50 results on '"Arenas-Pinto A"'
Search Results
2. Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross‐sectional and longitudinal analyses
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Alison Rodger, Lewis J. Haddow, Margaret Johnson, Fiona C Lampe, Anna Maria Geretti, Lorraine Sherr, Simon Collins, Alejandro Arenas-Pinto, Colette Smith, Monica Lascar, Andrew N. Phillips, Timothy Willem Jones, Jeffrey McDonnell, and Elaney Yousef
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Male ,medicine.medical_specialty ,Sexual transmission ,Anti-HIV Agents ,HIV Infections ,Medication Adherence ,Unit of alcohol ,Men who have sex with men ,Sexual and Gender Minorities ,Recreational Drug Use ,Internal medicine ,medicine ,Humans ,Outpatient clinic ,Pharmacology (medical) ,Homosexuality, Male ,business.industry ,Health Policy ,Smoking ,Alcohol dependence ,Hazard ratio ,Odds ratio ,Viral Load ,Cross-Sectional Studies ,Infectious Diseases ,Female ,business ,Viral load - Abstract
Objectives There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. Methods The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up. Results Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74 (2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated with ART non-adherence. After adjusting for demographic and socioeconomic factors, CAGE score ≥ 2 [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.09-2.13], current smoking (aOR = 1.58, 95% CI: 1.10-2.17) and injection drug use (aOR = 2.11, 95% CI: 1.00-4.47) were associated with viral non-suppression. During follow-up of a subset of 592 people virally suppressed at recruitment, a CAGE score ≥ 2 [adjusted hazard ratio (aHR) = 1.66, 95% CI: 1.03-2.74], use of 3 or more non-injection drugs (aHR = 1.82, 95% CI: 1.12-3.57) and injection drug use (aHR = 2.73, 95% CI: 1.08-6.89) were associated with viral rebound. Conclusions Screening and treatment for alcohol, cigarette and drug use should be integrated into HIV outpatient clinics, while clinicians should be alert to the potential for poorer virological outcomes.
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- 2021
3. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN)
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Victoria Jane Hall, Sarah Foulkes, Andre Charlett, Ana Atti, Edward J M Monk, Ruth Simmons, Edgar Wellington, Michelle J Cole, Ayoub Saei, Blanche Oguti, Katie Munro, Sarah Wallace, Peter D Kirwan, Madhumita Shrotri, Amoolya Vusirikala, Sakib Rokadiya, Meaghan Kall, Maria Zambon, Mary Ramsay, Tim Brooks, Colin S Brown, Meera A Chand, Susan Hopkins, N Andrews, A Atti, H Aziz, T Brooks, CS Brown, D Camero, C Carr, MA Chand, A Charlett, H Crawford, M Cole, J Conneely, S D'Arcangelo, J Ellis, S Evans, S Foulkes, N Gillson, R Gopal, L Hall, VJ Hall, P Harrington, S Hopkins, J Hewson, K Hoschler, D Ironmonger, J Islam, M Kall, I Karagiannis, O Kay, J Khawam, E King, P Kirwan, R Kyffin, A Lackenby, M Lattimore, E Linley, J Lopez-Bernal, L Mabey, R McGregor, S Miah, EJM Monk, K Munro, Z Naheed, A Nissr, AM O'Connell, B Oguti, H Okafor, S Organ, J Osbourne, A Otter, M Patel, S Platt, D Pople, K Potts, M Ramsay, J Robotham, S Rokadiya, C Rowe, A Saei, G Sebbage, A Semper, M Shrotri, R Simmons, A Soriano, P Staves, S Taylor, A Taylor, A Tengbe, S Tonge, A Vusirikala, S Wallace, E Wellington, M Zambon, D Corrigan, M Sartaj, L Cromey, S Campbell, K Braithwaite, L Price, L Haahr, S Stewart, ED Lacey, L Partridge, G Stevens, Y Ellis, H Hodgson, C Norman, B Larru, S Mcwilliam, S Winchester, P Cieciwa, A Pai, C Loughrey, A Watt, F Adair, A Hawkins, A Grant, R Temple-Purcell, J Howard, N Slawson, C Subudhi, S Davies, A Bexley, R Penn, N Wong, G Boyd, A Rajgopal, A Arenas-Pinto, R Matthews, A Whileman, R Laugharne, J Ledger, T Barnes, C Jones, D Botes, N Chitalia, S Akhtar, G Harrison, S Horne, N Walker, K Agwuh, V Maxwell, J Graves, S Williams, A O'Kelly, P Ridley, A Cowley, H Johnstone, P Swift, J Democratis, M Meda, C Callens, S Beazer, S Hams, V Irvine, B Chandrasekaran, C Forsyth, J Radmore, C Thomas, K Brown, S Roberts, P Burns, K Gajee, TM Byrne, F Sanderson, S Knight, E Macnaughton, BJL Burton, H Smith, R Chaudhuri, K Hollinshead, RJ Shorten, A Swan, C Favager, J Murira, S Baillon, S Hamer, K Gantert, J Russell, D Brennan, A Dave, A Chawla, F Westell, D Adeboyeku, P Papineni, C Pegg, M Williams, S Ahmad, S Ingram, C Gabriel, K Pagget, G Maloney, J Ashcroft, I Del Rosario, R Crosby-Nwaobi, C Reeks, S Fowler, L Prentice, M Spears, G McKerron, K McLelland-Brooks, J Anderson, S Donaldson, K Templeton, L Coke, N Elumogo, J Elliott, D Padgett, M Mirfenderesky, A Cross, J Price, S Joyce, I Sinanovic, M Howard, T Lewis, P Cowling, D Potoczna, S Brand, L Sheridan, B Wadams, A Lloyd, J Mouland, J Giles, G Pottinger, H Coles, M Joseph, M Lee, S Orr, H Chenoweth, C Auckland, R Lear, T Mahungu, A Rodger, K Penny-Thomas, S Pai, J Zamikula, E Smith, S Stone, E Boldock, D Howcroft, C Thompson, M Aga, P Domingos, S Gormley, C Kerrison, L Marsh, S Tazzyman, L Allsop, S Ambalkar, M Beekes, S Jose, J Tomlinson, A Jones, C Price, J Pepperell, M Schultz, J Day, A Boulos, E Defever, D McCracken, K Gray, A Houston, T Planche, R Pritchard Jones, Diane Wycherley, S Bennett, J Marrs, K Nimako, B Stewart, N Kalakonda, S Khanduri, A Ashby, M Holden, N Mahabir, J Harwood, B Payne, K Court, N Staines, R Longfellow, ME Green, LE Hughes, M Halkes, P Mercer, A Roebuck, E Wilson-Davies, L Gallego, R Lazarus, N Aldridge, L Berry, F Game, T Reynolds, C Holmes, M Wiselka, A Higham, M Booth, C Duff, J Alderton, H Jory, E Virgilio, T Chin, MZ Qazzafi, AM Moody, R Tilley, T Donaghy, K Shipman, R Sierra, N Jones, G Mills, D Harvey, YWJ Huang, J Birch, L Robinson, S Board, A Broadley, C Laven, N Todd, DW Eyre, K Jeffery, S Dunachie, C Duncan, P Klenerman, L Turtle, T De Silva, H Baxendale, JL Heeney, Group, SIREN Study, Dunachie, SJ, Kirwan, Peter [0000-0001-6904-0500], and Apollo - University of Cambridge Repository
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Adult ,Male ,medicine.medical_specialty ,Health Personnel ,030204 cardiovascular system & hematology ,Antibodies, Viral ,Lower risk ,Asymptomatic ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Pandemic ,Health care ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Asymptomatic Infections ,Pandemics ,SARS-CoV-2 ,business.industry ,Incidence (epidemiology) ,Public health ,COVID-19 ,Articles ,General Medicine ,Middle Aged ,England ,COVID-19 Nucleic Acid Testing ,Reinfection ,Cohort ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Background Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection. Methods A large, multicentre, prospective cohort study was done, with participants recruited from publicly funded hospitals in all regions of England. All health-care workers, support staff, and administrative staff working at hospitals who could remain engaged in follow-up for 12 months were eligible to join The SARS-CoV-2 Immunity and Reinfection Evaluation study. Participants were excluded if they had no PCR tests after enrolment, enrolled after Dec 31, 2020, or had insufficient PCR and antibody data for cohort assignment. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2–4 weeks) and completed questionnaires every 2 weeks on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive, or previous positive PCR or antibody test) or negative cohort (antibody negative, no previous positive PCR or antibody test). The primary outcome was a reinfection in the positive cohort or a primary infection in the negative cohort, determined by PCR tests. Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, or possible) and symptom-status, depending on the hierarchy of evidence. Primary infections in the negative cohort were defined as a first positive PCR test and seroconversions were excluded when not associated with a positive PCR test. A proportional hazards frailty model using a Poisson distribution was used to estimate incidence rate ratios (IRR) to compare infection rates in the two cohorts. Findings From June 18, 2020, to Dec 31, 2020, 30 625 participants were enrolled into the study. 51 participants withdrew from the study, 4913 were excluded, and 25 661 participants (with linked data on antibody and PCR testing) were included in the analysis. Data were extracted from all sources on Feb 5, 2021, and include data up to and including Jan 11, 2021. 155 infections were detected in the baseline positive cohort of 8278 participants, collectively contributing 2 047 113 person-days of follow-up. This compares with 1704 new PCR positive infections in the negative cohort of 17 383 participants, contributing 2 971 436 person-days of follow-up. The incidence density was 7·6 reinfections per 100 000 person-days in the positive cohort, compared with 57·3 primary infections per 100 000 person-days in the negative cohort, between June, 2020, and January, 2021. The adjusted IRR was 0·159 for all reinfections (95% CI 0·13–0·19) compared with PCR-confirmed primary infections. The median interval between primary infection and reinfection was more than 200 days. Interpretation A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. Funding Department of Health and Social Care of the UK Government, Public Health England, The National Institute for Health Research, with contributions from the Scottish, Welsh and Northern Irish governments.
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- 2021
4. Using trained dogs and organic semi-conducting sensors to identify asymptomatic and mild SARS-CoV-2 infections: an observational study
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Guest, Claire, Dewhirst, Sarah Y, Lindsay, Steve W, Allen, David J, Aziz, Sophie, Baerenbold, Oliver, Bradley, John, Chabildas, Unnati, Chen-Hussey, Vanessa, Clifford, Samuel, Cottis, Luke, Dennehy, Jessica, Foley, Erin, Gezan, Salvador A, Gibson, Tim, Greaves, Courtenay K, Kleinschmidt, Immo, Lambert, Sébastien, Last, Anna, Morant, Steve, Parker, Josephine E A, Pickett, John, Quilty, Billy J, Rooney, Ann, Shah, Manil, Somerville, Mark, Squires, Chelci, Walker, Martin, Logan, James G, Jones, Robert, Assis, Ana, Borthwick, Ewan, Caton, Laura, Edwards, Rachel, Heal, Janette, Hill, David, Jahan, Nazifa, Johnson, Cecelia, Kaye, Angela, Kirkpatrick, Emily, Kisha, Sarah, Ledeatte Williams, Zaena, Moar, Robert, Owonibi, Tolulope, Purcell, Benjamin, Rixson, Christopher, Spencer, Freya, Stefanidis, Anastasios, Stewart, Sophie, Tytheridge, Scott, Wakley, Sian, Wildman, Shanice, Aziz, Catherine, Care, Helen, Curtis, Emily, Dowse, Claire, Makepeace, Alan, Oultram, Sally-Anne, Smith, Jayde, Shenton, Fiona, Hutchins, Harry, Mart, Robert, Cartwright, Jo-anne, Forsey, Miranda, Goodsell, Kerry, Kittridge, Lauren, Nicholson, Anne, Ramos, Angelo, Ritches, Joanne, Setty, Niranjan, Vertue, Mark, Bergstrom, Malin, Chaudhary, Zain, De Wilton, Angus, Gaskell, Kate, Houlihan, Catherine, Jones, Imogen, Margaritis, Marios, Miralhes, Patricia, Owens, Leah, Rampling, Tommy, Rickman, Hannah, Boffito, Marta, Fernandez, Candida, Cotterell, Bryony, Guerdette, Anne-Marie, Tsaknis, George, Turns, Margaret, Walsh, Joanne, Frankland, Lisa, West, Raha, Holland, Maureen, Keenan, Natalie, Wassall, Helen, Young, Megan, Rangeley, Jade, Saalmink, Gwendolyn, Adlakha, Sanjay, Buckley, Philip, Allsop, Lynne, Smith, Susan, Sowter, Donna, Campbell, Alison, Jones, Julie, Laird, Steve, O’Toole, Sarah, Ryan, Courteney, Evans, Jessica, Rand, James, Schumacher, Natasha, Hazelton, Tracey, Dodgson, Andrew, Glasgow, Susannah, Kadiu, Denise, Lopuszansky, Orianne, Oommen, Anu, Prabhu, Joshi, Pursell, Molly, Turner, Jane, Walton, Hollie, Andrews, Robert, Cruickshank, Irena, Thompson, Catherine, Wainwright, Tania, Roebuck, Alun, Lawrence, Tara, Netherton, Kimberley, Hewitt, Claire, Shephardson, Sarah, Crasto, Winston Andrew, Lake, Judith, Musanhu, Rosemary, Walker, Rebecca, Burns, Karen, Higham, Andrew, Le Bas, Julie, Mackenzie, Nicola, Thatcher, Hilary, Beadle, Shannen, Buckley, Sarah, Castle, Gail, Fletcher, Aimee, Holbrook, Sara, Kane, Patricia, Lindley, Kate, Lowry, Tracey, Lupton, Stephanie, Oddy, Sharon, Slater, Lynda, Sylvester, Martin, Agwuh, Kenneth, Maxwell, Veronica, Ryder, Stephen, Topham, Kirsty, Egbuniwe, Obi, Matthews, Rebecca, Arenas-Pinto, Alejandro, Prymas, Paulina, Severn, Abigail, Shaw, Amber, Begum, Safia, Lenton, Daniel, Scriven, James, Leeman, Lucy, Rudge, Karen, Storr, Emma, Alvarez, Ana, Forster, Kate, Hind, Daniel, Cook, Natalie, Peeling, Rosanna, Carey, Peter, Wilson, Anne, and Davis, Jane
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Volatile Organic Compounds ,Dogs ,SARS-CoV-2 ,fungi ,Animals ,COVID-19 ,Humans ,Mass Screening ,General Medicine ,Asymptomatic Infections ,Sensitivity and Specificity - Abstract
Background A rapid, accurate, non-invasive diagnostic screen is needed to identify people with SARS-CoV-2 infection. We investigated whether organic semi-conducting (OSC) sensors and trained dogs could distinguish between people infected with asymptomatic or mild symptoms, and uninfected individuals, and the impact of screening at ports-of-entry. Methods Odour samples were collected from adults, and SARS-CoV-2 infection status confirmed using RT-PCR. OSC sensors captured the volatile organic compound (VOC) profile of odour samples. Trained dogs were tested in a double-blind trial to determine their ability to detect differences in VOCs between infected and uninfected individuals, with sensitivity and specificity as the primary outcome. Mathematical modelling was used to investigate the impact of bio-detection dogs for screening. Results About, 3921 adults were enrolled in the study and odour samples collected from 1097 SARS-CoV-2 infected and 2031 uninfected individuals. OSC sensors were able to distinguish between SARS-CoV-2 infected individuals and uninfected, with sensitivity from 98% (95% CI 95–100) to 100% and specificity from 99% (95% CI 97–100) to 100%. Six dogs were able to distinguish between samples with sensitivity ranging from 82% (95% CI 76–87) to 94% (95% CI 89–98) and specificity ranging from 76% (95% CI 70–82) to 92% (95% CI 88–96). Mathematical modelling suggests that dog screening plus a confirmatory PCR test could detect up to 89% of SARS-CoV-2 infections, averting up to 2.2 times as much transmission compared to isolation of symptomatic individuals only. Conclusions People infected with SARS-CoV-2, with asymptomatic or mild symptoms, have a distinct odour that can be identified by sensors and trained dogs with a high degree of accuracy. Odour-based diagnostics using sensors and/or dogs may prove a rapid and effective tool for screening large numbers of people. Trial Registration NCT04509713 (clinicaltrials.gov).
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- 2022
5. Genital Secretion HIV RNA Shedding in HIV-Positive Patients on Ritonavir-Boosted Protease Inhibitor Monotherapy or Standard Combination ART: A Cross-Sectional Sub-Study from the PIVOT Trial
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Vincent Lee, Wolfgang Stöhr, David Dunn, Alejandro Arenas-Pinto, Bridget Ferns, Eleni Nastouli, Nicholas J. Beeching, Rebecca Wiggins, Nicholas I. Paton, Laura Else, Zoe Warwick, Amanda Clarke, Charles J.N. Lacey, and Saye Khoo
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Male ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Semen ,Antiretroviral Therapy, Highly Active ,Humans ,Medicine ,Pharmacology (medical) ,Sex organ ,In patient ,Genitalia ,Pharmacology ,Ritonavir ,business.industry ,HIV Protease Inhibitors ,Middle Aged ,Virology ,Virus Shedding ,Cross-Sectional Studies ,Infectious Diseases ,Genital tract ,Vagina ,RNA, Viral ,Female ,Genital secretion ,business ,medicine.drug - Abstract
Background Protease inhibitors (PI) have relatively low penetration into the genital tract, raising concerns about the potential for genital HIV RNA shedding in patients taking PI-based regimens, particularly PI monotherapy (PI-mono). Methods We measured HIV RNA and PI drug concentrations in samples of semen, cervicovaginal and rectal mucosa secretions, and plasma in patients after 48–96 weeks on PI-mono or standard triple therapy. Results A total of 85 participants were recruited. Of the 43 participants on PI-mono (70% on darunavir [DRV]/ ritonavir [r]), 3 had detectable virus in semen or vaginal secretions (all below quantification limit), and none in rectal mucosa or plasma. Among those taking triple therapy, five had detectable virus in semen or vaginal secretions (HIV RNA >50 copies/ml in one), none in rectal mucosa and one in plasma. The median (IQR) concentration of DRV and atazanavir in semen (659.7 [339–1,089] and 128.8 [63–368] ng/ml, respectively) and cervico-vaginal samples (2,768 [312–7,879] and 1,836 [359–3,314] ng/ml, respectively) exceeded their protein adjusted median inhibition concentration (MIC50). DRV concentration in rectal secretions showed higher variability compared with concentration in the other sites, with particularly high rectal secretion/blood ratios (median 8.4, IQR 2.6–68.7:1). Conclusions We found no substantive evidence of HIV shedding in patients taking PI-mono, suggesting that PIs provide adequate control of virus in the genital compartment and are unlikely to lead to ongoing sexual transmission.
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- 2020
6. Learning and memory function in young people with and without perinatal HIV in England
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Alejandro, Arenas-Pinto, Ali, Judd, Diane, Melvin, Marthe, Le Prevost, Caroline, Foster, Kate, Sturgeon, Alan, Winston, Lindsay C, Thompson, Diana M, Gibb, and Hannah, Castro
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Adult ,Male ,Acquired Immunodeficiency Syndrome ,Executive Function ,Young Adult ,Multidisciplinary ,Adolescent ,Pregnancy ,Humans ,Learning ,Female ,HIV Infections ,Infectious Disease Transmission, Vertical - Abstract
Learning and memory are important for successful education and career progression. We assess these functions in young people (YP) with perinatal HIV (PHIV) (with or without a previous AIDS-defining illness) and a comparable group of HIV-negative YP. 234 PHIV and 68 HIV-negative YP completed 9 tests; 5 National Institutes of Health (NIH) Toolbox tests (2 executive function, 1 speed of information processing, 2 memory); 2 Hopkins Verbal Learning Test Revised (HVLT-R) (learning (L), delayed recall (R)), and 2 verbal application measures. Z-scores for each test were calculated using normative data and averaged by domain where appropriate. The effect of predictors on test scores in the three domains with the lowest z-scores were analysed using linear regression. 139(59%) and 48(71%) PHIV and HIV-negative YP were female, 202(86%) and 52(76%) Black, and median age was 19 [17, 21] and 18 [16, 21] years respectively. 55(24%) PHIV had a previous Center for Disease Control and Prevention (CDC) class C AIDS-defining diagnosis (PHIV/C). For HVLT-R, there was a trend towards PHIV/C YP having the lowest mean z-scores (L -1.5 (95% CI -1.8,-1.2), R -1.7 (-2.0,-1.4)) followed by PHIV without a CDC C diagnosis (L -1.3 (-1.4,-1.1), R -1.4 (-1.5,-1.2)) and then the HIV-negative group (L -1.0 (-1.3,-0.7), R -1.1 (-1.3,-0.8)); all were greater than 1 SD below the reference mean. The same trend was seen for verbal application measures; however, z-scores were within 1 SD below the reference mean. NIH Toolbox tests were similar for all groups. In multivariable analyses PHIV/C and Black ethnicity predicted lower HVLT-R scores. Black ethnicity also predicted lower executive function scores, however each year increase in age predicted higher scores. In conclusion, cognitive performance in verbal learning and recall fell below population normative scores, and was more pronounced in PHIV/C, supporting wider findings that earlier antiretroviral therapy initiation, before the occurrence of AIDS-defining conditions, may protect aspects of cognitive development.
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- 2021
7. Network meta-analysis of post-exposure prophylaxis randomized clinical trials
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Alejandro Arenas-Pinto, DAVID DALMAU, Laura Morata, Esteve Fernández, Josep Mallolas Masferrer, Gerard Espinosa, Marta Bodro, Alexy Inciarte, Montserrat Laguno Centeno, Ana González-Cordón, Alex Soriano, Elisa De Lazzari, Celia Cardozo Espínola, Vicens Diaz-Brito, and Felipe García
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Male ,0301 basic medicine ,medicine.medical_specialty ,Anti-HIV Agents ,Network Meta-Analysis ,education ,HIV Infections ,law.invention ,Sexual and Gender Minorities ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Homosexuality, Male ,completion ,Randomized Controlled Trials as Topic ,Maraviroc ,business.industry ,Elvitegravir ,Health Policy ,HIV ,Lopinavir ,Raltegravir ,030112 virology ,Discontinuation ,Atazanavir ,Regimen ,Infectious Diseases ,integrase inhibitors ,chemistry ,post-exposure prophylaxis ,cardiovascular system ,Post-Exposure Prophylaxis ,business ,circulatory and respiratory physiology ,medicine.drug - Abstract
OBJECTIVES: We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen. METHODS: After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events. RESULTS: Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events. CONCLUSIONS: Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.
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- 2021
8. Network meta-analysis of post-exposure prophylaxis randomized clinical trials
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Fernandez, I, deLazzari, E, Inciarte, A, Diaz-Brito, V, Milinkovic, A, Arenas-Pinto, A, Etcheverrry, F, Garcia, F, Leal, L, Domingo P., and Gatell, Jose Maria
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integrase inhibitors ,exposure prophylaxis ,education ,cardiovascular system ,HIV ,post‐ ,completion ,circulatory and respiratory physiology - Abstract
Objectives We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen. Methods After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events. Results Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events. Conclusions Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.
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- 2021
9. SARS-CoV-2 inhibition using a mucoadhesive, amphiphilic chitosan that may serve as an anti-viral nasal spray
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Malwina Jedrysik, Andreas G. Schätzlein, Rui Lopes, Pawel Botwina, Moutaz Badr, Krzysztof Pyrc, Malgorzata Benedyk, Agnieszka Dabrowska, Alejandro Arenas-Pinto, Ijeoma F. Uchegbu, Delmiro Fernandez-Reyes, Emilia Barreto Duran, Aleksandra Milewska, Ryan Mellor, and Tammy L. Kalber
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Male ,medicine.medical_treatment ,Science ,Mice, Transgenic ,Pharmacology ,Antiviral Agents ,Methylation ,Article ,Surface-Active Agents ,Viral entry ,In vivo ,Chlorocebus aethiops ,medicine ,Animals ,Humans ,Respiratory system ,Vero Cells ,Infectivity ,Mice, Inbred BALB C ,Multidisciplinary ,business.industry ,SARS-CoV-2 ,Nasal Sprays ,Viral Load ,COVID-19 Drug Treatment ,medicine.anatomical_structure ,Nasal spray ,A549 Cells ,Viral infection ,Vero cell ,Medicine ,business ,Viral load ,Biomedical materials ,Respiratory tract - Abstract
There are currently no cures for coronavirus infections, making the prevention of infections the only course open at the present time. The COVID-19 pandemic has been difficult to prevent, as the infection is spread by respiratory droplets and thus effective, scalable and safe preventive interventions are urgently needed. We hypothesise that preventing viral entry into mammalian nasal epithelial cells may be one way to limit the spread of COVID-19. Here we show that N-palmitoyl-N-monomethyl-N,N-dimethyl-N,N,N-trimethyl-6-O-glycolchitosan (GCPQ), a positively charged polymer that has been through an extensive Good Laboratory Practice toxicology screen, is able to reduce the infectivity of SARS-COV-2 in A549ACE2+ and Vero E6 cells with a log removal value of − 3 to − 4 at a concentration of 10–100 μg/ mL (p p 50/mL) showed a trend for nasal GCPQ (20 mg/kg) to inhibit viral load in the respiratory tract and brain, although the study was not powered to detect statistical significance. GCPQ’s electrostatic binding to the virus, preventing viral entry into the host cells, is the most likely mechanism of viral inhibition. Radiolabelled GCPQ studies in mice show that at a dose of 10 mg/kg, GCPQ has a long residence time in mouse nares, with 13.1% of the injected dose identified from SPECT/CT in the nares, 24 h after nasal dosing. With a no observed adverse effect level of 18 mg/kg in rats, following a 28-day repeat dose study, clinical testing of this polymer, as a COVID-19 prophylactic is warranted.
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- 2020
10. SARS-CoV-2 inhibition in human airway epithelial cells using a mucoadhesive, amphiphilic chitosan that may serve as an anti-viral nasal spray
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Krzysztof Pyrć, Aleksandra Milewska, Emilia Barreto Duran, Paweł Botwina, Rui Lopes, Alejandro Arenas-Pinto, Moutaz Badr, Ryan Mellor, Tammy L. Kalber, Delmiro Fernandes-Reyes, Andreas G. Schätzlein, and Ijeoma F. Uchegbu
- Abstract
There are currently no cures for coronavirus infections, making the prevention of infections the only course open at the present time. The COVID-19 pandemic has been difficult to prevent, as the infection is spread by respiratory droplets and thus effective, scalable and safe preventive interventions are urgently needed. We hypothesise that preventing viral entry into mammalian nasal epithelial cells may be one way to limit the spread of COVID-19. Here we show that N-palmitoyl-N-monomethyl-N,N-dimethyl-N,N,N-trimethyl-6-O-glycolchitosan (GCPQ), a positively charged polymer that has been through an extensive Good Laboratory Practice toxicology screen, is able to reduce the infectivity of SARS-COV-2 in A549ACE2+ and Vero E6 cells with a log removal value of −3 to −4 at a concentration of 10 – 100 μg/ mL (p < 0.05 compared to untreated controls) and to limit infectivity in human airway epithelial cells at a concentration of 500 μg/ mL (p < 0.05 compared to untreated controls). GCPQ is currently being developed as a pharmaceutical excipient in nasal and ocular formulations. GCPQ’s electrostatic binding to the virus, preventing viral entry into the host cells, is the most likely mechanism of viral inhibition. Radiolabelled GCPQ studies in mice show that at a dose of 10 mg/ kg, GCPQ has a long residence time in mouse nares, with 13.1% of the injected dose identified from SPECT/CT in the nares, 24 hours after nasal dosing. With a no observed adverse effect level of 18 mg/ kg in rats, following a 28-day repeat dose study, clinical testing of this polymer, as a COVID-19 prophylactic is warranted.
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- 2020
11. Reversible effect on lipids by switching from tenofovir disoproxil fumarate to tenofovir alafenamide and back
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Stefan Mauss, Alejandro Arenas-Pinto, Florian Berger, and Ana Milinkovic
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Tenofovir ,Anti-HIV Agents ,Immunology ,Urology ,HIV Infections ,Tenofovir alafenamide ,Retrospective data ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Interquartile range ,Total cholesterol ,Germany ,Immunology and Allergy ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Retrospective Studies ,Ldl cholesterol ,Alanine ,Cholesterol ,business.industry ,Drug Substitution ,Adenine ,Middle Aged ,Viral Load ,030104 developmental biology ,Infectious Diseases ,Logistic Models ,Treatment Outcome ,chemistry ,HIV-1 ,RNA, Viral ,Female ,business ,medicine.drug - Abstract
OBJECTIVE The aim of the current study is to assess the effect of tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) on lipids in patients switching from TDF to TAF and back. METHODS Retrospective data collection on patients who were initially switched from TDF to TAF and switched back to TDF after generics of TDF became available. RESULTS In total, 385 patients were included. Median duration of TDF exposure before switch was 317 weeks (interquartile range 172-494). After switching from TDF to TAF, mean total cholesterol (TC) increased from 186 ± 37 mg/dl at baseline to 206 ± 43 and 204 ± 43 mg/dl at weeks 12 and 24 (P
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- 2019
12. Risky Alcohol Consumption and Associated Health Behaviour Among HIV-Positive and HIV-Negative Patients in a UK Sexual Health and HIV Clinic: A Cross-Sectional Questionnaire Study
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Emmi Suonpera, Alejandro Arenas-Pinto, Rebecca Matthews, and Ana Milinkovic
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Adult ,Male ,Alcohol misuse ,medicine.medical_specialty ,Social Psychology ,Alcohol Drinking ,Substance-Related Disorders ,Sexual Behavior ,Population ,Health Behavior ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Medication Adherence ,Environmental health ,Antiretroviral Therapy, Highly Active ,Surveys and Questionnaires ,HIV Seropositivity ,Prevalence ,Medicine ,Humans ,Drug use ,education ,Questionnaire study ,Reproductive health ,education.field_of_study ,Original Paper ,Unsafe Sex ,business.industry ,Depression ,Public health ,Public Health, Environmental and Occupational Health ,HIV ,Middle Aged ,medicine.disease ,United Kingdom ,Health psychology ,Infectious Diseases ,Cross-Sectional Studies ,Mood disorders ,Socioeconomic Factors ,Female ,Sexual Health ,AUDIT ,business ,Alcohol consumption ,Alcohol-Related Disorders - Abstract
Alcohol misuse has been associated with negative consequences among HIV-positive patients. Data on real prevalence of risky alcohol consumption among the HIV-positive population in the UK are lacking. A cross-sectional questionnaire study using standardised validated instruments among HIV-positive (n = 227) and HIV-negative (n = 69) patients was performed. The prevalence of risky alcohol consumption (AUDIT) and associations with depressive symptoms (PHQ-9), problematic drug use (DUDIT), adherence to ART (CASE Adherence Index), sexual behaviour and demographic characteristics were assessed among both patient groups independently. A quarter (25.1%) of HIV-positive patients and 36.1% of HIV-negative patients reported risky alcohol consumption (AUDIT-score ≥ 8). In the multivariable analysis among HIV-positive patients depressive symptoms (p = 0.03) and problematic drug use (p = 0.007) were associated with risky alcohol consumption. Among HIV-negative patients these associations were not present. Risky alcohol consumption among HIV-positive patients is prevalent, and together with depressive symptoms and problematic drug use, may influence HIV-disease progression and patients’ wellbeing. Electronic supplementary material The online version of this article (10.1007/s10461-019-02714-2) contains supplementary material, which is available to authorized users.
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- 2019
13. Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England
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Ali Judd, Kate Sturgeon, Diane Melvin, Alejandro Arenas-Pinto, Alan Winston, Francesca Parrott, Deborah Ford, Caroline Foster, Katie Rowson, Michael Evangeli, Marthe Le Prevost, and Diana M. Gibb
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Social Psychology ,Human immunodeficiency virus (HIV) ,HIV Infections ,Anxiety ,Hospital Anxiety and Depression Scale ,medicine.disease_cause ,Perinatal hiv ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Interquartile range ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Child ,Psychiatry ,Depression (differential diagnoses) ,Social functioning ,Depression ,business.industry ,Public Health, Environmental and Occupational Health ,B730 ,Self Concept ,Caregivers ,England ,Cohort ,Female ,medicine.symptom ,business - Abstract
Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated the prevalence of symptoms of anxiety and depression in PHIV and HIV-affected (siblings of PHIV and/or had an HIV positive mother) young people in England. Symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) scores. A cross-sectional analysis was conducted of data from 283 young people with PHIV aged 13-21 years and 96 HIV-affected young people aged 13-23 years in the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. Linear regression investigated factors associated with higher (worse) anxiety and depression scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) young people were black African, respectively. There were no differences in raw or z-scores of anxiety and depression, or self-esteem, between PHIV and HIV-affected participants (all p values >0.1). Across both PHIV and HIV-affected groups, factors associated with higher anxiety scores were having more carers in childhood, speaking a language other than English at home, lower self-esteem, and ever thinking life was not worth living and lower social functioning. Factors associated with higher depression scores were male sex, death of one or both parents, ever excluded from school, lower self-esteem and lower social functioning. This study found anxiety and depression scores were similar among PHIV and HIV-affected young people and similar to that of population norms. Other studies have found an association between poorer mental health and worse health outcomes in young people with PHIV, highlighting the need to identify young people at increased risk and provide timely support.
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- 2018
14. 89976 ASSESSING PROTEIN BIOMARKERS ROLE IN CVD RISK PREDICTION IN PERSONS LIVING WITH HIV (PWH)
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Daniel Duprez, Jason V. Baker, Alejandro Arenas Pinto, Jiuzhou Wang, Lillian Haine, Sandra E. Safo, Mark N. Polizzotto, Therese Staub, Cavan S. Reilly, Mamta K. Jain, and James D. Neaton
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Oncology ,medicine.medical_specialty ,Protein biomarkers ,business.industry ,Cvd risk ,Internal medicine ,medicine ,Human immunodeficiency virus (HIV) ,General Medicine ,business ,medicine.disease_cause - Abstract
IMPACT: Our findings could potentially identify CVD at-risk persons living with HIV who might benefit from aggressive risk-reduction. OBJECTIVES/GOALS: PWH have higher rates of CVD than the general population yet CVD risk prediction models rely on traditional risk factors and fail to capture the heterogeneity of CVD risk in PWH. Here we identify protein biomarkers that are able to discriminate between CVD cases and controls in PWH, and we assess their added benefit beyond traditional risk factors. METHODS/STUDY POPULATION: We analyzed 459 baseline protein expression levels from five OLINK panels in a matched CVD (MI, coronary revascularization, stroke, CVD death) case-control study with 390 PWH from INSIGHT trials (131 cases, 259 controls). We formed 200 datasets via bootstrap. For each bootstrap set, a two-component partial least squares discriminant model (PLSDA) was fit. The importance of each variable in the discrimination of cases and controls in the PLSDA projection was assessed by the variable importance in projection (VIP) score. Proteins with average VIP scores > 1 were used in penalized logistic regression models with elastic net penalty, and proteins were ranked based on the number of times the protein had a nonzero coefficient. Proteins in the top 25th percentile were considered to have high discrimination. RESULTS/ANTICIPATED RESULTS: Participants had mean age 47 years, 13% were females, 4.9% had CVD at baseline and 69% were on ART at baseline. Eight proteins including the hepatocyte growth factor and interleukin-6 were identified as able to distinguish between CVD cases and controls within PWH. A protein score (PS) of the top-ranked proteins was developed using the bootstrap (for weights) and the entire data. The PS was found to be predictive of CVD independent of established CVD and HIV factors (Odds ratio: 2.17 CI: 1.58-2.99). A model with the PS and traditional risk factors had a 5.9% improvement in AUC over the baseline model (AUC=0.731 vs 0.69), which is an increase in model predictive power of 18%. Individuals with a PS above the median score were 3.1 (CI: 1.83- 5.41) times more likely to develop CVD than those with a protein score below the median score. DISCUSSION/SIGNIFICANCE OF FINDINGS: A protein score developed improved discrimination of PWH with CVD and those without, and helped identify PWH with high risk for developing CVD. If validated, this score and/or the individual proteins could be used in addition with established factors to identify CVD at-risk individuals who might benefit from aggressive risk-reduction.
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- 2021
15. Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3 L) utility index
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Shi, Yuan, Thompson, Jennifer, Walker, A Sarah, Paton, Nicholas I, Cheung, Yin Bun, Agweng, E, Awio, P, Bakeinyaga, G, Isabirye, C, Kabuga, U, Kasuswa, S, Katuramu, M, Kityo, C, Kiweewa, F, Kyomugisha, H, Lutalo, E, Mugyenyi, P, Mulima, D, Musana, H, Musitwa, G, Musiime, V, Ndigendawan, M, Namata, H, Nkalubo, J, Labejja, P Ocitti, Okello, P, Olal, P, Pimundu, G, Segonga, P, Ssali, F, Tamale, Z, Tumukunde, D, Namala, W, Byaruhanga, R, Kayiwa, J, Tukamushaba, J, Abunyang, S, Eram, D, Denis, O, Lwalanda, R, Mugarura, L, Namusanje, J, Nankya, I, Ndashimye, E, Nabulime, E, Senfuma, O, Bihabwa, G, Buluma, E, Easterbrook, P, Elbireer, A, Kambugu, A, Kamya, D, Katwere, M, Kiggundu, R, Komujuni, C, Laker, E, Lubwama, E, Mambule, I, Matovu, J, Nakajubi, A, Nakku, J, Nalumenya, R, Namuyimbwa, L, Semitala, F, Wandera, B, Wanyama, J, Mugerwa, H, Lugemwa, A, Ninsiima, E, Ssenkindu, T, Mwebe, S, Atwine, L, William, H, Katemba, C, Acaku, M, Ssebutinde, P, Kitizo, H, Kukundakwe, J, Naluguza, M, Ssegawa, K, Namayanja, Nsibuka, F, Tuhirirwe, P, Fortunate, M, Acen, J, Achidri, J, Amone, A, Chamai, M, Ditai, J, Kemigisa, M, Kiconco, M, Matama, C, Mbanza, D, Nambaziira, F, Odoi, M Owor, Rweyora, A, Tumwebaze, G, Kalanzi, H, Katabaazi, J, Kiyingi, A, Mbidde, M, Mugenyi, M, Mwebaze, R, Okong, P, Senoga, I, Abwola, M, Baliruno, D, Bwomezi, J, Kasede, A, Mudoola, M, Namisi, R, Ssennono, F, Tuhirwe, S, Abongomera, G, Amone, G, Abach, J, Aciro, I, Arach, B, Kidega, P, Omongin, J, Ocung, E, Odong, W, Philliam, A, Alima, H, Ahimbisibwe, B, Atuhaire, E, Atukunda, F, Bekusike, G, Bulegyeya, A, Kahatano, D, Kamukama, S, Kyoshabire, J, Nassali, A, Mbonye, A, Naturinda, TM, Ndukukire, Nshabohurira, A, Ntawiha, H, Rogers, A, Tibyasa, M, Kiirya, S, Atwongyeire, D, Nankya, A, Draleku, C, Nakiboneka, D, Odoch, D, Lakidi, L, Ruganda, R, Abiriga, R, Mulindwa, M, Balmoi, F, Kafuma, S, Moriku, E, Hakim, J, Reid, A, Chidziva, E, Musoro, G, Warambwa, C, Tinago, G, Mutsai, S, Phiri, M, Mudzingwa, S, Bafana, T, Masore, V, Moyo, C, Nhema, R, Chitongo, S, Heyderman, Robert, Kabanga, Lucky, Kaunda, Symon, Kudzala, Aubrey, Lifa, Linly, Mallewa, Jane, Moore, Mike, Mtali, Chrissie, Musowa, George, Mwimaniwa, Grace, Sikwese, Rosemary, van Oosterhout, Joep, Ziwoya, Milton, Chimbaka, H, Chitete, B, Kamanga, S, Kayinga, T, Makwakwa, E, Mbiya, R, Mlenga, M, Mphande, T, Mtika, C, Mushani, G, Ndhlovu, O, Ngonga, M, Nkhana, I, Nyirenda, R, Cheruiyot, P, Kwobah, C, Ekiru, W Lokitala, Mokaya, M, Mudogo, A, Nzioka, A, Siika, A, Tanui, M, Wachira, S, Wools-Kaloustian, K, Alipalli, P, Chikatula, E, Kipaila, J, Kunda, I, Lakhi, S, Malama, J, Mufwambi, W, Mulenga, L, Mwaba, P, Mwamba, E, Mweemba, A, Namfukwe, M, Kerukadho, E, Ngwatu, B, Birungi, J, Paton, N, Boles, J, Burke, A, Castle, L, Ghuman, S, Kendall, L, Hoppe, A, Tebbs, S, Thomason, M, Thompson, J, Walker, S, Whittle, J, Wilkes, H, Young, N, Kapuya, C, Kyomuhendo, F, Kyakundi, D, Mkandawire, N, Mulambo, S, Senyonjo, S, Angus, B, Arenas-Pinto, A, Palfreeman, A, Post, F, Ishola, D, Arribas, J, Colebunders, R, Floridia, M, Giuliano, M, Mallon, P, Walsh, P, De Rosa, M, Rinaldi, E, Weller, I, Gilks, C, Kangewende, A, Luyirika, E, Miiro, F, Mwamba, P, Ojoo, S, Phiri, S, van Oosterhout, J, Wapakabulo, A, Peto, T, French, N, Matenga, J, Cloherty, G, van Wyk, J, Norton, M, Lehrman, S, Lamba, P, Malik, K, Rooney, J, Snowden, W, Villacian, J, Team, EARNEST Trial, UAM. Departamento de Medicina, and Instituto de Investigación Sanitaria Hospital Universitario de La Paz (IdiPAZ)
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Adult ,Male ,Mean squared error ,Medicina ,Intraclass correlation ,HIV Infections ,lcsh:Computer applications to medicine. Medical informatics ,Standard deviation ,03 medical and health sciences ,0302 clinical medicine ,EQ-5D ,Outcome Assessment, Health Care ,Statistics ,Covariate ,Humans ,030212 general & internal medicine ,Least-Squares Analysis ,Africa South of the Sahara ,Health utility ,Mathematics ,Medical outcomes study HIV health survey ,Research ,030503 health policy & services ,1. No poverty ,Public Health, Environmental and Occupational Health ,General Medicine ,Health Surveys ,Regression ,3. Good health ,Mapping ,Ordinary least squares ,Quality of Life ,lcsh:R858-859.7 ,Female ,0305 other medical science ,Body mass index - Abstract
Background: Mapping of health-related quality-of-life measures to health utility values can facilitate cost-utility evaluation. Regression-based methods tend to lead to shrinkage of variance. This study aims to map the Medical Outcomes Study HIV Health Survey (MOS-HIV) to EuroQoL 5 Dimensions (EQ-5D-3 L) utility index, and to characterize the performance of three mapping methods, including ordinary least squares (OLS), equi-percentile method (EPM), and a recently proposed method called Mean Rank Method (MRM). Methods: This is a secondary analysis of data from a randomized HIV treatment trial. Baseline data from 421 participants were used to develop mapping functions. Follow-up data from 236 participants was used to validate the mapping functions. Results: In the training dataset, MRM and OLS, but not EPM, reproduced the observed mean utility (0.731). MRM, OLS and EPM under-estimated the standard deviation by 0.3, 26.6 and 1.7%, respectively. MRM had the lowest mean absolute error (0.143) and highest intraclass correlation coefficient (0.723) with the observed utility values, whereas OLS had the lowest mean squared error (0.038) and highest R-squared (0.542). Regressing the MRM- and OLS-mapped utility values upon body mass index and log-viral load gave covariate associations comparable to those estimated from the observed utility data (all P > 0.10). EPM did not achieve this property. Findings from the validation data were similar. Conclusions: Functions are available for mapping the MOS-HIV to the EQ-5D-3 L utility values. MRM and OLS were comparable in terms of agreement with the observed utility values at the individual level. MRM had better performance at the group level in terms of describing the utility distribution. Trial registration: NCT00988039. Registered 30 September 2009., The EARNEST trial was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP, Grant Code: IP.2007.33011.003) with contributions from the Medical Research Council, UK; Institito de Salud Carlos III, Spain (Grant A107/90015); Irish Aid, Ireland; Swedish International Development Cooperation Agency (SIDA), Sweden; Instituto Superiore di Sanita (ISS), Italy; The World Health Organisation; and Merck, USA. Substantive in-kind contributions were made by the Medical Research Council Clinical Trials Unit, UK [MC_UU_12023/23], CINECA, Bologna, Italy, Janssen Diagnostics, Beerse, Belgium; GSK/ViiV Healthcare Ltd., UK; Abbott Laboratories, USA. Trial medication was donated by AbbVie, Merck, Pfizer, GSK and Gilead. The Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi
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- 2019
16. Cognitive Function in Young Persons With and Without Perinatal HIV in the AALPHI Cohort in England: Role of Non–HIV-Related Factors
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Ali, Judd, Marthe, Le Prevost, Diane, Melvin, Alejandro, Arenas-Pinto, Francesca, Parrott, Alan, Winston, Caroline, Foster, Kate, Sturgeon, Katie, Rowson, Di M, Gibb, and B, Chipalo
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,C850 ,Black People ,HIV Infections ,Standard score ,B700 ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Interquartile range ,Internal medicine ,medicine ,Humans ,Cognitive Dysfunction ,030212 general & internal medicine ,Young adult ,Child ,Psychiatry ,Depression (differential diagnoses) ,business.industry ,Cognition ,B730 ,030112 virology ,Infectious Disease Transmission, Vertical ,Confidence interval ,Infectious Diseases ,Anti-Retroviral Agents ,England ,Cohort ,HIV-1 ,HIV/AIDS ,Female ,business ,Cohort study - Abstract
Background. There is limited evidence about the cognitive performance of older adolescents with perinatally acquired human immunodeficiency virus (HIV) compared with HIV-negative (HIV−) adolescents.\ud \ud Methods. A total of 296 perinatally HIV-infected (PHIV+) and 97 HIV− adolescents (aged 12–21 and 13–23 years, respectively) completed 12 tests covering 6 cognitive domains. The HIV− participants had PHIV+ siblings and/or an HIV-infected mother. Domain-specific and overall (NPZ-6) z scores were calculated for PHIV+ participants, with or without Centers for Disease Control and Prevention (CDC) stage C disease, and HIV− participants. Linear regression was performed to explore predictors of NPZ-6.\ud \ud Results. One hundred twenty-five (42%) of the PHIV+ and 31 (32%) of the HIV− participants were male; 251 (85%) and 69 (71%), respectively, were black African; and their median ages (interquartile range) were 16 (15–18) and 16 (14–18) years, respectively. In PHIV+ participants, 247 (86%) were receiving antiretroviral therapy, and 76 (26%) had a previous CDC C diagnosis. The mean (standard deviation) NPZ-6 score was −0.81 (0.99) in PHIV+ participants with a CDC C diagnosis (PHIV+/C), −0.45 (0.80) in those without a CDC C diagnosis (PHIV+/no C), and −0.32 (0.76) in HIV− participants (P < .001). After adjustment, there was no difference in NPZ-6 scores between PHIV+/no C and HIV− participants (adjusted coefficient, −0.01; 95% confidence interval, −.22 to .20). PHIV+/C participants scored below the HIV− group (adjusted coefficient, −0.44; −.70 to −.19). Older age predicted higher NPZ-6 scores, and black African ethnicity and worse depression predicted lower NPZ-6 scores. In a sensitivity analysis including PHIV+ participants only, no HIV-related factors apart from a CDC C diagnosis were associated with NPZ-6 scores.\ud \ud Conclusions. Cognitive performance was similar between PHIV+/no C and HIV− participants and indicated relatively mild impairment compared with normative data. The true impact on day-to-day functioning needs further investigation.
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- 2016
17. Protease inhibitor monotherapy for long-term management of HIV infection: a randomised, controlled, open-label, non-inferiority trial
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Nicholas I, Paton, Wolfgang, Stöhr, Alejandro, Arenas-Pinto, Martin, Fisher, Ian, Williams, Margaret, Johnson, Chloe, Orkin, Fabian, Chen, Vincent, Lee, Alan, Winston, Mark, Gompels, Julie, Fox, Karen, Scott, David T, Dunn, and R, James
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Adult ,Male ,Ritonavir ,HIV ,HIV Infections ,Articles ,HIV Protease Inhibitors ,Middle Aged ,Viral Load ,United Kingdom ,CD4 Lymphocyte Count ,Maintenance Chemotherapy ,Young Adult ,Treatment Outcome ,Drug Resistance, Viral ,HIV-1 ,Humans ,Female ,Aged - Abstract
Summary Background Standard-of-care antiretroviral therapy (ART) uses a combination of drugs deemed essential to minimise treatment failure and drug resistance. Protease inhibitors are potent, with a high genetic barrier to resistance, and have potential use as monotherapy after viral load suppression is achieved with combination treatment. We aimed to assess clinical risks and benefits of protease inhibitor monotherapy in long-term clinical use: in particular, the effect on drug resistance and future treatment options. Methods In this pragmatic, parallel-group, randomised, controlled, open-label, non-inferiority trial, we enrolled adults (≥18 years of age) positive for HIV attending 43 public sector treatment centres in the UK who had suppressed viral load (
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- 2015
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18. Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial
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Jacqueline Neuhaus, Gail V. Matthews, Juergen K. Rockstroh, Jose Hidalgo, Rui Sarmento-Castro, Lars Peters, Fred M. Gordin, Sean Emery, Christoph Stephan, Nagalingeswaran Kumarasamy, Nila J. Dharan, Kristen M. Marks, Alejandro Arenas-Pinto, and Carol Emerson
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,HIV Infections ,Lower risk ,law.invention ,Time-to-Treatment ,Cohort Studies ,03 medical and health sciences ,Liver disease ,Steatohepatitis/Metabolic Liver Disease ,0302 clinical medicine ,Randomized controlled trial ,law ,Fibrosis ,Internal medicine ,Early Medical Intervention ,medicine ,Humans ,030212 general & internal medicine ,Hepatology ,business.industry ,Hazard ratio ,Original Articles ,Hepatitis B ,medicine.disease ,Confidence interval ,3. Good health ,Substance abuse ,Anti-Retroviral Agents ,Disease Progression ,030211 gastroenterology & hepatology ,Female ,Original Article ,business - Abstract
The role of antiretroviral therapy (ART) in reducing or contributing to liver fibrosis in persons with human immunodeficiency virus (HIV) is unclear. We evaluated participants in the Strategic Timing of AntiRetroviral Treatment (START) trial for liver fibrosis using the AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4), and assessed for a benefit of early versus delayed ART on liver fibrosis progression. ART-naive persons with high CD4 counts (>500 cells/µL) from 222 clinical sites in 35 countries were randomized to receive ART either at study enrollment (immediate treatment arm) or when their CD4 count fell below 350 cells/µL (deferred treatment arm). The following outcomes were evaluated: fibrosis (APRI > 0.5 or FIB-4 > 1.45), significant fibrosis (APRI > 1.5 or FIB-4 > 3.25), hepatic flare, and resolution of elevated APRI and FIB-4 scores. Of the 4,684 enrolled into the START study, 104 did not have APRI or FIB-4 results and were excluded. Among 4,580 participants (2,273 immediate treatment; 2,307 deferred treatment), the median age was 36 years, 26.9% were female, and 30.4% were black. Three percent had an alcoholism or substance abuse history, 6.4% had hepatitis B and/or C, and 1.1% had significant fibrosis at baseline. The median CD4 count was 651, and 5.3% had HIV RNA ≤ 200. Immediate arm participants were at lower risk of developing increased fibrosis scores than deferred arm participants (hazard ratio [HR] = 0.66; 95% confidence interval [CI] = 0.57-0.78; P < 0.001) and more likely to have resolution of elevated baseline scores (HR 1.6; 95% CI 1.3-1.9; P < 0.001). Conclusions: Significant liver fibrosis was rare among ART-naive HIV-positive persons with high CD4 counts. Our findings suggest a benefit of early ART in preventing the development of liver fibrosis.
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- 2018
19. No neurocognitive advantage for immediate antiretroviral treatment in adults with greater than 500 CD4+ T-cell counts
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Moses S. Nsubuga, Birgit Grund, Luxshimi Lal, Richard W. Price, Gary Collins, Anchalee Avihingsanon, Augusto César Penalva De Oliveira, Alejandro Arenas-Pinto, Nicolas J. Mueller, Alan Winston, Eric Florence, Barbara Standridge, Mollie Poehlman-Roediger, Cate Carey, Kevin Robertson, Michael J. Vjecha, Bruce J. Brew, Jens D Lundgren, Edwina J. Wright, and Lucette A. Cysique
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,AIDS Dementia Complex ,Immunology ,HIV Infections ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Antiretroviral treatment ,Secondary Prevention ,Immunology and Allergy ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,medicine.diagnostic_test ,business.industry ,Neuropsychology ,Neuropsychological test ,Test (assessment) ,CD4 Lymphocyte Count ,Clinical trial ,Infectious Diseases ,Treatment Outcome ,Anti-Retroviral Agents ,Test performance ,Female ,business ,Neurocognitive ,030217 neurology & neurosurgery - Abstract
OBJECTIVE To compare the effect of immediate versus deferred antiretroviral treatment (ART) on neuropsychological test performance in treatment-naive HIV-positive adults with more than 500 CD4 cells/μl. DESIGN Randomized trial. METHODS The START parent study randomized participants to commence immediate versus deferred ART until CD4 less than 350 cells/μl. The START Neurology substudy used eight neuropsychological tests, at baseline, months 4, 8, 12 and annually, to compare groups for changes in test performance. Test results were internally standardized to z-scores. The primary outcome was the average of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline were compared by intent-to-treat using longitudinal mixed models. Changes from baseline to specific time points were compared using ANCOVA models. RESULTS The 592 participants had a median age of 34 years; median baseline CD4 count was 629 cells/μl; the mean follow-up was 3.4 years. ART was used for 94 and 32% of accrued person-years in the immediate and deferred groups, respectively. There was no difference between the immediate and deferred ART groups in QNPZ-8 change through follow-up [-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However, QNPZ-8 scores increased in both arms during the first year, by 0.22 and 0.24, respectively (P
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- 2018
20. Brain Perfusion, Regional Volumes, and Cognitive Function in Human Immunodeficiency Virus-positive Patients Treated With Protease Inhibitor Monotherapy
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Ruth Oliver, Claudia Godi, Amanda Clarke, Fabian Chen, Margaret Johnson, Manuel Jorge Cardoso, Alejandro Arenas-Pinto, Ian Williams, Wolfgang Stöhr, Lewis J. Haddow, Hans Rolf Jäger, Nicholas I. Paton, Alan Winston, Magdalena Sokolska, and Xavier Golay
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,030106 microbiology ,Caudate nucleus ,Perfusion scanning ,HIV Infections ,Grey matter ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Cognition ,Interquartile range ,Internal medicine ,HIV Seropositivity ,Medicine ,Humans ,Protease Inhibitors ,030212 general & internal medicine ,business.industry ,Functional Neuroimaging ,Brain ,Organ Size ,Middle Aged ,Magnetic Resonance Imaging ,Infectious Diseases ,medicine.anatomical_structure ,Treatment Outcome ,Frontal lobe ,Cerebral blood flow ,Cerebrovascular Circulation ,Cardiology ,Female ,Occipital lobe ,business ,Biomarkers - Abstract
BACKGROUND Protease inhibitor monotherapy (PIM) for human immunodeficiency virus (HIV) may exert suboptimal viral control in the central nervous system. We determined whether cerebral blood flow (CBF) and regional brain volumes were associated with PIM, and whether specific cognitive domains were associated with imaging biomarkers. METHODS Cognitive assessments and brain magnetic resonance imaging were performed after the final visit of a randomized HIV-treatment strategy trial. Participants were virologically suppressed on triple therapy at trial entry and followed for 3-5 years. We studied 37 patients randomized to ongoing triple therapy and 39 randomized to PIM. Resting CBF and normalized volumes were calculated for brain regions of interest, and correlated with treatment strategy and neuropsychological performance. RESULTS Mean age was 48.1 years (standard deviation 8.6 years), 63 male (83%), and 64 white (84%). Participants had median 8.1 years (interquartile range 6.4, 10.8) of antiretroviral therapy experience and CD4+ counts of median 640 cells/mm3 (interquartile range 490, 780). We found no difference between treatment arms in CBF or regional volumes. Regardless of treatment arm, poorer fine motor performance correlated with lower CBF in the caudate nucleus (P = .01), thalamus (P = .04), frontal cortex (P = .01), occipital cortex (P = .004), and cingulate cortex (P = .02), and was associated with smaller supratentorial white matter volume (decrease of 0.16 in Z-score per -1% of intracranial volume, 95% confidence interval 0.02-0.29; P = .023). CONCLUSIONS PIM does not confer an additional risk of neurological injury compared with triple therapy. There were correlations between fine motor impairment, grey matter hypoperfusion, and white matter volume loss. CLINICAL TRIALS REGISTRATION ISRCTN-04857074.
- Published
- 2018
21. Baseline prevalence and predictors of liver fibrosis among HIV-positive individuals: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial
- Author
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Susanna Naggie, Sanjay Bhagani, Jacqueline Neuhaus, SH Mehta, Manuela Doroana, Lars Peters, Juergen K. Rockstroh, Gail V. Matthews, Alejandro Arenas-Pinto, and E Vlahakis
- Subjects
medicine.medical_specialty ,business.industry ,Health Policy ,Hepatitis B ,medicine.disease ,Liver disease ,Infectious Diseases ,Fibrosis ,Interquartile range ,Internal medicine ,Cohort ,Coinfection ,medicine ,Physical therapy ,Pharmacology (medical) ,Transient elastography ,business ,Viral hepatitis - Abstract
Objectives Liver disease is increasingly recognized in HIV-positive individuals, even among those without viral hepatitis, partly as a result of the recent availability of noninvasive methods of liver fibrosis assessment. The objective of this substudy is to compare the effects of early versus deferred antiretroviral therapy (ART) on liver fibrosis progression. Methods Sites in the Strategic Timing of AntiRetroviral Treatment (START) study with access to FibroScan® were invited to participate in the Liver Fibrosis Progression Substudy. All substudy participants underwent FibroScan® at baseline, and two noninvasive serum algorithms, APRI and FIB-4, were calculated. Demographic and liver-related information was collected for all START participants at baseline. Results A total of 230 participants were enrolled in the substudy (11.5% with hepatitis B or C virus coinfection), of whom 221 had a valid transient elastography (TE) result. The median TE score was 4.9 kPa [interquartile range (IQR) 4.3–6.0 kPa]. Seventeen patients (7.8%) [95% confidence interval (CI) 5.1–12.1%] had a TE score of > 7.2 kPa, indicating significant liver fibrosis. Baseline factors associated with higher TE scores in multivariate analysis were higher alanine aminotransferase (ALT) per 10 U/L (P = 0.045), higher log10 HIV RNA (P
- Published
- 2015
22. Why START? Reflections that led to the conduct of this large long-term strategic HIV trial
- Author
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Brian Agan, Per Aagaard, Jan Harding, Jean-michel Molina, Jens Lundgren, Magnus Gisslen, Alejandro Arenas-Pinto, Borja Mora Peris, Ken Kunisaki, Vicente Estrada, Matti Ristola, Lars Østergaard, Sean Emery, Imad Kansau, Bruce Brew, Jose Arribas, and Julie Fox
- Subjects
medicine.medical_specialty ,Anti-Retroviral Agents ,business.industry ,Health Policy ,Treatment outcome ,Human immunodeficiency virus (HIV) ,Disease ,medicine.disease_cause ,medicine.disease ,Antiretroviral therapy ,Term (time) ,Infectious Diseases ,Acquired immunodeficiency syndrome (AIDS) ,Immunology ,medicine ,Pharmacology (medical) ,Intensive care medicine ,business ,Cohort study - Published
- 2015
23. Risk Factors for Fatality in HIV-Infected Patients with Dideoxynucleoside-Induced Severe Hyperlactataemia or Lactic Acidosis
- Author
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Krishnan Bhaskaran, Esteban Martínez, Ian Weller, David Dunn, Peter Reiss, Jennifer F Hoy, Alejandro Arenas-Pinto, Andrew Copas, Andrew Carr, Signe Westring Worm, Alison D. Grant, Rainer Weber, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, University of Zurich, and Arenas-Pinto, A
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,610 Medicine & health ,HIV Infections ,medicine.disease_cause ,Severity of Illness Index ,10234 Clinic for Infectious Diseases ,Risk Factors ,Internal medicine ,medicine ,2736 Pharmacology (medical) ,Humans ,Hiv infected patients ,Pharmacology (medical) ,Lactic Acid ,Intensive care medicine ,Acidosis ,Pharmacology ,business.industry ,Stavudine ,2725 Infectious Diseases ,Middle Aged ,medicine.disease ,Antiretroviral therapy ,Dideoxynucleosides ,3004 Pharmacology ,Infectious Diseases ,Lactic acidosis ,Cohort ,Toxicity ,HIV-1 ,Acidosis, Lactic ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Background Lactic acidosis (LA) and severe hyperlactataemia (HL) are infrequent but serious complications of antiretroviral therapy that have been associated with a high fatality rate. Methods In a multinational retrospective cohort study, LA was defined as arterial blood pH5 mmol/l. Logistic regression was used to identify factors associated with fatality. Sensitivity and specificity of different case definitions as predictors of death were compared. Results The overall case-fatality rate was 19/110 (17.3%), but among acidotic patients it was 33% (16/49 cases). There were 10 asymptomatic patients and none of them died as a consequence of the event. The median lactate for fatal, non-fatal and all patients was 8.3 mmol/l (IQR 7.2–13.1), 6.4 mmol/l (IQR 5.4–7.8) and 6.7 mmol/l (IQR 5.5–8.1), respectively. After adjusting for age and current CD4+ T-cell count, lactate >7 mmol/l (OR 6.27, 95% CI 1.13–34.93), blood bicarbonate 18 mmol/l, 95% CI 1.33–75.65) and concurrent opportunistic infections (OR 8.69, 95% CI 1.45–52.22) were independently associated with case fatality. Blood lactate >7 mmol/l showed a sensitivity of 84% for fatality with a specificity of 60%, whereas bicarbonate Conclusions Our data suggest that blood lactate >7 mmol/l and blood bicarbonate
- Published
- 2011
24. Risk of Suicidal Behavior With Use of Efavirenz: Results from the Strategic Timing of Antiretroviral Treatment Trial
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Alejandro Arenas-Pinto, Patricia M. Flynn, Esteban Martínez, Juan Sierra-Madero, Christine Katlama, Simon Collins, William M Chasanov, Dalibor Sedláček, Julie Fox, David A. Cooper, Nathan W. Cummins, Claudia Afonso, Pim Brouwers, Shweta Sharma, Karin L. Klingman, Birgit Grund, and Eynat Kedem
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,Cyclopropanes ,Male ,medicine.medical_specialty ,Randomization ,Efavirenz ,Anti-HIV Agents ,HIV Infections ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Antiretroviral Therapy, Highly Active ,HIV Seropositivity ,medicine ,Humans ,030212 general & internal medicine ,Intention-to-treat analysis ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Middle Aged ,Viral Load ,030112 virology ,Benzoxazines ,CD4 Lymphocyte Count ,Regimen ,Suicide ,Articles and Commentary ,Infectious Diseases ,chemistry ,Alkynes ,Female ,business ,Self-Injurious Behavior - Abstract
Background Randomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)-positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART). Methods The initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation. Results Of 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P = .81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P = .03) and 1.04 (P = .93) among those with other prespecified ART; (P = .07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group. Conclusions Participants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk.
- Published
- 2017
25. Evaluation of cerebrospinal fluid virological escape in patients on long-term protease inhibitor monotherapy
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Arenas-Pinto, Alejandro, Stohr, Wolfgang, Clarke, Amanda, Williams, Ian, Beeching, Nicholas J, Minton, Jane, Lee, Vincent, Paton, Nicholas I, and Monotherapy, Protease Inhibitor
- Subjects
medicine.medical_specialty ,Time Factors ,HIV Infections ,Asymptomatic ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Internal medicine ,Antiretroviral Therapy, Highly Active ,medicine ,HIV Protease Inhibitor ,Effective treatment ,Humans ,Pharmacology (medical) ,Protease inhibitor (pharmacology) ,In patient ,030212 general & internal medicine ,Cerebrospinal Fluid ,Pharmacology ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,HIV Protease Inhibitors ,Viral Load ,Surgery ,Infectious Diseases ,Treatment Outcome ,RNA, Viral ,Female ,medicine.symptom ,business ,Viral load ,030217 neurology & neurosurgery - Abstract
Background A strategy of protease inhibitor (PI) mono-therapy with re-introduction of triple therapy in those who rebound has been shown to be a safe and effective treatment simplification approach for long-term management. We sought evidence for cerebrospinal fluid (CSF) virological escape in patients on long-term PI monotherapy. Methods We performed lumbar puncture in asymptomatic participants with suppressed plasma HIV RNA after 96 weeks on the PI monotherapy arm (PI-mono) of the PIVOT trial. We also report CSF HIV RNA concentration in trial participants who were investigated for neurological/ neurocognitive symptoms during the trial regardless of study arm allocation. Results All 11 asymptomatic participants on PI-mono who were tested had undetectable CSF HIV RNA at week 96. One of the three symptomatic participants on PI-mono had CSF HIV RNA of 1,895 copies/ml (undetectable in plasma) and neither of two symptomatic participants on triple therapy had CSF HIV RNA detected. Conclusions CSF virological escape appears rare in asymptomatic patients on PI monotherapy and may not warrant routine CSF monitoring, but patients with symptoms merit more concern.
- Published
- 2017
26. Poster Abstracts
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Nesrina Imami, Alejandro Arenas-Pinto, Nicola Boydell, Katie Buston, Dorothea Miranda Geddes-barton, Wolfgang Stohr, Thomas Jones, and Gregory King
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Gerontology ,business.industry ,Health Policy ,Psychological intervention ,virus diseases ,Voluntary sector ,Context (language use) ,Men who have sex with men ,Developmental psychology ,law.invention ,Infectious Diseases ,Condom ,law ,Serodiscordant ,Medicine ,Pharmacology (medical) ,business ,Committed relationship ,Qualitative research - Abstract
Background: HIV prevention for men who have sex with men (MSM) hastypically focused on behaviour change at the individual-level, rather than aspart of a couple. However, recent research has highlighted the role of primarysexual partners in the transmission of HIV among young MSM in the US,estimating that as many as 84% of new transmissions were from men’s mainpartner. This suggests that work with couples could contribute to preventionefforts.Methods: We conducted qualitative in-depth interviews with 30 young MSM(aged 18-29) in Scotland, recruited via a number of strategies; onlineadvertisements, through voluntary sector organisations working with MSM,and snowballing. Thematic data analysis focused on identifying how menunderstand HIV risk management strategies in the context of relationships,specifically the role of ‘safer sex’ practices, HIV testing, and expectationsaround monogamy and/or sexual exclusivity.Results: At the time of interview, nine men reported being in a relationship,and the majority (n=28) discussed their aspirations for sex in long-termrelationships. Participants’ demonstrated varying levels of HIV literacy (i.e.HIV-related knowledge and an individual’s capacity to apply this), andalthough all discussed condom use as part of ‘safer sex’ and their individualmanagement of HIV risk, a recurring theme was desire to discontinue condomuse in the context of a committed relationship. Over a third of the men (n=22)discussed discontinuing condom use in this context. Of those in relationships,six had discontinued condom use, but not all tested for HIV prior to this, norexplicitly discussed expectations for monogamy and/or sexual exclusivity withtheir partners. Agreeing to testing and discussing expectations of fidelity werecomplicated by issues of trust and intimacy.Conclusion: How MSM understand and manage HIV risk in relationships hasimplications for future HIV prevention. Knowledge of their own (and partner’s)HIV status - particularly where serodiscordant relationships are identified -could enable men to make decisions around prevention, and whereappropriate, open up the possibility of accessing biomedical prevention. Ourresearch suggests young MSM in relationships continue to base safer sexdecisions on perceptions of fidelity and trust in their partners. Young MSMaccessing testing in clinical settings could be targeted for interventions toencourage HIV status disclosure and informed safer sex negotiation.
- Published
- 2014
27. Randomized controlled trial of the tolerability and completion of maraviroc compared with Kaletra® in combination with Truvada® for HIV post-exposure prophylaxis (MiPEP Trial)
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David Hawkins, Amanda Clarke, Gabriel Schembri, Ana Milinkovic, Richard Gilson, Martin Fisher, MiPEP Trial Team, Alejandro Arenas-Pinto, Andrew Williams, Nataliya Brima, P Benn, and Andrew Copas
- Subjects
0301 basic medicine ,Male ,Lopinavir/ritonavir ,HIV Infections ,Lopinavir ,law.invention ,Maraviroc ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Clinical endpoint ,Pharmacology (medical) ,030212 general & internal medicine ,Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination ,Drug Combinations ,Infectious Diseases ,Tolerability ,cardiovascular system ,Female ,Post-Exposure Prophylaxis ,circulatory and respiratory physiology ,medicine.drug ,Microbiology (medical) ,Adult ,medicine.medical_specialty ,Anti-HIV Agents ,education ,Emtricitabine ,Medication Adherence ,03 medical and health sciences ,Young Adult ,Cyclohexanes ,Internal medicine ,medicine ,Humans ,Pharmacology ,Ritonavir ,business.industry ,HIV Protease Inhibitors ,Triazoles ,030112 virology ,Surgery ,CD4 Lymphocyte Count ,Regimen ,chemistry ,HIV-1 ,business - Abstract
OBJECTIVES: Post-exposure prophylaxis (PEP) for HIV is often poorly tolerated and not completed. Alternative PEP regimens may improve adherence and completion, aiding HIV prevention. We conducted a randomized controlled trial of a maraviroc-based PEP regimen compared with a standard-of-care regimen using ritonavir-boosted lopinavir. METHODS: Patients meeting criteria for PEP were randomized to tenofovir disoproxil/emtricitabine (200/245 mg) once daily plus ritonavir-boosted lopinavir (Kaletra ® 400/100 mg) or maraviroc 300 mg twice daily. The composite primary endpoint was completion of 28 days of the allocated PEP regimen without grade 3 or 4 clinical or laboratory adverse events (AEs) related to the PEP medication. RESULTS: Two hundred and thirteen individuals were randomized (107 to maraviroc; 106 to Kaletra ® arm). Follow-up rates were high in both groups. There was no difference in the primary endpoint; 70 (71%) in the maraviroc and 64 (65%) in the Kaletra ® arm ( P = 0.36) completed PEP without grade 3 or 4 AEs. Discontinuation of PEP was the same (18%) in both groups. There were no grade 3 or 4 clinical AEs in either arm, but more grade 1 or 2 clinical AEs in the Kaletra ® arm (91% versus 70%; P
- Published
- 2016
28. Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy
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Stohr, Wolfgang, Dunn, David T, Arenas-Pinto, Alejandro, Orkin, Chloe, Clarke, Amanda, Williams, Ian, Johnson, Margaret, Beeching, Nicholas J, Wilkins, Edmund, Sanders, Karen, Paton, Nicholas I, and Ver, Protease Inhibitor Monotherapy
- Subjects
0301 basic medicine ,Oncology ,Adult ,Male ,medicine.medical_specialty ,Combination therapy ,030106 microbiology ,Immunology ,HIV Infections ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,Protease inhibitor (pharmacology) ,Protease Inhibitors ,030212 general & internal medicine ,Treatment Failure ,Survival analysis ,Darunavir ,business.industry ,Hazard ratio ,Lopinavir ,HIV Protease Inhibitors ,Middle Aged ,Viral Load ,Infectious Diseases ,HIV-1 ,Female ,business ,Viral load ,medicine.drug - Abstract
OBJECTIVE The Protease Inhibitor Monotherapy Versus Ongoing Triple Therapy (PIVOT) trial found that protease inhibitor monotherapy as a simplification strategy is well tolerated in terms of drug resistance but less effective than combination therapy in suppressing HIV viral load. We sought to identify factors associated with the risk of viral load rebound in this trial. METHODS PIVOT was a randomized controlled trial in HIV-positive adults with suppressed viral load for at least 24 weeks on combination therapy comparing a strategy of physician-selected ritonavir-boosted protease inhibitor monotherapy versus ongoing triple therapy. In participants receiving monotherapy, we analysed time to confirmed viral load rebound and its predictors using flexible parametric survival models. RESULTS Of 290 participants initiating protease inhibitor monotherapy (80% darunavir, 14% lopinavir, and 6% other), 93 developed viral load rebound on monotherapy. The risk of viral load rebound peaked at 9 months after starting monotherapy and then declined to approximately 5 per 100 person-years from 18 months onwards. Independent predictors of viral load rebound were duration of viral load suppression before starting monotherapy (hazard ratio 0.81 per additional year
- Published
- 2016
29. Longitudinal analysis of an HLA-B*51-restricted epitope in integrase reveals immune escape in early HIV-1 infection
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Tomàs Pumarola Suñe, Alejandro Arenas-Pinto, Clifford Leen, Montse Tuset, John Frater, Line Ohm-Laursen, Peter Flanagan, Sarah Fidler, and Julie Fox
- Subjects
Male ,Molecular Sequence Data ,Immunology ,Epitopes, T-Lymphocyte ,HIV Infections ,chemical and pharmacologic phenomena ,gag Gene Products, Human Immunodeficiency Virus ,Epitope ,Evolution, Molecular ,Interferon-gamma ,medicine ,Humans ,Immunology and Allergy ,Cytotoxic T cell ,Interferon gamma ,Avidity ,Longitudinal Studies ,Integrases ,biology ,ELISPOT ,Viral Load ,Virology ,Integrase ,CTL ,Infectious Diseases ,Mutation ,Disease Progression ,HIV-1 ,HLA-B51 Antigen ,biology.protein ,RNA, Viral ,Female ,Viral load ,T-Lymphocytes, Cytotoxic ,medicine.drug - Abstract
Objective: To fully define cytotoxic T-lymphocyte (CTL) escape variants of an HLA-B*51-restricted integrase epitope in early HIV-1 infection. Design: Ninety-four longitudinally sampled acute/early HIV-1 subtype B-infected participants were assessed to determine HLA-B*51-restricted LPPVVAKEI (LI9) escape variants. Methods: LI9 was sequenced at baseline and subsequent time points. Interferon-γ (IFNγ) ELISpot assays were performed using serial log dilutions of variant LI9 peptides to determine the cellular response and functional avidity. Results: There is a significant association between HLA-B*51 expression and an evolving LI9 sequence from baseline to year 1 (P
- Published
- 2013
30. Neurocognitive function and neuroimaging markers in virologically suppressed HIV-positive patients randomised to ritonavir-boosted protease inhibitor monotherapy or standard combination ART: a cross-sectional sub-study from the PIVOT Trial
- Author
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Janet Cairns, Steffi Thust, Amanda Clarke, Lewis J. Haddow, Rita Trombin, Margaret Johnson, Wolfgang Stöhr, Fabian Chen, Pivot Neurocognitive sub-study Team, Hans Rolf Jäger, Alan Winston, Claudia Godi, Xavier Golay, Nicholas I. Paton, Bhavana Solanky, and Alejandro Arenas-Pinto
- Subjects
Male ,neurocognitive function ,HIV Infections ,Neuropsychological Tests ,PIVOT Neurocognitive sub-study Team ,Lopinavir ,0302 clinical medicine ,Interquartile range ,Antiretroviral Therapy, Highly Active ,HIV Seropositivity ,030212 general & internal medicine ,Neuropsychological assessment ,neuroimaging ,medicine.diagnostic_test ,Brain ,11 Medical And Health Sciences ,Middle Aged ,Viral Load ,Magnetic Resonance Imaging ,3. Good health ,Infectious Diseases ,monotherapy ,HIV/AIDS ,Female ,medicine.drug ,Microbiology (medical) ,medicine.medical_specialty ,Randomization ,Neurocognitive Disorders ,Microbiology ,protease inhibitor ,03 medical and health sciences ,Neuroimaging ,Internal medicine ,medicine ,Humans ,Psychiatry ,Ritonavir ,business.industry ,HIV ,HIV Protease Inhibitors ,06 Biological Sciences ,Hyperintensity ,Confidence interval ,Cross-Sectional Studies ,HIV-1 ,business ,Neurocognitive ,030217 neurology & neurosurgery - Abstract
BACKGROUND: To determine whether treatment with ritonavir-boosted protease inhibitor (PI) monotherapy is associated with detrimental effects on neurocognitive function or brain imaging markers compared to standard antiretroviral therapy (ART). METHODS: Neuropsychological assessment and brain magnetic resonance imaging were performed at the last study visit in a subset of participants randomized to PI monotherapy (PI-mono group) or ongoing triple ART (OT group) in the PIVOT trial. We calculated a global z-score (NPZ-7) from the average of the individual test z-scores and the proportion of participants with symptomatic neurocognitive impairment (score >1 standard deviation below normative means in ≥2 cognitive domains and neurocognitive symptoms). In a subgroup, white matter hyperintensities, bicaudate index, global cortical (GCA) and medial temporal lobe atrophy scores and single voxel (basal ganglia) N-acetylaspartate (NAA)/Choline, NAA/Creatine and myo-inositol/Creatine ratios were measured. RESULTS: 146 participants (75 PI-mono) had neurocognitive testing (median time after randomization 3.8 years), of whom 78 were imaged. We found no difference between arms in NPZ-7 score (median -0.4 (interquartile range [IQR] = -0.7; 0.1) vs -0.3 (IQR = -0.7; 0.3) for the PI-mono and OT groups respectively, P = .28), the proportion with symptomatic neurocognitive impairment (13% and 18% in the PI-mono and OT groups respectively; P = .41), or any of the neuroimaging variables (P > .05). Symptomatic neurocognitive impairment was associated with higher GCA score (OR = 6.2 per additional score; 95% confidence interval, 1.7-22.3 P = .005) but no other imaging variables. CONCLUSIONS: Based on a comprehensive neuropsychological assessment and brain imaging, PI monotherapy does not increase the risk of neurocognitive impairment in stable human immunodeficiency virus-positive patients.
- Published
- 2016
31. Cost Effectiveness of Protease Inhibitor Monotherapy Versus Standard Triple Therapy in the Long-Term Management of HIV Patients: Analysis Using Evidence from the PIVOT Trial
- Author
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Alejandro Arenas-Pinto, David Dunn, Nicholas I. Paton, Lars Oddershede, Wolfgang Stöhr, Simon Walker, and Mark Sculpher
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Combination therapy ,Total cost ,Cost effectiveness ,Anti-HIV Agents ,Cost-Benefit Analysis ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Cost Savings ,Internal medicine ,Medicine ,Humans ,Operations management ,030212 general & internal medicine ,health care economics and organizations ,Randomized Controlled Trials as Topic ,Pharmacology ,Cost–benefit analysis ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,HIV Protease Inhibitors ,Viral Load ,Confidence interval ,United Kingdom ,Quality-adjusted life year ,Models, Economic ,Treatment Outcome ,Drug Therapy, Combination ,Female ,Quality-Adjusted Life Years ,0305 other medical science ,business ,Viral load - Abstract
Background: Protease inhibitor (PI) monotherapy can maintain virological suppression in the majority of patients once it has been established on triple therapy and may also have the potential for substantial cost savings arising from the use of fewer drugs. However, the cost effectiveness of PI monotherapy has yet to be demonstrated. Objectives: In this study we examine the cost effectiveness of PI monotherapy with prompt return to combination therapy in the event of viral load rebound compared with ongoing triple therapy (OT) in patients with suppressed viral load on combination antiretroviral therapy (ART) in the UK. Methods: The analysis used data from the PIVOT trial in which HIV-positive adults with suppressed viral load for ≥24 weeks on combination ART were randomised to maintain OT or to a strategy of PI monotherapy with prompt return to combination therapy if viral load rebounded. A cost-effectiveness analysis including long-term modelling was conducted. Main outcomes included UK National Health Service (NHS) costs and quality-adjusted life-years (QALYs) with comparative results presented as incremental cost-effectiveness ratios. Results: PI monotherapy was cost saving as a result of large savings in ART drug costs while being no less effective in terms of QALYs in the within-trial analysis and marginally less effective with lifetime modelling. In the base-case analysis over 3 years, the incremental total cost per patient was −£6424.11 (95 % confidence interval −7418.84 to −5429.38) and incremental QALYs were 0.0051 (95 % CI −0.0479 to 0.0582), resulting in PI monotherapy ‘dominating’ OT. Multiple scenario analyses found that PI monotherapy was cost saving with no marked differences in QALYs. Modelling of lifetime costs and QALYs showed that PI monotherapy was associated with significant cost savings and was marginally less effective; PI monotherapy was cost effective at accepted cost-effectiveness thresholds in all but one scenario analysis. Conclusions: Under most assumptions, PI monotherapy appears to be a cost-effective treatment strategy compared with OT for HIV-infected patients who have achieved sustained virological suppression.
- Published
- 2016
32. Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina
- Author
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Roberto CAUDA, Jens Lundgren, Alejandro Arenas-Pinto, Giuseppe Ippolito, CARLO FEDERICO PERNO, GINA GUALANO, Paolo Bonfanti, Delia Goletti, Vicenç Falcó, Tatiana Katerina Galpérine, Vincenzo Puro, Fabrizio Palmieri, Robert Miller, Viktar M. Mitsura, Daria Podlekareva, Vasily Bondarenko, GUIDO CAMANNI, Elisa De Lazzari, Miriam Lichtner, ANDREA COSTANTINI, Inma Ocana, Felipe García, Podlekareva, Daria N., Hiv/tb Study Writing, Group, Castagna, Antonella, D.N. Podlekareva, A. Mocroft, F.A. Post, V. Riekstina, J.M. Miro, H. Furrer, M.Bruyand, A.M. Panteleev, A.G.Rakhmanova, E.Girardi, M.H. Losso, JJ.Toibaro, J.Caylá, RF.Miller, N. Obel, A.Skrahina, N.Chentsova, JD. Lundgren, O. Kirk, G.Verucchi, and for HIV/TB study writing group
- Subjects
Combination antiretroviral therapy ,HIV/TB coinfection ,medicine.medical_specialty ,Tuberculosis ,Immunology ,Population ,tb treatment ,Eastern Europe ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,medicine ,Immunology and Allergy ,combination antiretroviral therapy ,eastern europe ,hiv/tb coinfection ,mortality ,multidrug-resistant tuberculosis ,outcome ,Mortality ,education ,Outcome ,Cause of death ,education.field_of_study ,TB COINFECTIONS ,business.industry ,Mortality rate ,HIV ,Hepatitis C ,Pyrazinamide ,Multidrug-resistant tuberculosi ,medicine.disease ,Infectious Diseases ,TB treatment ,Coinfection ,business ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina. METHODS: One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models. RESULTS: At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17-0.65), 0.28 (0.14-0.57), 0.34 (0.15-0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/μl [2.31 (1.56-3.45)], prior AIDS [1.74 (1.22-2.47)], disseminated TB [2.00 (1.38-2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe. CONCLUSION: The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
- Published
- 2009
33. The Risk of Developing Peripheral Neuropathy Induced by Nucleoside Reverse Transcriptase Inhibitors Decreases over Time: Evidence from the Delta Trial
- Author
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Alejandro Arenas-Pinto, Krishnan Bhaskaran, David Dunn, and Ian VD Weller
- Subjects
Adult ,Male ,Pharmacology ,Time Factors ,Anti-HIV Agents ,Zalcitabine ,Incidence ,Peripheral Nervous System Diseases ,HIV Infections ,Middle Aged ,Didanosine ,Infectious Diseases ,Double-Blind Method ,Risk Factors ,Humans ,Reverse Transcriptase Inhibitors ,Drug Therapy, Combination ,Female ,Pharmacology (medical) ,Zidovudine - Abstract
Background Peripheral neuropathy (PN) in HIV-infected individuals is thought be due to a toxic effect on mitochondria induced by some nucleoside reverse transcriptase inhibitors (NRTI). Methods A time-to-event analysis was performed using data from the Delta trial to study the incidence of PN in HIV-infected individuals receiving zidovudine (AZT) alone or in combination with didanosine (ddI) or zalcitabine (ddC). In an on-treatment analysis, changes in the incidence of PN by duration of treatment were directly estimated using a flexible parametric survival model. Results A total of 3,195 patients (total follow-up 4,593 person-years) were included in the analysis. AZT+ddC was associated with a higher incidence of PN (6.2 cases/100 person-years) compared with AZT monotherapy (3.0 cases/100 person-years) and AZT+ddI (2.2 cases/100 person-years). The risk of PN peaked around day 90 following randomization (at 8.9 events/100 person-years in the AZT+ddC arm). PN was also associated with age at entry (hazard ratio (HR)=2.35 for those aged 35–44 years compared with + T-cell count (HR=2.27 for CD4+ T-cell counts 3 compared with >350). Conclusion Our findings challenge the common supposition that PN arises from cumulative exposure to NRTIs. We found that patients who developed PN tended to do so shortly after exposure to antiretroviral therapy. Therefore, our results support the hypothesis of a susceptibility in a subgroup of patients. These results will be of direct interest to those working in resource-limited countries where potentially neurotoxic dideoxynucleosides are still widely used.
- Published
- 2008
34. Risk factors for lactic acidosis and severe hyperlactataemia in HIV-1-infected adults exposed to antiretroviral therapy
- Author
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Simon Edwards, Krishnan Bhaskaran, Esteban Martínez, David Dunn, Andrew Copas, P Chan, A Arenas Pinto, Alison D. Grant, T Overton, J Lundgren, Andrew Carr, I Weller, P Reiss, and Rainer Weber
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anti-HIV Agents ,medicine.medical_treatment ,Immunology ,HIV Infections ,Drug Administration Schedule ,Sex Factors ,Pregnancy ,Interquartile range ,Antiretroviral Therapy, Highly Active ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Lactic Acid ,Pregnancy Complications, Infectious ,Didanosine ,business.industry ,Stavudine ,Age Factors ,Immunosuppression ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,CD4 Lymphocyte Count ,Surgery ,Mitochondrial toxicity ,Infectious Diseases ,Lactic acidosis ,HIV-1 ,Reverse Transcriptase Inhibitors ,Acidosis, Lactic ,Female ,Epidemiologic Methods ,business ,medicine.drug - Abstract
Severe hyperlactataemia and lactic acidosis are rare serious complications of antiretroviral therapy (ART).Lactic acidosis was defined as pH7.35, bicarbonate20 mmol/l and raised lactate; hyperlactataemia as two consecutive lactates5 mmol/l. The case-control study of 110 cases and 220 controls(two randomly selected from treated patients by centre and calendar year) from centres in 10 countries included 40 (36.4%) female cases and 40 female controls (18.2%) (P0.001). Median age was 42.4 years [interquartile range (IQR, 36.0-52.5] for cases and 40 (IQR, 35.0-47.1) for controls (P = 0.013). More cases were nonwhite (41.9%) than controls (31.2%) (P = 0.032). Cases had a shorter duration of exposure to dideoxynucleosides.After adjusting for age, gender and current CD4 cell count, hyperlactataemia/lactic acidosis remained associated with exposure to didanosine in every category of exposure duration but was most strongly associated with exposure12 months. In a separate multivariable model, apart from exposure to stavudine, didanosine, or even more strongly both, age above 40 years [odds ratio (OR), 2.6; 95% confidence interval (CI), 1.08-6.29], female gender (OR, 5.97; 95% CI, 1.92-18.5) and advanced immunosuppression were independent associations (CD4 cell count 200-349, 100-199 and100 cells/mul: OR, 3.89, 7.58 and 8.11, respectively).Hyperlactataemia/lactic acidosis was associated with exposure to dideoxynucleosides, female gender, advanced immunosuppression and possibly ethnicity. This has important consequences for choice of ART in resource-limited settings. The association with shorter duration of exposure may support the hypothesis of susceptibility in a small proportion of patients.
- Published
- 2007
35. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection
- Author
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Per Aagaard, Jan Harding, CRISTINA BADIA, Jean-michel Molina, Jens Lundgren, Magnus Gisslen, Alejandro Arenas-Pinto, DAVID DALMAU, Borja Mora Peris, NNAKELU ERIOBU, Vicente Estrada, Simon Collins, Matti Ristola, Lucette Cysique, Lars Østergaard, Sean Emery, Imad Kansau, Hernando Knobel, Alvaro Humberto Borges, and Anthony Kelleher
- Subjects
HPTN 052 ,Adult ,Male ,medicine.medical_specialty ,Kaplan-Meier Estimate ,Asymptomatic ,Article ,Time-to-Treatment ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,HIV Seropositivity ,medicine ,Humans ,business.industry ,Hazard ratio ,HIV ,TERAPIA ANTIRRETROVIRAL DE ALTA ATIVIDADE ,Liter ,General Medicine ,Viral Load ,medicine.disease ,Interim analysis ,Confidence interval ,Surgery ,CD4 Lymphocyte Count ,Anti-Retroviral Agents ,Asymptomatic Diseases ,RNA, Viral ,Female ,medicine.symptom ,business ,Viral load ,Follow-Up Studies - Abstract
BACKGROUND: Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter.METHODS: We randomly assigned HIV-positive adults who had a CD4+ count of more than 500 cells per cubic millimeter to start antiretroviral therapy immediately (immediate-initiation group) or to defer it until the CD4+ count decreased to 350 cells per cubic millimeter or until the development of the acquired immunodeficiency syndrome (AIDS) or another condition that dictated the use of antiretroviral therapy (deferred-initiation group). The primary composite end point was any serious AIDS-related event, serious non-AIDS-related event, or death from any cause.RESULTS: A total of 4685 patients were followed for a mean of 3.0 years. At study entry, the median HIV viral load was 12,759 copies per milliliter, and the median CD4+ count was 651 cells per cubic millimeter. On May 15, 2015, on the basis of an interim analysis, the data and safety monitoring board determined that the study question had been answered and recommended that patients in the deferred-initiation group be offered antiretroviral therapy. The primary end point occurred in 42 patients in the immediate-initiation group (1.8%; 0.60 events per 100 person-years), as compared with 96 patients in the deferred-initiation group (4.1%; 1.38 events per 100 person-years), for a hazard ratio of 0.43 (95% confidence interval [CI], 0.30 to 0.62; PCONCLUSIONS: The initiation of antiretroviral therapy in HIV-positive adults with a CD4+ count of more than 500 cells per cubic millimeter provided net benefits over starting such therapy in patients after the CD4+ count had declined to 350 cells per cubic millimeter. (Funded by the National Institute of Allergy and Infectious Diseases and others; START ClinicalTrials.gov number, NCT00867048.).
- Published
- 2015
36. Peripheral neuropathy in HIV patients in sub-Saharan Africa failing first-line therapy and the response to second-line ART in the EARNEST trial
- Author
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Alejandro, Arenas-Pinto, Jennifer, Thompson, Godfrey, Musoro, Hellen, Musana, Abbas, Lugemwa, Andrew, Kambugu, Aggrey, Mweemba, Dickens, Atwongyeire, Margaret J, Thomason, A Sarah, Walker, Nicholas I, Paton, and J, Villacian
- Subjects
Adult ,CD4-Positive T-Lymphocytes ,Male ,medicine.medical_specialty ,Tuberculosis ,Neurology ,Anti-HIV Agents ,Antitubercular Agents ,HIV Infections ,Logistic regression ,Asymptomatic ,Lopinavir ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Virology ,Internal medicine ,Antiretroviral Therapy, Highly Active ,Raltegravir Potassium ,medicine ,Isoniazid ,Humans ,030212 general & internal medicine ,Tuberculosis, Pulmonary ,Africa South of the Sahara ,Ritonavir ,business.industry ,Alcohol Abstinence ,Smoking ,Peripheral Nervous System Diseases ,Middle Aged ,Viral Load ,medicine.disease ,Surgery ,CD4 Lymphocyte Count ,Clinical trial ,Drug Combinations ,Peripheral neuropathy ,Logistic Models ,HIV-1 ,RNA, Viral ,Female ,Neurology (clinical) ,medicine.symptom ,Complication ,business ,Viral load ,030217 neurology & neurosurgery - Abstract
Sensory peripheral neuropathy (PN) remains a common complication in HIV-positive patients despite effective combination anti-retroviral therapy (ART). Data on PN on second-line ART is scarce. We assessed PN using a standard tool in patients failing first-line ART and for 96 weeks following a switch to PI-based second-line ART in a large Randomised Clinical Trial in Sub-Saharan Africa. Factors associated with PN were investigated using logistic regression. Symptomatic PN (SPN) prevalence was 22% at entry (N = 1,251) and was associated (p
- Published
- 2015
37. Baseline prevalence and predictors of liver fibrosis among HIV-positive individuals: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial
- Author
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G V, Matthews, J, Neuhaus, S, Bhagani, S H, Mehta, E, Vlahakis, M, Doroana, S, Naggie, A, Arenas-Pinto, L, Peters, and J K, Rockstroh
- Subjects
Adult ,Liver Cirrhosis ,Male ,Cross-Sectional Studies ,Prevalence ,Elasticity Imaging Techniques ,Humans ,Female ,HIV Infections ,Biomarkers ,CD4 Lymphocyte Count - Abstract
Liver disease is increasingly recognized in HIV-positive individuals, even among those without viral hepatitis, partly as a result of the recent availability of noninvasive methods of liver fibrosis assessment. The objective of this substudy is to compare the effects of early versus deferred antiretroviral therapy (ART) on liver fibrosis progression.Sites in the Strategic Timing of AntiRetroviral Treatment (START) study with access to FibroScan® were invited to participate in the Liver Fibrosis Progression Substudy. All substudy participants underwent FibroScan® at baseline, and two noninvasive serum algorithms, APRI and FIB-4, were calculated. Demographic and liver-related information was collected for all START participants at baseline.A total of 230 participants were enrolled in the substudy (11.5% with hepatitis B or C virus coinfection), of whom 221 had a valid transient elastography (TE) result. The median TE score was 4.9 kPa [interquartile range (IQR) 4.3-6.0 kPa]. Seventeen patients (7.8%) [95% confidence interval (CI) 5.1-12.1%] had a TE score of 7.2 kPa, indicating significant liver fibrosis. Baseline factors associated with higher TE scores in multivariate analysis were higher alanine aminotransferase (ALT) per 10 U/L (P = 0.045), higher log10 HIV RNA (P 0.001) and Hispanic/Latino ethnicity (P = 0.01). TE correlated weakly with noninvasive markers.At baseline, significant liver fibrosis was observed in approximately 8% of participants, with higher ALT and HIV RNA the only clinical factors associated with increasing TE score. TE will be used annually to monitor fibrosis and evaluate the role of ART in further fibrosis progression.
- Published
- 2014
38. CRYPTOSPORIDIOSIS IN HIV-INFECTED VENEZUELAN ADULTS IS STRONGLY ASSOCIATED WITH ACUTE OR CHRONIC DIARRHEA
- Author
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Leonor Pocaterra, Alejandro Arenas-Pinto, Julio Castro, Giuseppe Ferrara, Luz Núñez, Gabriela Certad, and Andreina Bello
- Subjects
Adult ,Diarrhea ,Male ,medicine.medical_specialty ,Cryptosporidium infection ,Opportunistic infection ,Cryptosporidiosis ,Cryptosporidium ,HIV Infections ,Gastroenterology ,Feces ,Acquired immunodeficiency syndrome (AIDS) ,Virology ,Internal medicine ,parasitic diseases ,medicine ,Animals ,Humans ,Sida ,Leukopenia ,Isospora ,biology ,business.industry ,Venezuela ,medicine.disease ,biology.organism_classification ,Infectious Diseases ,Acute Disease ,Chronic Disease ,Immunology ,Female ,Parasitology ,Viral disease ,medicine.symptom ,business - Abstract
A cross-sectional study was undertaken to determine the prevalence of cryptosporidiosis and its clinical and laboratory pattern in Venezuelan HIV-infected patients (N = 397). At enrollment, they underwent thorough clinical history and physical examination and provided stool specimens for the identification of Cryptosporidium sp. and other parasites. Cryptosporidium sp. was identified in 59 subjects (15%). This infection was strongly associated with acute and chronic diarrhea, weight loss, CD4(+) counts below 100 cells/mm(3), older age in patients with leukopenia, and more than 5 stools per day when CD4(+) counts were below 100 cells/mm(3). In addition, patients with Cryptosporidium infection were less likely to be coinfected with Isospora belli (OR = 0.05, P = 0.001). In fact, results of the current study confirm the worldwide importance of cryptosporidiosis as a clinically significant opportunistic infection associated with an advanced stage of immunosuppression.
- Published
- 2005
39. ISOSPORIASIS IN VENEZUELAN ADULTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS: CLINICAL CHARACTERIZATION
- Author
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Gabriela Certad, Leonor Pocaterra, Andreina Bello, Julio Castro, Luz Núñez, Alejandro Arenas-Pinto, and Giuseppe Ferrara
- Subjects
Adult ,Male ,medicine.medical_specialty ,Opportunistic infection ,Isosporiasis ,Population ,HIV Infections ,Biology ,Gastroenterology ,Feces ,Virology ,Internal medicine ,Prevalence ,medicine ,Animals ,Humans ,Eosinophilia ,Sida ,education ,education.field_of_study ,Isospora ,Venezuela ,medicine.disease ,biology.organism_classification ,CD4 Lymphocyte Count ,Diarrhea ,Cross-Sectional Studies ,Infectious Diseases ,Immunology ,Female ,Parasitology ,Seasons ,Viral disease ,medicine.symptom - Abstract
A cross-sectional study was undertaken to determine the prevalence of isosporiasis and its clinical and laboratory pattern in Venezuelan patients infected with human immunodeficiency virus (HIV) (n = 397). At enrollment, they underwent a thorough clinical history and physical examination, and provided stool specimens for the identification of Isospora belli and other parasites. Isospora belli was identified in 56 subjects (14%) and diarrhea, either acute or chronic, was present in 98% of these cases (P < 0.001). Eosinophilia was strongly associated with isosporiasis (P = 0.01). It was also found that the presence of eosinophilia was more common in I. belli-infected patients without weight loss (P < 0.001). Twenty-six (81.25%) subjects with I. belli infection had CD4+ cell counts < 200 cells/mm3 (P = 0.03). In addition, the data and its description shows the association to be < 100 cells/mm3. This infection seems to be seasonal because the recovery of oocysts occurred mainly in months with significant rainfall. In fact, isosporiasis should be suspected in HIV-infected patients from tropical countries with diarrhea, weight loss, eosinophilia, and low CD4+ cell counts.
- Published
- 2003
40. Lactic acidosis in HIV infected patients: a systematic review of published cases
- Author
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Simon Edwards, Ian Weller, Alejandro Arenas-Pinto, and Alison D. Grant
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,HIV Infections ,Review ,Dermatology ,Zidovudine ,Risk Factors ,Internal medicine ,Case fatality rate ,Epidemiology ,medicine ,Humans ,Didanosine ,Aged ,business.industry ,Stavudine ,Lamivudine ,HIV Protease Inhibitors ,Middle Aged ,medicine.disease ,Mitochondrial toxicity ,Regimen ,Infectious Diseases ,Immunology ,Reverse Transcriptase Inhibitors ,Acidosis, Lactic ,Female ,business ,medicine.drug - Abstract
Objective: To describe the clinical, epidemiological, and biochemical characteristics of published cases of lactic acidosis (LA) and to generate hypotheses concerning risk factors associated with this complication. Methods: Systematic review of cases reported in the medical literature. Results: 217 published cases were identified, 90 of which fulfilled the study definition and had sufficient individual data on potential risk factors to be included. The 90 patients had a mean age of 40.1 years (range 16–69) and 53% were female. All 90 patients were taking nucleoside reverse transcriptase inhibitors (NRTI) at the time of the episode. Among the 83 patients with details of their antiretroviral therapy (ART) regimen 51 patients were taking stavudine, 29 zidovudine, 27 didanosine, and 25 lamivudine. Around 50% of the patients had abdominal pain, nausea, or vomiting. Hepatic steatosis was consistently reported (53/90) and in 36 (68%) there was histological evidence. The case fatality rate was 48%. Six cases were rechallenged with NRTI and three developed a further LA episode. Using data on the numbers of HIV infected individuals receiving care in the United States, we estimate that the risk of LA could be 2.5 times higher for women than men. Conclusions: NRTI use and female sex appear to be risk factors for the development of LA. What other factors are involved is still not clear but might include duration of NRTI therapy, specific drug use, and genetic predisposition. A case-control study is needed to better define risk factors for severe LA.
- Published
- 2003
41. Systemic inflammation and residual viraemia in HIV-positive adults on protease inhibitor monotherapy: a cross-sectional study
- Author
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Alejandro, Arenas-Pinto, Ana, Milinkovic, Dimitra, Peppa, Anna, McKendry, Mala, Maini, and Richard, Gilson
- Subjects
Adult ,Inflammation ,Male ,Serum Amyloid A Protein ,Ritonavir ,Systemic inflammation ,Interleukin-6 ,Interleukin-8 ,HIV Infections ,HIV Protease Inhibitors ,Middle Aged ,PI monotherapy ,Residual viraemia ,C-Reactive Protein ,Cross-Sectional Studies ,Humans ,Female ,Protease Inhibitors ,Viremia ,Biomarkers ,Research Article - Abstract
Background Increased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono). Methods HIV-infected adults with persistent HIV-RNA 3 mg/l (21% vs 20% in the PImono and cART groups respectively; p = 0.577) or SAA >6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P = 0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA >6.4 mg/l (OR = 1.74 and 1.46; 95% CI = 1.00 – 3.03 and 1.06 – 2.01; p = 0.051 and 0.02 respectively) and hsCRP >3 mg/l in (OR = 2.00 and 1.37; 95% CI = 1.09 – 3.69 and 1.02 – 1.85; p = 0.026 and 0.039 respectively). Conclusions We found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.
- Published
- 2014
42. Common Inherited Mitochondrial Dna Mutations and Nucleoside Reverse Transcriptase Inhibitor-Induced Severe Hyperlactataemia in HIV-Infected Adults: An Exploratory Study
- Author
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Neil Bradman, Martine Bolhaar, Catherine J. E. Ingram, Peter Reiss, Lilanganee Telisinghe, Alan Karstaedt, Alison D. Grant, Rosemary Ekong, Alejandro Arenas-Pinto, Rainer Weber, Ian V. D. Weller, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Global Health, University of Zurich, and Arenas-Pinto, Alejandro
- Subjects
Adult ,Male ,Mitochondrial DNA ,Anti-HIV Agents ,Respiratory chain ,Black People ,610 Medicine & health ,HIV Infections ,Biology ,medicine.disease_cause ,DNA, Mitochondrial ,Polymorphism, Single Nucleotide ,Haplogroup ,White People ,Nucleoside Reverse Transcriptase Inhibitor ,10234 Clinic for Infectious Diseases ,chemistry.chemical_compound ,Polymorphism (computer science) ,Hiv infected ,medicine ,2736 Pharmacology (medical) ,Humans ,Pharmacology (medical) ,Sequence Deletion ,Genetics ,Pharmacology ,Mutation ,2725 Infectious Diseases ,Middle Aged ,medicine.disease ,Virology ,Mitochondria ,Didanosine ,Stavudine ,3004 Pharmacology ,Infectious Diseases ,chemistry ,Lactic acidosis ,Case-Control Studies ,Leukocytes, Mononuclear ,Reverse Transcriptase Inhibitors ,Acidosis, Lactic ,Female ,Zidovudine ,DNA - Abstract
Background Genetic predisposition to dideoxynucleoside-induced mitochondrial dysfunction might be related to mitochondrial DNA (mtDNA) polymorphisms. Severe hyperlactataemia is probably the best model to assess such a predisposition. Methods For this exploratory study in White European and Black African HIV-infected adults, hypervariable region 1 of mtDNA samples from peripheral blood mono-nuclear cells or buccal smears of patients who have developed confirmed severe hyperlactataemia was sequenced. Additionally, 21 single nucleotide polymorphisms and a 9 bp deletion were genotyped to assign mtDNA haplogroups. Finally, entire mtDNA sequencing was performed in a subset of European samples. Samples were obtained from Black African cases and controls recruited from a single centre in Johannesburg, South Africa and from white European cases from Amsterdam, London and Zurich. Results A total of 40 cases and 38 controls from Johannesburg were included. All of the cases and 33 controls were receiving stavudine-based therapy at the time of the index date ( P=0.024). The distribution of mtDNA haplotypes was not different between cases and controls ( P=0.137), and neither were the predicted haplogroups ( P=0.751). In total, 11 of the 12 European cases were on stavudine and/or didanosine at the time of the event. No hypervariable region 1 haplotype was consistently found in the European cases. Sequencing of the entire mtDNA from three of these cases supported the absence of any shared mutations other than major alleles frequently seen in the mtDNA database. Conclusions We did not find an association between homoplasmic inherited mtDNA polymorphisms and severe hyperlactataemia. Our data do not support the existence of non-synonymous mtDNA mutations that explain an increased predisposition to dideoxynucleoside-induced mitochondrial dysfunction.
- Published
- 2012
43. Nevirapine increases high-density lipoprotein cholesterol concentration by stimulation of apolipoprotein A-I production
- Author
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John J.P. Kastelein, Hans P. Sauerwein, René Oesterholt, Elly A. M. Hassink, Alejandro Arenas-Pinto, Stephen P. Storfer, Remco Franssen, Kees Brinkman, Barbara A. Hutten, Erik S.G. Stroes, Peter Reiss, Raaj R. Sankatsing, Mariëtte T. Ackermans, Interne Geneeskunde, RS: NUTRIM - R1 - Metabolic Syndrome, Vascular Medicine, Amsterdam Cardiovascular Sciences, Epidemiology and Data Science, Other Research, Laboratory for Endocrinology, Other departments, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, and Infectious diseases
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nevirapine ,Magnetic Resonance Spectroscopy ,Apolipoprotein B ,Anti-HIV Agents ,HIV Infections ,chemistry.chemical_compound ,High-density lipoprotein ,immune system diseases ,Internal medicine ,Antiretroviral Therapy, Highly Active ,London ,medicine ,Humans ,Netherlands ,biology ,Reverse-transcriptase inhibitor ,Apolipoprotein A-I ,Cholesterol ,Cholesterol, HDL ,virus diseases ,Middle Aged ,Viral Load ,Virology ,Dideoxynucleosides ,Up-Regulation ,Kinetics ,Endocrinology ,Treatment Outcome ,chemistry ,Enzyme inhibitor ,Pharmacodynamics ,biology.protein ,HIV-1 ,RNA, Viral ,Reverse Transcriptase Inhibitors ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Lipoprotein - Abstract
Objective— The purpose of this study was to investigate the mechanism by which the nonnucleoside reverse transcriptase inhibitor (NNRTI) nevirapine (NVP) increases high-density lipoprotein cholesterol (HDLc) in treatment-experienced human immunodeficiency virus-1 (HIV-1)–infected patients. Methods and Results— Twelve HIV-1 infected patients, with stably suppressed HIV-1 viral load using AZT/3TC/abacavir for ≥6 months, added NVP to their current antiretroviral regimen. Patients received a primed bolus infusion of the stable isotope L-[1- 13 C]-valine for 12 hours before, as well as 6 and 24 weeks after, the addition of NVP to study apolipoprotein A-I (apoA-I) kinetics. Absolute production rate (APR) and fractional catabolic rate (FCR) of apoA-I were calculated using SAAM-II modeling. Major HDLc-modulating enzymes were assessed. Plasma apoA-I and HDLc levels increased significantly after 24 weeks of treatment by, respectively, 13±4% ( P =0.01) and 16±6% ( P =0.015). Concomitantly, apoA-I production rate at 24 weeks increased by 17±7% ( P =0.04). ApoA-I catabolism did not change. A modest increase of lecithin:cholesterol acyltransferase and cholesteryl ester transfer protein activity was observed. Conclusions— NVP increases apoA-I production, which contributes to the HDLc increase after introduction of NVP-containing regimens. In view of the potent antiatherogenic effects of apoA-I, the observed increase may contribute to the favorable cardiovascular profile of NVP.
- Published
- 2009
44. Low clinical relevance of risky alcohol consumption in a selected group of high adherent HIV-infected patients attended in the United Kingdom
- Author
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Alicia Gonzalez Baeza, Alejandro Arenas-Pinto, and Ana Milinkovic
- Subjects
Gerontology ,Consumption (economics) ,Univariate analysis ,Alcohol Use Disorders Identification Test ,business.industry ,Public Health, Environmental and Occupational Health ,Logistic regression ,medicine.disease ,Poster Sessions – Abstract P127 ,Infectious Diseases ,Quality of life ,Acquired immunodeficiency syndrome (AIDS) ,Cohort ,Medicine ,business ,Neurocognitive ,Demography - Abstract
Background: the prevalence of risky alcohol consumption, associated factors and its impact on the brain is not well established in clinically stable HIV-patients. Materials and methods: Within the PIVOT neurocognitive sub-study, effectively suppressed HIV-infected adults on either standard cART or ritonavir-boosted PI monotherapy completed the Alcohol Use Disorders Identification Test (AUDIT) designed to detect risky alcohol consumption. They also completed a brief neuropsychological assessment (NPZ 5) composed by five measures. For this cross-sectional analysis, we calculated rates of hazardous (AUDIT=8-15) or harmful (AUDIT=16-19) consumption and likely dependence (AUDIT>20). We explored the association between risky alcohol intakes (AUDIT>8) and clinical/demographical variables, conducting logistic regressions when significant association was found (p
- Published
- 2014
45. Platelet dysfunction-eosinophilia syndrome in parasitized Venezuelan children
- Author
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Arlette, Ruiz-Sáez, Luz Núñez, Sifontes, Rosa, Feijoo, Gabriela, Certad, Alejandro, Arenas-Pinto, Leonor, Pocaterra, Guiseppe, Ferrara, Rita, Giménez, Obdulita, Torres, Carlos, Goldstein, and Norma, Bosch
- Subjects
Male ,Platelet Function Tests ,Purpura, Thrombocytopenic ,Child, Preschool ,Eosinophilia ,Humans ,Female ,Blood Coagulation Tests ,Blood Platelet Disorders ,Syndrome ,Intestinal Diseases, Parasitic ,Child ,Venezuela - Abstract
Platelet dysfunction was detected in six children with purpura and eosinophilia. We conducted clinical evaluations, hematologic and platelet function tests, clotting studies (bleeding time, prothrombin time, partial thromboplastin time, thrombin time, factor XIII, factor VIII, and von Willebrand factor), assays for IgG and IgM antibodies to platelets, and a search for stool parasites. Mild bleeding phenomena (ecchymoses, petechiae, epistaxis, and gingival) were transient. All children showed intestinal parasites and marked eosinophilia (mean count = 2,615.2 cells/muL, 95% confidence interval = 1,259.6-5,429.8). Main abnormalities included prolonged bleeding times (50%) and defective aggregation with collagen (100%) adrenaline (66%), or ADP (66%). Antibodies to platelets were not detected. Anti-parasite therapy reversed the hemorrhagic manifestations and normalized eosinophil counts and platelet alterations. No relationship could be established between excess eosinophils, intensity of bleeding, or type and degree of platelet abnormalities. Thrombocytopathic features mimicked the intrinsic defect of storage pool disease. The possible pathogenic roles of eosinophilia and parasitism are reviewed. This is the first report of this pathologic combination in Latin American children.
- Published
- 2005
46. Association between parasitic intestinal infections and acute or chronic diarrhoea in HIV-infected patients in Caracas, Venezuela
- Author
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Luz Núñez, Giuseppe Ferrara, J Castro, G Certad, M A Bello, and A Arenas-Pinto
- Subjects
Adult ,Diarrhea ,Male ,medicine.medical_specialty ,AIDS-Related Opportunistic Infections ,Dermatology ,Gastroenterology ,Strongyloides stercoralis ,Cohort Studies ,Entamoeba histolytica ,Internal medicine ,Eosinophilia ,Weight Loss ,Prevalence ,Medicine ,Animals ,Humans ,Pharmacology (medical) ,Intestinal Diseases, Parasitic ,Sida ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,biology.organism_classification ,medicine.disease ,Venezuela ,Infectious Diseases ,Cryptosporidium parvum ,Strongyloidiasis ,Cross-Sectional Studies ,Case-Control Studies ,Immunology ,Acute Disease ,Chronic Disease ,Female ,medicine.symptom ,business - Abstract
A cross sectional survey was conducted to determine the association between enteric parasites and diarrhoea in HIV-infected adults in Caracas. Three hundred and four patients were evaluated: 104 had acute diarrhoea, 113 chronic diarrhoea and 87 were controls. Isopora belli infection was associated with acute ( P = 0.022) and chronic diarrhoea ( P = 0.003), Entamoeba histolytica/dispar infection was also associated with both acute ( P = 0.015) and chronic diarrhoea ( P = 0.017). Strongyloides stercoralis ( P = 0.003), and Cryptosporidium parvum ( P = 0.017) infections were associated mainly with chronic episodes. Weight loss ( P < 0.001), a non-infectious factor investigated, was significantly associated with diarrhoea. Eosinophilia, a laboratory parameter studied, was found to be associated with strongyloidiasis ( P = 0.001), giardiasis ( P = 0.001) and isoporiasis ( P = 0.003). In summary, the presence of enteric parasites in HIV-infected patients from tropical urban areas with diarrhoea, with or without significant weight loss, must be considered. Similarly, eosinophilia might suggest parasitic infection in these patients.
- Published
- 2003
47. Inappropriate claim of ‘failure of ritonavir-boosted lopinavir monotherapy in HIV’ in the Monotherapy Switzerland/Thailand (MOST) trial
- Author
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Alejandro Arenas-Pinto, Federico Pulido, Jose R. Arribas, Jean-Luc Meynard, Pierre-Marie Girard, and Nicholas I. Paton
- Subjects
medicine.medical_specialty ,Ritonavir ,business.industry ,Immunology ,Human immunodeficiency virus (HIV) ,HIV Infections ,Lopinavir ,Pyrimidinones ,medicine.disease_cause ,Virology ,Infectious Diseases ,Pharmacotherapy ,Internal medicine ,medicine ,Humans ,Reverse Transcriptase Inhibitors ,Immunology and Allergy ,Drug Therapy, Combination ,business ,medicine.drug - Published
- 2011
48. Neurocognitive Function in HIV Infected Patients on Antiretroviral Therapy
- Author
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Andrew De Burgh-Thomas, Martin Fisher, Kazeem Aderogba, Alan Winston, Wolfgang Stöhr, Charles J.N. Lacey, Nicholas I. Paton, David Dunn, Clifford Leen, Chloe Orkin, Nigel O'Farrell, and Alejandro Arenas-Pinto
- Subjects
Male ,Gerontology ,Multivariate analysis ,Cross-sectional study ,lcsh:Medicine ,HIV Infections ,Neuropsychological Tests ,Social and Behavioral Sciences ,RC0109 ,Cohort Studies ,Cognition ,Risk Factors ,Antiretroviral Therapy, Highly Active ,Neurobiology of Disease and Regeneration ,Pathology ,Psychology ,Medicine ,Hiv infected patients ,lcsh:Science ,Neuropathology ,Medicine(all) ,education.field_of_study ,Multidisciplinary ,Agricultural and Biological Sciences(all) ,Cognitive Neurology ,HIV diagnosis and management ,Middle Aged ,Viral Load ,Antivirals ,Mental Health ,Neurology ,Observational Studies ,Infectious diseases ,Female ,HIV clinical manifestations ,Viral load ,Research Article ,Adult ,medicine.medical_specialty ,Neurovirulence ,Psychometrics ,Clinical Research Design ,Cognitive Neuroscience ,Population ,Retrovirology and HIV immunopathogenesis ,Black People ,Viral diseases ,Microbiology ,White People ,Diagnostic Medicine ,Virology ,Internal medicine ,mental disorders ,Humans ,In patient ,education ,Biology ,Biochemistry, Genetics and Molecular Biology(all) ,business.industry ,lcsh:R ,HIV ,Antiretroviral therapy ,Cross-Sectional Studies ,Anatomical Pathology ,lcsh:Q ,business ,Neurocognitive ,Viral Transmission and Infection ,Neuroscience - Abstract
OBJECTIVE\ud \ud To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy.\ud \ud DESIGN\ud \ud We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial.\ud \ud MAIN OUTCOME MEASURE\ud \ud NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression.\ud \ud RESULTS\ud \ud Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was
- Published
- 2013
49. Safety and Efficacy of Didanosine Enteric-Coated Capsule in Patients with HIV-1 Infection
- Author
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Alejandro Arenas-Pinto
- Subjects
Drug ,Cart ,medicine.medical_specialty ,media_common.quotation_subject ,Context (language use) ,Gastroenterology ,immune system diseases ,Abacavir ,Internal medicine ,parasitic diseases ,medicine ,heterocyclic compounds ,Adverse effect ,Didanosine ,media_common ,business.industry ,lcsh:RM1-950 ,virus diseases ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,lcsh:Therapeutics. Pharmacology ,Pancreatitis ,Hyperlactatemia ,business ,medicine.drug ,Biomedical engineering - Abstract
Didanosine (ddl) has been used to treat HIV infection, in combination with other anti-retroviral drugs, for over 15 years. However, the use of the original formulation of ddI was limited by serious gastro-intestinal adverse effects, which were mainly attributable to the buffer used to protect ddI from the effect of gastric pH. Didanosine enteric-coated capsule (ddI-EC), a more recently introduced formulation, is less likely to cause gastrointestinal intolerance and its absorption might not be compromised by food intake. In this review we discuss efficacy of ddI-EC-containing anti-retroviral combinations (cART) both in naïve and previously treated patients. Because of its favorable resistance profile, ddI-EC has been shown to be potentially efficacious in rescuing patients in virological failure, even if they have nucleoside reverse transcriptase inhibitors (NRTI)-associated resistance mutations. However, ddI has been shown as a potent inducer of mitochondrial dysfunction. Peripheral neuropathy, severe hyperlactatemia and pancreatitis have all been described in patients exposed to ddI. Close monitoring of patients on ddI-EC-containing cART and low threshold for treatment modifications are required to prevent major complications. In the context of once daily cART, ddI-EC is a valid option, particularly when other agents are not available, or when other medical conditions preclude the use of drugs such as tenofovir or abacavir. The role of ddI-EC in second line cART may be even more important in resource-limited settings where additional options are lacking.
- Published
- 2009
50. Antiretroviral therapy and body weight in the START (Strategic Timing of Antiretroviral Treatment) trial
- Author
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Moestrup, K. S., Sharma, S., Baker, J., Collins, S., Carey, D., Maltez, F., Arenas-Pinto, A., Hawkins, K., Neaton, J., Macpherson, C., and Jens Lundgren
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