The impact of scaling-up combination antiretroviral therapy on patterns of mortality among HIV-positive persons in British Columbia, Canada

Abstract Combination antiretroviral therapy (cART), which is a lifelong therapy for people living with human immunodeficiency virus, has been associated with nephrotoxicity and hepatotoxicity leading to its discontinuation. This study aimed at investigating the ameliorative potential of naringenin and quercetin on cART-induced hepatotoxicity and nephrotoxicity. Seventy male Wistar rats (225–260 g) were divided into seven groups as control, cART, naringenin, quercetin, dimethyl sulfoxide (DMSO), naringenin/cART (CN) and quercetin/cART (CQ). cART (24 mg/kg), naringenin (50 mg/kg) and quercetin (50 mg/kg) were dissolved in 1% v/v DMSO and administered orally for 56 days. Combination of cART and bioflavonoids had significant increase in superoxide dismutase (P < 0.05), catalase (P < 0.01), reduced glutathione (P < 0.001) and decreased malondialdehyde (P < 0.001) compared to cART only. Tumor necrosis factor Alpha (TNFα) level increased significantly in cART and CQ (P < 0.01) groups, while others showed no significant changes compared to control. TNFα also significantly decreased in CQ level compared to cART (P < 0.001). In addition, significant increase in creatinine level in cART only indicated progressive renal toxicity. Also, progressive pathological changes including congested blood vessels and hepatocellular necrosis were found in the liver, while the kidney had glomerular atrophy, and tubular distortion in cART-only group. Control, naringenin- and quercetin-treated groups showed normal renal and hepatic cytoarchitecture. These findings elucidate that progressive renal and hepatic toxicity is associated with the continuous use of cART; however, a combination of quercetin and naringenin with cART showed possible potential of ameliorating the damages posed by cART.

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Relationship between Food Insecurity and Mortality among HIV-Positive Injection Drug Users Receiving Antiretroviral Therapy in British Columbia, Canada

PLoS ONE ◽

10.1371/journal.pone.0061277 ◽

2013 ◽

Vol 8 (5) ◽

pp. e61277 ◽

Cited By ~ 41

Author(s):

Aranka Anema ◽

Keith Chan ◽

Yalin Chen ◽

Sheri Weiser ◽

Julio S. G. Montaner ◽

...

Keyword(s):

British Columbia ◽

Antiretroviral Therapy ◽

Food Insecurity ◽

Injection Drug Users ◽

Drug Users ◽

Injection Drug ◽

Hiv Positive

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Nonsurgical Management of Severe Osteonecrosis of the Knee in an HIV-Positive Patient: A Case Report

Case Reports in Infectious Diseases ◽

10.1155/2011/935041 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Stephanie A. Nixon ◽

Kelly K. O'Brien ◽

Gary Rubin

Keyword(s):

Antiretroviral Therapy ◽

Medication Management ◽

Management Strategies ◽

Health Care Team ◽

Positive Patient ◽

Hiv Positive ◽

Combination Antiretroviral Therapy ◽

Nonsurgical Management ◽

Total Knee ◽

The Right

Due to the life-prolonging effects of combination antiretroviral therapy, many people with HIV are living longer. However, this enhanced longevity is often mirrored by increased disability resulting from HIV and/or the adverse effects of medication. Management of HIV-positive patients is further complicated by comorbidities related to aging, including bone and joint disorders. In this paper, we describe the nonsurgical management of an HIV-positive patient with premature onset of severe osteonecrosis of the knee. A 50-year-old man who had been HIV-positive for 16 years and on combination antiretroviral therapy for 11 years presented to his family physician with extreme discomfort in his right knee. He was diagnosed with osteonecrosis of the right knee, but resisted total knee arthroplasty because of potential complications under anesthesia related to comorbid advanced liver disease. Instead, a successful combination of non-surgical management strategies was employed by the patient and his health care team.

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Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children

Public Health Nutrition ◽

10.1017/s1368980011003181 ◽

2012 ◽

Vol 15 (8) ◽

pp. 1442-1445 ◽

Cited By ~ 3

Author(s):

Nidhi Choudhary ◽

Sunil Gomber ◽

Manish Narang

Keyword(s):

Antiretroviral Therapy ◽

Nutritional Status ◽

Short Stature ◽

Clinical Status ◽

Hiv Positive ◽

Who Guidelines ◽

First Line ◽

Immunological Profile ◽

Control And Prevention ◽

The Impact

AbstractObjectivesTo study the clinico-immunological, nutritional and growth characteristics of HIV-infected children and the impact of antiretroviral therapy (ART) on these parameters.DesignRetrospective study.SettingOut-patient department of a paediatric ART centre, Delhi, India.SubjectsHIV-positive children registered at the paediatric ART centre of the hospital were enrolled (n 130). Anthropometric measurements were used to classify children into the type of malnutrition according to definitions of the WHO and US Centers for Disease Control and Prevention. Clinical and immunological status of the children was recorded as per WHO guidelines. First-line ART was started based on guidelines of the National AIDS Control Organization. Nutritional status and clinico-immunological characteristics were followed up annually in children receiving ART.ResultsOf children ≤5 years of age (n 54), stunting was noted in 42·5 % contrary to wasting seen in only 12·9 %. In children >5 years of age (n 76), short stature (40·7 %) and underweight (39·4 %) were seen in almost equal proportions. Asymptomatic presentation was noted in 60·0 %. Following ART, a reduction in wasting was noted in 75·0 % of children ≤5 years of age, whereas only 44·4 % of underweight children >5 years of age showed an improvement after therapy. Stunting and short stature continued to persist in all in children (≤5 years and >5 years, respectively). Clinico-immunologically, 67·5 % improved in clinical status and 62·5 % showed immunological improvement.ConclusionsART improves the acute parameters of nutritional status like wasting. It also improves the clinical outcome and restores the immune system. At present first-line ART is effective in HIV-positive children.

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