan
- Centre for Nanohealth, Swansea University, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom
| |
Collapse
|