bluuebunny/crossref_metadata_2025_split huggingface dataset:
ART management in children perinatally infected with HIV from mothers who experience behavioural changes in Romania
Authors: Märdärescu Mariana , Cibea Alina , Petre Cristina , Neagu‐Drãghicenoiu Ruxandra , Ungurianu Rodica , Petrea Sorin , Maria Tudor Ana , Vlad Delia , Matei Carina , Alexandra Mãrdãrescu 
Published: November 2014

IntroductionDuring the recent years the rate of HIV perinatally exposed children in Romania has increased as a consequence of the expanding number of HIV‐infected women. These women belong to Romania's long‐terms survivors, aged between 20 and 24 years and to the group of new HIV infection cases (20–24 years), acquired through unsafe sexual contact and use of new psychoactive substance (IV).Materials and MethodsWe focused on 396 HIV perinatally exposed children born between 2008 and 2013, under surveillance in National Institute for Infectious Diseases “Prof. Dr. Matei Bals,” Bucharest. Of them, 43 acquired HIV through materno‐foetal transmission. Our aim was to observe the characteristics in their evolution under antiretroviral treatment and to emphasize the causes of treatment failure. Children with perinatally acquired HIV infection were followed in a retrospective case series. We assessed maternal characteristics, HIV vertical transmission prophylaxis, timing of diagnosis, immunological and virologic status and features of the evolution under combined antiretroviral therapy (cART).ResultsThe rate of mother‐to‐child HIV transmission was 10.8% versus the national rate registered in 2013, namely <5%. 16% of mothers belonged to the Romanian 1990s cohort and 84% were recently infected with HIV, through unprotected sexual contact (70%) or use of new psychoactive substances (14%). 51% of mothers were diagnosed postnatally as a consequence of their reluctance to access specific health services and in 57% CD4 value was <350 cell/mm. 41% of the monitored children were diagnosed with HIV infection at birth. Their median entry CD4 value was 23% and 49% had a CD4 >25%; median entry viral load was 7 log. 16 patients (37%) had undetectable viral load after six months of treatment. In 87.5% of them the virologic suppression was achieved and maintained with one single regimen (2 NRTIs+1 NNRTI or 2 NRTIs+1 PI/r). 15 children (35%) did not achieve suppression of viral load. 19 children (44%) faced special issues related to adherence to antiretroviral treatment, due to mothers’ poor adherence to a basic set of cares destined for their children.ConclusionsPrevention programmes in Romania must be designed on the basis of the new economic context and emerging psychoactive substance use. Hence, women who use drugs should benefit from a wider access to medical and social services.
Effectiveness of the prevention of mother‐to‐child transmission of HIV protocol applied at Saint Camille Medical Centre in Ouagadougou, Burkina Faso
Authors: Theophile Soubeiga Serge , Bisseye Cyrille , Compaore Rebecca , Assengone Elsa , Ouermi Djeneba , Djigma Florencia , Sagna Tani , Pietra Virginio , Simpore Jacques 
Published: November 2014

IntroductionDespite many prevention efforts, the number of children infected by HIV in sub‐Saharan Africa through vertical transmission remains high. This infection can be reduced through programmes of prevention of mother‐to‐child HIV transmission (PMTCT). The objective of this study was to evaluate the effectiveness of the PMTCT protocol at Saint Camille Medical Centre in Ouagadougou, Burkina Faso.MethodsFrom August 2012 to September 2013, samples of dried blood spot (DBS) were collected from 160 children aged 6 weeks born to HIV‐1 positive mothers who were under PMTCT protocol at Saint Camille Medical Centre and 40 children of the same age group from orphanages and whose mothers were dead or unknown. The samples were tested using the Abbott Real Time HIV‐1 Qualitative kit. The clinical data of mothers were collected and analyzed using SPSS Version 17.0 and Epi Info Version 6.0 softwares.ResultsAmong pregnant women in this study, 52.5% were predominantly young (24–29 years) and 60.62% were housewives. In total, 50.5% (101/200) were in combination of AZT/3TC/NVP and 29.5% (59/200) were on prophylaxis (AZT/3TC). The rate of vertical transmission of HIV‐1 was 0.0% (p<0.001) in children whose mothers were taking a combination of AZT/3TC/NVP (0/101) or were on a prophylaxis AZT/3TC treatment (0 /59). The rate of HIV‐1 transmission in orphaned children was 15.0% (6/40).ConclusionsThe PMTCT protocol is effective and reduces very significantly (p<0.001) the risk of transmission of HIV‐1 from mother to child. In addition, screening by PCR of orphaned children vertically infected with HIV, enabled them to receive an early treatment.
CD4/CD8 ratio is not predictive of multi‐morbidity prevalence in HIV‐infected patients but identify patients with higher CVD risk
Authors: Menozzi Marianna , Zona Stefano , Santoro Antonella , Carli Federica , Stentarelli Chiara , Mussini Cristina , Guaraldi Giovanni 
Published: November 2014

BackgroundCD4/CD8<0.8 is a surrogate marker of immune‐activation/immunosenescence and independently predicts mortality in the HIV‐infected patients due to non‐AIDS related events. Most studies showed that patients on antiretroviral therapy (ART) often fail to normalize the CD4/CD8 ratio despite CD4 count normalization. Primary objective of the study was to explore the impact of CD4/CD8<0.8 as independent predictor of HIV‐associated non‐AIDS (HANA) conditions and multimorbidity (MM) in HIV patients. In patients with no previous history of cardiovascular disease (CVD) a particular insight is provided in the association between impact of CD4/CD8<0.8 and risk prediction of CVD or radiological markers of subclinical CVD.Materials and Methods914 consecutive patients attending Modena Metabolic HIV Clinic were evaluated in a cross‐sectional retrospective study. Inclusion criteria: stable ART from ≥2 years; HIV‐RNA plasma levels<40 copies/mL; stable CD4 count≥350/mmc. CD4/CD8 strata (0.8) was chosen as a cut off representing the median value of the cohort. MM was defined as the presence of≥2 HANA conditions including standard defined: chronic kidney disease, hypertension, previous CVD events, osteoporosis and diabetes mellitus. Calendar year of ART initiation was defined: “PreART” (<2000); “EarlyART” (2000–2005) and “LateART” (>=2006). High CVD risk was defined for Framingham Risk Score (FRS)≥6. Subclinical CVD was defined using cardiac CT scan for calcium score (CAC)≥100. Logistic univariate and multivariable adjusted analysis were performed to assess relationships between variables.ResultsDemographic and HIV‐specific variables distribution in patients with and without MM are shown in Table 1.Figure 1 shows HANA distribution across CD4/CD8 strata: CVD prevalence only appeared to be higher in patients with no CD4/CD8>0.8.In multivariable analyses CD4/CD8<0.8 was not an independent predictor of MM (OR=1.225, CI 0.891; 1.681, p=0.211) after adjustment for age, gender and BMI. Patients with CD4/CD8<0.8 displayed higher CVD risk but not higher prevalence of subclinical CVD. At multivariable analyses CD4/CD8<0.8 remained predictor of higher CVD risk (OR=0.65, CI 0.47–0.917, p=0.014) after correction for sex, BMI, age strata and HIV infection duration.ConclusionsLow CD4/CD8 ratio was not associated with MM prevalence. Patients with CD4/CD8<0.8 ratio displayed higher prevalence of CVD. At multivariable logistic regression CD4/CD8<0.8 is an independent prepredictor of enhanced CVD risk. This may support role of immune‐activation/senescence in the pathogenesis of CVD.
Relationship between innate immunity, soluble markers and metabolic‐clinical parameters in HIV+ patients ART treated with HIV‐RNA<50 cp/mL
Authors: Dentone Chiara , Fenoglio Daniela , Signori Alessio , Cenderello Giovanni , Parodi Alessia , Bozzano Federica , Guerra Michele , De Leo Pasqualina , Bartolacci Valentina , Mantia Eugenio , Orofino Giancarlo , Kalli Francesca , Marras Francesco , Fraccaro Paolo , Giacomini Mauro , Cassola Giovanni , Bruzzone Bianca , Ferrea Giuseppe , Viscoli Claudio , Filaci Gilberto , De Maria Andrea , Di Biagio Antonio 
Published: November 2014

IntroductionThe persistence of immune activation and inflammation in HIV patients with HIV‐RNA (VL) undetectable causes many co‐morbidities [1–3]. The aim of this study is to correlate monocytes (m) and NK cell activation levels, soluble markers and oxidative stress with clinical, biochemical and metabolic data in HIV‐1 infected patients with VL≤50 copies (cp)/mL on antiretroviral therapy.Materials and MethodsMulticentre, cross‐sectional study in patients with VL≤50 cp/mL and on antiretroviral therapy by at least six months. We studied: activation/homing markers (CD38, HLA‐DR, CCR‐2, PDL‐1) on inflammatory, intermediate, proinflammatory m; activatory receptors NKp30, NKp46 and HLA‐DR on NK cells; soluble inflammatory (sCD14, adiponectina, MCP‐1) and stress oxidative markers (dRoms, antiRoms). Univariate analyses are performed with non‐parametric and Pearson tests. The significant correlations were adjusted for possible known confounding factors (smoking, Cytomegalovirus IgG serology, Raltegravir, Protease Inhibitor [PI] therapy and HCV‐RNA) with multivariate analysis.ResultsIn the 68 patients the positive correlation between age and antiRoms was significant also after adjustment for PI use (p=0.05). The% CD8+T was associated with% proinflammatory m (p=0.043) and with their expression of CCR2 mean fluorescence intensity (MFI) (p=0.012). The% NKp46+ was positively correlated with CD4+T count (p=0.001). The fibrinogen was positively associated with dRoms (p=0.052) and the positive correlation between triglycerides and antiRoms has been confirmed (p<0.001); the impact of antiRoms on HDL/triglycerides ratio (p=0.006) was observed after adjustment for PI use. The BMI was associated with smoking (p=0.011). Only the maraviroc‐treated patients showed minimal arterial pressure, fibrinogen and antiRoms lower (p=0.001, 0.004 e 0.006) and sCD14 values higher (p=0.029).ConclusionsPatients with long history of HIV infection and stable immunological and virological status showed interactions between acquired and innate immunity activation; moreover, the levels of some metabolic and inflammatory parameters correlate with oxidative stress values and innate immunity activation. The age, BMI and smoking impact metabolic and immunological parameters. The correlations between antiretroviral drugs and clinical‐immunological parameters need further confirmations.
Cerebrospinal fluid biomarkers in patients with plasma HIV RNA below 20 copies/mL
Authors: Calcagno Andrea , Atzori Cristiana , Romito Alessandra , Ecclesia Sara , Imperiale Daniele , Audagnotto Sabrina , Chiara Alberione Maria , Trentalange Alice , Di Perri Giovanni , Bonora Stefano 
Published: November 2014

IntroductionLow level HIV‐1 CSF replication (CsfLLV) is often found even in patients with controlled plasma viraemia. The clinical consequences of such finding are uncertain; however, both symptomatic neurological disturbances and neurocognitive disorders may arise in the context of CSF‐escape. Two reports suggested that low level replication in the CSF may be associated with increased CSF neopterine although the impact on other markers of neuroinflammation/damage is currently unknown.Materials and MethodsPatients with neurocognitive disorders, new neurological symptoms or followed in longitudinal studies were included provided that they were on HAART, with last available viral load below 20 copies/mL and without central nervous system (CNS)‐involving infections/neoplasms. After brain Magnetic Resonance (MR) CSF HIV RNA (CAP/CTM HIV‐1 v2.0) and biomarkers [total tau (t‐tau), phosphorylated tau (p‐tau), 1–42 Beta amyloid (Beta42), neopterine and S100beta] were measured through validated methods. Data are presented as medians (IQR); non‐parametric tests are used for all analysis.Results70 patients [66.7% male, median age 47.8 years (40–56), median BMI 22.2 kg/m2 (20–24)] were enrolled. Current and nadir CD4+ cell count were 379 (219–656) and 116 cell/mm3 (46–225); HIV RNA was undetectable since 19.7 months (9–53). CSF HIV RNA was undetectable in 24 (34.3%), below 20 copies/mL in 26 (37.1%), above 20 copies/mL in 25 patients [35.7%, median 69 copies/mL (41–134]). Median (IQR) CSF biomarkers values were as follows: t‐tau 109 pg/mL (<75–161), p‐tau 31.6 pg/mL (23.4–35.4), Beta42 818 pg/mL (623–973), neopterine 0.58 ng/mL (0.45–0.87) and S100beta 149 pg/mL (110–186). Patients with CsfLLV did not show significant differences as for demographic, therapeutic, virological, radiological variables. t‐tau (134 vs 92.6, p=0.05) and Beta42 (953 vs 675, p=0.007) were higher in patients with CsfLLV. Neopterine levels were directly associated with p‐tau (rho=0.42, p=0.01), with CSF HIV RNA (rho=0.24, p=0.06). and inversely with current CD4 cell count (rho=−0.29, p=03).ConclusionsIn patients with controlled HIV viraemia (below 20 copies/mL), CSF total tau, Beta42 and neopterine were higher in patients with detectable HIV RNA. Prospective and adequately powered studies are warranted for evaluating the clinical significance of compartmental viral replication and immune activation.
Tackling cardiovascular co‐morbidities in HIV‐positive patients: who, how and where?
Authors: Rolls Sophie , Denneny Emma , Marcus Rebecca , O'Connell Rebecca 
Published: November 2014

IntroductionCardiovascular disease (CVD) is a significant cause of non‐AIDS‐related morbidity and mortality in HIV‐positive individuals [1]. Management of CVD and associated risk factors in HIV are complicated by drug interactions [2]. Optimal management can require specialist input. A previous cohort review highlighted CVD, comorbidity and cardiovascular (CV) risk in our patients [3]. In response, a combined HIV and cardiovascular monthly clinic was established: an HIV consultant works in real time with a cardiologist. The clinic manages CV disease, complex CV co‐morbidities e.g. refractory hypertension, hyperlipidaemia, and assesses primary prevention. A dietician works alongside the clinic.AimsDescribe the clinic caseload; record clinic interventions and outcomes; recommend service development.Materials and MethodsWe conducted a retrospective notes review of patients attending the co‐morbidity clinic from January 2012 to May 2014. Data collected: demographic, HIV, CVD, CV risk, investigations and clinical interventions.ResultsFrom a cohort of approximately 960 patients (70% African), 60 (6%) were seen in the co‐morbidity clinic over the specified time period. Median age was 53 (range 24‐80). Although 60% of our cohort is female, 43% (26/60) of the CVD clinic were female. 42 (70%) were African. The mean CD4 was 560 (range 48‐1339). All patients were on ART and 6 (10%) had a detectable viral load > 400 copies/mL. Clinic caseload: i) CVD: 9 had a prior CV event (ACS or CVA); 5 had CCF; new diagnoses included LVH (2), cardiac dysfunction (6); AF (2); atrial thrombus (1). ii) Co‐morbidities: 48(80%) had hypertension – 10 (16.6%) were on quadruple therapy; 17 (28%) had diabetes; 35 (58%) were on a statin. Three had their smoking status clearly documented. Seventeen (28%) were referred to the dietician. Investigations included echo, 24‐hour BP/ tape, CT angio, cardiac MR.ConclusionsThe joint clinic facilitated real‐time decision making on clinical interventions. Patient access to cardiac investigations was expedited. Patients attended fewer outpatient appointments. Both cardiology and HIV clinicians preferred the benefits of joint working. Clinical outcomes were difficult to assess and will need further definition. Recommendations for development include: improved CV risk assessment, improved outcome measures, links to smoking cessation services.
Two years of Truvada for pre‐exposure prophylaxis utilization in the US
Authors: Flash Charlene , Landovitz Raphael , Mera Giler Robertino , Ng Leslie , Magnuson David , Bush Wooley Staci , Rawlings Keith 
Published: November 2014

IntroductionTruvada® (TVD) was approved in July 2012 by the US FDA for pre‐exposure prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV‐1 in high‐risk adults. This study explores the characteristics of US PrEP users and their prescribers over the past two years.Materials and MethodsA previously described algorithm was used to identify TVD for PrEP by excluding use for HIV treatment, post‐exposure prophylaxis, and off‐label treatment of chronic hepatitis B. National electronic patient level data from ~55% of all US retail pharmacies that dispensed TVD between January 1, 2012 and March 31, 2014 was collected. De‐identified patient‐level data including prescription refill data, medical claims and patient demographics were analyzed via logistic regression to estimate the odds of change by year.ResultsA total of 3253 unique individuals who started TVD for PrEP between January 1, 2012 and March 31, 2014 were included in this analysis. Women comprised 42.0% of PrEP users. Although mean age was 38.1+11.9 years, with males being significantly older (39.3+11.6) than females (36.4+12.3), 11.5% of individuals were under 25 years old. The proportion of males under 25 was 7.4% (95% CI 6.3–8.7); significantly lower than that of women, 17.2% (95% CI 15.3–19.3). New starts have increased from 293 in 2012 to 472 Q1 2014. During the 12‐month period ending March 31, 2013 and March 31, 2014 the number of new starts among females dropped from 44.5% to 22.9%.Sixty‐eight percent of TVD for PrEP prescriptions were written by five specialties: internal medicine (19%), family practice (18%), infectious diseases (11%), nurse practitioners (10%) and physician assistants (10%).ConclusionsThe population of TVD for PrEP users in the US nationally appears to be shifting demographically. It continues to be initiated mostly by primary care providers. Over a two‐year period new starts of Truvada for PrEP have increased considerably among males. While the overall proportion of female users decreased between Q1 2012 and Q1 2014, females that started on PrEP are younger than males. More community‐level data on PrEP usage will be helpful in informing local efforts to integrate PrEP in HIV prevention messaging and services.
Attitudes and beliefs towards early ART initiation in MSM with primary HIV infection
Authors: Parsons Victoria , Porter Kholoud , Gilson Richard , Hart Graham 
Published: November 2014

IntroductionART initiation in primary HIV infection (PHI) could reduce risk of transmission to sexual partners at a time of high viraemia, although health benefit for the individual remains unknown. We examined attitudes to early ART and associated beliefs in men who have sex with men (MSM) with PHI.Materials and MethodsSemi‐structured face‐to‐face in‐depth interviews were conducted with 13 MSM aged ≥16 years attending a central London HIV clinic, within 12 months of date of estimated HIV seroconversion. Audio recordings of interviews were transcribed verbatim and analyzed thematically.ResultsMedian age was 33 years (range 22–47), majority were white British (n=8), educated to university level (n=11) and were not on ART (n=10). Great diversity in ART knowledge and expectations around starting were observed, with some men assuming they would be prescribed ART immediately upon diagnosis. Deferral until CD4<350 came as a surprise and counterintuitive when put into the context of treating other diseases. For many, the decision to start ART was a balance of current and future health and quality of life. Fear of side effects was prevalent, with many believing them inevitable and a reason to avoid early ART. A perceived lack of “good quality” evidence showing a health benefit of early ART caused confusion. Avoiding the decision to start or deferring to their HIV clinician was common, however reported clinicians’ views also varied. Some men voiced a desire to be proactive and start early ART to control viral replication. In these cases men also reported a belief that ART could be temporary as they expected a cure in their lifetime. Men commonly described feeling “infected” and reducing this infectiousness was seen as a major benefit of ART; not purely to reduce the risk of transmission to sexual partners but to facilitate disclosure to partners, reduce anxiety and guilt and restore sexual confidence commonly lost after HIV diagnosis. Having a long‐term HIV‐negative partner was a strong facilitator to starting ART to reduce transmission in the absence of good evidence of individual health benefit.ConclusionsFactors involved in the decision to start ART in PHI were complex. Uncertainty over individual health benefits in conjunction with fear of toxicities were barriers to starting ART early. By contrast ART was seen as a facilitator to disclosure, and as a way to limit the consequences of infection until a cure is found.
Safety, tolerability and effectiveness of HIV non‐occupational prophylaxis in Taiwan
Authors: Li Hsing‐Chuan , Cheng Yu‐Ping , Yang Chia‐Jui 
Published: November 2014

IntroductionIncreasing numbers of new HIV infection is an important issue of public health in Taiwan. We aim to evaluate the safety, tolerability and effectiveness of HIV non‐occupational prophylaxis (nPEP) in Taiwan.Materials and MethodsWe conducted a prospective cohort observational study between March 2011 and May 2014. Three‐combined antiretroviral agents were prescribed for all the persons who sought for HIV post‐exposure prophylaxis after high risk sexual behaviour. HIV screening, health education and consultation were done before initiation of nPEP. Adverse effects were evaluated at Weeks 1, 2 and 4 and effectiveness was evaluated at Weeks 12 and 24. We also assessed adherence by pill count and regimen completion rates.ResultsDuring the study periods, 255 persons were enrolled. Among the enrolled cases, 43.9% (112/255) of them received zidovudine (AZT)‐based regimen while the others received tenofovir (TDF)‐based regimen and the third agent was composed of mostly lopinavir/ritonavir (81.4%). The completion rate of nPEP was 85.9% (219/255), and discontinuation rate of nPEP among AZT‐based regimen is higher than TDF‐based regimen (17.0% vs 8.2%). Any grade adverse effects are higher among AZT‐based regimen than TDF‐based regimen (62.5% vs 32.1%) although most adverse effects were grade 1–2. After a 24‐week follow‐up, only one person experienced HIV seroconversion and he had primary syphilis at the moment when he sought for nPEP.ConclusionsNPEP could be an effective prevention method in a part of HIV prevention strategy and TDF‐based regimen had better tolerability in Taiwan.