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 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.

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.

Emerging Trends in the Long-acting Antiretroviral Therapy: Current Status and Therapeutic Challenges

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajpushpa Labh ◽  
Rachna Gupta
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Drug Distribution ◽  
Antiretroviral Drugs ◽  
Current Status ◽  
People Living With Hiv ◽  
Viral Reservoirs ◽  
Emerging Trends ◽  
Gradual Development ◽  
Long Acting

: Antiretroviral drug therapy has significantly improved the prognosis and life expectancy of People Living with HIV over the years. But this progress comes with an important caveat that antiretroviral regimens generally require adherence to life-long, daily dosing, to keep viral multiplication under check. Non-adherence to such dosing leads to decreased efficacy and increased drug resistance against antiretroviral drugs. Besides, poor drug penetration to certain tissues like CNS and lymph nodes leads to build-up of viral reservoirs in these sites. To combat some of these challenges and improve patient compliance, long-acting antiretroviral drugs, are a new weapon in the arsenal, in fight against HIV. Few long acting preparations have been approved, and several others are in various clinical and preclinical stages of development. However, longacting formulations also have their share of clinical issues like limited drug distribution, long term adverse drug reactions, drug-drug interactions, and gradual development of drug resistance. Modern technological premises are being tested to mitigate some of these problems. One such promising approach involves nanotechnological methods, which are being used to develop ultra-long acting formulations and drug delivery systems, targeting tissues with residual HIV concentration. LongActing Slow Effective Release Antiretroviral Therapy aka LASER ART, also builds on nanotechnology and prodrug modifications to design preparations with tailor-made favorable pharmacokinetics and wider drug distribution. These recent advances are fueling the progression of antiretroviral therapy towards eliminating the disease.

scholarly journals The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data?

2021 ◽  
Vol 20 ◽  
pp. 232595822110090
Author(s):  
Kimberly K. Scarsi ◽  
Susan Swindells
Keyword(s):  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Virologic Suppression ◽  
Social Barriers ◽  
Treatment And Prevention ◽  
Undetectable Viremia ◽  
Long Acting ◽  
Available Information ◽  
Living With Hiv

As with other chronic conditions, adherence to daily medications remains a challenge for many individuals living with HIV due to structural, behavioral, and social barriers. Unfortunately, high levels of adherence to antiretroviral therapy are required to maintain virologic suppression. Alternative approaches are being explored to decrease the burden of daily pill administration, including long-acting injectable, oral, and implantable products. Phase 3 data support the efficacy of nanoformulated injectable cabotegravir and rilpivirine for HIV treatment in patients with undetectable viremia, but we have yet to learn how this strategy may benefit those with medication adherence challenges. Despite this, the affected community and HIV providers are very interested in exploring the role of long-acting therapies to address some types of barriers to medication adherence. This review summarizes available information about the potential for long-acting therapy to improve adherence for some patients and outlines associated opportunities and challenges with the implementation of long-acting therapy for the treatment and prevention of HIV.

scholarly journals Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 909
Author(s):  
Laura Cheney ◽  
John M. Barbaro ◽  
Joan W. Berman
Keyword(s):  
Quality Control ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Viral Suppression ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Foreign Material ◽  
Complete Understanding ◽  
Living With Hiv ◽  
Target Effects

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

scholarly journals Mortality and Retention in Care of HIV-Infected Patients According to Year of Admission and Availability of Antiretroviral Drugs in the Chilean National AIDS Program: Fundacion Arriaran 1990–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S420-S420
Author(s):  
Marcelo Wolff ◽  
Rebeca Northland ◽  
Danae Lizana ◽  
Claudia P Cortes
Keyword(s):  
Antiretroviral Therapy ◽  
Early Modern ◽  
Marked Reduction ◽  
Modern Art ◽  
Retention In Care ◽  
Antiretroviral Drugs ◽  
National Program ◽  
Hiv Epidemic ◽  
Aids Program ◽  
Period Of Occurrence

Abstract Background The HIV epidemic reached Chile in the mid 1980s, as response a national AIDS commission was created, AIDS care centers were organized (Fundacion Arriaran [FA] was the first) and free antiretroviral therapy (ART) was later provided with progressive coverage, complexity and availability over the years Objective. Quantify evolution of mortality, retention and abandonment (LTFU) over 25 years according to qualitatively different periods in the national program of access to ART, from no availability to full coverage with current drugs at FA center Methods Retrospective analysis of FA updated database of the 5080 adult patients admitted from 1990 to 2014, who were distributed in 4 groups: A: no ART availability (1990–92); B: mono/dual ART (1993–98); C: early modern ART (HAART) (1999–2007) and D: contemporary HAART (2008–14). Mortality, Retention and LTFU were evaluated at 1, 3, 5 and 10 year intervals from admission and at end of 2015. Mortality was included in period of occurrence; LTFU was permanent absence at center of &gt; 6 months during studied period. Local IRB approved the study Results Main results shown in Table. Mortality varied from 40% to 2%, and 62% to 7% at 1 and 5 years, for groups A and D respectively; 72% to 16% at 10 years for groups A and C, respectively. Retention at 5 years were 28%, 32%, 72% and 77% for groups A, B, C and D respectively. LTFU was 10%, 17%, 12% and 10% at 5 years for same groups, respectively. At 12/2015 6%, 19%, 61% and 84% from groups A, B, C and D, respectively, remained retained in care Conclusion This study showed the marked reduction in mortality and increase in retention of HIV patients concomitant to expanded access to therapy although LTFU remains a problem. Disclosures All authors: No reported disclosures.

scholarly journals Metabolic Syndrome Prevalence and Cardiovascular Risk Assessment in HIV-Positive Men with and without Antiretroviral Therapy

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 578
Author(s):  
Win-Long Lu ◽  
Yuan-Ti Lee ◽  
Gwo-Tarng Sheu
Keyword(s):  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Antiretroviral Drugs ◽  
Hiv Positive ◽  
Naive Group ◽  
Treatment Naïve ◽  
Group 2 ◽  
Group 1

Treatment of HIV infection is a lifelong process and associated with chronic diseases. We evaluated the prevalence and predictors of metabolic syndrome (MetS) and cardiovascular diseases (CVDs) with individual antiretroviral drugs exposure among HIV-infected men in Taiwan. A total of 200 patients’ data were collected with a mean age of 32.9. Among them, those who had CD4 positive cell number less than 350/mL were eligible to have highly active antiretroviral therapy (HAART). Patients were divided into group-1 that contains 45 treatment-naïve participants, and group-2 that includes 155 HAART treatment-experienced participants. MetS prevalence between group-1 and group-2 was 18% and 31%, respectively. The Framingham Risk Score (FRS) for the naïve and experienced groups were 4.7 ± 4.2 and 3.87 ± 5.92, respectively. High triglyceride (TG > 150 mg/dL) in group-1 and group-2 were 15.6% and 36.6% (p < 0.05), whereas, lower high-density lipoprotein (HDL < 39 mg/dL) in group-1 and group-2 presented as 76.7% versus 51% (p < 0.05), respectively. In group-2, treatment with protease inhibitors (PIs) resulted in higher TG levels when compared with non-nucleotide reverse transcriptase inhibitors (NNRTIs) and integrase inhibitors (InSTIs). The prevalence of MetS in the treatment-naïve group was lower than that of the treatment-experienced group; high TG level resulted in higher MetS prevalence in the treatment-experienced group. In contrast, the cardiovascular risk of FRS in the treatment-naïve group was higher than that of the treatment-experienced group, which may result from the low HDL level. Although group-1 participants have a higher risk of developing CVDs, in group-2, an increasing TG level in PIs user indicated higher CVDs risk. TG and HDL are two significant biofactors that required regular evaluation in HIV-positive individuals.

Sign in / Sign up

Export Citation Format

Share Document