Posts filed under ‘HIV/SIDA HAART’

Human Immunodeficiency Virus Drug Resistance: 2018 Recommendations of the International Antiviral Society–USA Panel

Clinical Infectious Diseases January 15, 2019 V.68 N.2 P.177–187

Huldrych F Günthard; Vincent Calvez; Roger Paredes; Deenan Pillay; Robert W Shafer …


Contemporary antiretroviral therapies (ART) and management strategies have diminished both human immunodeficiency virus (HIV) treatment failure and the acquired resistance to drugs in resource-rich regions, but transmission of drug-resistant viruses has not similarly decreased. In low- and middle-income regions, ART roll-out has improved outcomes, but has resulted in increasing acquired and transmitted resistances. Our objective was to review resistance to ART drugs and methods to detect it, and to provide updated recommendations for testing and monitoring for drug resistance in HIV-infected individuals.


A volunteer panel of experts appointed by the International Antiviral (formerly AIDS) Society–USA reviewed relevant peer-reviewed data that were published or presented at scientific conferences. Recommendations were rated according to the strength of the recommendation and quality of the evidence, and reached by full panel consensus.


Resistance testing remains a cornerstone of ART. It is recommended in newly-diagnosed individuals and in patients in whom ART has failed. Testing for transmitted integrase strand-transfer inhibitor resistance is currently not recommended, but this may change as more resistance emerges with widespread use. Sanger-based and next-generation sequencing approaches are each suited for genotypic testing. Testing for minority variants harboring drug resistance may only be considered if treatments depend on a first-generation nonnucleoside analogue reverse transcriptase inhibitor. Different HIV-1 subtypes do not need special considerations regarding resistance testing.


Testing for HIV drug resistance in drug-naive individuals and in patients in whom antiretroviral drugs are failing, and the appreciation of the role of testing, are crucial to the prevention and management of failure of ART.




January 20, 2019 at 11:08 am

Trends in utilization of statin therapy and contraindicated statin use in HIV-infected adults treated with antiretroviral therapy from 2007 through 2015

Journal of the American Heart Association December 18, V.7 N.24 P.:e010345

Rosenson RS et al.


HIV is associated with an increased risk for atherosclerotic cardiovascular disease, which may result in many people living with HIV taking a statin. Some statins are contraindicated with certain antiretroviral therapies ( ART ) and other medications commonly used by HIV -infected patients.

Methods and Results

We analyzed trends in the use of statins, including contraindicated statins, between 2007 and 2015 among HIV -infected patients aged ≥19 years taking ART who had employer-sponsored or Medicare supplemental health insurance in the Marketscan database (n=186 420). Statin use was identified using pharmacy claims. Contraindicated statin use was defined by a pharmacy claim for HIV protease inhibitors, cobicistat, hepatitis C protease inhibitors, anti-infectives, calcium channel blockers, amiodarone, gemfibrozil, or nefazodone followed by a fill for a contraindicated statin type and dosage within 90 days. The percentage of beneficiaries with HIV taking a statin remained unchanged between 2007 (24.6%) and 2015 (24.7%). Among those taking a statin, the percentage taking a contraindicated statin declined from 16.3% in 2007 to 9.0% in 2014 and then increased to 9.8% in 2015. The proportion of contraindicated statin fills attributable to HIV protease inhibitors declined from 63.9% in 2007 to 51.0% in 2015, while those attributable to cobicistat increased from 0% before 2012 to 20.6% in 2015.


Changes in ART regimens resulted in a decline in contraindicated statin use from 2007 to 2014, but this favorable trend was attenuated in 2015 because of increased use of cobicistat-containing ART regimens.



January 17, 2019 at 4:04 pm

Undetectable = Untransmittable and Your Health: The Personal Benefits of Early and Continuous Therapy for HIV Infection

Journal of Infectious Diseases, 7 January 2019 V.219 N.2 P.173–176


Mark J Siedner; Virginia Triant

In 2016, the Prevention Action Campaign launched the “U = U” (Undetectable = Untransmittable) campaign to publicize the preventative benefits of human immunodeficiency virus (HIV) antiretroviral therapy (ART) [1]. Based on accruing evidence from randomized clinical trials [2] and observational cohorts [3], the campaign intends to widely disseminate the message that an undetectable viral load means the virus is untransmittable to sexual partners and offspring. Indeed, the preventative benefits of effective HIV therapy have been responsible for averting vertical transmission to an estimated 1.6 million children, and to countless others through reductions in sexual transmission…



January 5, 2019 at 11:58 am

The Effect of Interrupted/Deferred Antiretroviral Therapy on Disease Risk: A SMART and START Combined Analysis

Journal of Infectious Diseases, 7 January 2019, V.219 N.2  P.254–263


Álvaro H Borges; Jacqueline Neuhaus; Shweta Sharma; James D Neaton; Keith Henry …


Pooled data from the SMART and START trials were used to compare deferred/intermittent versus immediate/continuous antiretroviral therapy (ART) on disease risk.


Endpoints assessed were AIDS, serious non-AIDS (SNA), cardiovascular disease (CVD), cancer, and death. Pooled (stratified by study) hazard ratios (HRs) from Cox models were obtained for deferred/intermittent ART versus immediate/continuous ART; analyses were conducted to assess consistency of HRs across baseline-defined subgroups.


Among 10156 participants, there were 124 AIDS, 247 SNA, 117 cancers, 103 CVD, and 120 deaths. Interventions in each trial led to similar differences in CD4 count and viral suppression. Pooled HRs (95% confidence interval) of deferred/intermittent ART versus immediate/continuous ART were for AIDS 3.63 (2.37–5.56); SNA 1.62 (1.25–2.09); CVD 1.59 (1.07–2.37); cancer 1.93 (1.32–2.83); and death 1.80 (1.24–2.61). Underlying risk was greater in SMART than START. Given the similar HRs for each trial, absolute risk differences between treatment groups were greater in SMART than START. Pooled HRs were similar across subgroups.


Treatment group differences in CD4 count and viral suppression were similar in SMART and START. Likely as a consequence, relative differences in risk of AIDS and SNA between immediate/continuous ART and deferred/intermittent ART were similar.

Clinical Trials Registration – NCT00027352 and NCT00867048.




January 5, 2019 at 11:57 am

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients.

PLoS One. March 16, 2017 V.12 N.3 P.:e0173858.

Hu Z1, Chen J2, Wang J3, Xiong Q1, Zhong Y1, Yang Y1, Xu C4, Wei H1.



Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC.


HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis.


60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0-205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia.


This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection


November 25, 2018 at 9:40 am

Pulmonary Cryptococcosis – Localized and Disseminated Infections in 27 Patients with AIDS.

Clinical Infectious Diseases September 1995 V.21 N.3 P.628–633

Marie-Caroline Meyohas; Patricia Roux; Diane Bollens; Christos Chouaid; Willy Rozenbaum …

We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans.

Twenty-seven patients (32%) had pulmonary cryptococcosis.

C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites.

All but one of the 27 patients had detectable CA in serum.

The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%).

Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident.

Outcome was poor (mean survival time, 23 weeks) despite treatment.

Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.




November 24, 2018 at 8:03 pm

Cryptococcus neoformans Pulmonary Infection in HIV-1-Infected Patients

Journal of Acquired Immune Deficiency Syndrome May 1990 V.3  N.5 P.480-484

Clark, Rebecca A.; Greer, Donald L.; Valainis, Gregory T…..

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1).

We review the initial presentation and clinical course of 18 HIV-1-infected (HIV +) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined.

The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%).

Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis.

Of six patients with an isolated Cn pulmonary infection, five have subsequently died.

Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse.

Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.



November 24, 2018 at 8:01 pm

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