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Copyright of Epidemiological Review / Przegląd Epidemiologiczny is the property of National Institute of Public Health - National Institute of Hygiene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PIboosted, comparing PLHIV with CD4⩽200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4⩽200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART naïve patients CD4⩽200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PIboosted with CD4⩽200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4.200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4⩽200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4⩽200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK. [ABSTRACT FROM AUTHOR]

The article focuses on the effects of patient and health care-related factors on the success of clinical care for HIV infection leading to the variation across demographic groups. The success of clinical care increased from 1999 to 2004. Despite differences in the prevalence of immunosuppression, all demographic subgroups benefited from the improvements.

Objective: The objective of the trial was to evaluate in a pilot setting the safety and efficacy of interleukin-2 (IL-2) therapy when used without concomitant antiretroviral therapy as a treatment for HIV infection. Design and Setting: This was a multicentre randomised three-arm trial conducted between September 1998 and March 2001 at three clinical centres in the United Kingdom. Participants: Participants were 36 antiretroviral treatment naïve HIV-1-infected patients with baseline CD4 T lymphocyte counts of at least 350 cells/mm³. Interventions: Participants were randomly assigned to receive IL-2 at 15 million international units (MIU) per day (12 participants) or 9 MIU/day (12 participants) or no treatment (12 participants). IL-2 was administered by twice-daily subcutaneous injections for five consecutive days every 8 wk. Outcome Measures: Primary outcome was the change from baseline CD4 T lymphocyte count at 24 wk. Safety and plasma HIV RNA levels were also monitored every 4 wk through 24 wk. The two IL-2 dose groups were combined for the primary analysis. Results: Area under curve (AUC) for change in the mean CD4 T lymphocyte count through 24 wk was 129 cells/mm³ for those assigned IL-2 (both dose groups combined) and 13 cells/mm³ for control participants (95% CI for difference, 51.3-181.2 cells/mm³; p = 0.0009). Compared to the control group, significant increases in CD4 cell count were observed for both IL-2 dose groups: 104.2/mm³ (p = 0.008) and 128.4 cells/mm³ (p = 0.002) for the 4.5 and 7.5 MIU dose groups, respectively. There were no significant differences between the IL-2 (0.13 log10 copies/ ml) and control (0.09 log10 copies/ml) groups for AUC of change in plasma HIV RNA over the 24-wk period of follow-up (95% CI for difference, -0.17 to 0.26; p = 0.70). Grade 4 and dose-limiting side effects were in keeping with those previously reported for IL-2 therapy. Conclusions: In participants with HIV infection and baseline CD4 T lymphocyte counts of at least 350 cells/mm³, intermittent subcutaneous IL-2 without concomitant antiretroviral therapy was well tolerated and produced significant increases in CD4 T lymphocyte counts and did not adversely affect plasma HIV RNA levels. [ABSTRACT FROM AUTHOR]

Background. Highly active antiretroviral therapy (HAART) results in an improvement in immunologic function. We sought to investigate the factors associated with increases in CD4 cell count among human immunodeficiency virus (HIV)-positive antiretroviral-naive patients starting HAART. Methods. Five hundred ninety-six subjects were followed for a median of 2.5 years (interquartile range, 1.0- 4.0 years). Factors associated with changes in CD4 cell counts in the first 3 months of HAART and from 3 months onwards were analyzed. Results. After 6, 12, and 24 months of HAART, the median increases in CD4 cell counts were 114, 181, and 248 cells/mm3, respectively; 84%, 84%, and 80% of subjects had a virus load of !400 copies/mL during the same periods. White ethnicity, higher pre-HAART virus load, and lower pre-HAART CD4 and CD8 cell counts were associated with greater increases in CD4 cell counts during the first 3 months of HAART. From 3 months onward, a greater cumulative proportion of time spent with virus load of <400 copies/mL was associated with a more favorable change in CD4 cell count (an average increase of 5.2 cells/mm³/year [95% confidence interval [CI], 3.8-6.7 cells/ mm³/year] for each extra 10% cumulative time spent with a virus load of <400 copies/mL) (P < .0001 ). For every 100 cells/mm³ higher in baseline CD4 cell count, the increase was 6 cells/mm³/year less (95% CI, 2-11 cells/mm³/ year) (P = .02 ). Sex, risk group, age, and HAART regimen were not associated with increases in CD4 cell counts. Conclusions. These findings emphasize the importance of maintaining virological suppression and suggest other factors that influence long-term CD4 cell response. [ABSTRACT FROM AUTHOR]

Focuses on a study which investigated the steady-state pharmacokinetics of elfavirenz and nevirapine when used in combination to treat human immunodeficiency virus type 1 (HIV-1)-infected subjects. Bioanalysis of nevirapine and efavirenz; Results; Discussion.

We assessed the efficacy and safety of 10-d monotherapy with the orally administered CCR5 antagonist maraviroc in 63 HIV-1-positive individuals prescreened for the absence of CXCR4-using virus. Maximum reduction in viral load occurred at a median of 10–15 d, with a mean reduction of ≥1.6 log10 copies/ml at all twice daily doses ≥100 mg. These results provide proof of concept that CCR5 antagonism is a viable antiretroviral therapeutic approach. [ABSTRACT FROM AUTHOR]

The article investigates the potential therapeutic benefits of interlukin (IL)-2 in treating HIV-infected patients by researchers from London, England. This study was designed to evaluate the use of IL-2 to delay initiation of administering highly-active antiretroviral therapy. The results of the study indicate that IL-2 increases CD4 cell counts with a strong dose-response relationship.

Volatile nitrites (amyl and butyl) are popular recreational drugs, especially in the homosexual population. Haemolytic anaemia is a rare complication of nitrite inhalation and occurs when the reducing capacity of the red cell enzymes is overcome by the oxidizing effect of the nitrite. We describe here a patient with HIV infection who developed a profound haemolytic anaemia after repeated inhalation of large quantities of amyl nitrite. [ABSTRACT FROM AUTHOR]

The presents a study which investigates the role of gender on response to efavirenz (EFV)-containing regimens in previously antiretroviral-naive HIV-positive patients from the Royal Free Hospital in London, England. Ninety-six women and 337 men were included in the study. Results of the study indicates that women have comparable virologic and immunologic outcomes to first-line EFV-containing regimens compared with men.

The article presents a study that assessed alternative method in measuring the preference-based health-related quality of life (HRQoL) in human immunodeficiency virus (HIV) treatment-experienced patients and the association of health status and clinical variables. It examines the HRQoL among patients who failed active antiretroviral therapy (HAART). It concludes that preference-based HRQoL was decreased relative to national norm and health status and clinical variables were directly associated.