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HIV can compromise the immune system; persons with HIV (PWH), especially those not receiving antiretroviral therapy (ART), might be vulnerable to SARS-CoV-2 infection. Studies have reported an increased risk for [...]

Introduction: HIV-controllers have the ability to spontaneously maintain viraemia at low or undetectable levels in the absence of antiretroviral treatment. Furthermore, HIV-controllers seem to have a superior capacity to spontaneously clear hepatitis C virus (HCV) compared to non HIV-controllers. Some of these subjects eventually lose HIV-controller status (transient controllers), whereas some HIV-controllers show a persistent natural HIV control (persistent controllers). We aimed to analyse whether persistent controllers have superior capacity to spontaneously clear HCV compared to transient controllers. Methods: We recruited HIV-controllers from January 1981 up to October 2016 with available antibodies to HCV (anti-HCV) data (n = 744). Factors associated with HIV spontaneous control in relation to HCV status were analysed in persistent and transient HIV-controllers with anti-HCV positive (n = 202 and n = 138 respectively) in comparison with 1700 HCV positive non HIV-controllers recruited from January 1981 up to March 2018, bivariate and multivariate analyses, following a logistic regression model, were applied. In addition, the factors related to the loss and time to lose HIV-controller status were explored (n = 744) using Log rank test and Kaplan-Meier curves, in this case the multivariate analysis consisted in a Cox regression model. Results: A higher frequency of HCV spontaneous clearance was found in persistent HIV-controllers (25.5%) compared to non-controllers (10.2%). After adjusting for potential confounders, as sex, age, HIV transmission risk, [CD4.sup.+] T-cell nadir and time of follow-up, HCV clearance was independently associated with persistent HIV spontaneous control (p = 0.002; OR (95% Cl) = 2.573 (1.428 to 4.633) ), but not with transient spontaneous control (p = 0.119; 1.589 (0.888 to 2.845) ). Furthermore, persistent HIV-controllers were more likely to spontaneously clear the HCV in comparison with transient controllers (p = 0.027; 0.377 (0.159 to 0.893). Finally not to lose or lengthen the time of losing this control was independently associated with HCV spontaneous clearance (p = 0.010; 0.503 (0.297 to 0.850). Conclusions: This study shows an association between spontaneous persistent HIV-control and HCV spontaneous clearance. The study findings support the idea of preserved immune mechanisms in persistent HIV control implicated in HCV spontaneous clearance. These results highlight persistent HIV-controllers but not transient controllers as a good model of functional HIV cure. Keywords: HIV; HCV; HIV-controllers; persistent; transient; HCV spontaneous clearance Additional information may be found under the Supporting Information tab for this article., 1 | INTRODUCTION HIV-controllers are a small group of subjects ( On the other hand, HIV-controllers as a whole seem to have a higher capacity to spontaneously clear hepatitis C [...]

The precise mechanism leading to profound immunodeficiency of HIV-infected patients is still only partially understood. Here, we show that more than 80% of [CD4.sup.+] T cells from HIV-infected patients have morphological abnormalities. Their membranes exhibited numerous large abnormal membrane microdomains (aMMDs), which trap and inactivate physiological receptors, such as that for IL-7. In patient plasma, we identified phospholipase A2 group IB (PLA2G1B) as the key molecule responsible for the formation of aMMDs. At physiological concentrations, PLA2G1B synergized with the HIV gp41 envelope protein, which appears to be a driver that targets PLA2G1B to the [CD4.sup.+] T cell surface. The PLA2G1B/gp41 pair induced [CD4.sup.+] T cell unresponsiveness (anergy). At high concentrations in vitro, PLA2G1B acted alone, independently of gp41, and inhibited the IL-2, IL-4, and IL-7 responses, as well as TCR-mediated activation and proliferation, of [CD4.sup.+] T cells. PLA2G1B also decreased [CD4.sup.+] T cell survival in vitro, likely playing a role in CD4 lymphopenia in conjunction with its induced IL-7 receptor defects. The effects on [CD4.sup.+] T cell anergy could be blocked by a PLA2G1B- specific neutralizing mAb in vitro and in vivo. The PLA2G1B/gp41 pair constitutes what we believe is a new mechanism of immune dysfunction and a compelling target for boosting immune responses in HIV-infected patients., Introduction [CD4.sup.+] lymphocytes play a critical role in the severe immunodeficiency that characterizes HIV-infected patients. Although fewer than 0.5% of blood [CD4.sup.+] T cells are infected, almost all are dysfunctional. [...]

A small percentage of people living with HIV-1 can control viral replication without antiretroviral therapy (ART). These patients are called elite controllers (ECs) if they are able to maintain viral suppression without initiating ART and posttreatment controllers (PTCs) if they control HIV replication after ART has been discontinued. Both types of controllers may serve as a model of a functional cure for HIV-1 but the mechanisms responsible for viral control have not been fully elucidated. In this review, we highlight key lessons that have been learned so far in the study of ECs and PTCs and their implications for HIV cure research., Since the early days of the HIV epidemic, unusual individuals were reported who were able to suppress plasma viremia to very low or undetectable levels and maintain their [CD4.sup.+] T [...]

Restriction of HIV-1 replication in elite controllers (ECs) is frequently attributed to T cell-mediated immune responses, while the specific contribution of innate immune cells is less clear. Here, we demonstrate an upregulation of the host long noncoding RNA (lncRNA) MIR4435-2HG in primary myeloid dendritic cells (mDCs) from ECs. Elevated expression of this lncRNA in mDCs was associated with a distinct immunometabolic profile, characterized by increased oxidative phosphorylation and glycolysis activities in response to TLR3 stimulation. Using functional assays, we show that MIR4435-2HG directly influenced the metabolic state of mDCs, likely through epigenetic mechanisms involving H3K27ac enrichment at an intronic enhancer in the RPTOR gene locus, the main component of the mammalian target of rapamycin complex 1 (mTORC1). Together, these results suggest a role of MIR4435-2HG for enhancing immunometabolic activities of mDCs in ECs through targeted epigenetic modifications of a member of the mTOR signaling pathway., Introduction Effective control of HIV-1 replication can be readily induced by highly active antiretroviral therapy (HAART) (1), but also occurs spontaneously in the absence of antiretroviral therapy in a small [...]

Background: Information about the relationship between HIV-associated immune suppression and COVID-19 outcomes is scarce. We aimed to characterize the epidemiological and clinical features, and impact of immunosuppression on COVID-19-related outcomes [...]

OBJECTIVES: To propose objective ratios using anthropometry and dual-energy X-ray absorptiometry (DXA) and to suggest cutoff points for them in order to classify lipodystrophy in male patients. METHODS: It is a cross-sectional study. DXA was applied and anthropometric measurements were performed in 100 men on highly active antiretroviral therapy. Receiver operating characteristic curves were used to propose cutoffs. Individuals were divided in without (lipo-) or with (lipo+) lipodystrophy and their metabolic parameters were compared. RESULTS: The following ratios were proposed: fat mass ratio by DXA (FMR), waist thigh ratio (WTR), waist calf ratio (WCR), and arm to trunk ratio (ATR). The best cutoffs observed for FMR, WTR and ATR were 1.26, 1.74 and 2.08, respectively. Using the proposed cutoff for FMR, we observed worse metabolic profile, with increased tryglicerides, fasting serum glucose and more hypercholesterolemia in the lipo+ group. WTR and ATR showed a significant correlation with FMR. CONCLUSIONS: Anthropometric ratios (WTR/ATR) and FMR can be used to aid the diagnosis of lipodystrophy in order to contribute to a more accurate and earlier diagnosis permitting intervention and even preventing metabolic disturbances. European Journal of Clinical Nutrition (2015) 69, 274-278;doi: 10.1038/ejcn.2014.149;published online 30 July 2014, INTRODUCTION The advances of highly active antiretroviral therapy (HAART) have led to unquestionable benefits and to a considerable improvement of the management of HIV-seropositive patients, with the viral infection having [...]

Heme oxygenase-1 (HO-1) is an inducible, detoxifying enzyme that is critical for limiting oxidative stress, inflammation, and cellular injury within the CNS and other tissues. Here, we demonstrate a deficiency of HO-1 expression in the brains of HIV-infected individuals. This HO-1 deficiency correlated with cognitive dysfunction, HIV replication in the CNS, and neuroimmune activation. In vitro analysis of HO-1 expression in HIV-infected macrophages, a primary CNS HIV reservoir along with microglia, demonstrated a decrease in HO-1 as HIV replication increased. HO-1 deficiency correlated with increased culture supernatant glutamate and neurotoxicity, suggesting a link among HIV infection, macrophage HO-1 deficiency, and neurodegeneration. HO-1 siRNA knockdown and HO enzymatic inhibition in HIV-infected macrophages increased supernatant glutamate and neurotoxicity. In contrast, increasing HO-1 expression through siRNA derepression or with nonselective pharmacologic inducers, including the CNS-penetrating drug dimethyl fumarate (DMF), decreased supernatant glutamate and neurotoxicity. Furthermore, IFN-γ, which is increased in CNS HIV infection, reduced HO-1 expression in cultured human astrocytes and macrophages. These findings indicate that HO-1 is a protective host factor against HIV-mediated neurodegeneration and suggest that HO-1 deficiency contributes to this degeneration. Furthermore, these results suggest that HO-1 induction in the CNS of HIV-infected patients on antiretroviral therapy could potentially protect against neurodegeneration and associated cognitive dysfunction., Introduction Heme oxygenase-1 (HO-1) is a sentinel, detoxifying enzyme that is induced in response to numerous insults, including inflammation and oxidative stress (1-3). The potent nti-inflammatory and cytoprotective actions of [...]

Author(s): Jeanne M. Marrazzo 1,*, Julia C. Dombrowski 2, Kenneth H. Mayer 3,4 Summary points Persons living with HIV who achieve sustained viral suppression with antiretroviral therapy can avoid sexual [...]

Background: While the description of protective humoral and T-cell immune responses has been reported among immunocompetent (IC) individuals, its characterization among PLWHIV remains uncertain. Methods: SARS-CoV-2-specific serological and functional T-cell [...]

Impaired hepatitis B virus vaccine (HBVV) efficacy has been observed in HIV-infected patients. We assessed the immunogenicity of double-dose (DD) hepatitis B virus revaccination in patients who had failed to respond to standard vaccination. A retrospective chart review of 4,663 patients ensued in two urban HIV clinics between January 2004 and March 2009. Of 363 patients who received three standard doses (SDs) of HBVV, 126 (34.7%) responded with detectable hepatitis B surface antibody [(HBsAb) HBsAb titer of [greater than or equal to] 10 mIU/ml] and 237 (65.3%) nonresponders (NRs) remained seronegative. Among NRs, 61 received three to eight additional SDs of HBVV; 29 received three double doses (DDs) of HBVV (40 [micro]g/dose), spaced at monthly dosing intervals; and 11 received from one to five additional SD HBVV (who remained seronegative) and then received three DDs HBVV. Response rate was significantly higher among the 40 DD recipients than among the 61 who received only additional SD (34/40, 85%, vs. 36/61, 59%; p = 0.006). In the revaccinated NR group (61 SD + 40 DD), a logistic regression analysis found that use of highly active antiretroviral therapy (HAART) (OR, 10.166; CI, 1.359-76.026; p = 0.024), and CD4 cell counts [greater than or equal to] 200 cells/[mm.sup.3] at the time of revaccination (OR, 9.233; CI, 1.393-61.207; p = 0.021) were associated with HBsAb response, as was DD HBV revaccination (OR, 4.177; CI, 1.282-13.614; p = 0.018). Rescue DD hepatitis B vaccination appears to improve the HBsAb response rate significantly in HIV-infected NR patients, especially after an adequate immune restoration with HAART. More prospective studies are needed to confirm these findings. DOI: 10.1089/apc.2009.0340

Nontyphoidal Salmonellae are a major cause of life-threatening bacteremia among HIV-infected individuals. Although cell-mediated immunity controls intracellular infection, antibodies protect against Salmonella bacteremia. We report that high-titer antibodies specific for Salmonella lipopolysaccharide (LPS) are associated with a Lack of Salmonella-killing in HIV-infected African adults. Killing was restored by genetically shortening LPS from the target Salmonella or removing LPS-specific antibodies from serum. Complement-mediated killing of Salmonella by healthy serum is shown to be induced specifically by antibodies against outer membrane proteins. This killing is Lost when excess antibody against Salmonella LPS is added. Thus, our study indicates that impaired immunity against nontyphoidal Salmonella bacteremia in HIV infection results from excess inhibitory antibodies against Salmonella LPS, whereas serum killing of Salmonella is induced by antibodies against outer membrane proteins. 10.1126/science.1180346

Background: HIV infection occurs predominantly in the mucosal surfaces of the gastrointestinal tract and is associated with compromised intestinal barrier integrity and dysbiosis that is not reversed by current antiretroviral therapy (ART). Innate lymphoid cells (ILCs) orchestrate mucosal barrier defences and are involved in the regulation of tissue homeostasis. However, the impact of HIV-1 infection on ILCs in the human intestinal mucosa and gut draining lymphoid tissue is unknown. Methods: Here, we present a large cohort of patients from a gastrointestinal clinic in KwaZulu-Natal, South Africa recruited within extremely high HIV endemic areas. Human gut draining lymph nodes and intestinal biopsies were collected during surgical procedures. Phenotypic characterization of ILCs was done using flow cytometry and immunohistochemistry. Moreover, we employed single-cell transcriptomics of pre-sorted ILCs to examine the gene expression profile and ex vivo response to HIV infection. Results: Total ILC levels in the gut of HIV uninfected individuals were comparable. However, we found ILC subtype-specific and regional changes between the small and large intestine. Intraepithelial ILC1 (p < 0.0001) and NK cells (p < 0.0001) were significantly enriched in the duodenum compared to the colon, whereas ILC3s were significantly expanded in the colon compared to the duodenum (p < 0.0001) in HIV uninfected individuals. In HIV infected participants, we observed expansion of duodenal ILC3s (p = 0.03) that was not found within the colon compared to HIV uninfected participants. The gut compartment-specific difference in ILC3 levels was independent of CD4 T-cell depletion observed in both compartments (p < 0.0001). We found modest changes in ILC3 levels within gut lymph nodes in HIV infected and uninfected individuals. Single-cell RNAseq of presorted ILCs from lymph nodes reveals tissue-specific transcriptional profiles between NK, ILC1 and ILC3 subsets with pending analysis of their response to HIV infection ex vivo. Conclusions: Compartment-specific differences in ILC subsets suggest distinct roles for these cells throughout the small and large intestine. Strikingly, ILC subset change in response to HIV infection within the small intestine with enriched ILC3s in HIV infected duodenal biopsies, irrespective of CD4 T cell depletion, suggests that ILC3s may play important roles in intestinal epithelial homeostasis that should be explored further for therapeutic potentials during chronic HIV-1 infection., OA05.03 O.E. Asowata (1); R. Fardoos (2); A. Singh (1); Y. Zungu (1); A. Ngoepe (1); F. Nene (1); A. Ntuli (1); F. Karim (1); A. Shalek (3); F. Anderson [...]

The impact of lipodystrophy (LD) on quality of life is high, but it has not been demonstrated in literature. The objective of the study was to assess the impact of LD on the health-related quality of life (HRQOL) in HIV-infected people on highly active antiretroviral therapy (HAART). Patients with LD phenotype defined by the Multicenter AIDS Cohort Study (MACS) were included. Three different methods were used to define LD severity: both patient and physician evaluation using the HIV Outpatient Study (HOPS) severity scales and the Lipodystrophy Case Definition (LDCD). The HRQOL was evaluated by MOS-HIV Health Survey. Four hundred one patients on HAART for a mean of 108 [+ or -] 52 months were evaluated for LD at the Metabolic Clinic of Modena and Reggio Emilia University were enrolled from January 2003 to July 2006. According to self-perceived or physician-based HOPS, 106 (26.5%) and 122 (30.4%) patients had severe LD. Females had significantly more severe LD. Few HRQOL scores correlated to LD severity using the physician-based score (both HOPSph and LDCD), while all the HRQOL scores correlated with LD severity when a patient-based score was used (HOPSpt). In multiple linear regression analysis, Mental Health HRQOL score, gender, body mass index, age, body image satisfaction were independent predictors of patient-based (HOPSpt) LD, while none of the HRQOL scores, but female gender, age, waist-to-hip ratio, limb fat, and body image satisfaction were correlated with physician-estimated HOPSph LD severity. HRQOL was strongly correlated with LD severity when a patientbased score was used. For an overall assessment of the impact of LD on HIV-infected people, both patientbased and physician-based measures are required.

Low high-density lipoprotein-cholesterol (HDL-C) levels have been associated with cardiovascular risk in non-HIV populations. Limited information exists on the prevalence of low HDL-C in HIV--infected patients and related factors remain largely unknown. The aims of this study were to estimate the prevalence and characteristics of low HDL-C levels in HIV-infected patients. A cross-sectional study was performed in consecutive HIV-infected patients cared for in an outpatient HIV clinic on the Mediterranean coast of Spain during a 2-month period (September 15, 2003 to November 15, 2003). HDL-C levels below 40 mg/dL were considered low. We analyzed data from 219 patients, 167 of whom were on antiretroviral therapy. The majority (45.20 %) were on non-nucleoside reverse transcriptase inhibitors (NNRTI); 22.83% were on treatment with protease inhibitors. The prevalence of low HDL-C levels was 44.74 % (98 of 219 patients). In multivariate analysis, hypertriglyceridemia (triglycerides >150 mg/dL; odds ratio [OR], 5.65; 95% confidence interval [CI], 2.85-11.23; p = 0.0001), HIV-1 RNA viral load greater than 50 copies per milliliter (OR, 3.15; 95% CI, 1.63-6.109; p = 0.001) and antiretroviral therapy with regimens other than NNRTIs-based regimens (OR, 2.17; 95% CI, 1.12-4.16; p = 0.021) were associated with low HDL-C levels. These data indicate that prevalence of low HDL-C among HIV-infected patients from this cohort was very high. Low HDL-C was related to triglyceride levels, HIV-1 RNA viral load and antiretroviral therapy composition. Undetectable viral load and treatment with NNRTIs are protective factors, whereas hypertriglyceridemia is directly associated with low HDL-C levels.

Although Legionnaires' disease occurs more commonly in patients with some degree of immunosuppression (diabetes, chronic lung disease, end stage renal disease, cancer, etc.), it has been infrequently described in patients infected with human immunodeficiency virus (HIV) and AIDS. Some studies suggest that pneumonia caused by Legionella tends to present with more severe clinical features and complications in the HIV-infected population. The use of antibiotic prophylaxis or the association of severe pneumonia with other pathogens may account for under diagnosis of the disease. We diagnosed five cases of Legionella pneumonia in patients with HIV infection at our institution during a 1-year period. The cases seen ranged in severity, regardless of the [CD4.sup.+] counts of the patients. Based on our observations, it seems impossible to discern whether HIV infection is an additional risk factor for Legionnaires' disease. We describe those five cases and review the available literature.

The purpose of this paper is to present validation data on the Events in Care Screening Questionnaire (ECSQ), which was designed to identify the needs and concerns of people living with HIV[AIDS (PLWHA) in nine specific domains: adherence to medical instructions; medical problems; specialty and inpatient hospital care; preventive health care and screening and behavioral health; sexual risk behavior; family planning; psychological symptoms; substance use; and life circumstances and demands. The ECSQ is the anchor for a more comprehensive measure called 'The Dynamics of Care,' and was administered in the context of a longitudinal study to evaluate New York State's HIV Special Needs Plan (HIV SNP), a Medicaid managed care model for PLWHA. Participants in the study, which began in March 2003 and closed recruitment in January 2007, were NYC PLWHA who were enrolled in either a Medicaid HIV SNP or Fee-For-Service plan. Participants were recruited through HIV SNP enrollment lists, direct on-site recruitment, and fliers. The specific event domains covered in the ECSQ were selected based on the purpose of the HIV SNP and the literature describing the needs and challenges that PLWHA face. Analyses are based on data from 628 study respondents over two times points. Results suggest that the concerns identified by PLWHA were largely consistent with their health care situation, heath status, risk behavior, and personal characteristics. Findings presented here lend support for the construct validity of the ECSQ and demonstrate its value as a starting point for inquiring more fully about the experiences of patients and improving the care they receive.

Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and el-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin} increased in both men (48 [micro]g/L; P = 0.02) and women (12/ [micro]g/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation.

HIV prevention has become a new priority for HIV clinicians, as their patients live longer and more sexually active lives. Prevention interventions can be effective in clinical settings, but first patients must be screened and inconsistent condom use must be disclosed. Audio computer-assisted self-interviews (ACASI) are an effective way to elicit this sensitive information. We assessed condom use by ACASI among 198 English- or Spanish-speaking HIV patients at 2 community hospital-based HIV clinics in Queens and the Bronx, New York. Among 120 patients reporting sex with a regular partner in the past 4 weeks, 41 (34%) reported not using a condom every time and 22 (18%) reported never using a condom. Among 81 reporting sex with a casual partner in the past 4 weeks, 21 (26%) reported not using a condom every time and 12 (15%) reported never using a condom. Overall, 24 of 129 sexually active patients (19%) reported never using a condom. In a multivariable model controlling for age, race/ethnicity, gender, and HIV exposure category, depression symptoms (Center for Epidemiological Studies Depression Scale [CES-D] score [greater than or equal to] 16; p = 0.03) and self-reported antiretroviral medication non-adherence ([less than or equal to] 95% doses in past 3 days; p = 0.03) were significantly associated with never using a condom with a regular or casual partner. ACASI interviews may be an effective way of identifying patients in clinical settings who require prevention counseling as well as other psychosocial services.

Despite the high prevalence of both mental disorders and HIV infection in much of sub-Saharan Africa, little is known about the occurrence of mental health disorders among HIV-infected individuals. We conducted a cross-sectional study among individuals enrolled into HIV care and treatment services near Cape Town, South Africa. Psychiatric diagnoses were measured using the Mini-International Neuropsychiatric Interview (MINI) administered by trained research nurses. In addition, all participants were administered brief rating scales for depression (the Center for Epidemiological Studies Depression Scale ICES-D]), posttraumatic stress disorder (PTSD), the Harvard Trauma Questionnaire (HTQ), and alcohol dependence/abuse (the Alcohol Use Disorders Identification Test [AUDIT]). The median age among the 465 participants was 33 years and 75% were female; 48% were receiving antiretroviral therapy. Overall, the prevalence of depression, PTSD and alcohol dependence/abuse was 14% (n = 62), 5% (n = 24), and 7% (n = 35), respectively. In multivariate analysis, the prevalence of all disorders was significantly higher among individuals who spoke Afrikaans compared to Xhosa. While the AUDIT showed excellent sensitivity and specificity in detecting MINI-defined dependence/abuse (area under the receiver-operating characteristic curve, 0.96), the HTQ and CES-D had lower performance characteristics in detecting PTSD (0.74) and depression (0.76), respectively. These data demonstrate high levels of depression, PTSD and alcohol dependence/abuse among HIV-infected individuals in this setting. Additional research is required to refine these rating scales for maximum applicability in cross-cultural populations. More generally, HIV care and treatment services represent an important venue to identify and manage individuals with common mental disorders in resource-limited settings.

We reviewed chest radiographs of 57 HIV-infected patients with pulmonary diseases in whom Streptococcus pneumoniae was the sole respiratory pathogen isolated to evaluate whether highly active antiretroviral therapy (HAART) or bacteremia modify radiographic appearance. Pneumococcal lung disease presented as lobar pneumonia in 40% of the cases, 54% of whom were on HAART; as bronchopneumonia in 42%, 58% on HAART; as interstitial infiltrates in 17%, 60% on HAART. Bacteremia was observed 38 times in 23 patients with CD4 less than 200/[mm.sup.3], and in 15 with CD4 greater than 200/[mm.sup.3] (p > 0.05). HAART does not significantly influences radiographic appearances of lung disease caused by Streptococcus pneumoniae (p > 0.05). Immunosuppression induced by HIV infection was a major risk factor for development of pneumococcal lung disease (p = 0.04) and influences radiographic appearance; bronchopneumonia (p = 0.006), in particular multifocal (p = 0.008), which was more frequent in subjects with CD4 less than 200/[mm.sup.3]. Bacteremia influences radiographic appearance of pneumococcal lung disease; lobar pneumonia was more frequent (p = 0.003), and considering CD4 cell count, was more frequent if CD4 cell count was above 200/[mm.sup.3]. An original finding of this study was the frequency of interstitial changes. This pattern of pneumonia, found in 17% of our patients, could represent a difference between HIV-seropositive and -seronegative subject in displaying pneumococcal lung disease.

To assess the incidence of and risk factors for acute pancreatitis in HIV-infected patients in the contemporary highly active antiretroviral therapy (HAART) era, we evaluated all cases of acute pancreatitis requiring hospitalization between 1996 and 2006 in patients followed at Johns Hopkins Hospital's HIV clinic. A nested, case-control analysis was employed for initial episodes of acute pancreatitis, and conditional logistic regression was used to assess risk factors. Of 5970 patients followed for 23,460 person-years (PYs), there were 85 episodes of acute pancreatitis (incidence: 3.6 events/1000 PYs). The incidence of pancreatitis from 1996 to 2000 was 2.6 events/1000 PYs; the incidence from 2001 to 2006 was 5.1 events/1000 PYs (p = 0.0014, comparing rates in two time periods). In multivariate regression, factors associated with pancreatitis included female gender (adjusted odds ratio [AOR] 2.96 [1.69, 5.19]; p < 0.001); stavudine use (AOR 2.19 [1.16, 4.15]; p = 0.016); aerosolized pentamidine use (OR 6.27; [1.42, 27.63]; p = 0.015); and CD4 count less than 50 cells/[mm.sup.3] (AOR 10.47 [3.33, 32.90]; p < 0.001). Race/ethnicity, HIV risk factor, HIV-1 RNA, and newer non-nucleoside reverse transcriptase inhibitors (NNRTI)- and protease inhibitor (PI)-based HAART regimens were not associated with an increased risk of pancreatitis after adjustment for the above factors. Pancreatitis remains a significant cause of morbidity in the HIV population in the HAART era. Acute pancreatitis is associated with female gender, severe immunosuppression, and stavudine and aerosolized pentamidine usage. Of note, newer antiretrovirals, particularly atazanavir, lopinivir/ritonavir, tenofovir, abacavir, and efavirenz, were not associated with an increased risk of pancreatitis.

Byline: Rafael. Martínez-Girón, Santiago. Martínez-Torre The simultaneous presentation of two noninflammatory pulmonary diseases, pulmonary alveolar proteinosis and Kaposi's sarcoma (Ks), in an HIV-infected patient, is described. A 29-year-old black race [...]

Background. Older healthy and HIV-infected adults exhibit physiological similarities. Frailty is a clinical syndrome associated with aging that identifies a subset of older adults at high risk of mortality and other outcomes. We investigated whether HIV infection increases the prevalence of a frailty-related phenotype (FRP) that approximates a clinical definition of frailty. Methods. We first defined the FRP and assessed its prevalence among HIV-uninfected men followed in the Multicenter AIDS Cohort Study (MACS) between 1994 and 2004. Using repeated measurements logistic regression models, we then assessed the association between FRP and HIV infection before the era of highly active antiretroviral therapies, adjusting for covariates among HIV-uninfected (N = 1905) and incident HIV cases (N = 245). Results. HIV infection was strongly associated with FRP prevalence. Compared to HIV-uninfected men of similar age, ethnicity and education, HIV-infected men were more likely to have the FRP for all durations of infection: for [less than or equal to] 4 years, the adjusted odds ratio (OR) was 3.38, with 95% confidence interval (CI), 1.25-9.11, and for 4.01-8 years and 8.01-12 years the corresponding figures were (OR = 12.95, 95% CI, 6.60-25.40) and (OR = 14.68, 95% CI, 7.60-28.35), respectively. The FRP prevalence for 55-year-old men infected with HIV for [less than or equal to] 4 years (3.4%; 95% CI, 1.3-8.6) was similar to that of uninfected men [greater than or equal to] 65 years old (3.4%; 95% CI, 1.5-7.6). Conclusion. In this cohort, HIV infection was associated with an earlier occurrence of a phenotype that resembles the phenotype of frailty in older adults without HIV infection. Studies of frailty in the setting of HIV infection may help to clarify the biological mechanism of frailty.

A retrospective cohort study was conducted to determine if the incidence of clinically significant weight loss (baseline body weight) was greater in HIV/hepatitis C virus (HCV)-coinfected patients who received highly active antiretroviral therapy (HAART) plus pegylated (PEG)-interferon and ribavirin compared with HCV-monoinfected patients who received PEG-interferon and ribavirin and HIV-monoinfected individuals who received only HAART. The incidence of weight loss is greater in dually treated patients with HIV/HCV than in treated HCV- or HIV-monoinfected patients.

Byline: A. S. Carvalhal (1,4), P. Belmonte-Abreu (1), J. Correa (2), L. Z. Goldani (2), S. B. Rourke (3) Author Affiliation: (1) Dept. of Psychiatry, University Federal Rio Grande Sul, Porto Alegre, Brazil (2) Infectious Diseases Unit, Hospital de Clinicas de Porto Alegre, Faculty of Medicine, University Federal Rio Grande Sul, Ramiro Barcelos 2350, Porto Alegre, RS 90035.002, Brazil (3) Neurobehavioral Research Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (4) Dept. of Psychiatry & Behavioral Neuroscience, McMaster University, Hamilton, ON, Canada Article History: Registration Date: 01/01/2006 Received Date: 11/01/2006 Accepted Date: 22/08/2006

This study focused on dietary glycemic index because insulin resistance can be important in the pathogenesis of fat deposition in human immunodeficiency virus (HIV). We evaluated differences in past dietary glycemic intake between men with HIV who developed fat deposition and those who did not. This was a nested case-control study consisting of 37 cases and 37 controls from the Nutrition for Healthy Living cohort. Food records from 6 to 24 months prior to development of fat deposition in cases were analyzed and compared with controls. Cases were defined as men with a waist-to-hip ratio >0.95 and body mass index (calculated as kg/[m.sup.2]) between 23 and 26. Controls were matched by age, race, body mass index, highly active antiretroviral therapy use, and CD4 count. Food records were analyzed using t tests for normally distributed nutrients and Wilcoxon rank-sum tests for nutrients with skewed distributions. Glycemic index was calculated for each meal and day. There was no significant difference in glycemic index for meals and day between participants with or without fat deposition. Both groups had a moderate dietary glycemic index intake. This study showed no association between dietary glycemic index and development of fat deposition in HIV. Instead, results of this study depict the potential benefits associated with eating high-quality diets, primarily adequate fiber and protein intake. Diet can be important in preventing development of fat deposition in patients with HIV.

Randomized, double-blind, placebo-controlled trial is used to evaluate the efficacy and safety of oxandrolone in promoting body weight and body cell mass (BCM) gain in HIV associated weight loss. Oxandrolone administration is found to be effective in promoting dose-dependent gains in body weight and BCM in HIV-infected men with weight loss.

A study was conducted to identify risk factors for a buffalo hump (BH) in HIV-infected adults in cross-sectional analyses of 2 HIV-infected ambulatory populations. Patients with a BH had a high prevalence of other features of HIVLD, similar to lipodystrophic patients without a BH.