Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiological study

ABSTRACT:Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium.

OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND

Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival : A cohort study

Background: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.Methods: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.Results: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.Conclusions: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC. © 2013 Worm et al.; licensee BioMed Central Ltd

Atazanavir has a better impact on lipid profiles than Fosamprenavir and Lopinavir in patients matched baseline triglycerides and cholesterol

info:eu-repo/semantics/nonPublishe

Fosamprenavir boosted with a single 100 mg capsule of Ritonavir as part of a once daily first line regimen in naive patients

info:eu-repo/semantics/nonPublishe

Downregulation of CD38 activation markers by atorvastatin in HIV patients with undetectable viral load

Immune activation and chronic inflammation are recognized as major component of HIV disease even in patients with undetectable viral load. We evaluated the effect of atorvastatin on CD38 activation in such patients, in a case-control study (133 cases - 266 controls). At week 48, CD38 activation was significantly lower in cases vs. controls, with no difference in high-sensitivity C-reactive protein (hsCRP) and CD4. These results suggest that atorvastatin reduces the level of immune activation in patients with undetectable viral load. © 2011 Wolters Kluwer HealthSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cardiovascular risk evaluation of HIV-infected patients in a case-control study: comparison of the D:A:D and Framingham equations

info:eu-repo/semantics/nonPublishe

Primary HIV infection: Is outcome after treatment interruption influenced by treatment initiation?

info:eu-repo/semantics/nonPublishe

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5–74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Experience of maternal immunization among women living with HIV in Belgium: A mixed-methods study

Objective: Maternal immunization during pregnancy has benefits for both women living with HIV (WLWH) and their HIV-exposed uninfected newborns. Vaccine hesitancy may hamper vaccine acceptability during pregnancy. We aimed to assess the experience of WLWH with a history of pregnancy with maternal immunization. Methods: In-person quantitative survey with embedded collection of qualitative data was performed among WLWH with a history of pregnancy. Results: Between October and November 2021, a total of 20 WLWH followed at Saint-Pierre University Hospital Center HIV reference center in Brussels (Belgium) were included. The majority originated from Sub-Saharan Africa and had education level below or equivalent to secondary school. Most of the participants agreed that vaccination during pregnancy is necessary, highlighting the benefits for the health of the mother and the newborn. Reluctant participants expressed concerns about safety or lack of information. Most of the participants mentioned health-care providers (HCP) (mainly HIV physician) as the main person of trust for vaccine information in general. Social media were also mentioned as an important source of information on vaccination. Conclusions: The benefits for the mother and the newborn were associated with favorable opinion on maternal immunization while doubt about safety or lack of information appeared to be hurdles to acceptance. Proactive communication on the benefit of maternal immunization for both the mother and newborn by HIV physician and HCP involved in prenatal care is needed to increase acceptability of maternal immunization among WLWH