scholarly journals Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Keiji Konishi ◽  
Hidenori Nakagawa ◽  
Akio Nakahira ◽  
Takahiro Okuno ◽  
Takeshi Inoue ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Mycobacterium Avium ◽  
Antiretroviral Drugs ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy ◽  
Important Indicator ◽  
Gastrointestinal Lesions ◽  
Poor Medication Adherence

Abstract Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy. Case presentation A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis. Conclusions Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.

scholarly journals Protein-losing Enteropathy Caused by Disseminated Mycobacterium Avium Complex Infection in a Patient Receiving Antiretroviral Therapy: An Autopsy Case Report

2021 ◽  
Author(s):  
Keiji Konishi ◽  
Hidenori Nakagawa ◽  
Akio Nakahira ◽  
Takahiro Okuno ◽  
Takeshi Inoue ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Mycobacterium Avium ◽  
Antiretroviral Drugs ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy ◽  
Important Indicator ◽  
Gastrointestinal Lesions ◽  
Incidence And Mortality ◽  
Poor Medication Adherence

Abstract Background: Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence and mortality of HIV, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we report a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy.Case presentation: A 29-year-old male diagnosed with AIDS for four years and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs two years prior to admission. However, it remained uncontrolled. Previous hospitalization a year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis.Conclusions: Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to its limited options for parenteral antiretroviral drugs.

scholarly journals Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
D. Donà ◽  
E. Mozzo ◽  
D. Luise ◽  
R. Lundin ◽  
A. Padoan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Hiv Infection ◽  
Antiretroviral Drugs ◽  
University Hospital ◽  
Bone Homeostasis ◽  
Mineral Density ◽  
Anthropometric Data ◽  
Hiv 1

Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43% of patients, while CTX in 61% of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.

scholarly journals Potential drug interactions in patients given antiretroviral therapy

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Wendel Mombaque dos Santos ◽  
Silvia Regina Secoli ◽  
Stela Maris de Mello Padoin
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Drug Interactions ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Antiretroviral Drugs ◽  
P Value ◽  
Potential Drug ◽  
Cross Sectional ◽  
Treatment Data

ABSTRACT Objective: to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods: a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results: of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions: the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.

scholarly journals HIV-1 CRF63_02A6 models as a tool for evaluating efficacy of developing antiretroviral drugs

2020 ◽  
Vol 10 (4) ◽  
pp. 769-774
Author(s):  
D. P. Zyryanova ◽  
N. V. Bogacheva ◽  
A. V. Totmenin ◽  
N. M. Gashnikova
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Reverse Transcriptase ◽  
Highly Active Antiretroviral Therapy ◽  
Federal District ◽  
Antiretroviral Drugs ◽  
Infection Process ◽  
Reverse Transcriptase Inhibitors ◽  
Infectious Molecular Clones ◽  
Hiv 1

Highly active antiretroviral therapy (HAART) allows not only to control the infection process in certain patient, but also to reduce a risk of HIV infection spreading in general, so that one of the goals for international community fighting against HIV-spread is to maximize coverage of infected subjects with HAART. Antiretroviral therapy in HIV infection is administered lifelong, so that therapeutic efficacy may be lowered due to emergence of resistant HIV-1 variants. Currently, development of new antiretroviral drugs is currently underway throughout the world, therefore standard HIV-1 models are demanded to evaluate antiviral efficacy of promising drugs. To reliably assess drug efficiency regarding Russiawide HIV-1 variants, HIV-1 genovariants widespread in Russia should be used as a virus model. A recently emerged recombinant form of CRF63_02A6 HIV-1 is spread in Russia being currently a dominant variant detected among HIV-infected individuals in an extended region of the Siberian Federal District: in the Novosibirsk, Tomsk, Omsk, Kemerovo Regions, Krasnoyarsk and Altai Krai. We have obtained CRF63_02A6 infectious isolates of HIV-1, one of which contains mutations, reducing the sensitivity to the applied inhibitors of the virus reverse transcriptase. In addition, we constructed infectious molecular clones based on HIV-1 CRF63_02A6 variants with an affinity for CCR5 coreceptors and CXCR4. Infectious isolates and molecular clones CRF63_02A6 tested as models for assessing efficacy of antiretroviral drugs using the example of the drug “Efavirenz”. The fifty percent inhibitory concentration determined on the models of HIV-1 infectious molecular clones and HIV-1 isolate 18RU7056 ranged from 0.00027 pg/ml to 0.00046 pg/ml being in agreement with data published elsewhere. Concentrations of “Efavirenz” used in the study did not suppress the replication of HIV-1 12RU6987, which is resistant to non-nucleoside reverse transcriptase inhibitors, which confirms the decrease in the sensitivity of HIV-1 12RU6987 to “Efavirenz” by no less than 10,000 times. Thus, our data demonstrate that CRF63_02A6 HIV-1 isolated strains and infectious molecular clones are relevant and complementary tools for assessing efficacy of developing drugs aimed at suppressing HIV-1, including non-nucleoside-resistant virus reverse transcriptase inhibitors.

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 Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chunxiang Guo ◽  
Yaxin Wu ◽  
Yang Zhang ◽  
Xinchao Liu ◽  
Aixin Li ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Reverse Transcriptase ◽  
Meta Analysis ◽  
Antiretroviral Drugs ◽  
Cochrane Library ◽  
Transmitted Drug Resistance ◽  
Reverse Transcriptase Inhibitors ◽  
Primary Hiv Infection

Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with primary HIV infection (PHI)/AHI/early HIV infection (EHI) and to describe the critical drug-resistant mutations.Methods: We systematically searched the literature between January 1, 2008, and April 30, 2021, in PubMed, Web of Science, Embase, and the Cochrane Library. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE.Results: The data of this meta-analysis come from 12 observational studies, covering 3,558 ART-naive individuals with PHI, AHI, or EHI. The overall prevalence of HIV-TDR is 9.3% (95% CI: 6.8%–11.8%, I2 = 81.1%, in 11 studies). The prevalence of resistance by drug class is the highest for the nonnucleoside reverse transcriptase inhibitors (NNRTIs) at 5.7% (95% CI: 2.9%–8.5%, I2 = 96.6%, in 11 studies), followed by nucleoside reverse transcriptase inhibitors (NRTIs) at 3.4% (95% CI: 1.8%–5.0%, I2 = 86.3%, in 10 studies) and protease inhibitors (PIs) at 3.3% (95% CI: 2.7%–3.9%, I2 = 15.6%, in 10 studies). The prevalence of TDR to integrase inhibitors (INIs) is 0.3% (95% CI: 0.1%–0.7%, I2 = 95.9%, in three studies), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is at a moderate level among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.

Prevalence of Depression and Associated Factors among Adults on Antiretroviral Therapy In Public Hospitals of Kembata Tembaro Zone, South Ethiopia

2020 ◽  
Author(s):  
Addisu Girma ◽  
Wondwosen Tekleselasie ◽  
Tadele Yohannes
Keyword(s):  
Social Support ◽  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Associated Factors ◽  
Public Hospitals ◽  
Living Alone ◽  
Prevalence Of Depression ◽  
Related Stigma ◽  
Poor Social Support ◽  
Poor Medication Adherence

Abstract BackgroundCurrently, people living with Human Immunodeficiency Virus have longer life expectancies with the use of antiretroviral therapy. However; depression is the most common in these patients, which has markedly resulted to poor health outcomes due to reduced adherence to treatment and deterioration of medical outcomes, including treatment resistance, increase the demand for the utilization of medical resources and increase the morbidity and mortality. The aim of this study was to assess the prevalence and associated factors of depression among adult people living with HIV attending antiretroviral therapy clinic in public hospitals at KembataTembaro Zone, South Ethiopia,2020.MethodAn institution based cross sectional study was conducted in public Hospitals of KembataTembaro Zone from March 1/2020-April30/2020. Systematic random sampling technique was used to select the study participants. Data were collected using a pretested and structured questionnaire. Multivariable Logistic regression was performed to assess factors associated with depression using odds ratio at 95% confidence interval and P-value < 0.05.ResultsThe prevalence of depression was 44.3% (95% CI: 39.4% − 49.2 Being female (AOR = 2.03, 95% CI: 1.21,3.40), living alone (AOR = 3.09,95%CI :1.68,5.68), Having HIV related stigma (AOR = 2.85, 95% CI: 1.73, 4.71), poor social support (AOR = 2.55, 95% CI: 1.48, 4.78), CD4 count less than 350 cell/ul (AOR = 2.66, 95% CI: 1.48, 4.58) and Poor medication adherence (AOR = 2.19,95% CI: 1.32, 3.65) were factors significantly associated with depression.ConclusionThe prevalence of depression was high. Being female, living alone, having HIV related stigma, Poor social support, CD4 count less than 350 cell/ul and poor medication adherence were associated with depression. Depression should be included as part of the routine consultation of HIV patients to ensure early detection and treatment.

scholarly journals The influence of genetic factors on the effectiveness, safety and tolerability of antiretroviral therapy in patients with hiv infection

2021 ◽  
Vol 13 (1) ◽  
pp. 21-28
Author(s):  
V. G. Kanestri ◽  
V. I. Shakhgildyan ◽  
A. V. Kravchenko ◽  
D. S. Konnov ◽  
A. A. Popova
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Development ◽  
Hiv Infection ◽  
Disease Progression ◽  
Genetic Markers ◽  
Large Scale ◽  
Genetic Factors ◽  
Antiretroviral Drugs ◽  
The Future ◽  
Integrated Approaches

This article provides an overview of the existing literature on the pharmacogenetic determinants of exposure and toxicity of antiretroviral drugs, as well as on genetic markers associated with the rate of disease progression. In addition, this article looks at current clinical opportunities as well as genetics in HIV drug development. Large-scale, integrated approaches to the genome are expected to significantly change the knowledge landscape in the future.

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