Journal of the International Association of Physicians in AIDS Care (JIAPAC) RSS feed -- OnlineFirst Articles

Etravirine for HIV-1: Addressing the Limitations of the Nonnucleoside Reverse Transcriptase Inhibitor Class

Grennan, J T., Walmsley, S. — Fri, 23 Oct 2009 15:36:03 PDT

Etravirine (ETR) is a second-generation nonnucleoside reverse transcriptase inhibitor (NNRTI) specifically designed for treatment-experienced patients infected with HIV-1. Its unique strength over other, older agents in the NNRTI class is its higher genetic barrier to resistance, allowing it to be used effectively in patients with limited treatment options. The arrival of ETR in the market has made sequential NNRTI therapy possible for the first time in the history of HIV treatment, as it can maintain virologic activity in the presence of certain (and sometimes multiple) NNRTI mutations. Although ETR has demonstrated efficacy in treatment-experienced and NNRTI-resistant patients in large trials, further analyses on its resistance profile are ongoing. As new data emerge on the weighting of ETR’s resistance-associated mutations (RAMs), investigators and clinicians will no doubt be able to further characterize its specific place in the HIV treatment armamentarium.

Screening Patients in Busy Hospital-Based HIV Care Centers for Hazardous and Harmful Drinking Patterns: The Identification of an Optimal Screening Tool

Strauss, S. M., Rindskopf, D. M. — Thu, 22 Oct 2009 11:10:13 PDT

Because many HIV care providers fail to detect patients' hazardous drinking, we examined the potential use of the AUDIT-C, the first 3 of the 10 items comprising the Alcohol Use Disorders Identification Test (AUDIT), to efficiently screen patients for alcohol abuse. To perform this examination, we used Item Response Theory (IRT) involving individual AUDIT items and AUDIT instruments completed by patients (N = 400) at a Designated AIDS Center (DAC) in New York City. At various AUDIT-C cutoff scores, specificities and sensitivities were then examined using the AUDIT as a "gold standard." For cutoff scores on the AUDIT from 4 to 8, cutoff scores on the AUDIT-C of 3 and 4, respectively, resulted in sensitivities between .94-.98 and .81-.89, respectively, and specificities between .82-.91 and .91-1.0, respectively. In busy HIV care centers, the AUDIT-C with cutoff scores of 3 or 4 is a reasonable alternative to the full AUDIT as an alcohol screening instrument.

HIV-1 Reverse Transcriptase Variation in Plasma and Genital Secretion of Antiretroviral-Naive Females

Mon, 12 Oct 2009 11:34:05 PDT

The reverse transcriptase (RT) enzyme of HIV type 1 (HIV-1) is largely targeted by the host immune selection pressure and would differ in the anatomical compartments, thereby having a drastic impact on viral quasi-species evolution. The HIV-1 RT region sequenced from plasma and genital secretions of 8 antiretroviral treatment (ART)-naive females was analyzed for the pattern of amino acid mutations and the ratio of synonymous and nonsynonymous substitutions to determine whether it is under different selection pressure in both the compartments. Phylogenetic and mutational analysis of the HIV-1 RT in plasma and genital secretions of HIV-1-infected ART-naive females showed limited variation likely reflecting the absence of differential selection pressure and therefore genetic variation in these compartments.

Epidemiology of Opportunistic Infections and Its Correlation With CD4 T-Lymphocyte Counts and Plasma Viral Load Among HIV-Positive Patients at a Tertiary Care Hospital in India

Gautam, H., Bhalla, P., Saini, S., Uppal, B., Kaur, R., Baveja, C. P., Dewan, R. — Tue, 15 Sep 2009 10:13:29 PDT

The study was conducted to find the correlation of CD4 counts and plasma viral load (PVL) with opportunistic infections (OIs) in HIV-positive patients. A total of 43 drug-naive patients enrolled in the study. Absolute CD4 counts and PVL were measured. On the basis of symptoms, sputum, stool, and blood samples were obtained for laboratory tests. Oral swabs were obtained from all the patients. Pneumocystis jiroveci pneumonia was found in 45.2% patients (odds ratio [OR] = 12.8 for CD4 counts ≤100 cells/mm³ and 8.5 for PVL >4.0 log₁₀ copies/mL). Pulmonary tuberculosis (TB; OR = 8.0 for PVL >4.0 log₁₀ copies/mL) and streptococcal pneumonia (detected only with CD4 counts <50 cells/mm³ and PVL >4.0 log₁₀ copies/mL) were seen in 41.9% and 12.9% patients, respectively. Among patients with diarrhea, Giardia lamblia was detected in 31% patients (OR = 3.0 for CD4 counts ≤100 cells/mm³ and 4.0 for PVL >4.0 log₁₀ copies/mL) and Cryptosporidium in 17.2% patients (OR = 1.8 for CD4 counts ≤100 cells/mm³ and found only with PVL >4.0 log₁₀ copies/mL). Shigellosis and Clostridium difficile toxin was present in 13.6% patients and 6.8% patients, respectively.

Tenofovir-Emtricitabine-Efavirenz in HIV-1-Infected Adults in Senegal: A 96-Week Pilot Trial in Treatment-Naive Patients

Tue, 15 Sep 2009 10:13:29 PDT

We report the results of a pilot open-label trial of a tenofovir (TDF)/emtricitabine (FTC)/efavirenz (EFV) combination conducted in Dakar, Senegal. Forty HIV-1-infected patients, naive of antiretroviral treatment and without active opportunistic disease, were included and followed through 96 weeks. At weeks 48 and 96, respectively, 82.5% and 85% of patients had HIV-1 RNA <400 copies/mL (72.5% and 77.5% with HIV-1 RNA <50 copies/mL). Between baseline and week 96, the mean (SD) CD4 count increased from 126 (102) to 338 (155) cells/mm³. The mean (SD) creatinine clearance decreased from 92 (36) to 73 (19) mL/min (P = .001). Treatment adherence was at least 94% at all scheduled visits. The efficacy and tolerability of a TDF/FTC/EFV combination were high and similar to those observed in Northern countries. This drug combination can be recommended in limited-resource countries, as did the World Health Organization (WHO) and should be made readily available as a fixed-dose combination.