bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infections and cancer after ARV: a Portuguese cohort
Authors: Pereira N , Caldas C , Azevedo C , Andrade P , Serrão R , Sarmento A 
Published: November 2012

Background and purpose of the studyThe advent of antiretroviral therapy (ARV) resulted in a significant decrease in opportunistic infections; however these diseases still represent an important cause of morbidity and mortality. ARV also changed the spectrum of cancers presented by HIV patients as a result of immune recovery and increased life expectancy. We intend to describe the variety of infections and cancers, AIDS or non‐AIDS related, identified in our patients in the new era of ARV and also identify possible risk factors related to this conditions.MethodsAssessment and registry of infectious and neoplastic conditions occurring after initiation of ARV in a cohort of HIV‐infected patients who started ARV between January 2007 and December 2011. We included records of these conditions until March 2012. Epidemiological, clinical and laboratory data were analyzed and compared with a control group of HIV‐infected patients that started ARV in the same period but did not experience those comorbidities. Patients lost to follow‐up were excluded. Statistical significance of the differences encountered was evaluated with T‐student test and chi‐square; differences were considered statistically significant when p<0.05.Results497 patients were included (71.0% were men) with a mean age of 43.4±12.5 years and average follow‐up of 30.9±16.8 months. In the analyzed period there were 112 events in 91 patients: 85 infections and 27 cancers. The most common infectious condition was tuberculosis (n=13) and the most common cancer was non‐Hodgkin's lymphoma (n=8). The interval between the introduction of ARV and the onset of these conditions was 15.1 months (min: 0.03, max: 57.40). We identified 22 deaths: 11 were result of infection and 11 from cancer. Statistically significant differences between the groups compared were identified in the following variables: risk factor for HIV infection, co‐infection with hepatitis B, clinical stage, viral load and CD4 T lymphocyte count before the beginning of ARV.ConclusionsWe identified a substantial number of infections and cancers in our cohort, with tuberculosis and lymphomas continuing to be particularly noteworthy. Patients who had these conditions initiated ART with more severe immunosuppression and higher viral load which reinforces the importance to establish a prompt diagnosis which enables an efficient treatment and low morbidity associated with infections and cancers, particularly those related to AIDS.
cART prescription trends in a prospective HIV cohort in rural Tanzania from 2007 to 2011
Authors: Franzeck F , Letang E , Mwaigomole G , Jullu B , Glass T , Nyogea D , Hatz C , Tanner M , Battegay M 
Published: November 2012

Comprehensive information on combined antiretroviral therapy (cART) regimens in rural Sub‐Saharan Africa over time is scarce, particularly on the use of stavudine (d4T) and second‐line regimens. Since 2010, World Health Organization (WHO) guidelines discourage using stavudine in first‐line regimens due to frequent and severe side‐effects. This study examined the practical adaption of this phasing‐out and described trends in use of various cART combinations in a rural Tanzanian setting. We analyzed longitudinal, prospectively collected data of HIV‐1‐infected adults initiating cART within the Kilombero Ulanga Antiretroviral Cohort (KIULARCO) in Ifakara, Tanzania from 2007–2011. This analysis included data of 3068 patients over a 5‐year period. Of these subjects, 1997 (66.9%) were female, median age was 37 (interquartile range [IQR] 31–44) years and median CD4 cell count at enrollment was 178 cells/µl (IQR 88‐291). The percentage of prescriptions containing stavudine in initial regimens (Table 1) fell from a peak of 75% in 2008 to 12.2% in 2011 (p for trend<0.001). TDF/FTC/EFV became available in 2009 and was used in 117 (41.6%) patients initiating cART in 2011. An overall on‐treatment analysis (Figure 1) revealed that d4T/3TC/NVP and AZT/3TC/EFV were the most prescribed combinations in each year, including 2011 (684 [32.5%] and 642 [30.5%] patients respectively). Of those on d4T/3TC/NVP in 2011, 632 (92.4%) were initiated in earlier years. The ratio of second‐line to total regimens remained stable over time (p for trend=0.19) with a maximum of 34 (1.2%) patients in 2011, whereof 32 (94.1%) received a combination of ABC/ddI/LPVr.Overall on‐treatment count of patients on cART combinations by year.image

Initial cART combinations prescribed by year.

2007
2008
2009
2010
2011

d4T/3TC/NVP
426 (66.6%) 536
536 (71.2%)
362 (46.8%)
93 (19.4%)
52 (12.2%)

d4T/3TC/EFV
25 (3.9%)
29 (3.8%)
25 (3.2%)
6 (1.2%)
0 (0%)

AZT/3TC/EFV
177 (27.7%)
174 (23.1%)
324 (41.9%)
160 (33.4%)
138 (32.4%)

AZT/3TC/NVP
7 (1.1%)
10 (1.3%)
5 (0.6%)
21 (4.4%)
54 (12.7%)

TDF/FTC/EFV
2 (0.3%)
2 (0.2%)
57 (7.3%)
199 (41.5%)
177 (41.6%)

Total
639
752
773
479
425

Initial cART with stavudine declined to low levels according to recommendations but the overall use of stavudine remains substantial. The usage of second‐line treatment is unusually low in view of expected therapeutic failure rates, indicating potential difficulties in management of suspected treatment failure cases. Monitoring of prescription trends is a simple and feasible approach to identify deficits in the implementation of treatment guidelines for optimal outcomes.
Clinical manifestations and survival of HIV/AIDS‐infected patients, southern region of Thailand
Authors: Chaimay B , Woradet S , Chantutanon S , Phuntara S , Suwanna K 
Published: November 2012

ObjectiveThe purpose of this study was to determine magnitude of clinical manifestations on survival of HIV/AIDS patients.MethodsThe HIV/AIDS information system, a database containing demographic factors and clinical manifestations was used. A prospective, hospital‐based cohort study was conducted in HIV/AIDS patients registered in both provincial and community hospitals from 14 provinces in southern region of Thailand, between January 1993 and April 2010. Totally, 52,459 of HIV/AIDS patients were routinely observed and followed up. One‐fifth of the HIV/AIDS patients died (n=11,767, 22.43%) during the follow‐up period. The outcome was timed from diagnosis of HIV/AIDS infection to death. Cox's proportional hazard model was used to analyze the magnitude of clinical manifestations on survival of HIV/AIDS patients.ResultsA statistically significant corresponding risk of clinical manifestation on death was found. HIV/AIDS patients who had clinical manifestations including: invasive cervical cancer (HR=0.14, 95% CI: 0.44 to 0.43), herpes simplex (0.81, 0.66 to 0.98), histoplasmosis (0.67, 0.46 to 0.97), Mycobacterium other species (0.78, 0.64 to 0.97) were more likely to have a longer life. However, patients expressed clinical manifestations including; candidiasis (1.45, 1.34 to 1.56), cryptococcosis (1.77, 1.64 to 1.91), cytomegalovirus retinitis (1.58, 1.26 to 1.98), HIV encephalopathy (2.17, 1.92 to 2.47), Mycobacterium avium complex (1.76, 1.32 to 2.33) Mycobacterium tuberculosis (1.25, 1.21 to 1.30), pneumonia recurrent (1.78, 1.61 to 1.96), Pneumocystis carinii (1.71, 1.63 to 1.78), salmonella septicemia (1.85, 1.43 to 2.39) toxoplasmosis (1.47, 1.30 to 1.66) and wasting syndrome (2.13, 2.04 to 2.21) were more likely to die faster.ConclusionIn conclusion, HIV/AIDS patients expressed clinical manifestations which were a risk of death must be monitored closely and intensively care to extend their life and increase their quality of life.
Dynamics of Epstein‐Barr Virus DNA concentrations in whole blood of HIV‐1‐infected patients during primary HIV‐1 infection
Authors: Steingrover R , Bekker V , Beld M , Lange J , Wolthers K , Kuijpers T , Prins J 
Published: November 2012

IntroductionEpstein‐Barr virus (EBV) viraemia is associated with nasopharyngeal carcinoma and lymphoproliferative diseases. In HIV‐1 infection, persistent EBV viraemia is a common phenomenon. The underlying mechanism of these high EBV DNA loads has not been clarified. We studied EBV viraemia during primary HIV‐1 infection (PHI) to explore the mechanism of EBV viraemia in HIV‐1 infection.MethodsPatients with PHI, participating in Primo‐SHM study, a clinical trial with three study arms: no treatment, 24 weeks of combination antiretroviral therapy (cART) and 60 weeks of cART, were sampled longitudinally during PHI and 24 and 48 weeks thereafter. EBV DNA was assayed by PCR on stored samples of lysed whole blood.Results39 patients were tested, in 22 of whom EBV DNA was detected at one or more time points. All patients tested positive for anti‐VCA and anti‐EBNA antibodies, most patients that had EBV viraemia did not receive cART or interrupted cART. The prevalence of EBV viraemia at baseline was 29%, 18% and 33% for the untreated, 24 weeks cART and continuous cART groups. At week 48, these percentages were 38, 64 and 17 respectively (p < 0.05). Individual concentrations of EBV DNA for the three groups are shown in Figure 1.The Black lines show the individual log10 transformed EBV DNA concentrations in whole blood in patients that remained untreated (panel a), patients that were treated for 24 weeks with cART (panel b) and patients that were treated continuously with cART (Panel c).imageConclusionIntermittent EBV viraemia is highly prevalent in patients with PHI. Assuming that patients with very early HIV‐1 infection are still immunocompetent, this indicates that EBV viraemia is not caused by immunodeficiency. Antiretroviral therapy started during PHI but not later during chronic HIV infection might reduce the prevalence of EBV viraemia in HIV‐1 infection.
Evaluation of the HIV‐HCV co‐infection status in a cohort of southeastern of Spain
Authors: Moreno Hernández A , Smilg Nicolás C , Vera Méndez F , Martínez Madrid O , Jimeno Almazán A , Alcalde Encinas M , Alcaraz Vidal B , Trujillo Santos J , Tornel Sánchez G , Vega Cervantes J , Mozo Cuadrado M , Belmonte Martínez L 
Published: November 2012

Purpose of the studyTo know the main epidemiological, virological and therapeutic characteristics of HCV infection and the degree of hepatic fibrosis in a cohort of HIV‐HCV co‐infected patients in a health area of southeastern of Spain.MethodsProspective cohort of co‐infected HIV‐HCV patients followed in the University Hospital of Saint Lucia (Spain), which describes the main epidemiological characteristics, degree of liver fibrosis assessed by transient elastography and the level of response to treatment for HCV during the period November 30, 2011–February 28, 2012.Summary of resultsThe cohort included 109 patients, of whom 27 were females (25%) and 82 males (75%), with a mean age of 45.8 (SD: 6.2) years and a mean time of infection of 18.8 (SD: 5.7) years. The main route of transmission was in this order: IDUs in 90 patients (83%), 13 (12%) by heterosexual intercourse and 3 (2.8%) in MSM. There were no statistically significant differences between the years of evolution of HCV based on the route of transmission (p=0.36). In the genotypic analysis, 55 patients were genotype 1a (51%), 13 genotype 1b (13%), 19 genotype 3 (17%) and 9 genotype 4 (8.3%). The median HCV viral load was 868,000 IU/ml (6.15 log10). In this cohort 31 patients (28%) received antiviral therapy for HCV: 2 (1.8%) Interferon (INF) non‐pegylated, 3 (2.8%) INF non‐pegylated with Ribavirin (RBV) and 25 (23%) INF pegylated with RBV. In 6 cases (19%) were achieved sustained viral response (SVR). In the 25 cases without SVR (81%), 9 (36%) were partial responders, 7 (28%) null responders, 6 (24%) relapsers and 3 (12%) discontinued treatment due to problems of tolerability. In 108 patients were determined the degree of liver fibrosis by transient elastography: 48 patients (44%) had significant fibrosis (F3–F4;>9.5 kpascal) and 30 (28%) liver cirrhosis (F4;>14.5 kpascal). In patients with F4, 5 (17%) had values between 14.5–20 kpascal, 14 (47%) values between 21–40 kpascal and 11 (37%) values over 40 kpascal.ConclusionsIn our cohort, the gender predominant was male and the abuse of intravenous drugs was the main cause of HCV transmission. Most patients had genotype 1a, high viral load (>800,000 UI/mL) and a poor rate of SVR (19.3%), predominating the partial response rate among non‐responders. A high proportion of patients (28%) had liver cirrhosis (F4), of which, a significant proportion of subjects (37%) were at high risk of hepatic decompensation (>40 kpascal).
Hepatotoxicity of antiretrovirals in patients with human immunodeficiency virus and viral hepatitis coinfections
Authors: Parenti P , Marconi L , Lupo S 
Published: November 2012

BackgroundAntiretroviral drugs used to treat HIV may cause hepatotoxicity. The high prevalence of persons with chronic hepatitis B or C coinfected, raised aminotransferases have many causes and neither specific markers is a indicator of liver injury, difficulties in interpreting the hepatotoxicity.ObjectiveWe evaluated hepatotoxicity in HIV/HCV‐ and/or HBV‐coinfected patients, risk factors and severity.MethodsProspective study of HIV‐1 patients with start HAART in Hospital Provincial del Centenario from Rosario, Argentina. Patients were classified into two groups, HCV and/or HBV coinfected vs. no coinfected. The major endpoint was hepatotoxicity defined as Benichou's Score within the first 6 months. This score is among the few validated, but little used in clinical practice. Secondary endpoints were risk factors and severity of hepatotoxicity.Results140 patients were included, 39% coinfected and 61% no coinfected. Females were similar in both groups; 21% and 27% respectively. The hepatotoxicity within the first 6 month was 44.3%, 75% in coinfected patients and 25% in no‐coinfected. RR 3.97 (95% confidence interval 2.34–6.75, p<0.0001). The hepatotoxicity was associated with the use of illicit drugs and alcohol, symptoms, high level aminotransferases previous to HAART and NNRTI+PI. 3% of hepatotoxicity was severe.Conclusions44% of HIV patients experienced hepatotoxicity, 75% in coinfected vs 25% in no coinfected. The relative risk of hepatoxocity was almost 4 times higher among in chronic hepatitis‐coinfected patients, compared with those with HIV non‐coinfected. In multivariate analysis, the risk factors were illicit drugs, alcohol, symptoms, high level aminotransferases and NRTI+PI. Only 3% of hepatotoxicity was severe. The Benichou's Score is better than level of aminotransferase for evaluated hepatotoxicity, so it would be recommended for use in clinical practice.
HBV and neurological impairment in HIV‐infected patients
Authors: Manolescu L , Marinescu P 
Published: November 2012

ObjectiveHIV can affect CNS in early stages of disease and determine neurological impairment. HBV DNA was found in CSF of HIV co‐infected patients, but little is known about the neurotropic character of this virus. Here we assessed the degree of association between HBV infection and neurological impairment in a large cohort of long‐term survivors, HIV‐infected patients that experienced multiple therapeutic schemes over time.MethodsA total of 462 HIV‐1‐infected patients were retrospectively followed up for 10 years for HBV infection and neurological impairment. The patients were tested for immune (flow cytometry) and virological parameters of HIV infection (Roche Amplicor, version 1.5/ COBAS AmpliPrep/COBAS TaqMan HIV‐1 test) and for HBV infection markers (HBsAg, anti HBc: Murex Biotech ELISA tests). Many of these patients have experienced between one and six regimens such as: 2 NRTIs, 3 NRTIs, 2 NRTIs+1 NNRTI, 1 NRTI+1 NNRTI+1 PI, 2 NRTIs+2 PIs.ResultsAfter 10 years 29.87% of the patients presented neurological impairment. Out of them 56.52% were HBV‐infected. The prevalence of HIV encephalopathy (HE) in our studied cohort was 22.7% and 50.4% of these patients were HBV‐infected. The median HIV diagnosis age was 7 and the median age of HE diagnosis was 10. In order to establish a possible correlation between HBV infection and HE we first reviewed and excluded the main risk factors associated with HE at the moment of diagnosis: low weight, anemia, constitutional symptoms, low CD4+count, high plasma HIV‐RNA load. No patient was infected with HCV. The groups of patients that presented HE and HBsAg and HE without HBsAg were balanced regarding sex, number of deceased patients, number of class C3 patients, but the patients in first group presented lower CD4 values at HE diagnosis vs patients from second group 2: 44.5 vs 95 cells/µL, p=0.3; lower nadir CD4 count: 38 vs 51 cell/µL, p=0.1; and slightly higher HIV viral load: 5.2 vs 5 log10 copies/mL, p = 0.2. There were only 53 patients that presented at the same time HE and HBV infection and the majority, 78.69%, were first infected with HBV.ConclusionsIn our studied cohort HBV infection was associated with HE but further studies are needed to prove HBV neurotropic potential. Absolute CD4 nadir count and class C3 are proved to be strong predictors of HE in HIV‐infected patients even after several changes in antiretroviral therapy schemes.
Persistence and clearance of HPV infection at anal site in a cohort of HIV‐positive males
Authors: Comi L , Pandolfo A , Rovati M , Cicconi P , Bini T , Cassani B , Romagnoli S , Marchetti G , d'Arminio Monforte A 
Published: November 2012

We aimed to assess the persistence and clearance of HPV‐DNA at anal site in a cohort of HIV‐positive patients (pts) asymptomatic for sexually transmitted diseases (STD). Consecutive HIV‐pos males underwent anoscopy, and each anal sample was analyzed for HPV‐PCR detection/genotyping (high‐risk genotypes: HR‐HPV) and for cytologic abnormalities (Bethesda System 2001: low and high grade SIL, LSIL‐HSIL). Immune activation in peripheral blood (CD8/CD38+) was assessed by flow cytometry. Pts were re‐examined at a 12–18 months follow‐up visit. Comparisons were assessed by Mann‐Whitney and chi‐square test. Factors related to HPV persistence were identified by logistic regression. 105 HIV‐pos males were studied: 89 (84%) were MSM, 76 (72%) were on HAART, median age was 42 (IQR:34–47), median CD4 count of 500 cell/mmc (IQR:366–680). HPV‐DNA was detected in anal swabs from 96 (91.4%) pts, 77 of them (80%) harbored HR‐HPV; 46 were coinfected with>1 HR‐HPV. Most frequent genotypes were HPV‐16 (30%), HPV‐58 (25%). In a median follow up of 18 months (IQR 12–24), 83/96 (86.4%) pts showed persistent HPV infection, while 13 (13.5%) became negative; conversely, 6 (5%) pts, HPV‐negative at baseline, acquired HPV infection. Younger pts and those with a shorter duration of HIV infection showed a higher prevalence of HPV persistence (Table). Conversely being on HAART and a longer duration of therapy were associated to viral clearance. Interestingly, pts with persistent HPV infection showed an activated immune profile at baseline, with significantly higher CD8+CD38+%. In the multivariate analysis only SIL at baseline (AOR 4.11, 95% CI 0.89–18.9, p=.06), being MSM (AOR 5.11, 95% CI 0.87–29.8, p=.06) and higher CD8+CD38+% (AOR 1.93, 95% CI 0.88–4.24, p=.09) were borderline associated with persistent anal HPV infection. Our results confirm a higher prevalence and persistence of anal HPV infection in HIV‐positive males; HIV‐pos pts with anal HPV infection should be thus strictly followed‐up for the early detection of pre‐cancerous lesions.

Table Demographic characteristics of study population at baseline according to persistence of HPV infection

Characteristics at baseline
HPV+ pts that become negative at follow‐up (n=13)
HPV+ pts that remain positive at follow‐up (n=83)
p

Age*
48 (42–60)
41 (33–46)
0.008

MSM°
9 (69%)
74 (89%)
0.071

HAART°
13 (100%)
57 (68%)
0.017

HAART duration (mths)*
121 (41.5–180)
46 (21.25–119.3)
0.030

HIV duration (mths)*
125 (56–202)
43 (22–130)
0.007

CD4+T cells/mmc*
525 (407–656)
500 (362–680)
0.59

Nadir CD4+T cells/mmc*
285 (173–403.5)
300 (163–396)
0.99

CD8+T cells/mmc*
846 (638–1008)
884 (748–1060)
0.26

HIV‐RNA cp/mL*
59 (39–59)
59 (39–16967)
0.15

CD8+CD37+%
1 (1–1)
2 (1–4)
0.003

Dysplasia
3 (23%)
52 (62.6%)
0.011

HR‐HPV°
8 (61.5%)
69 (83%)
0.12

Follow‐up duration (mths)*
18 (12.5–30)
18 (12–24)
0.58

Data are presented as the median (IQ R); °Data are presented as the number (percentage).
Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of north america cohort of rheumatoid arthritis patients
Authors: Jawaheer Damini , Messing Susan , Reed George , Ranganath Veena K. , Kremer Joel M. , Louie James S. , Khanna Dinesh , Greenberg Jeffrey D. , Furst Daniel E. 
Published: November 2012

AbstractObjectiveTo determine whether men with rheumatoid arthritis (RA) are more likely to achieve remission compared to women.MethodsRA patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) cohort between October 2001 and January 2010 were selected for the present analyses. Detailed clinical, demographic, and drug utilization data were available at enrollment (baseline) and at subsequent followup visits. We examined the influence of sex on the Clinical Disease Activity Index remission score (≤2.8) using sustained remission or point remission as the primary outcome measure in multivariate stepwise logistic regression models. We stratified the data by RA duration at baseline (≤2 years or >2 years) to investigate whether RA duration had differential effects on remission in men and women.ResultsA total of 10,299 RA patients (2,406 men and 7,893 women) were available for this study. In both early and established RA, women had more severe disease at baseline with worse disease activity measures, modified Health Assessment Questionnaire disability index score, pain on a visual analog scale, and depression. Women were also more likely to have been treated with disease‐modifying antirheumatic drugs and anti–tumor necrosis factor therapy compared to men. In the regression models, male sex was associated with sustained remission in early RA (odds ratio [OR] 1.38, 95% confidence interval [95% CI] 1.07–1.78, P = 0.01), but not in established RA. However, for point remission, an inverse association was observed with male sex in established RA (OR 0.65, 95% CI 0.48–0.87, P = 0.005) and not in early RA.ConclusionWithin the large real‐life CORRONA cohort of RA patients, men were more likely to achieve sustained remission compared to women in early RA, although not in established RA.