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Antiretroviral therapy [keywords]
- Increased mortality among HIV-positive men on antiretroviral therapy: survival differences between sexes explained by late initiation in Uganda. [Journal Article]
- HIV AIDS (Auckl) 2013.:111-9.
We aimed to assess the relationship between gender and survival among adult patients newly enrolled on antiretroviral therapy (ART) in Uganda. We also specifically examined the role of antenatal services in favoring women's access to HIV care.From an observational cohort study, we assessed survival and used logistic regression and differences in means to compare men and women who did not access care through antenatal services. Differences were assessed on measures of disease progression (WHO stage and CD4 count) and demographic (age, marital status, and education), behavioral (sexual activity, disclosure to partner, and testing), and clinical variables (hepatitis B and C, syphilis, malaria, and anemia). A mediational analysis that considered gender as the initial variable, time to death as the outcome, initial CD4 count as the mediator, and age as a covariate was performed using an accelerated failure time model with a Weibull distribution.Between 2004 and 2011, a total of 4775 patients initiated ART, and after exclusions 4537 (93.2%) were included in analysis. Men initiating ART were more likely to have a WHO disease stage III or IV (odds ratio: 1.46, 95% confidence interval [CI]: 1.29-1.66), and lower CD4 cell counts compared to women (median baseline CD4 124 cells/mm(3), interquartile range [IQR]: 43-205 versus 147 cells/mm(3), IQR: 68-212, P-value < 0.0001). Men were at an increased risk of death compared to women (hazard ratio: 1.38, 95% CI: 1.03-1.83). Baseline CD4 cell counts accounted for 43% of the increased risk of death in men (95% CI: 22%-113%). Access to care via antenatal services did not explain differences in outcomes.In this cohort there is a marked increase in risk of mortality for men and approximately half of it can be attributed to their later engagement in care. More effort is required to engage men in care in a timely manner.
- Short and long term mortality and causes of death in HIV/TB patients in Europe. [JOURNAL ARTICLE]
- Eur Respir J 2013 Jun 13.
Mortality of HIV/TB patients in Eastern Europe (EE) is high. Little is known about their causes of death (COD).To assess and compare mortality rates and COD in HIV/TB patients across EE and Western Europe and Argentina (WEA) in an international cohort study.Mortality rates and COD were analysed by time from TB diagnosis (<3/3-12/>12 months) in 1078 consecutive HIV-/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis.347 patients died during 2625 PYFU. Mortality in EE was 3-9-fold higher than in WEA. TB was the main COD in EE in 80%, 66% and 61% of patients who died <3, 3-12, or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (IRR 0.12 [95% CI 0.04-0.35]), standard TB-treatment (0.45 [0.20-0.99]) and antiretroviral therapy (0.32 [0.14-0.77]) were associated with reduced risk of TB-related death.Persistently higher mortality rates were observed in HIV/TB patients in EE, and TB was the dominant COD at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise management of HIV/TB patients and limit TB-associated mortality in this region.
- Effect of antiretroviral therapy on inflammatory markers of endothelial dysfunction in HIV treatment-Naïve infected patients. [Journal Article]
- J Med Virol 2013 Aug; 85(8):1321-6.
The aim of this study was to evaluate the effect of antiretroviral therapy on inflammatory markers of endothelial dysfunction in HIV treatment-naïve infected patients. This was a prospective cohort study in HIV treatment-naïve infected patients. The patients were assigned to a untreated group or a treatment group according to the therapeutic strategy received. Patients in the treatment group received efavirenz or lopinavir/ritonavir, each given with zidovudine and lamivudine. HIV RNA, CD4(+) cell count, and the levels of hsCRP, sCD40L, sICAM-1, sVCAM-1, and sE-selectin were measured before and 12 weeks after treatment. Fifty patients were enrolled: 13 in the untreated group and 37 in the treatment group; 48 (96%) completed the follow-up. The mean (±SD) age was 33 ± 9 years, and 38 (79%) were men. The median pretreatment CD4(+) cell counts were 263 cells/ml (IQR 118-341) in the treatment group and 658 cells/ml (IQR 475-887) in the untreated group. In the treatment group, the median serum sVCAM-1 and sICAM-1 levels decreased by a small but significant amount (1,400 and 228 ng/ml, respectively, P < 0.05) from before to after the 12 weeks. These levels did not change in the untreated group. Antiretroviral therapy is associated with a decrease in sVCAM-1 and sICAM-1 levels after 12 weeks of treatment. J. Med. Virol. 85:1321-1326, 2013. © 2013 Wiley Periodicals, Inc.
- Peliosis hepatis due to disseminated tuberculosis in a patient with AIDS. [JOURNAL ARTICLE]
- Infection 2013 Jun 14.
Peliosis hepatis is a rare histopathological entity of unknown etiology. We present a case of peliosis hepatis in a 44-year-old man with disseminated tuberculosis and acquired immunodeficiency syndrome. The diagnosis of peliosis hepatis was based on liver biopsy results which were suggestive of tuberculous etiology. Diagnosis of tuberculosis was confirmed by auramine stain, rRNA amplification and culture of Mycobacterium tuberculosis from synovial fluid of the elbow joint. The patient responded favourably to tuberculostatic treatment with four drugs and the early initiation of highly active antiretroviral therapy. Histopathological evidence of peliosis hepatis, without an obvious cause, makes it necessary to rule out tuberculosis, especially in the context of immunodeficiency diseases and immigrants from endemic areas.
- Neonatal Mortality in HIV-Exposed Infants Born to Women Receiving Combination Antiretroviral Therapy in Rural Uganda. [JOURNAL ARTICLE]
- J Trop Pediatr 2013 Jun 13.
As human immunodeficiency virus (HIV)-infected women gain access to combination antiretroviral therapy throughout sub-Saharan Africa, a growing number of infants are being born HIV-exposed but uninfected. Data about neonatal mortality and the impact of premature delivery, in this population are limited. We describe the 28-day mortality outcomes in a cohort of HIV-exposed infants who had ultrasound-confirmed gestational age in rural Uganda. There were 13 deaths among 351 infants, including 9 deaths in the perinatal period. Premature delivery was a strong predictor of mortality. The prevention of HIV transmission to infants is now possible in rural low-resource settings but the frequency of neonatal death among HIV-exposed infants remains extremely high, calling for new comprehensive interventions to reduce mortality in this growing population.
- Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy. [JOURNAL ARTICLE]
- Int J Infect Dis 2013 Jun 10.
BACKGROUND:There are limited data on treatment-related anemia in Asian HIV-infected children.
METHODS:Data from Asian HIV-infected children aged <18 years on first-line highly active antiretroviral therapy (HAART) were used. Children who had pre-existing severe anemia at baseline were excluded. Anemia was graded using the United States Division of AIDS (DAIDS) 2004 table. Potential risk factors for severe anemia were assessed by logistic regression.
RESULTS:Data from 1648 children (51.9% female, 62.8% World Health Organization (WHO) stage 3/4) were analyzed. Median (interquartile range) age was 6.8 (3.7-9.6) years, CD4% was 9 (3-16)%, and plasma HIV-RNA was 5.2 (4.7-5.6) log10 copies/ml at HAART initiation in those with available testing. The most common regimens were stavudine/lamivudine/nevirapine (42%) and zidovudine/lamivudine/nevirapine (25%). Severe anemia was identified in 47 (2.9%) children after a median time of 6 months after HAART initiation, with an incidence rate of 5.4 per 100 child-years. Mild anemia or moderate anemia at baseline (p = 0.024 and p = 0.005, respectively), previous or current use of zidovudine (p < 0.0001 and p = 0.013, respectively), and male sex (p = 0.008) were associated with severe anemia. Higher weight-for-age z-score (p = 0.004) was protective.
CONCLUSIONS:The incidence of severe anemia in Asian HIV-infected children after HAART initiation was low and mainly occurred during the first few months after HAART initiation. Mild to moderate anemia at baseline and using zidovudine were independent risk factors for the development of severe anemia.
- Efavirenz induced acute liver failure requiring liver transplantation in a slow drug metaboliser. [JOURNAL ARTICLE]
- J Clin Virol 2013 Jun 10.
Highly active antiretroviral therapy has revolutionised HIV management. However, many of these drugs are potentially hepatotoxic. Here, we report the first adult case of efavirenz induced acute liver failure successfully treated by liver transplantation. Furthermore, genetic analysis revealed our patient to be a slow efavirenz metaboliser, contributing to the severity of clinical presentation.