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.

A case of Pneumocystis jirovecii pneumonia in a patient with acquired immune deficiency syndrome who showed eosinophilia and an increased serum TARC/CCL17 level

Pneumocystis jirovecii pneumonia (PCP) in patients with acquired immune deficiency syndrome (AIDS) shows eosinophilic pneumonia like condition. The detailed mechanisms how AIDS-associated PCP causes eosinophilic pneumonia has not been elucidated, but it has been suggested that beta-D-glucan, a major component of Pneumocystis jirovecii, and T helper type 2 immunity may be involved in the mechanism of eosinophilia in the lung. We experienced the case who developed an eosinophilic pneumonia-like condition in a patient with AIDS-associated PCP, whose clinical course indicated the importance of TARC/CCL17 but not IL-4 and IL-5 as involved in eosinophilia caused by HIV and Pneumocystis jirovecii infection.

Pengaruh Pemberian Konseling Apoteker pada Pasien HIV-AIDS Di Poliklinik Rawat Jalan RS Bhayangkara TK I R. Said Sukanto

HIV-AIDS (Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome) merupakan suatu penyakit yang terus berkembang dan menjadi masalah global yang melanda dunia. HIV (Human Immunodeficiency Virus) adalah sejenis virus yang menyerang/menginfeksi limfosit yang menyebabkan turunnya kekebalan tubuh manusia. AIDS (Acquired Immune Deficiency Syndrome) adalah sekumpulan gejala penyakit yang timbul karena turunnya kekebalan yang disebabkan infeksi oleh HIV. Pengidap HIV memerlukan pengobatan dengan ARV (Antiretrovirus) untuk menurunkan jumlah virus HIV di dalam tubuh agar tidak masuk ke dalam stadium AIDS dan untuk mencegah terjadinya infeksi oportunistik dengan berbagai komplikasinya, dalam terapi pengobatan pasien. Tujuan penelitian ini yaitu untuk memperoleh gambaran karakterisitik (umur, jenis kelamin, pekerjaan, pendidikan, stadium penyakit) menganalisis pengaruh pemberian konseling Apoteker terhadap aspek pengetahuan, kepatuhan, kualitas hidup pasien dan efektivitas terapi ARV pada mengetahui pengaruh kepatuhan pasien dalam ART terhadap peningkatan kualitas hidup pasien HIV-AIDS di RS. Bhayangkara TK I R. Said Sukanto. Penelitian ini menggunakan metode quasi-eksperimental yang dilakukan secara prospektif. Penelitian ini dilakukan pada pasien HIV yang berobat di klinik rawat jalan RS Bhayangkara Tk I R. Said Sukanto. Pembagian kelompok kontrol dan kelompok intervensi menggunakan rumus sampling sederhana. Pengambilan data dan observasi dilakukan selama 6 (enam bulan) dari bulan Oktober 2019-Maret 2020. Aspek pengetahuan dan kualitas hidup diambil dengan menggunakan kuesioner, aspek kepatuhan diambil melalui obervasi data kunjungan pasien dan sisa obat sedangkan efektifitas terapi ARV diambil berdasarkan pemeriksaan CD4 pasien. Aspek pengetahuan diambil pada kunjungan pertama dan kedua, aspek kepatuhan diambil data tiap bulan, sedangkan aspek kualitas hidup dan efektifitas terapi diambil awal kunjungan dan 6 bulan kemudian. Hasil dari penelitian ini berdasarkan demografi kategori jenis kelamin yang paling dominan yaitu laki-laki sebanyak 46 responden (76,76%). Kategori usia yang paling dominan yaitu dengan rentang usia 30 tahun – 39 tahun sebanyak 29 responden (48,33%). Kategori Pendidikan yang paling dominan yaitu kategori SMA sebanyak 31 (51,67%). Status merital yang paling dominan yaitu kelompok menikah dengan total 34 (56,67%). Kepatuhan dalam terapi ODHA mempunyai pengaruh terhadap kualitas hidup pasien HIV-AIDS dengan nilai korelasi hasil uji Chi Sqaure 0,933 sebesar 0.373 > p value 0.01.

Use of antenatal corticosteroids in Brazil: data analysis from the National Survey Nascer no Brasil

ABSTRACT Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. Methods: Secondary data analysis from “Birth in Brazil”, a national hospital-based survey carried out in 2011–2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. Results: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26–34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks, the use of ANC was 23.9% in spontaneous deliveries, 20.6% in induced deliveries and 43.8% among those who did not go into labor. The variables vaginal delivery (OR 2.5; 95%CI 1.8–3.4) and living in the countryside were associated with not using ANC, and the occurrence of pre-eclampsia/eclampsia (OR 1.8; 95%CI 1.2–2.9) was associated with the use of ANC. Conclusions: The use of ANC among Brazilian pregnant women was low. Interventions to increase its use are necessary and can contribute to reduce neonatal mortality and morbidity. ANC should be promoted in pregnancies of less than 37 weeks, especially in cases of vaginal delivery and for those living in the countryside.

Factors Associated with Knowledge, Attitudes, and Prevention towards HIV/AIDS among Adults 15–49 Years in Mizoram, North East India: A Cross-Sectional Study

Despite a campaign of effective educational interventions targeting knowledge, attitudes, and prevention, Human Immunodeficiency-Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to be a significant public health issue in India, with Mizoram reporting the highest HIV/AIDS cases in 2018–2019. In this study, we extracted Mizoram state from the National Family Health Survey Fourth Series (NFHS-4) 2015–2016 datasets and investigated factors associated with respondents’ knowledge, attitudes, and prevention towards HIV/AIDS. The sample included 3555 adults aged 15–49 years residing in Mizoram, North-east India. Respondents who reported having ever heard of HIV/AIDS was 98%. Multivariate analysis indicated that the probability of having inadequate knowledge of HIV/AIDS was higher among those with no schooling, who were illiterate, of non-Christian faiths, belonging to backward tribes or caste, from poor households, and those who lived in rural areas, not exposed to media. The odds of mother-to-child transmission (PMTCT) of HIV/AIDS transmission was high among females (AOR = 3.12, 95% CI 2.34–4.16), respondents aged 35–39 years (AOR = 1.74, 95% CI 1.05–2.87) and those belonging to other backward class. The HIV/AIDS knowledge of respondents was found to be encouraging as the majority (98%) were considered to have a good level of understanding of the condition. An educational intervention to reduce the number of adults 15–49 years infected with HIV/AIDS in Mizoram should target those from low socioeconomic groups, those from non-Christian religions, and those from other backward classes.

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.

Mucocutaneous Manifestations in HIV/AIDS Patients

Background: The main target of human immunodeficiency virus (HIV) is cluster of differentiation 4 (CD4) T lymphocytes and several other immune cells that have CD4 receptors. They are also present in skin and mucosa, such as Langerhans cells (LC). Mucocutaneous lesions are one of the first clinical presentations of immunosuppression in HIV seropositive patients that manifest at different stages of the infection and require early diagnosis and prompt treatment. Purpose: To determine the clinical characteristics and the pattern of various mucocutaneous manifestations in Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) patients at Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya. Methods: This is a descriptive retrospective study with a cross-sectional design. The study subject was classified as all HIV-AIDS patients with mucocutaneous manifestations treated in Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya in 2019. Result: Out of the 614 patients who participated in the study, 72.1% were males. The majority of patients were in the age group 25–49 years (75.4%). The most common risk factor was heterosexuality (41.7%). Based on the distribution of mucocutaneous manifestations, the most common mucocutaneous manifestation was candidiasis mucocutan 387 patients (49.4%) followed by the pruritic papular eruption (PPE) 118 patients (15.1%) and human papillomavirus infection 57 patients (7.3%). Conclusion: Mucocutaneous manifestations occur throughout the course of HIV infection, and they can be considered as good clinical indicators for the progression of the disease and underlying immune status in resource-poor settings.

Artificial Stem Cells Mediated Inflammation-Tropic Delivery of Antiviral Drugs for Pneumonia Treatment

Background: Cytomegalovirus (CMV) pneumonia is a major cause of morbidity and mortality in immunodeficiency individuals including transplant recipients and Acquired Immune Deficiency Syndrome patients. Currently, antiviral drugs ganciclovir (GCV) and phosphonoformate (PFA) are first-line agents for pneumonia caused by herpesvirus infection. However, the therapy suffers from various limitations such as low efficiency, drug resistance, toxicity, and lack of specificity.Methods: The antiviral drugs GCV and PFA were loaded into the pH-responsive nanoparticles fabricated by poly(lactic-co-glycolic acid) (PLGA) and 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP), and further coated with cell membranes derived from bone marrow mesenchymal stem cells to form artificial stem cells, namely MPDGP. We evaluated the viral suppression effects of MPDGP in vitro and in vivo.Results: MPDGP showed significant inflammation tropism and efficient suppression of both viral replication and virus infection-associated inflammation in the CMV-induced pneumonia model. The synergistic effects by combination of viral DNA elongation inhibitor GCV and viral DNA polymerase inhibitor PFA on suppressing the inflammation efficiently. Conclusion: The present study develops a novel therapeutic intervention using artificial stem cells to deliver antiviral drugs at inflammatory sites, which shows great potential for the targeted treatment of pneumonia. To our best knowledge, we are the first to fabricate this kind of artificial stem cells to deliver the antiviral drugs for pneumonia treatment.

Therapeutic Drug Monitoring of Voriconazole in AIDS Patients

Background The safety and efficacy of Voriconazole in Acquired Immune Deficiency Syndrome (AIDS) patients is difficult to guarantee. In this study, Therapeutic Drug Monitoring (TDM) of Voriconazole in AIDS patients was investigated with the aim to further verify the significance of voriconazole TDM in AIDS patients and to explore more strategies to improve individualized medication. Methods The data of AIDS patients who underwent voriconazole TDM in our hospital from May 2018 to August 2021 were collected. The basic information of patients, the results of voriconazole TDM, the individualized intervention, the affecting factors of voriconazole concentration were analyzed, as well as the relationship between voriconazole trough concentration and safety. Results A total of 46 tests of voriconazole TDM were performed in 28 AIDS patients. Only 57.14% patients reached the therapeutic range at first TDM, and 87.50% patients reached the therapeutic range after intervention based on first TDM. 21.43% patients develop voriconazole-related Adverse Drug Reactions (ADRs), and ADRs were mostly occurred when voriconazole concentration is above 5.0 µg/mL. Spearman correlation coefficient rs was calculated to be 0.729 for voriconazole trough concentration and the incidence of ADRs, exhibiting a significant, positive linear correlation (P=0. 017). 50% patients had polypharmacy and drug interactions are common. For example, rifampicin can significantly reduce the plasma concentration of voriconazole. Multiple linear regression analysis showed Hypoproteinemia was a significant factor affecting voriconazole trough concentration(P=0.006). Conclusion AIDS patients usually have a low attainment rate of voriconazole trough concentration after initiation of standard dosing regimen. The affecting factors seem multifactorial and complex, of which hypoproteinemia is of great significance. Meanwhile, we need to be alert to the effects of drug interactions. The incidence of voriconazole related ADRs is high, mostly occurring when voriconazole concentration is above 5.0 µg/mL. Therefore, TDM can provide meaningful guidance for dosage optimization of voriconazole, and the dosage adjustment method in Chinese Guideline is applicable for the population of AIDS patients.