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Tsiakalos A, Routsias JG, Schinas G, Georgiadou S, Sipsas NV, Akinosoglou K. Investigating the Role of Anti-TPO Antibodies in HIV-Associated Thrombocytopenia before and after Initiation of HAART: A Case-Control Longitudinal Study. Viruses 2023; 15:2226. [PMID: 38005902 PMCID: PMC10675467 DOI: 10.3390/v15112226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This longitudinal, case-control study aimed to investigate the role of thrombopoietin (TPO) and anti-TPO antibodies in HIV-associated thrombocytopenia, focusing on the changes seen before and after the initiation of highly active antiretroviral therapy (HAART). Patients were assessed before and at least six months after the initiation of HAART. In total, 75 PLWHIV (age/sex-matched and randomized at 2:1, according to thrombocytopenia status) were included in this study. The baseline assessment revealed significantly higher TPO levels in thrombocytopenic patients (140.45 vs. 106.8 mg/mL, p = 0.008). Furthermore, anti-TPO-positive patients displayed lower platelet counts (109,000 vs. 139,000/L, p = 0.002) and TPO levels (114.7 vs. 142.7 mg/mL, p = 0.047). Longitudinally, HAART initiation reduced the frequency of thrombocytopenia from 75.47% to 33.96% (p < 0.001) and elevated the median platelet counts from 131,000 to 199,000 (p < 0.001). No significant difference in median platelet counts was found post-HAART among the anti-TPO subgroups (p = 0.338), a result contrasting with pre-HAART findings (p = 0.043). Changes in anti-TPO status corresponded with significant platelet count alterations (p = 0.036). Notably, patients who became anti-TPO negative showed a median increase of 95,000 platelets (IQR: 43,750-199,500). These marked differences between subgroups underscore the potential role of anti-TPO antibodies in modulating the hematological response to HAART. Further research is needed to elucidate the complex interplay between HIV infection, HAART, and thrombocytopenia.
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Affiliation(s)
| | - John G. Routsias
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Sarah Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece;
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Dardi F, Guarino D, Cennerazzo F, Ballerini A, Magnani I, Bertozzi R, Donato F, Martini G, Manes A, Galiè N, Palazzini M. Pulmonary Arterial Hypertension Associated with Portal Hypertension and HIV Infection: Comparative Characteristics and Prognostic Predictors. J Clin Med 2023; 12:3425. [PMID: 37240531 PMCID: PMC10219491 DOI: 10.3390/jcm12103425] [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: 04/13/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) may complicate both portal hypertension (Po-PAH) and HIV infection (HIV-PAH). These two conditions, however, frequently coexist in the same patient (HIV/Po-PAH). We evaluated clinical, functional, hemodynamic characteristics and prognostic parameters of these three groups of patients. METHODS We included patients with Po-PAH, HIV-PAH and HIV/Po-PAH referred to a single center. We compared clinical, functional and hemodynamic parameters, severity of liver disease [Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease-Na (MELD-Na) scores], CD4 count and highly active antiretroviral therapy (HAART) administration. Prognostic variables were identified through Cox-regression analysis. RESULTS Patients with Po-PAH (n = 128) were the oldest, patients with HIV-PAH (n = 41) had the worst hemodynamic profile and patients with HIV/Po-PAH (n = 35) had the best exercise capacity. Independent predictors of mortality were age and CTP score for Po-PAH, HAART administration for HIV-PAH, MELD-Na score and hepatic venous-portal gradient for HIV/Po-PAH. CONCLUSIONS Patients with HIV/Po-PAH are younger and have a better exercise capacity than patients with Po-PAH, have a better exercise capacity and hemodynamic profile compared to patients with HIV-PAH, and their prognosis seems to be related to the hepatic disease rather than to HIV infection. The prognosis of patients with Po-PAH and HIV-PAH seems to be related to the underlying disease.
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Affiliation(s)
- Fabio Dardi
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Daniele Guarino
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Francesco Cennerazzo
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Alberto Ballerini
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Ilenia Magnani
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Riccardo Bertozzi
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Federico Donato
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Giulia Martini
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
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Zhang C, Li Y, Lin Y, Zhang X, Huang Z, Bai G, Wan Y, Zhang W, Fang X, Li W. Joint Replacement Surgeries Can Be Safely Performed in HIV Patients. J Clin Med 2022; 12. [PMID: 36615092 DOI: 10.3390/jcm12010293] [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: 11/09/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Whether joint replacement surgery can be performed safely on HIV patients is still a matter of debate. This study aimed to report the surgical efficacy and complications of joint replacement surgery in HIV patients. A total of 21 HIV patients and 27 non-HIV patients who underwent arthroplasties in our hospital were retrospectively reviewed. The 21 HIV patients received 29 joint replacement surgeries including 27 cases of total hip arthroplasty (THA) and 2 cases of total knee arthroplasty (TKA). The non-HIV patients received 16 THA, 10 TKA, and 3 unicompartmental arthroplasty (UKA). The length of hospital stay of HIV patients was significantly lower than that of non-HIV patients. At the last follow-up, there were no significant complications both in the HIV group and the non-HIV groups. No medical staff had any occupational exposure. We concluded that joint replacement surgery in HIV patients is safe and effective. Optimization of patients is key to treatment success. Strictly following the standardized protection protocol can prevent the risk of occupational exposure.
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Sibiya T, Ghazi T, Mohan J, Nagiah S, Chuturgoon AA. Spirulina platensis Mitigates the Inhibition of Selected miRNAs that Promote Inflammation in HAART-Treated HepG2 Cells. Plants (Basel) 2022; 12:119. [PMID: 36616248 PMCID: PMC9824462 DOI: 10.3390/plants12010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
The introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV/AIDS has recently gained popularity. In addition, the significant role of microRNA expression in HIV pathogenesis cannot be overlooked; hence the need to explore the mechanisms of microRNA expression in the presence of HAART and Spirulina platensis (SP) in HepG2 cells. This study investigates the biochemical mechanisms of microRNA expression in HepG2 cells in the presence of HAART, SP, and the potential synergistic effect of HAART−SP. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine cell viability following SP treatment. The cellular redox status was assessed using the quantification of intracellular reactive oxygen species (ROS), lipid peroxidation, and a lactate dehydrogenase (LDH) assay. The fluorometric JC-1 assay was used to determine mitochondrial polarisation. The quantitative polymerase chain reaction (qPCR) was also employed for micro-RNA and gene expressions. The results show that MiR-146a (p < 0.0001) and miR-155 (p < 0.0001) levels increased in SP-treated cells. However, only miR-146a (p < 0.0001) in HAART−SP indicated an increase, while miR-155 (p < 0.0001) in HAART−SP treatment indicated a significant decreased expression. Further inflammation analysis revealed that Cox-1 mRNA expression was reduced in SP-treated cells (p = 0.4129). However, Cox-1 expression was significantly increased in HAART−SP-treated cells (p < 0.0001). The investigation revealed that HepG2 cells exposed to HAART−SP treatment showed a significant decrease in Cox-2 (p < 0.0001) expression. mRNA expression also decreased in SP-treated cells (p < 0.0001); therefore, SP potentially controls inflammation by regulating microRNA expressions. Moreover, the positive synergistic effect is indicated by normalised intracellular ROS levels (p < 0.0001) in the HAART−SP treatment. We hereby recommend further investigation on the synergistic roles of SP and HAART in the expression of microRNA with more focus on inflammatory and oxidative pathways.
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Affiliation(s)
- Thabani Sibiya
- Department of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4013, South Africa
| | - Terisha Ghazi
- Department of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4013, South Africa
| | - Jivanka Mohan
- Department of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4013, South Africa
| | - Savania Nagiah
- Department of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4013, South Africa
- Department of Human Biology, Medical Programme, Faculty of Health Sciences, Nelson Mandela University Missionvale, Bethelsdorp, Port Elizabeth 6059, South Africa
| | - Anil A. Chuturgoon
- Department of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4013, South Africa
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Shifera N, Yosef T, Mekonen M. Clinical and behavioral factors associated with undernutrition among highly active antiretroviral therapy users in Southwest Ethiopia. Front Nutr 2022; 9:914983. [PMID: 36618702 PMCID: PMC9815176 DOI: 10.3389/fnut.2022.914983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Globally, about 1.9 billion adults are overweight or obese, while 462 million are underweight. These are primarily found in countries with low and middle incomes, such as Ethiopia. Undernutrition is a frequent health problem among people living with HIV/AIDS; however, no large-scale research, including several health facilities, has been conducted in Ethiopia. Thus, this study aimed to assess the nutritional status and nutrition-related factors among highly active antiretroviral therapy (HAART) users in public hospitals in Southwest Ethiopia. Methods A cross-sectional facility study design was conducted in all public hospitals in Southwest Ethiopia from January to March 2021. A systematic sampling technique was used to select the study participants. The collected data were entered into EpiData 3.1 and then exported to SPSS version 24 for statistical analysis. Binary logistic regression analysis was done to identify the factors associated with the outcome variable. The level of significance was declared at a P-value of <0.05, with their corresponding 95% confidence level. Results A total of 402 HAART users have participated with a 100% response rate. The proportion of undernutrition (BMI <18.5 kg/m2) and patients with overweight or obesity (BMI ≥25 kg/m2) were 29.3% [95% CI: (24.6-33.5)] and 10% [95% CI: (6.6-12.9)], respectively. Out of undernutrition patients, severe undernutrition (BMI <16 kg/m2) accounted for 5.6%. Factors, such as food insecurity [AOR: 3.21, 95% CI: (1.76-5.91)], history of diarrhea [AOR: 2.86, 95% CI: (1.96-6.78)], CD4 cell count ≤ [AOR: 4.72, 95% CI: (2.14-12.13)], and substance user [AOR: 4.12, 95% CI: (2.31-7.30)], were the independent factors of undernutrition. Conclusion This study found that the prevalence of undernutrition was high compared with other settings. The government should also pay due attention to improving the treatment of HIV/AIDS by offering nutritional support services in hospitals. Moreover, policymakers and healthcare professionals consider the effects of these factors on nutrition while providing ART services.
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Sibiya T, Ghazi T, Mohan J, Nagiah S, Chuturgoon AA. Spirulina platensis Ameliorates Oxidative Stress Associated with Antiretroviral Drugs in HepG2 Cells. Plants (Basel) 2022; 11:plants11223143. [PMID: 36432871 PMCID: PMC9694780 DOI: 10.3390/plants11223143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 06/01/2023]
Abstract
Lately, Spirulina platensis (SP), as an antioxidant, has exhibited high potency in the treatment of oxidative stress, diabetes, immune disorder, inflammatory stress, and bacterial and viral-related diseases. This study investigated the possible protective role of Spirulina platensis against ARV-induced oxidative stress in HepG2 cells. Human liver (HepG2) cells were treated with ARVs ((Lamivudine (3TC): 1.51 µg/mL, tenofovir disoproxil fumarate (TDF): 0.3 µg/mL and Emtricitabine (FTC): 1.8 µg/mL)) for 96 h and thereafter treated with 1.5 µg/mL Spirulina platensis for 24 h. After the treatments, the gene and protein expressions of the antioxidant response pathway were determined using a quantitative polymerase chain reaction (qPCR) and Western blots. The results show that Spirulina platensis decreased the gene expressions of Akt (p < 0.0001) and eNOS (↓p < 0.0001) while, on the contrary, it increased the transcript levels of NRF-2 (↑p = 0.0021), Keap1 (↑p = 0.0002), CAT (↑p < 0.0001), and NQO-1 (↑p = 0.1432) in the HepG2 cells. Furthermore, the results show that Spirulina platensis also decreased the protein expressions of NRF-2 (↓p = 0.1226) and pNRF-2 (↓p = 0.0203). Interestingly, HAART-SP induced an NRF-2 pathway response through upregulating NRF-2 (except for FTC-SP) (↑p < 0.0001), CAT (↑p < 0.0001), and NQO-1 (except for FTC-SP) (↑p < 0.0001) mRNA expression. In addition, NRF-2 (↑p = 0.0085) and pNRF-2 (↑p < 0.0001) protein expression was upregulated in the HepG2 cells post-exposure to HAART-SP. The results, therefore, allude to the fact that Spirulina platensis has the potential to mitigate HAART-adverse drug reactions (HAART toxicity) through the activation of antioxidant response in HepG2 cells. We hereby recommend further studies on Spirulina platensis and HAART synergy.
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Affiliation(s)
- Thabani Sibiya
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Terisha Ghazi
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Jivanka Mohan
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Savania Nagiah
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
- Medical Programme, Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University Missionvale, Port Elizabeth 6059, South Africa
| | - Anil A. Chuturgoon
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
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Abstract
Cytomegalovirus (CMV) retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals. CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, but since HAART, Western countries have seen an 80% decrease in the incidence of the disease. More recently, CMV retinitis has been reported in patients who are immunosuppressed, often due to chemotherapy or immunomodulatory medications. The diagnosis of CMV retinitis is often suspected based on clinical findings, with polymerase chain reaction for confirmation of CMV, especially in atypical cases. Highly active antiretroviral therapy and anti-CMV medications (systemic or local) remain the mainstay of treatment. However, for those who are not responsive to HAART, CMV retinitis remains a challenge, and can still lead to significant vision loss. Moreover, a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity. Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis. These complications can arise following initiation of treatment or if patients show disease progression. Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.
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Affiliation(s)
| | - Steven Yeh
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jessica G. Shantha
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
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Xue W, Zhang Y, Wang H, Zhang Y, Hu X. Multicenter Study of Controlling Nutritional Status (CONUT) Score as a Prognostic Factor in Patients With HIV-Related Renal Cell Carcinoma. Front Immunol 2021; 12:778746. [PMID: 34917092 PMCID: PMC8669761 DOI: 10.3389/fimmu.2021.778746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/09/2021] [Indexed: 01/06/2023] Open
Abstract
Objective In recent years, the controlled nutritional status (CONUT) score has been widely recognized as a new indicator for assessing survival in patients with urological neoplasms, including renal, ureteral, and bladder cancer. However, the CONUT score has not been analyzed in patients with HIV-related urological neoplasms. Therefore, we aimed to evaluate the prognostic significance of the CONUT score in patients with HIV-related renal cell carcinoma (RCC). Methods A total of 106 patients with HIV-related RCC were recruited from four hospitals between 2012 and 2021, and all included patients received radical nephrectomy or partial nephrectomy. The CONUT score was calculated by serum albumin, total lymphocyte counts, and total cholesterol concentrations. Patients with RCC were divided into two groups according to the optimal cutoff value of the CONUT score. Survival analysis of different CONUT groups was performed by the Kaplan–Meier method and a log rank test. A Cox proportional risk model was used to test for correlations between clinical variables and cancer-specific survival (CSS), overall survival (OS), and disease-free survival (DFS). Clinical variables included age, sex, hypertension, diabetes, tumor grade, Fuhrman grade, histology, surgery, and CD4+ T lymphocyte count. Result The median age was 51 years, with 93 males and 13 females. At a median follow-up of 41 months, 25 patients (23.6%) had died or had tumor recurrence and metastasis. The optimal cutoff value for the CONUT score was 3, and a lower CONUT score was associated with the Fuhrman grade (P=0.024). Patients with lower CONUT scores had better CSS (HR 0.197, 95% CI 0.077-0.502, P=0.001), OS (HR 0.177, 95% CI 0.070-0.446, P<0.001) and DFS (HR 0.176, 95% CI 0.070-0.444, P<0.001). Multivariate Cox regression analysis indicated that a low CONUT score was an independent predictor of CSS, OS and DFS (CSS: HR=0.225, 95% CI 0.067-0.749, P=0.015; OS: HR=0.201, 95% CI 0.061-0.661, P=0.008; DFS: HR=0.227, 95% CI 0.078-0.664, P=0.007). In addition, a low Fuhrman grade was an independent predictor of CSS (HR 0.192, 95% CI 0.045-0.810, P=0.025), OS (HR 0.203, 95% CI 0.049-0.842, P=0.028), and DFS (HR 0.180, 95% CI 0.048-0.669, P=0.010), while other factors, such as age, sex, hypertension, diabetes, tumor grade, histology, surgery, and CD4+ T lymphocyte count, were not associated with survival outcome. Conclusion The CONUT score, an easily measurable immune-nutritional biomarker, may provide useful prognostic information in HIV-related RCC.
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Affiliation(s)
- Wenrui Xue
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yu Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hua Wang
- Chengdu Public Health Clinical Medical Center, Sichuan, China
| | - Yu Zhang
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaopeng Hu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Marima R, Hull R, Lolas G, Syrigos KN, Kgoebane-Maseko M, Kaufmann AM, Dlamini Z. The Catastrophic HPV/HIV Dual Viral Oncogenomics in Concert with Dysregulated Alternative Splicing in Cervical Cancer. Int J Mol Sci 2021; 22:10115. [PMID: 34576278 DOI: 10.3390/ijms221810115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/01/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
Cervical cancer is a public health problem and has devastating effects in low-to-middle-income countries (LTMICs) such as the sub-Saharan African (SSA) countries. Infection by the human papillomavirus (HPV) is the main cause of cervical cancer. HIV positive women have higher HPV prevalence and cervical cancer incidence than their HIV negative counterparts do. Concurrent HPV/HIV infection is catastrophic, particularly to African women due to the high prevalence of HIV infections. Although various studies show a relationship between HPV, HIV and cervical cancer, there is still a gap in the knowledge concerning the precise nature of this tripartite association. Firstly, most studies show the relationship between HPV and cervical cancer at genomic and epigenetic levels, while the transcriptomic landscape of this relationship remains to be elucidated. Even though many studies have shown HPV/HIV dual viral pathogenesis, the dual molecular oncoviral effects on the development of cervical cancer remains largely uncertain. Furthermore, the effect of highly active antiretroviral therapy (HAART) on the cellular splicing machinery is unclear. Emerging evidence indicates the vital role played by host splicing events in both HPV and HIV infection in the development and progression to cervical cancer. Therefore, decoding the transcriptome landscape of this tripartite relationship holds promising therapeutic potential. This review will focus on the link between cellular splicing machinery, HPV, HIV infection and the aberrant alternative splicing events that take place in HIV/HPV-associated cervical cancer. Finally, we will investigate how these aberrant splicing events can be targeted for the development of new therapeutic strategies against HPV/HIV-associated cervical cancer.
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Zhao T, Chen J, Fang H, Fu D, Su D, Zhang W. Diffusion tensor magnetic resonance imaging of white matter integrity in patients with HIV-associated neurocognitive disorders. Ann Transl Med 2020; 8:1314. [PMID: 33209894 PMCID: PMC7661883 DOI: 10.21037/atm-20-6342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study investigated the efficacy and neurotoxicity of highly active antiretroviral therapy (HAART) by evaluating white matter (WM) injury using diffusion tensor magnetic resonance imaging (DTI) in patients with human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND). Methods Forty-six patients with HAND underwent DTI before and every six months during HAART treatment. DTI data, including fractional anisotropy (FA) and mean diffusivity (MD) values of structural WM before and after HAART, were compared. The relationship between DTI values and plasma viral loads was tested. MD was more sensitive than FA for evaluating WM injury in HAND-positive patients. Results Following 12 months of HAART, increased MD values (compared to 6 months of HAART) were observed in the right temporal lobe, right parietal lobe, right occipital lobe, right anterior limb of the internal capsule, right lenticular nucleus, the right cerebral peduncle, left caudate nucleus, left dorsal thalamus, and left posterior limb of the internal capsule. MD values in the left genu of the internal capsule (r=0.350, P=0.017) and left corona radiata (r=0.338, P=0.021) were positively correlated with plasma viral loads. Conclusions DTI may be useful for assessing the efficacy and neurotoxicity of HAART in HAND-positive patients. Starting HAART may halt WM injury; however, prolonged HAART could worsen WM injury, highlighting the importance of optimal HAART duration.
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Affiliation(s)
| | | | - Hang Fang
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Danhui Fu
- Guangxi Medical University, Nanning, China
| | - Danke Su
- Guangxi Medical University, Nanning, China
| | - Wei Zhang
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, China
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Abstract
Purpose: Overview of the evolving epidemiology of human immunodeficiency virus (HIV)-related ocular disease over time. Method: Narrative review. Results: HIV enhances susceptibility to opportunistic eye infections, has direct pathogenic effects, and places patients at risk of immune recovery inflammatory syndromes in previously infected eyes after starting highly-active antiretroviral therapy (HAART). Widespread availability of HAART has resulted in a decrease of infectious ocular conditions such as cytomegalovirus retinitis, toxoplasmic retinitis, squamous cell carcinoma of the conjunctiva, and microvascular retinopathy. However, large coexisting burdens of tuberculosis, herpesvirus infection and syphilis (among others) continue to contribute to the burden of ocular disease, especially in low-resource settings. Growing risks of cataract, retinopathy and retinal nerve fiber thinning can affect patients with chronic HIV on HAART; thought due to chronic inflammation and immune activation. Conclusion: The changing epidemic of ocular disease in HIV-infected patients warrants close monitoring and identification of interventions that can help reduce the imminent burden of disease.
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Affiliation(s)
- Remco P H Peters
- Foundation for Professional Development, Research Unit , East London, South Africa.,Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre, CAPRHI School of Public Health & Primary Care , Maastricht, The Netherlands
| | | | - Manfred Zierhut
- Department of Ophthalmology, University of Tuebingen , Tübingen, Germany
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear , Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts, USA.,MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School , Addis Ababa, Ethiopia
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12
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Ren L, Wang B, Miao Z, Liu P, Zhou S, Feng Y, Yang S, Xia X, Wang K. A correlation analysis of HHV infection and its predictive factors in an HIV-seropositive population in Yunnan, China. J Med Virol 2019; 92:295-301. [PMID: 31621089 PMCID: PMC7004189 DOI: 10.1002/jmv.25609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/03/2019] [Accepted: 10/15/2019] [Indexed: 01/08/2023]
Abstract
Human herpesviruses (HHVs) have a particularly high prevalence in certain high‐risk populations and cause increased morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Screening and treating subclinical HHV infections reduce human immunodeficiency virus (HIV) infection incidence, disease progression, and transmission. However, there are few studies on HHVs, HIV coinfection rates, and their related risk factors. We aimed to clarify the prevalence of all eight HHVs in peripheral blood samples collected from HIV‐positive patients, and explore the association of HHV infection in HIV‐positive patients in an HIV‐seropositive population in Yunnan. We recruited 121 HIV‐positive patients with highly active antiretroviral therapy (HAART) and 45 healthy individuals. All the eight HHVs were detected using polymerase chain reaction and their epidemiological information and clinical data were collected and statistically analyzed. A high prevalence of HHVs (89.3%) was observed in individuals with HIV infections and with herpes simplex virus (HSV)‐2 (65.3%), and HSV‐1 (59.5%) being the most common. Coinfection with more than two different HHVs was more common in patients with HIV infections receiving HAART (72.7%) than in healthy controls. Older age, being married, higher HIV‐1 plasma viral loads, and use of antiviral protease inhibitors were independently correlated with an increased frequency of HHVs, but we found no association with CD4 count, WHO HIV clinical stage, and HIV infection duration. Our findings are of great significance for the prevention of HHV opportunistic infection in patients with AIDS and their clinical treatment. HHV co‐infection in AIDS patients deserves attention during the course of antiviral therapy. Suppressing HHV recurrences had a clinically significant effect on prolonging survival in some cohorts of HIV‐infected patients and may be an effective intervention in reducing HIV spread in China.
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Affiliation(s)
- Li Ren
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, Kunming, China.,Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Binghui Wang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Zhijiang Miao
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Pan Liu
- Department of Urology, Yan'an Hospital of Kunming Chenggong Hospital, Kunming, China
| | - Shiyi Zhou
- Department of Gastrointestinal Surgery, Kunming Engineering Technology Center of Diagnosis and Treatment of Digestive Diseases, Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yun Feng
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Shuting Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Kunming Engineering Technology Center of Diagnosis and Treatment of Digestive Diseases, Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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13
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Wei X, Zhang Y, Santella AJ, Wang L, Zhuang G, Li S, Zhang H. Effect of early highly active antiretroviral therapy on viral suppression among newly diagnosed men who have sex with men living with human immunodeficiency virus in Xi'an, China. J Med Virol 2019; 91:1263-1271. [PMID: 30840771 DOI: 10.1002/jmv.25449] [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: 01/14/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of men who have sex with men (MSM) living with human immunodeficiency virus (HIV) in China has increased rapidly and thus immediate highly active antiretroviral therapy (HAART) after diagnosis was implemented as a strategy to reduce the HIV transmission. METHODS MSM who were diagnosed with HIV and received HAART between 2013 to 2015 in Xi'an were divided into three groups (>350, 200-350, and <200 cell/μL) according to their baseline CD4+ T cell count. The time of follow-up was calculated from the first date of receiving HAART to December 31, 2016. The CD4+ T cell count was detected with 1 week before or after HAART. The plasma viral loads were tested after 1, 2, and 3 years of treatment. RESULTS Of 1442 subjects who received HAART, 690 (47.9%) cases were in >350 cell/μL group, whereas 400 (27.7%) cases and 352 (24.4%) cases were in the 200-350 cell/μL group and <200 cell/μL group, respectively. After 1 year of treatment, the viral suppression rate in the <200 cell/μL group was 91.1%, which was significantly lower than the other two groups. The logistic regression results show that the >350 cell/μL group and 200-350 cell/μL group predicted higher viral suppression rates. CONCLUSIONS Baseline CD4+ T cell count more than 350 cell/μL can improve viral suppression among MSM living with HIV. Furthermore, to reduce the transmission risk, the treatment compliance of people living with HIV with high CD4+ T cell levels should be improved, and their diagnosis to the treatment time should be decreased.
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Affiliation(s)
- Xiaoli Wei
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Yajuan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Anthony J Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Siwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hailan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
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14
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Liu Z, Deng X, Mo J, Jiang F, Wen B, Zhang Y, Pang J. [Moxibustion combined with highly active antiretroviral therapy for CD 4+ and γ chain cytokines of HIV infected patients]. Zhongguo Zhen Jiu 2018; 38:3-6. [PMID: 29354928 DOI: 10.13703/j.0255-2930.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effects of moxibustion combined with highly active antiretroviral therapy (HAART) and simple HAART for human immunodeficiency virus (HIV) infected patients. METHODS A total of 100 patients with HIV receiving HAART were randomized into an observation group and a control group, 50 cases in each one. In the observation group, moxibustion was used at Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6), etc. combined with HAART of zidovudine, lamivudine, nevirapine and efavirenzone, etc. Simple HAART was used in the control group. The patients were observed for 18 months. The indexes were CD4+, CD4+/CD8+, interleukin 2 (IL-2), interleukin 7 (IL-7), the incidence of side effects and the score of quality of life. RESULTS After treatment, CD4+, CD4+/CD8+, serum IL-2 and the scores of quality of life (physiological, psychological, social relation fields and comprehensive score) increased and serum IL-7 decreased compared with those before treatment in the two groups (P<0.01, P<0.05), with better results except CD4+ in the observation group (P<0.01, P<0.05). The incidences of gastrointestinal side effects and total side effects in the observation group were lower than those in the control group (14% (7/50) vs 32% (16/50), 58% (29/50) vs 80% (40/50), both P<0.05). CONCLUSION Moxibustion combined with HAART for HIV infected patients could reduce the incidence of side effects, improve medication compliance, CD4+/CD8+, IL-2, IL-7 and the quality of life.
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Affiliation(s)
- Zhenwei Liu
- AIDS Research Center, Ruikang Hospital of Guangxi University of CM, Nanning 530011, China
| | - Xin Deng
- AIDS Research Center, Ruikang Hospital of Guangxi University of CM, Nanning 530011, China
| | - Jinhua Mo
- Liver Transplantation Department, the First Affiliated Hospital of Guangxi University of CM
| | - Feng Jiang
- AIDS Research Center, Ruikang Hospital of Guangxi University of CM, Nanning 530011, China
| | - Bin Wen
- AIDS Research Center, Ruikang Hospital of Guangxi University of CM, Nanning 530011, China
| | - Yaping Zhang
- AIDS Research Center, Ruikang Hospital of Guangxi University of CM, Nanning 530011, China
| | - Jun Pang
- Chinese Medicine Administration Bureau of Guangxi Zhuang Autonomous Region
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15
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Sastry J, Mohammed H, Campos MM, Uetrecht J, Abu-Asab M. Nevirapine-induced liver lipid-SER inclusions and other ultrastructural aberrations. Ultrastruct Pathol 2018; 42:108-115. [PMID: 29424579 DOI: 10.1080/01913123.2017.1422831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nevirapine (NVP) therapy is associated with a high risk of serious liver injury and skin rash. Treatment of Brown Norway rats with NVP causes an immune-mediated skin rash. Even though NVP does not cause serious liver injury in wildtype animals, incubation of hepatocytes with NVP leads to the release of presumably danger-associated molecular pattern molecules (DAMPs), which activate macrophages. In this study, we examined the liver biopsies of Brown Norway rats treated with NVP to determine the histologic correlate to the release of DAMPs by hepatocytes. In vivo, debris from necrotic hepatocytes and endothelial cells were present in the liver sinusoids, a condition that can trigger an immune response. In addition to mitochondrial, hepatocytic, and endothelial damage, the drug induced large hepatocytic inclusions composed of lipid droplets surrounded by concentric whorls of smooth endoplasmic reticulum (SER) cisternae-lipid-SER (LSER) inclusions, which were deposited in the sinusoids. NVP is lipid soluble, and these LSER inclusions may be sinks of NVP or its metabolites. LSERs are deposited in the blood stream where they may be picked up by lymph nodes and contribute to initiation of an immune response leading to serious liver injury or skin rash. LSERs migration from liver to the blood stream may signify a novel mechanism of drug exocytosis.
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Affiliation(s)
- Jayram Sastry
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , Maryland, USA
| | - Heba Mohammed
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , Maryland, USA
| | - Maria Mercedes Campos
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , Maryland, USA
| | - Jack Uetrecht
- b Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Mones Abu-Asab
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , Maryland, USA
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16
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Mullins C, Miranda J, Sandoval H, Ramos-Duran L, Tonarelli SB. The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient: A Case Report. Innov Clin Neurosci 2018; 15:33-35. [PMID: 29497578 PMCID: PMC5819719] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature.
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Affiliation(s)
- Carola Mullins
- Drs. Mullins, Sandoval, and Ramos-Duran are with the Department of Radiology
- Dr. Miranda is with the Paul Foster School of Medicine
- Dr. Tonarelli is with the Department of Psychiatry- all with Texas Tech University Health Sciences Center in El Paso, Texas
| | - Jorge Miranda
- Drs. Mullins, Sandoval, and Ramos-Duran are with the Department of Radiology
- Dr. Miranda is with the Paul Foster School of Medicine
- Dr. Tonarelli is with the Department of Psychiatry- all with Texas Tech University Health Sciences Center in El Paso, Texas
| | - Hugo Sandoval
- Drs. Mullins, Sandoval, and Ramos-Duran are with the Department of Radiology
- Dr. Miranda is with the Paul Foster School of Medicine
- Dr. Tonarelli is with the Department of Psychiatry- all with Texas Tech University Health Sciences Center in El Paso, Texas
| | - Luis Ramos-Duran
- Drs. Mullins, Sandoval, and Ramos-Duran are with the Department of Radiology
- Dr. Miranda is with the Paul Foster School of Medicine
- Dr. Tonarelli is with the Department of Psychiatry- all with Texas Tech University Health Sciences Center in El Paso, Texas
| | - Silvina B Tonarelli
- Drs. Mullins, Sandoval, and Ramos-Duran are with the Department of Radiology
- Dr. Miranda is with the Paul Foster School of Medicine
- Dr. Tonarelli is with the Department of Psychiatry- all with Texas Tech University Health Sciences Center in El Paso, Texas
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17
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Abstract
Primary CNS lymphoma (PCNSL) has been designated an acquired immune deficiency syndrome (AIDS)-defining disease since 1983 and accounts for up to 15% of non-Hodgkin lymphomas in human immunodeficiency virus (HIV) patients. The majority of HIV patients are Epstein-Barr virus (EBV)-related. The most likely etiology is ineffective immunoregulation of EBV, inducing oncogenic protein expression, and subsequent loss of apoptosis and increased proliferation of lymphocytes. PCNSL generally presents with supratentorial, single or multiple, contrast-enhancing lesions. Neurologic symptoms can be headache, cognitive function disorders, focal neurologic, deficit and epilepsy. Differential diagnosis includes other oncologic or infectious causes, with cerebral toxoplasmosis being the most important. Magnetic resonance imaging characteristics, activity on 201thallium single-photon emission computed tomography, presence of EBV DNA in the cerebrospinal fluid, and toxoplasmosis serology can make either PCNSL or cerebral toxoplasmosis more or less likely. However, definitive diagnosis of PCNSL relies on histopathologic confirmation. First-choice treatment is combination antiretroviral therapy in combination with high-dose methotrexate(-based) chemotherapy in patients in whom this is feasible. Combination antiretroviral therapy combined with whole-brain radiotherapy may be an alternative. Treatment of EBV with antiviral agents such as ganciclovir or zidovudine may be beneficial, but this needs further study. Prognosis of HIV-related PCNSL is poor, with median survival varying from 2 to 4 months, but patients treated with chemotherapy do better (median survival 1.5 years).
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Affiliation(s)
- Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Center Daniel den Hoed, Rotterdam, The Netherlands.
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18
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Whitfield T, Dessain A, Taylor K, McQuillan O, Kingston M, Ajdukiewicz K. Retrospective analysis of the associations and effectiveness of performing therapeutic drug monitoring in pregnant HIV-positive women in two large centres in Manchester. Int J STD AIDS 2016; 28:499-504. [PMID: 27335118 DOI: 10.1177/0956462416656705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is no proven benefit for the routine use of therapeutic drug monitoring in HIV-positive pregnant women either for improving viral control or preventing mother-to-child transmission. This analysis reviewed a cohort of 171 HIV-positive pregnant women delivering between 1 January 2008 and 28 May 2013 to first establish which baseline characteristics are associated with having therapeutic drug monitoring performed, and whether therapeutic drug monitoring was associated with improved HIV control during pregnancy or mother-to-child transmission. Therapeutic drug monitoring was performed in 39% ( n = 66) of patients; it was associated with baseline characteristics of poor adherence to therapy (therapeutic drug monitoring 23% versus non-therapeutic drug monitoring 10%, p = 0.025) and the use of protease inhibitors (therapeutic drug monitoring 94% versus non-therapeutic drug monitoring 77%, p = 0.005). By multivariate analysis therapeutic drug monitoring was associated with medication alterations during pregnancy (therapeutic drug monitoring 68% versus non-therapeutic drug monitoring 12%, p = < 0.001), but not associated with any difference in viral load breakthrough during pregnancy (therapeutic drug monitoring 12% versus non-therapeutic drug monitoring 7%, p = 0.456) and viral load detectable at birth (therapeutic drug monitoring 14% versus non-therapeutic drug monitoring 9%, p = 0.503). There were no instances of mother-to-child transmission. Therapeutic drug monitoring's association with medication changes is postulated as partially causal in this cohort. There was no evidence of any association with improved control or reduced transmission of HIV to advocate routine therapeutic drug monitoring use.
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Affiliation(s)
- Thomas Whitfield
- 1 North Manchester General Infectious Diseases Department, Manchester, UK
| | - Amabel Dessain
- 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK
| | - Kelly Taylor
- 3 North Manchester General Paediatrics Department, Manchester, UK
| | - Orla McQuillan
- 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK
| | - Margaret Kingston
- 2 Central Manchester Foundation Trust Centre for Sexual Health, Manchester, UK
| | - Katherine Ajdukiewicz
- 1 North Manchester General Infectious Diseases Department, Manchester, UK.,4 University of Manchester, Manchester, UK
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Matuszkiewicz-Rowińska J, Wieliczko M. [Kidney disease in HIV-infected patient]. Wiad Lek 2016; 69:725-728. [PMID: 28033595] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the developed countries with an access to highly active antiretroviral therapy (HAART), the spectrum of renal complications observed in patients infected with HIV has shifted from HIV-associated kidney diseases to medications-related nephrotoxicities. In this article all types of these disorders, ranging from HIV-associated nephropathy (HIVAN), immune mediated glomerulopathies (HIVICK), and thrombotic microangiopathies to induced by HAART tubulopathies, acute toxic tubular necrosis, acute interstitial nephritis, crystal nephropathy, and chronic kidney disease have are shortly reviewed.
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Affiliation(s)
| | - Monika Wieliczko
- Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnętrznych WUM, Warszawa, Polska
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20
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James A, Oluwatosin B, Njideka G, Babafemi, Benjamin OG, Olufemi D, Leo R, Folorunso I, Phylis, Olusina O. CLEFT PALATE IN HIV-EXPOSED NEWBORNS OF MOTHERS ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY. Oral Surg 2014; 7:102-106. [PMID: 25653715 PMCID: PMC4313880 DOI: 10.1111/ors.12117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/30/2022]
Abstract
AIMS Cleft lip/palate, though rare, is the commonest head and neck congenital malformation. Both genetic and environmental factors have been implicated in the aetiopathogenesis but the role of in-utero exposure to human immunodeficiency virus (HIV) and highly active antiretroviral therapy (HAART) is still being investigated. This short communication reports the occurrence of cleft palate in three newborns exposed in-utero to HIV and HAART. MATERIAL AND METHODS This is a case series of HIV-exposed newborns observed to have cleft palate among a larger cohort of HIV-exposed and unexposed newborns in a study evaluating the effect of HIV infection and HAART on newborn hearing. The Risk Ratio (RR) was calculated to detect a potential association between in-utero exposure to Efavirenz containing ART and cleft palate. RESULTS Three HIV-exposed newborns with cleft palate were identified during hearing screening performed on 126 HIV-exposed and 121 HIV unexposed newborns. Two had exposure to tenofovir+lamivudine+efavirenz (TDF+3TC+EFV) while the third had exposure to zidovudine+lamivudine+nevirapine (ZDV+3TC+NVP) during the first trimester. There was no statistically significant association between presence of cleft palate and exposure to an EFV containing HAART regimen (p=0.07, RR=10.95 [0.94-126.84]). CONCLUSIONS This communication highlights the possible aetiologic role of HAART in cleft palate, the need for further prospective follow-up studies and establishment of antiretroviral pregnancy, birth and neonatal registries.
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Affiliation(s)
- Ayotunde James
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Nigeria
| | | | - Georgina Njideka
- Department of Virology, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS)
| | - Babafemi
- Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - David Olufemi
- Department of Virology, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS)
| | - Robert Leo
- Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Isaac Folorunso
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS)
| | - Phylis
- Department of Immunology & Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Olusegun Olusina
- Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS)
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Wakawa IA, Said JM, Abba WM, Shehu S, Rabbebe IB, Beida O. The impact of comorbid clinical depression on the health-related quality of life of adults on highly active antiretroviral therapy in maiduguri, northeastern Nigeria. Indian J Psychol Med 2014; 36:408-17. [PMID: 25336775 PMCID: PMC4201795 DOI: 10.4103/0253-7176.140731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. MATERIALS AND METHODS Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. RESULTS The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm(3) and diagnosis of depression were significant predictors poor QOL. CONCLUSION Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care.
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Affiliation(s)
- Ibrahim Abdu Wakawa
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Jidda Mohammed Said
- Department of Research and Training, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Wakil Musa Abba
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Saleh Shehu
- Department of Psychiatry, Bayero University Kano, Kano, Nigeria
| | - Isa Bukar Rabbebe
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Omeiza Beida
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
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22
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Reitter A, Stücker AU, Linde R, Königs C, Knecht G, Herrmann E, Schlößer R, Louwen F, Haberl A. Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med 2014; 15:525-36. [PMID: 24602285 DOI: 10.1111/hiv.12142] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. METHODS There were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. RESULTS In our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P < 0.001), from 26.1% to 75%, leading to obstetric changes, including an increase in the rate of vaginal deliveries (P < 0.001), from no vaginal births to 50%. The preterm delivery rate decreased significantly (P < 0.001), from 79.2% to 8.3%. There were no significant changes in the rate of GDM, pre-eclampsia, PROM or preterm contractions. CONCLUSIONS In the 11 years of our analysis, there was a significant reduction in the rate of preterm deliveries and an increase in the vaginal delivery rate, possibly reflecting changes in treatment policies in the same period and the availability of more effective antiretroviral therapy options. The rates of complications such as GDM, pre-eclampsia, preterm contractions, PROM and postnatal complications were stable over the 11 years, but were still increased compared with the general population.
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Affiliation(s)
- A Reitter
- Department of Obstetrics and Gynaecology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Rudek MA, Moore PC, Mitsuyasu RT, Dezube BJ, Aboulafia D, Gerecitano J, Sullivan R, Cianfrocca ME, Henry DH, Ratner L, Haigentz M, Dowlati A, Little RF, Ivy SP, Deeken JF. A phase 1/pharmacokinetic study of sunitinib in combination with highly active antiretroviral therapy in human immunodeficiency virus-positive patients with cancer: AIDS Malignancy Consortium trial AMC 061. Cancer 2014; 120:1194-202. [PMID: 24474568 DOI: 10.1002/cncr.28554] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/22/2013] [Accepted: 11/26/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND The treatment of non-acquired immunodeficiency syndrome-defining cancers may be complicated by drug interactions between highly active antiretroviral therapy (HAART) and chemotherapy. This trial is the first by the AIDS Malignancy Consortium to assess targeted therapies and HAART in human immunodeficiency virus-positive patients (ClinicalTrials.gov identifier: NCT00890747). METHODS In a modified phase 1 study of sunitinib, patients were stratified into 2 treatment arms based on whether they were receiving therapy with ritonavir, a potent CYP3A4 inhibitor. Patients in treatment arm 1 (non-ritonavir HAART) received standard sunitinib dosing (50 mg/day). Treatment arm 2 (ritonavir-based HAART) used a phase 1, 3 + 3 dose escalation design (from 25 mg/day to 50 mg/day). Cycles were comprised of 4 weeks on treatment followed by a 2-week break (6 weeks total). The pharmacokinetics of sunitinib and its active metabolite (N-desethyl sunitinib) were assessed. RESULTS Nineteen patients were enrolled and were evaluable. Patients on treatment arm 1 tolerated treatment with no dose-limiting toxicity observed. In treatment arm 2, a dose-limiting toxicity was experienced at a dose of 37.5 mg, and an additional 3 of 5 patients experienced grade 3 neutropenia (toxicity graded as per National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]), an uncommon toxicity of sunitinib. No patient achieved a response, but 10 patients had stable disease, including 8 with prolonged disease stability. Efavirenz, a potent inducer of CYP3A4, resulted in increased exposure of N-desethyl sunitinib, whereas ritonavir caused decreased exposure of the metabolite. Hand-foot syndrome was associated with higher steady-state trough concentrations of sunitinib. CONCLUSIONS Patients receiving non-ritonavir-based HAART regimens tolerated standard dosing of sunitinib. Patients receiving ritonavir-based therapy who were treated with a dose of 37.5 mg/day experienced higher toxicities. Dose reductions of sunitinib to 37.5 mg may be warranted in patients receiving ritonavir.
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Affiliation(s)
- Michelle A Rudek
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Shumba C, Atukunda R, Imakit R, Memiah P. Prevalence of Depressive Symptoms Amongst Highly Active Antiretroviral Therapy (HAART) Patients in AIDSRelief Uganda. J Public Health Afr 2013; 4:e19. [PMID: 28299108 PMCID: PMC5345437 DOI: 10.4081/jphia.2013.e19] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 08/22/2013] [Accepted: 11/11/2013] [Indexed: 01/30/2023] Open
Abstract
There is limited data on the prevalence of depression in HIV and AIDS patients in Sub-Saharan Africa and little resources have been allocated to address this issue. Depression affects patient adherence to treatment and predisposes patients to resistance which poses a public health threat. It also affects quality of life and productivity of patients. From August 2008 to March 2009, 731 patient adherence surveys were administered to assess disease, treatment knowledge and services received. The primary variable of interest was patients' level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion and was categorized as no depressive symptoms (score 0), low depressive symptoms (score 1-2), moderate depressive symptoms (score 3-4) and high depressive symptoms (score 5-10). Majority of the patients on highly active antiretroviral therapy (HAART) (59%) were found to have depressive symptoms and this was more among women than men (66% vs 43%). There was some association of depressive symptoms with non-disclosure (70% of those who had not disclosed had depressive symptoms compared to 53% among those who had disclosed). There is a high prevalence of depressive symptoms among adult patients on HAART. There is need for in-depth evaluation to find out the root causes of depressive symptoms among HAART patients in AIDSRelief clinics. There is need to integrate mental health management in HIV care and treatment as well as training the existing health workers on mental health management.
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Affiliation(s)
- Constance Shumba
- Uganda program, Institute of Human Virology, University of Maryland, Kampala Uganda
| | - Ruth Atukunda
- Uganda program, Institute of Human Virology, University of Maryland, Kampala Uganda
| | - Richard Imakit
- Uganda program, Institute of Human Virology, University of Maryland, Kampala Uganda
| | - Peter Memiah
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
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Mourad WF, Young R, Kabarriti R, Blakaj DM, Shourbaji RA, Glanzman J, Patel S, Ohri N, Yaparpalvi R, Beitler JJ, Kalnicki S, Garg MK. 25-year follow-up of HIV-positive patients with benign lymphoepithelial cysts of the parotid glands: a retrospective review. Anticancer Res 2013; 33:4927-4932. [PMID: 24222131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To report long-term outcomes for HIV-positive patients who underwent radiation therapy (RT) for benign lymphoepithelial cysts (BLEC) of the parotid glands. PATIENTS AND METHODS In this single institution retrospective study of HIV-associated BLEC of the parotids, the medical records of 37 HIV-positive patients who were treated with RT between 1987-2012 were reviewed. Patients were stratified into two groups; group A consisted of 15 patients (40.5%) who received a total dose of ≤18Gy, with a median dose 10 Gy (range 8-18Gy), and group B consisted of 22 patients (59.5%) who received a total dose of 24 Gy. In addition to dosing information, additional patient data were collected, including demographics, HAART compliance, follow-up, and re-treatment status. RESULTS The median age at the time of treatment was 41 (range=7-70) years. With a median follow-up of 35 (range=12-75) months for the entire cohort, the complete response (CR) and partial response (PR) rates were 35% and 8%, respectively. All but one of 15 patients in Group A (lower total dose) eventually experienced local failure with the re-emergence of parotid hypertrophy. Among the patients in group B (higher total dose of 24 Gy), 55%, 13%, and 32% experienced CR, PR, and LF, respectively. Median times to failure in groups A and B were 7 and 20 months, respectively (p<0.0001). Similarly, logistic regression test revealed the higher dose to be associated with better response rate (i.e. CR or PR) (p<0.0001), which was also statistically significant (p=0.03) after adjusting for confounding variables (age, race, gender, HAART use, and fractionation). CONCLUSION A total dose of 24 Gy continues to be recommended for durable cosmetic control of BLEC of the parotid glands that is associated with HIV-seropositivity.
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Affiliation(s)
- Waleed F Mourad
- M.D., Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E210th Street, Bronx, NY, 10467.
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Mbuagbaw L, Bonono-Momnougui RC, Thabane L. Considerations in using text messages to improve adherence to highly active antiretroviral therapy: a qualitative study among clients in Yaoundé, Cameroon. HIV AIDS (Auckl) 2012; 4:45-50. [PMID: 22570574 PMCID: PMC3346064 DOI: 10.2147/hiv.s29954] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Poor adherence to highly active antiretroviral therapy (HAART) is a major hindrance to the reduction of mortality and morbidity due to HIV. This qualitative study used focus groups to explore the views and experiences of HIV patients on HAART with adherence reminders, especially the text message (SMS [short message service]). The ethnographic data obtained were used to design a clinical trial to assess the effect of motivational text messages versus usual care to enhance adherence to HAART among HIV patients in Yaoundé, Cameroon. Participants appreciated the idea of a timely SMS reminder, and cited the physician as a role model. They expressed concerns about privacy. Long-term life goals were a motivating factor to adhere. Overall, text messaging was viewed positively as a tool with a dual function of reminder and motivator. Messages coming from the attending physician may have a stronger impact. Trials investigating the use of text messages to improve adherence to HAART need to consider the content and timing of SMS, taking into account technical challenges and privacy.
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Affiliation(s)
- Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
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Wayengera M, Kajumbula H, Byarugaba W. Harnessing pharmacogenomics to tackle resistance to the "nucleoside reverse trancripatse inhibitor" backbone of highly active antiretroviral therapy in resource limited settings. Open AIDS J 2008; 2:78-81. [PMID: 19274067 PMCID: PMC2627514 DOI: 10.2174/1874613600802010078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 11/22/2022] Open
Abstract
Background The sustainable use of HAART within the sub-Saharan and other developing world settings faces the emerging challenge of drug resistance. Nucleoside reverse transcriptase inhibitors (NRTI) form the backbone of HAART and preserving their “antiviral efficacy” is thus critical to sustainable HAART use. Methods A systematic review of the “mechanisms of evolution” of resistance to NRTI at the HIV genome level, and the phenotypic manifestations on drug pharmacokinetics was done. Conclusion This paper provides an evidence based account of how the knowledge of pharmacogenomics may be exploited to tackle NRTI resistance within limited resource.
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Affiliation(s)
- Misaki Wayengera
- Division of Human and Molecular Genetics-Dept of Pathology College of Health Sciences, Makerere University P.O. Box 7072, Kampala, Uganda.
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