bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health literacy, source of information and impact on adherence to therapy in people living with HIV
Authors: Ernst Dorner Thomas , Schulte‐Hermann Kathrin , Zanini Matteo , Leichsenring Birgit , Stefanek Wiltrut 
Published: November 2014

IntroductionAdequate information and health literacy (HL) has a high impact on patients understanding on the causes and consequences of many chronic diseases, including HIV, and is a crucial prerequisite to ensure adherence to therapy regimens. Several Austrian patient organizations developed an online survey together with MSD (the so‐called “PAB‐test”) aimed to evaluate how people living with HIV perceive the level of care in Austria.Materials and MethodsAn online survey has been developed to assess HL in people living with HIV and to evaluate the impact of HL on therapy adherence. HL was assessed with seven items regarding the self‐rated comprehension of HIV related information, which showed a high reliability (Cronbach's alpha=0.876). A low health literacy was defined by reaching a score below the median of 20 points in the related indicator.ResultsA total of 303 subjects completed the questionnaire. Women slightly had more often a low HL than men (57.1% vs 44.7%, p=0.335). Heterosexual subjects had more often a low HL compared to homosexual ones (58.3% vs 38.1%, p=0.007). Health literacy slightly increased with age (not significant). An increasing education level correlated with higher HL, (66.7%, 46.2%, and 38.9% of persons showed low HL with primary, secondary and tertiary education, respectively, p=0.037). The number of missed appointments with the HIV physician was significantly higher in the low HL population (30.0% vs 14.4%, p=0.002), which also showed to be more prone to interrupt the therapy without consulting a physician (22.4% vs 9.8%, p=0.006). The low HL population, however, did not report of having forgotten the medication intake more often than the one with high HL (33.1% vs 39.1%, p=0.305). The most important source of information is the treating physician, followed by NGOs/patient organizations and the internet (Figure 1).ConclusionsThere are significant differences in HL between different sub‐groups in the HIV community. Low HL is significantly associated with a higher frequency of missed doctor appointments and interruptions of treatment, but does not impact adherence to therapy (self‐reported). The identified information providers (medical doctors, NGOs/patient organizations) should be encouraged to contribute towards increased HL in HIV patients.
High rates of viral suppression in a cohort of HIV‐positive adults receiving ART in Ethiopian health centers irrespective of concomitant tuberculosis
Authors: Reepalu Anton , Tolera Balcha Taye , Skogmar Sten , Habtamu Jemal Zelalem , Sturegård Erik , Medstrand Patrik , Björkman Per 
Published: November 2014

IntroductionAntiretroviral therapy (ART) initiation during treatment for tuberculosis (TB) improves survival in HIV/TB co‐infected patients. Data on ART outcome for HIV/TB co‐infected patients managed in primary health care in low‐income regions is limited. We compared virological suppression rates, mortality and retention in care in HIV‐positive adults receiving care in five Ethiopian health centres with regard to TB co‐infection.Materials and MethodsHIV‐positive ART‐naïve adults eligible for ART initiation were prospectively recruited from October 2011 until March 2013. At inclusion, all patients submitted sputum for microbiological TB testing (smear microscopy, liquid culture and PCR). Virological suppression rates after six months of ART (VS; viral load <40 and <400 copies/mL) with regard to TB status was the primary outcome. The impact of HIV/TB co‐infection on VS rates was determined by multivariate regression analysis. Mortality and retention in care were analyzed by proportional hazard models.ResultsAmong 812 participants (TB 158; non‐TB 654), 678 started ART during the follow‐up period (TB 135; non‐TB 543). Median CD4 cell counts at ART initiation were 161 cells/µL (interquartile range [IQR], 98–243) and 184 (IQR, 118–256) for TB and non‐TB patients, respectively (p=0.05). No difference in retention in care between TB and non‐TB patients was observed during follow‐up; 25 (3.7%) patients died and 17 (2.5%) were lost to follow‐up (p=0.30 and p=0.83, respectively). Overall rates of VS at six months were 72.1% (<40 copies/mL) and 88.7% (<400 copies/mL), with similar results for subjects with and without TB co‐infection (<40 copies/mL: 65/92 (70.7%) vs. 304/420 (72.4%), p=0.74; <400 copies/mL: 77/92 (83.7%) vs. 377/420 (89.8%), p=0.10, respectively). CD4 cell count increase during treatment was 87 (IQR, 26–178) and 103 cells/µL (IQR, 38–173) for TB and non‐TB patients, respectively, with no significant difference between the two groups (p=0.49).ConclusionsHigh rates of VS were achieved in adults receiving ART at Ethiopian health centres managed by non‐physician clinicians, with no significant difference with regard to TB co‐infection. These findings demonstrate the feasibility of combined ART and anti‐TB treatment at primary health care level in low‐income countries. This study is registered with clinicaltrial.gov, NCT01433796.
Hepatic safety of RPV/FTC/TDF single tablet regimen in HIV/HCV‐coinfected patients. Preliminary results of the hEPAtic Study
Authors: Neukam Karin , Espinosa Nuria , Merino Dolores , Rivero‐Juárez Antonio , Carrero Ana , José Ríos María , Ruiz‐Morales Josefa , Gómez‐Berrocal Ana , Téllez Francisco , Díaz‐Menéndez Marta , Collado Antonio , Pérez‐Camacho Inés , Delgado‐Fernández Marcial , Vera‐Méndez Francisco , Pineda Juan A 
Published: November 2014

IntroductionAlthough hepatotoxicity related to antiretroviral treatment (ART) has become less frequent, hepatotoxic events, such as transaminase elevations (TE), are still a matter of concern. RPV/FTC/TDF (EPA) is a new single tablet regimen which is widely used in real life practice. Clinical trials showed an adequate profile of liver safety in the sub‐population of HIV/HCV‐coinfected patients receiving rilpivirine. However, the number of individuals included in these analyses is low [1]. The aim of this ongoing study is to evaluate the incidence of TE and total bilirubin elevations (TBE) during the first 48 weeks of EPA‐based therapy in a large population of HIV/HCV‐coinfected subjects outside of clinical trials.Patients and MethodsThis is a retrospective analysis of HIV/HCV‐coinfected subjects who started EPA at the infectious diseases units of 14 centres throughout Spain, included as cases. Subjects who started an ART different to EPA during the study period at the same hospitals were selected as controls. The primary outcome variables were grade 3 or 4 TE and grade 4 TBE.ResultsOf the 191 patients included, 31 (16.2%) subjects were naïve to ART. Eighty‐seven individuals started EPA and the remaining ones were controls. The most common NRTI backbone among the controls was TDF/FTC [59 (56.7%) patients] followed by NRTI‐sparing regimens [24 (23.1%) individuals] and ABC/3TC [17 (16.3%) subjects]. Among controls, 67 (64.4%) started a ritonavir‐boosted protease inhibitor, mainly DRV/r [41 (39.4%) patients] followed by ATV/r [16 (15.4%) subjects]. EFV, ETV and RAL were started in 16 (15.4%), 12 (11.5%) and 13 (12.5%) subjects, respectively. The median (Q1–Q3) follow‐up was 5.79 (3.65–8.61) months for the cases and 11.44 (5.8–12.88) months for the controls. TE was observed in two (2.3%) cases versus five (4.8%) controls (p=0.358), accounting for a density of incidence of 4.32/100 person‐years versus 5.51/100 person‐years [incidence rate difference (95% confidence interval): −1.88 (−9.95–6.2), p=0.354]. All TE were grade 3 and no patient discontinued ART due to TE. None of the cases developed TBE versus four (3.8%) controls, all of them receiving ATV/r.ConclusionsThe frequency of grade 3–4 TE associated with EPA in HIV/HCV‐coinfected patients under real life conditions is very low. In addition, TE in HIV/HCV‐coinfected patients treated with EPA are usually mild and do not lead to treatment discontinuation. TBE was not seen in patients taking EPA. All these data confirm that EPA is safe in this particular subpopulation.
Efficacy and tolerability of telaprevir (TVR)‐based triple therapy in HIV/HCV‐coinfected patients
Authors: De Los Santos Ignacio , Montes Marisa , Sanz‐Moreno Jose , De Miguel Julio , Sanz‐Sanz Jesus , Gaspar Gabriel , Perez‐Caballero Laura 
Published: November 2014

IntroductionClinical trials (CT) on triple therapy against HCV infection in HIV‐infected patients including TVR plus pegylated interferon and ribavirin (PR) have reported considerably higher response rates than with PR alone. This study was aimed to evaluate the efficacy and safety of triple therapy including TVR in HIV/HCV‐coinfected patients in real‐life conditions.Materials and MethodsHIV/HCV genotype 1 patients seen at four Hospitals in Madrid who received therapy including TVR plus PR for at least two weeks were included. The response was evaluated during treatment, and sustained viral response (SVR) was evaluated 12 and 24 weeks after the end of the treatment.ResultsFifty‐eight patients have been included; 79% male, median age 48 y.o.; 38% were IL28B rs12979860 genotype CT or TT, 58.6% of patients presented cirrhosis and 24.1% presented fibrosis F3. Infection with genotype 1a was observed in 53.4% of patients. Median baseline HCV‐RNA was 3,282,263 IU/mL (77.5% had >800,000 IU/mL). The most commonly used antiretroviral (ARV) drugs were tenofovir/emtricitabine [36 (62%) patients], etravirine [21 (36%) patients], abacavir/lamivudine [18 (31%) patients], boosted protease inhibitors [16 (27.5%) patients] and raltegravir [12 (20.6%) patients]. Of the 42 (72.4%) patients who had received previous HCV treatment, 13.7% were null responders, 25.8% were partial responders and 31% had relapsed. In an ITT approach, proportions of patients with undetectable HCV RNA were 67.8% (38/56) at TW4, 83.3% (40/48) at TW12, 80% (36/45) at TW24, 79.4% at TW36 (31/39) and 72% (26/36) at TW48. Fifteen (25.8%) patients discontinued HCV therapy [8 (13.8%) because they fulfilled stopping rules, 5 (8.6%) individuals due to adverse events and 2 (3.4%) were lost to follow‐up]. Rash associated with TVR (grade 1) was observed in two cases (3.4%) and all the patients showed anaemia at some point of treatment. In an analysis by ITT in the 31 patients who had a 60 week follow‐up after starting therapy, SVR‐12 was observed in 21 (67.7%) patients. And in the analysis by ITT in 28 patients who had a 72 week follow‐up after starting therapy, SVR‐24 was observed in 17 (60.7%) patients.ConclusionsResponse to triple therapy with TVR plus PR in HIV/HCV‐patients under real‐life conditions, and therefore, including a high proportion of difficult to treat patients, is similar to that found in CT. The safety profile of TVR‐based therapy is also comparable to that shown in CT, with only a rate of discontinuation of 8.6% of individuals related to toxicity.
Telaprevir or boceprevir in HIV/HCV‐1 co‐infected patients in a real‐life setting. Interim analysis (24 weeks). COINFECOVA‐SEICV study
Authors: Minguez Carlos , Ortega Enrique , Flores Juan , Carmena Jorge , Masiá Mar , Montero Marta , Reus Sergio , Tornero Carlos , Jose Galindo Maria , Garcia‐Deltoro Miguel , Amador Concepción , María Cuadrado Jose , Usó Jorge , López‐Aldeguer Jose 
Published: November 2014

IntroductionIn general, HIV co‐infected patients included in clinical trials evaluating the hepatitis C virus (HCV) therapy with telaprevir (TVR) or boceprevir (BOC) with advanced fibrosis, are scarce. We analyze data concerning the use of these drugs in a real‐life clinical setting with patients affected by a more advanced degree of fibrosis in a Spanish cohort.MethodsWe evaluated safety and efficacy in an interim analysis encompassing the first 24 weeks of triple therapy with peginterferon (alfa‐2a or alfa‐2b), ribavirin and TVR or BOC in an observational, multicentre study. HIV/HCV genotype 1 co‐infected patients beginning therapy from January 2012 to July 2013 were included.ResultsEnrolled patients were 155 (144 patients on TVR and 11 on BOC), average age was 47 years, 83% were male. With respect to HCV treatment, 44% were naïve, 13% relapsers, 17% partial responders, 21% null responders, and in seven patients, the previous response was unknown. All but three (98%) were under antiretroviral therapy (ART) (other than reverse transcriptase inhibitors, the backbone was raltegravir 43%, atazanavir 35%, and etravirine 28%). Median HCV‐RNA at baseline was 6.1 log10, 54% were cirrhotic and 38% F3. At week 4, 93% of patients continued on therapy, 81% at w12, and 73% at w24. Virological failure was observed more frequently in: cirrhotic patients (19% [95% CI, 11–27]) vs F3 (12% [CI, 4–20]); patients with TT allele of the IL28B polymorphism (40% [CI, 18–61]) vs CT (21% [CI, 12–31]), or CC (2,2% [CI, −2–6]); previous null responders (37.5% [CI, 21–54]) vs partial responders (15.4% [CI, 1–29]), naïve (13% [CI, 5–21]) or relapsers (0% [CI, 0–0]); and in patients with a genotype subtype 1a (23.6% [CI, 57–76]) vs 1b (8.1% [CI, −1–17]). Overall, 17% had virological failure and in 8% treatment was discontinued due to adverse events. Severe adverse events occurred in 30 patients (19%). Haematologic disorders were the most common type including severe anaemia in 12 (7.7%) patients. Erythropoietin was employed in 41 patients (26.4%) and 11 (7.1%) received blood transfusions. Nineteen patients (12.2%) were treated with G‐CSF, and 17 (11%) with thrombopoietin‐receptor agonists. Five patients died (3.2%), three due to hepatic decompensation, one due to pneumonia and one due to pulmonary hypertension.ConclusionsIn a real‐life setting, therapy against HCV in co‐infected patients with advanced liver fibrosis shows high virologic success at 24 weeks. However, frequent haematologic disorders are observed and a close monitoring and an intensive therapy are needed to optimize the results.
Safety analysis of raltegravir/truvada regimen in HIV/HCV co‐infected patients without switchback after HCV treatment
Authors: Ehret Robert , Walter Hauke , Ingiliz Patrick , Baumgarten Axel , Obermeier Martin , Krznaric Ivanka 
Published: November 2014

IntroductionDue to drug‐drug interactions of HIV‐ and HCV‐specific antivirals when initiating an HCV‐therapy, the antiretroviral therapy (ART) often has to be changed. The spectrum of applicable antiretrovirals is small, therefore many patients were switched to raltegravir/truvada (RAL/TVD) in our cohort. Due to the relatively low genetic barrier of RAL, this regimen may be endangered to fail, if the NRTI backbone is not fully active because of pre‐existing NRTI resistance. We investigated the long‐term follow‐up and safety of RAL/TVD in co‐infected patients after hepatitis C virus (HCV) therapy was stopped and the protective antiretroviral effect of interferon ended.Materials and MethodsTwenty patients initiated a direct‐acting antiviral (DAA) containing HCV therapy (8x faldaprevir, 6x telaprevir, 2x daclatasvir and 4x simeprevir) between 11/2011 and 01/2013. Seventeen were switched to RAL/TVD, three patients were not treated before, but started with the regimen. Diagnosis of HIV infection was dated between 1985 and 2010. The HI‐viral suppression was monitored retrospectively to date.ResultsThirteen of the twenty patients (65%) remained on RAL/TVD after finishing HCV treatment, for seven patients, no data about their ART continuation was available, after HCV therapy had stopped. All remaining thirteen patients showed an HI‐viral load below detection limit up to date (for 15 to 22 months, median 20 months). Only for four patients, historic resistance data were available but none showed NRTI mutations.ConclusionsSwitch to RAL/TVD as HIV ART due to initiating HCV therapy was safe for the observed small cohort even in long‐term follow‐up without switchback or a second ART switch. However, resistance data for the cohort was little, showing no NRTI mutations, indicating a relatively safe setting. Since no further data is available, physicians should keep in mind ART history, historical therapy failure and HIV‐resistance while switching ART to treat HCV in co‐infected patients. Further investigation in larger cohorts is needed, especially thinking of upcoming interferon‐free HCV regimen in heavily pre‐treated co‐infected patients.
Autologous stem cell transplantation in HIV‐related lymphoma in the rituximab era – a feasibility study in a monocentric cohort
Authors: Wieters Imke , Atta Johannes , Kann Gerrit , Owasil Junaid , Goepel Siri , Haberl Annette , Stephan Christoph , Wolf Timo 
Published: November 2014

IntroductionSince the introduction of highly active antiretroviral therapy (HAART) [1] and later on the availability of anti‐CD20 monoclonal antibody treatment [2], the therapeutic options as well as the prognosis of AIDS related lymphoma (ARL) have been improved. There is however no uniform agreement on how to treat patients who do not achieve a partial remission, who experience a relapse or who have very aggressive subtypes. Autologous hematopoietic stem cell transplantation (ASCT) has become an option for those patients. We retrospectively examined ARL patients to elucidate the feasibility of high‐dose chemotherapy and autologous stem cell transplantation.Patients and methodsData of seven male and one female HIV+ patients with ARL was collected and informed consent was obtained. Age, HIV disease characteristics (CD4 count, HIV‐RNA‐PCR, ART) and transplantation‐related details (histopathology, myeloablative therapy, neutrophil engraftment and NCI‐CTCAE during/after transplantation as well as follow up and survival) were obtained from the patients’ medical records.ResultsEight patients were treated with the intent of ASCT. The median age was at 64 years. Four patients had experienced prior AIDS. The median CD4 NADIR was at 157/µl, the median CD4 count at diagnosis of lymphoma at 81/µl. Five patients were receiving combination antiretroviral therapy (cART) at the time of lymphoma diagnosis, four of which had achieved a viral load of less than 50/µl. Two patients have died, due to (Nr. 8) a transplant‐related complication (non‐infectious leukoencephalophathy). The other patient died of an unknown reason (351 days after transplantation). The median survival is at 345 days to date. The time until engraftment was well at 11 days. Grade 3/4 haematological toxicity was present in all patients. Five out of three patients developed infectious complications, but there were no infection‐related deaths. One patients (Nr. 4) developed a Kaposi Sarcoma reactivation that necessitated further chemotherapy.ConclusionsASCT is feasible in high risk ARL with good engraftment. Toxicity was substantial and studies are needed to define which patients have an unduly high risk of toxicity.
Evolution trends over three decades of HIV infection late diagnosis: the experience of a Portuguese cohort of 705 HIV‐infected patients
Authors: Claudia Miranda Ana , Moneti Virginia , Brogueira Pedro , Peres Susana , Baptista Teresa , Aldir Isabel , Ventura Fernando , Borges Fernando , Mansinho Kamal 
Published: November 2014

IntroductionLate HIV diagnosis is common and associated with an increased risk of clinical progression, blunted immune response on antiretroviral (ARV) therapy and higher risk of drug toxicity. Across Europe, more than a third of patients are diagnosed late and consequently delay medical care. European Consensus definition group identify as late presentation (LP) persons, presenting for care, with a CD4 count below 350 cell/mm3 or presenting with AIDS‐defining event, regardless of CD4 cell count. Additionally, advanced HIV disease (AD) is defined by a CD4 count below 200 cell/mm3 or an AIDS defining condition in persons presenting to care.Materials and MethodsRetrospective observational study of a cohort of 705 HIV‐infected patients diagnosed between 1986 and 2014 and medically followed at an Infectious Diseases Service in Lisbon.ObjectivesEvaluate LP rate evolution in the last three decades (10‐year time intervals considered: 1986–1995; 1996–2005; 2006–2014); compare clinic, immunologic, virologic and therapeutic response over time. Identify main reasons responsible for late HIV diagnosis in order to promote optimized intervention strategies. SPSS version 20.0 was used for statistical analysis.ResultsStudy included 705 patients HIV diagnosed during 3 time intervals: group A n=82 [1986–1995]; group B n=332 [1996–2005]; group C n=291 [2006–2014]. Demographic and epidemiological characterization revealed (A vs B vs C): male predominance of 79% vs 66% vs 66%; mean age at diagnosis 30 vs 36 vs 42 years; Portugal (82% vs 70% vs 58%) and Africa (13% vs 23% vs 29%) as the main places of birth; transmission by heterosexual contact in 21% vs 47% vs 62%, MSM in 21% vs 15% vs 23% and IVDU in 57% vs 35% vs 13%. Mean CD4 at diagnosis was 362 vs 344 vs 377 cell/mm3. Considering the time intervals, LP was found in 52% vs 56% vs 52% of patients and AD in 31% vs 38% vs 35%, respectively. At first health care encounter, 46% vs 43% vs 39% of individuals presented with AIDS. Over follow up, the vast majority initiated ARV (95% vs 98% vs 84%) and mean CD4 at that time was 254 vs 282 vs 250 cell/mm3. The last immunologic and virologic determination available registered mean CD4 of 657 vs 644 vs 584 cell/mm3 and undetectable HIV plasma RNA in 92% vs 84% vs 82% of treated patients.ConclusionsThis study evidenced a maintained LP rate, slightly above 50% in each of the three analyzed last decades, and one‐third of patients presented AD at HIV diagnosis. At initial health care contact, nearly 40% of individuals met AIDS clinical or immunological criteria.
Late diagnosis among our ageing HIV population: a cohort study
Authors: Mensforth Sarah , Goodall Lisa , Bodasing Neena , Coultas James 
Published: November 2014

IntroductionWith the advent of combined antiretroviral therapy (cART), more people infected with HIV are living into older age; 22% of adults receiving care in the UK are aged over 50 years [1]. Age influences HIV infection; the likelihood of seroconversion illness, mean CD4 count and time from infection to development of AIDs defining illnesses decreases with increasing age. A UK study estimates that half of HIV infections in persons over 50 years are acquired at an age over 50 [2]. Studies exploring sexual practices in older persons have repeatedly shown that we cannot assume there is no risk of STI and HIV infection [3,4]. Physicians should be alert to risk of HIV even in the older cohort, where nearly half diagnoses are made late [2]. Local audit has demonstrated poor testing rates in the over 50's on the Acute Medical Unit. Late diagnosis (CD4<350) results in poorer outcomes and age confounds further; older late presenters are 2.4 times more likely to die within the first year of diagnosis than younger counterparts [2].Materials and MethodsA retrospective case notes review was conducted of all patients aged 60 years and over attending HIV clinic in the last 2 years. Outcomes audited included features around diagnosis; age, presentation, missed testing opportunities and CD4 count at diagnosis.ResultsOf the current cohort of 442 patients, 34 were over 60 years old (8%). Age at diagnosis in this group ranged from 36 to 80 years, mean 56.6 years. Presentation triggers included opportunistic infections or malignancies (n=10), constitutional symptoms (n=6), diagnosis of another STI (n=4), seroconversion illness (n=2), partner status (n=3). Eight patients were diagnosed through asymptomatic screening at Sexual Health. We identified missed opportunities in five patients who were not tested despite diagnoses or symptoms defined as clinical indicators for HIV. Half of older patients had a CD4 count of <200 at diagnosis.ConclusionsIt is imperative that general medical physicians and geriatricians are alert to enquiring about risk and testing for HIV where clinical indicators are present, irrespective of age. The oldest patient in the cohort was diagnosed with HIV aged 80 years. All patients with missed opportunities for testing were over 47 years old.