ABSTRACT
BACKGROUND: Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). METHODS: Patients admitted to IMD of a General University Hospital in Italy in March-June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient's characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. RESULTS: HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. CONCLUSIONS: Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages.
Subject(s)
Attitude of Health Personnel , Diagnostic Tests, Routine/statistics & numerical data , HIV Infections/diagnosis , Hospital Departments , Internal Medicine , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Hospitals, University , Humans , Italy , Male , Middle Aged , Surveys and QuestionnairesSubject(s)
Mutation , Mycobacterium Infections/genetics , Mycobacterium Infections/immunology , Receptors, Interleukin-12/genetics , Receptors, Interleukin-12/immunology , Adult , Female , Heterozygote , Humans , Immunosuppression Therapy/methods , Immunotherapy/methods , Mycobacterium Infections/microbiology , Protein SubunitsABSTRACT
OBJECTIVES: To evaluate the pharmacokinetic profile of ritonavir-boosted lopinavir in HIV-infected patients during rifabutin-based anti-mycobacterial therapy. PATIENTS AND METHODS: A longitudinal, cross-over pharmacokinetic evaluation of lopinavir with and without rifabutin in HIV-infected subjects with mycobacterial disease was done. All received lopinavir/ritonavir (400/100 mg twice a day)â+âan adjusted rifabutin dose of 150 mg every other day. Twelve-hour lopinavir pharmacokinetic sampling occurred at 2 weeks (T1) and 6 weeks (T2) after starting combined therapy and 10 weeks after completion of adjusted rifabutin (T3). Plasma was assayed using an HPLC method; lopinavir plasma concentration-time data were analysed using non-compartmental methods. RESULTS: In 10 patients with complete lopinavir curves at T1, T2 and T3 pharmacokinetic values were, respectively: AUC(0-12), 187.5, 161.8 and 121.1 µgâ·âh/mL; C(trough), 13.2, 10.0 and 7.7 µg/mL; C(max), 18.7, 15.9 and 13.3 µg/mL; and apparent oral clearance (CL/F), 0.035, 0.037 and 0.045 L/h/kg. Lopinavir C(trough) and AUC(0-12) were significantly higher at T1 compared with T3 while CL/F remained unchanged throughout. Combined treatment was well tolerated and none of the patients experienced moderate to severe lopinavir-related adverse events. CONCLUSIONS: Lopinavir serum concentrations are not reduced when the drug is administered together with an adjusted dose of 150 mg of rifabutin every other day.
Subject(s)
Anti-HIV Agents/pharmacokinetics , Antitubercular Agents/administration & dosage , HIV Infections/drug therapy , Lopinavir/pharmacokinetics , Rifabutin/administration & dosage , Tuberculosis/drug therapy , Adult , Anti-HIV Agents/administration & dosage , Chromatography, High Pressure Liquid , Drug Interactions , Female , HIV Infections/complications , Humans , Lopinavir/administration & dosage , Male , Middle Aged , Plasma/chemistry , Ritonavir/administration & dosage , Tuberculosis/complicationsABSTRACT
The emergence of multidrug-resistant TB (MDR-TB), and, more recently of extensively drug-resistant TB (XDR-TB) is a real threat to achieve TB control and elimination. Over 500.000 new cases of MDR TB occurred in 2008 worldwide, of whom 50.000 are XDR-TB. A very small fraction of estimated MDR cases are actually diagnosed and notified: hence, the long-term vision for full control of MDR-TB requires, essentially, the scaling-up of culture and DST capacity and the expanded use of high-technology assays for rapid determination of resistance. MDR cases are treatable and well designed regimens, largely based on second-line anti-TB drugs, can considerably improve cure rates. However treatment regimen need to be markedly improved through the introduction of less toxic and more powerful drugs, thus reducing duration of treatment and tolerability. The prevalence of MDR-TB and XDR-TB are inversely correlated with the quality of TB control and the proper use of second line anti-TB drugs. Adherence to proper standards of care and control is imperative and a top priority of all TB control efforts. However, the risk of an un-controllable epidemic of MDR- and XDR-TB is real considering current levels of financing and commitment to care.
