bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stigma reduces and social support increases engagement in medical care among persons with HIV infection in St. Petersburg, Russia
Authors: Kelly Jeffrey , Amirkhanian Yuri , Yakovlev Alexey , Musatov Vladimir , Meylakhs Anastasia , Kuznetsova Anna , Chaika Nikolay 
Published: November 2014

IntroductionThe proportion of people living with HIV (PLH) in care and on antiretroviral therapy (ART) in Russia is lower than in Sub‐Saharan Africa [1]. This is undoubtedly due to a variety of systems and structural issues related to poor treatment access, linkage and care delivery models. However, little research has explored the reasons that PLH are not in care from their own perspectives. This information can help to guide the development of approaches for improving HIV care engagement in the country.Materials and MethodsIn‐depth interviews were undertaken with 80 PLH in St. Petersburg who had never been in HIV medical care, had previously been out of care, or had always been in care. Participants were recruited through online PLH forums and Websites, outreach needle exchange and non‐government organisation (NGO) programs, and chain referral. The interviews elicited detailed information about participants’ experiences and circumstances responsible for being out of care, and factors contributing to nonretention in HIV treatment. Verbatim transcriptions of the interviews were coded and analyzed using MAXQDA software to identify emerging themes.ResultsTwo types of care engagement barriers most often emerged. Some related to medical services, and others to the family and social environment. The most frequent medical service barriers were poor treatment infrastructure conditions and access; dissatisfaction with quality of services and medical staff; and concerns over confidentiality and HIV status disclosure. Social barriers were fears of potential harm to family relationships, negative consequences if status became known at work, and public stigmatization and myths associated having an HIV+ status. Social support from the PLH community and from family and close friends facilitated care engagement, as did motivation to take care of oneself and one's family. Most participants also described circumstances in which engaging into HIV care was brought about by an urgent issue (opportunistic infections) or was enforced through hospitalization or imprisonment. Trust in one's doctor and simply not wanting to die were also common motives.ConclusionsStigma was a major barrier to care engagement, including fear that others would learn of one's HIV+ status, whether at work, in one's family, or in the general community. By contrast, support from family, friends and the PLH community contributed to care engagement.
HCV triple therapy in co‐infection HIV/HCV is not associated with a different risk of developing major depressive disorder
Authors: Fialho Renata , Keller Majella , File Alex , Woods Catherine , Pereira Marco , Yousseff Elaney , Tibble Jeremy , Harrison Neil , Fisher Martin , Rusted Jennifer , Whale Richard 
Published: November 2014

IntroductionHepatitis C (HCV) treatment options have changed with the development of direct activity antivirals (DAAs) and the availability of triple therapies have improved HCV cure rates. A common neuropsychiatric side effect of pegylated‐interferon and ribavirin treatment is major depressive disorder (MDD), however little is known about such adverse events with protease inhibitor‐based triple therapy. The aim of this study was to assess the rate of MDD in co‐infected HIV HCV patients undergoing different HCV treatments.MethodsAll participants were co‐infected HIV HCV attending the Royal Sussex County Hospital Brighton hepatology outpatient clinic between 2010 and 2014. Participants were assessed for DSM‐IV MDD and depression severity (using the Hamilton depression scale (HAMD)) at baseline and monthly after treatment initiation. HIV and HCV stages, genotype, reinfection and standard demographic variables were recorded. Influence of HCV stage (acute vs. chronic) and type of treatment (classic vs triple), emergence of MDD and clearance outcomes were analyzed using repeated measures and logistic regression models.ResultsFifty participants with a mean age of 42.65 years (SD=10.32) were included; most were male (98%). The majority had contracted HCV genotype 1 (64%) or 4 (26%). The HCV stage and treatment groups were matched for age and depression at baseline. No significant differences were found on virological outcomes considering HCV stage and treatment. From baseline to SVR, there was a significant increase in HAMD scores, F(4,36)=10.09, p<.001; this was not significantly influenced by HCV stage, F(4,35)=0.54, p=.708 or HCV treatment group, F(4,35)=0.60, p=.664. Those with chronic HCV were more likely to transition to MDD than acute infection (OR 7.77, 95% CI 2.04–29.54, p=.003). No differences were found for depression emergence by HCV treatment group (OR 0.83, 95% CI 0.22–3.13, p=.787).ConclusionsHCV triple therapy was not associated with a different risk of emergence of MDD versus classic treatment. MDD should be assessed before therapy initiation and monitored throughout treatment for any HCV treatment regime. Future research could usefully clarify mechanisms of MDD emergence and risk factors for this.
Experience of acute hepatitis C and HIV co‐infection in an inner city clinic in the UK
Authors: Ward Christopher , Lee Vincent 
Published: November 2014

IntroductionAcute hepatitis C infection (HCV) is increasing in the HIV‐infected population, particularly among men who have sex with men (MSM). Patients co‐infected with HCV and HIV progress more rapidly to liver cirrhosis and are at higher risk of hepatocellular carcinoma. We looked at our management of acute HCV to assess treatment outcome.Materials and MethodsWe performed a retrospective and prospective case note review of HIV‐HCV co‐infected patients attending a large inner city sexual health clinic from 2006‐to date. Acute HCV infections (less than six months) were identified and data was collected on demographics, transmission and treatment outcomes. Treatment regime was 48 weeks of weight‐based ribavirin and pegylated interferon α2a.ResultsSixty‐seven acute HCV infections were identified among 142 co‐infected patients, all of whom were male and 66 (98.5%) were MSM. Median age at diagnosis was 37 (range 20–59) and 58 (86.6%) were White British. Sixty patients (89.6%) were genotype 1, 3 (4.5%) were genotype 4 and 2 (3.0%) were genotype 2/3. A further 2 (3.0%) were re‐infections. A peak in new HCV diagnoses was seen in 2013 with 17 (25.4%). Route of transmission was sexual in all cases with 13 (19.4%) also injecting drugs, pointing to mixed transmission routes. Nine (69.2%) of these occurred in 2013. Nine (13.4%) patients cleared HCV themselves. Of the 58 who didn't clear HCV, 12 (20.7%) were lost to follow up/transferred care, 4 (6.9%) declined treatment awaiting newer agents, and 10 (17.2%) are waiting to start. A total of 32 patients started treatment. Six (18.8%) patients are currently on treatment and three (9.4%) await a final sustained virological response (SVR) test. Six out of twenty‐four (25.0%) stopped treatment due to lack of response and 1 stopped due to side effects. Fifteen (62.5%) achieved SVR and 2 (8.3%) failed to achieve SVR. Eight out of ten (80.0%) patients who had an early virological response (EVR) achieved SVR.ConclusionsOur data shows good treatment outcomes for acute HCV infection in HIV patients with an SVR rate of 62.5%. We've seen a steady increase in acute HCV infection, particularly in MSM injecting party drugs. Changing risk behaviours, particularly a rise in chem sex parties and club drug use, along with more anonymous partners and disclosure issues create difficulties in managing the HCV epidemic. More education is needed to raise awareness of HCV transmission and disclosure in our MSM population.
Plasmacytoid Dendritic cells (pDCs) in HIV‐infected and HIV/HCV‐co‐infected patients receiving successful treatment
Authors: Khokhlova Olga , Reizis Ara , Serebrovskaya Lidya , Gerasimova Natalia , Pokrovskiy Vadim 
Published: November 2014

IntroductionDepletion of cellular pool and constant activation of plasmacytoid dendritic cells (pDCs) in HIV‐infected persons (HIV+) are associated with disease progression and manifestation of opportunistic infections. The influence of highly‐active antiretroviral treatment (HAART) and suppressed HCV‐co‐infection (HIV+/HCV+) on the extent of these changes remains unknown.ObjectiveTo study parameters of pDCs in peripheral blood of HIV+ and HIV+/HCV+ patients on HAART.MethodsTwelve uninfected with HIV or HCV volunteers and 37 patients (12 HIV+, 9 HIV+/HCV+ and 16 HCV+) were enrolled. All HIV+ patients received HAART and had undetermined HIV viral load. All HCV+ patients had finished antiviral therapy (Pegasys/ribavirin) with sustained viral response for six months and more. The pDC population was enumerated by flow cytometry. In vitro IFN production in the whole blood in response to pDC‐specific stimulus unmethylated CpG oligonucleotides was determined by enzyme‐linked immunosorbent assay (ELISA).ResultsThe percentage of pDCs of peripheral blood mononuclear cells (PBMC) in HIV+/HCV+ was the lowest (0.08±0.02) but statistically not different from HIV+ (0.15±0.03; p=0.11) and significantly lower than HCV+ (0.17±0.015; p=0.4) and controls (0.27±0.045; p=0.03). Absolute number of pDCs in HIV+ on HAART (6.3±1.3) was not significantly lower than the control (10.25±1.75; p=0.09) but in HIV+/HCV+ (5.1±1.2; p=0.03), the difference was valid. IFN‐alpha production by pDCs in patients on HAART in HIV+ (2.4±0.9 pg/µl) and in HIV+/HCV+ (3.7±1 pg/µl) patients were significantly higher than in controls (in controls IFN‐alpha production by pDCs in the native plasma was below the level of detection (3 pg/µl), p=0.02 and p=0.0014).ConclusionsAbsolute number of pDC in HIV‐positive person on HAART with sustained viral response to treatment of HCV‐co‐infection was lower than in HIV‐mono‐infected. IFN‐alpha production by pDC in HIV+ and in HIV+/HCV+ patients receiving HAART remains higher than in uninfected persons.
Analysis of hepatitis non‐treatment causes in a cohort of HCV and HCV/HIV infected patients
Authors: Pereira Karen , Cláudia Miranda Ana , Baptista Teresa , Peres Susana , Antunes Isabel , Ventura Fernando , Borges Fernando , Mansinho Kamal 
Published: November 2014

IntroductionThe decision to start hepatitis C virus (HCV) treatment and its timing remains controversial. As new treatment regimens are approved, it is essential to identify patients eligible for each regimen in a timed and tailored approach. This study aims to identify the reasons to defer treatment of chronic hepatitis C infection in both HCV and HCV/HIV infected patients.Materials and MethodsRetrospective observational study of a cohort of HCV chronically infected patients with or without HIV infection, followed in an infectious disease clinic in Lisbon. Demographic, epidemiological, clinical, immunologic and virologic data were collected. Statistical analysis was performed with Microsoft Office®‐ Excel 2012. Kolmogorov‐Smirnov, t‐test, Chi‐square and correlation analysis were performed for a significant p value<0.05.ResultsThe study included 669 patients, 225 patients infected with HCV (group A) and 444 patients co‐infected with HCV/HIV (group B). The comparative analysis of those groups (A vs. B) showed: mean age was 49.4 years versus 46.9 (p<0.01), mean time since HCV diagnosis was 9.5 versus 14.6 years (p=0.558) both groups shared a male predominance and HCV acquisition due to intravenous drug use. Regarding genotype characterization, the predominant was 1a in both groups (p<0.01). Evaluation of IL28B polymorphism revealed CC 15.5% (A) versus 9.45% (B) (p<0.01). Group B mean TCD4 count was 585 cells/µL (mean percentage 27.1%). There was spontaneous viral clearance in 10.7% (A) versus 4.1% (B) (p<0.01). There were treated 52.0% (A) versus 32.2% (B) patients (p<0.01). For the untreated ones (107 – group A vs 270 – group B), no reason was identified for treatment deferral in 32.5% (A) versus 48.0% (B) patients. The most frequent reasons for deferring treatment were: withdrawal to follow‐up (33.7%), active staging of disease (7.2%), alcohol abuse (6.0%) and advanced age (6.0%) in group A versus low TCD4 cell count (17.1%), loss to follow‐up (7.5%), poor adherence (7.5%) and alcohol abuse (3.2%) in group B.ConclusionsOne of the highlighted cause for treatment deferral in both mono and co‐infected patients was withdrawal to follow‐up. In co‐infected patients, low TCD4 cell count and poor adherence, also gain prominence, suggesting that strategies to improve retention in care may be needed. Additionally, emergence of direct‐acting antiviral agents is expected to reduce these determinants in starting treatment, namely reduce the impact of low TCD4 count in co‐infected patients.
Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population
Authors: Thorsteinsson Kristina , Ladelund Steen , Jensen‐Fangel Søren , Lea Katzenstein Terese , Somuncu Johansen Isik , Pedersen Gitte , Junge Jette , Helleberg Marie , Storgaard Merete , Obel Niels , Lebech Anne‐Mette 
Published: November 2014

IntroductionWomen living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). WLWH in Denmark attend the National ICC screening program less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark.MethodsWe studied a nationwide cohort of WLWH and a cohort of age‐matched females from the general population in the period 1999–2010. Pathology samples were obtained from The Danish Pathology Data Bank containing nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.ResultsWe followed 1,143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person‐years. Compared to controls, the overall incidence of CIN1 or worse (CIN1+), CIN2+ and CIN3+ was higher in WLWH and predicted by young age and CD4 count <200 cells/µL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, incidences were comparable between WLWH and controls adherent to the National ICC screening program.ConclusionsOverall, WLWH develop more cervical disease than controls. However, incidences of CIN are comparable amongst WLWH and controls adherent to the National ICC screening program and with a normal baseline cytology.
Cancer prevalence in a metropolitan HIV clinic
Authors: Barnes Eleanor , Saxon Cara , Ahmad Sameena 
Published: November 2014

IntroductionMorbidity and mortality rates from AIDs defining cancers have fallen significantly since the introduction of highly active antiretroviral therapy (HAART). Patients are now living longer with HIV and are at a greater risk of other HIV‐ and non‐HIV related malignancies. We report what we believe to be the first UK cancer prevalence study in the modern HAART era.MethodsA retrospective review of electronic clinic letters was performed for all patients currently receiving, and those who had died whilst receiving, their HIV care at our centre. Demographics of patients with pre‐cancerous changes, an active or previous cancer were recorded.ResultsThere were 438 active patients (369 male, 69 female) and 18 deceased patients (12 male, 6 female) in April 2014. Thirty‐six out of four hundred fifty‐six (8%) cancer diagnoses were found overall. Thirty‐one out of four hundred thirty‐eight (7%) diagnoses in active patients and 5/18 (28%) in deceased patients. More than half of those diagnosed with cancer were aged 50 or over (17/31 [55%]). In active patients 17/31 (55%) were AIDs defining cancers, with the most common type of cancer diagnosis overall being Kaposi's sarcoma (12/31 [39%]). There were 5/31 (16%) cases of non‐Hodgkin's lymphoma. The most common non‐AIDs defining cancer was basal cell carcinoma of which there were 5/31 (16%) cases, followed by squamous cell carcinoma (3/31 [10%]) and testicular cancer (3/31 [10%]). Other cancers included colorectal (2/31 [6%]) and prostate cancer (1/31 [3%]). In all five deceased patients, cancer was the cause of death. There were four acute presentations with an aggressive glioma, Burkitt's lymphoma, an undiagnosed primary lung malignancy and a late diagnosed cervical cancer. The fifth patient died following the recurrence of a transitional cell cancer of the bladder after an initial diagnosis of seven years earlier. Eighteen out of sixty‐nine (26%) of females were found to have at least mild dyskariosis on cervical screening. Anal intraepithelial neoplasia was diagnosed in 4/438 (1%) of patients.ConclusionsNon‐AIDS defining malignancies account for almost half of the cancers in our cohort. This number may rise further as patients live longer with HIV. Good communication between oncologists and HIV physicians is paramount to manage the complex interactions of HIV and cancer, increase HIV testing in cancer services and address cancer risk factors in existing HIV patients.
Prevalence and predictors of malignancies in a polycentric cohort of HIV patients from Italy
Authors: Mazzotta Elena , Tontodonati Monica , Gabrielli Chiara , Mazzocato Susanna , Mazzetti Marcello , Falasca Katia , Cenderello Giovanni , Vecchiet Jacopo , Barchiesi Francesco , Francisci Daniela , Parruti Giustino 
Published: November 2014

IntroductionHIV infected patients have a higher risk of developing cancer than the general population. Kaposi's sarcoma, non‐Hodgkin's lymphoma, primary CNS lymphoma and invasive cervical cancers are considered as AIDS defining [1]. An increased incidence in recent years has been reported also for other malignancies after the introduction of cART [2,3].Materials and MethodsWe performed a retrospective multicentric evaluation of all HIV infected patients with both AIDS and non‐AIDS defining neoplasms at six Infectious Disease Units spread throughout Italy since 1991 through 2013. Cases were compared with equal number of controls without neoplasia followed at the same institutions, matched for length of HIV infection.ResultsSince 1991, 339 consecutive cases of malignancy were collected from the six convening centres, including approximately an equal proportion of AIDS (51.2%) and non‐AIDS defining tumours. Mean prevalence of tumours among centres was 8.3% (r. 6.1%–9.6%). Mean age at tumour diagnosis was significantly lower than in controls (42.6±11.0 vs 46.8±10.6 years, respectively, p<0.0001). As to risk factors for HIV infection, approximately 1/4 (26.1%) of patients were drug abusers, in equal proportion as in controls. A remarkable higher proportion of cancer patients had CD4 T‐cell counts <200 c/mmc at time of diagnosis (45.2% vs 13.3%, p<0.0001). Seventy percent of tumours occurred in males; 52.8% of tumour patients were diagnosed with AIDS before and 19.0% at the time of tumour diagnosis. Ninety (28.1%) tumour patients were dead at the time of data collection, a much higher proportion than among cases (12.9%, p<0.0001). Deaths among non‐AIDS (20.8%) and AIDS defining tumour patients (35.0%) were significantly different (p=0.005). Predictors of AIDS defining tumours at the time of data collection were: male sex (57.9% vs 40.6%, p=0.004), CD4 T‐cell counts <200 c/mmc (63.6% vs 44.1%, p<0.0001), whereas being cART treated at the time of tumour diagnosis was protective (38.0% vs 68.0%, p<0.0001). In the final multivariate model of logistic regression, male sex (OR=2.0, p=0.03) and not being cART treated (OR=2.5, p=0.001) held as independent predictors.ConclusionsOur retrospection revealed a considerably high proportion of non‐AIDS defining tumours, apparently at rise in recent years. We registered high prevalence of tumours in each centre. Absence of cART seemed related with AIDS defining tumours: once more prevention of late presentation appeared the way to avoid worse prognosis in this setting.
CNS safety at 48‐week of switching to ATV/r plus 3TC or two nucleos(t)ides in HIV‐suppressed patients on stable ART: the SALT neurocognitive sub‐study
Authors: Pérez Valero Ignacio , Pasquau Juan , Rubio Rafael , Ribero Antonio , Santos Jose , Sanz Jesus , Mariño Ana , Crespo Manel , Hernandez Jose , Antonio Iribarren Jose , Gutierrez Felix , Terron Alberto , Esteban Herminia , Antonio Pérez‐Molina Jose 
Published: November 2014

IntroductionDue to their low CNS penetrance, there are concerns about the capacity of non‐conventional PI‐based ART (monotherapy and dual therapies) to preserve neurocognitive performance (NP).MethodsWe evaluated the NP change of aviremic participants of the SALT clinical trial [1] switching therapy to dual therapy (DT: ATV/r+3TC) or triple therapy (TT: ATV/r+2NRTI) who agreed to perform an NP assessment (NPZ‐5) at baseline and W48. Neurocognitive impairment and NP were assessed using AAN‐2007 criteria [2] and global deficit scores (GDS) [3]. Neurocognitive change (GDS change: W48 – baseline) and the effect of DT on NP evolution crude and adjusted by significant confounders were determined using ANCOVA.ResultsA total of 158 patients were included (Table 1). They had shorter times because HIV diagnosis, ART initiation and HIV‐suppression and their virologic outcome at W48 by snapshot was higher (79.1% vs 72.7%; p=0.04) compared to the 128 patients not included in the sub‐study. By AAN‐2007 criteria, 51 patients in each ART group (68% vs 63%) were neurocognitively impaired at baseline (p=0.61). Forty‐seven patients were not reassessed at W48: 30 lost of follow‐up (16 DT‐14 TT) and 17 had non‐evaluable data (6 DT‐11 TT). Patients retested were more likely to be men (78.9% vs 61.4%) and had neurological cofounders (9.6% vs 0%) than patients non‐retested. At W48, 3 out of 16 (5.7%) patients on DT and 6 out of 21 (10.5%) on TT who were non‐impaired at baseline became impaired (p=0.49) while 10 out of 37 (18.9%) on DT and 7 out of 36 (12.3%) on TT who were neurocognitively impaired at baseline became non‐impaired (p=0.44). Mean GDS changes (95% CI) were: Overall −0.2 (−0.3 to −0.04): DT −0.26 (−0.4 to −0.07) and TT −0.08 (−0.2 to 0.07). NP was similar between DT and TT (0.15). This absence of differences was also observed in all cognitive tests. Effect of DT: −0.16 [−0.38 to 0.06]) (r2=0.16) on NP evolution was similar to TT (reference), even after adjusting (DT: −0.11 [−0.33 to 0.1], TT: reference) by significant confounders (geographical origin, previous ATV use and CD4 cell count) (r2=0.25).ConclusionsNP stability was observed after 48 weeks of follow up in the majority of patients whether DT or TT was used to maintain HIV‐suppression. Incidence rates of NP impairment or NP impairment recovery were also similar between DT and TT.