Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature

2021 ◽  
pp. 1-4
Author(s):  
N Seymour ◽  
M Robinson ◽  
D Richardson ◽  
H Mohammed ◽  
D Williams ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Drug Interactions ◽  
High Serum ◽  
Hiv Positive ◽  
Serum Concentrations ◽  
Intranasal Corticosteroids ◽  
Systemic Bioavailability ◽  
Immunodeficiency Virus ◽  
Intranasal Steroids

Abstract Background There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome. Method All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted. Results A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019. Conclusion The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

scholarly journals Decreased Bone Formative and Enhanced Resorptive Markers in Human Immunodeficiency Virus Infection: Indication of Normalization of the Bone-Remodeling Process during Highly Active Antiretroviral Therapy1

1999 ◽  
Vol 84 (1) ◽  
pp. 145-150 ◽  
Author(s):  
Pål Aukrust ◽  
Charlotte J. Haug ◽  
Thor Ueland ◽  
Egil Lien ◽  
Fredrik Müller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Bone Formation ◽  
Bone Remodeling ◽  
Highly Active Antiretroviral Therapy ◽  
Serum Concentrations ◽  
Marked Rise ◽  
Highly Active ◽  
Immunodeficiency Virus

As cytokines and 1,25-dihydroxyvitamin D [1,25-(OH)2D] appear to have an important role in bone homeostasis, we examined the possibility that human immunodeficiency virus (HIV)-infected patients, characterized by enhanced levels of proinflammatory cytokines and 1,25-(OH)2D deficiency, have disturbed bone metabolism by analyzing serum markers of bone formation (osteocalcin) and bone resorption (C-telopeptide) in 73 HIV-infected patients. HIV-infected patients with advanced clinical and immunological disease and high viral load were characterized by increased C-telopeptide and particularly by markedly depressed osteocalcin levels. HIV-infected patients had enhanced activation of the TNF system. Serum concentrations of p55 and p75-TNF receptors were negatively correlated with osteocalcin, and p75-TNF receptor was positively correlated with C-telopeptide. HIV-infected patients with advanced disease also had decreased serum concentrations of 1,25-(OH)2D, but this parameter was not correlated with osteocalcin or C-telopeptide. During 24 months with highly active antiretroviral therapy there was a marked rise in serum osteolcalcin levels together with a profound fall in viral load and TNF components and a marked rise in CD4+ T cell counts. Also, there was a shift from no correlation to a significant correlation between osteocalcin and C-telopeptide levels during such therapy. The present study suggests disturbed bone formation and resorption during HIV infection. Our findings indicating synchronization of bone remodeling during highly active antiretroviral therapy may represent a previously unrecognized beneficial effect of such therapy and expand our knowledge of the interactions between cytokines and bone in the bone-remodeling process.

scholarly journals Evaluation of Kidney Function Tests in HIV-Positive Patients Receiving Combined Antiretroviral Therapy

2021 ◽  
Author(s):  
emre aydın ◽  
Fatma Yılmaz Aydın ◽  
Yakup Demir ◽  
Yaşar Yıldırım ◽  
Mustafa Kemal Çelen
Keyword(s):  
Human Immunodeficiency Virus ◽  
Glomerular Filtration Rate ◽  
Antiretroviral Therapy ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Hiv Positive ◽  
Group 4 ◽  
Immunodeficiency Virus ◽  
Combined Antiretroviral Therapy ◽  
Group 5

Introduction: Human Immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases, and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material-method: A total of 127 HIV positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as Group 1; those that received Dolutegravir/Abacavir/Lamivudine combination as Group 2; those that received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as Group 3; those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as Group 4; and those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as Group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the eGFR levels of the study groups (p:<0.001). eGFR level was significantly higher in Group 4 compared to Groups 1, 2, and 3 (p:0.009, p:<0.001, p:<0.001, respectively) while it was significantly lower in Group 5 than groups 1, 2, and 3 (p:0.005, p:<0.001, p:<0.001, respectively). No significant eGFR difference was found between Group 4 and Group 5 (p>0.05). Serum creatinine level was significantly higher in Groups 4 and 5 compared to the other groups (p<0.001). Conclusion: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.

Reduction in Size and Number of Plantar Verrucae in Human Immunodeficiency Virus–Infected Individuals After the Implementation of Highly Active Antiretroviral Therapy

2015 ◽  
Vol 105 (5) ◽  
pp. 401-406 ◽  
Author(s):  
Endri Afesllari ◽  
Timothy J. Miller ◽  
Michael J. Huchital ◽  
Christy M. King ◽  
James S. Johnston ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Clinical Manifestations ◽  
Hiv Positive ◽  
Highly Active ◽  
Clinical Type ◽  
Size Number ◽  
Study Results ◽  
Immunodeficiency Virus

Background Implementation of highly active antiretroviral therapy (HAART) significantly increased the life expectancy of those living with human immunodeficiency virus (HIV). Except for prevalence, scientific reports regarding clinical manifestations of plantar verrucae in the post-HAART era are lacking. The objective of this study was to compare clinical manifestations of plantar verrucae between HIV-infected and noninfected individuals and then to compare these findings with those observed before the implementation of HAART. Methods Nineteen patients with plantar verrucae (ten with HIV and nine without HIV) were examined to determine the size, number, and clinical type of verrucae present. The two groups were first compared with each other and then with previously collected data from a similar analysis conducted in 1995, before the implementation of HAART. Statistical significance was determined using the Fisher exact test or the Wilcoxon rank sum test. Results No significant differences were observed in the size, number, or clinical type of verrucae between HIV-negative and HIV-positive patients. Compared with the 1995 data, there was a significant decrease in the number of verrucae lesions per individual and a nonsignificant decrease in the average size of verrucae in HIV-positive patients. Conclusions Study results indicate that the implementation of HAART has impacted the clinical manifestations of plantar verrucae in HIV-positive individuals. Further analyses with a larger number of patients are required to confirm and substantiate these findings.

Prevalence of Plantar Verrucae in Patients with Human Immunodeficiency Virus Infection During the Post–Highly Active Antiretroviral Therapy Era

2011 ◽  
Vol 101 (1) ◽  
pp. 35-40 ◽  
Author(s):  
James Johnston ◽  
Christy M. King ◽  
Sky Shanks ◽  
Saieh Khademi ◽  
Joseph Nelson ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Logistic Regression ◽  
Antiretroviral Therapy ◽  
Life Expectancy ◽  
Confidence Interval ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Hiv Positive ◽  
Highly Active ◽  
Immunodeficiency Virus

Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population. Methods: Attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIV-positive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity. Results: Patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5–11.0, P &lt; .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4–29.0, P &lt; .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1–9.9, P = .0002). Conclusions: Patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine. (J Am Podiatr Med Assoc 101(1): 35–40, 2011)

scholarly journals Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi

2008 ◽  
Vol 38 (1) ◽  
pp. 5-7 ◽  
Author(s):  
Simon D Makombe ◽  
Anthony D Harries ◽  
Joseph Kwong-Leung Yu ◽  
Mindy Hochgesang ◽  
Eustice Mhango ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Unfavourable Prognosis ◽  
Sub Saharan

AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.

scholarly journals Enhancement of Human Immunodeficiency Virus (HIV)-Specific CD8+ T Cells in Cerebrospinal Fluid Compared to Those in Blood among Antiretroviral Therapy-Naïve HIV-Positive Subjects

2008 ◽  
Vol 82 (21) ◽  
pp. 10418-10428 ◽  
Author(s):  
Shanmugalakshmi Sadagopal ◽  
Shelly L. Lorey ◽  
Louise Barnett ◽  
Rebecca Basham ◽  
Laurie Lebo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
T Cells ◽  
Cerebrospinal Fluid ◽  
Antiretroviral Therapy ◽  
Ex Vivo ◽  
Brain Magnetic Resonance Imaging ◽  
Hiv Positive ◽  
Lymphoid Tissues ◽  
Normal Brain ◽  
Immunodeficiency Virus

ABSTRACT During untreated human immunodeficiency virus type 1 (HIV-1) infection, virus-specific CD8+ T cells partially control HIV replication in peripheral lymphoid tissues, but host mechanisms of HIV control in the central nervous system (CNS) are incompletely understood. We characterized HIV-specific CD8+ T cells in cerebrospinal fluid (CSF) and peripheral blood among seven HIV-positive antiretroviral therapy-naïve subjects. All had grossly normal brain magnetic resonance imaging and spectroscopy and normal neuropsychometric testing. Frequencies of epitope-specific CD8+ T cells by direct tetramer staining were on average 2.4-fold higher in CSF than in blood (P = 0.0004), while HIV RNA concentrations were lower. Cells from CSF were readily expanded ex vivo and responded to a broader range of HIV-specific human leukocyte antigen class I restricted optimal peptides than did expanded cells from blood. HIV-specific CD8+ T cells, in contrast to total CD8+ T cells, in CSF and blood were at comparable maturation states, as assessed by CD45RO and CCR7 staining. The strong relationship between higher T-cell frequencies and lower levels of viral antigen in CSF could be the result of increased migration to and/or preferential expansion of HIV-specific T cells within the CNS. This suggests an important role for HIV-specific CD8+ T cells in control of intrathecal viral replication.

scholarly journals HAART: a risk factor for development of porphyria cutanea tarda?

2012 ◽  
Vol 45 (6) ◽  
pp. 764-767 ◽  
Author(s):  
Fred Bernardes Filho ◽  
Maria Victória Pinto Quaresma Santos ◽  
Felipe Nazareth de Matos Pinto de Carvalho ◽  
Carlos Gustavo Carneiro de Castro ◽  
Elisabete Dobao ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Porphyria Cutanea Tarda ◽  
Hiv Positive ◽  
Uroporphyrinogen Decarboxylase ◽  
Highly Active ◽  
Immunodeficiency Virus ◽  
Partial Deficiency ◽  
Alcohol Hepatitis

Porphyria cutanea tarda (PCT) is caused by inherited or acquired partial deficiency of the uroporphyrinogen-decarboxylase (Uro-D) enzyme activity. It is the most common form of porphyria. The main triggering factors to the development of porphyria cutanea tarda are alcohol, hepatitis C virus and human immunodeficiency virus. There are several reports of PCT associated with drugs, among them, antiretroviral therapy. We describe three HIV-positive patients, which showed photosensitivity as well as the emergence of tense blisters on sun-exposed areas during the use of highly active antiretroviral therapy (HAART) and discuss the possibility of PCT after the use of these drugs by those patients.

scholarly journals TAILoR (TelmisArtan and InsuLin Resistance in Human Immunodeficiency Virus [HIV]): An Adaptive-design, Dose-ranging Phase IIb Randomized Trial of Telmisartan for the Reduction of Insulin Resistance in HIV-positive Individuals on Combination Antiretroviral Therapy

2019 ◽  
Vol 70 (10) ◽  
pp. 2062-2072 ◽  
Author(s):  
Sudeep Pushpakom ◽  
Ruwanthi Kolamunnage-Dona ◽  
Claire Taylor ◽  
Terry Foster ◽  
Cath Spowart ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Primary Outcome ◽  
Adaptive Design ◽  
Stage Ii ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
Immunodeficiency Virus ◽  
Dose Ranging

Abstract Background Combination antiretroviral therapy results in metabolic abnormalities which increase cardiovascular disease risk. We evaluated whether telmisartan reduces insulin resistance in human immunodeficiency virus (HIV)–positive individuals on antiretrovirals. Methods We conducted a multicenter, randomized, open-label, dose-ranging controlled trial of telmisartan. Participants with HIV infection receiving combination antiretroviral therapy were randomized equally to either no intervention (control) or 20, 40, or 80 mg telmisartan once daily. The adaptive design allowed testing of all dose(s) of telmisartan in stage I, with the promising dose(s) being taken into stage II. The primary outcome measure was reduction in homeostasis model assessment of insulin resistance (HOMA-IR) at 24 weeks. Results A total of 377 patients were recruited. In stage I, 48, 49, 47, and 45 patients were randomized to control and 20, 40, and 80 mg telmisartan, respectively (total n = 189). At the interim analysis, 80 mg telmisartan was taken forward into stage II. At the end of stage II (n = 105, control; 106, 80-mg arm), there were no differences in HOMA-IR (estimated effect, 0.007; SE, 0.106) at 24 weeks between the telmisartan (80 mg) and nonintervention arms. Longitudinal analysis over 48 weeks showed no change in HOMA-IR, lipid or adipokine levels. There were significant (P ≤ .05), but marginal, improvements in revised Quantitative Insulin Sensitivity Check Index (QUICKI) (0.004) and plasma hs-CRP (−0.222 mg/L) and reduction in liver fat content (1.714 mean reduction; P = .005). Conclusions No significant effect of telmisartan was demonstrated on the primary outcome (HOMA-IR), but there were marginal improvements with some secondary outcome measures. Further studies in this population are warranted to identify novel strategies for preventing cardiovascular morbidity and mortality. Clinical Trial Registration ISRCTN registry (51069819).

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