bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute hepatitis C virus (HCV) infection in the setting of HIV coinfection: a single‐centre 10‐year follow‐up
Authors: Ingiliz Patrick , Steininger Katharina , Schuetze Marcel , Dupke Stephan , Carganico Andreas , Krznaric Ivanka , Wienbreyer Andreas , Baumgarten Axel 
Published: November 2014

IntroductionAcute hepatitis C virus (HCV) infection has emerged as a major cause of morbidity in the HIV‐infected population. Most guidelines recommend early treatment with pegylated interferon and ribavirin due to higher cure rates. The impact of acute HCV and its treatment on the outcome of the HIV‐infected population is unknown. With new treatment options for HCV, early treatment of acute HCV has to be questioned. Here, we report a long‐term analysis on patients with acute HCV.MethodsRetrospective analysis from an outpatient clinic from Berlin. All patients with the diagnosis of acute HCV according to The European AIDS Treatment Network (NEAT) criteria were included in the database at their date of HCV diagnosis and followed‐up until the last medical contact. Demographic data was taken from the medical file. A fibrosis estimation was performed using transient elastography (Fibroscan(®). A Fibroscan value above 7 kPa was considered as significant fibrosis, above 12.4 kPa as liver cirrhosis. The following outcomes were documented: (a) liver‐related: hepatic decompensation, cirrhosis, hepatocellular carcinoma. (b) non‐liver‐related: death, myocardial infarction, AIDS‐defining event, psychiatric hospitalisation.ResultsA total of 207 cases of acute HCV infection in HIV‐infected patients were diagnosed between May 2002 and September 2013. All patients were male and declared homosexual contacts as their risk factor for having acquired HIV. The mean age was 39 years, 162 patients (78%) were on antiretroviral treatment, and the median CD4 cell count was 593/mm3 (IQR 443–749). At HCV diagnosis, the highest median alanine aminotransferase (ALT) level was 408 IU/mL (159–871), the HCV viral load was 800,000 IU/mL (45x103–2.8x106). 22 cases (11%) cleared their infection spontaneously, 161 (77%) underwent interferon‐based treatment. Of those treated, 58% had a sustained virological response. 36 cases of HCV reinfection were documented. All patients were followed‐up over an interval of 806 patient‐years. The median liver stiffness was 5.3 kPa (4–7) after a median interval of 34 months. 33 patients developed significant fibrosis, and 11 patients (6%) developed cirrhosis. Nine (5%) patients died during follow‐up, and 11 developed non‐liver‐related endpoints. All but one deceased patients had interferon‐based treatment.ConclusionsSevere hepatic disease and death rarely occurs in a highly treated HCV population. As interferon‐based treatment may induce side effects, it is from now on justified to await new HCV treatment options.
Central nervous system penetration‐effectiveness rank does not reliably predict neurocognitive impairment in HIV‐infected individuals
Authors: Libertone Raffaella , Lorenzini Patrizia , Balestra Pietro , Pinnetti Carmela , Ricottini Martina , Maddalena Plazzi Maria , Menichetti Samanta , Zaccarelli Mauro , Nicastri Emanuele , Bellagamba Rita , Ammassari Adriana , Antinori Andrea 
Published: November 2014

IntroductionCentral nervous system (CNS) penetration‐effectiveness (CPE) rank was proposed in 2008 as an estimate of penetration of ARV regimen into the CNS, and validated as predictor of CSF HIV‐1 replication. Results on predictive role of CPE on neurocognitive and clinical outcome were conflicting.Materials and MethodsRetrospective, cross‐sectional analysis of neurocognitive profile in HIV‐infected cART‐treated patients. All patients underwent neuropsychological (NP) assessment by standardized battery of 14 tests on 5 different domains. People were classified as having NCI if they scored >1 standard deviation (SD) below the normal mean in at least two tests, or >2 SD below in one test. Linear and logistic regression analyses were fitted using as outcome Npz8 and impaired/not impaired respectively.ResultsA total of 660 HIV‐infected cART‐treated individuals from 2009 to 2014, contributing a total of 1003 tests (mean age 49 (IQR 43–56), male 82%; median current CD4 586/mm3; 18% HCV infected; HIV‐RNA <40 cp/mL in 84%). Current ARV regimen was 2NRTIs+1NNRTI 50.3%, 2NRTI+1PI/r in 32.6%, NRTI sparing in 11.1%. Mean CPE of current regimens was 6.6 (95% CI 6.5–6.7). As per test multivariable analysis, higher CPE values were associated to poor NP tasks (Beta=−0,09; 95% CI −0,14 −0,03; p=0.002 at multivariable linear regression). The association between higher CPE and increased NCI risk was confirmed at multivariable logistic regression, with a 1.24‐fold risk of NCI occurrence for each point increase of CPE of current regimen at the time of NP testing (see Table 1). In a sensitivity analysis performed only on patients at the first NP test, the association between higher CPE and poor NP tasks and enhanced NCI risk was only marginally confirmed (Beta=−0,05; [−0,12–0,02]; p=0,19; OR 1,13 [0,95–1,34]; p=0.17). Older age, longer time from HIV diagnosis, current CD4 count <350 cell/mm3 and lower education level were all associated to an increased risk of NCI.ConclusionsIn our analysis, higher CPE rank is associated to poorly performing at NP tasking. Even if selection bias could not be excluded due to retrospective cross‐sectional design, these results fitted with the direct correlation between high CPE and HIV dementia recently recorded in a large observational database. We think that CPE use to guide ART in patients neurocognitively impaired should be revised.
APRI and FIB‐4 scores are not associated with neurocognitive impairment in HIV‐infected persons
Authors: Libertone Raffaella , Balestra Pietro , Lorenzini Patrizia , Pinnetti Carmela , Ricottini Martina , Menichetti Samanta , Maddalena Plazzi Maria , Giannetti Alberto , Tozzi Valerio , Antinori Andrea , Ammassari Adriana 
Published: November 2014

IntroductionChronic liver disease leads to neurocognitive impairment (NCI) and more advanced liver fibrosis is associated with greater deficits. Further, cognitive performances do not differ significantly among patients affected by diverse types of chronic liver diseases. Thus, it would be useful to have a clinical tool associated with early cognitive change applicable to the HIV‐infected population with high HCV prevalence. Aim of the analysis was to assess the association between NCI and aspartate aminotransferase‐platelet ratio index (APRI) or Fibrosis‐4, which are non‐invasive scores used to assess liver fibrosis.Materials and MethodsSingle‐centre, retrospective, cross‐sectional analysis of cART‐treated HIV‐infected patients undergoing neuropsychological assessment (NPA) by a set of 14 standardized and comprehensive tests on five different domains: concentration and speed of mental processing; mental flexibility; memory, fine motor functioning; visual‐spatial and constructional abilities. NPA obtained from the same patient were included, if collected while receiving different cART. Patients were classified as having NCI, if they scored >1 SD below the normative mean in at least two tests, or below >2 SD in one test. HIV‐associated neurocognitive disorders (HAND) were classified according to Frascati's criteria, controlling for confounding comorbidities. Univariable analysis and multivariable logistic regression models were carried out.ResultsA total of 556 HIV‐infected cART‐treated patients from 2006 to 2013 were included: male 78%; IVDUs 14%; CDC stage C 31%; median CD4 nadir 200/mm3; median current CD4 501/mm3; undetectable HIV‐RNA in 368 (67%); and HCV‐positivity in 150 (29%). Frequency among score levels was for FIB‐4: min‐1.44=404 (73%), 1.45–3.25=118 (21%), 3.26‐max=28 (5%); for APRI: min‐0.5=414 (75%), 0.5–1.5=112 (20%), 1.5‐max=24 (4%). Median FIB‐4 and APRI were 0.98 and 0.27 in HIV+/HCV‐ and 1.40 and 0.50 in HIV+/HCV+ individuals, respectively. HAND was found in 176 (32%): 91 ANI, 73 MND, 12 HAD. Association of variables with NCI are shown in Table 1.ConclusionsIn this large population, HAND was not associated with commonly used non‐invasive liver fibrosis scores. As aetiology of cognitive dysfunction in HIV mono‐ and HCV co‐infected patients is multifactorial and partially unknown, our results support the hypothesis of a direct or indirect effect on cognitive function of the viruses, rather than the consequence of alterations residing outside the brain.
Low clinical relevance of risky alcohol consumption in a selected group of high adherent HIV‐infected patients attended in the United Kingdom
Authors: Gonzalez Baeza Alicia , Milinkovic Ana , Arenas‐Pinto Alejandro 
Published: November 2014

IntroductionThe prevalence of risky alcohol consumption, associated factors and its impact on the brain is not well established in clinically stable HIV patients.Materials and MethodsWithin the PIVOT neurocognitive sub‐study, effectively suppressed HIV‐infected adults on either standard cART or ritonavir‐boosted PI monotherapy completed the Alcohol Use Disorders Identification Test (AUDIT) designed to detect risky alcohol consumption. They also completed a brief neuropsychological assessment (NPZ 5) composed by five measures. For this cross‐sectional analysis, we calculated rates of hazardous (AUDIT=8–15) or harmful (AUDIT=16–19) consumption and likely dependence (AUDIT>20). We explored the association between risky alcohol intakes (AUDIT>8) and clinical/demographical variables, conducting logistic regressions when significant association was found (p<.05). Also, the association between cognitive performance and alcohol consumption was calculated and adjusted by potential confounders.ResultsOf the 146 included participants, the majority were male (86.3%), white (81.5%) and educated (mean years on formal education=15, SD=3.9). Average age was 47.6 years (SD=8.7), and 36.3% had risky consumption (29.5% hazardous, 6.2% harmful, 0.7% likely dependence). White ethnicity and male sex were positively associated with risky consumption (Table 1). After adjustments, white ethnicity remained significantly associated with risky consumption (1.64 [95% CI 0.34–2.95]; p=0.013). Better cognitive performance was associated with risky alcohol consumption in the univariate analysis (p<.001). After adjustment by ethnicity, sex and years of education, cognitive performance and risky alcohol consumption maintained significant association (0.45 [95% CI 0.19–0.70] p=0.001).ConclusionsDespite the substantially high prevalence of risky alcohol consumption, it was not associated with worse adherence, immunological or quality of life measures in this cohort of effectively suppressed patients but prevalence of likely alcohol dependency was extremely low. White patients were more vulnerable to risky consumption. Moreover, positive association between cognitive performance and risky alcohol consumption remained after adjustment. In our study, the association we found between cognitive function and alcohol consumption does not reflect the effect of alcohol dependency on cognition.
Facial emotional processing deficits in long‐term HIV‐suppressed patients
Authors: Gonzalez‐Baeza Alicia , Perez‐Valero Ignacio , Carvajal‐Molina Fernando , Bayon Carmen , Montes‐Ramirez Marisa , Ignacio Bernardino Jose , Arribas Jose R 
Published: November 2014

IntroductionEmotional processing is basic for social behaviour. We examine for the first time the facial emotion processing in long‐term HIV‐suppressed patients.Materials and MethodsCross‐sectional study comparing (ANOVA) six facial emotional processing tasks (two discrimination, two memory and two recognition) between HIV‐suppressed patients (HIV+) on effective antiretroviral therapy (>2 years) and matched (age, gender) healthy controls (HCs). Accuracy in the recognition of basic emotions (neutral, happiness, sadness, anger and fear) in each recognition task was also compared (Mann–Whitney U test) between HIV+ and HCs. In the subset of HIV+, we evaluate which factors were associated with impaired recognition of basic emotions (accuracy below 50%) by multiple logistic regression analysis. Overall performance in all six emotional tasks were separately compared between neurocognitive impaired and non‐impaired HIV+.ResultsWe included 107 HIV+, mainly Caucasian (89%) male (72%) with a mean age of 47.4 years, neurocognitively non‐impaired (75.5%), and 40 HCs. Overall discrimination (p=0.38), memory (p=0.65) and recognition tasks (p=0.29) were similar in both groups. However, HIV+ had lower sadness recognition in both recognition tasks and lower sadness, anger and fear recognition in the facial affect selection task (Figure 1). Only estimated pre‐morbid functioning (WAIS‐III‐R vocabulary subtest score) was significantly associated with sadness (1.99 [95% CI 1.18–3.58]; p=0.01) and anger recognition deficits (2.06 [95% CI 1.14–3.45]; p=0.015) in the facial affect selection task. In HIV+ individuals, neurocognitive impairment was associated with worse memory task results (p<0.01, d=0.88; p<0.01, d=1.48).ConclusionsWe did not find difference in the overall emotion processing between HIV+ and HIV‐ individuals. However, we found particular recognition deficits in the entire HIV+ sample. Estimated pre‐morbid functioning was associated with sadness and anger recognition deficits in the facial affect selection task. Neurocognitive impaired HIV+ had additional memory deficits. These recognition deficits might conduct to social difficulties.
Co‐infections and co‐morbidities among injecting drug users versus sexually infected patients in Bucharest
Authors: Manea Eliza , Jipa Raluca , Niculescu Iulia , Benea Serban , Benea Otilia , Arama Victoria , Hristea Adriana 
Published: November 2014

IntroductionAfter the 2008 introduction of new psychoactive substances (NPS) in Romania, the number of newly diagnosed HIV infections showed significant increase among injecting drug users (IDUs). Our objective was to analyze the differences between co‐infections related to the HIV infection, based on the way of transmission (IDUs versus sexually infected).Materials and MethodsA retrospective transversal study was carried out, analyzing 245 adult HIV‐positive patients, diagnosed between January 2013 and December 2013 in our hospital. We collected socio‐demographic, epidemiological and laboratory data at the diagnosis and analyzed them using SPSS version 20.ResultsMost patients (71%, 174/245) were men and the median age was 32 years (IQR: 26–38). 91 patients (37%) were former/active IDUs (most of them injecting both opioids and NPS), while 154 patients (63%) were sexually infected, with 84% being heterosexuals and 16% men having sex with men (MSM). The median CD4 count, at the moment of diagnosis, was 294 cells/mm3 (IQR: 119–483).Other co‐infections at diagnosis were toxoplasmosis (four patients), cryptococcosis (two patients) and cytomegalovirus reactivations (three patients) without significant association between the two groups.ConclusionHeterosexual transmission was the most common way of HIV transmission in 2013 in contrast with EU/CEE, where MSM accounted for the majority of cases of HIV epidemics in 2012 [1]. Sexually transmitted HIV infection was associated with late presentation, stage C and syphilis. We noted a high percentage of IDU transmission, which was associated with stage A and hepatitis C infection.
Difference in factors associated with low‐level viraemia and virological failure: results from the Austrian HIV Cohort Study
Authors: Leierer Gisela , Rieger Armin , Steuer Andrea , Sarcletti Mario , Geit Maria , Haas Bernhard , Taylor Ninon , Kanatschnig Manfred , Rappold Michaela , Ledergerber Bruno , Zangerle Robert 
Published: November 2014

IntroductionFor some patients, it remains a challenge to achieve complete virological suppression which is the goal of antiretroviral therapy (ART). Identifying factors associated with low‐level viraemia (LLV) and virological failure (VF) under ART might help to optimize management of these patients.Materials and MethodsWe investigated patients from the Austrian HIV Cohort Study receiving unmodified ART for >6 months with two nucleoside reverse‐transcriptase inhibitors (NRTIs) with either a non‐nucleoside reverse‐transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) or an integrase inhibitor (INSTI) between 1 July 2012 and 1 July 2013 with at least one viral load (VL) measurement below the limit of detection (BLD) or below level of quantification (BLQ) in their treatment history. VF was defined as HIV‐RNA levels ≥200 copies/mL and all other quantifiable measurements were classified as LLV. Factors associated with LLV and VF compared to BLD and BLQ were identified by using logistic regression models.ResultsOf the 2,276 patients analyzed, 1,972 (86.6%) were BLD or BLQ, 222 (9.8%) showed LLV and 82 (3.6%) had VF. A higher risk for LLV and VF was found in patients with ART interruptions and in patients with boosted PI therapy. The risk for LLV and VF was lower in patients from a centre which uses Abbott RealTime HIV‐1 assay compared to the other centres measuring VL by the Roche Cobas AmpliPrep/Cobas TaqMan 2.0. A higher risk for LLV but not for VF was found in patients with a higher VL before ART and shorter ART duration. A higher risk for VF but not for LLV was found in patients of younger age, originating from a high prevalence country, with a lower CD4 count and in male injecting drug users.ConclusionsThis study of well‐defined patients on stable ART over a period of more than six months gives insights into the different factors associated with LLV and VF. In patients with VF, factors associated with adherence play a prominent role, whereas in patients with LLV, the biology of viral replication comes additionally into effect. Despite its observational design, it has implications for patient management and forms the basis for future outcome studies.
A retrospective observational study of low‐level viraemia and its immunological and virological significance: which outcome to expect
Authors: Silva Joana , Pereira Karen , Rijo Joao , Alberto Teresa , Cabanas Joaquim , Gomes Perpetua , Farinha Helena , Mansinho Kamal 
Published: November 2014

IntroductionLow‐level viraemia (LLV) is observed in some patients with HIV‐1 infection on stable antiretroviral therapy (ART). The significance of these findings remains controversial as it conflicts with traditional optimal clinic outcome. This study aims to evaluate the effect of LLV on the establishment of virological failure (VF) and immune deterioration.MethodsRetrospective observational study of a cohort of HIV‐1 infected patients of an Infectious Diseases Clinic, who presented an HIV‐1 viral load of 20 to 200 cp/mL, during the year 2012. Patients who were not on ART or non‐adherent in the previous 6 months were excluded. Compliance was quantified by clinical and pharmaceutical records. Adherence was defined as ≥95% compliance rate. Demographic, clinical, immunological and therapeutic data were collected from clinical records. LLV was defined as a range of 20–200 cp/mL and stratified as transient (T‐LLV): only one measurement, persistent (P‐LLV): 2 consecutive measurements with an interval ≥3 months and recurrent (R‐LLV): ≥1 T‐LLV during an 18‐month follow‐up. Statistical analysis was performed with Microsoft Office® – Excel 2012. Kolmogorov–Smirnov test, t‐test and chi‐square test were performed for a significant p value <0.05.ResultsDuring 2012, 2161 HIV‐1 infected patients were evaluated at our Clinic, 93% of which were on ART. LLV was documented in 378 (19%), adherence was verified in 151 (52%). The analysis of this cohort (n=151) revealed: 77 (51%) T‐LLV, 13 (8.6%) R‐LLV and 61 (40%) P‐LLV. Mean viral load was 46 cp/mL. Mean TCD4 count was 665 cells/µL with a variation of +63 cells/µL during the study period. There was no VF documented. ART regimens were switched in 16 (11%) patients. Gastrointestinal disturbance was found in 13 (9%). Analysis showed no statistical differences between the analyzed variables (CD4 variation, time of diagnosis and treatment, duration of LLV persistence (less than or more than one year), number of ART regimens, ART regimen and type of NRTI backbone) for all groups (T‐LLV, R‐LLV, P‐LLV), except for mean viral load that showed significant superiority in the T‐LLV(38 cp/mL) and R‐LLV(36 cp/mL) vs P‐LLV(58 cp/mL) (p=0.01 and p<0.01, respectively).ConclusionsThe absence of significant differences in immunological and virological outcomes in this cohort and the absence of VF in all groups, suggests a scarce impact of LLV in patient's prognosis. Prospective studies, with longer follow‐up could bring more accurate information.
Comparison of routine versus targeted HIV testing strategies: coverage and estimated missed infections in emergency room and primary care centre
Authors: Jesús Pérez Elías María , Gomez‐Ayerbe Cristina , Muriel Alfonso , Eugenia Calonge Maria , Diaz Alberto , Pérez Elías Pilar , Martinez‐Colubi Maria , Uranga Almudena , Santos Cristina , Moreno Ana , Quereda Carmen , Navas Enrique , Moreno Santiago 
Published: November 2014

IntroductionDifferent HIV Testing Strategies (TS) and clinical care settings had not been face to face evaluated [1]. We compared coverage, Newly Diagnosed HIV Infection (NDHI) and Estimated Missing HIV Infections (MHI) in Hospital Emergency Room (HER) and Primary Care Center (PCC), in DRIVE study (Spanish acronym of HIV infection Rapid Diagnosis) and in clinical practice the year before DRIVE.Materials and MethodsIn DRIVE study, 18–60 years old, non‐HIV‐infected population visiting an HER or a PCC were proposed both a structured risk practices and clinical conditions questionnaire (RP&CC‐Q) and a rapid HIV test. This arm is the HIV Routine TS. We analyze a hypothetical arm, where risk practices were universally assessed with an RP&CC‐Q, subsequently risk‐positive patients where HIV tested, Targeted‐TS. Coverage was assessed as the ratio of tested population (TP)/attended population (AP) in HER and PCC. TP/AP ratios were also calculated in the year before, the Clinical Practice‐TS. NDHI was expressed per ‰ tests performed. MHI was estimated assuming in the non‐tested population, overall DRIVE rate of NDHI ‰ and NDHI ‰ in negative RP&CC‐Q.ResultsA total of 5329 RP&CC‐Q and rapid HIV tests were performed to 49.64% women, median age 37 (28–47) years old, mainly 74.9% Spaniards. Confirmed NDHI was 4.1‰, and in 48, 8% of RP&CC‐Q negative NDH was 0‰. HIV screening coverage was always better in PCC than in HER, and higher in DRIVE study than in clinical practice. Estimated MHI was higher in HER and in the clinical practice‐TS. Targeted‐TS coverage was lower, but resulted in similar NDHI and MHI than routine‐TS, testing half the population, see Table 1.ConclusionsBest HIV Testing Strategy is routine‐TS in Primary Care Center. Targeted‐TS resulted in same newly HIV diagnoses and missed HIV infections than routine‐TS with half the resources employed.