Behavioral and Clinical Characteristics and Outcomes of Treatment Among Older Patients Receiving Medical Care for HIV Infection in Iran

Background: Although the number of new HIV infections continues to decline in Iran, the number of HIV-infected patients aged ≥50 years continues to rise due to the introduction of new treatment and longer survival. The higher prevalence of medical comorbidities and treatment failure in this population is a critical challenge in HIV treatment. In the present study, prevalence of comorbidities, rate of response to treatment, and results of HIV drug resistance tests were explored in older patients. Methods: A cross-sectional study was conducted at a tertiary referral HIV center in Tehran, Iran. The data for all the HIV-positive patients older than 50 years old were collected by reviewing their medical records within the last 15 years. Data included demographic and behavioral characteristics, immunologic and virologic response, rate of treatment failure, and HIV resistance. Results: The records for 100 patients with a mean age of 62.5 (range 50-79) years were reviewed and analyzed. Medical comorbidities were observed in 20% of the patients, with HCV co-infection, diabetes mellitus, and neuropsychiatric impairments being the most common. Complete immunologic and virologic responses were respectively observed in 88 and 97% of patients. The treatment regimen was modified in 66 patients, with drug side effects being the reason in 63 patients (95.4%). HIV drug resistance tests showed a low rate of resistance (<10%) to all drugs used in this population. Conclusion: Our findings highlight the high prevalence of comorbidities in older HIV-positive individuals in Iran. A thorough endocrine and neuropsychiatric assessment at each visit is recommended for these patients. Access to an appropriate psychosocial support system will ensure earlier detection of HIV infection and comorbidities in the older population, and will undoubtedly improve the treatment outcome and quality of life among them.

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The Continuous Surveillance of InSTI resistance could be an important Public Health Tool in the Fight against HIV Infection

Current HIV Research ◽

10.2174/1570162x19666210301104636 ◽

2021 ◽

Vol 19 ◽

Author(s):

Giuseppa Visalli ◽

Alessio Facciolà ◽

Maria Giovanna Costanzo ◽

Angela Di Pietro

Keyword(s):

Drug Resistance ◽

Hiv Infection ◽

Hiv Treatment ◽

Large Cohort ◽

University Hospital ◽

Hiv Positive ◽

Percentage Increase ◽

Resistance Mutations ◽

Hiv Test ◽

Resistance Tests

Aims: To evaluate the frequency of the InSTIs mutations in a large cohort of HIV-infected people. Background: The Highly Active Anti-Retroviral Therapy (HAART) allow turning HIV infection from a fatal disease to a chronic infection and Integrase Strand Transfer Inhibitors (InSTIs) represent the cornerstone of this treatment. However, the spread of HIV-1 drug resistance mutations represents an emerging threat to the long-term success of HIV treatment programs. Objectives: To evaluate the trend of the HIV drug resistance to InSTIs in a large cohort of HIV-positive people in order to assess the risk represented by these subjects in the spread of the HIV infection to the community. Methods: A cross-sectional study was conducted analysing all the InSTIs resistance tests performed in HIV positive subjects in the period 2017-2019 by the HIV Laboratory of the University Hospital "Gaetano Martino" of Messina, Italy. Results: In 2017-2019, 252 InSTIs resistance tests were performed of which 59 (23.4%), 88 (34.9%) and 105 (41.7%) respectively in the three considered years. Overall, 28 (11.1%) samples showed resistance to at least one of the four InSTIs. We observed a significant percentage increase of 95% about the resistance to all the four drugs. Conclusion: Because the InSTI resistance is not rare, a continuous surveillance can represent nowadays, together with an incessant health education and a wide offer of the HIV test, the most important tool in the fight against HIV infection.

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Drug Resistance Tests to Predict Response to Treatment for HIV Infection

Annals of Internal Medicine ◽

10.7326/0003-4819-131-11-199912070-00025 ◽

1999 ◽

Vol 131 (11) ◽

pp. 813

Keyword(s):

Drug Resistance ◽

Hiv Infection ◽

Response To Treatment ◽

Resistance Tests

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Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054887 ◽

2021 ◽

pp. sextrans-2020-054887

Author(s):

Silvia Achia Nieuwenburg ◽

Ricardo Jamie Sprenger ◽

Maarten Franciscus Schim van der Loeff ◽

Henry John Christiaan de Vries

Keyword(s):

Hiv Infection ◽

Controlled Trial ◽

Clinical Manifestations ◽

Response To Treatment ◽

Disease Stage ◽

Hiv Positive ◽

Sexual Risk Behaviour ◽

Serological Response ◽

History Of ◽

Hiv Negative

ObjectivesHIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored.MethodsThis retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3–6 months. We included data of participants with ≥1 syphilis diagnosis in 2014–2019. Pearson’s χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses.ResultsWe included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032).ConclusionsIn repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.

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Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000200001 ◽

2012 ◽

Vol 45 (2) ◽

pp. 147-150 ◽

Cited By ~ 15

Author(s):

Guenael Freire de Souza ◽

Fernando Biscione ◽

Dirceu Bartolomeu Greco ◽

Ana Rabello

Keyword(s):

Hiv Infection ◽

Clinical Response ◽

Clinical Picture ◽

Treatment Initiation ◽

Early Recognition ◽

Response To Treatment ◽

Hiv Positive ◽

Large Area ◽

Belo Horizonte ◽

Hiv Negative

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

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Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2016/4897501 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Gweneth B. Lazenby ◽

Okeoma Mmeje ◽

Barbra M. Fisher ◽

Adriana Weinberg ◽

Erika K. Aaron ◽

...

Keyword(s):

Drug Resistance ◽

Hiv Infection ◽

Univariate Analysis ◽

Categorical Variables ◽

Continuous Variables ◽

Resistance Mutations ◽

Hiv Drug Resistance ◽

Fourfold Increase ◽

Perinatal Hiv ◽

Adverse Pregnancy

Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection.Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student’st-test and Wilcoxon rank-sum tests. Categorical variables were compared usingχ2and Fisher’s exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance.Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%,p=0.03), OR 6.0 (95% CI 1.0–34.8),p=0.05), including multiclass resistance (15% versus 0,p=0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%,p=0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%,p=0.08) and cesarean delivery (47% versus 46%,p=0.9). Two infants born to a single NPHIV woman acquired HIV infection.Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.

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Neurocysticercosis and HIV Infection: what can we learn from the published literature?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190054 ◽

2019 ◽

Vol 77 (5) ◽

pp. 357-365 ◽

Cited By ~ 4

Author(s):

Omar Herrera Vazquez ◽

Matthew L. Romo ◽

Agnès Fleury

Keyword(s):

Hiv Infection ◽

Immune Status ◽

Taenia Solium ◽

Response To Treatment ◽

Hiv Positive ◽

Historical Series ◽

Immunodeficiency Virus ◽

The Central Nervous System ◽

Published Research ◽

Hiv Negative

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

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