scholarly journals Kidney failure during HIV disease treated with tenofovir, multiple concurrent diseases and drug therapies

2012 ◽  
Vol 3 (2) ◽  
pp. 83
Author(s):  
Roberto Manfredi ◽  
Leonardo Calza ◽  
Vincenzo Colangeli ◽  
Nicola Dentale ◽  
Gabriella Verucchi
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Kidney Failure ◽  
Immunological Response ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Heart Infarction ◽  
Drug Classes ◽  
Significant Case ◽  
Life Threatening

A significant case report of a HIV infected patient in his fifties who experienced an excellent virological and immunological response to antiretroviral therapy (which has been modified just to prevent or avoid some adverse events), but developed a severe, sudden acute kidney failure while under a polypharmacy due to some underlying and overwhelming disorders (i.e. arterial hypertension, non-insulin-dependent diabetes mellitus, a recent acute heart infarction with remarkable remnants, and finally an anecdotal muscle-joint pain with self-prescription of non-steroideal anti-inflammatory drugs), represents the key point for a debate around the increasing frequency of “polypharmacy” in the field of HIV infection, even when HIV resistance to antiretroviral is not a concern. The continuing increase of mean age of HIV-infected population, plus the existing, sometimes unmodifiable risk factors for cardiovascular, dysmetabolic, and renal disorders, plus the adjunct of anecdotal illnesses prompting the resort to different drugs and medications, either prescribed for HIV infection itself, or taken for concurrent or subsequent diseases, or self-prescribed occasionally due to an intercurrent, trivial disorders per se, may prompt a complicated scenario culminating with a life-threatening acute renal failure of tubular origin. Our report gives us the opportunity to revise and discuss the expected interactions between antiretroviral therapy and the even growing exposure to multiple different drug and drug classes, which may be responsible for relevant drug interactions and direct or adjunctive end-organ impairment, up to life-threatening conditions, which may be avoided or prevented by considering carefully all comorbidites and co-treatments potentially administered to HIV infected patients, thirty years after the discovery of AIDS.

scholarly journals Kidney failure during HIV disease treated with tenofovir, multiple concurrent diseases and drug therapies

2012 ◽  
Vol 3 (2) ◽  
pp. 83-112
Author(s):  
Roberto Manfredi ◽  
Leonardo Calza ◽  
Vincenzo Colangeli ◽  
Nicola Dentale ◽  
Gabriella Verucchi
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Kidney Failure ◽  
Immunological Response ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Heart Infarction ◽  
Drug Classes ◽  
Significant Case ◽  
Life Threatening

A significant case report of a HIV infected patient in his fifties who experienced an excellent virological and immunological response to antiretroviral therapy (which has been modified just to prevent or avoid some adverse events), but developed a severe, sudden acute kidney failure while under a polypharmacy due to some underlying and overwhelming disorders (i.e. arterial hypertension, non-insulin-dependent diabetes mellitus, a recent acute heart infarction with remarkable remnants, and finally an anecdotal muscle-joint pain with self-prescription of non-steroideal anti-inflammatory drugs), represents the key point for a debate around the increasing frequency of “polypharmacy” in the field of HIV infection, even when HIV resistance to antiretroviral is not a concern. The continuing increase of mean age of HIV-infected population, plus the existing, sometimes unmodifiable risk factors for cardiovascular, dysmetabolic, and renal disorders, plus the adjunct of anecdotal illnesses prompting the resort to different drugs and medications, either prescribed for HIV infection itself, or taken for concurrent or subsequent diseases, or self-prescribed occasionally due to an intercurrent, trivial disorders per se, may prompt a complicated scenario culminating with a life-threatening acute renal failure of tubular origin. Our report gives us the opportunity to revise and discuss the expected interactions between antiretroviral therapy and the even growing exposure to multiple different drug and drug classes, which may be responsible for relevant drug interactions and direct or adjunctive end-organ impairment, up to life-threatening conditions, which may be avoided or prevented by considering carefully all comorbidites and co-treatments potentially administered to HIV infected patients, thirty years after the discovery of AIDS.

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 CLINICAL-EPIDEMIOLOGICAL CHARACTERISTIC OF AIDS-ASSOCIATED CRYPTOCOCCOSIS: DIAGNOSTICS AND THERAPEUTIC ASPECTS OF THE PROBLEM

2018 ◽  
Vol 23 (4) ◽  
pp. 156-164
Author(s):  
Alyona Borisovna Konkova-Reidman ◽  
A. A. Veksei ◽  
N. V. Smirnova ◽  
O. A. Pischulova
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Opportunistic Infections ◽  
Antifungal Drugs ◽  
Aids Patients ◽  
Life Threatening ◽  
Cd4 Lymphocyte ◽  
Definition Of ◽  
Chelyabinsk Region

Introduction Currently, cryptococcosis is among the three most life-threatening opportunistic infections in AIDS patients. Materials and methods. The analysis of cases of cryptococcosis in HIV-infected patients in the world, the Russian Federation and the Chelyabinsk region using the methods of descriptive and analytical epidemiology. Two clinical cases of verified cryptococcosis were analyzed in detail in patients in the phase of HIV infection progression in the absence of antiretroviral therapy. Results. The manifestation of the disease was observed in the phase of progression of HIV infection in the absence of antiretroviral therapy with low immune status of patients (CD4 + lymphocyte level less than 100 cells in 1 μl of blood). The diagnosis is verified on the basis of a complex of clinical, instrumental, biochemical, immunological and mycological methods. Successful courses of treatment with antifungal drugs: amphotericin B, itraconazole, fluconazole. Conclusions. The definition of cryptococcal antigen is not a method for evaluating the effectiveness of treatment due to its long-term persistence in CSF and serum, even with successful treatment. Prescribing antiretroviral therapy significantly increases the effectiveness of cryptococcosis treatment. In AIDS patients, antifungal therapy is stopped only after effective for 3-6 months ART (the number of CD4 + lymphocytes in the blood is more than 100-200 cells/μl).

Fluid Management of Children Who Have Diabetic Ketoacidosis

1995 ◽  
Vol 16 (8) ◽  
pp. 304-305
Keyword(s):  
Diabetic Ketoacidosis ◽  
Fluid Management ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Hydroxybutyric Acid ◽  
Acetoacetic Acid ◽  
Intracellular Space ◽  
Life Threatening ◽  
Insulin Dependent ◽  
Additional Water

Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic state that complicates insulin-dependent diabetes mellitus. In the absence of sufficient insulin, glucose is unable to enter cells, and the concentration in plasma increases. When the renal threshold is exceeded (generally at a concentration of about 180 mg/dL), an osmotic diuresis occurs, leading to dehydration. Additional water is lost through hyperventilation (an attempt to compensate for metabolic acidosis), vomiting, and in some cases, diarrhea. Water is drawn from the intracellular space to the plasma to equilibrate the tonicity of the two compartments, bolstering the circulation but producing further intracellular dehydration. Fat is metabolized for fuel because glucose without adequate insulin is not available to cells; beta-hydroxybutyric acid and acetoacetic acid are produced in the process and contribute to acidosis.

scholarly journals Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Abhijit Swami ◽  
Bhaskar Gupta ◽  
Prithwiraj Bhattacharjee
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
First Line ◽  
Drug Induced ◽  
Antitubercular Drugs ◽  
Disseminated Tuberculosis ◽  
Mucous Membranes ◽  
Life Threatening

Toxic epidermal necrolysis (TEN) is a potentially life-threatening disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Without proper management,TEN can cause sepsis leading to death of the patient. Though TEN is commonly drug induced, Isoniazid (INH) has been uncommonly associated with TEN. As INH is one of the first line drugs in treatment of tuberculosis, TEN induced INH needs modification of antitubercular therapy (ATT) with withdrawal of INH from the treatment regime along with other supportive treatments. Patients with HIV infection and disseminated tuberculosis need to be urgently initiated on an effective ATT on diagnosis of tuberculosis. However, if the patient develops potential life-threatening toxicity to first line antitubercular drugs like INH, an alternative effective ATT combination needs to be started as soon as the condition of the patient stabilizes as most of these patients present in advanced stage of HIV infection and this is to be followed by antiretroviral therapy (ART) as per guidelines. The present case reports the effectiveness of an ATT regime comprising Rifampicin, Pyrazinamide, Ethambutol, and Levofloxacin along with ART in situations where INH cannot be given in disseminated tuberculosis in HIV patients.

scholarly journals SOME ASPECTS OF MANAGEMENT OF HIV-INFECTED PATIENTS WITH PATHOLOGY OF DIGESTIVE SYSTEM IN CONTEXT OF FAMILY MEDICINE PRACTICE

2020 ◽  
Vol 8 (1) ◽  
pp. 72-83
Author(s):  
O. A. Golubovska ◽  
V. I. Vysotskyi
Keyword(s):  
Antiretroviral Therapy ◽  
Family Medicine ◽  
Hiv Infection ◽  
Digestive System ◽  
Inflammatory Diseases ◽  
Immunological Response ◽  
Virologic Response ◽  
Medical Surveillance ◽  
Treatment Regimens ◽  
Treatment Interruptions

Introduction. In the current situation of the HIV-infection epidemic, every 100-th citizen of Ukraine aged between 15 and 49 is infected with HIV. It is one of the highest rates among countries in the European Region. The issue of retaining HIV-positive patients in the medical surveillance system and support for adherence to ART treatment are becoming particularly relevant. At the same time, the comorbidity of HIV-infection with digestive system lesion is one of the main elements of pathological changes, both in the progression of HIV infection and in the occurrence of various complications leading to interruptions or failure to receive continuous antiretroviral therapy (ART). The purpose of the study is to examine the features of the digestive system lesions of HIV-infected patients and their impact on the effectiveness of antiretroviral therapy. Materials and methods. The study was conducted on randomly selected 215 HIV-infected patients in compliance with the bioethical and scientific standards, in accordance with industry standards and clinical guidelines approved by the Ministry of Health of Ukraine. Results and Discussion. Patients were divided into two comparison groups: the main group (MG) had 158 (73.5%) of HIV-infected persons with pathology of the digestive system, the controlled group (СG) had 57 (26.5%) of HIV-infected patients with no signs of gastric lesions of the gastrointestinal tract. Among the lesions of the digestive system in HIV-infected patients, hepatitis of viral and/or toxic genesis, chronic inflammatory diseases of the esophagus and gastroduodenal zone, chronic pancreatitis and cholecystitis were most often observed. In 61.4%, the pathology of the digestive tract was combined. When evaluating the efficacy of ART, no statistical difference was found between MG and CG in the frequency of the virologic response and the level of viral load at the beginning of the study and at 6 months of follow-up. However, MG patients had a worse immunologic response compared to CG, they were significantly more likely to switch the initial ART regimen, have breaks in treatment and development of adverse reactions. Patients treated for comorbid digestive system disorders had ART replacements less frequently and after 6 months of treatment they had an average level of CD4 + lymphocytes, which corresponded to the normal value. Conclusions. A significant majority of the examined patients with HIV-infection had digestive system lesions (73.5%). HIV-infected patients with digestive system pathology had more treatment interruptions, switch of ART regimens, and a worse immunological response, compared with the controlled group. Untreated diseases of the digestive system could be predictors of an increased break rate of ART, switch of treatment regimens, and decreased treatment efficacy. The introduction of an integrated, patient-oriented approach to the management of these nosologies in family medicine practice is proposed.

scholarly journals CLINICAL-EPIDEMIOLOGICAL CHARACTERISTIC OF AIDS-ASSOCIATED CRYPTOCOCCOSIS: DIAGNOSTICS AND THERAPEUTIC ASPECTS OF THE PROBLEM

2018 ◽  
Vol 23 (4) ◽  
pp. 156-164
Author(s):  
Alyona Borisovna Konkova-Reidman ◽  
A. A. Veksei ◽  
N. V. Smirnova ◽  
O. A. Pischulova
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Opportunistic Infections ◽  
Antifungal Drugs ◽  
Aids Patients ◽  
Life Threatening ◽  
Cd4 Lymphocyte ◽  
Definition Of ◽  
Chelyabinsk Region

Introduction Currently, cryptococcosis is among the three most life-threatening opportunistic infections in AIDS patients. Materials and methods. The analysis of cases of cryptococcosis in HIV-infected patients in the world, the Russian Federation and the Chelyabinsk region using the methods of descriptive and analytical epidemiology. Two clinical cases of verified cryptococcosis were analyzed in detail in patients in the phase of HIV infection progression in the absence of antiretroviral therapy. Results. The manifestation of the disease was observed in the phase of progression of HIV infection in the absence of antiretroviral therapy with low immune status of patients (CD4 + lymphocyte level less than 100 cells in 1 μl of blood). The diagnosis is verified on the basis of a complex of clinical, instrumental, biochemical, immunological and mycological methods. Successful courses of treatment with antifungal drugs: amphotericin B, itraconazole, fluconazole. Conclusions. The definition of cryptococcal antigen is not a method for evaluating the effectiveness of treatment due to its long-term persistence in CSF and serum, even with successful treatment. Prescribing antiretroviral therapy significantly increases the effectiveness of cryptococcosis treatment. In AIDS patients, antifungal therapy is stopped only after effective for 3-6 months ART (the number of CD4 + lymphocytes in the blood is more than 100-200 cells/μl).

Beneficial and Detrimental Effects of Antiretroviral Therapy on HIV-Associated Immunosenescence

Chemotherapy ◽  
2018 ◽  
Vol 63 (2) ◽  
pp. 64-75 ◽  
Author(s):  
Ornella Franzese ◽  
Maria Luisa Barbaccia ◽  
Enzo Bonmassar ◽  
Grazia Graziani
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Immunological Response ◽  
Antiretroviral Drugs ◽  
Hiv Patients ◽  
Progressive Decline ◽  
Highly Active ◽  
Anti Hiv Agents

Since the introduction of highly active antiretroviral therapy more than 2 decades ago, HIV-related deaths have dramatically decreased and HIV infection has become a chronic disease. Due to the inability of antiretroviral drugs to eradicate the virus, treatment of HIV infection requires a systemic lifelong therapy. However, even when successfully treated, HIV patients still show increased incidence of age-associated co-morbidities compared with uninfected individuals. Virus- induced immunosenescence, a process characterized by a progressive decline of immune system function, contributes to the premature ageing observed in HIV patients. Although antiretroviral therapy has significantly improved both the quality and length of patient lives, the life expectancy of treated patients is still shorter compared with that of uninfected individuals. In particular, while antiretroviral therapy can contrast some features of HIV-associated immunosenescence, several anti-HIV agents may themselves contribute to other aspects of immune ageing. Moreover, older HIV patients tend to have a worse immunological response to the antiviral therapy. In this review we will examine the available evidence on the role of antiretroviral therapy in the control of the main features regulating immunosenescence.

scholarly journals Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

2021 ◽  
Author(s):  
Ahmed Osman Saleh ◽  
Ruba Taha ◽  
Shehab Fareed A. Mohamed ◽  
Mohammed Bashir
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Autoimmune Diabetes ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Glucose Levels ◽  
Testicular Lymphoma ◽  
Chemotherapy Protocol ◽  
Life Threatening ◽  
Insulin Dependent

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.

Sign in / Sign up

Export Citation Format

Share Document