Lack of association between plasma levels of non-nucleoside reverse transcriptase inhibitors & virological outcomes during rifampicin co-administration in HIV-infected TB patients.

Background & objectives: Among patients with HIV-associated tuberculosis (TB), reduced plasma non-nucleoside reverse transcriptase inhibitors (NNRTI) concentrations during rifampicin (RMP) co-administration could lead to HIV treatment failure. This study was undertaken to examine the association between plasma nevirapine (NVP) and efavirenz (EFV) concentrations and virological outcomes in patients infected with HIV-1 and TB. Methods: This was a nested study undertaken in a clinical trial of patients with HIV-1 and TB, randomized to two different once-daily antiretroviral treatment (ART) regimens along with anti-TB treatment (ATT). Trough concentrations of plasma NVP and EFV were estimated at months 1 (during ATT and ART) and 6 months (ART only) by HPLC. Plasma HIV-1 RNA level >400 copies/ml or death within 6 months of ART were considered as unfavourable outcomes. Genotyping of CYP2B6 516G>T polymorphism was performed. Results: Twenty nine per cent of patients in NVP arm had an unfavourable outcome at 6 months compared to 9 per cent in EFV arm (P<0.08). The mean NVP and EFV levels estimated at 1 and 6 months did not significantly differ between favourable and unfavourable responders. Logistic regression analysis showed CYP2B6 516G>T polymorphism significantly associated with virologic outcome in patients receiving EFV–based regimen. Interpretation & conclusions: Trough plasma concentrations of NVP and EFV did not show any association with response to ART in patients on ATT and once-daily ART. CYP2B6 516G>T polymorphism was associated with virologic outcome among patients on EFV.

The potential of circulating endothelial progenitor cells to form colonies is inversely proportional to total vascular risk score in patients with coronary artery disease.

OBJECTIVE: The present study correlated the functional ability of culture-enriched EPCs to form colonies (EPC-CFUs), with risk factors and severity of CAD. METHODS: Blood mononuclear cells from healthy controls (n = 16) and patients with CAD (n =35) were cultured for seven days for the formation of EPC-CFUs. After the characterization of EPCs, the number of EPC-clusters were compared in the study groups and correlated with the presence or absence of individual CAD risk factors, total vascular risk score (TVRS) and the severity of CAD in patients with CAD by Student's 't' test and regression analysis. RESULTS: As compared to the patients, the controls showed significantly greater formation of EPC-CFUs. Patients with hypertension and smoking had significant reduction in the number of EPC-CFUs as compared to patients without these risk factors (p < 0.05). A negative correlation between TVRS and number of EPC-CFUs (r = -0.74, p < 0.05) and also between number of stenosing coronary arteries and EPC-CFUs (r = -0.42, p = 0.05) were observed. On multivariate analysis, however, only TVRS appeared to be a significant predictor of reduced formation of EPC-CFUs. CONCLUSION: The present study suggests that more is the number of CAD risk factors, lesser is the formation of EPC-clusters in culture.