Posts filed under ‘HIV/SIDA Laboratorio’

Brief Report: Enhanced Normalization of CD4/CD8 Ratio With Earlier Antiretroviral Therapy at Primary HIV Infection.

J Acquir Immune Defic Syndr. 2016 Sep 1;73(1):69-73.

Thornhill J1, Inshaw J, Kaleebu P, Cooper D, Ramjee G, Schechter M, Tambussi G, Fox J, Samuel M, Miro JM, Weber J, Porter K, Fidler S.

1 *Department of Medicine, Imperial College, London, United Kingdom; †Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom; ‡Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda; §Kirby Institute University of New South Wales and Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia; ‖HIV Prevention Unit, Medical Research Council, Durban, South Africa; ¶Projeto Praça Onze, Hospital Escola Sao Francisco de Assis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; #Division of Infectious Diseases, Ospedale San Raffaele, Milan, Italy; **Department of HIV, Faculty of Medicine, Guys and St Thomas’ NHS Trust/Kings College London, United Kingdom; and ††Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain.

Abstract

BACKGROUND:

Total CD4 T-cell counts predict HIV disease progression but do not necessarily reflect normalization of immune function. CD4/CD8 ratio is a marker of immune dysfunction, a prognostic indicator for non-AIDS mortality, and reflects viral reservoir size. Despite antiretroviral therapy (ART), recovery of CD4/CD8 ratio in chronic HIV infection is incomplete; we hypothesize enhanced CD4/CD8 ratio recovery with earlier treatment initiation in recently infected individuals.

METHODS:

CD4 count and CD4/CD8 ratio were analyzed using data from 2 cohorts: SPARTAC trial and the UK HIV Seroconverters Cohort where primary HIV infection (PHI) was defined as within 6 months from estimated date of infection. Using time-to-event methods and Cox proportional hazard models, we examined the effect of CD4/CD8 ratio at seroconversion on disease progression (CD4 <350 cells per cubic millimeter/ART initiation) and factors associated with time from ART initiation to CD4/CD8 normalization (ratio >1.0).

FINDINGS:

Of 573 seroconverters, 482 (84%) had abnormal CD4/CD8 ratios at HIV seroconversion. Individuals with higher CD4/CD8 ratio at seroconversion were significantly less likely to reach the disease progression endpoint [adjusted hazard ratio (aHR) (95% CI) = 0.52 (0.32 to 0.82), P = 0.005]. The longer the interval between seroconversion and ART initiation [HR (95% CI) = 0.98 per month increase (0.97, 0.99), P < 0.001], the less likely the CD4/CD8 ratio normalization. ART initiation within 6 months from seroconversion was significantly more likely to normalize [HR (95% CI) = 2.47 (1.67 to 3.67), P < 0.001] than those initiating later.

INTERPRETATION:

Most individuals presenting in PHI have abnormal CD4/CD8 ratios. The sooner the ART is initiated in PHI, the greater the probability of achieving normal CD4/CD8 ratio.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981213/pdf/qai-73-069.pdf

March 11, 2017 at 6:39 pm

HIV Whole-Genome Sequencing Now: Answering Still-Open Questions

Journal of Clinical Microbiology April 2016 V.54 N.4 P.834-835

Karin J. Metzner

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland

Diversity, evolution, and epidemiology of HIV are directly relevant to HIV transmission and pathogenesis; hence, they play a key role in antiretroviral treatment and vaccine design. Global HIV whole-genome sequencing would provide a treasure chest of data to answer many questions still open in these fields. An article by Berg et al. in this issue of the Journal of Clinical Microbiology describes a universal strategy to amplify and sequence heterogeneous HIV whole genomes

PDF

http://jcm.asm.org/content/54/4/834.full.pdf

March 9, 2017 at 3:28 pm

The Brief Case: A Reactive HIV Rapid Antibody Test in a Pregnant Woman

Journal of Clinical Microbiology April 2016 V.54 N.4 P.826-828

Melanie L. Yarbrough and Neil W. Anderson

A 32-year-old pregnant woman presented to her obstetrician for routine prenatal care during her 3rd month of pregnancy. She reported no major health concerns, with the exception of mild morning sickness that had been gradually improving. Upon physical examination, she appeared healthy and her vitals were stable and within normal limits.

Abdominal ultrasound revealed reassuring fetal heart tones, and her remaining physical exam was unremarkable.

She was counseled regarding the need for several routine prenatal laboratory tests, including testing for human immunodeficiency virus (HIV), to which she agreed.

A rapid HIV test performed in the obstetrician’s office was positive for antibodies against HIV.

The positive rapid antibody result was shared with the patient. She denied any risk factors for HIV infection, including intravenous drug use and sex with multiple partners.

The obstetrician stressed that the results were only preliminary and required confirmatory testing. Prior to sending the patient home, a blood sample was drawn for submission to the local clinical laboratory for additional testing. The obstetrician called the laboratory asking how long it would take for the Western blot confirmatory test to be performed.

A representative from the testing laboratory informed him that they now used the fourth-generation algorithm and therefore no longer performed confirmatory testing by Western blot assay….

PDF

http://jcm.asm.org/content/54/4/826.full.pdf

February 23, 2017 at 7:54 am

CD4 Decline Is Associated With Increased Risk of Cardiovascular Disease, Cancer, and Death in Virally Suppressed Patients With HIV

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.314-321

Marie Helleberg, Gitte Kronborg, Carsten S. Larsen, Gitte Pedersen, Court Pedersen, Niels Obel, and Jan Gerstoft

1Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet

2Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre

3Department. of Infectious Diseases, Aarhus University Hospital, Skejby

4Department of Infectious Diseases, Aalborg University Hospital

5Deptartment of Infectious Diseases, Odense University Hospital, Denmark

Background

The clinical implications of a considerable CD4 decline despite antiretroviral treatment and viral suppression are unknown. We aimed to test the hypothesis that a major CD4 decline could be a marker of cardiovascular disease or undiagnosed cancer.

Methods

Patients with human immunodeficiency virus (HIV) were followed in the Danish nationwide, population-based cohort study in the period 1995–2010 with quarterly CD4 measurements. Associations between a CD4 decline of ≥30% and cardiovascular disease, cancer, and death were analyzed using Poisson regression with date of CD4 decline as a time-updated variable.

Results

We followed 2584 virally suppressed HIV patients for 13 369 person-years (PY; median observation time, 4.7 years). Fifty-six patients developed CD4 decline (incidence rate, 4.2/1000 PY [95% confidence interval {CI}, 3.2–5.4]). CD4 counts dropped from a median of 492 cells/µL to 240 cells/µL. CD8, CD3, and total lymphocyte counts dropped concomitantly. No HIV-related factors, apart from treatment with didanosine, were associated with CD4 decline. The risk of cardiovascular disease, cancer, and death increased markedly ≤6 months after CD4 decline (incidence rate ratio, 11.7 [95% CI, 3.6–37.4] and 13.7 [95% CI, 4.3–43.6], respectively, and mortality rate ratio 4.3 [95% CI, 1.1–17.6]).

Conclusion

A major decline in CD4 count is associated with a marked increased risk of cardiovascular disease, cancer, and death among virally suppressed HIV patients. We studied the clinical implications of CD4 decline among virally suppressed human immunodeficiency virus patients and found that the risk of cardiovascular disease, cancer, and death was substantially increased within 6 months after a major CD4 decline and moderately increased thereafter.

PDF

http://cid.oxfordjournals.org/content/57/2/314.full.pdf

February 20, 2017 at 3:23 pm

2016 BHIVA GUIDELINES for the routine investigation and monitoring of Adult HIV-1-positive individuals 72 pags

British HIV Association

Writing Group: Brian Angus (Chair), Gary    Brook (Vice-chair), Funmi Awosusi, Gary Barker, Marta Boffito, Satyajit Das, Lucy Dorrell, Esther Dixon-Williams, Charlotte Hall, Bridie Howe, Sebastian Kalwij, Nashaba Matin, Eleni Nastouli, Frank Post, Melinda Tenant-Flowers, Erasmus Smit, Dan Wheals

NHS Evidence has accredited the process used by the British HIV Association (BHIVA) to produce guidelines.

Accreditation is valid for five years from July 2012 and is applicable to guidance produced using the processes described in the British HIV Association (BHIVA) Guideline Development Manual. More information on accreditation can be viewed at www.nice.org.uk/accreditation

PDF

http://www.bhiva.org/documents/Guidelines/Monitoring/2016-BHIVA-Monitoring-Guidelines.pdf

December 3, 2016 at 9:35 am

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

The Brief Case: Cryptosporidiosis in a Severely Immunocompromised HIV Patient

Journal of Clinical Microbiology September 2016 V.54 N.9 P.2219-2221

Alessandro Rossi and Marc Roger Couturier

aDepartment of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA

bARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA

A 52-year-old male with AIDS was admitted to the University of Utah Hospital with chronic (>3-month duration) watery diarrhea. The patient had been diagnosed with HIV infection 3 years prior to admission but had been noncompliant with antiviral therapy since primary diagnosis. Three months prior to admission (at the time of the diarrhea onset), his CD4+ cell count was critically low (6 cells/μl), he had an elevated viral load (∼54,000 copies/ml), and he was displaying rapid deterioration of overall health. The patient also suffered from multiple other known viral complications attributable to his severe immunosuppression, including chronic cytomegalovirus (CMV) retinitis and recurrent anogenital lesions caused by herpes simplex virus 2 (HSV-2)…

PDF

http://jcm.asm.org/content/54/9/2219.full.pdf+html

Closing the Brief Case: Cryptosporidiosis in a Severely Immunocompromised HIV Patient

Alessandro Rossi and Marc Roger Couturier

aDepartment of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA

bARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA

ANSWERS TO SELF-ASSESSMENT QUESTIONS

PDF

http://jcm.asm.org/content/54/9/2406.full.pdf+html

September 1, 2016 at 2:20 pm

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