Progress in the Treatment of HIV-Associated Lymphoma When Combined With the Antiretroviral Therapies

With the wide use of combination antiretroviral therapy (cART), the life expectancy of HIV-infected individuals drastically improved. However, HIV infection and HIV-associated cancers were the most common causes of death in the HIV-infected populations. The HIV-associated cancers are divided into acquired immune deficiency syndrome (AIDS)-defining and non-AIDS-defining cancers based on the incidence among the HIV-infected patients. Among HIV-associated cancers, acquired immune deficiency syndrome-related lymphoma (ARL) is still the most common condition and the leading cause of HIV/AIDS-related deaths. Diffuse large B-cell lymphoma (DLBCL) and Burkitt’s lymphoma (BL) are the most common subtypes of the ARL. Although Hodgkin’s lymphoma (HL) is not considered as an AIDS-defining cancer, incidence of HL in HIV-infected individuals is higher than the general population. The review summarizes the new progress in the treatment of HIV-associated lymphoma.

The Importance of Tissue Sanctuaries and Cellular Reservoirs of HIV-1

Purpose of Review: There have been significant developments in the treatment of people living with HIV-1/AIDS with current antiretroviral therapies; however, these developments have not been able to achieve a functional or sterilizing cure for HIV-1. While there are multiple barriers, one such barrier is the existence of pharmacological sanctuaries and viral reservoirs where the concentration of antiretrovirals is suboptimal, which includes the gut-associated lymphoid tissue, central nervous system, lymph nodes, and myeloid cells. This review will focus on illustrating the significance of these sanctuaries, specific barriers to optimal antiretroviral concentrations in each of these sites, and potential strategies to overcome these barriers. Recent Findings: Research and studies have shown that a uniform antiretroviral distribution is not achieved with current therapies. This may allow for low-level replication associated with low antiretroviral concentrations in these sanctuaries/reservoirs. Many methods are being investigated to increase antiretroviral concentrations in these sites, such as blocking transporting enzymes functions, modulating transporter expression and nanoformulations of current antiretrovirals. While these methods have been shown to increase antiretroviral concentrations in the sanctuaries/reservoirs, no functional or sterilizing cure has been achieved due to these approaches. Summary: New methods of increasing antiretroviral concentrations at the specific sites of HIV-1 replication has the potential to target cellular reservoirs. In order to optimize antiretroviral distribution into viral sanctuaries/reservoirs, additional research is needed.

Coinciding SARS-CoV-2 infection in HIV patients with cerebral toxoplasma

A massive and notorious impact of coronavirus disease 2019 (COVID-19) pandemic has affected communities worldwide, urging extra preventive measure, especially for individuals with comorbidities including those who are suffering from human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). We reported a case of a 45-year-old man with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV infection as well as toxoplasmosis. The patient presented to the hospital with decreased consciousness and stiffness on both hands and feet accompanied with loss of appetite, fever, and coughing. Since 2014, he had been diagnosed with HIV and undergone combined antiretroviral therapies. Toxoplasmosis was revealed by multislice computed tomography (MSCT) showing multiple rim-like lesion in cortex-subcortex of left temporal lobe along with surrounding perifocal oedema. Furthermore, the finding was corroborated by the contrasted image exhibiting rim enhancement patterns. The patient was also RT-PCR confirmed Covid-19. Following examinations, the patient received pyrimethamine with a loading dose of 200 mg. The management was continued with oral intake of pyrimethamine, clindamycin, folic acid, and vitamin B6 for maintenance dose. This case report suggests that HIV patient suffering from COVID-19 can be treated with antiretroviral therapies since the specific antivirus for SARS-CoV-2 has not yet available. We believe that this case report could contribute to more understanding on the development of clinical management for COVID-19 in HIV-positive patients.

Terapia antirretroviral em gestantes portadoras do HIV

Este estudo de revisão integrativa da literatura teve como objetivo revisar as evidências descritas em protocolos assistenciais às gestantes com HIV quanto ao tratamento com antirretroviral. Teve-se por questão norteadora: como são usadas as terapias antirretrovirais em gestantes? Os dados foram obtidos por meio de busca nas bases de dados LILACS e SCIELO, abrangendo o período de 2010 até 2016, nos idiomas português, inglês e espanhol. Identificou-se 17 artigos, dos quais seis atenderam aos critérios de inclusão adotados. Os resultados foram organizados em quadro. A caracterização revelou que a maioria dos autores são formados em medicina, realizaram estudo retrospectivo em bases de dados e 66,6% das publicações ocorreram no Brasil. Os resultados revelaram que o correto uso da terapia antirretrovital descrita em protocolo atualizado reduz o potencial de transmissão vertical e possibilita o nascimento de recém-nascidos sem o vírus da imunodeficiência adquirida. ABSTRACT This integrative literature review study aimed to review the evidence described in care protocols for pregnant women with HIV regarding antiretroviral treatment. The guiding question was: How are antiretroviral therapies used in pregnant women? The data were obtained by searching the LILACS and SCIELO databases, covering the period from 2010 to 2016, in Portuguese, English and Spanish. Seventeen articles were identified, six of which met the inclusion criteria adopted. The results were organized in a table. The characterization revealed that most authors are medical graduates, conducted retrospective study in databases and 66.6% of publications occurred in Brazil. The results revealed that the correct use of antiretroviral therapy described in an updated protocol reduces the potential for vertical transmission and enables the birth of newborns without acquired immunodeficiency virus.

The Systematic Development of Attributes And Levels For A Discrete Choice Experiment of HIV Patient Preferences For Long-Acting Antiretroviral Therapies In The United States

Introduction: Patient preferences for long-acting antiretroviral therapies (LA-ART) should inform development of regimens with optimal adherence and acceptability. We describe a systematic process used to identify attributes and levels for a discrete choice experiment (DCE) designed to elicit preferences for potential LA-ART options in the US. Methods: Our approach was conducted in four stages: data collection, data reduction, removing inappropriate attributes, and optimizing wording. We started with 8 attributes defining potential LA-ART products based on existing literature and knowledge of products in development. We conducted 12 key informant interviews with experts in HIV treatment. The list of attributes, the set of plausible levels for each attribute, and restrictions on combinations of attribute levels were updated iteratively.Results: Despite uncertainty about which products will become available, key informant discussions converged on 4 delivery modes (infusions and patches were not considered immediately feasible) and 6 additional attributes. Treatment effectiveness and frequency of clinical monitoring were dropped. Oral lead-in therapy was split into two attributes: pre-treatment time undetectable and pre-treatment negative reaction testing. We omitted product-specific systemic and local side effects. In addition to mode, the final set of attributes included: frequency of dosing; location of treatment; pain; pre-treatment time undetectable; pre-treatment negative reaction testing; and late-dose leeway.Conclusions: A systematic process successfully captured elements that are both feasible and relevant to evaluating the acceptability of potential LA-ART alternatives to patients.

A 28-Day Toxicity Study of Tenofovir Alafenamide Hemifumarate by Subcutaneous Infusion in Rats and Dogs

Human immunodeficiency virus (HIV) infection continues to be a serious global human health issue, with ∼38 million people living with HIV worldwide at the end of 2019. HIV preexposure prophylaxis (PrEP) has introduced the use of antiretroviral therapies as another helpful tool for slowing the spread of HIV worldwide.