CSF HIV RNA Escape in Opsoclonus-Myoclonus-Ataxia Syndrome: Case Report and Review of the Literature

Background: Human immunodeficiency viruses (HIV) infection is associated with a broad range of neurological manifestations, including opsoclonus-myoclonus ataxia syndrome (OMAS) occurring in primary infection, immune reconstitution syndrome or in case of opportunistic co-infection.Case: We report the exceptional case of a 43-year-old female under HIV treatment for 10 years who presented initially with suspected epileptic seizure. Although the clinical picture slightly improved under anti-epileptic treatment, it was rapidly attributed to OMAS. The patient exhibited marked opsoclonus, mild dysarthria, upper limbs intermittent myoclonus, ataxia in 4 limbs, truncal ataxia, and a severe gait ataxia (SARA score: 34). The diagnostic work-up showed radiological and biological signs of central nervous system (CNS) inflammation and cerebral venous sinus thromboses. The HIV viral load was higher in cerebrospinal fluid (CSF) than in the blood (4,560 copies/ml vs. 76 copies/ml). She was treated for 5 days with pulsed corticotherapy. Dolutegravir and anticoagulation administration were initiated. Follow-ups at 2 and 4 months showed a dramatic improvement of clinical neurologic status (SARA score at 4 months: 1), reduction of CNS inflammation and revealed undetectable CSF and serum viral loads.Conclusion: This case underlines the importance of the evaluation of the CSF viral load in HIV patients developing OMAS and suggests CSF HIV RNA escape as a novel cause for OMAS.

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Predictors of Missed Hepatitis C Intake Appointments and Failure to Establish Hepatitis C Care Among Patients Living With HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy173 ◽

2018 ◽

Vol 5 (7) ◽

Cited By ~ 9

Author(s):

Edward R Cachay ◽

Lucas Hill ◽

Francesca Torriani ◽

Craig Ballard ◽

David Grelotti ◽

...

Keyword(s):

Viral Load ◽

Hepatitis C ◽

Drug Use ◽

Mental Health Disorder ◽

Integrated Treatment ◽

Hiv Treatment ◽

Hcv Treatment ◽

Hiv Viral Load ◽

History Of ◽

Living With Hiv

Abstract Background We estimated and characterized the proportion of patients living with HIV (PLWH) who missed hepatitis C (HCV) intake appointments and subsequently failed to establish HCV care. Methods Logistic regression analyses were used to identify factors associated with missed HCV intake appointments and failure to establish HCV care among PLWH referred for HCV treatment between January 2014 and December 2017. In addition to demographics, variables included HIV treatment characteristics, type of insurance, liver health status, active alcohol or illicit drug use, unstable housing, and history of a mental health disorder (MHD). Results During the study period, 349 new HCV clinic appointments were scheduled for 202 unduplicated patients. Approximately half were nonwhite, and 80% had an undetectable HIV viral load. Drug use (31.7%), heavy alcohol use (32.8%), and MHD (37.8%) were prevalent. Over the 4-year period, 21.9% of PLWH referred for HCV treatment missed their HCV intake appointment. The proportion increased each year, from 17.2% in 2014 to 25.4% in 2017 (P = .021). Sixty-six of the 202 newly referred HCV patients (32.7%) missed their first HCV appointment, and 28 of these (42.4%) failed to establish HCV care. Having a history of MHD, CD4 <200, ongoing drug use, and being nonwhite were independent predictors of missing an intake HCV appointment. The strongest predictor of failure to establish HCV care was having a detectable HIV viral load. Conclusions The proportion of PLWH with missed HCV appointments increased over time. HCV elimination among PLWH may require integrated treatment of MHD and substance use.

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The Effects of Viral Load Burden on Pregnancy Loss among HIV-Infected Women in the United States

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/362357 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Jordan E. Cates ◽

Daniel Westreich ◽

Andrew Edmonds ◽

Rodney L. Wright ◽

Howard Minkoff ◽

...

Keyword(s):

United States ◽

Viral Load ◽

Pregnancy Loss ◽

Ethnically Diverse ◽

The United States ◽

Hiv Replication ◽

Hiv Viral Load ◽

Adjusted Risk ◽

Hiv Rna ◽

Risk Ratios

Background. To evaluate the effects of HIV viral load, measured cross-sectionally and cumulatively, on the risk of miscarriage or stillbirth (pregnancy loss) among HIV-infected women enrolled in the Women’s Interagency HIV Study between 1994 and 2013.Methods. We assessed three exposures: most recent viral load measure before the pregnancy ended, log10copy-years viremia from initiation of antiretroviral therapy (ART) to conception, and log10copy-years viremia in the two years before conception.Results. The risk of pregnancy loss for those with log10viral load >4.00 before pregnancy ended was 1.59 (95% confidence interval (CI): 0.99, 2.56) times as high as the risk for women whose log10viral load was ≤1.60. There was not a meaningful impact of log10copy-years viremia since ART or log10copy-years viremia in the two years before conception on pregnancy loss (adjusted risk ratios (aRRs): 0.80 (95% CI: 0.69, 0.92) and 1.00 (95% CI: 0.90, 1.11), resp.).Conclusions. Cumulative viral load burden does not appear to be an informative measure for pregnancy loss risk, but the extent of HIV replication during pregnancy, as represented by plasma HIV RNA viral load, predicted loss versus live birth in this ethnically diverse cohort of HIV-infected US women.

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Overview of Factors Associated with HIV Viral Load Suppression in Transgender Women

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa210 ◽

2020 ◽

Author(s):

Zil G Goldstein

Keyword(s):

Viral Load ◽

Transgender Women ◽

Hiv Treatment ◽

Viral Load Suppression ◽

Hiv Viral Load ◽

Treatment Cascade ◽

Factors Associated ◽

The World ◽

Hiv Treatment Cascade ◽

Almost All

Abstract Background Transgender women face a significantly higher HIV burden than their cisgender counterparts around the world with worse treatment outcomes in almost all categories. Content A mini-review of the available literature discussing HIV risk and factors associated with HIV viral load suppression in transgender women. Summary This review discusses the disparities transgender women face that contribute to both of these factors including race as well as social determinants of health and how they affect the HIV treatment cascade in this population.

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971. Unmasking the Undetectable: Identifying and Troubleshooting a Series of Falsely Elevated HIV Viral Load Results in a Group of Patients in a Community Clinic in San Antonio, Texas

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1157 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S514-S515

Author(s):

Ruth Serrano Pinilla ◽

Anthony Hartzler

Keyword(s):

Viral Load ◽

Past History ◽

Routine Practice ◽

Virologic Suppression ◽

Hiv Viral Load ◽

Improvement Project ◽

Hiv Rna ◽

History Of ◽

Systemic Problems ◽

Rna Levels

Abstract Background Using effective antiretroviral therapy to consistently suppress plasma HIV RNA levels to < 200 copies/mL is known to improve morbidity and mortality at all stages of HIV infection and prevent transmission to sexual partners. Logistical challenges such as transporting, processing, and storing samples may threaten the accuracy of the test results. Plasma Preparation tubes (PPT) or Ethylene Diamine Tetra Acetic Acid (EDTA) tubes can be used for this test. PPT tubes contain an inert gel that migrates during centrifugation, forming a barrier between the plasma and cellular elements. Adequate separation of cellular elements may not always occur, and this can result in falsely elevated HIV Viral load (VL) due to measurement of integrated intracellular virus. It is therefore routine practice to centrifuge samples twice when PPT tubes are used. This is not necessary with EDTA tubes. In addition, there are reports that HIV RNA levels may be higher with PPT tubes are used, compared to EDTA tubes. Methods This is a quality improvement project that reviews a series of falsely elevated HIV VL in a group of patients who reported adherence and had been previously virologically suppressed. Results A total of 20 unexpectedly elevated HIV VL were identified from January to March of 2020 after introduction of a new phlebotomist in our clinic. VL ranged from 200-2530 copies/ml. Most patients (18/20) had history of virologic suppression and reported adherence. We standardized our process by using only PPT tubes and centrifuging samples twice prior to processing. Our nurses reported visible residual cellular elements in some of the plasma specimens in the tubes even after appropriate centrifugation. We continued to see suspected erroneous results. We repeated the test in EDTA tubes. 16/19 had HIV VL < 20, the remainder ranged from 27-41 copies/ml. We then implemented the use of EDTA tubes in all samples. No further cases of falsely elevated VL have been seen since the change. Table 1 Conclusion We describe potential steps that can interfere in the accuracy of HIV VL results. Detailed review of past history and patient’s adherence to treatment is essential to identify systemic problems that may lead to errors. Close communication with staff and laboratory provider will be key to overcome such challenges. Disclosures All Authors: No reported disclosures

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72. Massive Weight Gain in People with HIV (PWH) Starting Initial Antiretroviral Therapy (ART): Risk Factors and Predictive Ability of Early Weight Gain

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.072 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S47-S48

Author(s):

Tanit Phupitakphol ◽

Dean McEwen ◽

Kellie Hawkins ◽

Edward Gardner

Keyword(s):

Viral Load ◽

Weight Gain ◽

Predictive Ability ◽

Cd4 Count ◽

Bivariate Analysis ◽

Patient Counseling ◽

Hiv Viral Load ◽

Hiv Rna ◽

Art Initiation ◽

Early Weight Gain

Abstract Background Using a clinic cohort of ART naïve PWH, we sought to understand factors associated with massive weight gain as well as to assess if early weight gain could help predict massive weight gain at two years. Methods This was a retrospective cohort study of PWH from a large, urban clinic initiating first ART from January 2005 through March 2019, who had 21 – 27 months follow-up without ART changes, and were suppressed (HIV-RNA < 200 cps/ml) during that time. We defined massive weight gain as the top 20% of weight gainers at two years measured by percent (%) gain compared to baseline. Using bivariate and multivariate logistic regression (including factors in bivariate analysis with p< 0.20), we assessed the association of demographics, ART regimen, baseline CD4 count, HIV viral load, and body mass index (BMI) with weight gain at 2 years. We also assessed early weight gain (between 4 and 12 wks) and its association with massive weight gain at two years. Results Of 266 PWH included (table1), the median age was 36 years (IQR 29 - 45), 9% were women, 14% black, and 43% Latino. Overall, median % weight gain at 2 years was 4% (-1.1 – 11.6) In bivariate analyses, baseline factors significantly associated with massive weight gain included lower CD4 count, higher viral load, and lower baseline BMI. In multivariate analysis the odds of having massive weight gain were higher with lower CD4 count, adjusted odds ratio (aOR) 0.8 (95% CI 0.6 – 0.9) per 100 cells/ul increase and higher viral load, aOR 2.6 (95% CI 1.4 – 4.6) per 1 log increase. Early weights were available for 217 individuals at a median of 56 days (IQR 44 – 63) after ART initiation. Early weight gain correlated with % weight gain at 2 years (R=0.58). Individuals with ≤ 3% early weight gain represented 66% of the population and had a 10% risk (14 of 144) of having massive weight gain at 2 years. In contrast, 43 individuals had > 5% early weight gain and their risk of massive weight gain at 2 years was 56% (24 of 43). Conclusion In this real-world dataset, drug class or specific NRTI use was not associated with massive weight gain which was primarily dependent on baseline CD4 count and HIV viral load. There was a moderate correlation between early weight gain and massive weight gain at 2 years which can help with patient counseling and interventions aimed at slowing weight gain in this population. Disclosures All Authors: No reported disclosures

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Modeling HIV disease progression and transmission at population-level: The potential impact of modifying disease progression in HIV treatment programs

10.1101/097337 ◽

2016 ◽

Author(s):

Jennifer M. Ross ◽

Roger Ying ◽

Connie L. Celum ◽

Jared M. Baeten ◽

Katherine K. Thomas ◽

...

Keyword(s):

Viral Load ◽

Hiv Infection ◽

Disease Progression ◽

Hiv Transmission ◽

Acute Infection ◽

Hiv Infections ◽

Hiv Treatment ◽

Hiv Viral Load ◽

Potential Impact ◽

The Impact

AbstractIntroductionMathematical models of HIV transmission that incorporate the dynamics of disease progression can estimate the potential impact of adjunctive strategies to antiretroviral therapy (ART) for HIV treatment and prevention. Suppressive treatment of HIV-positive persons co-infected with herpes simplex virus-2 (HSV-2) with valacyclovir, a medication directed against HSV-2, can lower HIV viral load, but the impact of valacyclovir on population HIV transmission has not been estimated.MethodsWe applied data on CD4 and viral load progression in ART-naïve persons studied in two HIV clinical trials to a novel, discrete-time Markov model. We validated our disease progression estimates using data from a trial of home-based HIV counseling and testing in KwaZulu-Natal, South Africa. Finally, we applied our disease progression estimates to a dynamic transmission model estimating the impact of providing valacyclovir to ART-naïve individuals to reduce onward transmission of HIV in three scenarios of different ART and valacyclovir population coverage. We assumed that valacyclovir reduced HIV viral load by 1.23 log copies/μL, and that persons treated with valacyclovir initiated ART more rapidly when their CD4 fell below 500 due to improved retention in pre-ART care.ResultsThe average duration of HIV infection following acute infection was 9.5 years. The duration of disease after acute infection and before reaching CD4 200 cells/μL was 2.53 years longer for females than males. Relative to a baseline of community HIV testing and counseling and ART initiation at CD4 <=500 cells/μL, valacyclovir with increased linkage to care resulted in 166,000 fewer HIV infections over ten years, with an incremental cost-effectiveness ratio (ICER) of $4,696 per HIV infection averted. The Test and Treat scenario with 70% ART coverage and no valacyclovir resulted in 202,000 fewer HIV infections at an ICER of $6,579.ConclusionEven when compared with initiation of valacyclovir, a safe drug that reduces HIV viral load, universal treatment for HIV is the optimal strategy for averting new infections and increasing public health benefit. Universal HIV treatment should be pursued by all countries to most effectively and efficiently reduce the HIV burden.

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Relationship between vitamin D and human immunodeficiency virus (HIV) viral load among HIV-infected patients in Kazakhstan

The Journal of Infection in Developing Countries ◽

10.3855/jidc.6808 ◽

2015 ◽

Vol 9 (11) ◽

pp. 1277-1283 ◽

Cited By ~ 2

Author(s):

Zhamilya Nugmanova ◽

Nimish Patel ◽

Gulzhakhan M Akhmetova ◽

Gulnara S Kurmangalieva ◽

Malika K Abdumananova ◽

...

Keyword(s):

Vitamin D ◽

Human Immunodeficiency Virus ◽

Viral Load ◽

Prevalence Ratio ◽

Cross Sectional Study ◽

Hiv Viral Load ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Hiv Rna ◽

Immunodeficiency Virus

Introduction: Human immunodeficiency virus (HIV) is associated with inflammation. An association between vitamin D deficiency and inflammation also exists. Our study attempts to examine whether there may be a relationship between vitamin D and HIV viral load (HIV RNA) by: 1) characterizing the distribution of 25-hydroxyvitamin D (25-OHD), and 2) determining if 25-OHD is independently associated with HIV RNA. Methodology: A cross-sectional study among HIV-infected adults was conducted. Demographics, clinical / social / HIV characteristics and data on antiretroviral therapy were collected by questionnaire, medical records and laboratory testing. All patients provided blood samples. Bivariate and multivariate analyses were conducted to quantify the relationship between vitamin D and HIV RNA. Results: Among the 564 patients, the median (interquartile range, IQR) 25-OHD value was 24.42 (16.22 – 34.10) ng/mL. The mean (standard deviation, SD) log-HIV RNA was 3.51 (1.11) copies/mL. There were 304 patients (53.9%) with an undetectable HIV RNA (< 500 copies/mL). In the bivariate analyses, no differences were observed between patients with and without an undetectable HIV RNA in mean (SD) 25-OHD, 25-OHD insufficiency (< 30 ng/mL), or 25-OHD deciles. In the log-binomial regression analyses, there was no association between 25-OHD and an undetectable HIV RNA (prevalence ratio: 1.00, 95% confidence interval: 0.99 – 1.01, p = 0.67). Conclusions: No relationship was observed between 25-OHD and HIV RNA among HIV-infected patients in Kazakhstan.

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Food Insecurity and Substance Use in HIV-Infected Adults in the Miami Adult Studies on HIV (MASH) Cohort (P04-066-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-066-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sabrina Martinez ◽

Adriana Campa ◽

Gustavo Zarini ◽

Qingyun Liu ◽

Leslie Seminario ◽

...

Keyword(s):

Substance Use ◽

Food Security ◽

Viral Load ◽

Food Insecurity ◽

Illicit Drug ◽

Hiv Treatment ◽

Household Food Security ◽

People Living With Hiv ◽

Hiv Viral Load ◽

Polysubstance Use

Abstract Objectives It has been estimated that about half of people living with HIV (PLWH) in inner-cities may experience food insecurity. Substance use is common among PLWH and a risk factor for food insecurity. The objective of this study was to evaluate the relationship between substance use and food security in HIV + adults in the MASH cohort in Miami, Florida. Methods A cross-sectional analysis of data from an observational longitudinal study was conducted in 324 HIV + adults on antiretroviral therapy. After obtaining informed consent, validated questionnaires on demographics, socioeconomic status and illicit drug use and the Alcohol Use Disorders Identification Test (AUDIT) were collected. Polysubstance use was defined as >1 substance, including drugs and alcohol. Food insecurity was determined using the US Household Food Security Survey. HIV disease progression parameters, CD4 cell count and HIV viral load, were obtained from medical records with the participants’ permission. Wilcoxon, chi-square and regression analyses were completed, adjusted for age, gender, race/ethnicity, income, education, household size and quality of life. Results The median age was 53.61 (IQR = 49.4–58.3) years, 59.6% were male, 66.4% were African American, and 70% had an annual income of $15,000 a year or less. Most, 84% used at least one illicit drug, 55.9% were polysubstance users and 25.6% were food insecure. Food insecurity was higher in those who used marijuana (P = 0.007) and polysubstance use (P < 0.001) compared with non-users. Cocaine users had higher food insecurity compared with non-users which trended towards significance (P = 0.076). In a regression model, opiate users were at significantly higher risk for food insecurity than non-users (OR = 1.99, 95% CI: 1.037, 3.80, P = 0.039). Polysubstance users had 3 times greater risk of experiencing food insecurity compared with non-users (OR = 3.22, 95% CI: 1.70, 6.13, P < 0.001). Food insecurity was also associated with having a detectable HIV viral load (P = 0.034). Conclusions The current study shows that food insecurity is associated with substance use, alone or in combination, and with uncontrolled HIV viral load among PLWH living in poverty. In resource poor settings, substance use treatment and nutritional services are greatly needed in order to advance HIV treatment and care. Funding Sources National Institute on Drug Abuse 5U01DA040381–03.

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The role of HIV viral load in mathematical models of HIV transmission and treatment: a review

BMJ Global Health ◽

10.1136/bmjgh-2019-001800 ◽

2020 ◽

Vol 5 (1) ◽

pp. e001800 ◽

Cited By ~ 2

Author(s):

Tracy Glass ◽

Landon Myer ◽

Maia Lesosky

Keyword(s):

Viral Load ◽

Mathematical Models ◽

Hiv Transmission ◽

Simulation Models ◽

Population Level ◽

Hiv Treatment ◽

Hiv Viral Load ◽

Hiv Epidemiology ◽

The Impact

IntroductionHIV viral load (VL) is accepted as a key biomarker in HIV transmission and pathogenesis. This paper presents a review of the role of VL testing in mathematical models for HIV prevention and treatment.MethodsA search for simulation models of HIV was conducted in PubMed, yielding a total of 1210 studies. Publications before the year 2000, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and disease monitoring strategy was extracted.Results and discussionA total of 279 studies related to HIV simulation models were included in the review, though only 17 (6%) included consideration of VL or VL testing and were evaluated in detail. Within the studies that included assessment of VL, routine monitoring was the focus, and usually in comparison to alternate monitoring strategies such as clinical or CD4 count-based monitoring. The majority of remaining models focus on the impact or delivery of antiretroviral therapy (n=68; 27%), pre-exposure prophylaxis (n=28; 11%) and/or HIV testing (n=24; 9%) on population estimates of HIV epidemiology and exclude consideration of VL. Few studies investigate or compare alternate VL monitoring frequencies, and only a small number of studies overall (3%) include consideration of vulnerable population groups such as pregnant women or infants.ConclusionsThere are very few simulations of HIV treatment or prevention that include VL measures, despite VL being recognised as the key determinant of both transmission and treatment outcomes. With growing emphasis on VL monitoring as key tool for population-level HIV control, there is a clear need for simulations of HIV epidemiology based on VL.

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Predictive factors of viral load high-risk events for virological failure in HIV/AIDS patients receiving long-term antiviral therapy

BMC Infectious Diseases ◽

10.1186/s12879-021-06162-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shanfang Qin ◽

Jingzhen Lai ◽

Hong Zhang ◽

Di Wei ◽

Qing Lv ◽

...

Keyword(s):

Viral Load ◽

High Risk ◽

Virological Failure ◽

Cox Regression ◽

Information Management System ◽

Hiv Treatment ◽

Hiv Viral Load ◽

Aids Patients ◽

Bivariate Logistic Regression ◽

Hiv Aids

Abstract Background In the era of anti-retroviral therapy (ART), the plasma HIV viral load (VL) is an important primary indicator for monitoring the HIV treatment response. To optimize the clinical management of HIV/AIDS patients, we investigated VL high-risk events related to virological failure (VF) and further explored the preventive factors of VL high-risk events. Methods The data were derived from China’s HIV/AIDS Comprehensive Response Information Management System. HIV infected patients who initiated or received ART in Guangxi between 2003 and 2019 were included. The contributions of VL after 6 months of ART to VF and AIDS-related death were analysed by Kaplan-Meier curves, log-rank tests and Cox regression analyses. Both descriptive analyses and bivariate logistic regression were employed to further explore the preventive factors related to VL high-risk events of VF. Results The cumulative rates of VF in the high low-level viremia group (high LLV) (χ2 = 18.45; P < 0.001) and non-suppressed group (χ2 = 82.99; P < 0.001) were significantly higher than those in the viral suppression (VS) group. Therefore, the VL high-risk events of VF was defined as highest VL > 200 copies/ml after 6 months of ART. Compared with the VS group, the adjusted hazard risk was 7.221 (95% CI: 2.668; 19.547) in the high LLV group and 8.351 (95% CI: 4.253; 16.398) in the non-suppressed group. Compared with single patients, married or cohabiting (AOR = 0.591; 95% CI: 0.408, 0.856) and divorced or separated (AOR = 0.425, 95% CI: 0.207, 0.873) patients were negatively associated with VL high-risk events. So were patients acquired HIV homosexually (AOR = 0.572; 95% CI: 0.335, 0.978). However, patients who had ART modification were 1.728 times (95% CI: 1.093, 2.732) more likely to have VL high-risk events, and patients who used cotrimoxazole during ART were 1.843 times (95% CI: 1.271, 2.672) more likely to have VL high-risk events. Conclusions A VL greater than 200 copies/ml is a VL high-risk event for VF. Intervention measurements should be adopted to optimize the surveillance of ART in patients who are single or widowed, who have ART modification, and who use cotrimoxazole during ART.

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