A Real-World Evidence-Based Management of HIV by Differential Duration HAART Treatment and its Association with Incidence of Oral Lesions

2021 ◽  
Vol 20 ◽  
Author(s):  
Wen Shu ◽  
Fei Du ◽  
Jin- Song Bai ◽  
Ling-Yun Yin ◽  
Kai-Wen Duan ◽  
...  
Keyword(s):  
Treatment Group ◽  
Real World ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Immunological Response ◽  
Treated Group ◽  
Cd4 Count ◽  
Chinese Patients ◽  
Oral Lesions ◽  
Cell Counts

Background: The efficacy of highly active antiretroviral therapy (HAART) therapy can be estimated by immunological response and the incidence of opportunistic infections. Objective: To evaluate the effectiveness of different durations of HAART in terms of immunological response markers (CD4 count and CD4/CD8 ratio) along with disease progression markers (incidence of oral lesions) in Chinese patients with HIV. Methods: This single-center, retrospective, real-world study included patients with HIV, grouped into treatment group and treatment-naïve group of which the former was further divided into (6, 12, and 18 months) based on the treatment duration. The CD4 and CD8 cell counts were analyzed by the FACSCalibur flow cytometry. Kruskal-Wallis test was applied to determine the outcome of different duration of HAART. Oral examination was carried out according to the WHO type IV examination Results: In 246 patients with HIV, CD4 counts increased significantly post-HAART compared with pre-HAART in all three treatment groups (P<.001), while CD8 count decreased significantly (P<.05) in all three treated group. A significant association of HAART with CD4/CD8 ratio was observed (P<.001). A significant increase in CD4 count was observed between 12-month and 18-month treatment group (P<.05). The occurrence of oral lesions reduced significantly in the treatment group. Conclusion: We observed a better response of HAART regimen with 18 months of duration than 12-months and 6-months therapies and reduction in oral lesions.

scholarly journals Liver Enzymes Abnormalities among Highly Active Antiretroviral Therapy Experienced and HAART Naïve HIV-1 Infected Patients at Debre Tabor Hospital, North West Ethiopia: A Comparative Cross-Sectional Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Melashu Balew Shiferaw ◽  
Ketema Tafess Tulu ◽  
Amtatachew Moges Zegeye ◽  
Amarech Asratie Wubante
Keyword(s):  
Antiretroviral Therapy ◽  
Viral Hepatitis ◽  
Liver Enzyme ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Cd4 Count ◽  
Cross Sectional ◽  
North West ◽  
Highly Active ◽  
Hiv 1

Liver disease has emerged as the most common non-AIDS-related cause of death in HIV patients. However, there is limited data regarding this condition including our setting in Ethiopia. Hence, liver enzyme abnormalities among highly active antiretroviral therapy (HAART) experienced and HAART naïve patients were assessed in this study. A total of 164 HAART experienced and 164 HAART naïve patients were studied. Blood specimen was collected to determine alanine aminotransferase (ALT) and aspartate aminotransferase (AST), CD4 count, and viral hepatitis. The prevalence of liver enzyme abnormality was 20.1% and 22.0% among HAART experienced and HAART naïve patients, respectively. The HAART experienced patients had higher mean ALT than HAART naïve patients (P=0.002). Viral hepatitis (AOR = 6.02; 95% CI = 1.87–19.39), opportunistic infections (AOR = 2.91; 95% CI = 1.04–8.19), current CD4 count <200 cells/mm3(AOR = 2.16; 95% CI = 1.06–4.39), and male sex (AOR = 1.83; 95% CI = 1.001–3.33) were associated with elevated ALT and/or AST. In conclusion, liver enzyme abnormalities were high in both HAART experienced and HAART naïve HIV-1 infected patients. Hence, monitoring and management of liver enzyme abnormalities in HIV-1 infected patients are important in our setting.

scholarly journals Reasons for immunologic inefficiency of antiretroviral therapy in patients with HIV

2014 ◽  
Vol 95 (4) ◽  
pp. 581-588 ◽  
Author(s):  
A F Oleynik ◽  
V Kh Fazylov
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Immunological Response ◽  
Response To Treatment ◽  
Highly Active ◽  
Cell Counts ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Cd4 Lymphocytes

The main component of the treatment of patients with HIV infection is highly active antiretroviral therapy (HAART), which can help to control the disease. The main goal of HAART is to increase the life duration and to maintain the quality of patients’ life. Improved survival among HIV-infected patients receiving highly active antiretroviral therapy is achieved mainly by a decrease of HIV RNA viral load, which increases CD4 lymphocytes count. However, some patients may present with discordant response to treatment, when there is no CD4 lymphocyte count elevation associated with the virus disappearing from the blood. Such patients retain immunodeficiency, despite long-term treatment. The risk of opportunistic infections on the background of insufficient immunological response, despite viral replication suppression, is higher than in patients with good immunological response to treatment. Consistently low CD4 cell counts are associated with an increased risk of AIDS diagnosis. Furthermore, this group of patients shows a slight increase in mortality not associated with AIDS-defining illnesses. The reasons for the low CD4 lymphocytes count increase in some patients achieving virologic response to HAART remain unclear. The immunological efficacy of treatment depends on many factors: baseline CD4 count, duration of HIV infection prior to HAART initiation, age, co-infection with HCV, presence of secondary diseases and comorbidities, HAART regimens, IL-2 use and others. Literature review covers the phenomenon of immunological «non-response» to HAART, factors leading to its development, and possible methods of correction. Currently, there are more questions than answers in the area of immunological non-effectiveness of HAART in HIV-infected patients.

scholarly journals Oral Cytokine Levels Are More Linked to Levels of Plasma and Oral HIV-1 RNA Than to CD4+ T-Cell Counts in People With HIV

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Joseph M Rocco ◽  
Zachary York ◽  
Chengli Shen ◽  
Caroline Shiboski ◽  
Jennifer Cyriaque-Webster ◽  
...  
Keyword(s):  
T Cell ◽  
Linear Regression ◽  
Opportunistic Infections ◽  
Cd4 Count ◽  
Cd4 T Cell ◽  
Plasma Viremia ◽  
Necrosis Factor Alpha ◽  
Cell Counts ◽  
Immune Mediators ◽  
Hiv 1

Abstract Background We determined the levels of 11 soluble immune mediators in oral washings of AIDS Clinical Trials Group A5254 participants with varying degrees of plasma viremia and CD4 T-cell counts to characterize the mucosal immune response at different stages of HIV-1 infection. Methods A5254 was a multicenter, cross-sectional study in people with HIV (PWH) recruited into 4 strata based on CD4 count and levels of plasma viremia: stratum (St) A: CD4 ≤200 cells/mm3, HIV-1 RNA (viral load [VL]) &gt;1000 cps/mL; St B: CD4 ≤200, VL ≤1000; St C: CD4 &gt;200, VL &gt;1000; St D: CD4 &gt;200, VL ≤1000. Oral/throat washings were obtained from all participants. Soluble markers were tested in oral/throat washings using a multibead fluorescent platform and were compared across strata. Linear regression was used to determine the associations between cytokines and HIV-1 in plasma and oral fluid. Results St A participants had higher levels of interleukin (IL)-1β, IL-6, IL-17, tumor necrosis factor alpha (TNFα), and interferon gamma (IFNγ) compared with St B and D (P = .02; P &lt; .0001) but were not different from St C. IL-8, IL-10, and IL-12 were elevated in St A compared with the other 3 strata (P = .046; P &lt; .0001). Linear regression demonstrated that oral HIV-1 levels were associated with IL-1β, IL-6, IL-8, and TNFα production (R &gt; .40; P &lt; .001) when controlling for CD4 count and opportunistic infections. Conclusions Our results show that high levels of oral HIV-1, rather than low CD4 counts, were linked to the production of oral immune mediators. Participants with AIDS and uncontrolled viremia demonstrated higher levels of pro- and anti-inflammatory soluble immune mediators compared with participants with lower HIV-1 RNA. The interplay of HIV-1 and these immune mediators could be important in the oral health of PWH.

Hydroxyurea Affects T-Lymphocyte Subsets in Sickle Cell Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3726-3726
Author(s):  
Devaki Sivasubramaniam ◽  
Osei Bekoe ◽  
Bharat Motwani ◽  
Sandra Allen ◽  
Lori Feldman ◽  
...  
Keyword(s):  
Treatment Group ◽  
Sickle Cell Disease ◽  
T Lymphocytes ◽  
Blood Cell ◽  
Sickle Cell ◽  
T Lymphocyte ◽  
Cd4 Count ◽  
Control Group ◽  
Cell Disease ◽  
Cell Counts

Abstract Hydroxyurea (HU) is now widely used in the treatment of sickle cell disease (SCD). The effect of this agent on T-lymphocytes in this disease has not been extensively studied. In other diseases such as human immunodeficiency virus (HIV) disease, HU was found to have a variable effect on T-cell subsets. We previously reported (Blood2002; 100: 363) a case of a sickle cell disease patient who was HIV- negative who was found to have low CD4 count on HU that normalized after stopping this agent. We have since conducted a case-controlled study in our sickle cell disease clinic in an attempt to analyze the effects of HU on CD4 count and other T-lymphocyte subsets. Written informed consent was obtained from 15 SCD patients. All patients had SCD as confirmed by hemoglobin electrophoresis. We placed patients into 2 cohorts: the treatment group consisted of patients already receiving HU therapy and the control group consisted of patients not taking HU. Among 15 patients, 8 patients were in treatment group and 7 patients were in the control group. In control group, 5 patients were female and 2 patients were male with mean age of 38 years. In treatment group, 7 patients were female and 1 was male with mean age of 35 years. In the treatment group, the mean duration of HU therapy was 4 years. We collected venous blood from all patients and tested for the following blood cell counts: total white blood cell (WBC), total neutrophil, total lymphocyte, CD4, CD8, CD3 cells and CD4/CD8 ratio. We also tested and found that there was no significant difference between the 2 cohorts for the presence of alloantibodies, cytomegalovirus virus and hepatitis C viral status. All patients were found to be HIV- negative. The lymphocyte assay was done using Coulter MAXAM hematology analyzer and using a combination of white blood cell counts and differential count in the same laboratory for all patients. We compared the mean value of total T-lymphocyte counts, T-cell subgroups CD4, CD8, CD3 levels and CD4/CD8 ratios between the 2 groups by performing the t-test (Table 1). Our study showed that the treatment group had a statistically significant increase in total T- lymphocyte count and in levels of the CD4, CD8 and CD3 levels compared to the control group. There was no difference in the CD4/CD8 ratio between the 2 groups. These results provide additional information to our previous observation of a lowered CD4 count in a SCD patient on HU. These results are consistent with findings in HIV positive patients where changes in T- lymphocytes subsets have been observed in patients treated with HU (AIDS2002; 14:619–621 and J Acquir Immune Defic Syndr2000; 25: 329–336). We conclude that in SCD patients HU can affect T-lymphocyte subset counts. The mechanism and clinical significance of the effect, if any, is unknown and requires further investigation. Table 1: Effects of HU on T-lymphocytes Blood test Control group treatment group P value * P-value significant below 0.05 Total WBC th/mm3 15.36 12.28 0.23 Neutrophil ct/mm3 7.87 4.92 0.12 Total lymphocyte ct/mm3 2458.83 3739.4 0.01* Absolute CD4, mm3 1621.7 2284.8 0.05* Absolute CD8, mm3 701.42 1340.33 0.01* Absolute CD3, mm3 2520 3723 0.01* CD4/CD8 Ratio 2.321 2.32 0.99

scholarly journals Clinical characteristics and predictors of mortality in hospitalized HIV-infected Nigerians

2011 ◽  
Vol 5 (05) ◽  
pp. 377-382 ◽  
Author(s):  
Patricia Aladi Agaba ◽  
Eunice Digin ◽  
Rahila Makai ◽  
Labake Apena ◽  
Oche O Agbaji ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Highly Active Antiretroviral Therapy ◽  
Clinical Characteristics ◽  
Opportunistic Infections ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Predictors Of Mortality ◽  
Cell Counts ◽  
Common Diagnosis ◽  
Cd4 Cell

Introduction: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a chief cause of death in sub-Saharan Africa. In this study, the clinical characteristics and predictors of mortality among hospitalized HIV infected adult Nigerians are reported. Methodology: The records of 354 patients were reviewed for demographic and clinical characteristics. Predictors of mortality using logistic regression in a retrospective study were also reviewed. Results: A total of 109 (30.8%) males and 245 (69.2%) females participated in the study. The mean age of all participants was 35 ± 8 years. Median baseline CD4 cell counts and viral load were 91 cells/mm³ and 63,438 copies/ml respectively. There was a total of 123 (34.8%) deaths while 231 (65.2%) patients were discharged home. Tuberculosis (TB) was the most common diagnosis on admission as well as the leading cause of death. Among all subjects, only male gender (adjusted odds ratio [AOR] 4.67, 95% confidence interval [CI]: 2.63-8.29); CD4 cell count ≤ 200 cells/mm3 (AOR 5.28, 95% CI: 2.99-9.31); length of hospital stay < 3 days (AOR 4.77, 95% CI: 1.35-16.86); and age ≥ 35 years (AOR 2.43, 95% CI: 1.41-4.19) were predictive of death. Conclusion: These findings illustrate the need for early diagnosis of HIV infection, appropriate treatment and prevention of opportunistic infections, and improved access to highly active antiretroviral therapy (HAART).

scholarly journals Therapeutic evaluation of homeopathic treatment for canine oral papillomatosis

2020 ◽  
Vol 13 (1) ◽  
pp. 206-213
Author(s):  
P. Albert Arockia Raj ◽  
Selvaraj Pavulraj ◽  
M. Asok Kumar ◽  
S. Sangeetha ◽  
R. Shanmugapriya ◽  
...  
Keyword(s):  
Treatment Group ◽  
Previous Treatment ◽  
Cost Effective ◽  
Clinical Score ◽  
Treated Group ◽  
Control Group ◽  
Placebo Control ◽  
Oral Lesions ◽  
Early Recovery ◽  
Homeopathic Treatment

Aim: A study was conducted to evaluate the ameliorative potential of homeopathic drugs in combination (Sulfur 30C, Thuja 30C, Graphites 30C, and Psorinum 30C) in 16 dogs affected with oral papillomatosis which was not undergone any previous treatment. Materials and Methods: Dogs affected with oral papillomatosis, which have not undergone any initial treatment and fed with a regular diet. Dogs (total=16) were randomly divided into two groups, namely, homeopathic treatment group (n=8) and placebo control group (n=8). Random number table was used for allocation. Homeopathic combination of drugs and placebo drug (distilled water) was administered orally twice daily for 15 days. Clinical evaluation in both groups of dogs was performed by the same investigator throughout the period of study (12 months). Dogs were clinically scored for oral lesions on days 0, 5, 7, 10, 15, 20, 25, 30, 45, 60, 90, 120, and 150 after initiation of treatment. Results: The homeopathic treatment group showed early recovery with a significant reduction in oral lesions reflected by clinical score (p<0.001) in comparison to placebo-treated group. Oral papillomatous lesions regressed in the homeopathic group between 7 and 15 days, whereas regression of papilloma in the placebo group occurred between 90 and 150 days. The homeopathic treated group was observed for 12 months post-treatment period and no recurrence of oral papilloma was observed. Conclusion: The current study proves that the combination of homeopathy drugs aids in fastening the regression of canine oral papilloma and proved to be safe and cost-effective.

Spectrum of opportunistic infections in relation to CD4 count in HIV-2 patients

2019 ◽  
Vol 12 (3) ◽  
pp. 137-141
Author(s):  
Kashmira Rajendra Hajare ◽  
◽  
Priya Patil ◽  
Rahul Kadu ◽  
◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Cd4 Count

scholarly journals Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

2021 ◽  
Author(s):  
John Jospeh Diamond Princy ◽  
Kshetrimayum Birendra Singh ◽  
Ningthoujam Biplab ◽  
Ningthoukhongjam Reema ◽  
Rajesh Boini ◽  
...  
Keyword(s):  
Platelet Count ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
Total Leukocyte Count ◽  
Hiv Patients ◽  
Positive Correlation ◽  
Highly Active ◽  
The Mean

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

scholarly journals Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Mohammad Reza Jabbari ◽  
Hoorieh Soleimanjahi ◽  
Somayeh Shatizadeh Malekshahi ◽  
Mohammad Gholami ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Cell Count ◽  
Previous History ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

<b><i>Objectives:</i></b> The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count &#x3c;100 cells/mm<sup>3</sup> and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. <b><i>Methods:</i></b> This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count &#x3c;100 cells/mm<sup>3</sup>, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). <b><i>Results:</i></b> Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (<i>p</i> value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (<i>p</i> &#x3c; 0.02). <b><i>Conclusions:</i></b> We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count &#x3c;100 mm<sup>3</sup>/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

Sign in / Sign up

Export Citation Format

Share Document