bluuebunny/crossref_metadata_2025_split huggingface dataset:
A MultiFactorial Risk Score to weigh toxicities and co‐morbidities relative to costs of antiretrovirals in a cohort of HIV‐infected patients
Authors: Tontodonati M , Sozio F , Vadini F , Polilli E , Ursini T , Calella G , Di Stefano P , Mazzotta E , Costantini A , D'Amario C , Parruti G 
Published: November 2012

Purpose of the studyConsidering costs of antiretrovirals (ARVs) for HIV patients is increasingly needed. A simple and comprehensive tool weighing comorbidities and ARV‐related toxicities could be useful to judge the appropriateness of use of more expensive drugs. We conceived a MultiFactorial Risk Score (MFRS) to evaluate the appropriateness of ARVs prescription relative to their costs.MethodsHIV patients were consecutively enrolled in 2010‐2011. We considered socio‐demographic characteristics, HIV history, cardiovascular risk factors, low energy fractures, bone density. Psychological factors were assessed by BDI, DS14 and TAS‐20. The MFRS was calculated as the sum of the following: age (<30y 1 point; 1 point increase every 5y, 10 for≥70); AIDS diagnosis (5); CD4 nadir (5 if <100; 1 point less every 100 CD4 increase); ART line (0 first, up to 5 for≥6 lines); lipodistrophy (5); HCV coinfection (7); education (1 degree, 2 secondary, 3 primary); alcohol (3) and drug abuse (5); working activity (3 if unemployed); hypertension (3); cholesterol≥200 mg/dl (3); diabetes (3); Framingham score (7 if>7%); creatinine (0 if <1 mg/dl, 1 if<1.2; 2 if<1.5>1.2, 5 if<2> 1.5, 7 if≥2); bone fractures (7); bone status at DEXA (0 normal, 3 osteopenic, 5 osteoporotic); cancer (5); depression (3 if BDI>17); other psychiatric illness (5). Annual costs of individual ART regimens were calculated. MFRS was correlated in univariate and multivariate models with all variables. All statistical analyses were carried out using Stata 10.1.Summary of resultsWe enrolled 241 HIV patients, 74.3% males, aged 44.5±9.9y; 19 patients (7.8%) were untreated, 74.8% of treated had undetectable HIV RNA. Mean Nadir CD4 counts were 218±168, 38.5% of patients had an AIDS diagnosis. Mean individual ARV annual cost was 10,976±5,360. Mean MFRS was 28.5±13.9 (4–64). MFRS was significantly higher (p<0.001) in patients with older age, longer duration of HIV infection, lower CD4 nadirs, AIDS diagnosis, lipodistrophy, HCV, smoking, lower education, alcohol/drug abuse, hypertension, carotid plaques, higher Framingham score, diabetes, bone fractures or disorders, depression, alexithymia, and higher ARV costs. In multivariate models, ARV costs were significantly higher in patients with older age, previous AIDS diagnosis, lower CD4 nadir and higher MFRS.ConclusionsMFRS may be a simple and reliable tool to match patients’ complexity and ARV costs, deserving further validation on larger samples.
Comprehensive care with antiretroviral therapy for injecting‐drug users associates to low community viral load and restriction of HIV outbreak
Authors: Kivelä P , Liitsola K , Aho I , Simola S , Tuomola P , Salminen M , Ristola M 
Published: November 2012

An outbreak of HIV was detected amongst Finnish injecting‐drug users (IDUs) in 1998. The outbreak was caused by CRF01‐AE virus [1]. A comprehensive care programme including infectious diseases, addiction medicine, low threshold methadone program, needle exchange, accommodation and other social services started in December 2000. Funding was provided by municipalities. We have described earlier how the outbreak became geographically and socially restricted [2]. The data of newly diagnosed HIV infections in the hospital district of Helsinki and Uusimaa (Helsinki region) amongst IDUs and HIV‐1 subtypes were obtained from the Finnish national HIV registry. The Helsinki University Central Hospital (HUCH) registry was used to obtain the number of IDUs in HIV care, on antiretroviral therapy (ART), and plasma HIV‐1 RNA (VL) amongst IDUs. The HUCH registry also includes IDUs diagnosed with HIV infection in other Finnish regions, but currently living in Helsinki region. The highest number (n=65) of newly diagnosed HIV infections among IDUs in Helsinki region was observed in 1999 (Figure 1). Between 1998 and 2011, 249 IDUs were diagnosed with HIV infection. From 1998 to 2004 the subtype was CRF01‐AE in 187 (92%) cases, other subtypes in 5 (2%) cases and not subtyped in 11 (5%) cases. From 2005 to 2011 the subtype was CRF01‐AE in 25 (54%) cases, other subtypes in 15 (33%) cases and not subtyped in 6 (13%) cases. In 2011 there were 4 IDUs diagnosed with HIV, one of them with CRF01‐AE. In the Helsinki region out of 183 HIV‐infected IDUs in 2005, 100 (55%) had VL<50 copies/ml and out of 167 HIV‐infected IDUs in 2011, 133 (80%) had VL<50 copies/ml in 2011. We propose that from 2005 the low HIV‐1 RNA in plasma of IDUs has contributed to the low incidence of HIV among IDUs in Helsinki region. However, the incidence of HIV started to decline before the decline of VL in the cohort (Figure 1). This suggests that other factors besides ART may have decreased the risk of HIV infection among IDUs before ART coverage of the cohort became considerable. Other subtypes of HIV circulated among IDUs in the Helsinki region during the observation period, which emphasises the necessity of health promoting services (e.g. needle exchange) to be available to all IDUs.image
The impact of introducing a satellite dispensary service at an outpatient HIV clinic
Authors: Vekeria S , Jalali F , Sonecha S , Bates I 
Published: November 2012

BackgroundStudies have demonstrated the potential impact of pharmaceutical services in HIV care [1]. We sought to extend HIV pharmacy services at the Dean Street outpatient HIV/GUM clinic to improve efficiency and enhance client satisfaction. The pharmacy team was expanded and a satellite dispensary was opened in the clinic. This project compares the new dispensary service with the previous one offered.MethodComparisons were made between the pre‐ and post‐change period across a range of pharmaceutical services provided and patient satisfaction feedback. Medicine‐related interventions, repeat prescription requests, waiting and dispensing times were recorded. Service satisfaction questionnaires were designed for patients to quantify aspects of service provision.ResultsTypes of interventions remain broadly similar (p=0.353), with an increase in the daily number of interventions (p=0.0038) and a decrease in time spent per intervention (p=0.006) in the new service delivery model. A greater dispensing time (p=0.035, p=0.001) and time per item (p=0.043, p=0.002) for prescriptions with related queries was seen across both periods. However, the time taken to dispense prescriptions remained similar pre‐ and post change (p=0.8). The patient satisfaction survey had a series of statements relating to pharmacy services; there was a stronger association with patient satisfaction seen for the provided services during the post‐change period. The number and types of repeat prescription requests remain unchanged (p=0.342); however, patient prescription requests were completed more efficiently post‐change (mean time 5.4 minutes) as compared to pre‐change (mean 12.6 minutes; p = 0.001). There was also a significantly lower rate of FP10 prescriptions issued in the post‐change period due to a greater choice of available medications.ConclusionThe care contributions of HIV pharmacists to a multidisciplinary HIV clinic providing patient‐centred care were measured before and after the introduction of a satellite dispensary service. The expanded pharmacy service has increased efficiency by completing more tasks in less time and increased access to medications for patients. Its focus is dealing with patient‐related queries and providing support for the patients seen at the clinic.
Reasons of hospitalization for HIV‐positive patients in the Infectology Center of Latvia in the period from 2009 to 2011
Authors: Sture G , Rozentale B , Zeltina I , Januskevica I , Sangirejeva A 
Published: November 2012

IntroductionIn Latvia, HIV‐positive patient count increases every year. 5189 HIV patients were registered in Latvia until January 2012. 1047 of them were in the AIDS stage. For the moment, healthcare of HIV patients is realized in two inpatient departments and one outpatient department; only patients with dual infection ‐ HIV and TB ‐ are observed in the TB center.Aim of studyTo identify problems, which are related to hospitalization of HIV‐positive patients, by improving patient care standards and if necessary change it.Materials1205 patient cards of hospitalization were analyzed in the period from January 2009 till December 2011 (year 2009 ‐ 351 patients, 2010 ‐ 391 patients, 2011 ‐ 463 patients). Statistical data analysis made by software ‐ SPSS and Microsoft Excel and described methods.ResultsWithin three years 1205 patients were hospitalized. In late AIDS stage, 714 patients were hospitalized. For the treatment of these patients ART, OI prophylactic treatment and OI therapy had to be included. Most common cause of hospitalization was opportunistic infection: 2009 ‐ 168 patients (47.8%); 2010 ‐ 201 patients (51.4%); 2011 ‐ 193 patients (41.9%). Second most common cause of hospitalization was liver disease: 2009 ‐ 37 patients (10.5%); 2010 ‐ 55 patients (14%); 2011 ‐ 47 patients (10.1%). Other reasons of hospitalization were lower respiratory tract infections‐pneumonia, bronchitis. Only in 5.9% cause of hospitalization was acute retroviral syndrome. In 4.4% hospitalizations outcome was death, only in 0.2% cases cause of death was associated with non‐AIDS disease. Average time of hospitalization was 12.8 days.

Patients' distribution by HIV/AIDS stage

Clinical categories/CD4
A
B
C

>500 c/mm3

79
22
41

499–200 c/mm3

141
55
115

<200 c/mm3

75
119
558

Conclusions1. HIV‐positive patient hospitalization count increases every year. 2. More often hospitalized patients are in late stage of HIV infection and reason of hospitalization is opportunistic infection, which extends time of hospitalization and costs. 3. Recommended immunization against VHB and S. pneumoniae, which would protect against non‐AIDS diseases. 4. Medical staff education needs to be updated, which would help to diagnose HIV infection in early stage of disease.
Impact of pharmacogenetic markers of CYP2B6 and clinical factors on plasma efavirenz level in HIV/tuberculosis co‐infected Thai patients
Authors: Manosuthi W , Sukasem C , Lueangniyomkul A , Mankatitham W , Thongyen S , Nilkamhang S , Manosuthi S , Sungkanuparph S 
Published: November 2012

Purpose of studyPolymorphisms of CYP2B6 are associated with altered activity of cytochrome P450 2B6 which has an effect on plasma efavirenz level. The data of these polymorphisms and their effect, particularly in HIV/TB co‐infected patients, is still limited.MethodsA total of 150 HIV‐infected Thai adults with active tuberculosis (TB) and receiving rifampicin‐containing anti‐TB regimen were prospectively enrolled to receive a once‐daily regimen of efavirenz 600 mg/tenofovir/lamivudine. Nine single nucleotide polymorphisms (SNPs) within CYP2B6 were genotyped using real‐time PCR‐based allelic discrimination. At 12 weeks after ART, plasma efavirenz levels at 12 hours after dosing were measured by HPLC assay.Summary of resultsOf all, the median (IQR) CD4 count was 44 (17–113) cells/mm3 and median (IQR) plasma HIV‐1 RNA was 5.8 (5.4–6.3) log copies/mL. Eight (5.3%) patients discontinued efavirenz due to adverse events prior to measuring efavirenz level. Of 142 patients, the frequencies of wild type, heterozygous mutant, and homozygous mutant of each SNP were 64C>T (89%, 10%, 1%), 499C>G (99%, 1%, 0%), 516G>T (45%, 47%, 8%), 785A>G (36%, 54%, 10%), 1375A>G (100%, 0%, 0%), 1459C>T (97%, 3%, 0%), 3003C>T (29%, 44%, 27%), 18492T>C (55, 39%, 6%), and 21563C>T (38%, 57%, 5%). Median (IQR) plasma efavirenz level of 102 patients who were concurrently receiving efavirenz and rifampicin was 2.08 (1.33–3.51) mg/dL and those of 40 patients who did not received rifampicin was 2.72 (1.80–5.21) mg/dL. Of 102 patients, heterozygous/homozygous mutant vs. wild type of 5 SNPs associated with high mean efavirenz level were 516G>T (3.6 vs. 1.9 mg/dL, P<0.001), 785A>G (3.2 vs. 2.0 mg/dL, P=0.001), 3003C>T (4.0 vs. 2.4 mg/dL, P=0.012), 18492T>C (3.5 vs. 2.0, P<0.001), 21563C;>T (3.4 vs. 1.9 mg/dL, P<0.001). Three of 9 haplotypes identified, including *6/*6, *1/*6, and *4/*6, were associated with high efavirenz level. By multivariate analysis, factors associated with high efavirenz level included specific haplotype (P<0.001), low body weight (P=0.003), and receiving rifampicin (P=0.058).ConclusionsParticular SNPs and haplotype of CYP2B6, especially *6/*6, has the greatest impact on efavirenz level in HIV/TB co‐infected Thai patients whereas low body weight and concurrent receiving rifampicin have lesser effects.
Mortality among HIV/AIDS patients with/without Mycobacterium tuberculosis infection in southern region of Thailand
Authors: Chaimay B , Woradet S , Chantutanon S , Phuntara S , Suwanna K 
Published: November 2012

ObjectThe purpose of this study was to gain knowledge of tuberculosis infection in HIV/AIDS‐infected patients, the purpose of this study was to investigate an association between tuberculosis infection and mortality in HIV/AIDS‐infected patients.MethodsA prospective, hospital‐based cohort study was conducted in HIV/AIDS patients registered in hospitals between January 1993 and April 2010. In total, 52,459 patients with HIV/AIDS infection were routinely observed and followed up, covering 14 provinces in southern region of Thailand.ResultsThe main results found that one‐third of the HIV/AIDS patients were infected with Mycobacterium tuberculosis (27.94%) during the follow‐up period. However, the risk of Mycobacterium tuberculosis infection was not statistically significant in terms of association with mortality among HIV/AIDS patients (HR: 1.01; 95% CI: 0.96 to 1.05). In contrary, HIV/AIDS patients with pulmonary tuberculosis were more likely to have a longer life by about 19% (HR: 0.81, 95% CI: 0.73 to 0.91). As well, HIV/AIDS patients with extrapulmonary tuberculosis were more likely to have a longer life by about 31% (HR: 0.69; 95% CI: 0.57 to 0.83).ConclusionIn conclusion, tuberculosis infection was associated with mortality among HIV/AIDS patients. Early treatment of tuberculosis is needed for HIV/AIDS patients, in order to decrease morbidity and mortality among HIV/AIDS patients with tuberculosis.
Characteristics of tuberculous meningitis in HIV‐infected patients
Authors: Hristea A , Manciuc C , Zaharia‐Kezdi E , Dorobat C , Arbune M , Olaru I , Jipa R , Niculescu I , Streinu‐Cercel A 
Published: November 2012

BackgroundTuberculous meningitis (TBM) has a substantial mortality even with anti‐tuberculous treatment, in HIV‐non‐infected patients. Purpose of the study. The objectives were to describe clinical and laboratory differences of TBM in HIV‐infected versus HIV non‐infected patients and to assess risk factors of death in HIV‐infected patients.MethodsWe retrospectively analyzed patients admitted to four infectious diseases hospitals in Romania, between 2001 and 2011, with TBM. Patients were defined as having TBM according to a consensus definition published by Marais et al. [1] and further divided into three categories of TBM (definite, probable and possible).ResultsWe identified 162 patients with TBM of which 47 (29%) tested positive for HIV infection. Sixty‐six patients had definite, 53 probable and 43 possible TBM. Out of the 47 HIV‐infected patients 25 had definite, 17 probable and 5 possible TBM. TBM in HIV‐infected patients vs. HIV non‐infected patients was significantly associated in multivariable analysis with younger age (p=0.01), in‐hospital mortality (p<0.001), absence of meningean syndrome (p=0.021), and absence of cranial nerve palsy (p=0.036). HIV‐infected patients who died had a median CD4 count of 61 cells/mm3 (IQR 21‐132) vs. 135 cells/mm3 (IQR 61–255) in patients who survived (p=0.014). HIV infection was diagnosed before TBM episode in 35 (75%) patients. Twenty‐four (51%) HIV‐infected patients had concomitant extra‐central nervous system tuberculosis.ConclusionsHIV infection is associated with increased mortality in patients with TBM. Most of our patients with TBM were late presenters. Death in HIV infected patients was associated with a lower median CD4 count.

HIV‐infected
HIV‐non‐infected
p‐value

Male N (%)
32 (68)
68 (59)
0.287

Age (years) (median, IQR)
22 (18–34)
34 (20–51)
0.005

Duration of symptoms before admission (days) (median, IQR)
10 (7–14)
10 (7–14)
0.878

Cranial nerve palsy N (%)
6 (13)
31 (27)
0.051

Meningean syndrome N (%)
34 (72)
102 (89)
0.010

Glasgow Coma Scale<7 N (%)
11 (23)
18 (16)
0.243

Cell number in CSF (cells/mm3) (median, IQR)
180 (91–457)
200 (86–400)
0.799

Protein CSF level (mg/dl) (median, IQR)
175 (120–542)
198 (129–279)
0.701

CSF/serum glucose<0.5 N (%)
32 (71)
96 (84)
0.079

In‐hospital mortality N (%)
18 (38)
13 (11)
<0.001
Insights on treatment of a Portuguese cohort of HCV/HIV coinfected patients
Authors: Silva C , Doroana M , Afonso C , Fernandes J , Antunes F 
Published: November 2012

Purpose of the studyThis study intends to characterize a Portuguese patient population with chronic HCV and HIV coinfection, followed at our Research Unit, underline the importance of early treatment and incorporate the importance of DDA for retreatment of HCV infection.MethodsRetrospective, observational analysis of medical records of 348 HCV/HIV coinfected patients from 2001 to 2011. Demographic, epidemiological, clinical and laboratory data and virologic response were collected.Summary of resultsReview of 348 HCV/HIV coinfected patients, 121 of those (34.7%) under treatment, predominantly male (77.0%) and Caucasians (94.8%) with a median age of 44 yrs old (min 25; max 77 yrs). Intravenous drug use was the main route of HCV infection, in 71.3% of patients, and 8.3% were related with MSM. Frequent morbidities were alcohol abuse (46.8%), illicit drug use (70.1%), methadone (25.6%) and mental disturbances (12.3%) of patients. Regarding HIV infection, six were HIV‐2 and 342 HIV‐1; 36.1% were stage A and 29.6% were stage C (CDC Atlanta), 94.8% on antiretroviral treatment and only 21.9% of them with more than 350 TCD4 cell count. Genotype 1 was the most prevalent (58.1%–117 genotype 1a, 26 genotype 1b); 1.6% were genotype 2, 22.8% genotype 3 and 17.5% genotype 4. Previous to treatment initiation, HCV ARN was above 600.000 IU/mL in 56.9% patients. Fibrosis was evaluated by fibroelastography in 41.1% and hepatic biopsy in 26.3% of patients; in those, 44.0% had a score above F2 (METAVIR) and ALT was elevated 2 times the limit in 38.0%, with an average value of 94 UI/L. IL 28B testing was performed in only 35 patients at the time, with 45.7% CC and 17.1% CT genotype. Treatment was started in 34.8% of patients, with 1.7 treatments per individual, and regimen was based on peguilated interferon with ribavirin in 93.6% of cases (72.1% with peginterferon alfa 2a). The SVR rate was 51.2%, with 28.9% non responders, 3 relapsers and 9 treatment interruptions due to major toxicities.ConclusionsOur data presents a low HCV treatment initiation, illustrated by 65.2% patients who did not begin any treatment. The majority completed treatment and the SVR rate was similar to literature. Individualized approach is essential to determine the optimal time to initiate HCV treatment, to assess patient adherence and adverse events management, in order to optimize treatment and reserve DDA drugs to experienced patients with worse predictive factors.
Sexually transmitted infection with an immune‐escape mutant hepatitis B virus (HBV) in an HBV‐vaccinated individual with acute HIV‐HCV infection
Authors: Ingiliz P , Krznaric I , Behrendt D , Baumgarten A , Berg T , Obermeier M 
Published: November 2012

Immune pressure exerted on HBV by anti‐HBV antibodies and long‐term therapy with drugs that mutagenize the viral polymerase gene can select for mutations in its surface gene, leading to vaccine escape and evasion from serological detection. In general, these mutations are considered to be poorly transmissible. However, cases of HBV infection with vaccine‐escape mutant viruses have been reported in vaccinated individuals, mainly from high‐prevalence regions of the world. The possibility of an infection with HBV despite an effective vaccination may pose a major health issue, requiring a change in routine diagnostic and screening programmes. Here, we report a case of a HBV vaccine escape mutant infection in an effectively vaccinated individual. The patient was a 27‐year old man who has sex with men (MSM) who presented in September 2011 for the first time in a Berlin outpatient HIV clinic due to a newly diagnosed HIV infection. He was aware of several sexual high‐risk contacts within the past, but had a negative HIV and HCV antibody test (ELISA) in April 2011. He complained about slight fever, swollen cervical and axillary lymph nodes and general muscle pain. The Western blot confirmed an HIV infection. The HIV viral load was 24,000 copies/mL, the CD4 count was 550/mm3. His ALT levels were elevated to 10×the upper limit of normal (ULN) and he was additionally found to have acute HCV infection: The HCV viral load was 2 million IU/mL, the HCV genotype was 2c. Furthermore, he was anti‐HBc negative, HBsAG negative, and his anti‐HBs level was 121 IU/L. He reported to have been vaccinated for HBV in the past. Three months later, the patient was routinely retested. At this time point, his HBsAg turned out to be positive and anti‐HBs antibodies had vanished. His HBV viral load was 600 million IU/mL, and ALT had decreased to 2×ULN. Population sequencing revealed a genotype F and a S143L mutation in the surface gene consistent with a vaccine escape mutant HBV. A retrospective analysis of the initial blood sample showed a HBV DNA of 90 IU/mL.ConclusionTo our knowledge, this is the first report of a sexually transmitted HBV virus with vaccine‐escape mutation in a vaccinated individual. Despite a fairly high CD4 count, the transmission may have been promoted by a loss of immunity through an acute HIV infection. Clinicians need to be aware of the possibility of HBV infections with mutant viruses.