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1. Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

Author

Zoest, R.A. van, Law, M., Sabin, C.A., Vaartjes, I., Valk, M. van der, Arends, J.E., Reiss, P., Wit, F.W., Geerlings, S.E., Godfried, M.H., Goorhuis, A., Hovius, J.W., Kuijpers, T.W., Nellen, F.J.B., Poll, D.T. van der, Prins, J.M., Vugt, H.J.M. van, Wiersinga, W.J., Wit, F.W.M.N., Duinen, M. van, Eden, J. van, Hes, A.M.H. van, Pijnappel, F.J.J., Weijsenfeld, A.M., Jurriaans, S., Back, N.K.T., Zaaijer, H.L., Berkhout, B., Cornelissen, M.T.E., Schinkel, C.J., Wolthers, K.C., Peters, E.J.G., Agtmael, M.A. van, Bomers, M., Heitmuller, M., Laan, L.M., Ang, C.W., Houdt, R. van, Pettersson, A.M., Vandenbroucke-Grauls, C.M.J.E., Berge, M. van den, Stegeman, A., Baas, S., Looff, L.H. de, Wintermans, B., Veenemans, J., Pronk, M.J.H., Ammerlaan, H.S.M., Munnik, E.S. de, Jansz, A.R., Tjhie, J., Wegdam, M.C.A., Deiman, B., Scharnhorst, V., Eeden, A. van, Brokking, W., Groot, M., Elsenburg, L.J.M., Damen, M., Kwa, I.S., Kasteren, M.E.E. van, Brouwer, A.E., Erve, R. van, Kruijf-van de Wiel, B.A.F.M. de, Ven, B. van de, Buiting, A.G.M., Kabel, P.J., Versteeg, D., Ende, M.E. van der, Bax, H.I., Gorp, E.C.M. van, Nouwen, J.L., Rijnders, B.J.A., Schurink, C.A.M., Verbon, A., Vries-Sluijs, T.E.M.S. de, Jong-Peltenburg, N.C. de, Bassant, N., Beek, J.E.A. van, Vriesde, M., Zonneveld, L.M. van, Berg-Cameron, H.J. van den, Groot, J. de, Zeeuw-de Man, M. de, Boucher, C.A.B., Koopmans, M.P.G., Kampen, J.J.A. van, Pas, S.D., Branger, J., Douma, R.A., Duijf-van de Ven, C.J.H.M., Schippers, E.F., Nieuwkoop, C. van, IJperen, J.M. van, Geilings, J., Hut, G. van der, Burgel, N.D. van, Leyten, E.M.S., Gelinck, L.B.S., Davids-Veldhuis, S., Hartingsveld, A.Y. van, Meerkerk, C., Wildenbeest, G.S., Heikens, E., Groeneveld, P.H.P., Bouwhuis, J.W., Lammers, A.J.J., Kraan, S., Hulzen, A.G.W. van, Kruiper, M.S.M., Bliek, G.L. van der, Bor, P.C.J., Bloembergen, P., Wolfhagen, M.J.H.M., Ruijs, G.J.H.M., Kroon, F.P., Boer, M.G.J. de, Scheper, H., Jolink, H., Dorama, W., Holten, N. van, Claas, E.C.J., Wessels, E., Hollander, J.G. den, Pogany, K., Roukens, A., Kastelijns, M., Smit, J.V., Smit, E., Struik-Kalkman, D., Tearno, C., Niekerk, T. van, Pontesilli, O., Lowe, S.H., Lashof, A.M.L.O., Posthouwer, D., Ackens, R.P., Burgers, K., Schippers, J., Weijenberg-Maes, B., Loo, I.H.M. van, Havenith, T.R.A., Mulder, J.W., Vrouenraets, S.M.E., Lauw, F.N., Broekhuizen, M.C. van, Vlasblom, D.J., Smits, P.H.M., Weijer, S., Moussaoui, R. el, Bosma, A.S., Vonderen, M.G.A. van, Kampschreur, L.M., Dijkstra, K., Faber, S., Weel, J., Kootstra, G.J., Delsing, C.E., Burg-van de Plas, M. van der, Heins, H., Kortmann, W., Twillert, G. van, Renckens, R., Ruiter-Pronk, D., Truijen-Oud, F.A. van, Stuart, J.W.T.C., IJzerman, E.P., Jansen, R., Reijden, W.A. van der, Brinkman, K., Berk, G.E.L. van den, Blok, W.L., Frissen, P.H.J., Lettinga, K.D., Schouten, W.E.M., Veenstra, J., Brouwer, C.J., Geerders, G.F., Hoeksema, K., Kleene, M.J., Meche, I.B. van der, Spelbrink, M., Toonen, A.J.M., Wijnands, S., Kwa, D., Regez, R., Crevel, R. van, Keuter, M., Ven, A.J.A.M. van der, Hofstede, H.J.M. ter, Dofferhoff, A.S.M., Hoogerwerf, J., Grintjes-Huisman, K.J.T., Haan, M. de, Marneef, M., Rahamat-Langendoen, J., Stelma, F.F., Burger, D., Gisolf, E.H., Hassing, R.J., Claassen, M., Beest, G. ter, Bentum, P.H.M. van, Langebeek, N., Tiemessen, R., Swanink, C.M.A., Lelyveld, S.F.L. van, Soetekouw, R., Prijt, L.M.M. van der, Swaluw, J. van der, Bermon, N., Herpers, B.L., Veenendaal, D., Verhagen, D.W.M., Wijk, M. van, Bierman, W.F.W., Bakker, M., Kleinnijenhuis, J., Kloeze, E., Stienstra, Y., Wilting, K.R., Wouthuyzen-Bakker, M., Boonstra, A., Meulen, P.A. van der, Weerd, D.A. de, Niesters, H.G.M., Leer-Buter, C.C. van, Knoester, M., Hoepelman, A.I.M., Barth, R.E., Bruns, A.H.W., Ellerbroek, P.M., Mudrikova, T., Oosterheert, J.J., Schadd, E.M., Wassenberg, M.W.M., Zoelen, M.A.D. van, Aarsman, K., Elst-Laurijssen, D.H., Rozemeijer, Graduate School, AII - Infectious diseases, APH - Aging & Later Life, Infectious diseases, Global Health, APH - Digital Health, APH - Personalized Medicine, APH - Global Health, Microbes in Health and Disease (MHD), Neurochirurgie, RS: MHeNs - R3 - Neuroscience, Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA MMI Staf (9), RS: CAPHRI - R4 - Health Inequities and Societal Participation, Internal medicine, Pediatric surgery, Amsterdam Movement Sciences - Rehabilitation & Development, ACS - Diabetes & metabolism, AGEM - Digestive immunity, Medical Microbiology and Infection Prevention, Amsterdam Reproduction & Development (AR&D), Internal Medicine, Virology, and Medical Microbiology & Infectious Diseases

Subjects
Male, Heart disease, Human immunodeficiency virus (HIV), risk prediction algorithms, Blood Pressure, HIV Infections, Disease, 030312 virology, medicine.disease_cause, SUBCLINICAL ATHEROSCLEROSIS, Risk Factors, cardiovascular disease, FRAMINGHAM, Pharmacology (medical), Netherlands, 0303 health sciences, INFECTED PATIENTS, Framingham Risk Score, Middle Aged, Prediction algorithms, Cholesterol, Infectious Diseases, Anti-Retroviral Agents, Cardiovascular Diseases, HUMAN-IMMUNODEFICIENCY-VIRUS, Female, Risk assessment, Algorithms, Adult, Anti-HIV Agents, CARDIOLOGY/AMERICAN HEART ASSOCIATION, HEART-DISEASE, AMERICAN-COLLEGE, DATA-COLLECTION, Risk Assessment, EVENTS, 03 medical and health sciences, SDG 3 - Good Health and Well-being, INFLAMMATION, Environmental health, SCORE, medicine, Humans, Propensity Score, business.industry, HIV, medicine.disease, CD4 Lymphocyte Count, MYOCARDIAL-INFARCTION, Propensity score matching, Disease risk, business
Abstract

Background: People living with HIV (PLWH) experience a higher cardiovascular disease (CVD) risk. Yet, traditional algorithms are often used to estimate CVD risk. We evaluated the performance of 4 commonly used algorithms.Setting: The Netherlands.Methods: We used data from 16,070 PLWH aged > 18 years, who were in care between 2000 and 2016, had no pre-existing CVD, had initiated first combination antiretroviral therapy >1 year ago, and had available data on CD4 count, smoking status, cholesterol, and blood pressure. Predictive performance of 4 algorithms [Data Collection on Adverse Effects of Anti-HIV Drugs Study (D: A: D); Systematic COronary Risk Evaluation adjusted for national data (SCORE-NL); Framingham CVD Risk Score (FRS); and American College of Cardiology and American Heart Association Pooled Cohort Equations (PCE)] was evaluated using a Kaplan-Meier approach. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed using observed-versusexpected ratios, calibration plots, and Greenwood-Nam-D'Agostino goodness-of-fit tests.Results: All algorithms showed acceptable discrimination (Harrell's C-statistic 0.73-0.79). On a population level, D: A: D, SCORE-NL, and PCE slightly underestimated, whereas FRS slightly overestimated CVD risk (observed-versus-expected ratios 1.35, 1.38, 1.14, and 0.92, respectively). D: A: D, FRS, and PCE best fitted our data but still yielded a statistically significant lack of fit (Greenwood-Nam-D'Agostino chi(2) ranged from 24.57 to 34.22, P Conclusions: All algorithms perform reasonably well in PLWH, with SCORE-NL performing poorest. Prediction algorithms are useful for clinical practice, but clinicians should be aware of their limitations (ie, lack of fit and slight underestimation of CVD risk in low-risk groups).

Published
2019

2. Postexpositiebehandeling tegen HIV buiten het ziekenhuis in Amsterdam, januari-december 2000

Author

Sonder, G. J. B., Regez, R. M., Brinkman, K., Prins, J. M., Mulder, J. W., Coutinho, R. A., van den Hoek, J. A. R., Infectious diseases, and Other departments

Abstract

The Infectious Diseases Department of the Amsterdam Public Health Service regularly sees people who have possibly been exposed to human body fluids infected with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV), as a result of incidents in either a non-hospital-related occupation or during their leisure time. Until January 2000, people reporting possible exposure were referred to hospitals for HIV post-exposure prophylaxis (HIV-PEP), whereas for HBV and HCV, the tracing of the infection source and the follow-up took place at the Public Health Service clinic. Since the introduction of a new protocol in January 2000, the Public Health Service as well as a hospital can establish an indication for HIV-PEP and prescribe it. In 2000, 322 persons reported to the Public Health Service. The source was tested in 194 incidents and an HIV test was carried out on 104 occasions. In 19 cases HIV antibodies were found or the source was known to be HIV positive. A total of 50 people were prescribed HIV-PEP; 16 times after a needle-stick accident, 22 times after a sexual accident, 6 times after a bite-wound and 6 times after direct exposure to human blood. The sources of 30 PEP recipients could be tested and after this 16 recipients could stop with the treatment due to a negative HIV test. In 4 cases PEP treatment was stopped following a review of the indication. Therefore, 30 people had an indication to complete the PEP treatment. Of these, more than 80% reported side effects and 3 people had to withdraw from the treatment at an early stage because of this. The implementation of the protocol has resulted in less confusion because the follow-up now takes place at one location. Compared to other studies, the average time between exposure and treatment is shorter and compliance is good. In the period up to 15 May 2001, no seroconversions had been observed

Published
2002

3. De haalbaarheid en de zin. Post-expositie-profylaxe

Author

Van der Ende, M. E., Regez, R. M., Schreij, G., Van der Meer, J. T.M., Danner, S. A., and Internal medicine

Abstract

The mean risk of acquiring HIV from a needle stick or a mucous membrane accident with HIV-infected blood is 0.3% and 0.1%, respectively. Factors increasing the risk of HIV transmission from percutaneous exposure include a deep injury, visible blood on the needle, a procedure with a hollow needle lying within a vessel, and a high plasma viral load in the host. A retrospective case control study among health care workers, the efficacy of zidovudine in preventing vertical HIV transmission, and the efficacy of current antiretroviral combination regimens in suppressing viral replication, resulted in new guidelines for post-exposure prophylaxis in the health care setting. The application of the guidelines in day-to-day practice is feasible, and treatment is usually completed. Toxicity is frequent, but most often mild and reversible. Of serious concern is the observation of a small number of severe adverse events related to antiretroviral drugs, i.e. nephrolithiasis (due to indinavir) and toxic hepatitis (due to nevirapine). In the Netherlands so far no HIV infection has been reported after an occupational accident.

Published
2001

6. Change to abacavir-lamivudine-tenofovir combination treatment in patients with HIV-1 who had complete virological suppression.

Author

Hoogewerf M, Regez RM, Schouten WEM, Weigel HM, Frissen PJH, Brinkman K, Hoogewerf, M, Regez, R M, Schouten, W E M, Weigel, H M, Frissen, P H J, and Brinkman, K

Abstract

Patients who have not received previous antiretroviral treatment (ART) have a high failure rate on the combination treatment of abacavir, lamivudine, and tenovir. We assessed the virological failure rate in eight patients with HIV-1 who switched to this combination after having complete virological suppression from their previous long-term ART (median 8.0 months, range 7.5-18.0). Five of the eight patients showed virological failure. Four of these five patients had either the K65R mutation, the M184V/I mutation, or both. This combination of drugs cannot therefore be recommended as alternative treatment in patients with HIV-1 who are fully virologically suppressed. [ABSTRACT FROM AUTHOR]

Published
2003
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7. [No HIV test: a chance missed].

Author

van den Berk GE, Jarbandhan AA, Regez RM, van Bergen JE, and Brinkman K

Subjects
Aged, Diagnosis, Differential, Female, HIV Infections immunology, HIV Infections prevention & control, HIV Infections transmission, Humans, Male, Middle Aged, Risk Factors, CD4 Lymphocyte Count, Disease Transmission, Infectious prevention & control, HIV Infections diagnosis, Mass Screening methods
Abstract

A 65-year-old man with weight loss, a 65-year-old Surinam woman with dyspnoea, and a 55-year-old lesbian woman suffering from painful joints, weight loss and diarrhoea were eventually diagnosed as being infected with HIV. At the time of diagnosis, all three patients had CD4 counts below 100 cells x 10(6)/l and had presented with aids defining symptoms. In the Netherlands, an estimated 40% of people infected with HIV do not know about their HIV status. Earlier recognition would reduce morbidity and mortality and furthermore, reduce transmission of the virus. For this reason we advocate routine HIV testing for all persons belonging to a population with an HIV prevalence above 0.2% but also for all patients presenting with unresolved chronic complaints, irrespective of HIV risk factors.

Published
2007

8. [Safety regarding invasive procedures in HIV-positive patients].

Author

Regez RM, Speekenbrink RG, Landsaat PM, Vahl AC, Kleipool AE, and Frissen PH

Subjects
Aortic Valve Insufficiency complications, HIV Infections complications, Hip Injuries complications, Humans, Male, Middle Aged, Viral Load, Aortic Valve Insufficiency surgery, Arthroplasty, Replacement, Hip, General Surgery, HIV Infections transmission, Hip Injuries surgery, Infectious Disease Transmission, Patient-to-Professional prevention & control
Abstract

A 46-year-old man and a 58-year-old man, both known for several years with HIV infection, were admitted for operations due to aortic valve insufficiency (aortic valve replacement) and posttraumatic coxarthrosis (total hip replacement) respectively. In accordance with the protocol, preoperative viral infections (HIV, hepatitis B and C) were inventoried, the HIV viral load was lowered medicinally and the operation team informed. During each operation a consultant was present in the operating theatre to provide advice in the case of a needlestick or cut accident. No accidents occurred. Both patients were discharged to home in a good condition.

Published
2002

9. [Post-exposure treatment against HIV outside of the hospital in Amsterdam, January-December 2000].

Author

Sonder GJ, Regez RM, Brinkman K, Prins JM, Mulder JW, Coutinho RA, and van den Hoek JA

Subjects
Accidents, Chemoprevention, Humans, Leisure Activities, Netherlands, Occupational Exposure, Patient Compliance, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Infections prevention & control
Abstract

The Infectious Diseases Department of the Amsterdam Public Health Service regularly sees people who have possibly been exposed to human body fluids infected with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV), as a result of incidents in either a non-hospital-related occupation or during their leisure time. Until January 2000, people reporting possible exposure were referred to hospitals for HIV post-exposure prophylaxis (HIV-PEP), whereas for HBV and HCV, the tracing of the infection source and the follow-up took place at the Public Health Service clinic. Since the introduction of a new protocol in January 2000, the Public Health Service as well as a hospital can establish an indication for HIV-PEP and prescribe it. In 2000, 322 persons reported to the Public Health Service. The source was tested in 194 incidents and an HIV test was carried out on 104 occasions. In 19 cases HIV antibodies were found or the source was known to be HIV positive. A total of 50 people were prescribed HIV-PEP; 16 times after a needle-stick accident, 22 times after a sexual accident, 6 times after a bite-wound and 6 times after direct exposure to human blood. The sources of 30 PEP recipients could be tested and after this 16 recipients could stop with the treatment due to a negative HIV test. In 4 cases PEP treatment was stopped following a review of the indication. Therefore, 30 people had an indication to complete the PEP treatment. Of these, more than 80% reported side effects and 3 people had to withdraw from the treatment at an early stage because of this. The implementation of the protocol has resulted in less confusion because the follow-up now takes place at one location. Compared to other studies, the average time between exposure and treatment is shorter and compliance is good. In the period up to 15 May 2001, no seroconversions had been observed.

Published
2002

10. [Reducing the risk of blood-transmitted infections of HIV, hepatitis B or C virus in a teaching hospital in Amsterdam--evaluation of a protocol for needlestick accidents among hospital staff during the period 1997-2001].

Author

Regez RM, Rietra PJ, van der Linden CT, Frissen PH, Weigel HM, and Brinkman K

Subjects
Adult, Cross Infection prevention & control, Female, Follow-Up Studies, Humans, Male, Netherlands, Occupational Exposure, Prospective Studies, Seroepidemiologic Studies, HIV Infections transmission, Hepatitis B transmission, Hepatitis C transmission, Infectious Disease Transmission, Patient-to-Professional prevention & control, Needlestick Injuries, Personnel, Hospital
Abstract

Objective: To evaluate a protocol for hospital staff aimed at reducing their risk of exposure to blood-transmitted infections., Design: Prospective., Method: In August 1997 a protocol was introduced to the Onze Lieve Vrouwe Gasthuis Hospital in Amsterdam, with procedures to be followed after percutaneous or mucocutaneous blood contact in which there was a chance of transmission of hepatitis B (HBV) or C (HCV), as well as guidelines for the prescription of post-exposure prophylaxis (PEP) after accidents with an HIV risk. In the period 1 August 1997-30 June 2001 data were collected from registration forms that reported accidents and the ensuing events., Results: A total of 403 accidents were reported by 138 (34.2%) physicians, 135 (33.5%) ward nurses, 46 (11.4%) operation assistants, 30 (7.4%) co-assistants, 21 (5.2%) analysts and 33 (8.2%) persons with another position. There was a constant increase in the number of reports over the period. The seroprevalence of the source patients was: 6.9% (25/360) HIV, 8.1% (6/74) HBV and 6.3% (23/363) HCV. PEP was prescribed on 46 occasions: 15 times for an HIV positive source and 31 times for what was initially an unknown HIV source. Following the introduction of a rapid HIV test in September 1999, there was a reduction in the number of unnecessary PEP prescriptions from 4 in 1997, 7 in 1998 and 16 in 1999 to 3 in 2000 and 1 in 2001. All 15 persons who were correctly started on a PEP treatment took the medication for a period of 28 days despite many side effects. No seroconversions were established during the follow-up period of 6 months.

Published
2002

11. Prospective longitudinal analysis of viral load and surrogate markers in relation to clinical progression in HIV type 1-infected persons.

Author

Bruisten SM, Frissen PH, Van Swieten P, Harrigan PR, Kinghorn I, Larder B, Weigel HM, De Vries E, Regez RM, Henrichs JH, Koot M, and Huisman JG

Subjects
Adult, CD4 Lymphocyte Count, Disease Progression, Follow-Up Studies, HIV Infections blood, HIV Infections immunology, Humans, Longitudinal Studies, Matched-Pair Analysis, Middle Aged, Predictive Value of Tests, Prospective Studies, RNA, Viral, Time Factors, CD4-Positive T-Lymphocytes cytology, HIV Core Protein p24 blood, HIV Infections virology, HIV-1 genetics, HIV-1 immunology, beta 2-Microglobulin analysis
Abstract

The temporal relationship between viral and surrogate markers and clinical status was analyzed prospectively every 8 weeks in 34 asymptomatic HIV-1-infected persons. After 3 years, 25 persons remained clinically healthy whereas 9 persons showed clinical progression. In accordance with other reports we found that at study entry HIV-RNA load was predictive of clinical progression. All markers tested evolved significantly in time in both progressors and nonprogressors. The HIV RNA load in plasma and HIV DNA load in T cells were linearly related only in nonprogressors. In addition, the RNA/DNA ratio during follow-up was significantly higher in progressors, indicating a higher replication rate in progressors. The HIV DNA load correlated inversely with CD4+ T cell counts and positively with p24 antigenemia in both nonprogressors and progressors. A significant correlation of HIV DNA load with SI phenotype occurred in progressors only. HIV RNA levels correlated with beta 2-microglobulin level and with p24 antigenemia but not with SI phenotype. These three markers can all routinely be measured in plasma; however, only the HIV RNA levels appear to be informative for clinical progression. Six to 8 months before clinical progression, an SI phenotype switch, increased HIV RNA in plasma, and decreased CD4+ T cell counts were all indicative of an impending clinical event.

Published
1997
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12. Cotrimoxazole is effective as primary prophylaxis for toxoplasmic encephalitis in HIV-infected patients: a case control study.

Author

Weigel HM, de Vries E, Regez RM, Henrichs JH, Ten Velden JJ, Frissen PH, and van der Meer JT

Subjects
Adult, Case-Control Studies, Female, HIV Infections parasitology, Humans, Male, Middle Aged, Retrospective Studies, AIDS-Related Opportunistic Infections prevention & control, Anti-Infective Agents therapeutic use, HIV Infections therapy, Toxoplasmosis, Cerebral prevention & control, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use
Abstract

In a case-control study, prophylaxis with cotrimoxazole for toxoplasmic encephalitis (TE) in HIV-infected patients was evaluated. Cotrimoxazole had been given as PCP prophylaxis. 20 patients with TE were identified and 72 matching control cases were found. All patients had IgG-antibodies to Toxoplasma gondii and CD4+ T-cell counts < or = 100/microliter. The use and duration of cotrimoxazole prophylaxis were recorded. It was found that among the patients with TE, none had used cotrimoxazole for > 70% of the observation time, and that the 1-y incidence was 0% in the control group vs. 41% in those patients without sufficient cotrimoxazole use. The conclusion is that cotrimoxazole is effective as primary prophylaxis for TE, even in a dose of 480 mg daily.

Published
1997
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