Posts filed under ‘HIV/SIDA HAART’

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Clin Infect Dis. April 24, 2019 V.68 N.9 P.1482-1493. 

Background

The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia.

Methods

We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor.

Results

At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001).

Conclusions

Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/pdf/ciy723.pdf

 

July 13, 2020 at 3:53 pm

Treatment of advanced AIDS-associated Kaposi sarcoma in resource-limited settings: a three-arm, open-label, randomised, non-inferiority trial.

Lancet April 11, 2020 V.395 N.10231 P.1195-1207.

Background

Optimal treatment regimens for AIDS-associated Kaposi sarcoma, a frequent contributor to morbidity and mortality among people with HIV, have not been systematically evaluated in low-income and middle-income countries, where the disease is most common. In this study, we aimed to investigate optimal treatment strategies for advanced stage disease in areas of high prevalence and limited resources.

Methods

In this open-label, non-inferiority trial, we enrolled people with HIV and advanced stage AIDS-associated Kaposi sarcoma attending 11 AIDS Clinical Trials Group sites in Brazil, Kenya, Malawi, South Africa, Uganda, and Zimbabwe. Eligible participants were randomly assigned (1:1:1) with a centralised computer system to receive either intravenous bleomycin and vincristine or oral etoposide (the investigational arms), or intravenous paclitaxel (the control arm), together with antiretroviral therapy (ART; combined efavirenz, tenofovir disoproxil fumarate, and emtricitabine). The primary outcome was progression-free survival (PFS) at week 48, using a 15% non-inferiority margin to compare the investigational groups against the active control group. Safety was assessed in all eligible treated study participants. The study was registered with ClinicalTrials.gov, NCT01435018.

Findings

334 participants were enrolled between Oct 1, 2013, and March 8, 2018, when the study was closed early due to inferiority of the bleomycin and vincristine plus ART arm, as per the recommendations of the Data and Safety Monitoring Board (DSMB). The etoposide plus ART arm also closed due to inferiority in March, 2016, following a DSMB recommendation. Week-48 PFS rates were higher in the paclitaxel plus ART arm than in both investigational arms. The absolute differences in PFS were -30% (95% CI -52 to -8) for the comparison of paclitaxel plus ART (week 48 PFS 50%, 32 to 67; n=59) and etoposide plus ART (20%, 6 to 33; n=59), and -20% (-33% to -7%) for the comparison of paclitaxel plus ART (64%, 55 to 73; n=138) and bleomycin and vincristine plus ART (44%, 35 to 53; n=132). Both CIs overlapped the non-inferiority margin. The most common adverse events, in 329 eligible participants who began treatment, were neutropenia (48 [15%]), low serum albumin (33 [10%]), weight loss (29 [9%]), and anaemia (28 [9%]), occurring at similar frequency across treatment arms.

Interpretation

Non-inferiority of either investigational intervention was not shown, with paclitaxel plus ART showing superiority to both oral etoposide plus ART and bleomycin and vincristine plus ART, supporting its use in treating advanced AIDS-associated Kaposi sarcoma in resource-limited settings.

Funding

US National Institute of Allergy and Infectious Diseases and National Cancer Institute, National Institutes of Health.

PDF

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(19)33222-2.pdf

July 1, 2020 at 6:38 pm

Pregnancy outcomes of women conceiving on ART compared to those commenced on ART during pregnancy

Clinical Infectious Diseases June 2020

Globally, the number of HIV-infected women of child-bearing age conceiving on ART is increasing. Evidence of ART safety at conception and during pregnancy and adverse pregnancy outcomes remains conflicting. The PROMISE 1077 breastfeeding (BF) and formula feeding (FF) international multisite trials provide an opportunity to examine the impact of ART at conception on pregnancy outcomes with subsequent pregnancies.

Methods

The PROMISE 1077BF/1077FF trials were designed to address key questions in the management of HIV-infected women who did not meet clinical guidelines for ART treatment during the time of the trials. After the period of risk of mother-to-child transmission was over, women were randomized to either continue or discontinue ART. We compared subsequent pregnancy outcomes of non-breastfeeding women randomized to continue ART following delivery, or breastfeeding women randomized to continue ART following breastfeeding cessation who conceived while on ART to women randomized to discontinue ART, who re-started ART after pregnancy was diagnosed.

Results

Pregnancy outcomes of 939 subsequent pregnancies of 826 mothers were recorded. The intention-to-treat analyses showed increased incidence of low birth weight (<2500gm) for women who conceived while on ART {relative risk 2.65 (95% CI 1.20, 5.81)}, and also a higher risk of spontaneous abortion, stillbirth, or neonatal death {hazard ratio 1.40 (0.99, 1.98)} compared to women who re-started ART after they were found to be pregnant during trial follow up.

Conclusions

We found an increased risk for adverse pregnancy outcomes in women conceiving on ART emphasising the need for improved obstetric and neonatal care for this group.

abstract

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa805/5860458

PDF (hacer clic en PDF)

June 23, 2020 at 8:32 pm

EDITORIAL – The Burden of COVID-19 in People Living With HIV: A Syndemic Perspective

AIDS Behav April 2020

La aparición de COVID-19 crea otra carga de salud para las personas que viven con el VIH (PLWH) que enfrentan múltiples enfermedades y pueden tener un mayor riesgo de enfermedades graves de salud física debido a COVID-19.

Nuestras capacidades para abordar estas morbilidades en las PLWH deben considerarse junto con las cargas producidas socialmente que ponen a esta población en riesgo de COVID-19 y aumentan la probabilidad de resultados adversos.

Estas cargas pueden afectar el bienestar físico, emocional y social de las PLWH e interferir con la prestación de asistencia sanitaria efectiva y el acceso al tratamiento del VIH.

Pensamos que se puede usar un marco sindemico para conceptualizar el impacto potencial de COVID-19 entre las PLWH para informar el desarrollo de los servicios de programación de salud.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165075/pdf/10461_2020_Article_2871.pdf

June 18, 2020 at 4:52 pm

Letter – COVID-19 in Patients With HIV: Clinical Case Series

Lancet HIV May 2020 V.7 N.5:e314-e316. 

A partir del 24/03/20, la pandemia de COVID-19 ha afectado a casi 400 000 personas en 168 países de los cinco continentes.

Los pacientes > 60 años y aquellos con comorbilidades (p. ej. Hipertensión, diabetes, enfermedad cardiovascular, enfermedad pulmonar y enfermedad renal crónica) presentan cuadros más graves y peor pronóstico….

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159872/pdf/main.pdf

June 18, 2020 at 4:49 pm

Letter – SARS-CoV-2 and HIV

J Med Virol March 2020

Leímos la publicación sobre “Co ‐ infección de SARS ‐ CoV ‐ 2 y VIH en un paciente en la ciudad de Wuhan, China” con gran interés. Dado que la infección por VIH es una enfermedad común en Asia, la concurrencia entre la infección por VIH y otras enfermedades es un problema interesante. El presente caso de Zhu et al 1 podría ser el primer informe sobre coinfección de SARS-CoV-2 y VIH. Zhu et al 1 señalaron que “la infección por VIH debe considerarse como un grupo vulnerable” a COVID-19. Sin embargo, no existe una interrelación identificada entre las dos infecciones virales. De hecho …

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228403/pdf/JMV-9999-na.pdf

June 18, 2020 at 4:47 pm

COVID-19 in People Living With Human Immunodeficiency Virus: A Case Series of 33 Patients

Infection May 11, 2020 V.11 P.1-6.  doi: 10.1007/s15010-020-01438-z.  Online ahead of print.

Härter G, Spinner CD, Roider J, et al.

Introducción

Los datos sobre las personas que viven con el VIH (PLWH) en la actual pandemia de SARS-CoV-2 son aún escasos. Esta serie de casos de 33 pacientes PLWH con COVID-19 revela síntomas y resultados en esta población especial.

Métodos

Análisis retrospectivo de datos anónimos que incluyen edad, sexo, parámetros asociados al VIH, síntomas y resultados.

Resultados

Tres de 32 pacientes con resultados documentados murieron (9%). El 91% de los pacientes se recuperaron y el 76% se clasificaron como casos leves. Todos los pacientes estaban en TARV, 22 de ellos con un régimen que contenía TDF y 4 con DRV.

Conclusiones

Esta serie de casos preliminares no respalda el exceso de morbi-mortalidad entre las PLWH COVID-19 sintomáticas y con supresión viral en TARV. Las infecciones por SARS-CoV-2 pueden ocurrir durante el TARV potenciado a base de DRV/r y/o con TARV que contiene TDF.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211976/pdf/15010_2020_Article_1438.pdf

May 19, 2020 at 2:15 pm

Outcomes among HIV-positive patients hospitalized with COVID-19.

medRxiv May 12, 2020

Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM, Zervou FN, Rebick G, Klein E, Reich J, Jones S, Rahimian J.

La infección por SARS-CoV-2 continúa causando morbi-mortalidad significativas en todo el mundo. Los datos preliminares sobre la infección por SARS-CoV-2 sugieren que algunos huéspedes inmunocomprometidos experimentan peores resultados. Realizamos un estudio de cohorte pareado retrospectivo para caracterizar los resultados en pacientes VIH positivos con infección por SARS-CoV-2.

Métodos

Aprovechando datos recopilados de los registros médicos electrónicos de todos los pacientes hospitalizados en NYU Langone Health con COVID-19 entre el 2/marzo/20 y 23/abril/20, comparamos 21 pacientes con VIH con 42 pacientes sin VIH usando un codicioso algoritmo vecino más cercano. Las características de admisión, los resultados de laboratorio y los resultados hospitalarios se registraron y compararon entre los dos grupos.

Resultados

Si bien hubo una tendencia hacia mayores tasas de ingreso en la UCI, ARM y mortalidad en pacientes con VIH, estas diferencias no fueron estadísticamente significativas. Las tasas de estos resultados en nuestra cohorte son similares a las publicadas previamente para todos los pacientes hospitalizados con COVID-19. Los pacientes con VIH tuvieron valores significativamente más altos de ingreso y pico de Proteína C Reactiva. Otros bio-marcadores inflamatorios no diferían significativamente entre los grupos, aunque los pacientes VIH positivos tendían a tener valores máximos más altos durante su curso clínico. Tres pacientes VIH positivos tenían neumonía bacteriana superpuesta con cultivos de esputo positivos, y los tres pacientes fallecieron durante la hospitalización. No hubo diferencias en la frecuencia de eventos trombóticos o infarto de miocardio entre estos grupos.

Conclusión

Este estudio proporciona evidencia de que la coinfección por VIH no tiene un impacto significativo en la presentación, el curso hospitalario o los resultados de los pacientes infectados con SARS-CoV-2, en comparación con pacientes no VIH emparejados. Se requiere un estudio más amplio para determinar si las tendencias que observamos se aplican a todos los pacientes con VIH.

FULL TEXT

https://www.medrxiv.org/content/10.1101/2020.05.07.20094797v1

PDF

https://www.medrxiv.org/content/10.1101/2020.05.07.20094797v1.full.pdf

May 19, 2020 at 2:13 pm

Compromised CD4:CD8 ratio recovery in people living with HIV aged over 50 years: an observational study.

HIV Med. February 2020 V.21 N.2 P.109-118.

Francis-Morris A1, Mackie NE2, Eliahoo J3, Ramzan F2, Fidler S1,4, Pollock KM1,2,4.

Abstract

OBJECTIVES:

Persistent CD4:CD8 ratio inversion (< 1) is associated with mortality in older people. We investigated the interaction of the effects of baseline CD8 count and age at HIV diagnosis on CD4:CD8 ratio recovery with antiretroviral therapy (ART).

METHODS:

An observational study (1 January 2007 to 31 December 2016) was carried out using routinely collected data from the HIV outpatient services at Imperial College Healthcare NHS Trust, London, UK. CD4 and CD8 counts, prior to and during ART, treatment during primary HIV infection (PHI) and HIV-1 viral load were included in univariate and multivariate analyses using Cox proportional hazard regression.

RESULTS:

Data were included for 876 patients starting ART, where HIV suppression was achieved. Of these patients, 741 of 876 (84.6%) were male and 507 of 876 (57.9%) were Caucasian. The median time on ART was 38 [interquartile range (IQR) 17-66] months. CD8 count change on ART was bidirectional; low CD8 counts (≤ 600 cells/μL) increased and high CD8 counts (> 900 cells/μL) decreased. The median pre-ART CD4:CD8 ratio was 0.41 (IQR 0.24-0.63), and recovery (≥ 1) occurred in 274 of 876 patients (31.3%). Pre- and post-ART CD4:CD8 ratios were lower in those aged > 50 years compared with young adults aged 18-30 years (P < 0.001 and P = 0.002, respectively). After adjustment, younger age at HIV diagnosis (P < 0.001) and treatment during PHI (P < 0.001) were favourable for CD4:CD8 ratio normalization.

CONCLUSIONS:

Older age (> 50 years) at HIV diagnosis was associated with persistent CD4:CD8 ratio inversion, whereas treatment of PHI was protective. These findings confirm the need for testing and early treatment of people aged > 50 years, and could be used in a risk management algorithm for enhanced surveillance.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003811/pdf/HIV-21-109.pdf

March 4, 2020 at 3:38 pm

2020-01 Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV 378 pag DHHS

Developed by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC)

What’s New in the Guidelines? (Last updated December 18, 2019 and last reviewed December 18, 2019)

* Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)

* Dolutegravir Recommendations for Individuals of Childbearing Potential

* Laboratory Testing for Initial Assessment and Monitoring of People with HIV Receiving Antiretroviral   Therapy

* Initiation of Antiretroviral Therapy

* What to Start

* Optimizing Antiretroviral Therapy in the Setting of Virologic Suppression

* Acute and Recent (Early) HIV Infection

* HIV and the Older Person

* Tuberculosis/HIV Coinfection

* Cost Considerations and Antiretroviral Therapy

* Table Updates

PDF

https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

January 10, 2020 at 7:32 am

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