Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)最新文献

{"title":"Vanishing lung syndrome and HIV infection: an uncommon yet potentially fatal sequela of cigarette smoking.","authors":"Deepthi Mani,&nbsp;Donald G Guinee,&nbsp;David M Aboulafia","doi":"10.1177/1545109712444755","DOIUrl":"https://doi.org/10.1177/1545109712444755","url":null,"abstract":"<p><p>Persons with HIV infection have a higher risk of infectious pulmonary complications, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and pulmonary fibrosis than individuals not infected with HIV. Herein, we describe the clinical course of a patient with longstanding and well-controlled HIV infection and multiple previous pneumothoraces who presented to medical attention with insidious onset of shortness of breath and was diagnosed with vanishing lung syndrome (VLS). The VLS or giant bullous emphysema is a distinct clinical syndrome characterized by large bullae, predominantly in the upper lobes, occupying at least one third of the hemithorax and compressing surrounding normal lung parenchyma. It is a progressive disorder that typically occurs in young men, the majority of whom are smokers. As people with HIV/AIDS are now surviving well into middle age and beyond, clinicians are more likely to encounter VLS and severe obstructive lung disease, which are potentially fatal but preventable conditions.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 4","pages":"230-3"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712444755","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30599084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyneuropathy associated with the diffuse infiltrative lymphocytosis syndrome.","authors":"Jessica R Golbus,&nbsp;Gary Gallagher,&nbsp;Gerald Blackburn,&nbsp;Sandro Cinti","doi":"10.1177/1545109712442798","DOIUrl":"https://doi.org/10.1177/1545109712442798","url":null,"abstract":"<p><p>Diffuse infiltrative lymphocytosis syndrome (DILS) arises in HIV-positive patients secondary to infiltration of lymphocytes into the peripheral tissues and produces the disease's characteristic symptoms-parotid gland enlargement and a sicca syndrome. Many patients, however, first seek medical attention for treatment of the extraglandular manifestations of DILS, most commonly interstitial pneumonitis. In this case report, we describe an atypical presentation of DILS characterized by polyradiculoneuropathy in the absence of parotid gland enlargement or interstitial pneumonitis. Minor salivary gland biopsy of the patient's lip confirmed a chronic inflammatory state with lymphoid aggregates within the minor salivary glands. He was started on prednisone with immediate improvement in his symptoms. This report illustrates for clinicians the diverse extraglandular manifestations of DILS and underscores the importance of considering it in the differential diagnosis of HIV-positive patients with a preserved CD4 count who present with peripheral neuropathy.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":" ","pages":"223-6"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712442798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40191402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse transcriptase genotypes in pediatric patients failing initial antiretroviral therapy in Gaborone, Botswana.","authors":"Michael Tolle,&nbsp;Leigh Howard,&nbsp;Brianna Kirk,&nbsp;Andres Gomila,&nbsp;Heidi Schwarzwald,&nbsp;Gabriel Anabwani","doi":"10.1177/1545109711422273","DOIUrl":"https://doi.org/10.1177/1545109711422273","url":null,"abstract":"<p><strong>Background: </strong>Limited data are available on patterns of resistance mutations in pediatric patients in southern Africa, where HIV-1 subtype C (HIV-1C) predominates.</p><p><strong>Methods: </strong>Retrospective chart review of pediatric patients. Nucleoside reverse transcriptase inhibitor (NRTI)- and nonnucleoside reverse transcriptase inhibitor (NNRTI)-associated resistance mutations quantified from population-based sequencing genotypic resistance assay results taken at time of first-line antiretroviral therapy (ART) failure (first-line ART = stavudine [d4T] or zidovudine [ZDV] + lamivudine [3TC] + nevirapine [NVP] or efavirenz [EFV]).</p><p><strong>Results: </strong>Total number of patients with resistance assays analyzed is 45. Nucleoside reverse transcriptase inhibitor-associated mutation frequencies noted were M184V (n = 41; 91.1%); thymidine analogue mutations (TAMs; n = 20; 44.4%); >1 TAM (n = 9; 20%); TAM-2 pathway (n = 10; 22.2%); TAM-1 pathway (n = 7; 15.6%); TAM-1 and TAM-2 pathways (n = 3; 6.7%); K65R (n = 2; 4.4%); Q151M (n = 1; 2.2%); and L74V (n = 0; 0%). Nonnucleoside reverse transcriptase inhibitor-associated mutation frequencies noted were associated with notable resistance to either/both NVP and EFV (n = 40; 88.9%); K103N (n = 15; 33.3%); ≥1 mutations associated with etravirine (ETR) failure (K101E, Y181C, and G190A; n =20; 44.4%); and ≥2 notable NNRTI mutations (n = 12; 26.7%).</p><p><strong>Conclusions: </strong>In this cohort, low-genetic barrier mutations were common, as were TAMs, including more than 1 TAM. Mutations compromising nonthymidine analogue backbones were rare, suggesting that it is likely that children who fail first-line NRTI backbones containing d4T or ZDV/3TC would still respond to abacavir (ABC), didanosine (ddI), and, for adolescents, tenofovir (TDF). Our data support the empiric continuation of 3TC in second-line regimens.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 4","pages":"260-8"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109711422273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30186908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diarrhea associated with lopinavir/ritonavir-based therapy: results of a meta-analysis of 1469 HIV-1-infected participants.","authors":"Colleen M Wegzyn,&nbsp;Linda M Fredrick,&nbsp;Roxann O Stubbs,&nbsp;William C Woodward,&nbsp;Michael Norton","doi":"10.1177/1545109712442984","DOIUrl":"https://doi.org/10.1177/1545109712442984","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy is associated with adverse events (AEs). The most frequently reported AE associated with lopinavir/ritonavir (LPV/r) containing regimens is diarrhea. The objective of this meta-analysis is to describe the incidence, prevalence, and duration of diarrhea in individuals taking LPV/r.</p><p><strong>Methods: </strong>This is a meta-analysis of Abbott-conducted clinical trials. Inclusion criteria included prospective randomized clinical trials with the LPV/r tablet formulation and had AE data (moderate/severe diarrhea) available through 48 weeks of treatment.</p><p><strong>Results: </strong>Three trials (total 1469 participants) met the inclusion criteria. In all, 11.2% of participants reported moderate/severe diarrhea by week 8, with median time to resolution of 7.4 weeks. The overall 48-week incidence of moderate/severe diarrhea was 15.5%. The discontinuation rate due to moderate/severe diarrhea was 1.3%.</p><p><strong>Conclusions: </strong>Moderate/severe diarrhea occurred in less than 1 in 6 participants taking LPV/r, typically started in the first 8 weeks of treatment and infrequently resulted in premature discontinuation.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":" ","pages":"252-9"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712442984","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40192513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of dual-energy x-ray absorptiometry (DXA) scans in HIV-infected patients.","authors":"S A Dickinson,&nbsp;L E Fantry","doi":"10.1177/1545109712438751","DOIUrl":"https://doi.org/10.1177/1545109712438751","url":null,"abstract":"<p><p>Multiple studies have demonstrated increased rates of osteopenia and osteoporosis in HIV-infected patients but there have been no published studies on current screening practices. We conducted a retrospective chart review of 2924 patients attending an urban HIV clinic. Thirty patients (1%) had dual-energy x-ray absorptiometry (DXA) scans. Patients undergoing DXA scans were more likely to be older, women, and have nondetectable HIV viral load and CD4 count ≥200. The most frequently cited indications for screening were perimenopausal or postmenopausal status and HIV infection. Of the patients screened, 96% had osteopenia or osteoporosis with a median T-score of -1.9 and a median of 3.8 osteoporosis risk factors in addition to HIV.  Of the 20 practitioners in the clinic, only 7 had patients with screening DXA scans. DXA scans are underutilized in the HIV population given the high rate of osteopenia and osteoporosis detected in this study.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 4","pages":"239-44"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712438751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30581399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential antiretroviral adherence: things to consider.","authors":"Ehsan Chitsaz","doi":"10.1177/1545109712444465","DOIUrl":"https://doi.org/10.1177/1545109712444465","url":null,"abstract":"Dr Shuter et al reported the results of a study examining the stability of the adherence to antiretroviral therapy (ART) measured by Medication Event Monitoring System (MEMS) in 2 separate time points. It is very interesting to discern the extent that short-term adherence measured by MEMS technology predicts the adherence to antiretroviral (ARV) medications over the long run. Adherence to ART is the mainstay of HIV treatment since excellent adherence is associated with favorable viral suppression. Clinical trials and longitudinal studies usually provide the capacity to assess the adherence to ART over a short period of time (typically 24-week measurements); however, it is the long-run adherence that identifies the adequacy of treatment to achieve the desirable viral suppression and HIV clinical outcomes. For this purpose, the authors compared the adherence measured by MEMS cap monitoring among a cohort of HIV-infected patients that participated in a study in 2004 to 2005 (study I) and the same cohort recruited again between 2008 and 2009 (study II) to repeat measuring ART adherence after 4 years. The authors showed that the mean adherence rates in the first and second periods were not significantly different and are, in fact, strongly correlated. They conclude that the ART adherence rates measured by MEMS caps are closely correlated at 2 time points several years apart. The findings of this study are remarkable; however, there are a few issues that need to be considered before drawing any inference. First, seemingly patients with more favorable adherence to ARV medications and/or less-advanced HIV disease are more likely to be included in the study cohort. In study I, 84 patients were primarily enrolled and 64 completed the study. The characteristics of participant and nonparticipants were assessed. Participants had a higher CD4 count compared with those who did not participate. In study II (2008-2009), of 64 participants who completed study I, authors included in the final analysis only 48 participants who managed to complete study II, whereas 16 (25%) were excluded (4 had died, 8 had been lost to follow-up [hence not recruited for study II], and 4 did not complete study II). The mean adherence rate in study I of the 16 participants who did not complete study II was not significantly different from the 48 participants who were included in the analysis. Nevertheless, it is not unlikely to contemplate that these individuals’ adherence and behaviors have changed over time from their initial adherence profile in study I. This potential change in adherence in turn can explicate, at least in part, their outcomes being mortality, loss to follow-up, or dropout. In addition, the proportion of patients meeting the criteria to be diagnosed with AIDS was 80% in the first period, while this proportion decreased to 75% in the second cohort. This is despite the fact that provided the ‘‘time elapsed since HIV diagnosis’’ was relatively high in the beginning of ","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 4","pages":"217-8; author reply 219"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712444465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30832030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increase in lymphogranuloma venereum cases in South Florida.","authors":"José Guillermo Castro,&nbsp;Olga Ponomareva,&nbsp;María Alcaide,&nbsp;Isabella Rosa-Cunha,&nbsp;Paula Dilanchian,&nbsp;Dean Willis","doi":"10.1177/1545109712447198","DOIUrl":"https://doi.org/10.1177/1545109712447198","url":null,"abstract":"<p><p>The purpose of the study was to evaluate the clinic prevalence and clinical characteristics of patients with LGV since 2007 when active clinic surveillance started. We review all the reports of rectal Chlamydia trachomatis and LGV testing of those samples. Chlamydia trachomatis LGV DNA was detected by Nucleic Acid Amplification/ompA gene sequencing. Medical records of all patients with LGV were reviewed. Prevalence of rectal CT among tested individuals was relatively stable during the study period: 2007 (15%), 2008 (15%), 2009 (12%) and 2010 (14%). Eight cases of LGV were identified during the study period, one in 2009 and seven in 2010. All individuals were male and all except one had sex with only men. Most of them were also infected with HIV (62.5%). We concluded that this is the first report of LGV cases in South Florida and shows a rapid increase in the number of cases in the last year.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":" ","pages":"220-2"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712447198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39972762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A giant pancreatic pseudocyst in a patient with HIV infection.","authors":"Giuseppe Vittorio De Socio,&nbsp;Margherita Vispi,&nbsp;Matthias Joachim Fischer,&nbsp;Franco Baldelli","doi":"10.1177/1545109712444164","DOIUrl":"https://doi.org/10.1177/1545109712444164","url":null,"abstract":"<p><p>This article describes the first case of a giant pancreatic pseudocyst in a 48-year-old man with HIV infection under combination antiretroviral therapy. The patient presented with an abdominal mass involving the epigastrium, left hypochondrium, and left flank. An enhanced abdominal computed tomography (CT) scan showed a well-defined cyst of 21 cm in diameter, with a liquid content that dislocated adjacent viscera. Microbiological and cytological tests on fluid were negative, confirming diagnosis of pancreatic pseudocyst. The CT-guided percutaneous drainage was carried out and the patient's clinical condition gradually improved.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 4","pages":"227-9"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712444164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30589645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance-associated mutations in HIV-1 among patients failing first-line antiretroviral therapy.","authors":"Sanjeev Saini,&nbsp;Preena Bhalla,&nbsp;Hitender Gautam,&nbsp;Usha Krishan Baveja,&nbsp;S Tazeen Pasha,&nbsp;Richa Dewan","doi":"10.1177/1545109711421217","DOIUrl":"https://doi.org/10.1177/1545109711421217","url":null,"abstract":"<p><p>Thirty-five HIV-1 infected patients showing clinical and/or immunological failure to first line antiretroviral therapy (ART) according to WHO criteria were recruited from the ART center of Lok Nayak Hospital, New Delhi to detect the presence of resistance-mutations in reverse transcriptase (RT) and protease (PR) region of pol gene of HIV-1. Plasma viral load (PVL) was estimated. HIV-1 pol gene region encoding complete protease and reverse transcriptase (codons; 1-232 to 1-242) was reverse transcribed, followed by nested PCR. The PCR product was sequenced and analyzed. Plasma samples from 94.3% of patients with PVL >log(10) 3.0 c/mL could be amplified and analyzed. Virologic failure was detected in 65.7% of patients according to WHO criteria (PVL >log(10) 4.0). All patients were found to be infected with subtype C. One or more resistance-mutations were observed among 90.9% of study sequences. Nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations were seen among all patients, with M184V and thymidine analogue mutations (TAM) being most frequently detected (75.6% and 72.7%, respectively). Nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance-mutations were detected in 63.6% of sequences, of which Y181C/I (47.6%), K103N (33.3%) and G190S (28.6%) are the most common. None of the sequences showed major protease inhibitors (PIs) resistance mutation. High prevalence of NRTI and NNRTI drug resistance mutations among the study participants warrants the use of genotypic resistance testing to prevent accumulation of resistance mutations, which would limit future treatment options.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 3","pages":"203-9"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109711421217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30200334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The immune reconstitution inflammatory syndrome with tuberculosis: a common problem in Ethiopian HIV-infected patients beginning antiretroviral therapy.","authors":"Kedir Ali,&nbsp;Stephen A Klotz","doi":"10.1177/1545109711402212","DOIUrl":"https://doi.org/10.1177/1545109711402212","url":null,"abstract":"<p><p>The Immune Reconstitution Inflammatory Syndrome (IRIS) in Ethiopian HIV-infected patients coinfected with tuberculosis (TB) was studied. HIV-infected outpatients initiating antiretroviral therapy (ART) at an HIV clinic in northern Ethiopia from January 2007 through September 2008 were identified (n = 1977). Patients with TB-IRIS occurring within 6 months of starting ART (n = 143) were compared with a control group of patients with HIV who began ART but did not develop TB-IRIS (n = 277). ART was not interrupted in any patient. Eleven (8%) patients with TB-IRIS died. New or \"unmasked\" TB with accompanying IRIS occurred in 132 or 92% of the cases. Worsening or \"paradoxical\" TB (ie, already known to be present and treated) was accompanied by IRIS in 11 (8%) patients. There was no significant difference between \"unmasked\" and \"paradoxical\" cases with respect to presentation of disease and outcome. Only a low baseline CD4 count (mean: 102 cells/μL) and a past history of World Health Organization (WHO) Clinical Stage 3 or 4 were associated with TB-IRIS (P < .05). The clinical manifestations of TB-IRIS were diverse, requiring a high index of suspicion. For example, pleural disease occurred in 13 patients, TB lymphadenitis in 17, intracranial TB in 9 patients, and disseminated TB in 15 patients. The majority of patients (88%) responded to continuation of ART and TB therapy. Thus, TB-IRIS is common in Ethiopian patients beginning ART, occurring in 7% of patients initiating antiretroviral therapy.</p>","PeriodicalId":86092,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)","volume":"11 3","pages":"198-202"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109711402212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29841441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}