Characteristics, immunological response & treatment outcomes of HIV-2 compared with HIV-1 & dual infections (HIV 1/ 2) in Mumbai.

Background & objectives: Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). Methods: Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. Results: A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/µl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. Interpretation & conclusions: In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.

Compuestos nitrogenados en pacientes con insuficiencia renal crónica terminal: sometidos a dos procedimientos de diálisis / Nitrogenous compounds in patients with terminal chronic renal failure treatment by two dialysed procedures

Se realizó un estudio comparativo de los compuestos nitrogenados (creatinina, úrea, ácido úrico y proteínas totales), y de la depuración de creatinina, en sujetos sanos y en pacientes con insuficiencia renal crónica terminal, sometidos a diálisis peritoneal ambulatoria contínua (DPAC) o a hemodiálisis. Para ambos tratamientos (hemodiálisis o DPAC), los niveles de creatinina (6,54 ñ 1,69 y 7,93 ñ 2,41mg/dl respectivamente) estuvieron por encima de los valores obtenidos en los controles (creatinina: 0,83 ñ 0,12 y úrea: 25,17 ñ 6,29 mg/dl); mientras que las concentraciones de ácido úrico (2,54 ñ 0,74 y 6,16 ñ 1,67 mg/dl respectivamente) y proteínas totales (7,40 ñ 0,80 y 6,40 ñ 0,65 mg/dl respectivamente) permanecieron dentro del rango normal. La depuración de creatinina fue menor de 12 ml/min en los individuos dializados por cualquiera de los dos procedimientos, en contraste a los controles, donde superó los 100 ml/min