Posts filed under ‘HIV/SIDA’

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.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354418/pdf/pone.0173858.pdf

Advertisements

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.

abstract

https://academic.oup.com/cid/article-abstract/21/3/628/362645?redirectedFrom=fulltext

PDF

https://doi.org/10.1093/clinids/21.3.628

 

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.

abstract

https://journals.lww.com/jaids/Abstract/1990/05000/Cryptococcus_neoformans_Pulmonary_Infection_in.3.aspx

PDF (CLIC en PDF)

November 24, 2018 at 8:01 pm

Being PrEPared  – Preexposure Prophylaxis and HIV Disparities.

N Engl J of Med October 4, 2018 V.379 P.1293-1295

Perspective

Robert H. Goldstein, M.D., Ph.D., Carl G. Streed, Jr., M.D., and Sean R. Cahill, Ph.D.

If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC).1 This prediction highlights the long road ahead if we are to end the spread of HIV in the United States, but it does not tell the full story, which is complicated and nuanced….

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1804306?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1804306

November 6, 2018 at 8:21 am

Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Pre-exposure Prophylaxis among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study.

Clinical Infectious Diseases September 15, 2018.             

Liu AY1,2, Vittinghoff E3, von Felten P1, Amico KR4, Anderson PL5, Lester R6, Andrew E1, Estes I7,8, Serrano P7,8, Brothers J7,8, Buchbinder S1,2,3, Hosek S7,8, Fuchs JD2,9.

Author information

1 Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.

2 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

3 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

4 Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

5 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO USA.

6 Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

7 Ruth M. Rothstein CORE Center, Chicago, IL, USA.

8 Stroger Hospital of Cook County, Department of Psychiatry, Chicago, IL.

9 Center for Learning & Innovation, San Francisco Department of Public Health, San Francisco, CA, USA.

Abstract

BACKGROUND:

Young men who have sex with men (MSM) are among the most vulnerable to HIV infection in the United States. While pre-exposure prophylaxis (PrEP) has demonstrated effectiveness, adherence and retention in care have been low among youth.

METHODS:

We conducted a randomized controlled trial to evaluate the impact of a youth-tailored, bi-directional text-messaging PrEP support intervention (PrEPmate) on study retention and PrEP adherence. Young individuals at risk for HIV acquisition initiating PrEP within Chicago’s safety-net hospital system were randomized 2:1 to receive PrEPmate or standard of care (SoC) for 36 weeks. The primary retention outcome was study-visit completion, and the primary adherence outcome was tenofovir diphosphate (TFV-DP) concentrations ≥700 fmol/punch (consistent with ≥4 doses/week) assessed at 4, 12, 24, and 36 weeks. The impact of PrEPmate on retention and adherence was evaluated using generalized estimating equation logistic models with robust standard errors.

RESULTS:

From April 2015 to March 2016, 121 participants enrolled (mean age 24; 27% Black, 36% Latino). Across all visits, participants who received PrEPmate were more likely to attend study visits (86% PrEPmate vs. 71% SoC, OR=2.62, 95%CI 1.24-5.54) and have TFV-DP levels consistent with ≥4 doses/week (72% PrEPmate vs. 57% SoC, OR=2.05, 95%CI 1.06-3.94). PrEPmate efficacy did not differ significantly by age, race/ethnicity, education, or insurance. Overall, 88% reported PrEPmate to be very/somewhat helpful, and 92% would recommend PrEPmate to others.

CONCLUSIONS:

An interactive text-messaging intervention had high acceptability and significantly increased study-visit retention and PrEP adherence among young individuals at risk for HIV acquisition.

FULL TEXT

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy810/5098440

PDF (CLIC en PDF

October 9, 2018 at 7:52 am

Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis

Clinical Infectious Diseases September 1, 2018 V.67 N.5 P.676–686

EDITOR’S CHOICE

Michael W Traeger; Sophia E Schroeder; Edwina J Wright; Margaret E Hellard; Vincent J Cornelisse..

This systematic review and meta-analysis of 17 open-label studies published to 2017 found that daily HIV pre-exposure prophylaxis use among men who have sex with men is associated with increased sexually transmitted infection diagnoses and an increase in condomless sex.

Background

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM.

Methods

We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed.

Results

Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19–2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99–1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.

Conclusion

Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.

FULL TEXT

https://academic.oup.com/cid/article/67/5/676/4917600

PDF (CLIC en PDF)

September 2, 2018 at 10:36 am

Bioequivalence of a Fixed-Dose Combination Tablet of the Complete Two-Drug Regimen of Dolutegravir and Rilpivirine for Treatment of HIV-1 Infection

Antimicrobial Agents and Chemotherapy September 2018 V.62 N.9

Rashmi Mehta, Allen Wolstenholme, Kristin Di Lullo, Caifeng Fu, Shashidhar Joshi, Herta Crauwels, Naomi Givens, Simon Vanveggel, Brian Wynne and Kimberly Adkison

A complete 2-drug regimen of dolutegravir at 50 mg and rilpivirine at 25 mg was approved to treat HIV-1 infection in virologically suppressed patients after demonstrating acceptable efficacy and tolerability.

This study investigated the bioequivalence and pharmacokinetics of the fixed-dose combination tablet compared with those of separate tablets. Secondary endpoints were the tolerability and safety of the fixed-dose combination tablet.

In this open-label, randomized-sequence, 2-way crossover trial, single doses of the fixed-dose combination tablet (the test treatment) and the combination of separate tablets (the reference treatment) were administered to healthy adults after a moderate-fat meal, with a 21-day washout between treatments.

Pharmacokinetic samples were collected through 12 days after dosing. The primary endpoints were the area under the plasma concentration-time curve (AUC) and the maximum concentration of drug in plasma (Cmax). The study employed a prespecified sample size reestimation based on a blind midpoint review of Cmax variability to update the enrollment size to achieve statistical power.

Of 118 participants enrolled, 113 received both treatments and underwent pharmacokinetic assessment.

The 90% confidence intervals for the geometric least-squares mean ratios for the AUC from 0 h to infinity, the AUC from 0 h to the last quantifiable measurement, and Cmax (test treatment versus reference treatment) were within the bioequivalence range of 0.80 to 1.25 for both drugs, indicating bioequivalence.

In this study, a single dose of either treatment was well tolerated overall, with 4% (n = 5) and 3% (n = 3) of participants reporting adverse events considered related to the test and reference treatments, respectively.

The dolutegravir-rilpivirine fixed-dose combination tablet is bioequivalent to a combination of separate tablets, and no new safety signals emerged.

(This study has been registered at ClinicalTrials.gov under identifier NCT02741557.)

FULL TEXT

https://aac.asm.org/content/62/9/e00748-18?etoc=

PDF

https://aac.asm.org/content/aac/62/9/e00748-18.full.pdf

August 29, 2018 at 3:45 pm

Older Posts


Calendar

December 2018
M T W T F S S
« Nov    
 12
3456789
10111213141516
17181920212223
24252627282930
31  

Posts by Month

Posts by Category