scholarly journals NeuroAIDS: An Evolving Epidemic

2009 ◽  
Vol 36 (03) ◽  
pp. 285-295 ◽  
Author(s):  
Christopher Power ◽  
Lysa Boissé ◽  
Sean Rourke ◽  
M. John Gill
Keyword(s):  
Nervous System ◽  
Hiv Infection ◽  
Neurological Disorders ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Sensory Neuropathy ◽  
Antiretroviral Drugs ◽  
System Disease ◽  
Highly Active ◽  
Increased Risk

Over 60,000 Canadians are infected with human immunodeficiency virus (HIV). Greater than 50% of these individuals will develop a neurological disorder despite the availability of highly active antiretroviral therapy. HIV causes nervous system disease at all stages of infection with adverse effects on quality of life, adherence to medications, employment and survival. These disorders include opportunistic infections in addition to distinct HIV-associated neurological syndromes and undesirable treatment-related effects. The latter two groups of disorders are often undiagnosed and untreated in both adolescents and adults. Direct HIV infection of central nervous system causes HIV-associated dementia, which is a progressive subcortical dementia. HIV infection of the peripheral nervous system produces a painful sensory neuropathy termed distal sensory polyneuropathy, which may be exacerbated by several antiretroviral drugs. Other important HIV-induced neurological disorders include vacuolar myelopathy and an increased risk of seizures. Future issues that will confound the presentation and treatment of HIV-induced nervous system disorders include the increasing prevalence of drug-resistant HIV strains, increasing age of HIV-infected patients, hepatitis C virus co-infection and the Immune Reconstitution Inflammatory Syndrome. Herein, we review the clinical presentations, underlying pathogenesis and treatments of this burgeoning group of neurological disorders.

Neuro-AIDS: Current status and Challenges to Antiretroviral Drug Therapy (ART) for Its Treatment.

2020 ◽  
Vol 15 ◽  
Author(s):  
Smita P. Kakad ◽  
Sanjay J. Kshirsagar
Keyword(s):  
Nervous System ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Sensory Neuropathy ◽  
Current Status ◽  
Viral Reservoir ◽  
Viral Reservoirs ◽  
Highly Active ◽  
Aids Therapy ◽  
The Brain

Introduction: The infiltration of HIV into the brain alters the functions of the nervous system known as NeuroAIDS. It leads to neuronal defects clinically manifested by motor and cognitive dysfunctions. Materials/Methods: Current antiretroviral therapy can prevent viral replication but cannot cure the disease completely. HAART-Highly active antiretroviral therapy used for the treatment of HIV infection. Challenges in neuro-AIDS therapy are as shown in the graphical abstract. One of the challenges is latent viral reservoirs like the brain; which acts as a sanctuary site for viruses. Nearly ~50% of HIV patients show neuropathological signs. Nervous system related disorders including AIDS dementia, sensory neuropathy, and myelopathy have a 25% of prevalence in patients having access to a highly active combination antiretroviral therapy. Results/Conclusions: Brain is one of the viral sanctuary sites for HIV. The current need of neuro-AIDS therapy is to target the brain as a viral reservoir. Drugs should cross or bypass the blood-brain barrier to reach the brain with effective concentrations. Current research on novel drug delivery approaches may prove helpful to treat neuro-AIDS and related disorders effectively.

scholarly journals Reasons for immunologic inefficiency of antiretroviral therapy in patients with HIV

2014 ◽  
Vol 95 (4) ◽  
pp. 581-588 ◽  
Author(s):  
A F Oleynik ◽  
V Kh Fazylov
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Immunological Response ◽  
Response To Treatment ◽  
Highly Active ◽  
Cell Counts ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Cd4 Lymphocytes

The main component of the treatment of patients with HIV infection is highly active antiretroviral therapy (HAART), which can help to control the disease. The main goal of HAART is to increase the life duration and to maintain the quality of patients’ life. Improved survival among HIV-infected patients receiving highly active antiretroviral therapy is achieved mainly by a decrease of HIV RNA viral load, which increases CD4 lymphocytes count. However, some patients may present with discordant response to treatment, when there is no CD4 lymphocyte count elevation associated with the virus disappearing from the blood. Such patients retain immunodeficiency, despite long-term treatment. The risk of opportunistic infections on the background of insufficient immunological response, despite viral replication suppression, is higher than in patients with good immunological response to treatment. Consistently low CD4 cell counts are associated with an increased risk of AIDS diagnosis. Furthermore, this group of patients shows a slight increase in mortality not associated with AIDS-defining illnesses. The reasons for the low CD4 lymphocytes count increase in some patients achieving virologic response to HAART remain unclear. The immunological efficacy of treatment depends on many factors: baseline CD4 count, duration of HIV infection prior to HAART initiation, age, co-infection with HCV, presence of secondary diseases and comorbidities, HAART regimens, IL-2 use and others. Literature review covers the phenomenon of immunological «non-response» to HAART, factors leading to its development, and possible methods of correction. Currently, there are more questions than answers in the area of immunological non-effectiveness of HAART in HIV-infected patients.

scholarly journals Trends in Mortality From Human Immunodeficiency Virus Infection, 1984–2016: An Autopsy-Based Study

2019 ◽  
Vol 144 (5) ◽  
pp. 572-579 ◽  
Author(s):  
Sobia Nizami ◽  
Cameron Morales ◽  
Kelly Hu ◽  
Robert Holzman ◽  
Amy Rapkiewicz
Keyword(s):  
New York ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
City Hospital ◽  
Aids Epidemic ◽  
Highly Active ◽  
Immunodeficiency Virus

Context.— With increasing use and efficacy of antiretroviral therapy for human immunodeficiency virus (HIV) infection, deaths from acquired immunodeficiency syndrome (AIDS)–defining conditions have decreased. Objective.— To examine trends in the cause of death of HIV-infected patients who underwent autopsy at a major New York City hospital from 1984 to 2016, a period including the major epochs of the AIDS epidemic. Design.— Retrospective review of autopsy records and charts with modeling of trends by logistic regression using polynomial models. Results.— We identified 252 autopsies in adult patients with AIDS (by 1982 definition) or HIV infection. Prior to widespread use of highly active antiretroviral therapy, in 1984–1995, on average 13 autopsies per year were done. Post–highly active antiretroviral therapy, the average number of autopsies declined to 4.5 per year. The fitted mean age at death was 35 years in 1984 and increased curvilinearly to 46 years (95% CI, 43–49) in 2016 (P < .001). By regression analysis, mean CD4+ T-cell count increased from 6 in 1992 to 64 in 2016 (P = .01). The proportion of AIDS-defining opportunistic infections decreased, from 79% in 1984–1987 to 41% in 2008–2011 and 29% in 2012–2016 (P = .04). The frequency of nonopportunistic infections, however, increased from 37% in 1984–1987 to 73% in 2008–2011 and 57% in 2012–2016 (P = .001). The frequency of AIDS-defining and other malignancies did not change significantly during the study period. The prevalence of atherosclerosis at autopsy rose dramatically, from 21% in 1988–1991 to 54% in 2008–2011 (P < .001). Conclusions.— Despite limitations of autopsy studies, many trends in the evolution of the HIV/AIDS epidemic are readily discernable.

HIV and increased risk of cardiovascular diseases

Sexual Health ◽  
2005 ◽  
Vol 2 (4) ◽  
pp. 219 ◽  
Author(s):  
Satyajit Das
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Survival Rate ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Observational Studies ◽  
Insulin Metabolism ◽  
Highly Active ◽  
Increased Risk ◽  
Fat Redistribution

Highly active antiretroviral therapy (HAART) has significantly increased the survival rate of patients with HIV. However, abnormalities of lipid and insulin metabolism have been recognised and there is an increasing prevalence of fat redistribution, frank diabetes and hyperlipidaemia in HIV-infected patients receiving HAART. Several observational studies have described associations between HIV infection, HAART and cardiovascular disease. The management of risk factors for cardiovascular disease is expected to play an important role in the treatment of HIV infection.

scholarly journals Predictors and consequences of anaemia among antiretroviral-naïve HIV-infected and HIV-uninfected children in Tanzania

2009 ◽  
Vol 13 (2) ◽  
pp. 289-296 ◽  
Author(s):  
Anirban Chatterjee ◽  
Ronald J Bosch ◽  
Roland Kupka ◽  
David J Hunter ◽  
Gernard I Msamanga ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Child Survival ◽  
Hiv Prevalence ◽  
Maternal Characteristics ◽  
Survival Status ◽  
Highly Active ◽  
Cell Counts ◽  
Hiv Positive Women ◽  
Increased Risk

AbstractObjectivePredictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality.DesignProspective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth.SettingDar es Salaam, Tanzania.SubjectsThe study sample consisted of 829 children born to HIV-positive women.ResultsAdvanced maternal clinical HIV disease (relative risk (RR) for stage ≥2 v. stage 1: 1·31, 95 % CI 1·14, 1·51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3v. ≥350 cells/mm3: 1·58, 95 % CI 1·05, 2·37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1·99, 95 % CI 1·06, 3·72).ConclusionsComprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence.

Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era

2005 ◽  
Vol 11 (0) ◽  
pp. 72-82 ◽  
Author(s):  
Christian Manzardo ◽  
María del Mar Ortega ◽  
Omar Sued ◽  
Felipe García ◽  
Asunción Moreno ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Developed Countries ◽  
Highly Active

scholarly journals Insulin Resistance and Glucose Dysregulation in Hiv Treated Patients

2018 ◽  
Vol 6 (03) ◽  
Author(s):  
Prof. Xu Yancheng ◽  
Salama A. ALI ◽  
Ass. Prof Chen Xiaoqi
Keyword(s):  
Insulin Resistance ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Current Knowledge ◽  
Antiretroviral Drugs ◽  
Fat Accumulation ◽  
Highly Active ◽  
Age Related ◽  
Glucose Dysregulation

The emergence of a new HIV infected elderly population as a result of chronic use of highly active antiretroviral therapy (HAART) has attributed to the increase of metabolic disorders particularly insulin resistance(IR) and diabetes, dyslipidemia and lipodystrophy.The pathogenesis of these metabolic derangements is complex and multifactorial and could be a consequence of an interplay between traditional age-related risk factors, HIV infection, antiretroviral therapy effects, the inflammatory effect and immune activation in this population. IR in HIV infection has numerous causes which include not only the direct effects of antiretroviral drugs but also factors such as aging and restoration to health accompanied by fat accumulation. Studies have shown that insulin levels increase over time with antiretroviral therapy, likely the result of improved health, fat accumulation, and aging, and that increases in visceral fat and upper trunk fat are associated with a higher risk of IR in HIV infected and uninfected individuals. Since metabolic and cardiovascular disease (CVD) increase with aging, knowledge of the optimal management of these conditions is essential for practitioners caring for HIV infected patients including endocrine subspecialists. This review aims to synthesize the current knowledge on insulin resistance and dysregulation of glucose on treated HIV population

scholarly journals Disseminated Mycobacterium avium complex in an adolescent with perinatally-acquired HIV infection

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Nurul I. Hariadi ◽  
R. Alexander Blackwood
Keyword(s):  
Hiv Infection ◽  
Mycobacterium Avium ◽  
Highly Active Antiretroviral Therapy ◽  
Mycobacterium Avium Complex ◽  
Opportunistic Infections ◽  
Cd4 Cell Count ◽  
Gm Csf ◽  
Highly Active ◽  
Perinatally Acquired ◽  
Immunodeficiency Syndrome

<em>Mycobacterium avium complex</em> (MAC) is the most frequent nontuberculous mycobacteria implicated in opportunistic infections that define acquired immunodeficiency syndrome. With highly active antiretroviral therapy, disseminated MAC (dMAC) has become a rare entity. This unique case of dMAC was diagnosed in an adolescent with newly diagnosed perinatally- acquired HIV infection whose initial CD4 cell count was severely depleted and viral load was extremely high. While maximized treatment regimen had not been able to control his dMAC, improvement was noted when granulocyte macrophage colony-stimulating factor (GM-CSF) was added. GM-CSF should be considered as an adjunctive therapy in patients with refractory dMAC.

scholarly journals Impact of HIV infection and smoking on lung immunity and related disorders

2015 ◽  
Vol 46 (6) ◽  
pp. 1781-1795 ◽  
Author(s):  
Theresa M. Rossouw ◽  
Ronald Anderson ◽  
Charles Feldman
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Healthcare Providers ◽  
Adverse Health Effects ◽  
Highly Active ◽  
Life Years ◽  
Primary Focus ◽  
The Impact

HIV-infected persons not only have higher rates of smoking than the general population, but are also unusually vulnerable to the associated adverse health effects, both infective and noninfective in origin. Indeed, in the setting of well-organised care and availability of highly active antiretroviral therapy, HIV-infected smokers lose more life-years to smoking than to HIV infection per se, presenting a major challenge to healthcare providers. Not surprisingly, the respiratory system is particularly susceptible to the damaging interactive chronic inflammatory and immunosuppressive effects of HIV and smoking, intensifying the risk of the development of opportunistic infections, as well as lung cancer and obstructive lung disorders. The impact of smoking on the immunopathogenesis and frequencies of these respiratory conditions in the setting of HIV infection, as well as on the efficacy of antiretroviral therapy, represent the primary focus of this review.

Sign in / Sign up

Export Citation Format

Share Document