Journal of the International Association of Physicians in AIDS Care (JIAPAC) current issue

HIV-Infected Thais Need Help to Adjust to a Normal Life in Society

Hultqvist, E., Martensson, T., Samnang, V., Andersson, R. — Wed, 16 Sep 2009 09:25:19 PDT

A Retrospective Analysis of AIDS-Associated Kaposi's Sarcoma in Patients With Undetectable HIV Viral Loads and CD4 Counts Greater Than 300 cells/mm3

Mani, D., Neil, N., Israel, R., Aboulafia, D. M. — Wed, 16 Sep 2009 09:25:19 PDT

Objective: To compare the clinical course of patients with AIDS-related Kaposi’s sarcoma (KS) with CD4 counts >300 cells/mm³ and undetectable HIV viral loads (VLs) to patients with AIDS-KS with lesser CD4 counts and detectable HIV VLs.

Methods: We retrospectively analyzed a cohort of 91 patients with AIDS-KS in a multispeciality clinic. We used ² and Student t tests to analyze intragroup differences; survival was determined by Kaplan-Meier analysis.

Results: Twenty (22%) of the 91 patients had newly diagnosed, persistent or progressive KS despite CD4 counts >300 cells/mm³ and undetectable HIV VLs. Age, gender, ethnicity, mode and duration of HIV acquisition, type of antiretroviral therapy (ART), and KS therapy did not differ significantly (P ≤ .005) between this group and the remaining 71 patients. Although tumor stage and response to KS therapy were similar, there was a significantly greater risk of death among the patients with CD4 counts <300 cells/mm³ and detectable HIV VLs (P = .048).

Conclusions: In the highly active antiretroviral (HAART) era, a substantial proportion of patients with KS had undetectable HIV VLs and CD4 counts greater than the level typically associated with opportunistic diseases. They required systemic therapy to control their KS but were significantly less likely to die and demonstrated a trend toward better 15-year survival than patients having KS with lesser CD4 counts and detectable HIV VLs.

Human Papillomavirus in Women With and Without HIV-1 Infection Attending an STI Clinic in Vitoria, Brazil

Wed, 16 Sep 2009 09:25:19 PDT

We conducted a cross-sectional study in Vitória, Brazil, to assess the prevalence of human papillomavirus (HPV) infection in HIV-positive and HIV-negative women attending a sexually transmitted infection (STI)/AIDS clinic. We also investigated the presence of HPV genotypes and assessed covariates for HIV infection. Enrolled patients received a gynecological evaluation, and cervical scrape samples were collected for cytological analysis and HPV-DNA polymerase chain reaction (PCR). A blood sample was obtained to determine HIV status. HPV infection and squamous intraepithelial lesions were studied in 284 women, 112 (39.4%) HIV-positive women and 172 (60.5%) HIV-negative women. HPV-DNA was detected in 133 (46.8%). HIV-infected women were almost twice as likely to be concurrently infected with HPV than HIV-negative women (OR = 1.87 95% CI: 1.16-3.03). The high proportion of HPV detected among women attending an STI/AIDS clinic, particularly among HIV-infected women, proves the importance of screening this high-risk group in the hope of earlier detection and treatment of cervical intraepithelial neoplasia (CIN).

When ''No'' Means ''Yes'': The Gender Implications of HIV Programming in a Zimbabwean University

Masvawure, T. B., Terry, P. E., Adlis, S., Mhloyi, M. — Wed, 16 Sep 2009 09:25:19 PDT

Objectives: This study assessed the nature and extent of sexual risk-taking behavior by students in a Zimbabwean university and identified some of the sociocultural factors that facilitate sexual risk taking by female and male students. The main outcome measures of the study were condom use, number of sexual partners, and attitudes toward gender equity and equality.

Methods: A cross-sectional design was used and a questionnaire was administered to 933 students. Information pertaining to students’ sexual practices, condom use practices, attitudes toward HIV testing, and their beliefs pertaining to women’s role in sexual decision making and a woman’s right to refuse sexual intercourse were among some of the variables assessed.

Results: The vast majority of the university students (83%) are sexually experienced; only a third used condoms at their last sexual encounter; the use or nonuse of condoms was significantly associated with age, sex, marital status, and attitudes toward gender issues. There were also significant differences in the sexual behavior and attitudes of female and male students.

Conclusion: Our study suggests that HIV prevention efforts targeted at university students need to incorporate a discussion of broader cultural beliefs, particularly those pertaining to gender role myths, if they are to be effective.

Comparison of 3-Drug Versus 4-Drug and PI Versus Non-PI Combinations as Initial HAART: Experience From 1998 to 2007

Jhaveri, M. A., Browning, S. R., Bush, H., Thornton, A., Greenberg, R. N. — Wed, 16 Sep 2009 09:25:19 PDT

Although established in controlled studies that there is no advantage to 4-drug highly active antiretroviral therapy (HAART) or regimens with or without protease inhibitors (PIs), we questioned this finding in a clinical setting (ie, no inclusion criteria). Ours is a single clinic retrospective study including all participants >18 years of age during their first year of HAART. A total of 190 participants were reviewed, with 168 (88%) attaining a viral load <400 copies/mL at the end of a year of HAART; 144 of 164 (88%) succeeded with 3 drugs and 24 of 26 (92%) with 4 drugs (P = .51). In all, 59 of 71 (83%) succeeded using a PI versus 109 of 119 (92%) without a PI (P = .08). Male gender and exposure time to HAART were significant variables for a successful outcome. Failures were due to side effects (50%), nonadherence (45%), and drug allergy (5%). Our results support current guidelines recommending 3-drug HAART.

Observational Study to Evaluate Clinical Outcomes After First-Line Efavirenz-or Lopinavir-Ritonavir-Based HAART in Treatment-Naive Patients

Wed, 16 Sep 2009 09:25:19 PDT

Purpose: To evaluate clinical, immunological, and virological outcomes after first-line highly active antiretroviral therapy (HAART) with a regimen including either efavirenz (EFV) or lopinavir/ritonavir (LPV/r) in treament-naive adult patients in routine clinical care.

Method: An ongoing prospective, observational follow-up study included all patients starting their first antiretroviral therapy (ART) with any of the studied regimens from July 1998 to July 2004. The follow-up period was finalized in September 2006, when all patients completed an observation of at least 96 weeks. Mortality rates, CD4 counts, viral suppression (HIV RNA below 50 copies/mL), and discontinuation of any component of the regimen were compared at 48 and 96 weeks.

Results: Despite the worst immunological status of the LPV/r group patients at baseline, this regimen was at least as effective as the one based on EFV not only in terms of treatment durability but also in terms of virological responses, nevertheless with an apparently quicker immune recovery. In general terms, both regimens present similar tolerability and safety outcomes except for the higher risk of increasing triglyceride (TG) levels in the LPV/r group. Low durability was observed in both regimens.

Conclusion: In a routine clinical care setting, initial HAART containing LPV/r seems to present an effectiveness, tolerability, and toxicity similar to the one containing EFV.

First HAART in HIV-Infected Patients With High Viral Load: Value of HIV RNA Levels at 12 Weeks to Predict Virologic Outcome

Wed, 16 Sep 2009 09:25:19 PDT

The aim of this study is to identify the role of incomplete suppression during the first months of highly active antiretroviral treatment (HAART) to predict virologic failure in patients with high levels of HIV replication. In a retrospective, longitudinal, and multicenter study, response to HAART was assessed in treatment-naive adults with HIV RNA >100 000 copies/mL, and factors predicting failure were analyzed through regression analyses. A total of 118 patients were included. Virologic failure occurred more often in patients with >500 copies/mL at week 12 (Cox regression: Exp (B) 3.22; P = .02). HIV RNA >500 copies/mL at week 12 predicted incomplete virologic response (odds ratio [OR] = 9.33; P = .002] but not viral rebound. Major antiretroviral resistant mutations were present in 11 of 14 patients. HIV RNA >500 copies/mL at week 12 of first HAART predicts incomplete virologic response in patients with high levels of replication at baseline. Most patients carried resistance mutations at the time of failure.

Adverse Drug Reactions to Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Regimen: A 24-Week Prospective Study

Jena, A., Sachdeva, R. K., Sharma, A., Wanchu, A. — Wed, 16 Sep 2009 09:25:19 PDT

Background: Few studies have addressed the issue of adverse drug reactions with non-protease inhibitor (PI)-based antiretroviral therapy (ART) in resource-constrained settings. We studied prospectively the incidence of adverse drug reactions with generic ART among our patients.

Methodology: A total of 100 HIV-infected individuals were recruited. Patients received nevirapine (NVP) or efavirenz (EFV) with lamivudine (3TC) and zidovudine (ZDV)/stavudine (d4T). They were followed for 6 months for evidence of adverse drug reactions.

Results: The mean CD4 count was 114.09 ± 60.07 cells/mm³ (range, 12-232 cells/mm³). Transient gastrointestinal symptoms were most frequent. Fourteen individuals (12 receiving ZDV/d4T, 3TC, NVP and 2 receiving ZDV/d4T, 3TC, EFV) developed skin rash. Among patients receiving NVP, 25.7% developed grade 1 hepatotoxicity. Three patients had numbness in both lower limbs. Among those individuals who received EFV, 32.3% individuals had central nervous system (CNS) symptoms in the form of insomnia, vivid dreams, dizziness, and drowsiness.

Conclusion: As the developing world increasingly uses generic ART, the clinician must be constantly vigilant for treatment-related adverse events.

Primary HIV-1 Drug Resistance and Polymorphic Patterns Among Injecting Drug Users (IDUs) in Chennai, Southern India

Iqbal, H. S., Solomon, S. S., Madhavan, V., Solomon, S., Balakrishnan, P. — Wed, 16 Sep 2009 09:25:19 PDT

Background and Objective: India has 1.1 million injecting drug users (IDUs) with an HIV prevalence rate as high as 64%. Drug resistance screening before therapy is beneficial to the individual. Here, we have studied primary drug resistance among IDUs in Chennai.

Methods: Specimens (n = 55) collected between March 2005 and April 2006 were subjected to genotyping assay. The mutations for the drug resistance were interpreted using the Stanford HIV Drug Resistance Database.

Results: M41LM (1.8%), K65KN (1.8%), and G73GS (2.7%) were found to be associated with low-level resistance to zidovudine (ZDV), stavudine (d4T), abacavir (ABC), didanosine (ddI), emtricitabine (FTC), tenofovir (TDF), and saquinavir (SQV) in each specimen. The rate of polymorphisms is significantly different from universally established subtype ‘‘C’’-specific polymorphisms (P < .0001).

Conclusion: The presence of drug resistance mutations, though minimal, is alarming as it could spread easily between IDUs and from them to their sexual partners. The genetic variation is of importance in vaccine design.