Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV / 中华医学杂志(英文版)

BACKGROUND@#Central nervous system (CNS) symptoms after efavirenz (EFV) treatment in people living with human immunodeficiency virus (HIV) could persist and impact their quality of life. We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF), which is considered an alternative option for subjects who do not tolerate EFV. Most specifically, we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants' neuropsychiatric toxicity symptoms in a real-life setting.@*METHODS@#A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity ≥ grade 2. The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks. The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire, as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12, 24, and 48. Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch.@*RESULTS@#One hundred ninety-six participants (96.9% men, median age: 37.5 years, median: 3.7 years on prior EFV-containing regimens) were included in the study. Significant improvements in anxiety and sleep disturbance symptoms were observed at 12, 24, and 48 weeks after switching to E/C/F/TAF (P < 0.05). No significant change in depression symptom scores was observed. At 48 weeks after switch, HIV viral load <50 copies/mL was maintained in all of the participants, median fasting lipid levels were moderately increased (total cholesterol [TC]: 8.2 mg/dL, low-density lipoprotein cholesterol [LDL-C]: 8.5 mg/dL, high-density lipoprotein cholesterol [HDL-C]: 2.9 mg/dL, and triglyceride (TG): 1.6 mg/dL, and the TC:HDL-C ratio remained stable.@*CONCLUSIONS@#The single-pill combination regimens E/C/F/TAF is safe and well tolerated. This study reveals that switching from EFV to E/C/F/TAF significantly reduces neuropsychiatric toxicity symptoms in people living with HIV with grade 2 or higher CNS complaints.

Estudio de alteraciones neurocognitivas en pacientes infectados por el virus de la inmunodeficiencia humana / Study of neurocognitive alterations in patients infected by the human immunodeficiency virus

El virus de inmunodeficiencia humana, conocido por su impacto en el sistema inmunológico, ocasionamanifestacionesneurológicas progresivas con afectación cognitiva, perturbando funciones de atención, memoria, lenguaje, ejecución y procesamiento de la información, lo cual interfiere de forma negativa en la vida social, laboral y familiar del paciente. Objetivos: Evaluar las alteraciones de diferentes funciones neurocognitivas de los pacientes con infección por el virusde inmunodeficienciahumana, en una institución prestadora de servicios de salud de la cuidad de Ibagué - Colombia. Método: Se utilizó la Evaluación Cognitiva Montreal (MoCA), la cual fue diseñada como un instrumento ágil para determinar alteraciones cognitivas leves. La población objeto de estudio la constituyeron 44 pacientes portadores de virus de inmunodeficiencia humana, seleccionados dentro de un marco de muestreo no-probabilístico con muestra intencional o de conveniencia, entre los 14 y 75 años de edad. Resultados: Mayor deterioro neurocognitivo en los pacientes diagnosticados con virus de inmunodeficiencia humana de mayor edad; datos epidemiológicos indican que la edad más avanzada se asocia a una mayor prevalencia de desorden neurocognitivo asociado al virus de inmunodeficiencia humana. Conclusiones: El estudio de los mecanismos del deterioro neurocognitivo en pacientes con virus de inmunodeficiencia humana se hace cada vez más relevante, porque cada día aumenta su esperanza de vida, pero a su vez genera complicaciones con mayor predominio de la comorbilidad médica, psiquiátrica y neurológica(AU)

Introduction: The Human Immunodeficiency Virus, known for its impact on the immune system, causes progressive neurologic manifestations with cognitive impairment, disrupting attention functions, memory, language, execution and processing of information. The latter negatively interferes in social, work and family life of the patient. Objectives: To evaluate alterations in varied neurocognitive functions on patients with Human Immunodeficiency Virusinfection, at a health institution in Ibague, Colombia. Method: The Montreal Cognitive Assessment (MoCA) was used. It was designed as a tool to determine mild cognitive alterations. The study population was made up of 44 carriers of Human Immunodeficiency Virus who were selected within a framework of non-probabilistic sampling and with purposive sample or convenience, between 14 and 75 years old. Results: Greater neurocognitive impairment in patients diagnosed with Human Immunodeficiency Virus in legal age; someepidemiological data indicate that the older age is associated with a higher prevalence of neurocognitive disorder associated with Human Immunodeficiency Virus. Conclusions: The study of the neurocognitive impairment mechanisms in patients with Human Immunodeficiency Virus becomes increasingly more relevant, as their life expectancy increases daily. On the other hand, it causes complications with greater prevalence of medical psychiatric and neurological comorbidity(AU)

The Incidence and Clinical Characteristics of Acute Serum Creatinine Elevation more than 1.5 mg/dL among the Patients Treated with Tenofovir/Emtricitabine-containing HAART Regimens

BACKGROUND: The combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has been the first choice nucleoside reverse transcriptase inhibitor (NRTI) according to many reliable antiretroviral treatment (ART) guidelines because of its high efficacy. However, TDF-related renal toxicity reported in Western countries is a challenging issue regarding clinical use. We conducted this study to evaluate the incidence and characteristics of an acute increase in serum creatinine (Cr) level > 1.5 mg/dL among TDF/FTC-based highly active antiretroviral treatment (HAART)-treated patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 205 HIV-infected patients treated with TDF/FTC-containing regimens between 1 February 2010 and 30 April 2014. Three groups of TDF/FTC + ritonavir-boosted protease inhibitor (PI/r), TDF/FTC + non-nucleoside reverse transcriptase inhibitor (NNRTI), and TDF/FTC + integrase strand transfer inhibitor (INSTI), and three PI/r subgroups of TDF/FTC + lopinavir (LPV)/r, TDF/FTC + atazanavir (ATV)/r, TDF/FTC + darunavir (DRV)/r were evaluated. RESULTS: A total 136 patients (91 in the TDF/FTC + PI/r group, 20 in the TDF/FTC + NNRTI group and 25 in the TDF/FTC + INSTI group) were included in the statistical analysis. Four cases (4.9%; all in the TDF/FTC + PI/r group) among 136 patients showed an acute increase in serum Cr more than 1.5 mg/dL, so the overall incidence was 2.8 cases per 100 patient-years. One case was a patient treated with TDF/FTC + LPV/r, and the others were treated with TDF/FTC + ATV/r. No case of an acute increase in serum Cr was observed in the TDF/FTC + DRV/r group. The incidence of serum Cr increase more than 1.5 mg/dL in TDF/FTC + PI/r group was 4.0 cases per 100 patient-years. CONCLUSION: Although only a small number of patients were evaluated retrospectively from a single center, the TDF/FTC + PI/r regimen may have been related with relatively higher tendency of increment of serum Cr level. These findings reinforce the importance of close follow-ups of HIV-infected patients treated with the TDF/FTC + PI/r regimens.

Treatment of chronic hepatitis B / 대한내과학회지

Despite the introduction of hepatitis B virus (HBV) vaccine for over 20 years now, HBV infection remains an important health problem. Antiviral treatment of chronic hepatitis B has dramatically changed over the last decade. A variety of therapeutic options are now available for the treatment of chronic hepatitis B infection, including four nucleos (t) ide analogues (i.e lamivudine, adefovir, entecavir and clevudine), along with standard and pegylated interferon. Newer oral nucleos (t) ide analogues that include tenofovir, emtricitabine and telbivudine are soon likely to be approved in Korea. Given the wide array of choices and the complex nature of chronic hepatitis B (CHB) infection, selection of the appropriate therapeutic agent can be challenging for clinicians. To help guide clinicians in treating patients with CHB, the Korean Association for the Study of the Liver published a guideline in 2004, which was subsequently revised in 2007 on the basis of new developments in the field. This review includes the range of treatment options and criteria for determining when and how to most effectively intervene with antiviral therapy for chronically infected patients with HBV.