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Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects
Fernandes, Ana Paula Morais;Sanches, Roberta Seron;Mill, Judy;Lucy, Daniel;Palha, Pedro Fredemir;Dalri, Maria Célia Barcellos;
Revista Latino-Americana de Enfermagem , 2007, DOI: 10.1590/S0104-11692007000500024
Abstract: several side effects have been strongly associated with antiretroviral therapy in hiv patients. among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as hiv patients. this manuscript presents an analysis of current literature regarding the psychosocial aspects of hiv patients with lipodystrophy associated with antiretroviral therapy. the results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. this analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for hiv patients affected by this problem.
Pericardial effusion of HIV-infected patients - results of a prospective multicenter cohort study in the era of antiretroviral therapy
A Lind, N Reinsch, K Neuhaus, S Esser, N Brockmeyer, A Potthoff, S Pankuweit, R Erbel, B Maisch, T Neumann, the HIV-HEART Study on behalf of the Competence Network of Heart Failure and the Competence Network of HIV/AIDS
European Journal of Medical Research , 2011, DOI: 10.1186/2047-783x-16-11-480
Abstract: The HIV-HEART (HIV-infection and HEART disease) study is a cardiology driven, prospective and multicenter cohort study. Outpatients with a known HIV-infection were recruited during a 20 month period in a consecutive manner from September 2004 to May 2006. The study comprehends classic parameters of HIV-infection, comprising CD4-cell count (cluster of differentiation) and virus load, as well as non-invasive tests of cardiac diseases, including a thorough transthoracic echocardiography.802 HIV-infected patients (female: 16.6%) with a mean age of 44.2 ± 10.3 years, were included. Duration of HIV-infection since initial diagnosis was 7.6 ± 5.8 years. Of all participants, 85.2% received antiretroviral therapy. Virus load was detectable in 34.4% and CD4 - cell count was in 12.4% less than 200 cells/μL. Pericardial effusions were present in only two patients of the analysed population. None of the participants had signs of a relevant cardiovascular impairment by pericardial effusion.Our results demonstrate that the era of antiretroviral therapy goes along with low rates of pericardial effusions in HIV-infected outpatients. Our findings are in contrast to the results of publications, performed before the common use of antiretroviral therapy.HIV-infection is often associated with cardiac disorders [1]. Nevertheless, cardiac involvement in this patient population was frequently underdiagnosed or attributed incorrectly to other non-cardiac disease processes [2].In particular symptoms, such as fatigue or reduced exercise intolerance, are common in this patient population and could belong to chronic cardiac disorders, such as pericardial effusion. In fact, previous studies described, that a pericardial effusion is present in up to 11% of cases [3] and, therefore, it was supposed to be one of the most common cardiac disorder in HIV-infected subjects [4].However, the development of antiretroviral therapeutics dramatically changed the natural history of the HIV-infection. Although
Antiretroviral effect of lovastatin on HIV-1-infected individuals without highly active antiretroviral therapy (The LIVE study): a phase-II randomized clinical trial
Carlos J Montoya, Fabian Jaimes, Edwin A Higuita, Sandra Convers-Páez, Santiago Estrada, Francisco Gutierrez, Pedro Amariles, Newar Giraldo, Cristina Pe?aloza, Maria T Rugeles
Trials , 2009, DOI: 10.1186/1745-6215-10-41
Abstract: Randomized, double-blinded, placebo controlled, single-center, phase-II clinical trial. One hundred and ten chronically HIV-1-infected patients, older than 18 years and na?ve for antirretroviral therapy (i.e., without prior or current management with antiretroviral drugs) will be enrolled at the outpatient services from the most important centres for health insurance care in Medellin-Colombia. The interventions will be lovastatin (40 mg/day, orally, for 12 months; 55 patients) or placebo (55 patients). Our primary aim will be to determine the effect of lovastatin on viral replication. The secondary aim will be to determine the effect of lovastatin on CD4+ T-cell count in peripheral blood. As tertiary aims we will explore differences in CD8+ T-cell count, expression of activation markers (CD38 and HLA-DR) on CD4 and CD8 T cells, cholesterol metabolism, LFA-1/ICAM-1 function, Rho GTPases function and clinical evolution between treated and not treated HIV-1-infected individuals.Preliminary descriptive studies have suggested that statins (lovastatin) may have anti HIV-1 activity and that their administration is safe, with the potential effect of controlling HIV-1 replication in chronically infected individuals who had not received antiretroviral medications. Considering that there is limited clinical data available on this topic, all these findings warrant further evaluation to determine if long-term administration of statins may benefit the virological and immunological evolution in HIV-1-infected individuals before the use of antiretroviral therapy is required.Registration number NCT00721305.Type-1 human immunodeficiency virus (HIV-1), the etiologic agent of the acquired immunodeficiency syndrome (AIDS), causes a chronic disease characterized by a progressive loss of CD4+ T cells associated with other quantitative and qualitative alterations of the immune response. Currently, HIV-1 infection is among the most important public health problems around the world: at the e
Micro-Structural Brain Alterations in Aviremic HIV+ Patients with Minor Neurocognitive Disorders: A Multi-Contrast Study at High Field  [PDF]
Cristina Granziera, Alessandro Daducci, Samanta Simioni, Matthias Cavassini, Alexis Roche, Djalel Meskaldji, Tobias Kober, Melanie Metral, Alexandra Calmy, Gunther Helms, Bernard Hirschel, Fran?ois Lazeyras, Reto Meuli, Gunnar Krueger, Renaud A. Du Pasquier
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072547
Abstract: Objective Mild neurocognitive disorders (MND) affect a subset of HIV+ patients under effective combination antiretroviral therapy (cART). In this study, we used an innovative multi-contrast magnetic resonance imaging (MRI) approach at high-field to assess the presence of micro-structural brain alterations in MND+ patients. Methods We enrolled 17 MND+ and 19 MND? patients with undetectable HIV-1 RNA and 19 healthy controls (HC). MRI acquisitions at 3T included: MP2RAGE for T1 relaxation times, Magnetization Transfer (MT), T2* and Susceptibility Weighted Imaging (SWI) to probe micro-structural integrity and iron deposition in the brain. Statistical analysis used permutation-based tests and correction for family-wise error rate. Multiple regression analysis was performed between MRI data and (i) neuropsychological results (ii) HIV infection characteristics. A linear discriminant analysis (LDA) based on MRI data was performed between MND+ and MND? patients and cross-validated with a leave-one-out test. Results Our data revealed loss of structural integrity and micro-oedema in MND+ compared to HC in the global white and cortical gray matter, as well as in the thalamus and basal ganglia. Multiple regression analysis showed a significant influence of sub-cortical nuclei alterations on the executive index of MND+ patients (p = 0.04 he and R2 = 95.2). The LDA distinguished MND+ and MND? patients with a classification quality of 73% after cross-validation. Conclusion Our study shows micro-structural brain tissue alterations in MND+ patients under effective therapy and suggests that multi-contrast MRI at high field is a powerful approach to discriminate between HIV+ patients on cART with and without mild neurocognitive deficits.
Cost-Effectiveness of Antiretroviral Therapy for Multidrug-Resistant HIV: Past, Present, and Future  [PDF]
Marianne Harris,Bohdan Nosyk,Richard Harrigan,Viviane Dias Lima,Calvin Cohen,Julio Montaner
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/595762
Abstract: In the early years of the highly active antiretroviral therapy (HAART) era, HIV with resistance to two or more agents in different antiretroviral classes posed a significant clinical challenge. Multidrug-resistant (MDR) HIV was an important cause of treatment failure, morbidity, and mortality. Treatment options at the time were limited; multiple drug regimens with or without enfuvirtide were used with some success but proved to be difficult to sustain for reasons of tolerability, toxicity, and cost. Starting in 2006, data began to emerge supporting the use of new drugs from the original antiretroviral classes (tipranavir, darunavir, and etravirine) and drugs from new classes (raltegravir and maraviroc) for the treatment of MDR HIV. Their availability has enabled patients with MDR HIV to achieve full and durable viral suppression with more compact and cost-effective regimens including at least two and often three fully active agents. The emergence of drug-resistant HIV is expected to continue to become less frequent in the future, driven by improvements in the convenience, tolerability, efficacy, and durability of first-line HAART regimens. To continue this trend, the optimal rollout of HAART in both rich and resource-limited settings will require careful planning and strategic use of antiretroviral drugs and monitoring technologies. 1. Introduction In the early years of the highly active antiretroviral therapy (HAART) era starting in 1996, HIV with resistance to two or more agents in different antiretroviral classes posed a significant clinical challenge. Multidrug-resistant (MDR) HIV was an important cause of treatment failure and consequent morbidity and mortality [1]. In 1998, a large drug resistance survey among viremic HIV patients in the United States showed that 13% harbored three-class-resistant virus and 48% had two-class resistance [2]. With improvements in understanding of viral dynamics and the efficacy of first-line regimens, MDR HIV has become less common but has not disappeared entirely, as demonstrated in a Canadian cohort of HAART-treated individuals followed until 2007 [3]. While three-class antiretroviral drug resistance is now very unusual (2%), two-class resistance was observed in 17% of the cohort. Fortunately, treatment options for patients with MDR HIV have improved substantially in terms of effectiveness, toxicity, and tolerability, while remaining cost-effective in most cases. 2. Past (1996–2005) 2.1. The HAART Era The HAART era began in 1996, with the availability of triple drug regimens and clinical trial data demonstrating
Differences in Salivary Flow Level, Xerostomia, and Flavor Alteration in Mexican HIV Patients Who Did or Did Not Receive Antiretroviral Therapy  [PDF]
Sandra López-Verdín,Jaime Andrade-Villanueva,Ana Lourdes Zamora-Perez,Ronell Bologna-Molina,José Justino Cervantes-Cabrera,Nelly Molina-Frechero
AIDS Research and Treatment , 2013, DOI: 10.1155/2013/613278
Abstract: Introduction. Objective and subjective alterations related to salivary flow have been reported in patients infected with human immunodeficiency virus (HIV), and these alterations are associated with the introduction of antiretroviral therapy. The aim of the current study was to discern whether these alterations are disease induced or secondary to drug therapy. Objective. The objective was to determine the relationships between low salivary flow, xerostomia, and flavor alterations in HIV patients who did or did not receive antiretroviral therapy. Materials and Methods. In this cross-sectional study, HIV patients were divided into two groups based on whether they had received antiretroviral therapy. Those patients with a previous diagnosis of any salivary gland disease were excluded. A survey was used to assess subjective variables, and colorimetry and salivary flow rates were measured using the Schirmer global test. Results. A total of 293 patients were included. The therapy group showed a significantly lower average salivary flow than did the group without therapy, and we observed that the flow rate tended to decrease after one year of therapy. The results were not conclusive, despite significant differences in xerostomia and flavor alteration between the groups. Conclusion. The study results suggest that antiretroviral therapy can cause cumulative damage that affects the amount of salivary flow. 1. Introduction Oral diseases related to human immunodeficiency virus (HIV) infection have been extensively described in the clearing house classification [1] and have since been used as indicators of this condition. Additionally, both objective and subjective alterations related to salivary flow (hyposalivation, xerostomia, and dysgeusia) have been reported in these patients but have not yet been completely linked to the advent of highly active antiretroviral therapy (HAART). It is difficult to discern whether these alterations are part of the course of the disease or therapeutic side effects; various studies, which can be divided into two theories, have been performed on this subject. On the one hand, certain authors theorize that high levels of HIV RNA might reside in the lymph nodes that are enclosed within the parotid gland during embryonic development, thus directly infecting the salivary gland with HIV [2–6]. On the other hand, others suggest an indirect process in which increased CD8+ lymphocyte infiltration into these lymph nodes could trigger significant hyperplasia in the parotid gland, which ultimately manifests as salivary gland hypofunction or
Evaluation of bone alterations in the jaws of HIV-infected menopausal women  [cached]
Bruno Vieira Caputo,Gabriela Cineze Traversa-Caputo,Claudio Costa,Elcio Magdalena Giovani
Brazilian Oral Research , 2013,
Abstract: The advent of highly active antiretroviral therapy (HAART) has caused a reduction in mortality, thus contributing to an increase in the number of women with HIV AIDS who reach the climacteric period, experience decline in ovarian function, and develop complications of viral infection and HAART, which can accelerate bone loss. The aim of this study was to detect possible alterations in the jaws of HIV-infected women by panoramic radiography. The study comprised a total of 120 women above 40 years of age who were divided into the following two groups: women who are HIV positive (Group I) and women with no known HIV infection (Group II). Measurement of the following three radiomorphometric indexes was performed by panoramic radiography: Mental Index (MI), Panoramic Mandibular Index (PMI) and Antegonial Depth (AD). A total of 70% of women in the control group and 50% of women in the HIV group were in the postmenopausal period, and the average values of both MI (p = 0.0054) and AD (p < 0.0001) for this period were lower in the HIV group than in the control group. For patients who were in the premenopausal period, the average AD was lower in the HIV group than in the control group (p = 0.0003). Despite the difference in the average age between groups, greater bone resorption in the mandible was found in the group of HIV-positive women.
Early Antiretroviral Therapy reduces the incidence of otorrhea in a randomized study of early and deferred antiretroviral therapy: Evidence from the Children with HIV Early Antiretroviral Therapy (CHER) Study
Clotilde Hainline, Reghana Taliep, Gill Sorour, Sharon Nachman, Helena Rabie, Els Dobbels, Anita van Rensburg, Morna Cornell, Avy Violari, Shabir A Madhi, Mark F Cotton
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-448
Abstract: Data were reviewed from the start of the trial in July 2005 until 20 June 2007, when the Data Safety Monitoring Board recommended that randomization to the deferred arm should stop and that all infants in this arm be reviewed for commencing antiretroviral therapy. Infants entered the study at a median of 7.4 weeks of age. Eleven of 38 (29%) on deferred therapy and 7 of 75 (9%) in the early-therapy group developed otorrhea (risk ratio 3.1, 95% confidence interval (CI) 1.31-7.36; p = 0.01).Early initiation of antiretroviral therapy is associated with significantly less otorrhea than when a deferred strategy is followed.NCT00102960. ClinicalTrials.GovChronic suppurative otitis media (CSOM), usually accompanied by otorrhea, is a major cause of hearing impairment in children, especially in developing countries. Management is either unsatisfactory or very difficult [1]. Otorrhea typically occurs after perforation of the tympanic membrane as a complication of acute otitis media, with subsequent discharge of pus into the external ear canal. Acute otitis media is hard to diagnose in young infants due to non-specificity of presenting symptoms and the difficulty of visualizing the tympanic membrane [2]. Otorrhea, however, is easy to visualize and does not require any equipment [1].The study was a retrospective folder search for otorrhea identified in the clinical notes and assumed due to a perforation of the tympanum, which is the most common cause. External otitis media was excluded clinically. Otitis media and otorrhea are World Health Organization (WHO) stage II events for HIV in children [3]. Both occur frequently in HIV-infected children [4-6]. Antiretroviral therapy (ART) was associated with a reduction in otitis media and CSOM in a retrospective cohort [7].In a sub-analysis of a prospective randomized strategy trial, we compared otorrhea in young HIV-infected infants receiving early versus delayed ART. Infants aged 6 to 12 weeks of age with confirmed HIV infection and a
Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study
Walter H Curioso, Deanna Kepka, Robinson Cabello, Patricia Segura, Ann E Kurth
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-13
Abstract: At two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data.Among the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment.Overall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.Individuals living with HIV/AIDS in resource-constrained settings now have increased access to antiretroviral therapy (ART) medications. In Peru, the HIV/AIDS epidemic has been largely concentrated among men who have sex with men (MSM) [1,2]. The seroprevalence for MSM is 10-22% [2-4], compared to 0.1-0.4% for the general population [5], and 1% for female sex workers [6]. Antiretroviral therapy, available through the national ART program in Peru since 2004 [1,7], is a key component of improving health outcomes for HIV-positive individuals. To achieve optimal results from ART, high levels of patient adherence to ART are critical [8-10]. The availability of ART allows HIV patients to be managed effectively as a serious chronic rather than terminal illness [8,11].Adherence plays an importa
Barriers and facilitators to patients\' adherence to antiretroviral treatment in Zambia: a qualitative study
N Sanjobo, JC Frich, A Fretheim
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2008,
Abstract: Patients\' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients\' and health care professionals\' perceived barriers and facilitators to patients\' adherence to ART. Based on data from individual interviews and focus group interviews with a total of 60 patients and 12 health care professionals, we identified barriers and facilitators related to patients\' beliefs and behaviours, the health service, and socio-economic and cultural factors. Among the barriers we identified were lack of communication and information about ART, inadequate time during consultations, lack of follow-up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, and lack of nutritional support. Feeling better, prospects of living longer, family support, information about ART, support for income-generating activities, disclosure of HIV status, prayers and transport support were among the facilitators. Our study suggests that several issues need to be considered when providing ART. Further research is needed to study interactions between patients and their health care providers. Our findings can inform interventions to improve adherence to ART.
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