Bone quality assessed using quantitative ultrasound at the distal radius does not differ in antiretroviral therapy‐naïve
            HIV
            ‐positive and
            HIV
            ‐negative Rwandan women

Purpose To evaluate and determine predictors of squamous cell carcinoma of the anus (SCCA) outcomes in the highly active antiretroviral therapy (HAART) era for HIV-positive and -negative individuals using large national Veterans Affairs (VA) Administration databases. Patients and Methods We used the VA administrative databases to perform a retrospective cohort study in 1,184 veterans diagnosed with SCCA between 1998 and 2004. We calculated HIV infection rates and used logistic regression to identify epidemiologic factors that were associated with HIV infection. Kaplan-Meier curves and Cox proportional hazards models were calculated to compare survival between HIV-positive and HIV-negative veterans. Results In our cohort, 175 patients (15%) were HIV positive. The median age of the HIV-negative and -positive patients was 63 and 49 years, respectively (P < .001). Individuals with HIV were eight times more likely to be male (P = .01) and three times more likely to be African American (P < .001). There were no differences between HIV-positive and HIV-negative individuals in the receipt of treatment. The 2-year observed survival rates were 77% and 75% among HIV-positive and HIV-negative individuals, respectively. In multivariate Cox analysis, significant predictors of survival were age, sex, metastasis at diagnosis, and comorbidity score. HIV infection did not affect survival. Conclusion A noteworthy proportion of individuals with SCCA in the VA system are HIV positive. HIV-associated SCCA seems mainly to be a disease among younger men. Survival of SCCA is equivalent between HIV-positive and HIV-negative individuals in the HAART era. Treatment should not be withheld or deintensified based on HIV status.

Download Full-text

Therapy Related Leukemia in HIV Patients after Treatment for Non-Hodgkin Lymphoma

Blood ◽

10.1182/blood.v112.11.5284.5284 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5284-5284

Author(s):

Jed Katzel ◽

Sanford Kempin ◽

David Vesole ◽

Portia Lagmay-Fuentes ◽

William Cook ◽

...

Keyword(s):

Bone Marrow ◽

Flow Cytometry ◽

Radiation Therapy ◽

Antiretroviral Therapy ◽

Burkitt’S Lymphoma ◽

Burkitt's Lymphoma ◽

Hiv Positive ◽

Secondary Malignancies ◽

Hiv Patients ◽

Hiv Negative

Abstract Therapy related secondary malignancies after NHL are well characterized in the HIV negative population. The increased risk of secondary leukemia is most commonly associated with alkylating agents, topoisomerase II inhibitors and radiation therapy. We describe 2 patients with HIV-associated Burkitt’s lymphoma who subsequently developed acute leukemia. Case Report 1: An HIV positive 60 yr old male was diagnosed with Burkitt’s lymphoma five years after beginning antiretroviral therapy. Lymph node flow cytometry demonstrated: CD10+, CD19+, CD20+, KAPPA+. He achieved a complete remission after completing the Vanderbilt regimen (cyclophosphamide, methotrexate, bleomycin, vincristine, and doxorubicin) (McMaster M, et al. J Clin Oncol. 1991:9:941–946). Eight years later, he presented with acute myelomonocytic leukemia (M4) after a myelodysplastic prodrome. Flow cytometry demonstrated CD11c+, CD13+, CD33+, CD34+, CD 64+ and cytogenetics showed 5q(−) and 20q(−). He received induction chemotherapy with arsenic trioxide and low dose cytarabine. He did not achieve a remission, and died 2 months later. Case Report 2: A 45 yr old male presented with severe abdominal pain, and fever. During laparotomy, he was found to have a cecal mass consistent with Burkitt’s lymphoma. A bone marrow biopsy also showed Burkitt’s lymphoma: CD10+, CD19+, CD20+, CD22+, CD 38+, CD45+, CD71+. He was subsequently diagnosed with HIV with a CD4 count of 60/uL. He was treated with CODOX-M (cyclophosphamide, doxorubicin, vincristine, methotrexate, IT cytarabine, IT methotrexate) and IVAC (Ifosfamide, etoposide, cytarabine, IT methotrexate) (Magrath I, et al. J Clin Oncol1996;14:925–934) achieving a CR. He remained on antiretroviral therapy throughout his course. Two years later, he presented with thrombocytopenia. A bone marrow aspirate was consistent with precursor B-cell ALL CD19+, CD34+, CD79a+ and TdT+ distinct from the previous Burkitt’s lymphoma. He was treated with the L20 (Clarkson B, et al. Haematol Blood Transfus1990;33:397–408) protocol achieving a durable CR. He continued his retroviral therapy during his treatment. Conclusions: HIV positive patients have an increased propensity to develop malignancy independent of prior chemotherapy or radiotherapy exposure. In the era of HAART, the survival of HIV positive patients has markedly improved. Although the role of chemotherapy and radiation therapy are well documented as causative agents of neoplasia, the risk of HAART therapy with toxicity of nuclear, cytoplasmic and cell membrane effects potentially inducing malignancies is less well defined. Many of these agents are considered oncogenic in animal models but have not been proven to cause tumors in humans. However, it is conceivable, given the cellular toxicities of antineoplastic and antiretroviral therapy, that in combination they could cause myelodysplasia or further lymphodysplasia. It is too early to know if HIV patients are at a greater risk for development of secondary malignancies as a long-term complication of chemotherapy. However, because recent studies have demonstrated that HIV+ patients on highly active antiretroviral therapy (HAART) have comparable responses to chemotherapy compared to HIV negative patients, we recommend that patients continue HAART while receiving treatment for malignancy. Close surveillance for the appearance of secondary leukemias is warranted.

Download Full-text

Cardiac Effects of Antiretroviral Therapy in HIV-Negative Infants Born to HIV-Positive Mothers

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2010.08.620 ◽

2011 ◽

Vol 57 (1) ◽

pp. 76-85 ◽

Cited By ~ 60

Author(s):

Steven E. Lipshultz ◽

William T. Shearer ◽

Bruce Thompson ◽

Kenneth C. Rich ◽

Irene Cheng ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Positive ◽

Cardiac Effects ◽

Hiv Positive Mothers ◽

Hiv Negative

Download Full-text

Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome

Case Reports in Hematology ◽

10.1155/2016/8502641 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Bradley T. Williamson ◽

Heather A. Leitch

Keyword(s):

Bone Marrow ◽

Viral Load ◽

Antiretroviral Therapy ◽

Myelodysplastic Syndromes ◽

Hiv Positive ◽

Combination Antiretroviral Therapy ◽

Hiv Viral Load ◽

Hiv Patients ◽

Age Of Diagnosis ◽

Hiv Negative

Introduction. In advanced HIV prior to combination antiretroviral therapy (ART), dysplastic marrow changes occurred and resolved with ART. Few reports of myelodysplastic syndromes (MDS) in well-controlled HIV exist and management is undefined.Methods. Patients with well-controlled HIV and higher risk MDS were identified; characteristics, treatment, and outcomes were reviewed.Results. Of 292 MDS patients since 1996, 1 (0.3%) was HIV-positive. A 56-year-old woman presented with cytopenias. CD4 was 1310 cells/mL and HIV viral load <40 copies/mL. Bone marrow biopsy showed RCMD and karyotype included del(5q) and del(7q); IPSS was intermediate-2 risk. She received azacitidine at 75% dose. Cycle 2, at full dose, was complicated by marrow aplasia and possible AML; she elected palliation. Three additional HIV patients with higher risk MDS, aged 56–64, were identified from the literature. All had deletions involving chromosomes 5 and 7. MDS treatment of 2 was not reported and one received palliation; all died of AML.Conclusion. Four higher risk MDS in well-controlled HIV were below the median age of diagnosis for HIV-negative patients; all had adverse karyotype. This is the first report of an HIV patient receiving MDS treatment with azacitidine. Cytopenias were profound and dosing in HIV patients should be considered with caution.

Download Full-text

Alarming tuberculosis rate among people who inject drugs in Vietnam

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab548 ◽

2021 ◽

Author(s):

Nicolas Nagot ◽

Vinh Vu Hai ◽

Thuy Thi Thu Dong ◽

Oanh Khuat Thi Hai ◽

Delphine Rapoud ◽

...

Keyword(s):

Antiretroviral Therapy ◽

People Who Inject Drugs ◽

Risk Groups ◽

High Rate ◽

Hiv Positive ◽

Cross Sectional Survey ◽

Community Based ◽

Cross Sectional ◽

Chest X Ray ◽

Hiv Negative

Abstract Background The tuberculosis (TB) epidemic is not homogeneous in the general population but presents high-risk groups. People who inject drugs (PWID) are such a group. However, TB among PWID remains largely undocumented. Our goal was to assess the prevalence of TB and the risk factors associated with TB among PWID in Vietnam. Methods We implemented a cross-sectional survey among two community-based cohorts of HIV-positive and HIV-negative PWID in Hai Phong. Participants were screened for TB using questions on TB symptoms. Those who reported any symptom were accompanied by peers to the TB clinic for chest X-Ray. If the latter was abnormal, a sputum was collected to perform an Xpert® MTB/RIF test. Results 885 PWID were screened for TB. For both cohorts, most PWID were male (>90.0%), with a median age of 42 years. Beside heroin injection, 52.5% of participants reported smoking methamphetamine, and 63.2% were on methadone. Among HIV-positive PWID (N=451), 90.4% were on antiretroviral therapy and 81.6% had a viral load <1,000 copies/mL. Using a complete-case analysis, the estimated TB prevalence was 2.3% (95%CI: 1.0-4.5) and 2.1% (95%CI: 0.8-4.2) among HIV-positives and HIV-negatives, respectively. Living in couple, arrest over the past six months, homelessness and smoking methamphetamine were independently associated with TB but not HIV infection. Conclusions In a context of very large antiretroviral therapy coverage, this extremely high rate of TB among PWID requires urgent actions.

Download Full-text

Characteristics of HIV-positive pregnant women and HIV- and antiretroviral therapy-exposed fetuses: A case-control study

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11745 ◽

2020 ◽

Vol 14 (08) ◽

pp. 901-907

Author(s):

Tung-Che Hung ◽

Li-Cheng Lu ◽

Mei-Hui Lin ◽

Yu-Chia Hu ◽

Chien-Yu Cheng ◽

...

Keyword(s):

Body Weight ◽

Antiretroviral Therapy ◽

Pregnant Women ◽

Case Control Study ◽

Case Control ◽

Hiv Positive ◽

Positive Group ◽

Hiv Positive Women ◽

Control Study ◽

Hiv Negative

Introduction: This study determined risk factors, obstetric comorbidities, and fetal conditions among HIV-positive mothers to improve their maternal care. Methodology: This retrospective case-control study included HIV-positive pregnant women 18 years of age or older and age-, parity-, and delivery method-matched HIV-negative controls between 2011 and 2018. Those who had stillbirth were excluded. Baseline demographics, labor process, CD4 count, plasma HIV viral load, and antiretroviral therapy (ART) regimen were recorded. Fetal conditions were recorded as well. Results: Forty HIV-positive women (45 parities; 22 via NSD, 23 via C/S) were included, with 45 HIV-negative parities as controls. Twenty-nine (72.5%) HIV-positive women had illicit drug use. In the HIV-positive group, 17% received ART prior to first perinatal visit, and 75.6% reached viral suppression pre-delivery. Zidovudine and ritonavir-boosted lopinavir were the majorly prescribed ART. Mild perineal lacerations via NSD were observed in HIV-positive women. Fetal body weight was lower in HIV- and ART-exposed fetuses (2665 vs 3010 g, p < 0.001). Preterm delivery PTB (28.9% vs 8.9%, p= 0.015) and small-for gestational age SGA (28.9% vs 8.8%, p = 0.003) rates were higher in the HIV-positive group. There was no vertical transmission of HIV. Conclusions: HIV-positive women tend to deliver fetuses with low body weight and have higher SGA and PTB rates. Given that most women received zidovudine and protease inhibitors, benefits of newer agents for HIV-positive pregnancies should be studied.

Download Full-text

Adverse Pregnancy Outcomes Among HIV-positive Women in the Era of Universal Antiretroviral Therapy Remain Elevated Compared With HIV-negative Women

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000003174 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Vincent J. Tukei ◽

Heather J. Hoffman ◽

Lauren Greenberg ◽

Ramatlapeng Thabelo ◽

Masepeli Nchephe ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Hiv Positive ◽

Hiv Positive Women ◽

Adverse Pregnancy ◽

Hiv Negative

Download Full-text

DOES KNOWLEDGE ABOUT ANTIRETROVIRAL THERAPY AND MOTHER-TO-CHILD TRANSMISSION AFFECT THE RELATIONSHIPS BETWEEN HIV STATUS AND FERTILITY PREFERENCES AND CONTRACEPTIVE USE? NEW EVIDENCE FROM NIGERIA AND ZAMBIA

Journal of Biosocial Science ◽

10.1017/s0021932013000655 ◽

2013 ◽

Vol 46 (5) ◽

pp. 580-599 ◽

Cited By ~ 4

Author(s):

AKINRINOLA BANKOLE ◽

ANN E. BIDDLECOM ◽

KUMBUTSO DZEKEDZEKE ◽

JOSHUA O. AKINYEMI ◽

OLUTOSIN AWOLUDE ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Contraceptive Use ◽

Hiv Positive ◽

Hiv Status ◽

Child Transmission ◽

Hiv Positive Women ◽

Childbearing Desires ◽

Living With Hiv ◽

Mother To Child ◽

Hiv Negative

SummaryThe increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009–2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

Download Full-text

Highly active antiretroviral therapy increases fibrinolytic and protein activity in pregnant women

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2018.v37.181-187 ◽

2018 ◽

Vol 37 (3) ◽

pp. 181

Author(s):

Evarista Odaburhine Osime ◽

Catherine Obar

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Highly Active Antiretroviral Therapy ◽

Protein C ◽

Protein S ◽

Enzyme Linked Immunosorbent Assay ◽

Hiv Positive ◽

Highly Active ◽

The Impact ◽

Hiv Negative

BACKGROUNDVarious studies have examined optimal methods for Prevention of Mother to Child Transmission (PMTCT) of human immunodeficiency virus (HIV) and subsequent outcome of response to highly active antiretroviral therapy (HAART) as well as the impact of pregnancy on outcomes of HIV in the Pre-HAART era. Little is known of the impact of pregnancy in response to HAART in Africa. This study is aimed to evaluate euglobulin lysis time (ELT), protein C and protein S in HIV-positive pregnant women on HAART. METHODSThis was a cross-sectional study comprised of 150 participants attending Ante-Natal Clinic (ANC) in Central Hospital, Benin City. Pregnant women on HAART (Test subjects) (n=50, mean age 34 years), 50 pregnant newly diagnosed HIV-positive women that had not yet commenced HAART (n=50, mean age 31 years) and 50 pregnant HIV-negative women (n=50, mean age 30 years) which served as controls. The ELT was determined by methods described by Bain, protein C and protein S were determined using Enzyme Linked Immunosorbent Assay (ELISA). RESULTSThere was a significant increase in ELT in both pregnant women on HAART and not on HAART) when compared to HIV-negative pregnant women (p<0.05). There was a significant decrease in protein C in test subjects when compared with controls (p<0.05) and protein S increased significantly in HIV-positive pregnant women on HAART when compared to those not on HAART and HIV-negative pregnant women (p<0.05). CONCLUSIONThere are changes in ELT, protein C and protein S parameters with the introduction of HAART in pregnancy.

Download Full-text