HIV-1 genetic diversity and drug resistance mutations in the northern Brazilian region

ABSTRACT Brazil is a huge continental country with striking geographic differences which are well illustrated in the HIV/AIDS epidemic. Contrasting with the significant decline in the national AIDS detection rate in the last decade, a linear growth has been reported in the Northern region. Despite its public health and epidemiologic importance, there is scarce HIV-1 molecular data from Northern Brazil. This scoping review summarizes recent epidemiologic data with special emphasis on HIV-1 genetic diversity and antiretroviral drug resistance mutations in patients from the seven Northern states of Brazil. Studies from the Northern Brazil on different HIV-1 genomic regions, mostly pol (protease/reverse transcriptase) sequences of naïve/antiretroviral treated adults/children were retrieved from PubMed/MEDLINE electronic database. These studies indicate a consistent molecular profile largely dominated by HIV-1 subtype B with minor contribution of subtypes F1 and C and infrequent detection of other subtypes (A1, D, K), recombinants (BF1, BC), circulating recombinant forms (CRF) as the new CRF90_BF1 and CRF02_AG-like, CRF28-29_BF-like, CRF31_BC-like, and a potential new CRF_BF1. This pattern indicates a founder effect of subtype B and the introduction of non-B-subtypes and recombinants probably generated in the Southern/Southeastern regions. In naïve populations transmitted drug resistance (TDR) can impact the outcome of first-line antiretroviral treatment and prophylactic/preventive regimens. In the Northern region TDR rates are moderate while patients failing highly active antiretroviral therapy (HAART) showed high prevalence of acquired drug resistance mutations. The limited HIV-1 molecular data from Northern Brazil reflects the great challenges to generate comprehensive scientific data in isolated, underprivileged areas. It also highlights the need to invest in local capacity building which supported by adequate infrastructure and funding can promote robust research activities to help reduce the scientific asymmetries in the Northern region. Currently the impacts of the overwhelming COVID-19 pandemic on the expanding HIV/AIDS epidemic in Northern Brazil deserves to be closely monitored.

Idiopathic intracranial hypertension associated with anaemia, secondary to antiretroviral drug in a human immunodeficiency virus positive patient

Papilledema in a patient with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is an alarming finding. Any condition giving rise to raised intracranial tension (ICT) can cause papilledema, and in these patients, it could be secondary to opportunistic infections like meningitis to neoplasm. We report a case of a 28-year old female with HIV on antiretroviral therapy, who presented to us, with papilledema. Her fundus examination revealed superficial hemorrhages and Roth's spots along with papilledema. Patient was diagnosed with idiopathic intracranial hypertension (IIH), and all other possible systemic associations were ruled out. Her blood tests showed severe anemia. The papilledema and retinal changes resolved with treatment of anemia. This is a rare presentation of IIH in HIV positive patient due to anemia, secondary to zidovudine adverse effect.

Comparison of Antiretroviral Regimens: Adverse Effects and Tolerability Failure that Cause Regimen Switching / 감염과화학요법

BACKGROUND: The efficacy of antiretroviral therapy (ART) has improved, and the adverse effects of antiretroviral drugs have been reduced. However, these adverse effects still significantly influence patient compliance, increasing the risk of tolerability failure. Therefore, we investigated the adverse effects and tolerability failure causing changes in the first ART regimen, and identified the regimens that were most vulnerable to switching. MATERIALS AND METHODS: We enrolled patients with human immunodeficiency virus (HIV) who commenced their first ART between January 1, 2011 and July 30, 2014. Patients who started their first ART regimen at the Kyungpook National University Hospital were included in the study if they were aged > or =18 years and were followed-up for > or =12 weeks. The primary dependent variable was the duration of treatment on the same ART regimen. We analyzed the maintenance rate of the first ART regimen based on the treatment duration between these groups using survival analysis and log rank test. The frequency of the adverse effects of ART regimens was analyzed by multiple response data analysis. RESULTS: During the investigation period, 137 patients were enrolled. Eighty-one patients were maintained on the initial treatment regimen (59.1%). In protease inhibitor (PI)-based regimen group, 54 patients were maintained on the initial treatment regimen (54/98, 55.1%). In non-nucleoside reverse transcriptase inhibitor (NNRTI)-and integrase inhibitor (II)-based regimen group, 15 (15/26, 57.7%) and 12 (12/13, 92.3%) patients were maintained on the initial treatment regimen, respectively. Adverse effects that induced ART switching included rash (16/35, 45.7%), gastrointestinal discomfort or pain (7/35, 20%), diarrhea (7/35, 20%), hyperbilirubinemia (6/35, 17.1%), headache or dizziness (3/35, 8.5%). Among the treatment regimens, the group receiving an II-based regimen showed the least switching. The group receiving PI-and NRTI-based regimens were most likely to switch due to adverse effects during the early treatment period. However, after about 18 months, switching was rarely observed in these groups. Among the PI drugs, darunavir/ritonavir showed fewer drug changes than atazanavir/ritonavir (P = 0.004, log rank test) and lopinavir/ritonavir (P = 0.010). Among the NNRTI drugs, rilpivirne produced less switching than efavirenz (P = 0.045). CONCLUSION: Adverse effects to ART resulted in about a quarter of patients switching drugs during the early treatment period. II-based regimens were advantageous because they were less likely to induce switching within 18 months of treatment commencement. These findings indicated the importance of considering and monitoring the adverse effects of ART in order to improve adherence.

Adverse Drug Reaction Reports in an Antiretroviral Treatment Centre in Jos, North Central Nigeria.

Background: Reports of adverse drug reactions (ADR) in the era of increasing uptake of antiretroviral drugs particularly in Sub Saharan Africa and especially in Nigeria have been on the rise. Aim: We set out to collate and characterize the pattern of adverse drug reactions in patients on antiretroviral drugs in our treatment centre. Study Design: Retrospective Cross sectional study Place and Duration of Study: The study was carried out at the APIN Centre, Jos University Teaching Hospital, Plateau State, North Central Nigeria from July 2010 to December 2012. Methodology: We reviewed the case files and data base entries of 215 patients attending our treatment centre. These are patients who had reported cases of adverse drug reactions. We took note of demographic profiles of the patients, the medical history as well as the different types of antiretroviral drugs the patients were taking. The types of adverse drug reactions and offending drugs were noted and categorized using descriptive statistics. Results: Out of 215 case files and databases of patients in which there were reports of adverse drug reactions, 80 (37.2%) were male and 135 (62.8%) were female. Almost thirty two percent (31.6%) of the patients were on Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP), 14.9%on Zidovudine/Lamivudine/Tenofovir/Lopinavir/ritonavir (AZT/3TC/TDF/LPV/r), 13.5% on Stavudine/Lamivudine/Nevirapine (D4T/3TC/NVP). Anemia was the most common ADR representing 23.4% of all ADRs and 29.3% of all ADRs were associated with Zidovudine. Conclusion: Our study shows that in antiretroviral treatment centre such as our own, healthcare providers/practitioners should take particular note of troubling adverse drug reactions such as anaemia. Healthcare providers/practitioners should particularly have in place alternative treatment regimens as these adverse drug reactions may be potential cause of medication non adherence which in the long run lead to treatment failure.

Lesiones bucales en pacientes con VIH/SIDA asociadas a tratamiento antirretroviral y carga viral / Oral lesions associated with antiretroviral treatment and viral load in HIV/AIDS patients

Objetivo: determinar la asociación entre las manifestaciones bucales de pacientes VIH/SIDA con la terapia antirretroviral y carga viral. Métodos: estudio de corte transversal, en una población de 166 pacientes en Cartagena, Colombia, para la recolección de la información se tuvo en cuenta los conceptos del Centro de intercambio de criterios sobre problemas bucales relacionados con la infección por el VIH y los parámetros para el diagnóstico clínico de las manifestaciones bucales asociadas a VIH establecidos por el Centro Colaborador de la Organización Mundial de la Salud (OMS) para la realización del examen estomatológico, los niveles de carga viral y terapia antirretroviral se obtuvieron de la historia clínica médica. Resultados: el 66,7 % de afectados fueron hombres, mientras que el 33,3 % fueron mujeres. La edad promedio fue de 36,1 años, la prevalencia de manifestaciones bucales asociadas al VIH fue del 59,5 %, la candidiasis fue la más frecuente 35,5 %, los pacientes tratados con monoterapia presentaron menos manifestaciones bucales, OR: 0,20; IC: 0,00-0,96 (P<0,02). Conclusión: los pacientes tratados con monoterapia farmacológica antirretroviral presentaron menos lesiones bucales que aquellos tratados con biterapia.

Objective: determine the association between oral manifestations and antiretroviral therapy and viral load in HIV/AIDS patients. Methods: a cross-sectional study was conducted of a population of 166 patients in Cartagena, Colombia. Data collection followed the recommendations of the Center for the exchange of criteria on oral conditions related to HIV infection, and the parameters for the clinical diagnosis of oral manifestations associated with HIV infection established by the WHO (World Health Organization) Collaborating Center for oral checkups. Viral load and antiretroviral therapy data were obtained from medical records. Results: 66.7% of the patients affected were men and 33.3% were women. Mean age was 36.1 years. Prevalence of oral manifestations associated with HIV was 59.5%, and candidiasis was the most common with 35.5%. Patients under monotherapy presented fewer oral manifestations (OR: 0.20; CI: 0.00-0.96 (P<0.02)). Conclusion: Patients under antiretroviral drug monotherapy presented fewer oral lesions than those under bitherapy.

HIV drug resistance in treatment-naive HIV patients / 대한내과학회지

Antiretroviral therapy for treatment of human immunodeficiency virus type 1 (HIV-1) infection has improved steadily since the introduction of combination therapy in 1996. With the advancement of antiretroviral therapy, the mortality of AIDS patients has markedly improved. However, drug resistance has been emerging as a major problem in HIV treatment. Several studies reported that the prevalence of transmitted resistant virus involving antiretroviral-naive people in developed countries was around 10%. Primary drug resistance is rare in HIV-1 infected patients in Korea. A cohort study is need to monitor resistant HIV-1 among newly infected individuals.

Anesthetic Management of Cesarean Section in Human Immunodeficiency Virus (HIV)Positive Pregnant Woman : A case report

Anesthesiologists are encountering an increasing number of human immunodeficiency virus (HIV) infections in pregnant women. In HIV infected patients, the history should include an evaluation of opportunistic infections, malignancies and treatments with antiretroviral drugs. The anesthesiologist should be aware of the possible toxic side effects or interactions between the antiretroviral drugs and anesthetics. In addition, a HIV infection passing from patient to physician can occur. Therefore, safety measures must be taken when handling body fluid or blood. We report the anesthetic management of an elective cesarean section in a HIV positive pregnant woman who was treated with antiretroviral drugs to decrease the possibility of vertical transmission.