bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of mother‐to‐child transmission: experience of a Portuguese centre
Authors: Piñeiro Carmela , Fernandes Sofia , Figueiredo Cristóvão , Sofia Santos Ana , Moucho Marina , Serrão Rosário , Montenegro Nuno , Sarmento António 
Published: November 2014

IntroductionHIV infection during pregnancy still raises controversial issues. Combined antiretroviral therapy (cART) has been successful in reducing mother‐to‐child transmission (MTCT). Routine screening in pregnancy and in pre‐conception consultation proved to be one of the best methods able to get this treatment on time. We review our experience with pregnant patients with HIV infection.Materials and MethodsRetrospective and descriptive study. Data obtained from HIV‐infected pregnant women from 1999 to 2012 with delivery and subsequent infectious diseases follow‐up at our hospital.ResultsWe evaluated 136 patients (169 pregnancies), with a total of 147 living newborns (2 twin pregnancies) and 1 stillbirth. Median age at pregnancy was 30 (SD 5.7) years. Four patients were HIV‐2 infected and one HIV‐1+2 infected. 26 (19.1%) women were HCV co‐infected and 6 (4.4%) HBV co‐infected; 1 patient has HCV and HBV co‐infection. Sexual risk for HIV acquisition was determined in 102 (75%) patients and 31 (22.8%) were intravenous drug users. 33/136 (24.2%) women were diagnosed on routine screening in pregnancy, 4 during delivery and 2 immediately after delivery. 36 (26.4%) patients had an AIDS‐defining entity before pregnancy and no new opportunistic infections were diagnosed. ART was used in 157 (92.9%) pregnancies and 15 (9.5%) of them were treated only with NRTIs. At the time of delivery 86/144 (59.7%) patients had undetectable viral load (VL) (25 patients without VL determined), 91.7% of those on ART. 119 (70.4%) had a TCD4 cell count above 200 cells/mm3. MTCT occurred in 3/147 cases (2%): in one mother HIV‐1 infection was diagnosed three weeks before delivery, other immediately after delivery and the third woman started cART (2NRTI+1PI/r) in the second trimester of pregnancy, always adherent and without secondary effects, VL at delivery was 50 copies/mL and elective C‐section was performed.ConclusionsThe fact that 24% of patients were diagnosed during pregnancy shows the importance of routine screening to all pregnant women. MTCT occurred in three children, but only one was administered cART for prevention.
A comparison of inpatient admissions in 2012 from two European countries
Authors: Tittle Victoria , Cenderello Giovanni , Pasa Ambra , Patel Preya , Artioli Stefania , Dentone Chiara , Fraccaro Paolo , Giacomini Mauro , Setti Maurizio , Di Biagio Antonio , Nelson Mark 
Published: November 2014

IntroductionThis study compares the trends of HIV inpatient admissions between a London tertiary HIV centre (United Kingdom) and four infectious disease wards in Italy (IT) to recognize common patterns across Europe.MethodsData regarding HIV inpatient admissions was collected by using discharge diagnostic codes from 1 January to 31 December 2012, including patient demographics, combined antiretroviral therapy (cART) history, CD4, viral load (VL) and mortality rates. Discharge diagnoses were categorized according to the International Classification of Disease (ICD) 9 and 10 system. All ICD categories that reach a 3% threshold of total admissions were analyzed.ResultsA total of 731 admissions (257 in Italy and 474 in the United Kingdom) for 521 patients (1.5 mean admission per patient). Female admissions were higher in Italy at 22.6% (n=58) compared to 14.9% (n=47) in the United Kingdom. Median age of patients was 47 years old. There was an undetectable VL in 65.8% (n=169) of admissions in Italy and 67.1% (n=319) in the United Kingdom (p=0.385); 86.4% (n=222) and 82.4% (n=389) of admissions were on cART, respectively. Mean CD4 was 302 in Italy compared to 368 in the United Kingdom (p=0.003). Average length of admission was 16 days with a 10.2% (n=21) mortality rate in Italy compared to 8 days with 2.8% (n=9) mortality in the United Kingdom (p<0.001). HCV co‐infection was present in 64.6% (n=166) in Italy and 13.5% (n=64) in the United Kingdom and commonest mode of transmission was needle use in Italy (67.3%, n=173) and men who have sex with men in the UK cohort (59.9%, n=284). The cause of inpatient admissions according to ICD codes can be seen in following Figure 1.ConclusionsSignificant differences in the duration of inpatient admission and mortality rates can be observed between these two cohorts which is secondary to the impact of Hepatitis C co‐infection in Italy. However increases in the number of Hepatitis C co‐infection patients amongst MSM in London has been reported [1] and route of transmission in Italy is shifting towards MSM [2], therefore it is important to learn how HIV is developing and managed in a global context to help plan future for services. The UK cohort demonstrates a wider range of conditions necessitating admission, and with an ageing HIV population, this is expected to increase in the future, requiring general and specialist HIV physicians to work closely together. The HIV‐RNA threshold is 400 copies/mL to account for blips according to British HIV Association (BHIVA) Guidelines 2012 [3].
The CD4:CD8 ratio is associated with IMT progression in HIV‐infected patients on antiretroviral treatment
Authors: Bernal Enrique , Serrano Jose , Perez Ana , Valero Salvador , Garcia Eva , Marín Irene , Muñoz Angeles , Miguel Gomez Verdú Jose , Vera Carmen , Cano Alfredo 
Published: November 2014

IntroductionInversion of the CD4:CD8 ratio (<1) has been identified as a hallmark of immunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and intima‐media thickness (IMT) progression in treated HIV‐infected patients as a marker of early atherosclerosis.Materials and MethodsA longitudinal study during three years was conducted in 120 HIV‐infected patients receiving antiretroviral treatment (ART). We analyzed the associations between the CD4:CD8 ratio, cardiovascular risk factor and antiretroviral (ARV) treatment and progression of subclinical atherosclerosis assessed using carotid IMT at baseline and after three years.ResultsFinally, 96 patients completed the study. Seventy‐six (79.1%) patients were male, aged 44±10 years, 39 (40.6%) were on treatment with Protease inhibitors, 49 (51.04%) with non‐nucleoside reverse transcriptase inhibitors (NNRTI), 6 (6.25%) with integrase inhibitors, 3 (3.12%) with maraviroc and 2 (2.08%) only with nucleoside reverse transcriptase inhibitors (NRTI). The mean of ARV exposition was 6.9±5.9 years. Twenty six (27 %) patients had family history of ischemic heart disease, 51 (53.12%) were smokers, 12 (12.5%) hypertensive, 4 (4.16%) type 2 diabetes, 23 (23.9%) with dyslipidemia and 31 (32.3%) were infected with C hepatitis virus. Baseline IMT was significantly associated with age (rho=0.497; p<0.001), basal glucemia (rho=0.323; p=0.001), triglycerides (rho=0.232; p=0.023), Framingham score (rho=0.324; p=0.001), CD4:CD8 ratio (rho=−0.176; p=0.05) and dyslipidemia (0.72±0.16 mm vs 0.63±0.11 mm; p=0.029). In multivariable analysis where cardiovascular risk factor and ARV were included, IMT progression was inversely associated with CD4:CD8 ratio (OR=0.283; CI 95% 0.099–0.809; p=0.019) and treatment with NNRTI (OR=0.283; CI 95% 0.099–0.809; p=0.019).ConclusionsThe inversion of CD4:CD8 ratio in treated HIV‐infected patients is independently associated with IMT progression, a marker of age‐associated disease. Therefore, it might be clinically useful as predictor of cardiovascular events. Surprisingly, there was a positive correlation between receiving NNRTI and progression of IMT.
Acceptability of PrEP among HIV negative Portuguese men who have sex with men that attended 2014 Lisbon pride fair
Authors: Miguel Rocha Luís , José Campos Maria , Brito João , Fuertes Ricardo , Rojas Jesus , Pinto Nuno , Mendão Luís , Esteves Julio 
Published: November 2014

IntroductionConsistent use of PrEP reduces HIV transmission from sexual practices amongst men who have sex with men (MSM) up to 92% [1]. Lisbon MSM cohort study estimates point that 59.3% of their participants at entrance (1593 HIV negative MSM enrolled between April 2011 and May 2013) were eligible for PrEP [2], according to the 2014 USA PrEP guidelines [3]. Studies about PrEP acceptability and implementation support policies aimed at increasing and rolling out its use. Hence, the exploratory study about PrEP acceptability in MSM at Lisbon.Materials and MethodsA street‐based intercept survey, adapted from Mantell et al. study [4], was the one used on MSM attending the 2014 Lisbon pride fair. The survey included socio‐demographic data, PrEP awareness and readiness to use it, probability of MSM's social network to also use it, promptness to join PrEP‐related studies, type of PrEP warranted and condomless anal sex practice in the last six months.ResultsA total of 110 HIV negative Portuguese MSM responded, with a median age of 33% and 84% of them identified themselves as gay. A majority of MSM were unaware of PrEP (59%); those that were aware, had heard of it trough CheckpointLx (31%), internet (22%) or health professionals (20%). 66% were likely or very likely to participate in PrEP‐related studies. 57% of MSM were likely or very likely to use PrEP if available and reported that some, if not almost all of their social network, will do it too (70%). Type of PrEP preferred was oral, a pill a day (43%), followed by oral, intermittent intake (32%). Overall 41% of MSM had condomless anal sex practice in the last six months.ConclusionsIn this MSM Portuguese sample, a general willingness to adopt PrEP was predominant, specially the oral daily intake. Forty‐one percent of participants had had condomless anal sex practice in the last six months and therefore fitted within the criteria to be on Pre‐Exposure Prophylaxis (PrEP), according to MSM Risk Index in 2014 USA PrEP guidelines. PrEP, when available in Portugal, should be a powerful tool for HIV prevention in this key population.
HIV‐1 group O integrase displays lower susceptibility to raltegravir and has a different mutational pathway for resistance than HIV‐1 group M
Authors: Depatureaux Agnès , Mesplède Thibault , Quashie Peter , Oliveira Maureen , Moisi Daniela , Brenner Bluma , Wainberg Mark 
Published: November 2014

IntroductionHIV‐1 group O (HIV‐O) is a rare HIV‐1 variant characterized by a high number of polymorphisms, especially in the integrase gene, e.g. positions L74I, S153A, G163Q and T206S. As HIV‐O integrase enzymes have not previously been studied, our aim was to assess the impact of HIV‐O integrase polymorphisms on susceptibility to integrase inhibitors and emergence of resistance associated mutations.Viruses and MethodsWe cloned and purified integrase proteins from each of HIV‐1 Group O clades A (HIV‐O/A) and B (HIV‐O/B), a HIV‐O divergent strain (HIV‐O/Div), and HIV‐1 group M (subtype B, HIV‐M/B) and characterized these enzymes for susceptibility to integrase strand transfer inhibitors (INSTIs) in cell‐free assays and in tissue culture, in the absence or presence of varying concentrations of several INSTIs. The inhibition constant (Ki) and IC50 were calculated and compared for HIV‐M and HIV‐O integrases. Selections for resistance‐related mutations were performed using cord blood mononuclear cells and increasing concentration of INSTIs.ResultsHIV‐O integrase and viruses were more susceptible to raltegravir (RAL) in competitive inhibition assays and in tissue culture than were HIV‐M enzymes and viruses, respectively. During selection, we observed different pathways of resistance depending on the drug and clade. Mutations selected in HIV‐O can be classified as follows: (1) mutations described for HIV‐M such as T97A, Q148R, V151A/I (RAL), T66I, E92Q, E157Q (EVG) and M50I, R263K (DTG) and (2) signature mutations for HIV‐O (i.e. not described in HIV‐M) F121C (HIV‐O/B for RAL), V75I (HIV‐O/A for RAL) and S153V (HIV‐O/A for DTG). Only the HIV‐O/Div selected the Q148R mutation for RAL and R263K+M50I for DTG, as previously described for HIV‐M. None of the HIV‐O viruses selected either N155H or Y143C. The selection of the specific S153V mutation could be explained at the nucleotide level: HIV‐O at this position contains an alanine and substitution of alanine to valine (153AGGC→153VGTC) is easier than substitution of alanine to tyrosine (153AGGC→153YTAC), with only a transversion needed instead of one transition plus one transversion.ConclusionsThis is the first report of susceptibility and resistance in vitro to INSTIs for HIV‐O. Our study confirmed the impact of HIV‐O polymorphism, on susceptibility to INSTIs and the emergence of resistance mutations.
Seroincidence of HIV and prevalence of transmitted drug resistance of HIV‐1 strains among persons seeking voluntary counselling and testing in Taiwan
Authors: Liu Wen‐Chun , Chang Lan‐Hsin , Wu Pei‐Ying , Luo Yu‐Zhen , Wu Cheng‐Hsin , Su Yi‐Ching , Lai Chung‐Chi , Chang Sui‐Yuan , Hung Chien‐Ching 
Published: November 2014

IntroductionThe total case number of persons who are newly diagnosed with HIV continues to increase in Taiwan and men who have sex with men (MSM) have re‐emerged as the leading risk group for HIV transmission. In this study, we aimed to estimate the incidence rate of HIV infection among those individuals who sought voluntary counselling and testing (VCT) service at a university hospital.MethodsBetween 1 April, 2006 and 31 December, 2013, 18,246 tests for HIV antibody were performed among 12143 individuals at the VCT service. A total of 2157 individuals who tested negative for anti‐HIV antibody had subsequent follow‐up tests at the same VCT service, which composed the study population for estimation of incidence rate of recent HIV infection. The BED assays were used to identify recent HIV infections that occurred within the previous six months before seeking VCT service.ResultsDuring the 6.5‐year study period, 647 individuals were diagnosed as being HIV‐positive, with an overall HIV seroprevalence of 3.55% (95% CI 3.27–3.82). The overall incidence rate of HIV infection was estimated 4.13 per 100 person‐years of follow‐up (95% CI 3.67–4.69 per 100 person‐years of follow‐up). MSM had an estimated 10‐fold higher seroprevalence and seroincidence of HIV than heterosexuals. Of 647 clients testing positive for HIV, 603 clients were MSM (93.2%) and 477 patients (70.8%) subsequently sought HIV care at the hospital; 226 (47.4%) were diagnosed as having recent HIV infections by the BED assay, while 244 (51.2%) long‐term infection and 7 without data by the BED assay. Of those patients, 173 (75.6%) and 178 patients (73.0%) with recent HIV infection and long‐term infection had data of transmitted drug resistance mutations, respectively. The prevalence of transmitted drug resistance mutations to any class of antiretroviral therapy was 9.0% and 10.6% (p=0.68), respectively, of the HIV‐1 strains from the patients with recent HIV infection and long‐term infection, respectively.ConclusionsThe seroincidence rate of HIV among persons seeking VCT was estimated 4.13 per 100 person‐years of follow‐up. The prevalence of transmitted drug resistance to any class of antiretroviral agents was similar between those who were recently infected with HIV and those who had long‐term infection in Taiwan.
Lamivudine monotherapy as a safe option for HIV‐infected paediatric clients with adherence challenges: new evidence from a large South African cohort
Authors: Linder Verena , Goldswain Cheree , Boon Gerald , Carty Craig , Jackson Valerie , Harper Kim , Lambert John 
Published: November 2014

IntroductionHIV‐infected children in resource‐poor settings comprise a unique population who require antiretroviral therapy (ART) in careful consideration of social and structural barriers to compliance. Given these aggregate challenges and emerging research into “holding” treatment options, we investigated the efficacy of lamivudine monotherapy (LM) as an alternative to more complex second and third line therapies.MethodsA retrospective review of all eligible LM events (=6 months) from a cohort of two linked health facilities in the Eastern Cape Province, South Africa was undertaken. Events were disaggregated according to absolute CD4 count at initiation (Group 1: >200 cells/L, n=64; Group 2:=200cells/L, n=10). Study endpoints were defined as a decline of absolute CD4=200 cells/L (Group 1), WHO stage 3 or 4 event (Groups 1& 2), or initiation of second or third line (Groups 1 & 2).ResultsSeventy‐four eligible LM events were identified among 71 HIV‐positive children (58% male; median age at LM 9.7 years and median LM duration 11.5 months). CD4 decreases and measured WHO stage 3 or 4 events did not yield overall significance between groups (Table 1). No deaths were recorded.ConclusionsLM offers a promising alternative approach to ART management in young patients with an absolute CD4 >200 cells/L pending availability and/or willingness to adhere to second or third line therapies. In more immunocompromised children, LM may be considered as a last option if either the child or caretaker has concerns about second or third line management, or has defaulted repeatedly.
Time on drug analysis based on real life data
Authors: Schülter Eugen , Kaiser Rolf , Zazzi Maurizio , Sönnerborg Anders , Camacho Ricardo , Verheyen Jens 
Published: November 2014

IntroductionThe health condition of HIV‐1 infected patients has improved during the last years, but lifelong antiretroviral treatment is still needed. However resistance, multiple side effects and drug to drug interactions of antiretrovirals challenge the establishment of a long lasting regimen. The average running time of each antiretroviral drug composing the therapy episodes combination antiretroviral therapy (cART) may be seen as an indicator of effectiveness and tolerability.Materials and MethodsTo evaluate the running time of each drug used in HIV‐1 treatment, we extracted therapy episodes from the latest release of the EuResist database (www.euresist.org). The evaluation period was from Oct 2006 to Oct 2012. Inclusion criteria for this analysis were continuous patient monitoring for at least two years (i.e. latest therapy start in Oct 2010), and the extraction of at least 100 cases per drug analyzed. Drug intake interruptions of less than a month were ignored.ResultsAt the time of data extraction (Feb 2013), the EuResist database contained data from 61,953 patients of which 11,499 fulfilled the inclusion criteria. We obtained 37,035 drug treatment lines from 38,153 cARTs and the overall average length of drug intake was 18.7 months. For each single drug these average durations measured in months were: 18.3 (3TC); 20.8 (ABC); 12.3 (d4T); 14.3 (ddI); 23.2 (FTC); 23.0 (TDF); 13.4 (ZDV); 19.8 (EFV); 21.9 (ETR); 17.7 (NVP); 19.2 (ATV); 22.7 (DRV); 18.7 (FPV); 17.9 (LPV); 15.2 (SQV); 14.6 (TPV); 22.6 (RAL); 21.9 (MVC) and 8.9 (T20). Overall drug discontinuation rates at one, two and three years were 35.0, 48.8 and 95.8%, respectively. Average discontinuation rates for the different drug classes at two years these were: 46.2% for NRTIs; 49.7% for NNRTIs; 55.4% for PIs and 37.6% for Raltegravir/Maraviroc.ConclusionsIn this cohort the overall frequency of therapy changes is high. After two years of treatment, on average 49% of the patients change at least one drug in their cART. Thus, we have to expect numerous changes in the long term perspective of treatments. The observed differences in durations suggest that newer drugs might have advantages over older ones. However possible reasons and confounding factors (such as number of past treatment lines, co‐medication, risk group, etc.) were not addressed at this time of the analysis.
Durability of first antiretroviral treatment in HIV chronically infected patients: why change and what are the outcomes?
Authors: Moniz Patricia , Alçada Filipa , Peres Susana , Borges Fernando , Baptista Teresa , Claudia Miranda Ana , Antunes Isabel , Aldir Isabel , Ventura Fernando , Nina Jaime , Mansinho Kamal 
Published: November 2014

IntroductionFirst antiretroviral therapy (ART) is often switched to simpler, more potent or better tolerated regimens [1, 2]. Although discontinuation rates are frequently studied, the durability of regimens is rarely approached.Materials and MethodsRetrospective study with the following objectives: analyze first ART schemes and their durability in naive patients with chronic HIV‐1 and 2 infections, evaluate factors influencing ART change, second‐line ART and consequent virologic and immunologic responses. Patients had follow‐ups in a Central University Hospital, started ART between January 2007 and December 2012 and changed first regimens. Clinical data was obtained from medical records and analyzed using the Statistical Package for the Social Sciences (version 20).ResultsOf the 652 naive patients who started ART, 164 changed regimens. The majority had HIV‐1 infection (n=158). The mean age was 43.9 years (standard deviation±14.3), with a male predominance of 57.9%. Regimens with efavirenz were the most common amongst HIV‐1 patients (50%) followed by lopinavir/r (22%). In HIV‐2 patients, lopinavir/r (n=3) regimens were most prevalent. First ART regimens had a mean duration of 12.1 months. There was no difference between NNRTI (59.8%) and protease inhibitor (40.2%) schemes regarding durability. Adverse reactions were the major cause of ART switching (55.5%) followed by therapy resistance (12.1%). Age was inversely related to durability (p=0.007 Mann‐Whitney, Phi coefficient −0.161) and associated with the appearance of adverse reactions (p=0.04, Chi‐square). Younger patients had a reduced risk of adverse reactions by 27%. Adverse reactions increased the risk of inferior durability by 40%. Psychiatric symptoms (28.4%) were the most prevalent, all attributed to efavirenz. The year of ART initiation was associated with different durability rates (p=0.005, Mann‐Whitney). Patients started on ART before the year 2010 reduced the probability of inferior ART duration by 25.8%. After second‐line ART regimens, TCD4+ counts>500 cell/µL were increased by 38% and favourable virologic outcome achieved in 84%.ConclusionsAdverse reactions were the main cause for ART switching, supporting a cautious approach when initiating regimens, particularly in older patients. All ART naive patients who changed initial therapy had favourable immunological and virologic responses.