Starting effect of highly active antiretroviral therapy on the incidence of anemia in HIV-infected patients / 上海预防医学

ObjectiveTo investigate the risk factors of anemia in HIV-infected patients receiving highly active antiretroviral therapy （HAART） in the Pudong New Area. MethodsA retrospective cohort study was conducted among HIV-infected patients who started HAART from 2005 to 2020 in Pudong New Area. Cox proportional hazards model was used to analyze the risk factors of anemia， moderate or severe anemia， and chronic anemia. The piecewise linear mixed-effect model was used to analyze the association between initial HAART classes and hemoglobin change in the follow-up. ResultsA total of 2 403 HIV-infected patients were included in the analysis. Among them， there were 357 cases of new onset anemia， 86 cases of chronic anemia and 102 cases of moderate or severe anemia， with the incidence density of 4.41/100 person years， 0.89/100 person years and 0.96/100 person years respectively. Multifactorial Cox regression analysis results showed that female， age >45 years， baseline CD4+ T lymphocyte count （CD4） <200 cells‧μL-1， opportunistic infections， glomerular filtration rate （eGFR） <60 mL‧min-1‧（1.73 m2）-1， and zidovudine （AZT） or protease inhibitor （PIs） based regimens were associated factors for the development of anemia. Female， age >45 years， CD4 <200 cells‧μL-1， opportunistic infections， and AZT-based regimens were associated with the development of chronic anemia. Mild anemia at baseline and AZT-based regimens were associated with the development of moderate or severe anemia. Linear mixed-effects model showed that the use of AZT （-7.87 g‧L-1， 95%CI： -9.42 to -6.32） or PIs （-3.43 g‧L-1， 95%CI： -5.57 to -1.30） was associated with lower Hb at follow-up. ConclusionInitial use of AZT and PIs is associated with progression to anemia and a lower follow-up hemoglobin level. Increased hemoglobin monitoring in users of AZT and PIs may be beneficial， especially during the first 6 months after initiation of HAART.

Cd4 count at the time of presentation in newly diagnosed HIV patients in a tertiary care hospital in south India: implications for the programme

Background: Lower CD4 count at initiation of antiretroviral therapy (ART) can have a significant negative impact on subsequent disease progression and mortality among HIV patients. Hence, author assessed the status of the CD4 count at the time of diagnosis and factors associated with lower CD4 count among newly diagnosed HIV cases.Methods: A prospective observational study was conducted in a single integrated counseling and testing center, affiliated with a Medical College and Hospital, Andhra Pradesh. All newly diagnosed HIV cases in the setting between January to December 2017 were included. The CD4 count was assessed as per national guidelines for enumeration of CD4 2015.Results: The final analysis included 125 participants. The mean CD4 count at diagnosis was 276.51±228.37. Only 19 (15.20%) people had CD4 count >500, 47 (37.60%) had between 200-500 and 59 (47.20%) had CD4 count <200. Only 20% had appropriate knowledge of treatment. Among the study population, 43 (34.70%) had symptomatic conditions attributed to HIV infection, 44 (35.50%) participants had an AIDS-defining illness at the time of diagnosis. Only 3 (2.40%) had voluntary counseling and testing. Even though male gender, poor educational status, having more sexual partners, poor knowledge related to HIV diagnosis and treatment was associated with higher odds of low CD4 count (<200), none of the associations were statistically significant.Conclusions: The mean CD4 count was low and almost half of newly diagnosed cases had low CD4 count (<200) at the time of diagnosis. There is a strong need to intensify the efforts to fill the gaps in the screening for the early diagnosis to maximize the benefits of HAART and to stop the spread of the infection.

Survival status and influencing factors of HIV/AIDS on highly active anti-retrovial therapy in Shandong province / 中华流行病学杂志

Objective: To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province. Methods: Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively, and Fine-Gray model was used to identify the influencing factors related to survival time. Results: Through K-M method, a higher AIDS-related cumulated death rate than the CIF, was estimated. Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong, 5 593 of them met the inclusion criteria. The cumulative incidence rate for AIDS-related death was 3.08% in 1 year, 4.21% in 3 years, 5.37% in 5 years, and 7.59% in 10 years respectively by CIF. Results from the F-G analysis showed that HIV/AIDS patients who were on HAART, the ones who had college degree or above (HR=0.40, 95%CI: 0.24-0.65) were less likely to die of AIDS-associated diseases. However, HIV/AIDS patients who were on HAART and living in the western areas of Shandong (HR=1.33, 95%CI: 1.01-1.89), diagnosed by medical institutions (HR=1.39, 95%CI: 1.06-1.80), started to receive care ≥1 year after diagnosis (HR=2.02, 95%CI: 1.30-3.15), their CD(4) cell count less than 200 cells/μl (HR=3.41, 95%CI: 2.59-4.59) at the time of diagnosis, with NVP in antiviral treatment (ART) regime (HR=1.36, 95%CI: 1.03-1.88), at Ⅲ/Ⅳ clinical stages (HR=2.61, 95%CI: 1.94-3.53) and CD(4) cell count less than 350 cells/μl (HR=5.48,95%CI: 2.32-12.72) at initiation of HAART ect., were more likely to die of AIDS-associated diseases. Conclusions: With the existence of competing risks, the cumulative incidence rate for AIDS-related death was overestimated by K-M, suggesting that competing risk models should be used in the survival analysis. Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.

Survival status and influencing factors of HIV/AIDS on highly active anti-retrovial therapy in Shandong province / 中华流行病学杂志

Objective To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province.Methods Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively,and Fine-Gray model was used to identify the influencing factors related to survival time.Results Through K-M method,a higher AIDS-related cumulated death rate than the CIF,was estimated.Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong,5 593 of them met the inclusion criteria.The cumulative incidence rate for AIDS-related death was 3.08％ in 1 year,4.21％ in 3 years,5.37％ in 5 years,and 7.59％ in 10 years respectively by CIF.Results from the F-G analysis showed that HIV/AIDS patients who were on HAART,the ones who had college degree or above (HR=0.40,95％CI:0.24-0.65) were less likely to die of AIDS-associated diseases.However,HIV/AIDS patients who were on HAART and living in the western areas of Shandong (HR=1.33,95％CI:1.01-1.89),diagnosed by medical institutions (HR=1.39,95％CI:1.06-1.80),started to receive care ≥1 year after diagnosis (HR=2.02,95％CI:1.30-3.15),their CD,cell count less than 200 cells/μl (HR=3.41,95％CI:2.59-4.59) at the time of diagnosis,with NVP in antiviral treatment (ART) regime (HR=1.36,95％CI:1.03-1.88),at Ⅲ/Ⅳ clinical stages (HR=2.61,95％CI:1.94-3.53) and CD4 cell count less than 350 cells/μl (HR=5.48,95％CI:2.32-12.72) at initiation of HAART ect.,were more likely to die of AIDS-associated diseases.Conclusions With the existence of competing risks,the cumulative incidence rate for AIDS-related death was overestimated by K-M,suggesting that competing risk models should be used in the survival analysis.Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.

Research progress on highly active anti-retroviral therapy induced secondary osteoporosis / 中国实验动物学报

Highly active anti-retroviral therapy(HAART)is a principal therapy method for AIDS. However, HAART is also one of crucial factors inducing bone mass loss and osteoporosis but its related mechanisms are obscure. Of note,nucleotide reverse transcriptase inhibitor(NRTI)and protease inhibitors(PI)may play key roles in inducing osteoporosis. This review summarizes the research progress in epidemiology and associated mechanisms on osteoporosis induced by NRTI and PI.

Red Cell Characteristics in Anaemic HIV Infected Patients.

Background: Anaemia is the most frequently encountered haematological complication in human immunodeficiency virus (HIV) infected patients and acquired immunodeficiency syndrome (AIDS) even in the era of highly active anti-retroviral therapy (HAART). Although HAART appears to be associated with a somewhat lower risk of anaemia, anaemia remains common in the HAART era. This study looks at the characteristics of red blood cells in anaemic HIV infected patients with emphasis on red cell indices. Materials and Methods: A total of 60 patients aged 18-66 years were recruited, comprising of 40 HIV infected, treatment naïve individuals who were also anaemic patients and 20 individuals who were non anaemic patients. Venous blood (5 mls) was collected by vacutainer from each patient who consented into an anti-coagulant K3 EDTA specimen bottle for haematological indices which included Haemoglobin (Hb), Packed cell volume (PCV), White blood cell (WBC) & differentials, Platelet count and red blood cell indices by automated counter, CD4+ cell count by semi-automated flow cytometer, and HIV viral load was quantitated using PCR- based diagnostic tests. Peripheral blood smear for morphology was done by routine manual methods and stained with Romanowsky stain. Results: Majority (72.5%) have normocytic anaemia, 10.0% have microcytic anaemia and 17.5% have macrocytic anaemia. Majority (55.0%) of the HIV infected anaemic subjects have normocytic/normochromic red blood cells on morphology. The mean WBC of HIV infected anaemic patients (7.20 x109/L±4.93) was significantly different from the mean WBC of HIV infected non-anaemic patients (5.66 x109/L±1.74) (p=0.008). The mean platelet count of HIV infected anaemic patients (277.27 x109/L±126.76) was significantly different from the mean platelet count of HIV infected non-anaemic patients (207.40 x109/L±61.86) (p=0.006). Conclusion: Anaemia in HIV infection was found to be normocytic normochromic anaemia.

Serum Creatinine, Urea and Their CD4+ T-lymphocyte Count among HIV Positive Patients before and after Initiation of HAART at St. Paul’s General Specialized Hospital In Addis Ababa, Ethiopia.

Objective: To describe the serum level of urea and creatinine, and as well as CD4+ T cell count of blood among HIV positive patients before and after initiation of HAART in St. Paulo’s general specialized hospital. Methods: A retrospective follow up study was conducted among HIV infected individuals who take HAART drug combination regimens such as (TDF/3TC/EFV), (TDF/3TC/NVP), (AZT/3TC/NVP), (D4T/3TC/EFV) and (D4T/3TC/NVP) and visit St. Paulo’s generalized hospital laboratory for renal function testing from 2007-2009G.C. Results: A total of 2026 HIV positive patients started HAART between 2007-2009G.C in St. Paulo’s ART clinic. Among them 380 HIV patients, with two and three visits for CD4+ and renal function test (creatinine & urea), were recruited to the study. Of whom 240 (63.2%) were female and 140(36.8%) male. Out of 380 patients, 104(27.4%) were taking 1b30, 94(24.7%) were using 1a30, 77(20.3%) were taking 1d, 57(15%) 1c, 14(3.7%) tdf/3tc/efv, 12(3.2%) use tdf/3tc/nvp and 22(5.7%) were taking other drug types. The statuses of CD4+ T cell count of patients become improved as they are using HAART drug through visit. These were 115, 266 and 298 out of 380 have greater than 200 CD4+ T cell count on 6th, 12th, 18th months time difference respectively. But the numbers of patients who have renal dysfunction were increased as they were using HAART drug as treatment through visits. These might indicate that, use of HAART drug combination may improve the immune status HIV positive patients even though some renal side effects are there. Therefore, patients (HAART drug user) should have a follow up on renal function to monitor side effects of drug. Conclusion: HAART resulted in improved Immune status of HIV patients with remarkable increase in CD4 T lymphocyte count but at the same time there was an increase in Azotemia after the introduction part of HAART which suggests the impact of drug in renal function. This is especially true for TDF containing drug regimens (TDF/3TC/NVP) which dramatically improve CD4 T lymphocyte count and show significant Azotemia over times.

Study of different intervention time of HAART in PMTCT of the blocking effect / 中国基层医药

Objective To investigate the HAART in PMTCT different intervention time of blocking effect. Methods 49 cases who received out -patient examination and hospital delivery of HIV positive pregnant women were selected,the intervention time pregnant 14 weeks,pregnant 28 weeks.The patients were divided into three groups,group A (n =20),group B (n =19),group C (n =10).The safe delivery,the newborn 50 out of 18 months of tracking and detection,and the results were analyzed.Results Three groups of antiviral HIV infected maternal immune status (P >0.05 ),antiviral CD +4 cell number variation had no statistical significance (P >0.05 ),the blocking effect was A group of infants 0 infection.In group B,1 cases of infant infection.Group C 2 cases of infant infection.Compared between group A and group B,the difference was not statistically significant (χ2 =0.97,P >0.05),compared between group B and group C,the difference was not statistically significant (χ2 =1.40,P >0.05). Compared between group A and group C,the difference had statistical significance (χ2 =4.08,P <0.05 ). Conclusion HAART for blocking HIV mother to child transmission effect is very significant,if in 14 weeks pregnant initiation of HAART,the infant HIV infection rate is lower,recommended the early antiviral treatment and after childbirth to strengthen follow -up and management.

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in ;Nanjing / 中华流行病学杂志

Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in ;Nanjing / 中华流行病学杂志

Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.

Factors related to HIV-associated lipodystrophy among patients on antiretroviral therapy / 中华流行病学杂志

Objective To describe the distribution and related risk factors of lipodystrophy (LD) among AIDS patients treated with antiretroviral drugs.Methods A cross-sectional study was performed on 261 AIDS patients treated with antiretroviral drugs.All the subjects were followed in the Center for Disease Control and Prevention of two counties in northern Anhui province from May 25 to 30,2012.Data related to demography,physical examination,history of antiretroviral treatment,HIV plasma viral load,and CD4 +T cell count were collected.Clinical examination was based on an assessment of changes in face,legs,arms,buttocks (peripheral sites),back,chest,neck or abdomen or change in waist size (central sites) as quoted by the clinicians.Results LD was observed in 147 (56.3％) patients.The differences of age,gender,quality of sleep,weight and time of treatment between LD and non-lipodystrophy (NLD) groups were statistically significant (P＜0.05).Results from the Multivariate logistic regression analysis showed that the risk of women suffering from LD was 1.894 times ofthd males (95％CI:1.075-3.338).The risk of those with LD showed an 1.448-fold increase regarding the time of treatment for each additional year (95％CI:1.267-1.654).Patients with poor quality of sleep were prone to LD with 11.901 times more than those with good quality of sleep (95％CI:2.701-52.441).Conclusion LD was commonly observed in AIDS patients who were under antiretroviral therapy.Gender,tine of treatment and the quality of sleep appeared the main factors related to the results of observation.

Quality of sleep and quality of life in adolescents infected with human immunodeficiency virus / Qualidade do sono e qualidade de vida em adolescentes infectados pelo vírus da imunodeficiência humana

OBJECTIVES: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. METHODS: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. RESULTS: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. CONCLUSIONS: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.

OBJETIVOS: Avaliar as características do sono de adolescentes infectados pelo HIV e estudar se os aspectos psicossociais estão associados à qualidade do sono. MÉTODOS: Estudo transversal, que avaliou 102 adolescentes, com idades entre 10 e 20 anos, infectados pelo HIV, e 120 controles, de ambos os gêneros. Para a coleta de dados, aplicaram-se: a Sleep Disturbance Scale for Children, a Epworth Sleepiness Scale, e o Pediatric Quality of Life Inventory. RESULTADOS: Verificou-se prevalência de distúrbios do sono em 77,4% dos pacientes e em 75% nos controles, e houve correlação entre qualidade do sono e de vida. Adolescentes HIV-positivos apresentaram maior pontuação nos distúrbios respiratórios do sono e maior prevalência de sonolência diurna excessiva. CONCLUSÕES: Adolescentes infectados pelo HIV apresentaram qualidade de sono semelhante à da população saudável. Isso provavelmente decorre pela melhora de suas condições de vida resultante do sucesso da terapia antirretroviral em pacientes HIV-positivos e pelas vulnerabilidades que afetam adolescentes brasileiros de grandes centros urbanos.

Síndrome de lipodistrofia en pacientes con VIH/sida que reciben terapia antirretroviral de gran actividad en Tepic, México / Lipodystrophy syndrome in HIV/AIDS patients receiving highly active antiretroviral therapy in Tepic, Mexico

Objetivo: determinar la relación entre la manifestación del síndrome de lipodistrofia y la terapia antirretroviral de gran actividad en pacientes con VIH/sida. Métodos: se realizó un estudio descriptivo, transversal y correlacional en pacientes con VIH/sida que reciben terapia antirretroviral de gran actividad, atendidos entre marzo y diciembre de 2007 en el Centro Ambulatorio de Prevención y Atención del Sida e Infecciones de Transmisión Sexual (CAPASITS) de Tepic, Nayarit, México. La definición y diagnóstico del síndrome se realizó mediante el método de The National Centre in HIV Epidemiology and Clinical Research (NCHECR) de Australia. Se utilizó la prueba de chi cuadrado para evaluar la dependencia entre el síndrome y la terapia. Se evaluaron 175 pacientes (128 hombres y 47 mujeres), de 19 a 72 años de edad. Resultados: se diagnosticaron 141 pacientes (80,6) con síndrome de lipodistrofia (IC95% 74,7-86.4 %); el 82,6 % correspondió a hombres y el 74,5 % a mujeres. Según la severidad, el porcentaje fue de 17 % de grado 1, 3 % de grado 2, 10 % de grado 3 y 51 % de grado IV. Las pruebas de chi cuadrado para evaluar dependencia entre el síndrome y la terapia resultaron no significativas. Conclusiones: el síndrome de lipodistrofia severo resulta un serio problema para la apariencia de pacientes de VIH/sida que reciben o no la terapia antirretroviral y que agrega un riesgo cardiovascular importante que debe ser considerado para intentar su prevención o tratamiento. Aunque los resultados pueden presentar sesgos y limitaciones, aportan una aproximación importante para sustentar y planificar intervenciones sanitarias que disminuirían el impacto del síndrome en la salud de los pacientes con VIH/sida.

Objective: to establish the relationship between lipodystrophy syndrome and highly active anti-retroviral therapy in HIV/AIDS patients. Methods: a cross-sectional, descriptive and co-relational study was conducted in HIV/AIDS patients, who had received highly active antiretroviral therapy in Centro Ambulatorio de Prevención y Atención del Sida e Infecciones de Transmisión Sexual (CAPASITS) de Tepic in Nayarit, Méjico from March to December, 2007. The definition and diagnosis of this syndrome was based on the method developed by the National Center in HIV Epidemiology and Clinical Research (NCHECR) method in Australia. The Chi square test evaluated the dependence between syndrome and therapy. One hundred seventy five patients (128 men and 47 women) aged 19-72 years were evaluated. Results: one hundred forty one patients (80.6 %) were diagnosed with lipodystrophy syndrome (CI95%74,7-86,4 %); 82.6 % corresponded to men and 74.5 % to women. According to severity, 17 % classified as grade 1; 1.3 % in grade 2; 10 % in grade 3 and 51 % as grade IV. The Chi square tests for the evaluation of dependence between syndrome and therapy were not significant. Conclusions: severe lipodystrophy syndrome is a serious health problem for HIV/AIDS patients receiving antiretroviral therapy or not. It adds a significant cardiovascular risk that must be considered for prevention or treatment. Although the results may be biased or restricted, they represent an important approach to planning and performing health interventions that will reduce the impact of the syndrome on the health of HIV/AIDS patients.

Diferenças ultrassonográficas da quantidade de gordura corporal e os antirretrovirais / Differences in body fat distribution assessed by ultrasonography in patients receiving antiretroviral drugs

OBJETIVO: Este estudo procurou avaliar o conteúdo de gordura dos portadores do HIV segundo o tempo de uso da terapia antirretroviral (TEMPARV), < 1 ano e > 1 ano. MÉTODOS: A regressão linear múltipla foi utilizada para investigar a associação entre as variáveis ultrassonográficas dos compartimentos corporais de gordura (CCG) da face, braço, abdômen subcutâneo e visceral e as seguintes variáveis explanatórias: sexo, idade, IMC e TEMPARV. RESULTADOS: Do total de pacientes (187), 102 com TEMPARV > 1ano eram portadores de lipodistrofia relacionada ao HIV (LD-HIV), diagnosticados de acordo com os questionários clínicos. Já aqueles com TEMPARV < 1 ano (n= 85, ≈46%) não apresentavam LD-HIV. Com relação ao compartimento visceral, a diferença entre os pacientes com TEMPARV > 1 ano e < 1 ano foi de 11 mm de gordura adicionais naqueles em TEMPARV > 1 ano. As mulheres tinham mais gordura que os homens em todos os CCG periféricos, enquanto eles tinham 7,2 mm a mais de gordura visceral que elas, em média. CONCLUSÃO: A ultrassonografia é um método capaz de medir a espessura de gordura dos CGC aplicável à prática clínica para diagnosticar a LD-HIV.

OBJECTIVE: This study aimed to evaluate the body fat content of HIV patients according to the duration of antiretroviral therapy use (DURARV), < 1 year and > 1 year. METHODS: Multiple linear regression was used to investigate the association between ultrasonographic variables of body fat compartments (BFCs) of the face, arm, subcutaneous and visceral abdomen, and the following explanatory variables: gender, age, BMI, and DURARV. RESULTS: Of all patients (187), 102 of them with DURARV > 1 year were suffering from HIV-related lipodystrophy (HIV-LD), diagnosed through clinical questionnaires. Those with DURARV < 1 year (n = 85, = 46%) did not have HIV-LD. Regarding the visceral compartment, the difference between those with DURARV > 1 year and < 1 year was 11 mm of additional fat content in those with DURARV > 1 year. Women had more fat than men in all peripheral BFCs, while men had 7.2 mm more visceral fat than women, on average. CONCLUSION: Ultrasonography is a method capable of measuring the thickness of BFCs and is applicable to clinical practice to diagnose HIV-LD.

Opportunistic infections in relation to antiretroviral status among AIDS patients from south India.

Background: There is a need to generate data from India on relative frequencies of specific opportunistic infections (OIs) in different regions and their relation to the choice of commonly used generic highly active anti-retroviral therapy (HAART) regimens. Objectives: To document the prevailing prevalence pattern of OIs both before and after HAART, to look for reduction in OIs following HAART, to assess the risk of developing new OIs within 6 months of HAART initiation and to see if there is any difference in the risk of developing a new OI within 6 months of HAART initiation, for those on Efavirenz (EFV)-based regimens and Nevirapine (NVP)-based regimens. Materials and Methods: In a prospective observational cohort study conducted in South India involving 108 ART-naive AIDS patients, different pathogens were isolated and identified using standard laboratory techniques. Data analysis was done using SPSS software (version 16.0). Risk of developing an OI after HAART initiation was assessed using the likelihood ratio test from Cox regression models. Results: Tuberculosis (53.4%), oral Candidiasis (27.2%) and Herpes Zoster (14.7%) were the common infections seen. There was a drastic reduction of 96.59% in OI events after 6 months of HAART. The risk of developing an OI within 6 months of HAART initiation was 5.56%. Time to development of an OI in the first 6 months of HAART was shorter for the NVP-based regimens than with EFV-based regimens, but this difference was not statistically significant (HR=0.891, 95% CI: 0.179-4.429; P=0.888). Conclusion: Tuberculosis is the most important OI before initiation of HAART. Both EFV and NVP-based regimens are equally efficacious in controlling OIs.

The evaluation of four-year highly active antiretroviral therapy in HIV-1 infected patients / 中华内科杂志

Objective To observe that antiretroviral efficacy, immune reconstitution of four-year highly active antiretroviral therapy (HAART), and evaluate its side effect in Chinese HIV-1-infected patients. Methods A total of 258 HIV-1 infected patients, given HAART regimens composed of two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) for mean 51.5 months, measured HIV RNA viral load(VL) and the counts of CD4+ T cell,CD8+ T cell at the baseline and 6, 12, 24, 36 and 48 months after HAART initiation, respectively,monitoring side effect, blood routine, main biochemical parameters, and other disadvantageous accidents during the 51.5-month treatment. Results Plasma HIV-1 RNA level was determined by fluorescent quantitative polymerase chain reactions (FQ-PCR) at the baseline and 6, 12, 24, 36 and 48 months after starting HAART, and showed 5.27, 2.97, 2. 74, 2. 62, 2. 67 and 2.75 lg (copies/ml), respectively. The counts of CD4+ T cell from (127±63) cells/μl at the baseline increased to (190±115), (248±93),(269±127), (296 ± 156) and (317 ± 195) cells/μl at 6, 12, 24, 36 and 48 months after starting HAART. A total of 149 treated patients (57.8%)had gastrointestinal side effects, peripheral polyneuropathy, various rashes, central nervous system disorders, fever or baldness. Twenty-two patients changed one of three medicines to another because toxicity. Sixteen changed the regimen to the second line HAART for lactic acidosis or other serious toxicities. Conclusions A total of 258 HIV-1 infected Chinese patients treated with two NRTI and one NNRTI as first line HAART regimen during mean 51.5 months,showed a good antiretroviral efficacy and immune reconstitution, but a few site-effects at the parts of patients. It is necessary to treat adverse effect and change HAART regimen for severe toxicity in time.

The therapeutic effects of highly active anti-retroviral therapy in 74 treatment-naive patients with AIDS in China / 中华内科杂志

Objective To evaluate the therapeutic effect of highly active anti-retroviral therapy (HAART) in treatment-na(i)ve Chinese patients with AIDS, to provide evidences for standardizing HAART.Methods Seventy-four treatment-naive AIDS patients were initiated with HAART and followed up regularly for 3 years. The clinical and laboratory data, side effects and drug resistance were observed and analyzed during the follow-up period. Results Of the 74 patients, 46 were males and 28 were females, with the average age being 42 years. The mean HIV viral load was ( 2. 2 ± 2.0 ) × 105 copies/ml and the baseline mean CD4+ T lymphocyte count was (62 ± 71 )cells/μl before treatment. After treatment for 3, 6, 12, 18,24, 30 and 36 months, the percentage of undetectable HIV viral road (less than 50 copies/ml ) was 71.6%, 83.8%, 75.7%, 77.0%, 82.4%, 81.1% and 79.7% respectively, and CD4+T lymphocyte count ascended to ( 167 ± 105), ( 177 ± 129), (238 ± 137), (290 ± 158), (304 ± 191 ), (331 ± 175) and ( 352 ± 202 ) cells/μl. The increase in amplitude of CD4+ T lymphocyte count in different periods examined was different, with the period of 0-3 months post-treatment demonstrating the most obvious augmentation ( P ＜ 0. 01 ) . The most common adverse reactions were liver function injury ( 52/74,70. 3% ), hyperlipemia (52/74, 70. 3%), hematopoietic inhibition of the bone marrow (33/74, 44. 6% ),peripheral neuritis (32/74, 43.2% ) and lipoatrophy (26/74, 35. 1%). Clinical drug resistance were found in nine patients and HIV gene mutations were detected in these patients. Conclusions Chinese treatment-naive AIDS patients have achieved good virological and immunological response to generic-drugpredominant HAART regimes with low drug resistance, but relatively more side effects.

Clinical spectrum of 15 patients with HIV-related ocular involvement in Tehran / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the frequency of HIV-related ocular involvement and to describe the characteristics of involvement in a special clinic in Tehran.METHODS: In this cross sectional study, 141 patients (125 male and 16 female, 282 eyes) of HIV-infected patients with various stages of HIV infection that were referred to Center of behavioral diseases were evaluated during a period of 7 months. Every patient had a complete profile including demographic data, method of HIV transmission, recent CD4 T cell lymphocyte count, serological studies for common sexual or blood-born viruses and toxoplasmosis, history of antiretroviral therapy, and associated systemic disease. RESULTS: A total of 141 patients were evaluated. HIV-related ocular involvement was detected in 15 patients (10.6%), including 3 mycobacterium tuberculosis-related choroiditis, 2 cytomegalovirus retinitis, 2 retinal toxoplasmosis, 2 herpes simplex virus-related lesions, 1 HIV-associated retinopathy, 1 herpes zoster ophthalmicus, 1 undetermined vitritis, and 3 cases of cranial nerve involvement including 2 cases of gaze palsy and 1 case of papilitis. In our study, mean CD4 T cell lymphocyte count was fewer in patients with ocular involvement than in patients without ocular involvement (204.7±123.8 vs 403.7±339.7, P=0.029), but there was no difference in other possible associated factors between two groups.lesions are the most common HIV-related ocular involvements in Tehran that is different from those of recent publications in developed countries.

Development and application of HIV testing technologies for HIV/AIDS highly active anti-retroviral therapy in China / 中华检验医学杂志

Currently the highly active anti-retroviral therapy (HAART) is the most effective and practical approach for AIDS treatment. However, as the public health strategy for HIV/AIDS prevention and control, governmental involvement is highly needed. Since 2004 Chinese govemment actively responded to the United Nations' proposition and promised, "Four Free and One Care" policy, to promote HAART for AIDS patients in whole country, which was free of charge for all the AIDS patients. HIV related testing technologies are important assurance for effective implementation of HAART and replacement of anti-HIV drugs, including screening and confirmation of HIV/AIDS patients, screening of patients for HAART, evaluation of treatment effcacy and side effects, monitoring HIV-1 drug resistance and molecular evolution. In this issue, there are 6 papers describing the research on HAABT and relevant HIV testing technologies. The studies clearly demonstrated that great development was made in HIV testing technologies, which played significant supportive roles for HAART implementation in China.

Metabolic Complications in Korean HIV/AIDS Patients Receiving Highly Active Anti-retroviral Therapy / 감염과화학요법

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count 6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.