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Fursa O, Bannister W, Neesgaard B, Podlekareva D, Kowalska J, Benfield T, Gerstoft J, Reekie J, Rasmussen LD, Aho I, Guaraldi G, Staub T, Miro JM, Laporte JM, Elbirt D, Trofimova T, Sedlacek D, Matulionyte R, Oprea C, Bernasconi E, Hadžiosmanović V, Mocroft A, Peters L. SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort. HIV Med 2024. [PMID: 38433476 DOI: 10.1111/hiv.13620] [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: 12/17/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described. METHODS We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive. RESULTS Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3-26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3 , and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9-4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6-0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe). CONCLUSIONS We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.
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Affiliation(s)
- O Fursa
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - W Bannister
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - B Neesgaard
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - D Podlekareva
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
- Department of Respiratory and Infectious Diseases, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - T Benfield
- Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - J Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - J Reekie
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - I Aho
- Division of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - G Guaraldi
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - T Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg City, Luxembourg
| | - J M Miro
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Laporte
- Hospital Universitario de Alava, Vitoria-Gasteiz, Spain
| | - D Elbirt
- Allergy, Immunology and HIV Unit, Kaplan Medical Center, Rehovot, Israel
| | - T Trofimova
- Novgorod Centre for AIDS prevention and control, Veliky Novgorod, Russian Federation
| | - D Sedlacek
- Department of Infectious Diseases and Travel Medicine, Medical Faculty and Teaching Hospital Plzen, Charles University Prague, Plzen, Czech Republic
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital, Vilnius, Lithuania
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - E Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - V Hadžiosmanović
- Infectious Diseases Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Mocroft
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
- UCL Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), London, UK
| | - L Peters
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
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Balayan T, Begovac J, Skrzat-Klapaczyńska A, Aho I, Alexiev I, Bukovinova P, Salemovic D, Gokengin D, Harxhi A, Holban T, Jevtovic D, Kase K, Lakatos B, Latysheva I, Matulionyte R, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Horban A, Kowalska JD. Where are we with pre-exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group. HIV Med 2020; 22:67-72. [PMID: 33021049 DOI: 10.1111/hiv.12960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/14/2020] [Revised: 07/03/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.
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Affiliation(s)
- T Balayan
- National Center for Disease Control and Prevention, Yerevan, Armenia
| | - J Begovac
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - A Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - I Aho
- Helsinki University Hospital, Helsinki, Finland
| | - I Alexiev
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - P Bukovinova
- Deptartment of Infectious Diseases and Geographical Medicine UH, University Hospital, Bratislava, Slovakia
| | - D Salemovic
- Clinic for Infectious Diseases, Belgrade, Serbia
| | | | - A Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, Tirana, Albania
| | - T Holban
- Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - D Jevtovic
- Belgrade University School of Medicine Infectious Diseases Hospital, Belgrade, Serbia
| | - K Kase
- Department of Infectious Diseases, West Tallinn Central Hospital, Tallinn, Estonia
| | - B Lakatos
- Saint Laszlo Hospital National Center of HIV, Semmelweis University Faculty of Infectious Diseases, Budapest, Hungary
| | - I Latysheva
- Republican Clinical Hospital of Infectious Diseases of Ministry of Healthcare of Russian Federation, St Petersburg, Russia
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Infectious Diseases Centre, Vilnius University, Vilnius, Lithuania
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A Papadopoulos
- Medical School -National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Athens, Greece
| | - N Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - D Sedlacek
- HIV Center University Hospital, Pilsen, Czech Republic
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - A Vassilenko
- Belarusian State Medical University, Minsk, Belarus
| | - M Vasylyev
- Lviv Regional Public Health Center, Lviv, Ukraine
| | - A Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, Banja Luka, Banja Luka, RS, Bosnia & Herzegovina, Banja Luka, Bosnia and Herzegovina
| | - N Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases - Sofia, Medical University Sofia, Sofia, Bulgaria
| | - O Yurin
- Central Research Institute of Epidemiology, Federal AIDS Centre, Moscow, Russian Federation
| | - A Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
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Santos JR, Cozzi-Lepri A, Phillips A, De Wit S, Pedersen C, Reiss P, Blaxhult A, Lazzarin A, Sluzhynska M, Orkin C, Duvivier C, Bogner J, Gargalianos-Kakolyris P, Schmid P, Hassoun G, Khromova I, Beniowski M, Hadziosmanovic V, Sedlacek D, Paredes R, Lundgren JD. Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe. HIV Med 2018; 19:324-338. [PMID: 29388732 DOI: 10.1111/hiv.12581] [Citation(s) in RCA: 4] [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] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens. METHODS Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches. RESULTS The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART. CONCLUSIONS Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.
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Affiliation(s)
- J R Santos
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - A Phillips
- Royal Free and University College, London, UK
| | - S De Wit
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - C Pedersen
- Odense University Hospital, Odense, Denmark
| | - P Reiss
- Academic Medical Center, Amsterdam, the Netherlands
| | - A Blaxhult
- Karolinska Institute, Venhälsan, Stockholm, Sweden
| | - A Lazzarin
- San Raffaele Scientific Institute, Milan, Italy
| | - M Sluzhynska
- Lviv Regional HIV/AIDS Prevention and Control Centre, Kiev, Ukraine
| | - C Orkin
- Royal London Hospital, London, UK
| | - C Duvivier
- Hôpital Necker-Enfants Malades, Paris, France
| | - J Bogner
- Medizinische Poliklinik, Munchen, Germany
| | | | - P Schmid
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - G Hassoun
- Rambam Health Care Campus, Haifa, Israel
| | - I Khromova
- Centre for HIV/AIDS and Infectious Diseases, Moscow, Russia
| | | | - V Hadziosmanovic
- Klinicki Centar Univerziteta Sarajevo (KCUS), Sarajevo, Bosnia & Herzegovina
| | - D Sedlacek
- Charles University Hospital, Plzen, Czech Republic
| | - R Paredes
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Barcelona, Spain.,Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - J D Lundgren
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Daartz J, Winey B, Bussiere M, Gierga D, Crawford B, Sedlacek D, Cotter C. SU-E-T-433: Evaluation of the ArcCheck Device for Patient-Specific Quality Assurance in Step-And-Shoot IMRT for Single-Fraction Spinal SBRT. Med Phys 2013. [DOI: 10.1118/1.4814867] [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: 11/07/2022] Open
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5
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Rozsypal H, Stankova M, Sedlacek D, Snopkova S, Kapla J, Aster V, Machala L, Jilich D, Dlouhy P, Kolcakova J, Zjevikova A, Jerhotova Z, Olbrechtova L. [Guidelines for caring for HIV-infected adults and postexposure prophylaxis for HIV infection]. Klin Mikrobiol Infekc Lek 2013; 19:62-71. [PMID: 23991476] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors present instructions for providing antiretroviral therapy in the Czech health care system, based partly on recommendations from abroad and partly on their own experiences of caring for HIV /AIDS patients. The structure and content are similar to those in the 2010 edition, with new study outcomes and modern trends in treatment strategy being taken into consideration. The guidelines are based on systematic patient assessment and aimed at making an accurate diagnosis and formulating recommendations according to individual criteria. The document provides specific instructions for decisions on initiating antiretroviral therapy, selection of individual drugs, monitoring of treatment effect and adverse reactions, and reaction to potential therapy failure. Special attention is paid to administration of antiretroviral drugs to pregnant women and patients with comorbidities, especially tuberculosis, hepatitis or renal insufficiency. The new version includes procedures for postexposure prophylaxis for HIV infection. The guidelines are supplemented by a table summary of antiretroviral drugs. The presented document is to be used in negotiations between the association,state authorities and health care payers.
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Affiliation(s)
- H Rozsypal
- Klinika infeklnich a tropickych nemoci, 1. lekaiska fakulta, Univerzita Karlova v Praze a Nemocnice Na Bulovce, Praha
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6
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Hanzlikova J, Sedlacek D, Liska M, Gorcikova J, Vlas T, Amiramini S, Panzner P, Maly M. Histamine increases the level of IFNγ produced by HIV-1 specific CTLs and this production depends on total IgE level. J Immunol Methods 2012; 375:1-6. [DOI: 10.1016/j.jim.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 12/14/2022]
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Treska V, Sutnar A, Mukensnabl P, Manakova T, Sedlacek D, Mirka H, Ferda J. Liver abscess in human toxocariasis. BRATISL MED J 2011; 112:644-647. [PMID: 22180993] [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: 05/31/2023]
Abstract
BACKGROUND Toxocariasis is a parasitic infection caused by Toxocara canis or Toxocara cati. It is distributed worldwide. Liver is the main organ affected by Toxocara infection, typically with multiple eosinophilic infiltrates. Liver abscess formation is a very rare condition. METHOD The authors report on a case of Toxocariasis infection with abscess formation in the right liver lobe. The diagnosis was made upon patient's history, clinical examination, use of ultrasonography, computed tomography and especially upon positive serologic test and hypereosinophilia. After unsuccessful conservative treatment (Mebendazole, antibiotics and corticoids), right hepatectomy was performed. RESULTS The postoperative course was complicated by biliary fistula in the resection area. The complication was successfully managed by temporary stent implantation to the left hepatic duct. Six months after the operation, the patient is with no complications. CONCLUSION Liver abscess formation is a rare condition associated with Toxocara infection. It is still a matter of debate whether liver abscess results from severe parasitic infection or whether human toxocariasis is a predisposing cause of pyogenic liver abscess formation. Liver resection is the only treatment option when sepsis fails to respond to conservative treatment (Fig. 5, Ref. 22).
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Affiliation(s)
- V Treska
- Department of Surgery, School of Medicine, University Hospital, Pilsen, Czech Republic.
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Reekie J, Reiss P, Ledergerber B, Sedlacek D, Parczewski M, Gatell J, Katlama C, Fätkenheuer G, Lundgren JD, Mocroft A. A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study. HIV Med 2010; 12:259-68. [PMID: 20812948 DOI: 10.1111/j.1468-1293.2010.00877.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine, efavirenz and lopinavir regimens based on these measures. METHODS Patients starting a nevirapine, efavirenz or lopinavir-based cART regimen for the first time after 1 January 2000 were included in the analysis. Follow-up started ≥ 3 months after initiation of treatment if viral load was <500 HIV-1 RNA copies/mL. Durability was measured as discontinuation rate or development/worsening of clinical markers. RESULTS A total of 603 patients (21%) started nevirapine-based cART, 1465 (51%) efavirenz, and 818 (28%) lopinavir. After adjustment there was no significant difference in the risk of discontinuation for any reason between the groups on nevirapine and efavirenz (P=0.43) or lopinavir (P=0.13). Compared with the nevirapine group, those on efavirenz had a 48% (P=0.0002) and those on lopinavir a 63% (P<0.0001) lower risk of discontinuation because of treatment failure and a 31% (P=0.01) and 66% (P<.0001) higher risk, respectively, of discontinuation because of toxicities or patient/physician choice. There were no significant differences in the incidence of non-AIDS-related events, worsening anaemia, severe weight loss, increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels or increased total cholesterol. Compared with patients on nevirapine, those on lopinavir had an 80% higher incidence of high-density lipoprotein (HDL) cholesterol decreasing below 0.9 mmol/L (P=0.003), but there was no significant difference in this variable between those on nevirapine and those on efavirenz (P=0.39). CONCLUSIONS The long-term durability of nevirapine-based cART, based on risk of all-cause discontinuation and development of long-term adverse events, was comparable to that of efavirenz or lopinavir, in patients in routine clinical practice across Europe who initially tolerated and virologically responded to their regimen.
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Affiliation(s)
- J Reekie
- Research Department of Infection & Population Health, University College London Medical School, Royal Free Campus, London, UK.
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Mocroft A, Rockstroh J, Soriano V, Ledergerber B, Kirk O, Vinogradova E, Reiss P, Katlama C, Phillips AN, Lundgren JD, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Clumeck N, De Wit S, Poll B, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Katlama C, Viard JP, Girard PM, Marc TS, Vanhems P, Pradier C, Dabis F, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Staszewski S, Bickel M, Goebel FD, Fätkenheuer G, Rockstroh J, Schmidt R, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Matez F, Duiculescu D, Streinu-Cercel A, Vinogradova E, Rakhmanova A, Jevtovic D, Mokrás M, Staneková D, González-Lahoz J, Sánchez-Conde M, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Bannister W, Mollerup D, Podlevkareva D, Olsen CH, Kjær J. Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection? Antivir Ther 2005. [DOI: 10.1177/135965350501000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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]
Abstract
Background Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
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Affiliation(s)
- Amanda Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | - Ole Kirk
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | | | - Andrew N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Jens D Lundgren
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | - I Karpov
- Belarus State Medical University, Minsk
| | | | - N Clumeck
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - S De Wit
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - B Poll
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | | | | | | | - K Zilmer
- West-Tallinn Central Hospital, Tallinn
| | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | | | | | - M Bickel
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | - G Panos
- A Filandras and E Karabatsaki, 1st IKA Hospital, Athens
| | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga
| | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | - E Mularska
- Osrodek Diagnostyki i Terapii AIDS, Chorzow
| | | | | | | | | | - F Matez
- Hospital Curry Cabral, Lisbon
| | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale: Dr. Victor Babes, Bucarest
| | | | | | | | - D Jevtovic
- The Institute for Infectious and Tropical Diseases, Belgrade
| | | | | | | | | | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | - A Karlsson
- Karolinska University Hospital, Stockholm
| | - P Pehrson
- Karolinska University Hospital, Huddinge
| | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St. Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - M Murphy
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St. Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St. Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Abstract
This study was conducted to determine whether family medicine residents' documentation of patient and family alcohol problems corresponded with patients' assessments. A random sample of 180 patient charts from a university-based family practice was audited and 78% (n = 140) of these patients participated in telephone interviews. Of those who participated in the telephone interview, 40% (n = 56) reported a positive family history of drinking problems, 28% (n = 39) indicated that they were currently concerned about the alcohol use of someone in their family, and 24% (n = 34) reported that at least one family member currently had an alcohol problem. Ninety-six percent (n = 134) of the subjects indicated that they believed physicians should ask about family alcohol problems and 91% (n = 128) believed physicians could be helpful in alcohol treatment at least some of the time. The audit of the 180 medical records indicated that residents charted a positive family history on 13% (n = 23) of the records and noted impact upon the family due to a member's drinking in 2% (n = 4) of the records. The study revealed that residents frequently did not identify alcohol problems or related family difficulties and highlighted the need for training and education in this area.
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Affiliation(s)
- A V Graham
- Department of Family Medicine, Case Western Reserve University, Cleveland, OH 44106-4950
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Graham AV, Sedlacek D, Reeb KG, Thompson JS. Early diagnosis and treatment of alcoholism. J Fam Pract 1984; 19:297-313. [PMID: 6470631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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