1
|
Mørup SB, Leung P, Reilly C, Sherman BT, Chang W, Milojevic M, Milinkovic A, Liappis A, Borgwardt L, Petoumenos K, Paredes R, Mistry SS, MacPherson CR, Lundgren J, Helleberg M, Reekie J, Murray DD. The association between single-nucleotide polymorphisms within type 1 interferon pathway genes and human immunodeficiency virus type 1 viral load in antiretroviral-naïve participants. AIDS Res Ther 2024; 21:27. [PMID: 38698440 PMCID: PMC11067292 DOI: 10.1186/s12981-024-00610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Human genetic contribution to HIV progression remains inadequately explained. The type 1 interferon (IFN) pathway is important for host control of HIV and variation in type 1 IFN genes may contribute to disease progression. This study assessed the impact of variations at the gene and pathway level of type 1 IFN on HIV-1 viral load (VL). METHODS Two cohorts of antiretroviral (ART) naïve participants living with HIV (PLWH) with either early (START) or advanced infection (FIRST) were analysed separately. Type 1 IFN genes (n = 17) and receptor subunits (IFNAR1, IFNAR2) were examined for both cumulated type 1 IFN pathway analysis and individual gene analysis. SKAT-O was applied to detect associations between the genotype and HIV-1 study entry viral load (log10 transformed) as a proxy for set point VL; P-values were corrected using Bonferroni (P < 0.0025). RESULTS The analyses among those with early infection included 2429 individuals from five continents. The median study entry HIV VL was 14,623 (IQR 3460-45100) copies/mL. Across 673 SNPs within 19 type 1 IFN genes, no significant association with study entry VL was detected. Conversely, examining individual genes in START showed a borderline significant association between IFNW1, and study entry VL (P = 0.0025). This significance remained after separate adjustments for age, CD4+ T-cell count, CD4+/CD8+ T-cell ratio and recent infection. When controlling for population structure using linear mixed effects models (LME), in addition to principal components used in the main model, this was no longer significant (p = 0.0244). In subgroup analyses stratified by geographical region, the association between IFNW1 and study entry VL was only observed among African participants, although, the association was not significant when controlling for population structure using LME. Of the 17 SNPs within the IFNW1 region, only rs79876898 (A > G) was associated with study entry VL (p = 0.0020, beta = 0.32; G associated with higher study entry VL than A) in single SNP association analyses. The findings were not reproduced in FIRST participants. CONCLUSION Across 19 type 1 IFN genes, only IFNW1 was associated with HIV-1 study entry VL in a cohort of ART-naïve individuals in early stages of their infection, however, this was no longer significant in sensitivity analyses that controlled for population structures using LME.
Collapse
Affiliation(s)
- Sara Bohnstedt Mørup
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Preston Leung
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cavan Reilly
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brad T Sherman
- Laboratory of Human Retrovirology and Immunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Weizhong Chang
- Laboratory of Human Retrovirology and Immunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Maja Milojevic
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ana Milinkovic
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Angelike Liappis
- Washington DC Veterans Affairs Medical Center and The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Line Borgwardt
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kathy Petoumenos
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Roger Paredes
- Department of Infectious Diseases and IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Shweta S Mistry
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Cameron R MacPherson
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Institut Roche, Boulogne-Billancourt, France
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel D Murray
- Centre of Excellence for Health, Immunity, and Infections, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
2
|
Batterham RL, Bedimo RJ, Diaz RS, Guaraldi G, Lo J, Martínez E, McComsey GA, Milinkovic A, Naito T, Noe S, O'Shea D, Paredes R, Schapiro JM, Sulkowski MS, Venter F, Waters L, Yoruk IU, Young B. Cardiometabolic health in people with HIV: expert consensus review. J Antimicrob Chemother 2024:dkae116. [PMID: 38656584 DOI: 10.1093/jac/dkae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts. METHODS A targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in workshops and completed surveys to refine consensus data statements and generate clinical recommendations. RESULTS Overall, 10 data statements, five data gaps and 14 clinical recommendations achieved consensus. In the data statements, the panel describes increased risk of cardiometabolic health concerns in people with HIV compared with the general population, known risk factors, and the potential impact of antiretroviral therapy. The panel also identified data gaps to inform future research in people with HIV. Finally, in the clinical recommendations, the panel emphasizes the need for a holistic approach to comprehensive care that includes regular assessment of cardiometabolic health, access to cardiometabolic health services, counselling on potential changes in weight after initiating or switching antiretroviral therapy and encouraging a healthy lifestyle to lower cardiometabolic health risk. CONCLUSIONS On the basis of available data and expert consensus, an international panel developed clinical recommendations to address the increased risk of cardiometabolic disorders in people with HIV to ensure appropriate cardiometabolic health management for this population.
Collapse
Affiliation(s)
- Rachel L Batterham
- UCL Division of Medicine, UCL School of Life and Medical Sciences, University College London, Gower Street, London WC1E 6BT, UK
- University College London Hospitals Biomedical Research Centre, National Institute for Health and Care Research, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Roger J Bedimo
- Infectious Disease Section, VA North Texas Health Care System, 4500 S Lancaster Road, Dallas, TX 75216, USA
- Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ricardo S Diaz
- Infectious Diseases Department, Paulista School of Medicine, Federal University of São Paulo, R. Sena Madureira, 1500 Vila Clementino, São Paulo, 04021-001, Brazil
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy
| | - Janet Lo
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Grace A McComsey
- Case Center for Diabetes, Obesity and Metabolism, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ana Milinkovic
- Global Medical, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
- HIV Services, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
- Imperial College London, Exhibition Road, South Kensington, London SW7 2BX, UK
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - Sebastian Noe
- MVZ Karlsplatz, MVZ Karlsplatz 8, 80335, Munich, Germany
| | - Donal O'Shea
- Health Sciences Centre, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Roger Paredes
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Jonathan M Schapiro
- National Hemophilia Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - François Venter
- Ezintsha, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - Laura Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, 350 Euston Road, Regent's Place, London NW1 3AX, UK
| | - Ilksen Ungan Yoruk
- General Medicines Europe, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Benjamin Young
- Global Medical, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
| |
Collapse
|
3
|
Moore AE, Burns JE, Sally D, Milinkovic A, Krokos G, John J, Rookyard C, Borca A, Pool ER, Tostevin A, Harman A, Dulnoan DS, Gilson R, Arenas-Pinto A, Cook GJ, Saunders J, Dunn D, Blake GM, Pett SL. Bone turnover change after randomized switch from tenofovir disoproxil to tenofovir alafenamide fumarate in men with HIV. AIDS 2024; 38:521-529. [PMID: 38061030 PMCID: PMC10906193 DOI: 10.1097/qad.0000000000003811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate. DESIGN Open-label, randomized controlled trial. SETTING Single-site, outpatient, secondary care. PARTICIPANTS Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks. INTERVENTION Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization). MAIN OUTCOME MEASURES :[ 18 F]NaF-PET/CT for bone turnover (standardized uptake values, SUV mean ) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD. RESULTS Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23-103 (median 55) weeks. LS-SUV mean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUV mean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX ( P = 0.02, P1NP, P = 0.17). CONCLUSION Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUV mean ) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUV mean may be due to inadequate power.
Collapse
Affiliation(s)
- Amelia E.B. Moore
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
- Osteoporosis Unit, Guy's and St Thomas’ NHS Foundation Trust
| | - James E. Burns
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Deirdre Sally
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Ana Milinkovic
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Georgios Krokos
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Joemon John
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Christopher Rookyard
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Alessandro Borca
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Erica R.M. Pool
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Anna Tostevin
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Alyss Harman
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | | | - Richard Gilson
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Alejandro Arenas-Pinto
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Gary J.R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - John Saunders
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - David Dunn
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital, London, UK
| | - Sarah L. Pett
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| |
Collapse
|
4
|
O'Halloran C, Gilleece Y, Leung S, Canuto V, McAlpine C, Ross S, Norcross C, Gaffney S, Siani N, Hickey W, Moore A, Rajkovic-Hooley O, Milinkovic A. Real world utilisation of doravirine among people living with human immunodeficiency virus in England (DRIVE-REAL). Int J STD AIDS 2024; 35:206-216. [PMID: 37970812 DOI: 10.1177/09564624231215977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Doravirine is a non-nucleoside reverse transcriptase inhibitor recommended for the treatment of virologically suppressed and treatment naïve people living with HIV. The DRIVE-REAL study aimed to describe the characteristics, treatment patterns, and virological outcomes of doravirine users in a real-world cohort in the UK. METHODS A retrospective, observational, multi-centre chart review was conducted for 300 adults living with HIV initiating doravirine-containing antiretroviral therapy. RESULTS At baseline 83% of individuals were male, 45% aged ≥50 years, 65% white ethnicity. Median time since HIV diagnosis was 12 years. 96% were antiretroviral therapy-experienced, 87% had a HIV viral load <50 copies/ml, and 15% had resistance to at least one antiretroviral drug. 66% had comorbidities, most commonly depression (26%), and 70% were taking at least one co-medication. At six months, 94% (n = 283/300) were still receiving doravirine. Viral load data were available for n = 266/300 individuals and 95% (n = 253/266) had viral load <50 copies/ml. CONCLUSIONS Individuals initiating doravirine in this cohort are predominantly treatment-experienced white middle-aged males, with a high frequency of comorbidities and co-medication. The majority of individuals at 6 months remained on doravirine and maintained or achieved HIV viral suppression. This study provides epidemiologic characteristics that can inform clinical care and subsequent hypothesis-testing studies.
Collapse
Affiliation(s)
| | - Yvonne Gilleece
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | - Suki Leung
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Veronica Canuto
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Connor McAlpine
- College London and Mortimer Market Centre, Centre for Clinical Research in Infection and Sexual Health University, London, UK
| | - Sophie Ross
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | - Claire Norcross
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | | | - Nipur Siani
- Medical Affairs (HIV), MSD (UK) Limited, London, UK
| | | | - Adam Moore
- Adelphi Real World (ARW), Bollington, UK
| | | | - Ana Milinkovic
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| |
Collapse
|
5
|
Arenas-Pinto A, Bakewell N, Milinkovic A, Williams I, Vera J, Post FA, Anderson J, Beynon M, O'Brien A, Doyle N, Gilson R, Pett SL, Winston A, Sabin CA. Hepatic steatosis in people older and younger than fifty who are living with HIV and HIV-negative controls: A cross-sectional study nested within the POPPY cohort. HIV Med 2024; 25:95-106. [PMID: 37670375 DOI: 10.1111/hiv.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hepatic steatosis is a major cause of chronic liver disease associated with several negative health outcomes. We compared the prevalence of and factors associated with steatosis in people living with and without HIV. METHODS Older (>50 years) and younger (<50 years) people with HIV and older HIV-negative controls (>50 years) underwent liver transient elastography examination with controlled attenuation parameter (steatosis ≥238 dB/m, moderate/severe steatosis ≥280 dB/m, liver fibrosis ≥7.1 kPa). We compared groups using logistic regression/Chi-squared/Fisher's exact/Kruskal-Wallis tests. RESULTS In total, 317 participants (109 older people with HIV; 101 younger people with HIV; 107 HIV-negative controls) were predominantly white (86%) and male (76%), and 21% were living with obesity (body mass index ≥30 kg/m2 ). Most (97%) people with HIV had undetectable HIV RNA. The prevalence of fibrosis was 8.4%, 3.0%, and 6.5% in the three groups, respectively (p = 0.26). Fibrosis was predominately (>65%) mild. The prevalence of steatosis was the same in older people with HIV (66.4%) and controls (66.4%) but lower in younger people with HIV (37.4%; p < 0.001). After adjustment, younger people with HIV were less likely to have steatosis (odds ratio [OR] 0.26; 95% confidence interval [CI] 0.14-0.52) than controls, but male sex (OR 2.45; 95% CI 1.20-4.50) and high waist-to-hip ratio (OR 3.04; 95% CI 1.74-5.33) were associated with an increased odds of steatosis. We found no association between steatosis and HIV-related variables. CONCLUSIONS The prevalence of hepatic steatosis and fibrosis was similar between older participants regardless of HIV status. Age, sex, and abdominal obesity, but not HIV-related variables, were associated with steatosis. Interventions for controlling obesity should be integrated into routine HIV care.
Collapse
Affiliation(s)
- Alejandro Arenas-Pinto
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit at University College London, London, UK
- Central and North-West London NHS Foundation Trust, London, UK
| | | | - Ana Milinkovic
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ian Williams
- Institute for Global Health, University College London, London, UK
- Central and North-West London NHS Foundation Trust, London, UK
| | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Michelle Beynon
- Institute for Global Health, University College London, London, UK
- Central and North-West London NHS Foundation Trust, London, UK
| | - Alastair O'Brien
- Institute of Liver and Digestive Health, University College London, London, UK
| | | | - Richard Gilson
- Institute for Global Health, University College London, London, UK
- Central and North-West London NHS Foundation Trust, London, UK
| | - Sarah L Pett
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit at University College London, London, UK
- Central and North-West London NHS Foundation Trust, London, UK
| | | | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
6
|
Sullivan AK, Saunders J, Desai M, Cartier A, Mitchell HD, Jaffer S, Ogaz D, Chiavenna C, Charlett A, Diamente V, Golombek R, Manavi K, Priestley C, Waters LJ, Milinkovic A, McOwan A, Estcourt C, Sabin CA, Rodger A, Gold D, Gazzard BG, McCormack S, Gill ON. HIV pre-exposure prophylaxis and its implementation in the PrEP Impact Trial in England: a pragmatic health technology assessment. Lancet HIV 2023; 10:e790-e806. [PMID: 38040478 DOI: 10.1016/s2352-3018(23)00256-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. To enable routine commissioning of PrEP in England, we aimed to establish population need, duration of need, PrEP uptake, and duration of use in attendees of sexual health services (SHS) in England. METHODS The Impact Trial was a prospective, open-label, single-arm, multicentre trial conducted at 157 SHS across England between Oct 13, 2017, and July 12, 2020. Clinicians assessed HIV-negative attendees for their risk of HIV acquisition to identify those who were eligible to participate and receive either daily or event-based oral PrEP (tenofovir disoproxil maleate with emtricitabine), as appropriate. Eligible participants were aged 16 years or older, considered HIV-negative on the day of enrolment, and willing to adhere to the trial procedures. Non-trial attendees are mutually exclusive of trial participants and included SHS attendees who were not recruited to the Impact Trial at any point. They include HIV-negative individuals aged 16 years or older who attended a participating SHS at least once after recruitment at that SHS had begun and before Feb 29, 2020. The main outcomes assessed were PrEP need, uptake, and use, and HIV and sexually transmitted infection (STI) incidence. Data are presented up to Feb 29, 2020, before the introduction of COVID-19 control measures. The study is registered with ClinicalTrials.gov, NCT03253757. FINDINGS In this analysis, we include 21 356 of 24 268 participants enrolled before Feb 29, 2020. 20 403 participants (95·5%) were men who have sex with men (MSM). Uptake of PrEP among SHS attendees clinically assessed and coded as eligible was 21 292 (57·1%) of 37 289. 18 400 trial participants had at least one post-enrolment visit and a median of 361 days of follow-up (IQR 143-638); 14 039 (75·9%) of these had enough PrEP prescribed to provide protection for 75% of their follow-up time. Among MSM, HIV incidence was 0·13 (95% CI 0·08-0·19) per 100 person-years in trial participants (27 seroconversions) and 0·95 (95% CI 0·88-1·03) per 100 person-years in non-trial attendees (587 seroconversions; proportionate reduction of 86·8%, 95% CI 80·2-91·6). 18 607 bacterial STIs were recorded (incidence 68·1 per 100 person-years in trial participants who were MSM). 4343 (24·4%) MSM participants were diagnosed with two or more STIs, accounting for 14 800 (79·5%) of all 18 607 diagnoses. INTERPRETATION PrEP need was higher than initially estimated by an expert stakeholder group. The high proportion of follow-up time protected by PrEP suggests that the need for protection persisted throughout trial participation for most participants. HIV incidence among MSM trial participants was low. The large unmet need for PrEP suggests that greater provision is required to maximise the potential of a national programme. The high incidence of bacterial STIs among participants, concentrated within a subgroup of PrEP users, presents an opportunity for tailored STI control measures. FUNDING NHS England.
Collapse
Affiliation(s)
- Ann K Sullivan
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK; UK Health Security Agency, London, UK.
| | - John Saunders
- UK Health Security Agency, London, UK; University College London, London, UK; National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | | | - Andrea Cartier
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | | | - Sajjida Jaffer
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | - Dana Ogaz
- UK Health Security Agency, London, UK
| | | | | | - Victor Diamente
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | - Rainer Golombek
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | - Kaveh Manavi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Laura J Waters
- Central and North West London NHS Foundation Trust, London, UK
| | - Ana Milinkovic
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | | | - Caroline A Sabin
- University College London, London, UK; National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | | | | | - Brian G Gazzard
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, UK; University College London, London, UK
| | | |
Collapse
|
7
|
Vrbic M, Milinkovic A. Two vicious circles associated with the aging of the immune system in the development of severe forms of COVID-19. Front Aging 2023; 4:1260053. [PMID: 37780864 PMCID: PMC10537960 DOI: 10.3389/fragi.2023.1260053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
Background: The immune-inflammatory response is the basis of the pathophysiology of SARS-Cov-2 infection. In severe cases of COVID-19 uncontrolled systemic inflammatory response causes multiorgan dysfunction (MODS), as the most common immediate cause of death. Unfavorable outcome of the COVID-19 most often occurs in elderly patients. The aim of the study was to establish parameters with prognostic significance in severe cases of COVID-19 according to life years, laboratory markers of sepsis and MODS, as well as the number of peripheral CD4+ and CD8+T lymphocytes in 20 consecutively selected critically ill patients. Results: Eleven subjects were male, 9 female, mean age 73.45 ± 11.59, among which the oldest patient was 94 and the youngest 43 years. All the patients met the sepsis and MODS criteria. Increased age and low CD4+ and CD8+T cell counts were identified as independent predictors of death. Only the two youngest patients (43 and 50 years old) survived 28 days, and they are the only ones with a CD4 lymphocyte count above 500 cells/mm3. Conclusion: Senescence of the immune system is mostly characterized by reduced regenerative capacity of adaptive immunity with diminished ability to respond to new antigens and a manifested proinflammatory phenotype. Additional reduction of protective capacity by further deterioration of T cell quantity and quality due to sepsis itself and mutual interaction of senescent T cells and vascular endothelial cells in the induction of cytokine storm represent two complementary vicious cycles in the development of sepsis-related multiorgan dysfunction.
Collapse
Affiliation(s)
| | - Ana Milinkovic
- Chelsea and Westminster Foundation Trust and Imperial College London, London, United Kingdom
| |
Collapse
|
8
|
Mazzitelli M, Trunfio M, Milinkovic A, Castelli E, Sasset L, Leoni D, Salvucci M, Cazzaro R, Calcinoni I, Balducci P, Ribeiro GCQ, Filagrana G, Scaglione V, Cattelan AM. Sleep disturbances and their correlation with cardiovascular risk, obesity, and mood disorders in people with HIV. AIDS 2023; 37:925-934. [PMID: 36723511 DOI: 10.1097/qad.0000000000003493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationship between sleep disorders (SDs), cardiovascular risk (CVR), and mood disorders (MDs) has been studied in detail in the general population, but far less in people with HIV (PWH). METHODS Cross-sectional analysis in single centre cohort of PWH. Sleep quality was assessed using by Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire (BQ), Pittsburgh Sleep Quality Index (PSQI); anxiety and depression were evaluated by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Demographic, clinical and HIV-related data were collected, and Framingham and Data collection on Adverse effects of anti-HIV Drugs (DAD)-10 scores were computed in modelling associations with each SDs scale. RESULTS Data were collected for 721 PWH on stable combination antiretroviral therapy (cART) (median age of 53 years, 71.8% males, 96% with undetectable HIV RNA, 50.3% on cART potentially affecting sleep, and 20.4% on hypno-inducing drugs), 76.9% had SDs 60.3, 31.3, 31.1, and 7.9% at PSQI, BQ, ISI, and ESS, respectively. Anxiety and depression were detected in 28.3 and 16.1% participants, respectively. BQ score was independently associated with high BMI ( P < 0.001), Framingham risk >10% ( P < 0.001), and both DAD-10R and -10F score >10% ( P < 0.001 and P = 0.031). PSQI and ISI scores were independently associated with depression and anxiety ( P < 0.001). No association between SDs and specific antiretroviral regimens, nor HIV-related parameters was detected. CONCLUSIONS In our cohort of PWH on stable ART, despite the alarmingly higher prevalence, SDs were associated with the same determinants (cardiovascular risk factors and MDs) observed in the general population.
Collapse
Affiliation(s)
- Maria Mazzitelli
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, Turin, Italy
- HIV Neurobehavioral Research Program and Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, California, USA
| | - Ana Milinkovic
- Chelsea and Westminster Foundation Trust
- Imperial College London, London, UK
| | - Eleonora Castelli
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Lolita Sasset
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Davide Leoni
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | | | | | | | | | | | | | - Vincenzo Scaglione
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Anna M Cattelan
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
- Student at University of Padua, Padua University Hospital
- University of Padua, Padua, Italy
| |
Collapse
|
9
|
Ates AC, Bachnak A, Murateva Y, Toiber Kent Y, Blackburn S, Boffito M, Milinkovic A, Tong T, Varadarajan M. Results of a Multi-Disciplinary Approach Involving Geriatricians of a Clinic for Older People Living with HIV. AIDS Patient Care STDS 2023; 37:213-214. [PMID: 37083444 DOI: 10.1089/apc.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Aylin Cansu Ates
- Imperial College London Faculty of Medicine, London, United Kingdom
| | - Andrei Bachnak
- Imperial College London Faculty of Medicine, London, United Kingdom
| | - Yana Murateva
- Imperial College London Faculty of Medicine, London, United Kingdom
| | | | - Sophie Blackburn
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Marta Boffito
- Imperial College London Faculty of Medicine, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Ana Milinkovic
- Imperial College London Faculty of Medicine, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Tim Tong
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Maithili Varadarajan
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| |
Collapse
|
10
|
Szubert AJ, Pollock KM, Cheeseman HM, Alagaratnam J, Bern H, Bird O, Boffito M, Byrne R, Cole T, Cosgrove CA, Faust SN, Fidler S, Galiza E, Hassanin H, Kalyan M, Libri V, McFarlane LR, Milinkovic A, O'Hara J, Owen DR, Owens D, Pacurar M, Rampling T, Skene S, Winston A, Woolley J, Yim YTN, Dunn DT, McCormack S, Shattock RJ. COVAC1 phase 2a expanded safety and immunogenicity study of a self-amplifying RNA vaccine against SARS-CoV-2. EClinicalMedicine 2023; 56:101823. [PMID: 36684396 PMCID: PMC9837478 DOI: 10.1016/j.eclinm.2022.101823] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Lipid nanoparticle (LNP) encapsulated self-amplifying RNA (saRNA) is well tolerated and immunogenic in SARS-CoV-2 seronegative and seropositive individuals aged 18-75. Methods A phase 2a expanded safety and immunogenicity study of a saRNA SARS-CoV-2 vaccine candidate LNP-nCoVsaRNA, was conducted at participating centres in the UK between 10th August 2020 and 30th July 2021. Participants received 1 μg then 10 μg of LNP-nCoVsaRNA, ∼14 weeks apart. Solicited adverse events (AEs) were collected for one week post-each vaccine, and unsolicited AEs throughout. Binding and neutralisating anti-SARS-CoV-2 antibody raised in participant sera was measured by means of an anti-Spike (S) IgG ELISA, and SARS-CoV-2 pseudoneutralisation assay. (The trial is registered: ISRCTN17072692, EudraCT 2020-001646-20). Findings 216 healthy individuals (median age 51 years) received 1.0 μg followed by 10.0 μg of the vaccine. 28/216 participants were either known to have previous SARS-CoV2 infection and/or were positive for anti-Spike (S) IgG at baseline. Reactogenicity was as expected based on the reactions following licensed COVID-19 vaccines, and there were no serious AEs related to vaccination. 80% of baseline SARS-CoV-2 naïve individuals (147/183) seroconverted two weeks post second immunization, irrespective of age (18-75); 56% (102/183) had detectable neutralising antibodies. Almost all (28/31) SARS-CoV-2 positive individuals had increased S IgG binding antibodies following their first 1.0 μg dose with a ≥0.5log10 increase in 71% (22/31). Interpretation Encapsulated saRNA was well tolerated and immunogenic in adults aged 18-75 years. Seroconversion rates in antigen naïve were higher than those reported in our dose-ranging study. Further work is required to determine if this difference is related to a longer dosing interval (14 vs. 4 weeks) or dosing with 1.0 μg followed by 10.0 μg. Boosting of S IgG antibodies was observed with a single 1.0 μg injection in those with pre-existing immune responses. Funding Grants and gifts from the Medical Research Council UKRI (MC_PC_19076), the National Institute for Health Research/Vaccine Task Force, Partners of Citadel and Citadel Securities, Sir Joseph Hotung Charitable Settlement, Jon Moulton Charity Trust, Pierre Andurand, and Restore the Earth.
Collapse
Affiliation(s)
| | - Katrina M. Pollock
- Department of Infectious Disease, Imperial College London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | | | | | - Henry Bern
- cMRC Clinical Trials Unit at UCL, London, UK
| | - Olivia Bird
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | | | - Ruth Byrne
- Chelsea & Westminster Hospital, London, UK
| | - Tom Cole
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Catherine A. Cosgrove
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, UK
| | - Eva Galiza
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | - Hana Hassanin
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mohini Kalyan
- Department of Infectious Disease, Imperial College London, UK
| | - Vincenzo Libri
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London, UK
| | - David R. Owen
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Daniel Owens
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Mihaela Pacurar
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Tommy Rampling
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Simon Skene
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, UK
| | - James Woolley
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Yee Ting N. Yim
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | | | - COVAC 1 Study Teaml
- cMRC Clinical Trials Unit at UCL, London, UK
- Department of Infectious Disease, Imperial College London, UK
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
- Chelsea & Westminster Hospital, London, UK
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
11
|
Bannister WP, Mast TC, de Wit S, Gerstoft J, Wiese L, Milinkovic A, Hadziosmanovic V, Clarke A, Rasmussen LD, Lacombe K, Schommers P, Staub T, Zagalo A, Portu JJ, Tau L, Calmy A, Cavassini M, Gisinger M, Borodulina E, Mocroft A, Reekie J, Peters L. Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens. AIDS 2022; 36:2107-2119. [PMID: 35848573 DOI: 10.1097/qad.0000000000003332] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Weight gain is becoming increasingly prevalent amongst people with HIV (PWH) receiving contemporary antiretroviral treatment. We investigated BMI changes and clinical impact in a large prospective observational study. METHODS PWH aged ≥18 years were included who started a new antiretroviral (baseline) during 2010-2019 with baseline and ≥1 follow-up BMI assessment available. Rates of clinical outcomes (cardiovascular disease [CVD], malignancies, diabetes mellitus [DM] and all-cause mortality) were analysed using Poisson regression to assess effect of time-updated BMI changes (>1 kg/m 2 decrease, ±1 kg/m 2 stable, >1 kg/m 2 increase), lagged by 1-year to reduce reverse causality. Analyses were adjusted for baseline BMI plus key confounders including antiretroviral exposure. RESULTS 6721 PWH were included; 72.3% were male, median age 48 years (interquartile range [IQR] 40-55). At baseline, 8.4% were antiretroviral-naive, and 5.0% were underweight, 59.7% healthy weight, 27.5% overweight, and 7.8% were living with obesity. There was an 8.2% increase in proportion of overweight and 4.8% in obesity over the study period (median follow-up 4.4 years [IQR 2.6-6.7]).100 CVDs, 149 malignancies, 144 DMs, and 257 deaths were observed with incidence rates 4.4, 6.8, 6.6, 10.6 per 1000 person-years of follow-up, respectively. Compared to stable BMI, >1 kg/m 2 increase was associated with increased risk of DM (adjusted incidence rate ratio [IRR]: 1.96, 95% confidence interval [CI]: 1.36-2.80) and >1 kg/m 2 decrease with increased risk of death (adjusted IRR: 2.33, 95% CI: 1.73-3.13). No significant associations were observed between BMI changes and CVD or malignancies. CONCLUSIONS A BMI increase was associated with DM and a decrease associated with death.
Collapse
Affiliation(s)
- Wendy P Bannister
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Stéphane de Wit
- CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lothar Wiese
- Sjællands Universitetshospital, Roskilde, Denmark
| | | | - Vesna Hadziosmanovic
- University Clinical Centre Sarajevo, Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina
| | - Amanda Clarke
- University Hospitals Sussex NHS Foundation Trust and Brighton & Sussex Medical School, Brighton, UK
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Karine Lacombe
- Sorbonne Université, IPLESP Inserm UMR-S1136, AP-HP, Paris, France
| | - Philipp Schommers
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Thérèse Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg
| | - Alexandra Zagalo
- Santa Maria University Hospital, Department of Infectious Diseases, Lisbon, Portugal
| | | | - Luba Tau
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | - Amanda Mocroft
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Wu S, Hilton O, Pereira B, Girometti N, Milinkovic A, Ollandini G, Boffito M. Correlation between different equations to calculate free testosterone for improved detection of hypogonadism in people living with HIV. Int J STD AIDS 2022; 33:613-617. [PMID: 35379047 DOI: 10.1177/09564624221083760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of hypogonadism in people living with HIV (PLWH) remains challenging by the lack of a standardised diagnostic algorithm. Since sexual hormone-binding globulin levels are commonly increased in PLWH, guidelines recommend assessing free testosterone (FT) along with total testosterone levels. We compared different online equations available to estimate FT levels and found a good correlation amongst all algorithms. Estimating FT levels increased diagnostic accuracy of hypogonadism and therefore should be encouraged in clinical practice in PLWH with clinical symptoms of hypogonadism, even when total testosterone levels are normal.
Collapse
Affiliation(s)
- Shuang Wu
- 4615Department of Infectious Diseases, Imperial College London, London, UK
| | - Orla Hilton
- 4615Department of Infectious Diseases, Imperial College London, London, UK
| | - Branca Pereira
- 4615Department of Infectious Diseases, Imperial College London, London, UK.,HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicolo Girometti
- HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ana Milinkovic
- HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Giangiacomo Ollandini
- Urology Department, 156774Milton Keynes University Hospital, Milton Keynes, UK.,Department of HIV and Sexual Health, 577312King's College Hospital, London, UK
| | - Marta Boffito
- 4615Department of Infectious Diseases, Imperial College London, London, UK.,HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
13
|
Milinkovic A, Pereira B, Mazziteli M, Girometti N, Asboe D, Pozniak A, Boffito M. Delivering specialised care to people ageing with HIV in the UK: experience and evolution of services from 2009 to 2019. The Lancet HIV 2022; 9 Suppl 1:S1. [DOI: 10.1016/s2352-3018(22)00066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Pereira B, Mazzitelli M, Milinkovic A, Casley C, Rubio J, Channa R, Girometti N, Asboe D, Pozniak A, Boffito M. Evaluation of a Clinic Dedicated to People Aging with HIV at Chelsea and Westminster Hospital: Results of a 10-Year Experience. AIDS Res Hum Retroviruses 2022; 38:188-197. [PMID: 34269603 DOI: 10.1089/aid.2021.0083] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Successful management of HIV infection as a chronic condition has resulted in a demographic shift where the proportion of people living with HIV (PLWH) older than 50 years is steadily increasing. A dedicated clinic to PLWH older than 50 years was established at Chelsea and Westminster Hospital in January 2009 and then extended to HIV services across the directorate. We report the results of a service evaluation reviewing 10 years of activities of this clinic between January 2009 and 2019. We aimed to estimate the prevalence of major noninfectious comorbidities, polypharmacy (≥5 medications), and multimorbidity (≥2 non-HIV-related comorbidities) and describe algorithms devised for use in HIV outpatient clinics across the directorate. A cohort of 744 PLWH older than 50 years attending this service were analyzed (93% male; mean age of 56 ± 5.5 years; 84% white ethnicity); 97.7% were on antiretroviral treatment and 95.9% had undetectable HIV-RNA at the time of evaluation. The most common comorbidities diagnosed were dyslipidemia (50.1%), hypertension (21.5%), mental health disorders (depression and/or anxiety disorders, 15.7%), osteoporosis (12.2%), obesity (11.9%), chronic kidney disease (7.5%), and diabetes (5.8%). Low vitamin D levels were found in 62% of patients [43% with vitamin D deficiency (<40 mmol/liter) and 57% with vitamin D insufficiency (40-70 mmol/liter)]. The overall prevalence of polypharmacy and multimorbidity was 46.6% and 69.3%, respectively. This study showed significant rates of non-HIV-related comorbidities and polypharmacy in PLWH older than 50 years, leading on to the implementation of clinical care pathways and new joint HIV/specialty clinics (cardiology, nephrology, neurology, metabolic, menopause, and geriatric) to improve prevention, diagnosis, and management of major comorbidities in people aging with HIV.
Collapse
Affiliation(s)
- Branca Pereira
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Maria Mazzitelli
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Medical and Surgical Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Ana Milinkovic
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Christina Casley
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Javier Rubio
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachel Channa
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicolo Girometti
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David Asboe
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Anton Pozniak
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Marta Boffito
- HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
15
|
Pereira B, Mazzitelli M, Milinkovic A, Moyle G, Mandalia S, Al-hussaini A, Boffito M. Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in People Aging with HIV. AIDS Res Hum Retroviruses 2022; 38:80-86. [PMID: 34652963 DOI: 10.1089/aid.2021.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cardiovascular disease (CVD) is an important cause of morbidity in people living with HIV (PLWH). We compared the predictive value of HIV-related and traditional CVD risk factors to assess which factors best predict the presence of subclinical coronary atherosclerosis in PLWH. This is a cross-sectional study in PLWH over 50 years of age who performed computed tomography coronary artery calcium (CAC) scoring between 2009 and 2019 at Chelsea and Westminster Hospital. The following outcomes were analyzed: CAC = 0 (no calcification), CAC >0 (any calcification), CAC >100 (moderate calcification), and CAC >400 (severe calcification). Univariate and multivariate logistic regression analyses were performed to assess predictors of coronary calcification. A total of 744 patients were included (mean age 56 ± 5.7 years, 94.8% male, 84% white). A CAC >0 was found in 392 (52.7%), CAC >100 in 90 (12.1%), and CAC >400 in 42 (5.6%) subjects. CAC >100 was strongly associated with hypertension [odds ratio, OR: 2.91, (95% confidence interval: 1.93-4.36), p < .001], dyslipidemia [2.71 (1.81-4.06), p < .001], and diabetes [2.53 (1.29-4.96), p = .01]. Regarding HIV-specific factors, a significant association was found with exposure (>6 years) to protease inhibitors [1.67 (1.06-2.61), p = .05], whereas exposure to tenofovir (>8 years) was negatively associated with CAC >100 [0.54 (0.30-0.98), p = .05]. Despite the high prevalence of hypertension (45.4%) only 21.5% were on antihypertensives, whereas only 29.2% of eligible candidates were receiving lipid-lowering drugs for primary prevention of CVD. Traditional cardiometabolic risk factors remain the strongest predictors of coronary atherosclerosis in PLWH as in the general population. These results underscore the importance of optimizing treatment of hypertension and promoting primary prevention strategies that may be underused in PLWH.
Collapse
Affiliation(s)
- Branca Pereira
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Maria Mazzitelli
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Health Sciences Department, “Magna Graecia University,” Catanzaro, Italy
| | - Ana Milinkovic
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Graeme Moyle
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Sundhiya Mandalia
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Abtehale Al-hussaini
- Cardiology Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Marta Boffito
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| |
Collapse
|
16
|
Pollock KM, Cheeseman HM, Szubert AJ, Libri V, Boffito M, Owen D, Bern H, O'Hara J, McFarlane LR, Lemm NM, McKay PF, Rampling T, Yim YTN, Milinkovic A, Kingsley C, Cole T, Fagerbrink S, Aban M, Tanaka M, Mehdipour S, Robbins A, Budd W, Faust SN, Hassanin H, Cosgrove CA, Winston A, Fidler S, Dunn DT, McCormack S, Shattock RJ. Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial. EClinicalMedicine 2022; 44:101262. [PMID: 35043093 PMCID: PMC8759012 DOI: 10.1016/j.eclinm.2021.101262] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lipid nanoparticle (LNP) encapsulated self-amplifying RNA (saRNA) is a novel technology formulated as a low dose vaccine against COVID-19. METHODS A phase I first-in-human dose-ranging trial of a saRNA COVID-19 vaccine candidate LNP-nCoVsaRNA, was conducted at Imperial Clinical Research Facility, and participating centres in London, UK, between 19th June to 28th October 2020. Participants received two intramuscular (IM) injections of LNP-nCoVsaRNA at six different dose levels, 0.1-10.0μg, given four weeks apart. An open-label dose escalation was followed by a dose evaluation. Solicited adverse events (AEs) were collected for one week from enrolment, with follow-up at regular intervals (1-8 weeks). The binding and neutralisation capacity of anti-SARS-CoV-2 antibody raised in participant sera was measured by means of an anti-Spike (S) IgG ELISA, immunoblot, SARS-CoV-2 pseudoneutralisation and wild type neutralisation assays. (The trial is registered: ISRCTN17072692, EudraCT 2020-001646-20). FINDINGS 192 healthy individuals with no history or serological evidence of COVID-19, aged 18-45 years were enrolled. The vaccine was well tolerated with no serious adverse events related to vaccination. Seroconversion at week six whether measured by ELISA or immunoblot was related to dose (both p<0.001), ranging from 8% (3/39; 0.1μg) to 61% (14/23; 10.0μg) in ELISA and 46% (18/39; 0.3μg) to 87% (20/23; 5.0μg and 10.0μg) in a post-hoc immunoblot assay. Geometric mean (GM) anti-S IgG concentrations ranged from 74 (95% CI, 45-119) at 0.1μg to 1023 (468-2236) ng/mL at 5.0μg (p<0.001) and was not higher at 10.0μg. Neutralisation of SARS-CoV-2 by participant sera was measurable in 15% (6/39; 0.1μg) to 48% (11/23; 5.0μg) depending on dose level received. INTERPRETATION Encapsulated saRNA is safe for clinical development, is immunogenic at low dose levels but failed to induce 100% seroconversion. Modifications to optimise humoral responses are required to realise its potential as an effective vaccine against SARS-CoV-2. FUNDING This study was co-funded by grants and gifts from the Medical Research Council UKRI (MC_PC_19076), and the National Institute Health Research/Vaccine Task Force, Partners of Citadel and Citadel Securities, Sir Joseph Hotung Charitable Settlement, Jon Moulton Charity Trust, Pierre Andurand, Restore the Earth.
Collapse
Affiliation(s)
- Katrina M. Pollock
- Department of Infectious Disease, Imperial College London
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | | | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Marta Boffito
- Department of Infectious Disease, Imperial College London
- Chelsea & Westminster Hospital, London
| | - David Owen
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, London, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London
| | | | | | - Paul F. McKay
- Department of Infectious Disease, Imperial College London
| | - Tommy Rampling
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Yee Ting N. Yim
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | - Tom Cole
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Susanne Fagerbrink
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Marites Aban
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Maniola Tanaka
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Savviz Mehdipour
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Alexander Robbins
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - William Budd
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hana Hassanin
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | - Alan Winston
- Department of Infectious Disease, Imperial College London
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London
| | | | | | - Robin J. Shattock
- Department of Infectious Disease, Imperial College London
- Corresponding author.
| | | |
Collapse
|
17
|
Amele S, Sandri AK, Rodger A, Vandekerckhove L, Benfield T, Milinkovic A, Duvivier C, Stellbrink HJ, Sambatakou H, Chkhartishvili N, Caldeira L, Laguno M, Domingo P, Wandeler G, Gisinger M, Kuzovatova E, Dragovic G, Knysz B, Matulionyte R, Rockstroh JK, Lundgren JD, Mocroft A, Peters L. HCV reinfection after HCV therapy among HIV/HCV-coinfected individuals in Europe. HIV Med 2021; 23:684-692. [PMID: 34882940 DOI: 10.1111/hiv.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/22/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Although direct-acting antivirals (DAAs) can clear HCV in nearly all HIV/HCV-coinfected individuals, high rates of reinfection may hamper efforts to eliminate HCV in this population. We investigated reinfection after sustained virological response (SVR) in HIV/HCV-coinfected individuals in Europe. METHODS Factors associated with odds of reinfection by 2 years after SVR in EuroSIDA participants with one or more HCV-RNA test and 2 years follow-up were assessed using logistic regression. RESULTS Overall, 1022 individuals were included. The median age was 50 (interquartile range: 43-54 years), and most were male (78%), injection drug users (52%), and received interferon (IFN)-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7-8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11-0.38; 0.43, 95% CI: 0.22-0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis. CONCLUSIONS Among HIV/HCV-coinfected individuals in Europe, 7.3% were reinfected with HCV within 24 months of achieving SVR, with evidence suggesting that this is decreasing over time and with use of newer HCV regimens. Harm reduction to reduce reinfection and surveillance to detect early reinfection with an offer of treatment are essential to eliminate HCV.
Collapse
Affiliation(s)
- Sarah Amele
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | - Thomas Benfield
- Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Claudine Duvivier
- AP-HP - Necker Enfants Malades Hospital, Infectious Diseases Department; Necker Pasteur Center for Infectious Diseases and Tropical Medicine; Université de Paris; IHU Imagine, Paris, France
| | | | | | | | - Luis Caldeira
- Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal
| | | | - Pere Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute, Nizhny Novgorod, Russia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.,CHIP, Rigshospitalet, Copenhagen, Denmark
| | | | | |
Collapse
|
18
|
Mocroft A, Miro JM, Wandeler G, Llibre JM, Boyd A, van Bremen K, Beniowski M, Mikhalik J, Cavassini M, Maltez F, Duvivier C, Uberti Foppa C, Knysz B, Bakowska E, Kuzovatova E, Domingo P, Zagalo A, Viard JP, Degen O, Milinkovic A, Benfield T, Peters L. The association between hepatitis B virus infection and nonliver malignancies in persons living with HIV: results from the EuroSIDA study. HIV Med 2021; 23:585-598. [PMID: 34889022 DOI: 10.1111/hiv.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of hepatitis B virus (HBV) infection on non-liver malignancies in people living with HIV (PLWH). METHODS All persons aged ≥ 18 years with known hepatitis B virus (HBV) surface antigen (HBsAg) status after the latest of 1 January 2001 and enrolment in the EuroSIDA cohort (baseline) were included in the study; persons were categorized as HBV positive or negative using the latest HBsAg test and followed to their first diagnosis of nonliver malignancy or their last visit. RESULTS Of 17 485 PLWH included in the study, 1269 (7.2%) were HBV positive at baseline. During 151 766 person-years of follow-up (PYFU), there were 1298 nonliver malignancies, 1199 in those currently HBV negative [incidence rate (IR) 8.42/1000 PYFU; 95% confidence interval (CI) 7.94-8.90/1000 PYFU] and 99 in those HBV positive (IR 10.54/1000 PYFU; 95% CI 8.47-12.62/1000 PYFU). After adjustment for baseline confounders, there was a significantly increased incidence of nonliver malignancies in HBV-positive versus HBV-negative individuals [adjusted incidence rate ratio (aIRR) 1.23; 95% CI 1.00-1.51]. Compared to HBV-negative individuals, HBsAg-positive/HBV-DNA-positive individuals had significantly increased incidences of nonliver malignancies (aIRR 1.37; 95% CI 1.00-1.89) and NHL (aIRR 2.57; 95% CI 1.16-5.68). There was no significant association between HBV and lung or anal cancer. CONCLUSIONS We found increased rates of nonliver malignancies in HBsAg-positive participants, the increases being most pronounced in those who were HBV DNA positive and for NHL. If confirmed, these results may have implications for increased cancer screening in HIV-positive subjects with chronic HBV infection.
Collapse
Affiliation(s)
- Amanda Mocroft
- CHIP, Rigshospitalet, Copenhagen, Denmark.,Centre for Clinical Research Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jose M Miro
- Hospital Clinic-IDIBAPS University of Barcelona, Barcelona, Spain
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Josep M Llibre
- Infectious Diseases Unit & Fight AIDS Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Anders Boyd
- Stichting HIV Monitoring (SHM), Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | | | - Marek Beniowski
- Diagnostics and Therapy for AIDS, Specialistic Hospital, Chorzów, Poland
| | | | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, Paris, France.,University of Paris, INSERM U1016, Paris, France.,HU Imagine, Paris, France.,Institut Pasteur, Institut Pasteur Medical Center, Paris, France
| | | | | | | | - Elena Kuzovatova
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology, Nizhny Novgorod, Russia
| | - Pere Domingo
- Department of Infectious Diseases, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | - Alexandra Zagalo
- Department of Infectious Diseases, Santa Maria University Hospital, Lisbon, Portugal
| | - Jean-Paul Viard
- Diagnostic and Therapeutic Center, Hôtel-Dieu, AP-HP, Paris, France
| | - Olaf Degen
- University Clinic Hamburg Eppendorf, Hamburg, Germany
| | | | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | | |
Collapse
|
19
|
Bracchi M, Pagani N, Dalla Pria A, Milinkovic A, Nwokolo N, Thomas L, Mandalia S, Boffito M, Moyle G. A phase IV, open-label three-arm study investigating the impact of a combination of tenofovir disoproxil fumarate/emtricitabine with raltegravir or dolutegravir or elvitegravir/cobicistat on renal function in HIV-1 antiretroviral naïve patients. HIV Res Clin Pract 2021; 22:128-139. [PMID: 34551678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objectives: Tenofovir DF (TDF) remains one of the preferred backbone agents for naïve HIV patients starting antiretroviral treatment (ART). The impact of TDF on renal function and metabolic parameters may vary by anchor agent. We investigated the impact of TDF in combination with 3 different integrase inhibitors on tubular and glomerular function, and metabolic parameters in ART-naïve patients.Methods: Sixty patients with normal renal function were randomised (20 per arm) to TDF/emtricitabine (FTC) plus either raltegravir (RAL) (400 mg b.d.), dolutegravir (DTG) or elvitegravir/cobicistat (EVG/c) for 48 weeks.Results: 57 patients completed the study. Significant increases in RBP/creatinine ratio at week 24 were seen in all arms [RAL +4.7 μg/mmol (CI 0.43 to 8.98, p = 0.032); DTG +4.96 μg/mmol (CI 0.77 to 9.15, p = 0.021); EVG/c +6.95 μg/mmol (CI 2.53 to 11.36, p = 0.002)], although this was not sustained to week 48 in the RAL arm. Similar changes across the arms were observed for urinary α1microglobulin (RAL +6.20 mg/L, p = 0.030; DTG +6.30 mg/L, p = 0.025; EVG/c +8.15 mg/L, p = 0.003). Urinary β2microglobulin significantly increased at week 24 with DTG and EVG/c but remained unchanged in the RAL arm. Glomerular filtration measured with CKD-EPI creatinine-cystatin C increased significantly in the RAL arm at week 24 through 48 but declined modestly in other two arms. Total and LDL cholesterol decreased in the RAL arm, but increased in the EVG/c arm, with no significant changes in the DTG arm. Weight increased significantly from baseline with DTG but not RAL or EVG/c.Conclusion: INSTIs in combination with TDF/FTC impact differently on tubular microproteinuria, eGFR, metabolic markers and weight. Use of TDF/FTC with RAL had the least tubular effects and the most favorable metabolic profile.
Collapse
Affiliation(s)
- Margherita Bracchi
- HIV/GUM, St Stephen's AIDS Trust - Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Nicole Pagani
- Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom
| | - Alessia Dalla Pria
- HIV/GUM, St Stephen's AIDS Trust - Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Ana Milinkovic
- HIV/GUM, St Stephen's AIDS Trust - Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Marta Boffito
- HIV/GUM, St Stephen's AIDS Trust - Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Graeme Moyle
- HIV/GUM, St Stephen's AIDS Trust - Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
20
|
Mazzitelli M, Branca Isabel P, Muramatsu T, Chirwa M, Mandalia S, Moyle G, Marta B, Milinkovic A. FRAX assessment in people ageing with HIV. HIV Med 2021; 23:103-108. [PMID: 34541758 DOI: 10.1111/hiv.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current British HIV Association (BHIVA) guidelines recommend the use of FRAX for the routine assessment of bone fracture risk in people living with HIV over 50 years of age every 3 years. Bone mineral density measurement with dual-energy X-ray absorptiometry (DXA) scan is recommended for those with increased fracture risk (FRAX major > 10%). Our objectives were to estimate the prevalence of and risk factors for osteoporosis in a population of PLWH aged > 50 years and assess the utility of FRAX in predicting the presence of DXA-proven osteoporosis in this cohort. METHODS This was a cross-sectional study of a cohort of PLWH aged > 50 years attending the Chelsea and Westminster Hospital and who had a DXA scan between January 2009 and December 2018. FRAX scores were calculated using the Sheffield algorithm. Multiple regression models and Cohen's kappa values were used to assess risk factors for osteoporosis and agreement between FRAX and DXA scan results, respectively. RESULTS In all, 744 patients were included (92.9% male, mean age 56 ± 5 years). The prevalence rates of osteoporosis (at DXA scans) and osteopenia were 12.2% and 63.7%, respectively. FRAX major was > 10% in only two patients, while 90/91 (98.9%) patients with osteoporosis had a normal FRAX score. The presence of osteoporosis was significantly associated with low body mass index and estimated glomerular filtration rate (p < 0.05). CONCLUSION Our results indicate that FRAX scores did not predict the presence of osteoporosis in our population of PLWH over 50 years of age and therefore FRAX scores may not be the appropriate tool to define eligibility to perform DXA scans in PLWH.
Collapse
Affiliation(s)
- Maria Mazzitelli
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Medical and Surgical Sciences Department, "Magna Graecia" University, Catanzaro, Italy
| | | | - Takashi Muramatsu
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mimie Chirwa
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Sundhiya Mandalia
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Graeme Moyle
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Boffito Marta
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Division of Infectious Diseases, Imperial College, London, UK
| | - Ana Milinkovic
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
21
|
Lei JJH, Pereira B, Moyle G, Boffito M, Milinkovic A. The benefits of tenofovir discontinuation with or without bisphosphonate therapy in osteoporotic people living with HIV. HIV Med 2021; 22:816-823. [PMID: 34258828 DOI: 10.1111/hiv.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Treatment with bisphosphonates and discontinuation of tenofovir disoproxil fumarate (TDF) are recommended strategies for managing osteoporosis in people living with HIV (PLHIV). This study aimed to compare the effects on bone mineral density (BMD) of TDF discontinuation with and without bisphosphonate therapy in osteoporotic PLHIV. METHODS The present study is a retrospective cohort analysis of dual-energy X-ray absorptiometry scan results of PLHIV attending Chelsea and Westminster Hospital HIV clinic between 2009 and 2020. Osteoporotic (T-score < -2.5) patients with ≥ 6 months' TDF exposure were included. Changes in BMD and T-scores at the lumbar spine (LS) and femoral neck (FN) were assessed. RESULTS A total of 84 participants were included, of whom 43 discontinued TDF only (TS) and 41 switched from TDF and received bisphosphonates (TS+): 86.9% were male; 77.4% were white; median (interquartile range, IQR) age was 54.8 (51.0-58.5) years; and median (IQR) TDF exposure was 6.5 (3.5-10.4) years. At a median follow-up of 2 years after TDF-discontinuation, mean spine BMD increased significantly in both groups, but bisphosphonate recipients had greater improvements (4.83% vs. 7.79%; P < 0.019); LS T-scores improved significantly but changes were comparable between groups (TS, 0.5 vs. TS+, 0.6; P = 0.270). At the FN, no significant increases in BMD were observed (TS, 3.05% vs. TS+, 2.71%; P = 0.205); T-scores significantly improved in bisphosphonate recipients only (+0.2; P = 0.003). A greater proportion recovered from osteoporosis in the TS+ group (34.9% vs. 43.9%), although differences between groups were not significant (P = 0.503). CONCLUSIONS Our real-world data indicate that although TDF discontinuation significantly improved bone health in osteoporotic PLHIV, combining bisphosphonates with TDF discontinuation resulted in greater improvements in BMD.
Collapse
Affiliation(s)
| | - Branca Pereira
- Imperial College London, London, UK.,HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Graeme Moyle
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Marta Boffito
- Imperial College London, London, UK.,HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ana Milinkovic
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
22
|
Wang X, Milinkovic A, Pereira B, Moyle G, Fedele S, Thomas L, Yener D, Connolly S, McClure M, Boffito M. Pharmacokinetics of once-daily doravirine over 72 h following drug cessation. J Antimicrob Chemother 2021; 75:1658-1660. [PMID: 32083675 DOI: 10.1093/jac/dkaa038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Dilek Yener
- Chelsea and Westminster Hospital, London, UK
| | | | | | - Marta Boffito
- Imperial College London, London, UK.,Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
23
|
Milinkovic A, Singh S, Simmons B, Pozniak A, Boffito M, Nwokolo N. Multimodality assessment of sleep outcomes in people living with HIV performed using validated sleep questionnaires. Int J STD AIDS 2021; 31:996-1003. [PMID: 32772688 DOI: 10.1177/0956462420941693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Studies conducted in people living with HIV (PLHIV) report high rates of sleep disturbance, without a clear explanation as to cause or effect. Therefore, we proposed use of multiple validated questionnaires that would allow a more comprehensive evaluation of sleep quality in PLHIV. We administered eight validated sleep and wellbeing questionnaires, recording different aspects of sleep in order to provide a comprehensive description of sleep quality, quantity, daytime functioning, wakefulness, and general wellbeing. Associations with demographics and clinical data were analyzed by univariable/multivariable analyses. Of 254 subjects 99% were male (98% men who have sex with men), 88% white, mean age 41 (SD ± 9.9) years, HIV duration eight years (SD ± 6.3), 94% were on antiretroviral therapy, mean CD4 cell count was 724 cells/mm3, 81% had HIV RNA<40 copies/ml, 72% were university educated, and 60% used 'chemsex' drugs. Almost half (45%) reported poor sleep quality, 22% insomnia, 21% daytime sleepiness, and 33% fatigue. As individual factors, HIV duration ≥10 years, anxiety, depression, and recreational drug use were associated with poor quality sleep, fatigue, and poorer functional outcomes (p ≤ 0.05). The prevalence of sleep disturbance was high in our cohort of PLHIV. Sleep disturbance was associated with longer duration of HIV infection, depression, anxiety, and recreational drug use.
Collapse
Affiliation(s)
- Ana Milinkovic
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Suveer Singh
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Bryony Simmons
- Faculty of Medicine, Imperial College London, London, UK
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,The London School of Hygiene & Tropical Medicine, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Mazzitelli M, Isabel Pereira B, Moyle G, Asboe D, Pozniak A, Boffito M, Milinkovic A. Factors associated with overweight/obesity in a cohort of people living with HIV over 50 years of age. AIDS Care 2021; 34:542-544. [PMID: 34082628 DOI: 10.1080/09540121.2021.1935438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Changes in body weight in people living with HIV vary by regimen components, timing of therapy introduction (naive, switch) and demographic factors. Our objective was to evaluate weight change and factors associated in an ageing cohort of treated subjects with HIV at Chelsea and Westminster Hospital. We found that the prevalence of obesity was similar to general population and was associated with a number of health conditions, which increase metabolic risk.
Collapse
Affiliation(s)
- Maria Mazzitelli
- Unit of Infectious and Tropical Diseases, Department Health Sciences, "Magna Graecia" University, Catanzaro, Italy.,HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | | | - Graeme Moyle
- HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - David Asboe
- HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Anton Pozniak
- HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Marta Boffito
- HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK.,Imperial College London, London, UK
| | - Ana Milinkovic
- HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London, UK
| |
Collapse
|
25
|
Fernández I, de Lazzari E, Inciarte A, Diaz-Brito V, Milinkovic A, Arenas-Pinto A, Etcheverrry F, García F, Leal L. Network meta-analysis of post-exposure prophylaxis randomized clinical trials. HIV Med 2020; 22:218-224. [PMID: 33108035 DOI: 10.1111/hiv.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen. METHODS After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events. RESULTS Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events. CONCLUSIONS Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.
Collapse
Affiliation(s)
- I Fernández
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Inciarte
- Infectious Diseases Department-HIV Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - V Diaz-Brito
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Milinkovic
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - A Arenas-Pinto
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - F Etcheverrry
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F García
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology, AIDS Research Group, (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - L Leal
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology, AIDS Research Group, (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
26
|
Mariot P, Boffito M, Ustianowski A, Milinkovic A, Lindergard G, Moore A, Taylor-Stokes G, Patel Y, Praet C, Mackay C. Étude RETRO : utilisation du raltégravir 1200 mg une fois par jour en vie réelle. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
27
|
Suonpera E, Matthews R, Milinkovic A, Arenas-Pinto A. Risky Alcohol Consumption and Associated Health Behaviour Among HIV-Positive and HIV-Negative Patients in a UK Sexual Health and HIV Clinic: A Cross-Sectional Questionnaire Study. AIDS Behav 2020; 24:1717-1726. [PMID: 31664572 PMCID: PMC7220979 DOI: 10.1007/s10461-019-02714-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Alcohol misuse has been associated with negative consequences among HIV-positive patients. Data on real prevalence of risky alcohol consumption among the HIV-positive population in the UK are lacking. A cross-sectional questionnaire study using standardised validated instruments among HIV-positive (n = 227) and HIV-negative (n = 69) patients was performed. The prevalence of risky alcohol consumption (AUDIT) and associations with depressive symptoms (PHQ-9), problematic drug use (DUDIT), adherence to ART (CASE Adherence Index), sexual behaviour and demographic characteristics were assessed among both patient groups independently. A quarter (25.1%) of HIV-positive patients and 36.1% of HIV-negative patients reported risky alcohol consumption (AUDIT-score ≥ 8). In the multivariable analysis among HIV-positive patients depressive symptoms (p = 0.03) and problematic drug use (p = 0.007) were associated with risky alcohol consumption. Among HIV-negative patients these associations were not present. Risky alcohol consumption among HIV-positive patients is prevalent, and together with depressive symptoms and problematic drug use, may influence HIV-disease progression and patients' wellbeing.
Collapse
Affiliation(s)
- Emmi Suonpera
- Centre for Clinical Research in Infection and Sexual Health, UCL Institute for Global Health, University College London, London, UK.
- Mortimer Market Centre, UCL Institute for Global Health, Off Capper Street, London, WC1E 6JB, UK.
| | - Rebecca Matthews
- Centre for Clinical Research in Infection and Sexual Health, UCL Institute for Global Health, University College London, London, UK
| | - Ana Milinkovic
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alejandro Arenas-Pinto
- Centre for Clinical Research in Infection and Sexual Health, UCL Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- MRC Clinical Trials Unit at UCL, London, UK
| |
Collapse
|
28
|
De Francesco D, Winston A, Underwood J, Cresswell FV, Anderson J, Post FA, Williams I, Mallon PW, Sachikonye M, Babalis D, Vera JH, Bagkeris E, Milinkovic A, Sabin CA. Cognitive function, depressive symptoms and syphilis in HIV-positive and HIV-negative individuals. Int J STD AIDS 2019; 30:440-446. [PMID: 30999830 DOI: 10.1177/0956462418817612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated associations between history of syphilis infection and both cognitive function and depressive symptoms in people living with HIV (PLHIV) and comparable HIV-negative controls. Syphilis serological tests, cognitive function and depression were assessed in PLHIV and controls participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study. Cognitive test scores were converted to demographically adjusted T-scores (mean = 50, SD = 10) and then averaged to obtain a global T-score. Severity of depressive symptoms was assessed via the Patient Health Questionnaire-9. Associations of syphilis with global T-scores and depression were assessed using median regression. The 623 PLHIV and 246 HIV-negative controls were predominantly male (89.3% and 66.5%) with median age (interquartile range [IQR]) of 57 (53-63) and 58 (53-63) years, respectively. PLHIV had lower global cognitive T-scores (median [IQR] 48.7 [45.1, 52.1] versus 50.5 [47.0, 53.9], p < 0.001), more severe depressive symptoms (median [IQR] 4 [1, 10] versus 1 [0, 3], p < 0.001) and were more likely to report history of syphilis infection (22.0% versus 8.1%) than controls. There was no significant association between history of syphilis and global cognitive function in either PLHIV (p = 0.69) or controls (p = 0.10). Participants with a history of syphilis had more severe depressive symptoms (median [IQR] 4 [1, 9] versus 2 [0, 8], p = 0.03); however, the association became non-significant (p = 0.62) after adjusting for HIV status and potential confounders. Despite the higher prevalence of syphilis infection in PLHIV, there was no evidence of an association between history of syphilis infection and impaired cognitive function nor depressive symptoms after accounting for potential confounders.
Collapse
Affiliation(s)
| | - Alan Winston
- 2 Division of Infectious Diseases, Imperial College London, London, UK
| | | | - Fiona V Cresswell
- 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,4 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Frank A Post
- 6 King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Daphne Babalis
- 10 Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jaime H Vera
- 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,11 Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Ana Milinkovic
- 12 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | |
Collapse
|
29
|
Saunders J, Brima N, Orzol M, Phillips L, Milinkovic A, Carpenter G, Copas A, Gilson R. Prospective observational study to evaluate the performance of the BioSure HIV Self-Test in the hands of lay users. Sex Transm Infect 2017; 94:169-173. [PMID: 28924053 DOI: 10.1136/sextrans-2017-053231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/20/2017] [Accepted: 08/08/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In order to assess whether the BioSure HIV Self-Test could be reliably performed by users at home and to determine whether they were able to perform and correctly interpret the test, we carried out an evaluation study among attendees at a sexual health service. METHODS A prospective observational study of clinic attendees to determine their ability to follow the instructions, complete the test on themselves and correctly interpret the results. The evaluation included interpretation of three dummy (contrived) devices, chosen at random from a sample of 12 devices, to ensure that a sufficient number of all possible test outcomes were included. RESULTS Two hundred participants were recruited. 97.0% (95% CI 93.5 to 98.9) conducted the test so as to achieve a valid result. 99.5% correctly identified the test result. Participants correctly interpreted the result of 94.0% (95% CI 91.4 to 95.9) of 586 contrived devices. CONCLUSIONS The majority of participants were able to follow the instructions and perform the test in order to get a valid result. Interpretation of the test results was good and the majority of participants were able to correctly read the result of their own and contrived tests. The availability of HIV self-tests will provide another option to increase access to testing particularly for those who may not wish or are unable to access clinical services.
Collapse
Affiliation(s)
- John Saunders
- Research Department of Infection and Population Health, University College London, London, UK
| | - Nataliya Brima
- Research Department of Infection and Population Health, University College London, London, UK
| | - Marzena Orzol
- Research Department of Infection and Population Health, University College London, London, UK
| | - Laura Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Ana Milinkovic
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Andrew Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| |
Collapse
|
30
|
Milinkovic A, Benn P, Arenas-Pinto A, Brima N, Copas A, Clarke A, Fisher M, Schembri G, Hawkins D, Williams A, Gilson R. Randomized controlled trial of the tolerability and completion of maraviroc compared with Kaletra® in combination with Truvada® for HIV post-exposure prophylaxis (MiPEP Trial). J Antimicrob Chemother 2017; 72:1760-1768. [PMID: 28369381 DOI: 10.1093/jac/dkx062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ana Milinkovic
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Paul Benn
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
| | - Alejandro Arenas-Pinto
- Centre for Sexual Health and HIV Research, University College London, UK
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
| | - Nataliya Brima
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Amanda Clarke
- The Claude Nicol Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Martin Fisher
- The Claude Nicol Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Manchester Royal Infirmary, Manchester, UK
| | - David Hawkins
- Chelsea and Westminster NHS Foundation Trust, The John Hunter Clinic, London, UK
| | - Andy Williams
- Royal London Hospital, Ambrose King Centre, London, UK
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, University College London, UK
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
| | | |
Collapse
|
31
|
Randell P, Jackson A, Milinkovic A, Boffito M, Moyle G. An open-label, randomized study of the impact on insulin sensitivity, lipid profile and vascular inflammation by treatment with lopinavir/ritonavir or raltegravir in HIV-negative male volunteers. Antivir Ther 2016; 22:145-151. [PMID: 27708251 DOI: 10.3851/imp3098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We aimed to measure the effect of raltegravir (RAL) on insulin sensitivity and surrogates of cardiovascular risk in healthy HIV-seronegative volunteers compared to that of lopinavir/r (LPV/r), a positive control. METHODS An open-label, two phase crossover study in HIV-negative male subjects randomized 1:1 to receive either 2 weeks of LPV/r followed by a 2-week washout period and 2 weeks of RAL, or RAL initially followed by LPV/r. A hyperinsulinaemic euglycaemic clamp was performed prior to and following each 2-week dosing phase. Fasting samples for lipids, adiponectin, leptin, vascular inflammatory biomarkers and CD36 were also taken. RESULTS A total of 16 subjects completed the study. At the baseline visit the mean insulin-stimulated glucose disposal per unit insulin (M/I) was 7.97 and 8.30 for LPV/r and RAL, respectively. The mean (sem) percentage change from baseline was -16.10% (3.84) after 2 weeks of LPV/r and -0.43% (4.83) after 2 weeks of RAL. Absolute M/I was 25% lower for LPV/r than for RAL (P=0.001). Triglycerides and total cholesterol rose significantly with LPV/r (+0.5 mmol/l, P=0.002 and +0.4 mmol/l, P<0.0001), but were unchanged with RAL. Proathrogenic lipid subfractions of low-density lipoprotein (LDL) cholesterol increased with LPV/r and were unaffected with RAL. LDL peak and mean particle diameter and LDL I significantly decreased with LPV/r (P<0.05), and trend of increased LDL III was detected. High-sensitivity C-reactive protein declined with RAL (-0.2 mg/l, P=0.043) but was elevated after LPV/r (+0.25 mg/l, P=0.03). CONCLUSIONS RAL was not associated with measurable change in glycaemic, metabolic or inflammatory effects.
Collapse
Affiliation(s)
- Paul Randell
- St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Akil Jackson
- St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK.,Present: Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Present: Gilead Sciences Ltd., London, UK
| | - Ana Milinkovic
- St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK.,Present: Research Department of Infection and Population Health, University College London, London, UK
| | - Marta Boffito
- St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Graeme Moyle
- St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
32
|
|
33
|
Arenas-Pinto A, Milinkovic A, Peppa D, McKendry A, Maini M, Gilson R. Systemic inflammation and residual viraemia in HIV-positive adults on protease inhibitor monotherapy: a cross-sectional study. BMC Infect Dis 2015; 15:138. [PMID: 25888119 PMCID: PMC4374398 DOI: 10.1186/s12879-015-0889-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono). METHODS HIV-infected adults with persistent HIV-RNA<50 copies/ml and treated with either a) PImono or b) standard triple-drug cART were recruited for this cross-sectional, exploratory study. Plasma samples were tested for high-sensitivity CRP (hsCRP), Serum Amyloid A (SAA), soluble CD14, IL-6, IL-8 and Cytochrome C. HIV-RNA was measured by real-time PCR (detection limit of 10 copies/ml). RESULTS 81 patients were recruited (31% on PImono). Two out of 25 (8%) and 3 of 56 (5.4%) patients from the PImono and cART groups respectively had detectable HIV-RNA. Significant correlation between SAA and hsCRP was observed (0.804). No difference between groups was found on prevalence of hsCRP>3 mg/l (21% vs 20% in the PImono and cART groups respectively; p=0.577) or SAA>6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P=0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA>6.4 mg/l (OR=1.74 and 1.46; 95% CI=1.00-3.03 and 1.06-2.01; p=0.051 and 0.02 respectively) and hsCRP>3 mg/l in (OR=2.00 and 1.37; 95% CI=1.09-3.69 and 1.02-1.85; p=0.026 and 0.039 respectively). CONCLUSIONS We found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.
Collapse
Affiliation(s)
- Alejandro Arenas-Pinto
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. .,MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
| | - Ana Milinkovic
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK.
| | - Dimitra Peppa
- The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK. .,Research Department of Infection and Immunity, University College London, London, UK.
| | - Anna McKendry
- The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK.
| | - Mala Maini
- Research Department of Infection and Immunity, University College London, London, UK.
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK.
| |
Collapse
|
34
|
Pérez-Molina JA, Serrano O, Milinkovic A, Domingo P, Currán A, Knobel H, Gaspar G, Rodrigo A, Jiménez-Expósito MJ, Hernández-Novoa B, Moreno S. Comparison of Antiviral Activity of Regimens Containing Nucleos(t)ide (NUC) Pairs in HIV-Infected Patients Initiating REScue Therapy (The NUCREST Study). HIV Clinical Trials 2015; 11:294-302. [DOI: 10.1310/hct1105-294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
35
|
Abstract
Nevirapine (Viramune, Boehringer Ingelheim Ltd) is the first marketed non-nucleoside reverse transcriptase inhibitor. As with any antiretroviral drug, nevirapine should always be used as part of a fully suppressive regimen. Clinical studies have shown that nevirapine-containing regimens may accomplish durable virological and immunological responses in approximately half of all antiretroviral-naive patients. It can also be successfully used as a component of salvage therapies and as a part of a strategy to simplify protease inhibitor-containing regimens. Nevirapine has a beneficial effect on the lipid profile in both treatment-naive and -experienced patients. Nevirapine also has an important role in preventing mother-to-child transmission of HIV. It is usually well-tolerated with rash and liver toxicity being the most frequently reported adverse events. Nevirapine interacts with cytochrome P450 enzymes both as a substrate and as an inducer. For this reason, therapeutic drug monitoring should be recommended whenever nevirapine is used with protease inhibitors, methadone (Methadose, Rosemont Pharmaceuticals Ltd), oral contraceptives, rifampicin (Rifadin, Aventis Pharma) and other potentially interacting drugs. Nevirapine-resistant mutations are common to the non-nucleoside reverse transcriptase inhibitor family and they include K103N, V106A, Y181C, Y188C and G190A. A better understanding of the nevirapine profile will certainly contribute to ensuring that its clinical application becomes more effective and beneficial.
Collapse
Affiliation(s)
- Ana Milinkovic
- Hospital Clinic Barcelona, Hospital de dia de infectiones; Piso 1 Escalera 2, Villarroel 170; 08036 Barcelona, Spain.
| | | |
Collapse
|
36
|
García AI, Milinkovic A, Tomás X, Rios J, Pérez I, Vidal-Sicart S, Pomés J, Del Amo M, Mallolas J. MRI signal changes of the bone marrow in HIV-infected patients with lipodystrophy: correlation with clinical parameters. Skeletal Radiol 2011; 40:1295-301. [PMID: 21479859 DOI: 10.1007/s00256-011-1147-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 02/27/2011] [Accepted: 02/28/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the prevalence, imaging appearance, and clinical significance, of bone marrow MR signal changes in a group of human immunodeficiency virus (HIV)-infected patients with lipodystrophy syndrome. MATERIALS AND METHODS Twenty-eight HIV-infected patients with lipodystrophy syndrome treated with highly active antiretroviral therapy, and 12 HIV-negative controls underwent MRI of the legs. Whole-body MRI, SPECT/CT, and a complete radiographic skeletal survey were obtained in subjects with signal changes in bone marrow. MRI and clinical evaluations were reviewed 6 months after baseline to determine changes after switching from thymidine analogs (TA) to tenofovir-DF (TDF). MRI results correlated with clinical parameters. RESULTS We observed foci of a serous-like pattern (low signal and no enhancement on T1-weighted, high signal on T2-weighted images) in 4 out of 28 patients (14.3%) and an intermediate signal on T1-weighted images in 4 out of 28 patients (14.3%). Serous-like lesions were located in the lower limbs and scattered in the talus, calcaneus, femurs, and humeral bones; they showed slight uptake on SPECT bone scans and were normal on CT and radiographs. Patients with serous-like lesions had significantly lower peripheral and total fat at baseline than other groups (P < 0.05). No changes at 6 months were observed on MRI, and the serous-like lesion group showed good peripheral fat recovery after changing drug treatment. CONCLUSION A serous-like MRI pattern is observed in the peripheral skeletons of HIV-infected patients with lipodystrophy, which correlates with peripheral lipoatrophy, and should not be misdiagnosed as malignant or infectious diseases. Although the MR lesions did not improve after switching the treatment, there was evidence of lipoatrophy recovery.
Collapse
Affiliation(s)
- Ana I García
- Department of Radiology, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
van Vonderen MGA, van Agtmael MA, Hassink EAM, Milinkovic A, Brinkman K, Geerlings SE, Ristola M, van Eeden A, Danner SA, Reiss P. Zidovudine/lamivudine for HIV-1 infection contributes to limb fat loss. PLoS One 2009; 4:e5647. [PMID: 19479079 PMCID: PMC2682584 DOI: 10.1371/journal.pone.0005647] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 03/27/2009] [Indexed: 11/23/2022] Open
Abstract
Background Lipoatrophy is known to be associated with stavudine as part of the treatment for HIV infection, but it is less clear if this serious side effect is also related to other nucleoside reverse transcriptase inhibitors like zidovudine. We aimed to determine whether zidovudine-sparing first-line antiretroviral therapy would lead to less lipoatrophy and other metabolic changes than zidovudine-containing therapy. Methodology/Principal Findings Fifty antiretroviral therapy-naïve HIV-1 infected men with an indication to start antiretroviral therapy were included in a randomized single blinded clinical trial. Randomisation was between zidovudine-containing therapy (zidovudine/lamivudine+lopinavir/ritonavir) and zidovudine-sparing therapy (nevirapine+lopinavir/ritonavir). Main outcome measures were body composition assessed by computed tomography and dual-energy X-ray absorptiometry scan and lipid profile before and after 3, 12, 24 months of antiretroviral therapy. In the zidovudine/lamivudine+lopinavir/ritonavir group, from 3 months onward limb fat decreased progressively by 684±293 grams (estimated mean±standard error of the mean)(p = 0.02) up to 24 months whereas abdominal fat increased, but exclusively in the visceral compartment (+21.9±8.1 cm2, p = 0.008)). In contrast, in the nevirapine+lopinavir/ritonavir group, a generalized increase in fat mass was observed. After 24 months no significant differences in high density lipoprotein and total/high density lipoprotein cholesterol ratio were found between both treatment groups, but total and low density lipoprotein cholesterol levels were higher in the nevirapine+lopinavir/ritonavir group (6.1±0.2 versus 5.3±0.2 and 3.6±0.1 versus 2.8±0.1 mmol/l respectively, p<0.05). Virologic response and safety were comparable in both groups. Conclusions/Significance Zidovudine/lamivudine+lopinavir/ritonavir, but not nevirapine+lopinavir/ritonavir in antiretroviral therapy-naïve patients, is associated with lipoatrophy and greater relative intraabdominal lipohypertrophy, suggesting that zidovudine/lamivudine contributes to both these features of lipodystrophy. These findings support to no longer consider zidovudine/lamivudine as one of the preferred possible components of first-line antiretroviral therapy where alternative treatments are available. Trial Registration ClinicalTrials.gov NCT 00122226
Collapse
Affiliation(s)
- Marit G A van Vonderen
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Laguno M, Cifuentes C, Murillas J, Veloso S, Larrousse M, Payeras A, Bonet L, Vidal F, Milinkovic A, Bassa A, Villalonga C, Pérez I, Tural C, Martínez-Rebollar M, Calvo M, Blanco JL, Martínez E, Sánchez-Tapias JM, Gatell JM, Mallolas J. Randomized trial comparing pegylated interferon alpha-2b versus pegylated interferon alpha-2a, both plus ribavirin, to treat chronic hepatitis C in human immunodeficiency virus patients. Hepatology 2009; 49:22-31. [PMID: 19085908 DOI: 10.1002/hep.22598] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
UNLABELLED Although two pegylated interferons (Peg-IFN) are available to treat chronic hepatitis C virus (HCV) infection, no head-to-head comparative studies have been published. We aim to compare the efficacy and safety of PEG IFN alfa-2b (PEG 2b) versus PEG IFN alfa-2a (PEG 2a), plus ribavirin (RBV). A prospective, randomized, multi-center, open-label clinical trial including 182 human immunodeficiency virus (HIV)-hepatitis C virus (HCV) patients naïve for HCV therapy was performed. Patients were assigned to PEG 2b (80-150 mug/week; n = 96) or PEG 2a (180 mug/week; n = 86), plus RBV (800-1200 mg/day) for 48 weeks. The primary endpoint was sustained virological response (SVR: negative HCV-RNA 24 weeks after completion of treatment). At baseline, both groups were well balanced: 73% male; 63% HCV genotype 1 or [corrected] 4; 29% had fibrosis index of 3 or greater. The overall SVR was 44% (42% PEG 2b versus 46% PEG 2a, P = 0.65). Among genotypes 1 or [corrected] 4, SVRs were 28% versus 32% (P = 0.67) and 62% versus 71% (P = 0.6) in genotypes 2 or [corrected] 3 for PEG 2b and PEG 2a, respectively. Early virological response (EVR; >or=2 log reduction from baseline or negative HCV-RNA at week 12) was 70% in the PEG 2b group and 80% in the PEG 2a group (P = 0.13), reaching a positive predictive value of SVR of 64% and a negative predictive value of 100% in both arms. Side effects were present in 96% of patients but led to treatment discontinuation in 10% of patients (8% on PEG 2b and 13% on PEG 2a, P = 0.47). CONCLUSION In patients with HIV, HCV therapy with PEG 2b or PEG 2a plus RBV had no significant differences in efficacy and safety.
Collapse
|
39
|
Mestre G, Garcia F, Martinez E, Milinkovic A, Lopez A, León A, Mora B, Argelich R, Lozano JM, Peña J, Gatell JM, Plana M. Short Communication: Natural killer cells and expression of KIR receptors in chronic HIV type 1-infected patients after different strategies of structured therapy interruption. AIDS Res Hum Retroviruses 2008; 24:1485-95. [PMID: 19025397 DOI: 10.1089/aid.2008.0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few data evaluating the NK cell profile during structured therapy interruption (STI) in chronic HIV-1 infection are available. Changes in NK cell percentages and KIR and NKG2A receptors were analyzed at baseline and after 2 years of follow-up in 121 patients on ART with CD4(+) >450 cells/ml and VL <200 copies/ml randomized in three arms according to the criteria employed to resume ART during STI: virological arm (VA n = 47, VL >30,000 copies/ml or CD4 <350 cells/ml), immunological arm (IA n = 37, CD4< 350 cells/ml), and a control arm (n = 37) in which ART was maintained. After 2 years of follow-up, a decrease in CD3(-)CD56(+) CD16(+) cell percentages in VA and IA patients, but not in CA patients, was observed. Those patients with higher decrease in CD3(-)CD56(+)CD16(+) cells had a higher decrease in CD4(+) cells (r = 0.35, p = 0.001) and higher increase in PVL (r = -0.26, p = 0.02). KIR and NKG2A receptor expression tended to increase in CA and decreased in the other two arms (more in IA than in VA). Patients who displayed a greater decrease in CD4(+) T cells and a greater rise in PVL after 2 years of follow-up had a significantly higher decrease in KIR and NKG2A receptors expressed in CD3(-)CD56(+) cells. Patients who presented the lowest levels of total NK cells and KIR and NKG2A receptor expression after STI showed the poorest virology or immunology outcomes. This finding suggests that STI could decrease the number of NK subsets, which is related to the worst clinical development in these patients.
Collapse
Affiliation(s)
- Gabriel Mestre
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Milinkovic
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Anna Lopez
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Retrovirology and Viral Immunopathology Laboratory, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Agathe León
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Borja Mora
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Roger Argelich
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - José Manuel Lozano
- Immunology Laboratory, Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - José Peña
- Immunology Laboratory, Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - José M. Gatell
- Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- HIV Vaccine Development in Catalonia (HIVACAT), Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Retrovirology and Viral Immunopathology Laboratory, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
40
|
Leon A, Martinez E, Milinkovic A, Mora B, Mallolas J, Blanco JL, Larrousse M, Laguno M, Gallart T, Plana M, Gatell JM, Garcia F. Influence of repeated cycles of structured therapy interruption on the rate of recovery of CD4+ T cells after highly active antiretroviral therapy resumption. J Antimicrob Chemother 2008; 63:184-8. [DOI: 10.1093/jac/dkn461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
41
|
Laguno M, Larrousse M, Luis Blanco J, Leon A, Milinkovic A, Martínez-Rebozler M, Loncá M, Martinez E, Sanchez-Tapias JM, de Lazzari E, Maria Gatell J, Costa J, Mallolas J. Prevalence and clinical relevance of occult hepatitis B in the fibrosis progression and antiviral response to INF therapy in HIV-HCV-coinfected patients. AIDS Res Hum Retroviruses 2008; 24:547-53. [PMID: 18393687 DOI: 10.1089/aid.2007.9994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Occult hepatitis B virus (HBV) infection is diagnosed when HBc antibodies (HBcAb) and HBV DNA are detectable in serum while hepatitis B surface antigen (HBsAg) is not. This situation has been frequently described in patients with chronic hepatitis C virus (HCV) infection. The objective of this study was to evaluate the prevalence of occult hepatitis B in HIV-HCV-coinfected patients and its clinical relevance in liver histology and viral response after interferon therapy for HCV. A total of 238 HIV-HCV-infected patients,negative for HBsAg, were included. Serum samples were analyzed for the presence of HBV DNA and HBcAb.HBV DNA quantification was determined with the Cobas TaqMan HBV Test (detection limit 6 IU/ml). Data from liver biopsy and laboratory tests were also analyzed. HBcAb resulted in 142 (60%) patients, being the independent associated factors: male gender, previous history of intravenous drug use, age, CD4 count,and HAV antibody presence. Among 90 HBcAb patients that we could analyze, HBV DNA was positive in 15 (16.7% of occult hepatitis B infection in this group, and 6.3% in the whole HIV-HCV cohort studied). No baseline factors, liver histology, or HCV therapy response were related to the presence of HBV DNA. We found that occult hepatitis B is a frequent condition present in at least 6.3% of our HCV-HIV patients and in more than 16% of those with HBcAb. Despite the high prevalence, this phenomenon does not seem to affect the clinical evolution of chronic hepatitis C or modify the viral response to interferon-based HCV therapies
Collapse
|
42
|
Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med 2007; 8:251-8. [PMID: 17461853 DOI: 10.1111/j.1468-1293.2007.00468.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the introduction of highly active antiretroviral therapy (HAART), the incidence of death in HIV-infected patients has dramatically decreased, and causes of death other than those related to HIV infection have increased, although it is unclear how these parameters compare with those in the age-matched general population living in the same geographical region. METHODS Consecutive HIV-infected adults who were prescribed HAART in our hospital were prospectively followed from January 1997 to December 2004 or until death, loss to follow-up or discontinuation of HAART. Estimations of the annual incidence and causes of death in the general population of similar age in Catalonia per calendar year in the study period were obtained and compared with those in the HIV-infected cohort. RESULTS There were 235 deaths among the 4471 patients on HAART (5%). The incidence of mortality decreased over time in HIV-infected patients (P<0.001; chi(2) test for trend), although it has remained approximately five times higher than that for the age-matched general population. AIDS-related events were the most common cause of death (n=95; 40%), although they significantly decreased over time (P<0.001; chi(2) test for trend), whereas liver diseases (P<0.001; chi(2) test for trend) and non-AIDS-defining infections (P=0.008; chi(2) test for trend) significantly increased over time. Infections in general (33 times higher), liver diseases (11 times higher) and non-Hodgkin lymphoma (5 times higher) were overrepresented as causes of death in the HIV-infected cohort compared with the age-matched general population. CONCLUSIONS Non-AIDS-defining infectious diseases, liver diseases, and non-Hodgkin lymphoma represent specific targets for efforts to further decrease mortality in HIV-infected patients receiving HAART.
Collapse
Affiliation(s)
- E Martínez
- Infectious Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic Universitari, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hill A, Ruxrungtham K, Hanvanich M, Katlama C, Wolf E, Soriano V, Milinkovic A, Gatell J, Ribera E. Systematic review of clinical trials evaluating low doses of stavudine as part of antiretroviral treatment. Expert Opin Pharmacother 2007; 8:679-88. [PMID: 17376022 DOI: 10.1517/14656566.8.5.679] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Stavudine is a nucleoside analogue used for the treatment of HIV-1 infection, as part of highly active antiretroviral treatment. In developing countries, stavudine is used widely, owing to low cost and inclusion in generic fixed-dose combinations. In developed countries, stavudine is now rarely used, although it is highly effective. This is because newer drugs show lower rates of mitochondrial toxicities, such as lipoatrophy, peripheral neuropathy and lactic acidosis. In the development of stavudine, there was evidence that a dosage of 20-30 mg b.i.d. was effective, but the 40-mg b.i.d. dose gained regulatory approval. This review analyses the clinical trials conducted before and after the regulatory approval of stavudine, and shows that the dose of 30 mg b.i.d. has equivalent antiviral efficacy (given the caveats of meta-analysis), with some evidence of lower rates of peripheral neuropathy and lipoatrophy. With limited resources for HIV-1 treatment in developing countries, and only 25% of eligible patients receiving highly active antiretroviral treatment, low-cost treatment options such as stavudine still need to be pursued, if safety can be improved by dose optimisation.
Collapse
|
44
|
Milinkovic A, Martinez E, López S, De Lazzari E, Miró O, Vidal S, Blanco JL, Garrabou G, Laguno M, Arnaiz JA, Leon A, Larrousse M, Lonca M, Mallolas J, Gatell JM. The Impact of Reducing Stavudine dose versus switching to tenofovir on plasma lipids, body composition and mitochondrial function in HIV-infected patients. Antivir Ther 2007. [DOI: 10.1177/135965350701200301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Stavudine (d4T)-containing regimens are associated with a potential for lipoatrophy and dyslipidaemia. We assessed the safety and efficacy of reducing the dose of stavudine compared with switching to tenofovir or maintaining the standard dose of d4T. Methods Clinically stable HIV-infected patients receiving antiretroviral therapy containing stavudine 40 mg twice daily with a plasma HIV RNA <200 copies/ml for at least 6 months were randomized to maintain stavudine 40 mg twice daily (d4T40 arm), to reduce to 30 mg twice daily (d4T30 arm), or to switch from d4T to tenofovir (TDF arm). Results Fifty-eight (93% male) patients were included: 22 in the d4T40 arm, 19 in the d4T30 arm and 17 in TDF arm. At baseline, median time on d4T was 6 years (interquartile range [IQR] 2.6–7.1), median age 43 years (IQR 36–51) and median CD4+ T-cell count was 587/mm3 (IQR 329–892). At week 24, median limb fat changes (g) were as follows: d4T40=-182 (95% CI: -469—5); d4T30=527 (95% CI: -343–694); and TDF=402 (95% CI: 130–835; d4T40 versus TDF, P=0.0003). Significant differences between median values of laboratory parameters were detected: triglycerides (mg/dl): d4T40=19; d4T30=-23 and TDF=-79 (d4T40 versus TDF, P=0.03); and total cholesterol (mg/dl): d4t40=22, d4T30=-4, and TDF=-28 (d4T40 versus TDF, P=0.04). No significant difference was observed in mitochondrial function assessed in peripheral blood mononuclear cells. Conclusions Although both strategies were associated with a trend toward a decrease in plasma lipids and an increase in body fat, the only significant changes were observed among those who switched to tenofovir.
Collapse
Affiliation(s)
- Ana Milinkovic
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sonia López
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Oscar Miró
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sergi Vidal
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - José L Blanco
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Gloria Garrabou
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Joan A Arnaiz
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Agathe Leon
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Maria Larrousse
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Montserrat Lonca
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - José M Gatell
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
Blanch J, Rousaud A, Milinkovic A, Martinez E, Peri J, Gatell J. A structured group psychotherapy programme improves adjustment to lipodistrophy in HIV+ patients: Preliminary data. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
46
|
Laguno M, Larrousse M, Murillas J, Blanco JL, León A, Milinkovic A, Loncá M, Martinez E, Sánchez-Tapias JM, de Lazzari E, Gatell JM, Costa J, Mallolas J. Predictive Value of Early Virologic Response in HIV/Hepatitis C Virus-Coinfected Patients Treated With an Interferon-Based Regimen Plus Ribavirin. J Acquir Immune Defic Syndr 2007; 44:174-8. [PMID: 17106276 DOI: 10.1097/qai.0b013e31802b812d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As a result of adverse events, a moderate rate of virologic response, and high costs associated with hepatitis C virus (HCV) therapy, finding early markers of sustained treatment response is a clinical priority. In the HCV-monoinfected population, a reduction >or=2 log in plasma HCV RNA at week 12 of therapy (early virologic response [EVR]) predicts a sustained virologic response (SVR). Few data are available in HIV/HCV-coinfected patients, however. METHODS A subanalysis of data from HIV/HCV-coinfected patients treated with pegylated interferon-alpha-2b (PEG, 100-150 mug/wk) or interferon-alpha-2b (IFN, 3 MIU 3 times per week) plus ribavirin (RBV, 800-1200 mg/d) was conducted in a randomized single-center clinical trial. The duration of treatment was 48 weeks (only 24 weeks for HCV genotype 2 or 3 with a baseline HCV RNA level <800,000 IU/mL). RESULTS Ninety-five patients were randomized (43 assigned to IFN + RBV and 52 assigned to PEG + RBV). Eighty patients completed at least 12 weeks on therapy and were included in the EVR analysis. Thirty-five (43%) of them attained an SVR (56% and 30% of patients treated with PEG and IFN, respectively; P = 0.026). An EVR occurred in 55 (69%; 80% of PEG + RBV group and 56% of IFN + RBV group). Overall, 35 of 55 patients with an EVR were sustained responders, yielding a positive predictive value of 64% (70% in PEG + RBV arm and 55% in IFN + RBV arm). None of the patients who demonstrated an HCV RNA decline of <2 logs at week 12 reached an SVR (negative predictive value of 100%). CONCLUSION Our results confirm the utility of an EVR to predict the chance of the lack of an SVR in HIV/HCV-coinfected patients, particularly those treated with PEG.
Collapse
Affiliation(s)
- Montserrat Laguno
- Infectious Diseases Service, Hospital Clínic Universitari de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Milinkovic A, Martinez E, López S, de Lazzari E, Miró O, Vidal S, Blanco JL, Garrabou G, Laguno M, Arnaiz JA, Leon A, Larrousse M, Lonca M, Mallolas J, Gatell JM. The impact of reducing stavudine dose versus switching to tenofovir on plasma lipids, body composition and mitochondrial function in HIV-infected patients. Antivir Ther 2007; 12:407-15. [PMID: 17591031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Stavudine (d4T)-containing regimens are associated with a potential for lipoatrophy and dyslipidaemia. We assessed the safety and efficacy of reducing the dose of stavudine compared with switching to tenofovir or maintaining the standard dose of d4T. METHODS Clinically stable HIV-infected patients receiving antiretroviral therapy containing stavudine 40 mg twice daily with a plasma HIV RNA < 200 copies/ml for at least 6 months were randomized to maintain stavudine 40 mg twice daily (d4T40 arm), to reduce to 30 mg twice daily (d4T30 arm), or to switch from d4T to tenofovir (TDF arm). RESULTS Fifty-eight (93% male) patients were included: 22 in the d4T40 arm, 19 in the d4T30 arm and 17 in TDF arm. At baseline, median time on d4T was 6 years (interquartile range [IQR] 2.6-7.1), median age 43 years (IQR 36-51) and median CD4+ T-cell count was 587/mm3 (IQR 329-892). At week 24, median limb fat changes (g) were as follows: d4T40 = -182 (95% CI: -469- -5); d4T30 = 527 (95% CI: -343-694); and TDF = 402 (95% CI: 130-835; d4T40 versus TDF, P = 0.0003). Significant differences between median values of laboratory parameters were detected: triglycerides (mg/dl): d4T40 = 19; d4T30 = -23 and TDF = -79 (d4T40 versus TDF, P = 0.03); and total cholesterol (mg/dl): d4t40 = 22, d4T30 = -4, and TDF = -28 (d4T40 versus TDF, P = 0.04). No significant difference was observed in mitochondrial function assessed in peripheral blood mononuclear cells. CONCLUSIONS Although both strategies were associated with a trend toward a decrease in plasma lipids and an increase in body fat, the only significant changes were observed among those who switched to tenofovir.
Collapse
Affiliation(s)
- Ana Milinkovic
- Infectious Diseases Unit, Hospital Clinic Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Triple-nucleoside therapy with abacavir (ABV)/lamivudine (3TC)/zidovudine (ZDV) combination tablets provides simple, nonfood-dependent, twice-daily, well-tolerated therapy with the potential to improve long-term adherence at a lower cost than other triple-drug regimens. Of all the triple nucleoside reverse transcriptase inhibitor combinations currently available, ABV/3TC/ZDV is most extensively studied. Although ABV/3TC/ZDV is possibly less potent than other treatment options when used alone, other attributes described in this review make it an attractive option for selected patients. This combination spares the use of protease inhibitors and their associated side effects, such as metabolic abnormalities, which may contribute to premature cardiovascular disease. Furthermore, by using only one drug class, it may maintain a greater number of future treatment options. Data from ongoing clinical trials may result in expanding the use of ABV/3TC/ZDV as a component of multidrug, highly active antiretroviral therapy regimens.
Collapse
Affiliation(s)
- Ana Milinkovic
- Infectious Diseases Unit Hospital Clinic, Barcelona C/ Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit Hospital Clinic, Barcelona C/ Villarroel 170, 08036 Barcelona, Spain
| |
Collapse
|
49
|
Blanco JL, Biglia A, De Lazzari E, Mallolas J, Martinez E, Pumarola T, Larrousse M, Milinkovic A, León A, Lonca M, Laguno M, Gatell JM. Antiretroviral activity of didanosine in patients with different clusters of reverse transcriptase mutations. AIDS 2006; 20:1891-2. [PMID: 16954732 DOI: 10.1097/01.aids.0000244210.33876.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patterns of mutations associated with didanosine (ddI) resistance are still a controversial issue. The correlation between different clusters of reverse transcriptase mutations with the short-term virological activity of ddI when added to a failing regimen was examined in 40 patients. The median fall in plasma viral load at week 4 was 0.67 log10 copies/ml. There was good correlation between the median fall in plasma HIV RNA levels and the number of nucleoside-associated (P = 0.0152) or thymidine-associated (P = 0.0142) mutations. In conclusion, ddI retained substantial antiretroviral activity when the number of nucleoside-associated or thymidine-associated mutations was less than four.
Collapse
|
50
|
Blanco JL, Biglia A, Martinez E, Sánchez M, de Lazzari E, Leon A, Milinkovic A, Larrousse M, Lonca M, Laguno M, Mallolas J, Gatell JM. Intrathoracic fat in HIV-infected patients. HIV Med 2006; 7:213-7. [PMID: 16630033 DOI: 10.1111/j.1468-1293.2006.00361.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of HIV infection or antiretroviral therapy on the intrathoracic fat compartment is unknown. METHODS Consecutive clinically stable HIV-infected adult patients, irrespective of exposure to antiretroviral therapy, and non-HIV-infected healthy volunteers, both without clinical evidence of body fat changes consistent with lipodystrophy and adjusted for age, gender and body mass index, were recruited for this study. Thoracic and abdominal fat was assessed by computed tomography and compared between patients and controls. RESULTS There were nine women (33%) and 18 men (67%) in each group. Nineteen patients (70%) had been taking antiretrovirals for a median of 8 months (interquartile range: 6-11). Among the HIV-infected patients, intrathoracic fat (median; interquartile range) did not differ significantly between treated (6.7 cm(2); 4.5-8.3 cm(2)) and untreated (6.9 cm(2); 5.7-10.9 cm(2)) individuals (P=0.288). However, intrathoracic fat content (median; interquartile range) was higher in HIV-infected patients (6.8 cm(2); 5.6-10.5 cm(2)) than in controls (5.6 cm(2); 3.9-6.7 cm(2)) (P=0.025). Intrathoracic fat was positively correlated with intra-abdominal fat both in patients (rho=0.6, P=0.002) and in controls (rho=0.7, P=0.004). CONCLUSION In HIV-infected adults without clinical evidence of lipodystrophy, intrathoracic fat content was higher than in healthy persons and positively correlated with intra-abdominal fat content.
Collapse
Affiliation(s)
- J L Blanco
- Infectious Diseases Unit, Hospital Clinic-Institut d'Investigaciones Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|