scholarly journals Impact of the M184V Resistance Mutation on Virological Efficacy and Durability of Lamivudine-Based Dual Antiretroviral Regimens as Maintenance Therapy in Individuals With Suppressed HIV-1 RNA: A Cohort Study

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Roberta Gagliardini ◽  
Arturo Ciccullo ◽  
Alberto Borghetti ◽  
Franco Maggiolo ◽  
Dario Bartolozzi ◽  
...  
Keyword(s):  
Resistance Mutation ◽  
Dual Therapy ◽  
Virologic Suppression ◽  
Lamivudine Resistance ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
History Of ◽  
Cd4 Cell ◽  
Virological Efficacy ◽  
Selection Of

Abstract Background Dual therapy (DT) with boosted protease inhibitors (bPIs) plus lamivudine has been shown to be superior to bPI monotherapy in virologically suppressed patients despite previous selection of the lamivudine resistance M184V mutation. We compared the virological efficacy of lamivudine-based DT in patients with and without a history of M184V detection. Methods We retrospectively analyzed patients with HIV-RNA ≤50 copies/mL switching to DT with at least 1 previous resistance genotype in the ARCA database. Time to virological failure (VF; HIV-RNA ≥200 copies/mL or 2 consecutive HIV-RNA >50 copies/mL) and to treatment discontinuation (TD) was analyzed by survival analysis. Results Four hundred thirty-six patients switching to lamivudine plus bPIs (70%) or integrase inhibitors (30%) were included. Patients with M184V (n = 87) were older, had lower nadir CD4+ cell count, longer duration of antiretroviral therapy and of virologic suppression, and higher rate of hepatitis C virus infection compared with patients without M184V. The 3-year probability of remaining free from VF was 91.9% (95% confidence interval [CI], 86.6–97.2) without M184V and 87.8% (95% CI, 78.4–97.2) with M184V (P = .323). The time to TD did not differ between groups. Multivariate analysis adjusting for baseline variables differing between groups also did not detect M184V as being associated with VF or TD; however, the 3-year probability of remaining free of viral blips (isolated HIV-RNA 51–199 copies/mL) was 79.8% (95% CI, 67.8%–91.8%) with M184V vs 90.1% (95% CI, 84.0%–96.2%) without M184V (P = .016). Conclusions Previous selection of M184V did not increase the risk of VF or TD with lamivudine-based DT but was associated with a higher probability of viral blips.

scholarly journals Evaluation of the Efficacy and Tolerability of Dolutegravir Plus Lamivudine as a Switch Strategy in Treatment-experienced HIV-infected Patients

2020 ◽  
Author(s):  
Wei Hua ◽  
Sen Wang ◽  
Bin Su ◽  
Wenxin Wang ◽  
An Liu ◽  
...  
Keyword(s):  
Safety Data ◽  
Dual Therapy ◽  
Drug Regimen ◽  
Clinical Findings ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Prior Art ◽  
Cd4 Cell ◽  
Switch Strategy

Abstract Background: Dual therapy containing dolutegravir (DTG) plus lamivudine (3TC) is a reasonable alternative antiretroviral therapy (ART) option in treatment-experienced patients, which could prevent long-term toxicity and reduce treatment cost. But so far, the effectiveness as safety data of this two-drug regimen is still limited. Methods: This observational study included treatment-experienced HIV-infected patients who switched to a dual regimen containing DTG (50mg/QD) plus 3TC (300mg/QD). Efficacy (HIV RNA <50 copies/mL), safety, and metabolic changes based on laboratory and clinical findings at 48 weeks were analyzed.Results: A total of 33 patients were included, who switched for the following reasons: treatment failure in 5 /33patients (15.2%), simplification in 10 patients (30.3%), and drug toxicity in 18 patients (54.5%). The patients were treated with ART for a median of 2.1 years (interquartile range = 1.0-4.2) before drug switching, and 28/33(84.8%) patients were virologically suppressed at baseline. After switching to DTG plus 3TC, all 33 patients (100%) showed HIV RNA <50 copies/mL after 48 weeks, and the CD4+ cell count was significantly increased (+82 cell/mm3, p=0.0071). We observed a significant increase in LDL-C (+0.77mg/dL, p<0.0001) after switch, however, triglycerides (-0.6mg/dL, p=0.0179) and cholesterol/HDL-C ratio (-0.327, p=0.0366) were found significantly decreased. A significant decrease in eGFR was also observed (-17.8 ml/min, p=0.0047). No patient discontinued due to adverse events.Conclusions: The use of dual therapy containing DTG and 3TC is effective and well-tolerated in treatment-experienced patients under any prior ART, without significant adverse drug reaction.

scholarly journals FRAILTY AND PRE-FRAILTY IN A CONTEMPORARY COHORT OF HIV-INFECTED ADULTS

2014 ◽  
pp. 1-8
Author(s):  
N.F. ÖNEN ◽  
P. PATEL ◽  
J. BAKER ◽  
L. CONLEY ◽  
J.T. BROOKS ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Physical Inactivity ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
History Of ◽  
Observational Cohort ◽  
Cd4 Cell ◽  
Population Design ◽  
D Dimer

Objectives: To determine the prevalence of pre-frailty among HIV-infected persons and associationswith pre-frailty and frailty in this population. Design, Setting and Participants:From a contemporary,prospective observational cohort of HIV-infected persons (SUN Study), we determined, using a cross-sectionalanalytic study design, the proportions of non-frail, pre-frail, and frail persons by the respective presence of 0, 1-2, and ≥ 3 of 5 established frailty criteria: unintentional weight loss, exhaustion, physical-inactivity, weak-gripand slow-walk. We evaluated associations with pre-frailty/frailty using multivariate analysis. Results:Of 322participants assessed (79% men, 58% white non-Hispanic, median age 47 years, 95% on combinationantiretroviral therapy [cART], median CD4 + cell count 641 cells/mm3 and 93% HIV RNA < 400 copies/mL),57% were non-frail, 38% pre-frail, and 5% frail. Age increased from non-frailty through frailty. Notably,however, half of pre-frail and frail participants were < 50 years, and of those, 42% and 100%, respectively, werelong-term unemployed (versus 16% of non-frail counterparts). In multivariate analysis, pre-frail/frailparticipants were more likely to have Hepatitis C seropositivity (adjusted odds ratio [aOR] 3.24, 95% CI: 1.35-7.78), a history of AIDS-defining-illness (aOR 3.51, 95% CI: 1.82-6.76), greater depressive symptoms (aOR1.16, 95% CI:1.09-1.23), higher D-dimer levels (aOR 2.94, 95% CI:1.10-7.87), and were less likely to be whitenon-Hispanic (aOR 0.35, 95% CI: 0.20-0.61). Conclusions:Pre-frailty and frailty are prevalent in the cART eraand are associated with unemployment even among persons < 50 years. Pre-frailty appears to be an intermediatestate in the spectrum from non-frailty through frailty and our characterization of pre-frailty/frailty suggestscomplex multifactorial associations.

scholarly journals RISK FACTORS FOR THE DEVELOPMENT OF NON-HODGKIN’S LYMPHOMA IN PATIENTS WITH HIV AND HEPATITIS С COINFECTION

2013 ◽  
Vol 18 (5) ◽  
pp. 4-8
Author(s):  
E. L Melnikova ◽  
E. V Volchkova ◽  
E. V Ivannikov ◽  
A. Ya Olshansky ◽  
V. N Vdovina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Viral Load ◽  
Cell Count ◽  
Hodgkin's Lymphoma ◽  
Virologic Suppression ◽  
Hiv Viral Load ◽  
Cd4 Cell Count ◽  
The Mean ◽  
Hcv Coinfection ◽  
Cd4 Cell

The objective of the study was to investigate risk factors for the development of non-Hodgkin's lymphoma (NHL) in HIV-infected patients with hepatitis С virus (HCV) coinfection. A total of 37 HIV-positive subjects with NHL treated in the Moscow Center for Prevention and Control of AIDS between 2009 and 2013 were included in the study. HIV patients were divided into 2 groups: 23 cases with HCV coinfection and 14 patients without HCV coinfection. At the time of making the diagnosis of NHL 90% of patients had CD4 cell count < 350 cell/mm 3. The mean CD4 cell count in the first group (120±123 cell/mm 3) was significantly lower (p=0,035), than in patients without HCV coinfection (267±253 cell/mm3). At the time of making the diagnosis of NHL 70% of patients had HIV viral load ≥5,00 log10. The mean viral load was 5,47±1,09 log10 copies/ml in the first group and 4,06±2,03 log10 copies/ml in the second group (p=0,033). At the time of making the diagnosis of NHL 78% of patients did not receive combination antiretroviral therapy (cART). In most patients who received cART virologic suppression unsufficient and CD4 cell count remained to be low. Risk factors associated with an increased risk of NHL in HIV-infected patients with HCV coinfection are low CD4 cell count, high HIV viral load and lack of effective cART. Timely initiation of cART followed by complete virologic suppression and CD4 recovery are key factors to prevent NHL in HIV-infected patients.

scholarly journals Patterns of Use and Outcomes in Patients Treated with Etravirine in the HIV Research Network

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Kelly Gebo ◽  
Cindy Voss ◽  
Joseph Mrus ◽  
HIV Research Network
Keyword(s):  
Clinical Care ◽  
Primary Objective ◽  
Research Network ◽  
Virologic Suppression ◽  
Cd4 Cell Count ◽  
Patterns Of Use ◽  
Regimen Change ◽  
Hiv Research ◽  
Cd4 Cell ◽  
Hiv 1

This observational analysis examined the clinical outcomes of patients receiving etravirine-(ETR-) based therapy, particularly with protease inhibitors (PIs) other than darunavir (DRV) and with raltegravir (RAL). Data included treatment-experienced adults in the HIV Research Network who began ETR-containing antiretroviral regimens in 2008–2010. The primary objective was to assess 6-month outcomes (durability, i.e., still on an ETR-containing regimen; change in CD4+ cell count and HIV-1 RNA <400 copies/mL). The cohort included 587 patients receiving ETR; 42% of ETR use was in patients not on DRV/ritonavir (r). Patients receiving ETR plus DRV/r had longer durability versus those on ETR plus a PI other than DRV/r at months 6 (91.2% versus 85.5%) and 12 (77.4% versus 65.2%), respectively. Patients on regimens with a PI other than DRV/r were the least likely to be receiving ETR at month 6 (85.5%) versus patients on other ETR-based regimens. Patients on regimens without a PI and without RAL had lower virologic suppression (month 6, 54.2%; month 12, 63.2%) versus patients on other ETR-based regimens. In a clinical care, nontrial setting, ETR was used in regimens without DRV/r. In this population, the 6-month response rates were similar and durable across all regimens, except when ETR was used without RAL and without a PI.

Brain tumour? – Cerebellar histoplasmosis as a solitary mass lesion

2019 ◽  
Vol 30 (12) ◽  
pp. 1218-1220 ◽  
Author(s):  
Michael Riste ◽  
Neena Bodasing ◽  
Anthony Cadwgan
Keyword(s):  
Histoplasma Capsulatum ◽  
Brain Magnetic Resonance Imaging ◽  
Brain Biopsy ◽  
Ataxic Gait ◽  
Stereotactic Brain Biopsy ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Cd4 Cell ◽  
Inflammatory Syndrome

A 50-year-old man who had been living in Thailand presented with a history of falls, deteriorating vision and weight loss over several months. He had been admitted to a hospital in Thailand where he was given a diagnosis of multiple sclerosis. Neurological examination revealed a mild ataxic gait and lateral nystagmus, but no other abnormalities. He tested positive for human immunodeficiency virus with a CD4 cell count of 16 cells/µL. Brain magnetic resonance imaging was suggestive of an intrinsic neoplasm and he underwent stereotactic brain biopsy which showed numerous yeast-like organisms. Panfungal polymerase chain reaction was positive for Histoplasma capsulatum. He received liposomal amphotericin B for six weeks, followed by itraconazole, and started antiretroviral therapy four weeks into treatment. He developed an immune reconstitution inflammatory syndrome which responded well to steroids. Six months after diagnosis, he has no neurological symptoms or signs and remains on itraconazole. Isolated bulky central nervous system histoplasmomas are exceedingly rare. A clinical suspicion of immunosuppression was key in making this diagnosis.

HIV RNA and CD4 cell count response to protease inhibitor therapy in an urban AIDS clinic: response to both initial and salvage therapy

AIDS ◽  
1999 ◽  
Vol 13 (6) ◽  
pp. F35-F43 ◽  
Author(s):  
Steven G. Deeks ◽  
Frederick M. Hecht ◽  
Melinda Swanson ◽  
Tarek Elbeik ◽  
Richard Loftus ◽  
...  
Keyword(s):  
Protease Inhibitor ◽  
Cell Count ◽  
Salvage Therapy ◽  
Inhibitor Therapy ◽  
Protease Inhibitor Therapy ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Count Response ◽  
Cd4 Cell

Initiation of highly active antiretroviral therapy in advanced AIDS with CD4 < 50 cells/mm3 in a resource-limited setting: efficacy and tolerability

2005 ◽  
Vol 16 (3) ◽  
pp. 243-246 ◽  
Author(s):  
Somnuek Sungkanuparph ◽  
Sasisopin Kiertiburanakul ◽  
Weerawat Manosuthi ◽  
Wiphawee Kiatatchasai ◽  
Asda Vibhagool
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Highly Active Antiretroviral Therapy ◽  
Adverse Drug Events ◽  
Opportunistic Infections ◽  
Transcriptase Inhibitor ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Highly Active ◽  
Cd4 Cell

In developing countries, patients often present late with advanced AIDS and a very low CD4 cell count. A retrospective cohort study was conducted in HIV-infected patients who had been initiated into highly active antiretroviral therapy (HAART) with CD4 cell count <50 cells/mm3. There were 159 patients of mean age 36.6 years and 60.4% had previous major opportunistic infections. Mean CD4 was 22 cells/mm3 and 80% had HIV RNA>100,000 copies/mL. The majority of HAART regimens is non-nucleoside reverse transcriptase inhibitor-based (81.8%). In as-treated analysis, 50, 71.2, 79.7, 79.4, and 80.1% of patients achieved undetectable HIV RNA (<50 copies/mL) at 12, 24, 36, 48, and 60 weeks, respectively. The corresponding mean CD4 counts were 95, 125, 166, 201, and 225 cells/mm3. Twenty two patients (13.8%) had adverse drug events and half of these had to discontinue HAART. Initiation of HAART in advanced AIDS with CD4 cell count <50 cells/mm3 is effective, safe, and well tolerated and should not be delayed.

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