Posts filed under ‘HIV/SIDA Complicaciones’

Visceral leishmaniasis in immunocompromised diagnostic and therapeutic approach and evaluation of the recently released IDSA guidelines.

Infez Med. 2016 Dec 1;24(4):265-271.

Pagliano P, Ascione T, Di Flumeri G, Boccia G, De Caro F.

Visceral Leishmaniasis (VL) is a chronic infectious disease endemic in tropical and sub-tropical areas including the Mediterranean basin, caused by a group of protozoan parasites of the genus Leishmania and transmitted by phlebotomine sandflies.

Typically, VL is classified as a zoonotic infection when Leishmania infantum is the causative agent and as an anthroponotic one when L. donovani is the causative agent. Immunocompromised patients, in particular HIV positive, are considered at risk of VL.

They may present atypical signs and poor response to the treatment due to a compromission of T-helper and regulatory cells activity. Also pregnancy can be considered a condition predisposing to Leishmania reactivation and to the changes in immune response, due to a switch toward a Th2 response reported in this condition of the life.

Laboratory diagnosis is based on microscopy for parasites detection on bone-marrow or spleen aspirates. Value of serology remains high in term of sensibility, but a positive test has to be confirmed by microscopy or molecular tests.

Hypergammaglobulinemia and pancytopenia are the main alteration identified by blood examination. Treatment is based on use of liposomal amphotericin B (L-AmB) whose administration is associated to lower incidence of side effects, in respect to antimonials and other formulations of AmB. Use of Miltefosine needs further investigation when L. infantum is the causative agent. Relapses to treatment are observed in coinfected HIV patients. They can benefit of a second cycle, but cumulative efficacy of the treatment can be low.

PDF

http://www.infezmed.it/media/journal/Vol_24_4_2016_2.pdf

January 12, 2017 at 9:02 am

Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study

Journal of Infectious Diseases December 1, 2016 V.214 N.11 P.1672-1681

Krishna P. Reddy, Robert A. Parker, Elena Losina, Travis P. Baggett, A. David Paltiel, Nancy A. Rigotti, Milton C. Weinstein, Kenneth A. Freedberg, and Rochelle P. Walensky

1Medical Practice Evaluation Center

2Division of Pulmonary and Critical Care Medicine

3Division of General Internal Medicine

4Biostatistics Center

5Tobacco Research and Treatment Center

6Mongan Institute for Health Policy

7Division of Infectious Diseases, Massachusetts General Hospital

8Harvard Medical School

9Department of Orthopedic Surgery

10Division of Infectious Diseases, Brigham and Women’s Hospital

11Department of Biostatistics

12Department of Epidemiology, Boston University School of Public Health

13Boston Health Care for the Homeless Program

14Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts

15Yale School of Public Health, New Haven, Connecticut

Background

In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes.

Methods

We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0–1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking.

Results

Men and women entering HIV care at age 40 years (mean CD4+ T-cell count, 360 cells/µL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+ T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%–25% of HIV-infected smokers could save approximately 106 000–265 000 years of life.

Conclusions

HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.

PDF

http://jid.oxfordjournals.org/content/214/11/1672.full.pdf+html

December 11, 2016 at 8:29 pm

Editorial – The Shifting Paradigm of Care for Adults Living With HIV – Smoking Cessation for Longer Life

Journal of Infectious Diseases December 1, 2016 V.214 N.11 P.1618-1620

Keri N. Althoff

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

There are few truths in medical science that are as agreed upon as this: smoking is bad for health. In persons with human immunodeficiency virus (HIV) infection, smoking is a scourge, with recent prevalence estimates of 42%, which Reddy et al, in this issue of The Journal of Infectious Diseases, translated to an estimated 247 586 smokers among those in HIV care in the United States [1, 2]. It is hypothesized that adults living with HIV start smoking at younger ages, smoke more heavily and for a longer duration, and have lower rates of cessation than the general population in the United States. However, population-based estimates are not available. The problem may seem insurmountable, particularly because a delay in the manifestations of harm from smoking creates a lack of urgency for cessation. Because the HIV infection paradigm has changed from an acutely terminal illness to a chronic infection with a life expectancy approaching that of uninfected adults, the paradigm of how we protect the health of people living with HIV has also evolved.

Reddy et al estimate a gain in life expectancy of 5.7 years among men and 4.6 years among women who quit smoking upon entering into HIV care [2]. The authors predict that if a quarter of HIV-infected adults quit smoking, 265 000 years of life could be regained at the population level. It is reasonable to assume that there is also an increased quality of life, not only quantity of life, given the strong associations of smoking with a poorer immunologic response to antiretroviral therapy (ART) and the development of cancer, cardiovascular disease, chronic obstructive pulmonary disease, and lower respiratory tract infections [3]. After accounting for nonadherence to …

PDF

http://jid.oxfordjournals.org/content/214/11/1618.full.pdf+html

December 11, 2016 at 8:28 pm

2016 BHIVA GUIDELINES for the treatment of HIV-1-positive Adults with antiretroviral therapy

The British HIV Association

Writing Group

Laura Waters (Chair)

N Ahmed, B Angus, M Boffito, M Bower, D Churchill, D Dunn, S Edwards, C Emerson, S Fidler, †M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston

†Professor Martin Fisher died in April 2015 – he made a significant contribution to these, many other guidelines and our speciality as a whole – he is greatly missed.

Introduction

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection on antiretroviral therapy (ART).

The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of people living with HIV (PLWH) on treatment; (iii) management of individuals experiencing virological failure; and (iv) recommendations in specific populations where other factors need to be taken into consideration.

The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection, and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines.

The 2016 interim update to the 2015 BHIVA antiretroviral guidelines has been published online to include tenofovir-alafenamide/emtricitabine as a preferred NRTI backbone for first-line therapy. Changes were based on new data and the consensus opinion of the writing committee. All changes to the guideline are highlighted and include updates to the chronic kidney disease and bone disease sections of special populations and some small changes to managing virological failure. The next formal update to the guidelines in anticipated in 2017.

PDF

http://www.bhiva.org/documents/Guidelines/Treatment/2016/treatment-guidelines-2016-interim-update.pdf

December 3, 2016 at 9:33 am

Human Immunodeficiency Virus and Total Joint Arthroplasty: The Risk for Infection Is Reduced

Journal of Arthroplasty October 2016 V.31 N.10 P.2146–2151

Mohammad Ali Enayatollahi, Dermot Murphy, Mitchell G. Maltenfort, Javad Parvizi

Background

Highly active antiretroviral therapy (HAART) has changed the face of human immunodeficiency virus (HIV) and allowed patients to live for many decades. HIV and HAART are known risk factors for osteonecrosis of bone, osteopenia, and osteoporosis. Therefore, the demand for total joint arthroplasty (TJA) in HIV-infected patients is on the rise. We attempted to determine whether modern treatments for HIV have impacted the rate of periprosthetic joint infection (PJI).

Methods

Conducting a systematic review, 25 studies with a total of 722 TJAs were identified. We extracted data on rates of PJI after primary TJA in HIV-infected patients with and without hemophilia and data on administration of HAART at the time of arthroplasty.

Results

Three hundred eighty-one TJAs were performed in 293 patients with HIV infection without hemophilia. The follow-up ranged between 1.5 months and 11 years. Nine patients developed PJI. In patients with both HIV and hemophilia, 341 primary TJAs were performed. Forty-five received treatment for PJI. Follow-up ranged between 1 year and 26 years. Rates of PJI were 2.28% and 10.98% for HIV-only patients and patients with HIV and hemophilia, respectively. This difference was statistically significant (P < .0001) with a 5.28 odds ratio for hemophilia. HAART was associated with fewer infections overall (odds ratio, 0.12).

Conclusion

The rates of PJI after TJA in HIV-only patients are lower than those in patients with both HIV and hemophilia. Treatment of patients with HAART and optimization of underlying comorbidities appears to lower the rate of PJI in this patient population.

abstract

http://www.arthroplastyjournal.org/article/S0883-5403(16)00206-0/fulltext

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00206-0/pdf

November 2, 2016 at 12:48 pm

HIV infection results in metabolic alterations in the gut microbiota different from those induced by other diseases.

Sci Rep. 2016 May 18;6:26192.

Serrano-Villar S1, Rojo D2, Martínez-Martínez M3, Deusch S4, Vázquez-Castellanos JF5,6, Sainz T7, Vera M8, Moreno S1, Estrada V9, Gosalbes MJ5,6, Latorre A5,6,10, Margolles A11, Seifert J4, Barbas C2, Moya A5,6,10, Ferrer M3.

Author information

1Department of Infectious Diseases, University Hospital Ramón y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.

2Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad CEU San Pablo, Campus Montepríncipe, Madrid, Spain.

3Institute of Catalysis, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.

4Institute of Animal Science, Universität Hohenheim, Stuttgart, Germany.

5Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO) – Public Health, Valencia, Spain.

6Network Research Center for Epidemiology and Public Health (CIBER-ESP), Madrid, Spain.

7Department of Pediatric Infectious Diseases, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid, Spain.

8Centro Sanitario Sandoval, Madrid, Spain.

9HIV Unit, Department of Internal Medicine, University Hospital Clínico San Carlos, Madrid, Spain.

10Instituto Cavanilles de Biodiversidad y Biología Evolutiva (Universidad de Valencia), Valencia, Spain.

11Department of Microbiology and Biochemistry of Dairy Products, Dairy Research Institute (IPLA), CSIC, Villaviciosa, Asturias, Spain.

Abstract

Imbalances in gut bacteria have been associated with multiple diseases. However, whether there are disease-specific changes in gut microbial metabolism remains unknown. Here, we demonstrate that human immunodeficiency virus (HIV) infection (n = 33) changes, at quantifiable levels, the metabolism of gut bacteria. These changes are different than those observed in patients with the auto-immune disease systemic lupus erythaematosus (n = 18), and Clostridium difficile-associated diarrhoea (n = 6). Using healthy controls as a baseline (n = 16), we demonstrate that a trend in the nature and directionality of the metabolic changes exists according to the type of the disease. The impact on the gut microbial activity, and thus the metabolite composition and metabolic flux of gut microbes, is therefore disease-dependent. Our data further provide experimental evidence that HIV infection drastically changed the microbial community, and the species responsible for the metabolism of 4 amino acids, in contrast to patients with the other two diseases and healthy controls. The identification in this present work of specific metabolic deficits in HIV-infected patients may define nutritional supplements to improve the health of these patients

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870624/pdf/srep26192.pdf

September 19, 2016 at 7:43 pm

What happens to cardiovascular system behind the undetectable level of HIV viremia?

AIDS Res Ther. 2016 Apr 27;13:21.

d’Ettorre G1, Ceccarelli G1, Pavone P1, Vittozzi P1, De Girolamo G1, Schietroma I1, Serafino S1, Giustini N1, Vullo V1.

Author information

1Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Viale del Policlinico 155, Rome, Italy.

Abstract

Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848790/pdf/12981_2016_Article_105.pdf

September 19, 2016 at 7:42 pm

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