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Ruiz-Herrera VV, Navarro-Lara SA, Andrade-Villanueva JF, Alvarez-Zavala M, Sánchez-Reyes K, Toscano-Piña M, Méndez-Clemente AS, Martínez-Ayala P, Valle-Rodríguez A, González-Hernández LA. Pilot study on the efficacy and safety of berberine in people with metabolic syndrome and human immunodeficiency virus infection. Int J STD AIDS 2023; 34:1042-1052. [PMID: 37611246 DOI: 10.1177/09564624231196600] [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: 08/25/2023]
Abstract
BACKGROUND Antiretroviral therapy has increased the life expectancy of people living with HIV. However, this increase is not free of comorbidities, and metabolic syndrome is one of the most prevalent. Berberine is an alkaloid nutraceutical that has been shown to ameliorate metabolic disorders such as prediabetes, polycystic ovary syndrome, and non-alcoholic fatty liver disease. However, it has not been tested in HIV infection. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of berberine in improving metabolic syndrome. METHODS AND RESULTS In this double-blind, placebo-controlled trial, adults living with HIV under virological suppression and metabolic syndrome received either berberine 500 mg TID or placebo for 20 weeks. The primary outcomes were a composite of weight reduction, insulin resistance decrease, and lipid profile improvement. A total of 43 participants were randomized (22 in the berberine group and 21 in the placebo group); 36 participants completed the follow-up and were analyzed. The berberine group showed a reduction in weight and body mass index, lower insulin resistance, and a reduction in TNF-alpha. The control group had higher total cholesterol, c-LDL, and IL-6 concentration. CONCLUSION In people living with HIV under virological suppression, berberine was safe and improves clinical and biochemical components of metabolic syndrome. However, further studies with more participants and longer intervention periods need to be explored.
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Affiliation(s)
- Vida V Ruiz-Herrera
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | - Shaúl A Navarro-Lara
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Servicio de Medicina Interna, Guadalajara, México
| | - Jaime F Andrade-Villanueva
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Monserrat Alvarez-Zavala
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Karina Sánchez-Reyes
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Marcela Toscano-Piña
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | | | - Pedro Martínez-Ayala
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | | | - Luz A González-Hernández
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
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Jang W, Kandimalla L, Rajan S, Abreu R, Campos JE. Monkeypox in an immunocompromised patient with underlying human immunodeficiency virus and syphilis infections in Southern Florida of the United States: a case report. AIDS Res Ther 2023; 20:12. [PMID: 36800970 DOI: 10.1186/s12981-023-00504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The orthopoxvirus causes the rare disease monkeypox, and underlying immune deficiencies might lead to worse outcomes. In this report, we described a rare case of monkeypox with an underlying immune deficiency caused by human immunodeficiency virus infection which was combined with syphilis. This report discusses differences in the initial clinical presentation and clinical course compared to typical monkeypox cases. CASE PRESENTATION We report the case of a 32-year-old man with human immunodeficiency virus infection who was admitted to a hospital in Southern Florida. The patient presented to the emergency department with shortness of breath, fever, cough and left-sided chest wall pain. Physical examination revealed a pustular skin rash, consisting of generalised exanthema with small white and red papules. Upon arrival, he was found to be in sepsis with lactic acidosis. Chest radiography showed left-sided pneumothorax and minimal atelectasis in the left mid-lung, with a small pleural effusion at the left lung base. An infectious disease specialist raised the possibility of monkeypox, and the lesion sample tested positive for monkeypox deoxyribonucleic acid. In this case, the possible diagnosis of skin lesions varied because the patient tested positive for syphilis and human immunodeficiency virus. For that reason, the differential diagnosis of monkeypox infection is prolonged owing to its initial atypical clinical features. CONCLUSIONS Patients with underlying immune deficiency who have human immunodeficiency virus infection and syphilis can present with atypical clinical features and delay proper diagnosis, which can increase the risk of spreading monkeypox in hospitals. Thus, patients with rash and risky sexual behaviour should be screened for monkeypox or other sexually transmitted diseases such as syphilis, and a readily available, rapid, and accurate test is necessary to stop the spread of the disease.
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Abstract
We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.
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Affiliation(s)
- Cho Ryok Kang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea.,Infectious Disease Control Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sook Ja Yang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
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Breillat P, Pourcher V, Deshayes S, Buob D, Cez A, Michel PA, Boffa JJ, Langlois V, Grateau G, Georgin-Lavialle S. AA Amyloidosis in the Course of HIV Infection: A Report of 19 Cases Including 4 New French Cases and a Comprehensive Review of Literature. Nephron Clin Pract 2021; 145:675-683. [PMID: 34265778 DOI: 10.1159/000516982] [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: 12/11/2020] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV infection has been recently retained as an unclear cause of AA amyloidosis. Our aim was to investigate cases of AA amyloidosis associated with HIV infection to understand if it could be considered as a cause of AA amyloidosis. METHODS A comprehensive literature review was conducted as well as retrospective study from French cases collected from our national reference center for AA amyloidosis. RESULTS Altogether, 19 patients with AA amyloidosis and HIV infection were found with 68% of men and median age at amyloidosis diagnosis of 38 years (range 28-75 years). Clinical presentation was nephrotic syndrome in 94% (n = 17/18). Among patients with renal involvement and assessable outcome (n = 17), 11 (64.7%) progressed to chronic kidney disease, with 6 (35%) end-stage renal disease. Seventy-five percent of patients had uncontrolled HIV infection and 71.4% CD4 counts <400/mm3 at amyloidosis diagnosis. Repeated or chronic bacterial or fungal infection was found in 47% of cases and a history of parenteral drug use in 55% of patients. Three patients had no classical or at least no suspected AA amyloidosis cause found or reported. CONCLUSIONS AA Amyloidosis is a rare condition in HIV patients with common renal involvement and significant risk of progression to chronic renal insufficiency. Because of the frequency related to other inflammatory conditions in this population, HIV is probably not an independent risk factor for AA amyloidosis.
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Affiliation(s)
- Paul Breillat
- Department of Internal Medicine, Sorbonne University, AP-HP, Tenon Hospital, Centre De Référence Des Maladies Auto-Inflammatoires Et Des Amyloses D'origine Inflammatoire (CEREMAIA), Paris, France
| | - Valérie Pourcher
- Department of Infectious Diseases, Sorbonne University, APHP, Pitié Salpétrière Hospital, INSERM 1136, Paris, France
| | - Samuel Deshayes
- Department of Internal Medicine, Normandie University, UNICAEN, CHU De Caen Normandie, Caen, France
| | - David Buob
- Department of Biopathology, Sorbonne University, AP-HP, Tenon Hospital, Paris, France
| | - Alexandre Cez
- Department of Nephrology, Sorbonne University, AP-HP, Tenon Hospital, Paris, France
| | | | - Jean-Jacques Boffa
- Department of Nephrology, Sorbonne University, AP-HP, Tenon Hospital, Paris, France
| | - Vincent Langlois
- Department of Internal Medicine, Jacques Monod Hospital, Le Havre, France
| | - Gilles Grateau
- Department of Internal Medicine, Sorbonne University, AP-HP, Tenon Hospital, Centre De Référence Des Maladies Auto-Inflammatoires Et Des Amyloses D'origine Inflammatoire (CEREMAIA), Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Sorbonne University, AP-HP, Tenon Hospital, Centre De Référence Des Maladies Auto-Inflammatoires Et Des Amyloses D'origine Inflammatoire (CEREMAIA), Paris, France
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Altuwaijri TA, Alhindi GK, Al-Qattan NM, Alkharashi SK, Somily AM, Altoijry AH. Occurrence of Venous Thromboembolism in Hospitalized Patients with Tuberculosis in Saudi Arabia: A Retrospective Cohort Study. Int J Mycobacteriol 2021; 9:205-208. [PMID: 32474545 DOI: 10.4103/ijmy.ijmy_28_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The purpose of this study was to assess the risk of venous thromboembolism (VTE) and the potential need for thromboprophylaxis in patients with tuberculosis (TB). Methods A total of 103 patients who underwent treatment for TB at the King Khalid University Hospital in Riyadh between February 2015 to May 2018, the percentage of patients diagnosed with TB who developed VTE was assessed. This was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh. Fisher's exact test was used to analyze the categorical variables.P < 0.05 was considered statistically significant. Results Our data showed the prevalence of VTE in TB patients to be 2.93% (3/103). VTE occurred irrespective of the type of TB (pulmonary and/or extrapulmonary). All TB patients with VTE showed no significant association with factors such as human immunodeficiency virus coinfection, malignancy, and multidrug-resistant TB. Conclusion Our study showed that TB patients in Saudi Arabia may be at a higher risk for developing VTE and should be carefully monitored as potential candidates for additional thromboprophylaxis; further studies are recommended to establish more reliable assessment and recommendations.
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Affiliation(s)
- Talal A Altuwaijri
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ghada K Alhindi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Noha M Al-Qattan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sara K Alkharashi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ali M Somily
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed H Altoijry
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Goedhals J, Joubert G, Sherriff A, Theron M. Gestational trophoblastic disease and human immunodeficiency virus infection: A 10-year retrospective analysis of patients from the Free State Province, South Africa. Int J Gynaecol Obstet 2020; 152:448-449. [PMID: 33025609 DOI: 10.1002/ijgo.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/01/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jacqueline Goedhals
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Service, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Alicia Sherriff
- Department of Oncology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Magda Theron
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State and National Health Laboratory Service, Bloemfontein, South Africa
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Sanvisens A, Rivas I, Faure E, Espinach N, Hernandez-Rubio A, Majó X, Colom J, Muga R. Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study. World J Gastroenterol 2020; 26:5874-5883. [PMID: 33132641 PMCID: PMC7579757 DOI: 10.3748/wjg.v26.i38.5874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine.
AIM To assess HCV treatment rates in an Opioid Treatment Program (OTP).
METHODS This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors.
RESULTS Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive (n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80).
CONCLUSION HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain
| | - Inmaculada Rivas
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Eva Faure
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Néstor Espinach
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Anna Hernandez-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
| | - Xavier Majó
- Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
| | - Joan Colom
- Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
| | - Robert Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
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González-Alcaide G, Menchi-Elanzi M, Nacarapa E, Ramos-Rincón JM. HIV/AIDS research in Africa and the Middle East: participation and equity in North-South collaborations and relationships. Global Health 2020; 16:83. [PMID: 32943058 PMCID: PMC7499968 DOI: 10.1186/s12992-020-00609-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV/AIDS has attracted considerable research attention since the 1980s. In the current context of globalization and the predominance of cooperative work, it is crucial to analyze the participation of the countries and regions where the infection is most prevalent. This study assesses the participation of African countries in publications on the topic, as well as the degree of equity or influence existing in North-South relations. METHODS We identified all articles and reviews of HIV/AIDS indexed in the Web of Science Core Collection. We analyzed the scientific production, collaboration, and contributions from African and Middle Eastern countries to scientific activity in the region. The concept of leadership, measured through the participation as the first author of documents in collaboration was used to determine the equity in research produced through international collaboration. RESULTS A total of 68,808 documents published from 2010 to 2017 were analyzed. Researchers from North America and Europe participated in 82.14% of the global scientific production on HIV/AIDS, compared to just 21.61% from Africa and the Middle East. Furthermore, the publications that did come out of these regions was concentrated in a small number of countries, led by South Africa (41% of the documents). Other features associated with HIV/AIDS publications from Africa include the importance of international collaboration from the USA, the UK, and other European countries (75-93% of the documents) and the limited participation as first authors that is evident (30 to 36% of the documents). Finally, the publications to which African countries contributed had a notably different disciplinary orientation, with a predominance of research on public health, epidemiology, and drug therapy. CONCLUSIONS It is essential to foster more balance in research output, avoid the concentration of resources that reproduces the global North-South model on the African continent, and focus the research agenda on local priorities. To accomplish this, the global North should strengthen the transfer of research skills and seek equity in cooperative ties, favoring the empowerment of African countries. These efforts should be concentrated in countries with low scientific activity and high incidence and prevalence of the disease. It is also essential to foster intraregional collaborations between African countries.
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Affiliation(s)
| | - Marouane Menchi-Elanzi
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain
| | - Edy Nacarapa
- Infectious Disease Division, Carmelo Hospital of Chókwè - Daughters of Charity, Saint Vincent of Paul, Chókwè, Gaza Province, Mozambique
- Tinpswalo Association, Research Unit, Vincentian Association to Fight AIDS and TB, Chókwè, Gaza Province, Mozambique
| | - José-Manuel Ramos-Rincón
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain.
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain.
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Kawai S, Suzuki H, Okuma Y. Durvalumab Consolidation Treatment after Chemoradiotherapy for an HIV-Positive Patient with Locally Advanced Non-Small Cell Lung Cancer. Case Rep Oncol 2020; 13:747-753. [PMID: 32774270 PMCID: PMC7383185 DOI: 10.1159/000507390] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
Due to antiretroviral therapy, human immunodeficiency virus (HIV) patients and non-HIV patients have a similar life expectancy. The leading cause of death among HIV patients is lung cancer. However, clinical toxicities with immune checkpoint inhibitors, including durvalumab, in HIV-positive patients with non-small cell lung cancer (NSCLC) remain unknown. We report a 45-year-old Japanese HIV patient, who was safely treated with durvalumab consolidation therapy after concurrent chemoradiotherapy (CCRT) for locally advanced NSCLC without significant toxicities until his disease progressed. This case demonstrates the safety of durvalumab consolidation therapy for HIV-positive patients after CCRT for locally advanced NSCLC.
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Affiliation(s)
- Shoko Kawai
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroe Suzuki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Efobi CC, Azuike EC, Nwankwo BE, Chidolue UN, Okoye HC. The Perception of People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome toward Human Immunodeficiency Virus Infection: A Single-Center Experience. Niger Med J 2020; 61:84-89. [PMID: 32675900 PMCID: PMC7357804 DOI: 10.4103/nmj.nmj_90_19] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background: The prevention and control of human immunodeficiency virus (HIV) infection depend on the prevention of new infections as well as treating currently infected individuals. Adequate knowledge of HIV infection among person living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) may be an important tool in reducing spread of the virus. Objective: The objective of the study was to evaluate knowledge and attitude of PLWHA on HIV infection. Methodology: This was a cross-sectional study conducted at the Chukwuemeka Odumegwu Ojukwu Teaching Hospital. Knowledge of infection, spread, control, and effect was sought from HIV-positive respondents using a structured questionnaire. Information about their attitude and beliefs was also obtained. Collected data were analyzed using the Statistical Package for Social Sciences for Windows, Version 21.0. Results: A total of 70 HIV-positive patients, including 23 (32.9%) males and 47 (67.1%) females with a mean age of 37.7 years were participated. The overall knowledge on HIV transmission, clinical effects, complications, and controls was good in 15.7%, average in 72.9%, and poor in 11.4%. Knowledge of means of transmission was appropriate in majority of them. Majority of 66 (94.3%) patients showed a positive attitude to life. Conclusion: Most of the HIV-positive patients had average knowledge on HIV, and majority had a positive attitude to life.
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Affiliation(s)
- Chilota Chibuife Efobi
- Department of Haematology and Immunology, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Àwka Campus, Anambra, Nigeria
| | - Emmanuel Chukwunonye Azuike
- Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra, Nigeria
| | - Basil Elochukwu Nwankwo
- Department of ENT, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra, Nigeria
| | - Uzoma Nnenna Chidolue
- Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra, Nigeria
| | - Helen Chioma Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Abstract
The first human immunodeficiency virus (HIV) infection was reported in Korea in 1985. The number of HIV-infected persons domestically increased in the 1990s showing epidemic indigenousization. Since then, the number of new infections gradually increased every year, and recently more than 1,000 newly infected cases were reported per year. A total of 12,522 infected individuals have been reported up to 2015, of which 2,020 died. The male to female ratio was 15.4:1, and 34.2% of them were under 30 years old. The infection route was homosexual and bisexual contact in 60.1% of cases and heterosexual contact in 34.6% of cases. Candidiasis, Pneumocystis pneumonia, tuberculosis were common as a AIDS (acquired immune deficiency syndrome)-defining illness. But with the introduction of antiretroviral therapy in the late 1990s, non-AIDS defining illnesses such as metabolic complications, cardiovascular diseases, bone diseases, and neuropsychiatric disorders such as neurocognitive dysfunction, depression, and anxiety are emerging as new health problems. The management policy switched its focus from regulating and monitoring of HIV-infected persons to ensuring access to treatment and promotion of voluntary HIV testing in high-risk groups. Also as the age of the infected persons increases, a need for various supports such as social rehabilitation, life counseling, and welfare has emerged.
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Affiliation(s)
- June Myung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Nam Joong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Sik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
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Abstract
PURPOSE OF REVIEW This study aims to review the history of the human immunodeficiency virus (HIV) infection epidemic in China. RECENT FINDINGS The HIV infection epidemic in China has evolved significantly over the past 35 years, from initially exclusively within people who inject drugs (PWID), to outbreaks due to plasma collection contamination in the mid-1990s, to now almost exclusive transmission via sexual contact. The number of newly-diagnosed cases and the number HIV-related deaths have increased each year since 2004, coinciding with a massive scale-up of both HIV testing and antiretroviral therapy initiation. The proportion of cases diagnosed later in their disease progression has remained constant. The initial outbreaks of HIV across China were identified quickly and the overall trends have been monitored. While the HIV epidemic among PWID has been well managed, the growing HIV epidemic via sexual contact has grown more complex and even more difficult to control.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
- University of California, California, Los Angeles, USA.
| | - Junfang Chen
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
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Ishihara A, Hatakeyama S, Suzuki J, Amano Y, Sasahara T, Toshima M, Morisawa Y. Histological evidence for the cardiac safety of high-dose pegylated liposomal doxorubicin in a patient with HIV-associated Kaposi sarcoma: a case report and literature review. BMC Infect Dis 2019; 19:848. [PMID: 31615436 PMCID: PMC6794836 DOI: 10.1186/s12879-019-4500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pegylated liposomal doxorubicin plays an important role in the treatment of patients with severe refractory human immunodeficiency virus (HIV)-associated Kaposi sarcoma (KS). High cumulative doses of conventional doxorubicin exceeding 500 mg/m2 are known to cause cardiac toxicity. However, the safe cumulative dose of pegylated liposomal doxorubicin is unclear. Case presentation A 40-year-old Japanese man with HIV infection presented with pain, edema, and multiple skin nodules on both legs which worsened over several months. He was diagnosed with HIV-associated KS. He received long-term pegylated liposomal doxorubicin combined with antiretroviral therapy for advanced, progressive KS. The cumulative dose of pegylated liposomal doxorubicin reached 980 mg/m2. The patient’s left ventricular ejection fraction remained unchanged from baseline during treatment. After he died as a result of cachexia and wasting, caused by recurrent sepsis and advanced KS, an autopsy specimen of his heart revealed little or no evidence of histological cardiac damage. We also conducted a literature review focusing on histological changes of the myocardium in patients treated with a cumulative dose of pegylated liposomal doxorubicin exceeding 500 mg/m2. Conclusions This case report and literature review suggest that high (> 500 mg/m2) cumulative doses of pegylated liposomal doxorubicin may be used without significant histological/clinical cardiac toxicity in patients with HIV-associated KS.
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Affiliation(s)
- Ayaka Ishihara
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. .,Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Jun Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Yusuke Amano
- Department of Diagnostic Pathology, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Teppei Sasahara
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.,Department of Infection and Immunity, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Masaki Toshima
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Yuji Morisawa
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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15
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de Lima Morais TM, Soares CD, Wanderley AEC, de Oliveira CRR, Ribeiro CMB, de Almeida OP, de Carvalho MGF, Ferreira SMS. Oral melanomas in HIV-positive patients: Report of two cases and review of the literature. Oral Oncol 2020; 101:104375. [PMID: 31371241 DOI: 10.1016/j.oraloncology.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/10/2019] [Accepted: 07/20/2019] [Indexed: 11/23/2022]
Abstract
Oral melanoma in HIV-positive patients is exceedingly rare, with only two cases reported in the literature published in English. Herein, we report two additional cases of oral melanomas which occurred as oral masses in the upper gingiva and hard palate in 35- and 27-year-old HIV-positive women. Significant thrombocytopenia, anemia, reduced CD4 cells, and high HIV load occurred in both patients. Microscopically, the lesions showed a variable proliferation of fusiform and epithelioid-pigmented cells, with cellular pleomorphism and high mitotic index. The diagnosis of melanoma was supported by positive immunoreactivity for S-100, MelanA, and HMB-45. Both cases had an unfavorable outcome, and the patients died a few months after the initial diagnosis. Because of its rarity, oral melanoma occurring in HIV-positive patients can pose problems in diagnosis and should be clinically distinguished from Kaposi's sarcoma, which is more common in the context of the immunodeficiency syndrome.
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16
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Dekkers CC, Westerink J, Hoepelman AIM, Arends JE. Overcoming Obstacles in Lipid-lowering Therapy in Patients with HIV - A Systematic Review of Current Evidence. AIDS Rev 2019; 20:205-219. [PMID: 30548018 DOI: 10.24875/aidsrev.18000016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2022]
Abstract
Cardiovascular risk management in human immunodeficiency virus (HIV)-infected individuals is gaining increased attention due to the rising incidence and prevalence of cardiovascular disease in this population. Despite the availability of efficacious treatment strategies, implementation of guideline advocated preventive therapy, such as lipid-lowering therapy with statins, is hampered by perceived, expected, and real side effects as well as by expected interactions with combination antiretroviral therapy. These obstacles to optimal treatment have resulted in a large gap between the number of patients in whom lipid-lowering therapy is indicated and those actually taking lipid-lowering medication. In the past few years, research has shown that the majority of patient-reported side effects is not causally related to statin therapy but is attributable to the nocebo effect. Furthermore, excessive caution due to expected drug interactions between statins and antiretroviral therapy is often unnecessary, especially with novel classes of antiretroviral therapy. The main aim of this review is to discuss the causes and consequences of this lipid-lowering treatment gap in HIV-infected patients together with a practical guide on how to overcome these obstacles. In addition, new treatment options on the optimal cardiovascular management focusing primarily on novel classes of antiretroviral therapy and lipid-lowering medication will be discussed.
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Affiliation(s)
- Coco C Dekkers
- Department of Internal Medicine and Infectious Diseases. University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine. University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases. University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases. University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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17
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Patita M, Nunes G, Fonseca C. Idiopathic Rectal Ulcer Associated with Human Immunodeficiency Virus Infection. J Gastrointest Surg 2019; 23:1080-1081. [PMID: 30565067 DOI: 10.1007/s11605-018-4055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/13/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Marta Patita
- Gastroenterology Department, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267, Almada, Portugal.
| | - Gonçalo Nunes
- Gastroenterology Department, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Cristina Fonseca
- Gastroenterology Department, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267, Almada, Portugal
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18
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Nicolás D, Ambrosioni J, de Lazzari E, Suarez A, Manzardo C, Agüero F, Mosquera MM, Costa J, Ligero C, Marcos MÁ, Sánchez-Palomino S, Fernández E, Plana M, Yerly S, Gatell JM, Miró JM. Epidemiological changes of acute/recent human immunodeficiency virus type 1 infection in Barcelona, Spain (1997-2015): a prospective cohort study. Clin Microbiol Infect 2018; 25:878-884. [PMID: 30472421 DOI: 10.1016/j.cmi.2018.10.021] [Citation(s) in RCA: 7] [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] [Received: 07/17/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.
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Affiliation(s)
- D Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Suarez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M M Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - J Costa
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - C Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Á Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - S Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - E Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - S Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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19
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Kara M, Caliskan E, Atay G, Sutcu M, Kaba O, Adaletli I, Hancerli Torun S, Somer A. Shear wave elastography of parotid glands in pediatric patients with HIV infection. Radiol Med 2018; 124:126-131. [PMID: 30259316 DOI: 10.1007/s11547-018-0945-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 05/17/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Parotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects. MATERIALS AND METHODS This single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann-Whitney U test were used in statistical analysis. RESULTS Stiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses. CONCLUSIONS PG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.
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Affiliation(s)
- Manolya Kara
- Department of Pediatric Infectious Diseases, Istanbul University Faculty of Medicine, Turgut Ozal Street, No: 118, 34093, Fatih, Istanbul, Turkey.
| | - Emine Caliskan
- Department of Pediatric Radiology, Seyhan State Hospital, Adana, Turkey
| | - Gurkan Atay
- Department of Pediatric Intensive Care, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sutcu
- Department of Pediatric Infectious Diseases, Konya Training and Research Hospital, Konya, Turkey
| | - Ozge Kaba
- Department of Pediatric Infectious Diseases, Istanbul University Faculty of Medicine, Turgut Ozal Street, No: 118, 34093, Fatih, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Pediatric Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Istanbul University Faculty of Medicine, Turgut Ozal Street, No: 118, 34093, Fatih, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul University Faculty of Medicine, Turgut Ozal Street, No: 118, 34093, Fatih, Istanbul, Turkey
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Nowacka A, Rancati V, Roumy A, Monney P, Marcucci CE, Kirsch M. Multiple Cardiac Papillary Fibroelastomas - Are They Really Rare or Underdiagnosed? Heart Lung Circ 2018; 28:e83-e85. [PMID: 30415831 DOI: 10.1016/j.hlc.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Anna Nowacka
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland.
| | - Valentina Rancati
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Aurelien Roumy
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Carlo E Marcucci
- Department of Anesthesiology, University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
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Valanikas E, Dinas K, Tziomalos K. Cancer prevention in patients with human immunodeficiency virus infection. World J Clin Oncol 2018; 9:71-73. [PMID: 30254961 PMCID: PMC6153129 DOI: 10.5306/wjco.v9.i5.71] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/16/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer is a leading cause of death in patients with human immunodeficiency virus (HIV) infection. With the advent of antiretroviral treatment, the risk of AIDS-defining cancers declined but the ageing of this population resulted in the emergence of other common cancers, particularly lung and hepatocellular cancer. Accordingly, screening programs similar to the general population should be implemented in patients with HIV infection. Vaccination against common oncogenic viruses is also essential. However, rates of cancer screening and vaccination against HPV and HBV are considerably low in this population, highlighting a pressing need to educate patients and healthcare professionals about the importance of cancer preventive measures in these vulnerable patients.
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Affiliation(s)
- Evripidis Valanikas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki 54642, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
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22
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Van Hout MC, Mhlanga-Gunda R. Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in sub Saharan Africa: a scoping review of extant literature. BMC Int Health Hum Rights 2018; 18:31. [PMID: 30081894 PMCID: PMC6080512 DOI: 10.1186/s12914-018-0170-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sub Saharan African (SSA) prisons have seen a substantial increase in women prisoners in recent years. Despite this increase, women prisoners constitute a minority in male dominated prison environments, and their special health needs are often neglected. Research activity on prison health remains scant in SSA, with gathering of strategic information generally restricted to infectious diseases (human immunodeficiency virus infection HIV/tuberculosis TB), and particularly focused on male prisoners. Health care provisions for women (and pregnant women) in SSA prisons are anecdotally reported to fall far short of the equivalence care standards mandated by human rights and international recommendations, and the recent agreements set out in the Southern African Development Community (SADC) Minimum Standards for HIV in Prisons. METHODS A scoping review mapped what is currently known about women prisoners' health experiences, unique prison health care needs and health care outcomes in SSA. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2017). Following removal of duplicates and application of exclusion measures, 46 records remained, which represented 18 of the 49 SSA countries. These records were subsequently charted and thematically analysed. RESULTS Three themes were generated; 'The Prison Regime'; 'Navigating inside the Prison Health Infrastructure' and 'Accessing the outside Community and Primary Care Health Services'. Women in SSA prisons experience the same substandard nutrition, overcrowding and unhygienic conditions which exacerbate poor health and infectious disease transmission as males. Human rights abuses, substandard prison conditions and poor access to prison based and community clinical care, along with the invisible nature of women and that of their unique health needs are deplorable. CONCLUSIONS The review has highlighted the dearth of gender specific strategic information on women prisoners in the region, appalling environmental conditions and prison health care provision, and violation of human rights for those incarcerated. Enhanced donor support, resource allocation, prison health and population health policy reform, health systems surveillance and gender sensitive prison health service provision is warranted. This will help address women prisoners' conditions and their specific health needs in SSA prisons, and ultimately bridge the gap between prison and population health in the region.
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Affiliation(s)
| | - Rosemary Mhlanga-Gunda
- College of Health Sciences, Centre for Evaluation of Public Health Interventions, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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23
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Flauzino T, Simao ANC, de Almeida ERD, Morimoto HK, Oliveira SR, Alfieri DF, Ueda LT, Dichi I, Reiche EMV. Association between Vitamin D Status, Oxidative Stress Biomarkers and Viral Load in Human Immunodeficiency Virus Type 1 Infection. Curr HIV Res 2018; 15:336-344. [PMID: 28990534 DOI: 10.2174/1570162x15666171005170227] [Citation(s) in RCA: 7] [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] [Received: 06/14/2017] [Revised: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The role of vitamin D in the pathophysiology of human immunodeficiency virus type 1 (HIV-1) infection is still unclear. OBJECTIVE To evaluate the associations between vitamin D and immunological, virological, and oxidative stress biomarkers in individuals with human immunodeficiency virus type 1 (HIV-1) infection. METHODS The serum levels of 25 hydroxyvitamin D [25(OH)D] were determined in 314 HIV-1- infected individuals and 127 controls and the values ≥30 ng/mL defined a vitamin D sufficient (VDS) status, and <30 ng/mL defined the presence of hypovitaminosis D (HD). Oxidative stress was evaluated with plasma levels of lipid hydroperoxides, advanced oxidation protein products (AOPP), carbonyl protein, nitric oxide metabolites (NOx), total radical-trapping antioxidant parameter (TRAP), and sulfhydryl groups of proteins. Plasma HIV-1 viral load and CD4+/CD8+ T cells were quantified. RESULTS The 25(OH)D levels and vitamin D status did not differ between HIV-1-infected individuals and controls. Hydroperoxides and AOPP were higher (p<0.0001 and p=0.002, respectively), whereas TRAP, carbonyl protein, and NOx were lower in HIV-1-infected individuals than controls (p<0.0001). HIV-1-infected individuals with HD showed higher hydroperoxide levels than those with a VDS status (p=0.012) and controls (p=0.022), independent of ethnicity and antiretroviral therapy. A positive correlation between 25(OH)D ≥30 ng/mL and viral load was observed when expressed as the number of copies/mL (r=0.178, p=0.039), as well as log10 copies/mL (r=0.183, p=0.033). CONCLUSION These results suggest the bimodal influence of vitamin D in the modulation of immune response in HIV-1 infection, considering its differential susceptibility to modulation of the various immune targets and pathways.
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Affiliation(s)
- Tamires Flauzino
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Andrea N C Simao
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Elaine R D de Almeida
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Helena K Morimoto
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Sayonara R Oliveira
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Daniela F Alfieri
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Luiz T Ueda
- Integrated Center of Infectious Diseases of 17a Secretariat of Health of Parana, Londrina, Parana State, Brazil
| | - Isaias Dichi
- Department of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Edna M V Reiche
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, State University of Londrina, Londrina, Brazil
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Zheng S, Tan TT, Chien JMF. Cryptococcus gattii Infection Presenting as an Aggressive Lung Mass. Mycopathologia 2017; 183:597-602. [PMID: 29214455 DOI: 10.1007/s11046-017-0233-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/10/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Cryptococcus gattii is an endemic fungus predominantly isolated in the tropical and subtropical regions, causing predominantly pulmonary disease with a predilection for the central nervous system. Herein, we report a case of rapidly progressing C. gattii pneumonia in an immune-deficient but virologically suppressed host with underlying human immunodeficiency viral (HIV) infection, exhibiting various fungal morphologies from bronchoalveolar lavage (BAL) cytological specimens. A 51-year-old Chinese male with known HIV disease was admitted to the Singapore General Hospital for evaluation of functional decline, febrile episodes, and a left hilar mass on chest radiograph. Computed tomography (CT) showed consolidation in the apical segment of the left lower lobe. He underwent bronchoscopy and BAL. Positron emission tomography-computed tomography done 10 days after the initial CT showed approximate doubling of the pulmonary lesion. Cytological examination of the fluid revealed yeasts of varying sizes. Subsequent fungal culture from BAL fluid grew C. gattii 10 days later.
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Affiliation(s)
- Shuwei Zheng
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jaime Mei Fong Chien
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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Sumonu T, Imarhiagbe F, Owolabi L, Ogunrin O, Komolafe M, Ilesanmi O. Cognitive functions in newly diagnosed patients with HIV infection in a tertiary health facility: Assessment using community screening interview for dementia. eNeurologicalSci 2017; 9:8-13. [PMID: 29260041 PMCID: PMC5731538 DOI: 10.1016/j.ensci.2017.10.001] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/15/2017] [Accepted: 10/20/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Neurocognitive dysfunction is a detrimental complication of HIV infection. In this study we attempt to characterize the pattern of cognitive dysfunction in a sample of Nigerian patients with newly diagnosed HIV infection. METHODS We conducted a prospective study in which 50 patients with newly diagnosed HIV infection were studied along with 50 normal control subjects. The participants were evaluated with the medical history, general, physical and neurological examination. Laboratory evaluation and chest X-Ray were done for all patients. The Community Screening Interview for Dementia (CSID) questionnaire was administered to all the study participants. RESULTS About 70% of the patients were in advanced disease stage. The mean age (SD) of the patients and controls in years were 36.44 ± 8.22 and 35.40 ± 11.53 respectively. More than half (56%) of the patients had secondary level of education (12 years of education). About 20% of the patients had severe neurocognitive impairment while 48% had minor neurocognitive disorder. The patients with HIV infection performed poorly in the domains of language, memory, orientation, attention/calculation and praxis relative to controls (p < 0.05).There were no significant effect of gender, age, sex and level of education on cognitive functions in the patients (p > 0.05) but the presence of opportunistic infections had negative impact on the performances on orientation and total CSID scores in the patients with HIV infection (p < 0.05). CONCLUSION Patients with newly diagnosed HIV infection have poor cognitive functions when compared to normal controls and some presence of opportunistic infections in the patient is a significant risk factor for cognitive impairment.
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Affiliation(s)
- T.A. Sumonu
- Neurology Unit, Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - F. Imarhiagbe
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - L.F. Owolabi
- Neurology Unit, Department of Medicine, Aminu kano Teaching Hospital, Kano, Kano State, Nigeria
| | - O.A. Ogunrin
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - M.A. Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University, Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - O.S. Ilesanmi
- Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
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Laranjinha I, João Matias P, Dickson J, Estibeiro H, Boquinhas H, Barata JD. Prognostic Factors of Human Immunodeficiency Virus-Infected Patients on Chronic Hemodialysis. Blood Purif 2017; 44:244-250. [PMID: 28968598 DOI: 10.1159/000478966] [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: 01/17/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The number of human immunodeficiency virus (HIV)-infected patients on hemodialysis (HD) have increased, and their prognostic factors are still poorly clarified. The study aimed to identify factors that can influence the survival of HIV-infected patients on HD. METHODS We performed a retrospective cohort study of 44 HIV-infected patients on HD. RESULTS A total of 17 patients (39%) died. Median survival on HD was 30.8 months and the survival rate at 1 and 5 years was 82.5 and 62.9%, respectively. Male (relative risk [RR] 3.1, p = 0.040) and blacks (RR 2.5, p = 0.037) had higher risk of death. The patients who died had a shorter duration of HIV infection (p = 0.028), had a higher viral load (p = 0.044), more opportunistic infections (p = 0.013), and a lower serum albumin (p = 0.009). Lower serum albumin, nonsexual HIV transmission, viral load, opportunistic infections, and usage of catheters were associated with lower survival. CONCLUSION Several demographic, viral, and dialysis variables may help to predict survival of this population. The intervention in these factors could improve their prognosis.
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Affiliation(s)
- Ivo Laranjinha
- Department of Nephrology, Hospital de Santa Cruz, Lisbon, Portugal
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Liang SJ, Zheng QY, Yang YL, Yang Y, Liu CY. Use of etanercept to treat rheumatoid arthritis in an HIV-positive patient: a case-based review. Rheumatol Int 2017; 37:1207-1212. [PMID: 28255643 DOI: 10.1007/s00296-017-3690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 12/11/2022]
Abstract
Rheumatoid arthritis (RA) is a relatively common autoimmune disease that is associated with progressive disability and systemic complications, with a relatively high socioeconomic burden. The treatment of RA has been revolutionized by the use of biological drugs, such as anti-tumor necrosis factor (TNF) agents. A wide spectrum of RA disease severity has been reported among patients with human immunodeficiency virus (HIV) infection. Yet, only a few cases using anti-TNF therapy have been described in this clinical population. Therefore, the aim of our case-based review was to describe the successful use of etanercept in a 38-year-old female patient with RA concomitant with HIV infection, who had been resistant to the first-line anti-rheumatic therapies. As per routine care guidelines, the patient was screened for hepatitis virus infection, latent tuberculosis, and other infectious conditions, prior to the initiation of etanercept treatment. CD4 cell count, HIV viral load, and adverse effects were closely monitored during the treatment. The HIV infection remained stable with etanercept treatment, without the need for anti-retrovirus agents. No adverse effects and serious infections were identified during the treatment. Therefore, anti-TNF therapy is a viable alternative for the treatment of RA in patients with HIV, who do not respond to conventional anti-rheumatic therapies. The relationship between TNF-α and HIV infection, as well as cautionary guidelines regarding the utilization of anti-TNF therapy in this clinical population, is discussed.
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Affiliation(s)
- Shen-Ju Liang
- Division of Rheumatology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Quan-You Zheng
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yan-Long Yang
- Division of Rheumatology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Yi Yang
- Division of Rheumatology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Chong-Yang Liu
- Division of Rheumatology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
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Tsachouridou O, Skoura L, Zebekakis P, Margariti A, Georgiou A, Bougiouklis D, Pilalas D, Galanos A, Daniilidis M, Metallidis S. Antiretroviral naive and treated patients: Discrepancies of B cell subsets during the natural course of human immunodeficiency virus type 1 infection. World J Virol 2016; 5:155-160. [PMID: 27878102 PMCID: PMC5105048 DOI: 10.5501/wjv.v5.i4.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/24/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate alterations of memory B cell subpopulations during a 48-wk period in human immunodeficiency virus type 1 (HIV-1) patients.
METHODS Forty-one antiretroviral naïve and 41 treated HIV-1 patients matched for age and duration of HIV infection were recruited. All clinical, epidemiological and laboratory data were recorded or measured. The different B cell subsets were characterized according to their surface markers: Total B cells (CD19+), memory B cells (CD19+CD27+, BMCs), resting BMCs (CD19+CD27+CD21high, RM), exhausted BMCs (CD19+CD21lowCD27-, EM), IgM memory B (CD19+CD27+IgMhigh), isotype-switched BMCs (CD19+CD27+IgM-, ITS) and activated BMCs (CD19+CD21low+CD27+, AM) at baseline on week 4 and week 48.
RESULTS Mean counts of BMCs were higher in treated patients. There was a marginal upward trend of IgM memory B cell proportions which differed significantly in the treated group (overall trend, P = 0.004). ITS BMC increased over time significantly in all patients. Naive patients had of lower levels of EM B cells compared to treated, with a downward trend, irrespectively of highly active antiretroviral therapy (HAART) intake. Severe impairment of EM B cells was recorded to both treated (P = 0.024) and naive (P = 0.023) and patients. Higher proportions of RM cells were noted in HAART group, which differed significantly on week 4th (P = 0.017) and 48th (P = 0.03). Higher levels of AM were preserved in HAART naive group during the whole study period (week 4: P = 0.018 and 48: P = 0.035). HIV-RNA viremia strongly correlated with AM B cells (r = 0.54, P = 0.01) and moderately with RM cells (r = -0.45, P = 0.026) at baseline.
CONCLUSION HIV disrupts memory B cell subpopulations leading to impaired immunologic memory over time. BMC, RM, EM and ITS BMC were higher in patients under HAART. Activated BMCs (AM) were higher in patients without HAART. Viremia correlated with AM and RM. Significant depletion was recorded in EM B cells irrespectively of HAART intake. Perturbations in BMC-populations are not fully restored by antiretrovirals.
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Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive subtype of non-Hodgkin lymphoma that commonly occurs in human immunodeficiency virus (HIV)-positive individuals, and affects oral sites. Occasionally, it has been described in HIV-negative patients and involving non-oral sites. Pathologically, PBL is a high-grade B-cell lymphoma that displays the immunophenotype of a terminally differentiated B-lymphocyte with loss of B-cell markers (CD20) and expression of plasma-cell antigens. Epstein-Barr virus infection and MYC rearrangements are frequently observed. Treatment of PBL is challenging because of the lack of established treatment and poor outcomes, with median survival times shorter than one year. In this review, we discuss the clinical and epidemiologic spectrum of PBL as well as its distinct pathological features. Finally, we summarize the currently available approaches for the treatment of patients with PBL.
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Affiliation(s)
| | - Juan-Manuel Sancho
- Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Josep-María Ribera
- Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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Leeds IL, Alturki H, Canner JK, Schneider EB, Efron JE, Wick EC, Gearhart SL, Safar B, Fang SH. Outcomes of abdominoperineal resection for management of anal cancer in HIV-positive patients: a national case review. World J Surg Oncol 2016; 14:208. [PMID: 27495294 PMCID: PMC4974747 DOI: 10.1186/s12957-016-0970-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of anal cancer in human immunodeficiency virus (HIV)-positive individuals is increasing, and how co-infection affects outcomes is not fully understood. This study sought to describe the current outcome disparities between anal cancer patients with and without HIV undergoing abdominoperineal resection (APR). METHODS A retrospective review of all US patients diagnosed with anal squamous cell carcinoma, undergoing an APR, was performed. Cases were identified using a weighted derivative of the Healthcare Utilization Project's National Inpatient Sample (2000-2011). Patients greater than 60 years old were excluded after finding a skewed population distribution between those with and without HIV infection. Multivariable logistic regression and generalized linear modeling analysis examined factors associated with postoperative outcomes and cost. Perioperative complications, in-hospital mortality, length of hospital stay, and hospital costs were compared for those undergoing APR with and without HIV infection. RESULTS A total of 1725 patients diagnosed with anal squamous cell cancer undergoing APR were identified, of whom 308 (17.9 %) were HIV-positive. HIV-positive patients were younger than HIV-negative patients undergoing APR for anal cancer (median age 47 years old versus 51 years old, p < 0.001) and were more likely to be male (95.1 versus 30.6 %, p < 0.001). Postoperative hemorrhage was more frequent in the HIV-positive group (5.1 versus 1.5 %, p = 0.05). Mortality was low in both groups (0 % in HIV-positive versus 1.49 % in HIV-negative, p = 0.355), and length of stay (LOS) (10+ days; 75th percentile of patient data) was similar (36.9 % with HIV versus 29.8 % without HIV, p = 0.262). Greater hospitalization costs were associated with patients who experienced a complication. However, there was no difference in hospitalization costs seen between HIV-positive and HIV-negative patients (p = 0.66). CONCLUSIONS HIV status is not associated with worse postoperative recovery after APR for anal cancer as measured by length of stay or hospitalization cost. Further study may support APRs to be used more aggressively in HIV-positive patients with anal cancer.
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Affiliation(s)
- Ira L Leeds
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
| | - Hasan Alturki
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric B Schneider
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan E Efron
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA
| | - Elizabeth C Wick
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA
| | - Susan L Gearhart
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA
| | - Bashar Safar
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA
| | - Sandy H Fang
- Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA
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Executive summary of the GESIDA/National AIDS Plan Consensus Document on Antiretroviral Therapy in Adults Infected by the Human Immunodeficiency Virus (Updated January 2016). Enferm Infecc Microbiol Clin 2016; 34:439-51. [PMID: 27068257 DOI: 10.1016/j.eimc.2016.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The objective of ART is to achieve an undetectable plasma viral load (PVL). Initial ART should comprise 3 drugs, namely, 2 nucleoside reverse transcriptase inhibitors (NRTI), and 1 drug from another family. Four of the recommended regimens, all of which have an integrase strand transfer inhibitor (INSTI) as the third drug, are considered a preferred regimen; a further 6 regimens, which are based on an INSTI, a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor boosted with cobicistat or ritonavir (PI/COBI, PI/r), are considered alternatives. The reasons and criteria for switching ART are presented both for patients with an undetectable PVL and for patients who experience virological failure, in which case the rescue regimen should include 3 (or at least 2) drugs that are fully active against HIV. The specific criteria for ART in special situations (acute infection, HIV-2 infection, pregnancy) and comorbid conditions (tuberculosis and other opportunistic infections, kidney disease, liver disease, and cancer) are updated.
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Astolfo MF, D'Antonio F, Dartiguelongue JB, Arabolaza MN, Cheistwer A, De Matteo E, Torrado L, Martínez Iriart E. [Oral plasmablastic lymphoma in a human immunodeficiency virus positive child: a case report]. ARCH ARGENT PEDIATR 2016; 114:e95-9. [PMID: 27079412 DOI: 10.5546/aap.2016.e95] [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: 05/14/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022]
Abstract
Plasmablastic lymphoma is a rare and aggressive subtype of diffuse large B cell non-Hodgkin lymphoma, originally described in the oral cavity of male adults with acquired immune deficiency syndrome. It is composed of neoplastic ceils which resemble immunoblasts but present immunophenotype distinctive of plasma cell and Epstein-Barr virus latent infection. In children, it is an even rarer disease. We present a case of oral plasmablastic lymphoma in a vertically transmitted human immunodeficiency virus-positive five-year-old child.
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Affiliation(s)
- María Florencia Astolfo
- Residencia de Clínica Pediátrica, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina.
| | - Federico D'Antonio
- Residencia de Clínica Pediátrica, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - Juan B Dartiguelongue
- Departamento de Medicina, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - María N Arabolaza
- Residencia de Clínica Pediátrica, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - Ariel Cheistwer
- Departamento de Medicina, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - Elena De Matteo
- Servicio de Anatomía Patológica, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - Lidia Torrado
- Servicio de Infectología, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
| | - Emilio Martínez Iriart
- Departamento de Medicina, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, C1425EFD, Argentina
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Márquez M, Fernández Gutiérrez del Álamo C, Girón-González JA. Gut epithelial barrier dysfunction in human immunodeficiency virus-hepatitis C virus coinfected patients: Influence on innate and acquired immunity. World J Gastroenterol 2016; 22:1433-1448. [PMID: 26819512 PMCID: PMC4721978 DOI: 10.3748/wjg.v22.i4.1433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/11/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Even in cases where viral replication has been controlled by antiretroviral therapy for long periods of time, human immunodeficiency virus (HIV)-infected patients have several non-acquired immunodeficiency syndrome (AIDS) related co-morbidities, including liver disease, cardiovascular disease and neurocognitive decline, which have a clear impact on survival. It has been considered that persistent innate and acquired immune activation contributes to the pathogenesis of these non-AIDS related diseases. Immune activation has been related with several conditions, remarkably with the bacterial translocation related with the intestinal barrier damage by the HIV or by hepatitis C virus (HCV)-related liver cirrhosis. Consequently, increased morbidity and mortality must be expected in HIV-HCV coinfected patients. Disrupted gut barrier lead to an increased passage of microbial products and to an activation of the mucosal immune system and secretion of inflammatory mediators, which in turn might increase barrier dysfunction. In the present review, the intestinal barrier structure, measures of intestinal barrier dysfunction and the modifications of them in HIV monoinfection and in HIV-HCV coinfection will be considered. Both pathogenesis and the consequences for the progression of liver disease secondary to gut microbial fragment leakage and immune activation will be assessed.
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Abstract
Non-Hodgkin's lymphoma (NHL) is the third common malignant lesion of the oral region. Plasmablastic lymphomas are rare, aggressive neoplasms occurring mostly in human immunodeficiency virus (HIV) infected individual which accounts for approximately 2.6% of all NHL. It usually presents as a diffuse growth and with diffuse pattern of histological presentation. It is very difficult to differentiate this lymphoma from other NHL. Immunohistochemical evaluation of various markers is an important criteria of the diagnostic protocol. Here, we describe a case of plasmablastic lymphoma in a 50-year-old female HIV-infected patient. The diagnosis was based on histopathological examination and immunophenotyping.
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Affiliation(s)
- Dinkar Desai
- Department of Oral and Maxillofacial Pathology and Microbiology, AJ Institute of Dental Sciences, Manipal, Karnataka, India
| | - Siddharth Pandit
- Department of Oral and Maxillofacial Pathology and Microbiology, AJ Institute of Dental Sciences, Manipal, Karnataka, India
| | - Shiny Jasphin
- Post-Doctoral Fellow, Melaka Manipal Medical College, Manipal, Karnataka, India
| | - Akhil S Shetty
- Department of Dentistry, Kanachur Medical Hospital and Research Centre, Deralakatte, Mangalore, Karnataka, India
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García-Álvarez L, Pérez-Matute P, Blanco JR, Ibarra V, Oteo JA. High prevalence of asymptomatic carriers of Tropheryma whipplei in different populations from the North of Spain. Enferm Infecc Microbiol Clin 2015; 34:340-5. [PMID: 26585816 DOI: 10.1016/j.eimc.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 07/09/2015] [Revised: 09/09/2015] [Accepted: 09/16/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Tropheryma whipplei is the causative agent of Whipple disease. T. whipplei has also been detected in asymptomatic carriers with a very different prevalence. To date, in Spain, there are no data regarding the prevalence of T. whipplei in a healthy population or in HIV-positive patients, or in chronic fatigue syndrome (CFS). Therefore, the aim of this work was to assess the prevalence of T. whipplei in stools in those populations. METHODS Stools from 21 HIV-negative subjects, 65 HIV-infected, and 12 CFS patients were analysed using real time-PCR. HIV-negative and positive subjects were divided into two groups, depending on the presence/absence of metabolic syndrome (MS). Positive samples were sequenced. RESULTS The prevalence of T. whipplei was 25.51% in 98 stool samples analysed. Prevalence in HIV-positive patients was significantly higher than in HIV-negative (33.8% vs. 9.09%, p=0.008). Prevalence in the control group with no associated diseases was 20%, whereas no positive samples were observed in HIV-negative patients with MS, or in those diagnosed with CFS. The prevalence observed in HIV-positive patients without MS was 30.35%, and with MS it was 55.5%. The number of positive samples varies depending on the primers used, although no statistically significant differences were observed. CONCLUSIONS There is a high prevalence of asymptomatic carriers of T. whipplei among healthy and in HIV-infected people from Spain. The role of T. whipplei in HIV patients with MS is unclear, but the prevalence is higher than in other populations.
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Affiliation(s)
- Lara García-Álvarez
- Infectious Diseases Department, Hospital San Pedro-Center for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Patricia Pérez-Matute
- Infectious Diseases Department, Hospital San Pedro-Center for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - José Ramón Blanco
- Infectious Diseases Department, Hospital San Pedro-Center for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Valvanera Ibarra
- Infectious Diseases Department, Hospital San Pedro-Center for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - José Antonio Oteo
- Infectious Diseases Department, Hospital San Pedro-Center for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain.
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Shahbaz S, Manicardi M, Guaraldi G, Raggi P. Cardiovascular disease in human immunodeficiency virus infected patients: A true or perceived risk? World J Cardiol 2015; 7:633-644. [PMID: 26516417 PMCID: PMC4620074 DOI: 10.4330/wjc.v7.i10.633] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/31/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
After the successful introduction of highly active antiretroviral agents the survival of patients infected with the human immunodeficiency virus (HIV) in developed countries has increased substantially. This has allowed the surfacing of several chronic diseases among which cardiovascular disease (CVD) is prominent. The pathogenesis of CVD in HIV is complex and involves a combination of traditional and HIV related factors. An accurate assessment of risk of CVD in these patients is still elusive and as a consequence the most appropriate preventive and therapeutic interventions remain controversial.
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Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F, Barelli A, Raise E. Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era. World J Virol 2015; 4:209-218. [PMID: 26279983 PMCID: PMC4534813 DOI: 10.5501/wjv.v4.i3.209] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.
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Serafini G, Montebovi F, Lamis DA, Erbuto D, Girardi P, Amore M, Pompili M. Associations among depression, suicidal behavior, and quality of life in patients with human immunodeficiency virus. World J Virol 2015; 4:303-312. [PMID: 26279991 PMCID: PMC4534821 DOI: 10.5501/wjv.v4.i3.303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/19/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the potential associations among major depression, quality of life, and suicidal behavior in human immunodeficiency virus (HIV) patients.
METHODS: A detailed MEDLINE search was carried out to identify all articles and book chapters in English published from January 1995 to January 2015.
RESULTS: Based on the main findings, the prevalence of major depressive disorder (MDD) ranged from 14.0% to 27.2%. Furthermore, the prevalence of suicidal ideation varied from 13.6% to 31.0% whereas, attempted suicides were reported to range from 3.9% to 32.7%. Interestingly, various associated risk factors for both depression and suicide were identified in HIV patients. Finally, consistent associations were reported among MDD, suicidal ideation, and poor quality of life in individuals living with HIV.
CONCLUSION: Although additional studies are needed to elucidate this complex association, our results suggest the importance of early detection of both MDD and suicidality in patients living with HIV.
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Asensi V, Collazos J, Valle-Garay E. Can antiretroviral therapy be tailored to each human immunodeficiency virus-infected individual? Role of pharmacogenomics. World J Virol 2015; 4:169-177. [PMID: 26279978 PMCID: PMC4534808 DOI: 10.5501/wjv.v4.i3.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/07/2015] [Accepted: 06/11/2015] [Indexed: 02/05/2023] Open
Abstract
Pharmacogenetics refers to the effect of single nucleotide polymorphisms (SNPs) within human genes on drug therapy outcome. Its study might help clinicians to increase the efficacy of antiretroviral drugs by improving their pharmacokinetics and pharmacodynamics and by decreasing their side effects. HLAB*5701 genotyping to avoid the abacavir-associated hypersensitivity reaction (HSR) is a cost-effective diagnostic tool, with a 100% of negative predictive value, and, therefore, it has been included in the guidelines for treatment of human immunodeficiency virus (HIV) infection. HALDRB*0101 associates with nevirapine-induced HSR. CYP2B6 SNPs modify efavirenz plasma levels and their genotyping help decreasing its central nervous system, hepatic and HSR toxicities. Cytokines SNPs might influence the development of drug-associated lipodystrophy. APOA5, APOB, APOC3 and APOE SNPs modify lipids plasma levels and might influence the coronary artery disease risk of HIV-infected individuals receiving antiretroviral therapy. UGT1A1*28 and ABCB1 (MDR1) 3435C > T SNPs modify atazanavir plasma levels and enhance hyperbilirubinemia. Much more effort needs to be still devoted to complete large prospective studies with multiple SNPs genotyping in order to reveal more clues about the role played by host genetics in antiretroviral drug efficacy and toxicity.
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Ben-Natan M, Hazanov Y. Women's willingness to be tested for human immunodeficiency virus during pregnancy: A review. World J Virol 2015; 4:245-54. [PMID: 26279985 PMCID: PMC4534815 DOI: 10.5501/wjv.v4.i3.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 02/05/2023] Open
Abstract
Mother-to-child-transmission of human immunodeficiency virus (HIV) is a primary cause of pediatric infections with HIV. Many of these infections involve women who were not tested early enough in pregnancy, or who did not receive prevention services. HIV testing of pregnant women is considered to be one of the key strategies for preventing mother-to-child-transmission of HIV, but HIV testing rates among pregnant women in various countries remain suboptimal. Understanding the factors relating to women's willingness to be tested for HIV during pregnancy is critical for developing strategies to increase HIV testing rates among pregnant women. Extensive research points to various factors relating to women's willingness to be tested for HIV during pregnancy, and various recommendations aimed at improving testing rates among pregnant women have been suggested based on the research. In light of the goals set by the United Nations to reduce the rate of infants infected with HIV, it is necessary to summarize what is currently known regarding factors related to women's willingness to be tested for HIV during pregnancy. The purpose of this review is therefore to examine factors related to women's willingness to be tested for HIV during pregnancy, and to summarize recommendations for practice and further research.
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Berenguer J, Polo R, Aldeguer JL, Lozano F, Aguirrebengoa K, Arribas JR, Blanco JR, Boix V, Casado JL, Clotet B, Crespo M, Domingo P, Estrada V, García F, Gatell JM, González-García J, Gutiérrez F, Iribarren JA, Knobel H, Llibre JM, Locutura J, López JC, Miró JM, Moreno S, Podzamczer D, Portilla J, Pulido F, Ribera E, Riera M, Rubio R, Santos J, Sanz-Moreno J, Sanz J, Téllez MJ, Tuset M, Rivero A; Expert Panel of GESIDA and the National AIDS Plan. Executive summary of the GESIDA/National AIDS Plan Consensus Document on antiretroviral therapy in adults infected by the human immunodeficiency virus (updated January 2015). Enferm Infecc Microbiol Clin 2015; 33:544-56. [PMID: 26021186 DOI: 10.1016/j.eimc.2015.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022]
Abstract
In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation vary depending on the CD4+ T-lymphocyte count, the presence of opportunistic infections or comorbid conditions, age, and the efforts to prevent the transmission of HIV. The objective of ART is to achieve an undetectable plasma viral load (PVL). Initial ART should comprise three drugs, namely, two nucleoside reverse transcriptase inhibitors (NRTI) and one drug from another family. Three of the recommended regimens, all of which have an integrase strand transfer inhibitor (INSTI) as the third drug, are considered a preferred regimen; a further seven regimens, which are based on an INSTI, an non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor boosted with ritonavir (PI/r), are considered alternatives. The reasons and criteria for switching ART are presented both for patients with an undetectable PVL and for patients who experience virological failure, in which case the rescue regimen should include three (or at least two) drugs that are fully active against HIV. The specific criteria for ART in special situations (acute infection, HIV-2 infection, pregnancy) and comorbid conditions (tuberculosis and other opportunistic infections, kidney disease, liver disease, and cancer) are updated.
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Kleines M, Scheithauer S, Schiefer J, Häusler M. Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience. Diagn Microbiol Infect Dis 2014; 80:207-15. [PMID: 25178670 DOI: 10.1016/j.diagmicrobio.2014.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Received: 12/06/2013] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
The cerebrospinal fluid (CSF) polymerase chain reaction (PCR) is the gold standard to detect cerebral viral activity. As positive findings do not prove an impact on the neurological disorder, data interpretation is difficult. To better assess the impact of positive CSF PCR findings in different neurological diseases and to identify coherences facilitating CSF PCR data interpretation, we performed this retrospective analysis of CSF PCR data of 481 pediatric and 2604 adult patients, including herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and enteroviruses (EV). Nucleic acid of EBV was detected in 1.6% (39/2449), of VZV in 1.3% (34/2624), of HSV in 1.24% (37/2994), of EV in 0.4% (10/2364), of HHV-6 in 0.17% (4/2417), and of CMV in 0.2% (5/2514) of the patients. Newborns and elderly people showed highest infection rates. HSV, VZV, and EV prevailed in typical infectious central nervous system (CNS) diseases; EBV, in further inflammatory neurological diseases; HSV and EBV, in immunocompromised patients; and EBV, HSV, and HHV-6, in further non-inflammatory neurological diseases. Analysis of successive PCR studies revealed delayed viral detection for EBV (6/147) and HSV (1/217), respectively. Rapid viral clearance was typical for HSV, VZV, CMV, and EV infections, although the maximum duration of viral detection was 15days for HSV and 12days for VZV, respectively. This suggests that the detection of HSV, VZV, CMV, and EV strongly indicates symptomatic viral CNS disease. Secondary viral reactivation mostly underlies positive EBV and HHV-6 findings. Their detection does not rule out clinical impact but recommends searching for additional underlying conditions.
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Affiliation(s)
- Michael Kleines
- Division of Virology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany.
| | - Johannes Schiefer
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.
| | - Martin Häusler
- Department of Pediatrics, Division of Pediatric Neurology and Social Pediatrics, RWTH Aachen University Hospital, Aachen, Germany.
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Brasileiro CB, Abreu MHNG, Mesquita RA. Critical review of topical management of oral hairy leukoplakia. World J Clin Cases 2014; 2:253-256. [PMID: 25032199 PMCID: PMC4097151 DOI: 10.12998/wjcc.v2.i7.253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/02/2014] [Accepted: 05/16/2014] [Indexed: 02/05/2023] Open
Abstract
Oral hairy leukoplakia (OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish the normal characteristics of the tongue, to eliminate pathogenic microorganisms, to improve patient comfort and for cosmetic reasons. Proposed treatments for this condition include surgery, systemic antiviral treatment and topical management. Topical treatment is an inexpensive and safe therapy that is easy to apply, noninvasive, free of systemic adverse effects and effective over a long period of time. The aim of this study was to present a review of the literature for topical therapy for OHL. Gentian violet, retinoids, podophyllin, acyclovir and podophyllin associated with topical antiviral drugs were used to treat OHL. Reports with this focus are limited, and since 2010, no new studies have been published that discuss the efficacy of topical treatments for OHL. Podophyllin with acyclovir cream was found to be effective, causing regression of lesions with no recurrences. Additional searches are necessary to provide clinical evidence of topical management effectiveness.
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Mínguez-Gallego C, Vera-Remartinez EJ, Albert-Coll M, Roldán-Puchalt MC, Aguilar-Climent M, Rovira-Ferrando RE, Andrés-Soler J, Roig-Espert B, Penadés-Vidal M, Usó-Blasco J. [Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)]. Enferm Infecc Microbiol Clin 2015; 33:173-80. [PMID: 25027695 DOI: 10.1016/j.eimc.2014.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 03/18/2014] [Accepted: 04/16/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (<2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies.
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Araújo I, Enjuanes-Grau C, Lopez-Guarch CJ, Narankiewicz D, Ruiz-Cano MJ, Velazquez-Martin T, Delgado J, Escribano P. Pulmonary arterial hypertension related to human immunodeficiency virus infection: A case series. World J Cardiol 2014; 6:495-501. [PMID: 24976921 PMCID: PMC4072839 DOI: 10.4330/wjc.v6.i6.495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/21/2014] [Accepted: 05/08/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To present 18 new cases of human immunodeficiency virus (HIV)-related pulmonary arterial hypertension (PAH) with presenting features, treatment options and follow-up data.
METHODS: This is a single-centre, retrospective, observational study that used prospectively collected data, conducted during a 14-year period on HIV-related PAH patients who were referred to a pulmonary hypertension unit. All patients infected with HIV were consecutively admitted for an initial evaluation of PAH during the study period and included in our study. Right heart catheterisation was used for the diagnosis of PAH. Specific PAH treatment was started according to the physician’s judgment and the recommendations for idiopathic PAH. The data collected included demographic characteristics, parameters related to both HIV infection and PAH and disease follow-up.
RESULTS: Eighteen patients were included. Intravenous drug use was the major risk factor for HIV infection. Risk factors for PAH, other than HIV infection, were present in 55.5% patients. The elapsed time between HIV infection and PAH diagnoses was 12.2 ± 6.9 years. At PAH diagnosis, 94.1% patients had a CD4 cell count > 200 cells/μL. Highly active antiretroviral therapy (present in 47.1% patients) was associated with an accelerated onset of PAH. Survival rates were 93.8%, 92.9% and 85.7% at one, two and three years, respectively. Concerning specific therapy, 33.3% of the patients were started on a prostacyclin analogue, and the rest were on oral drugs, mainly phosphodiesterase-5 inhibitors. During the follow-up period, specific therapy was de-escalated to oral drugs in all of the living patients.
CONCLUSION: The survival rates of HIV-related PAH patients were higher, most likely due to new aggressive specific therapy. The majority of patients were on oral specific therapy and clinically stable. Moreover, sildenafil appears to be a safe therapy for less severe HIV-related PAH.
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Panel de expertos de GeSIDA., Plan Nacional sobre el Sida. [GeSIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2014)]. Enferm Infecc Microbiol Clin 2014; 32:446.e1-42. [PMID: 24953253 DOI: 10.1016/j.eimc.2014.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/18/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This consensus document is an update of combined antiretroviral therapy (cART) guidelines for HIV-1 infected adult patients. METHODS To formulate these recommendations a panel composed of members of the Grupo de Estudio de Sida and the Plan Nacional sobre el Sida reviewed the efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendations strength and the evidence in which they are supported are based on modified criteria of the Infectious Diseases Society of America. RESULTS In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation varies with the clinical circumstances: CDC stage B or C disease (A-I), asymptomatic patients (depending on the CD4+ T-lymphocyte count: <350cells/μL, A-I; 350-500 cells/μL, A-II, and >500 cells/μL, B-III), comorbid conditions (HIV nephropathy, chronic hepatitis caused by HBV or HCV, age >55years, high cardiovascular risk, neurocognitive disorders, and cancer, A-II), and prevention of transmission of HIV (mother-to-child or heterosexual, A-I; men who have sex with men, A-III). The objective of ART is to achieve an undetectable plasma viral load. Initial ART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors and a third drug from a different family (non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor). Some of the possible initial regimens have been considered alternatives. This update presents the causes and criteria for switching ART in patients with undetectable plasma viral load and in cases of virological failure where rescue ART should comprise 2 or 3 drugs that are fully active against the virus. An update is also provided for the specific criteria for ART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer). CONCLUSIONS These new guidelines updates previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.
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Lavolé A, Toper C, Belmont L, Ruppert AM, Wislez M, Cadranel J. [Lung cancer and HIV infection]. Rev Mal Respir 2013; 31:133-41. [PMID: 24602680 DOI: 10.1016/j.rmr.2013.07.009] [Citation(s) in RCA: 8] [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] [Received: 07/26/2012] [Accepted: 07/11/2013] [Indexed: 01/18/2023]
Abstract
AIDS was the cause of the majority of deaths from HIV infection before 1996 but since the introduction of antiretroviral therapies the causes of mortality have changed considerably. In 2010, 75 % of deaths were due to diseases other than AIDS, the majority being cancers. Lung cancer is the most common in terms of both incidence and mortality. It shows specific features when compared to the general population: there is an excess risk due to heavy smoking but also probably due to immunosuppression. The age of onset is younger and the prognosis worse than in the general population. Management is difficult, partly due to the aggressive nature of the tumor and partly to co-morbidities and potential interactions between anticancer and antiretroviral therapies. A phase II therapeutic trial (IFCT-CHIVA 1001) is under way nationally.
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Affiliation(s)
- A Lavolé
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France.
| | - C Toper
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - L Belmont
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - A-M Ruppert
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - M Wislez
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - J Cadranel
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
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Panel de expertos de GeSIDA y Plan Nacional sobre el Sida. [Consensus Statement by GeSIDA/National AIDS Plan Secretariat on antiretroviral treatment in adults infected by the human immunodeficiency virus (Updated January 2013)]. Enferm Infecc Microbiol Clin 2013; 31:602.e1-602.e98. [PMID: 24161378 DOI: 10.1016/j.eimc.2013.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/08/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This consensus document is an update of combined antiretroviral therapy (cART) guidelines for HIV-1 infected adult patients. METHODS To formulate these recommendations a panel composed of members of the GeSIDA/National AIDS Plan Secretariat (Grupo de Estudio de Sida and the Secretaría del Plan Nacional sobre el Sida) reviewed the efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. The strength of the recommendations and the evidence which support them are based on a modification of the criteria of Infectious Diseases Society of America. RESULTS cART is recommended in patients with symptoms of HIV infection, in pregnant women, in serodiscordant couples with high risk of transmission, in hepatitisB co-infection requiring treatment, and in HIV nephropathy. cART is recommended in asymptomatic patients if CD4 is <500cells/μl. If CD4 are >500cells/μl cART should be considered in the case of chronic hepatitisC, cirrhosis, high cardiovascular risk, plasma viral load >100.000 copies/ml, proportion of CD4 cells <14%, neurocognitive deficits, and in people aged >55years. The objective of cART is to achieve an undetectable viral load. The first cART should include 2 reverse transcriptase inhibitors (RTI) nucleoside analogs and a third drug (a non-analog RTI, a ritonavir boosted protease inhibitor, or an integrase inhibitor). The panel has consensually selected some drug combinations, for the first cART and specific criteria for cART in acute HIV infection, in tuberculosis and other HIV related opportunistic infections, for the women and in pregnancy, in hepatitisB or C co-infection, in HIV-2 infection, and in post-exposure prophylaxis. CONCLUSIONS These new guidelines update previous recommendations related to first cART (when to begin and what drugs should be used), how to monitor, and what to do in case of viral failure or adverse drug reactions. cART specific criteria in comorbid patients and special situations are similarly updated.
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Basu S, Kumar A. Giant molluscum contagiosum - a clue to the diagnosis of human immunodeficiency virus infection. J Epidemiol Glob Health 2013; 3:289-91. [PMID: 24206800 DOI: 10.1016/j.jegh.2013.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 11/29/2022] Open
Abstract
Molluscum contagiosum (MC) is a benign cutaneous viral infection, affecting mainly children and young adults. Though the disease is self-limiting in immunocompetent individuals, a severe and prolonged course is associated with Human Immunodeficiency Virus (HIV) infection. The following reports an apparently healthy 2-year-old boy with extensive MC without any systemic illness. His parents died of tuberculosis. Investigations revealed him to be a case of HIV infection with severe immunosuppression. The fact that awareness of this condition as being the first sign of HIV infection should prompt diagnostic investigation, especially in India where access to healthcare facilities is limited.
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Abstract
Background: Musculoskeletal involvement in human immunodeficiency virus (HIV) infected patients are important disease manifestations, responsible for increased morbidity and also decreased quality of life. Objectives: To study the spectrum of different musculoskeletal involvement in HIV infected patients and its impact on quality of life. Patients and Methods: Three hundred (n = 300) HIV-1 reactive patients were evaluated in respect to different musculoskeletal involvement including the quality of life from January 2010 to January 2011. Results: Male to female ratio was 11:1 with a mean age of 35 (±6.4) years and mean duration of the disease was 3 (±1.54) years. Majority of cases were truck drivers, motel workers, and jewelry workers. Musculoskeletal disorders were observed in a total of 190 cases (63.33%). The spectrum of musculoskeletal involvement was: Body ache in 140 (46.7%), arthralgia in 80 (26.7%), mechanical low back pain in 25 (8.3%), osteoporosis in 20 (6.7%), painful articular syndrome in 10 (3.3%), hypertrophic osteoarthropathy in two (0.7%), pyomyositis in two (0.7%), osteomyelitis in one (0.3%), and avascular bone necrosis in one patient (0.3%). Rheumatologic disorders associated were: Reactive arthritis in seven (2.3%), fibromyalgia in four (1.3%), septic arthritis in three (1%), acute gout in three (1%), spondyloarthropathy in two (0.7%), rheumatoid arthritis in two (0.7%), dermatomyositis in one (0.3%), and systemic lupus erythematosus (SLE) in one patient (0.3%). But HIV associated arthritis and diffuse infiltrative lymphocytosis syndrome (DILS) were not detected. Most of the patients had decreased quality of life. Conclusions: Musculoskeletal involvement was common in HIV patients causing increased morbidity, so early detection and timely intervention is essential to improve quality of life.
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Affiliation(s)
- Alakes Kumar Kole
- Department of Medicine, North Bengal Medical College, Darjeeling, India
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