ABSTRACT
OBJECTIVES: To evaluate the effect of the interleukin 28B (IL-28B) genotype on hepatitis C virus (HCV) viral kinetics in the first 4 weeks from start of treatment with pegylated interferon plus ribavirin (PEG-IFN/RBV) in HIV/HCV co-infected patients. METHODS: HIV/HCV co-infected patients naive to PEG-IFN/RBV treatment were enrolled in a prospective study. HCV RNA plasma viral loads were measured at baseline and at weeks 1, 2 and 4 after commencement of treatment. Patients were grouped by HCV genotype (genotype 1/4 versus 3) and by IL-28B genotype (CC versus non-CC). Differences in viral load reduction were evaluated by IL-28B genotype between baseline, week 1, week 2 and week 4. RESULTS: One hundred and nineteen HIV/HCV patients were included in the study. HCV patients with genotype 1/4 and bearing the IL-28 CC genotype showed the greatest reductions in HCV RNA plasma levels between baseline and weeks 1 (B-1), 2 (B-2) and 4 (B-4) than did those with non-CC genotypes (B-1: 1.06 ± 0.89 versus 0.48 ± 0.48 log IU/mL, P = 0.009; B-2: 1.36 ± 0.72 versus 0.77 ± 0.66 log IU/mL, P = 0.01; and B-4: 1.91 ± 0.64 versus 1.38 ± 0.96 log IU/mL, P = 0.03). However, differences between weeks 1 and 2 (W1-2) and between weeks 2 and 4 (W2-4) were not associated with the IL-28B genotype (W1-2: CC 0.48 ± 0.42 versus non-CC 0.38 ± 0.38 log IU/mL, P = 0.62; W2-4: CC 0.32 ± 0.23 versus non-CC 0.39 ± 0.31 log IU/mL, P = 0.67). No differences in decline of HCV RNA viral load were found in HCV genotype 3 patients. CONCLUSIONS: The IL-28B genotype impacts on viral kinetics during the first week of treatment with PEG-IFN/RBV in patients with HCV genotype 1/4.
Subject(s)
Antiviral Agents/administration & dosage , Hepacivirus/isolation & purification , Hepatitis C/genetics , Interferons/administration & dosage , Interleukins/genetics , Ribavirin/administration & dosage , Viral Load , Adult , Drug Therapy, Combination/methods , Female , Genotype , HIV Infections/complications , Hepatitis C/complications , Hepatitis C/drug therapy , Hepatitis C/virology , Humans , Male , Plasma/virology , Prospective Studies , RNA, Viral/blood , Treatment OutcomeABSTRACT
OBJECTIVE: Guidelines recommendation to extend treatment duration in genotype 1 hepatitis C virus (HCV)/HIV-coinfected patients who clear the virus later than treatment week 4 is not evidence-based. Our main objective was to study the ability of week 12 viral response [early virologic response (EVR)] to predict long-term outcome in patients treated for 48 weeks. DESIGN: Multicenter retrospective cohort analysis. METHODS: Genotype 1 HCV treatment-naive, HIV-coinfected adult patients with compensated liver disease who started combination therapy with fixed-dose pegylated-interferon (pegIFN) alfa-2a or weight-based pegIFN alfa-2b plus ribavirin were included. Univariate and forward stepwise logistic regression analysis were used to identify predictors of sustained viral response (SVR) and relapse. RESULTS: By intention-to-treat analysis, 31.3% (87/278) of patients achieved an SVR. SVR rate was more than three-fold higher in patients who cleared the virus by week 12 of treatment compared with late responders. Among 123 end-of-treatment responders, 36 (29.3%) relapsed. Relapse risk increased in patients with cirrhosis, in those with ribavirin dose reductions and in late responders: more than 65% of patients who cleared the virus between weeks 12 and 24 relapsed following 48 weeks of treatment compared with 10% of those attaining a complete EVR (<15 IU/ml) at treatment week 12 (risk ratio 6.4, 95% confidence interval 2.9-14.4). CONCLUSION: Viral response at treatment week 12 is a strong predictor of long-term outcome. Genotype 1 HCV/HIV-coinfected patients who achieve a complete EVR (<15 IU/ml) are at low risk of viral relapse after completing the standard 48 weeks of therapy.
Subject(s)
HIV Infections/virology , HIV-1 , Hepacivirus/genetics , Hepatitis C, Chronic/virology , Adult , Antiviral Agents/administration & dosage , Drug Administration Schedule , Female , Genotype , HIV Infections/drug therapy , HIV Infections/genetics , Hepatitis C, Chronic/drug therapy , Humans , Interferon alpha-2 , Interferon-alpha/administration & dosage , Male , Polyethylene Glycols/administration & dosage , RNA, Viral/genetics , Recombinant Proteins , Recurrence , Regression Analysis , Retrospective Studies , Ribavirin/administration & dosage , Treatment Outcome , Viral LoadABSTRACT
Liver-related disease has increased as a cause of hospitalization and in-hospital death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART). Better clinical management of these diseases may contribute to decreasing their incidence. Admissions due to liver-related disease in HIV-infected patients in our institution increased from 2.9% in 1998-1999 to 11.3% in 2004-2005 (P = 0.001). In-hospital deaths due to this cause increased from 2.7% in 1998-1999 to 26% in 2002-2003 (P = 0.02), with a subsequent decrease to 22% in 2004-2005. Hospitalization of HIV-infected patients for liver-related disease continues to increase, whereas the rate of in-hospital deaths from this cause appears to have changed since 2003.
Subject(s)
HIV Infections/epidemiology , Hospital Mortality/trends , Liver Diseases/epidemiology , Patient Admission/trends , Adolescent , Adult , Aged , Antiretroviral Therapy, Highly Active , Comorbidity , Cross-Sectional Studies , Female , HIV Infections/drug therapy , Humans , Liver Diseases/mortality , Male , Middle Aged , Patient Admission/statistics & numerical data , Retrospective Studies , Spain/epidemiology , Young AdultABSTRACT
La hepatopatía ha aumentado como causa de ingreso y muerte intrahospitalaria en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) tras la aparición de la terapia antirretroviral de gran actividad (TARGA). Un mejor manejo clínico de la hepatopatía podría ayudar a disminuir su incidencia. En nuestro centro, los ingresos por hepatopatía aumentaron del 2,9% en 1998-1999 al 11,3% en 2004-2005 (p = 0,001). Las muertes intrahospitalarias debidas a hepatopatía aumentaron del 2,7% en 1998-1999 al 26% en el período 2002-2003 (p = 0,02) y disminuyeron al 22% en 2004-2005. Si bien el número de ingresos por hepatopatía en pacientes infectados por el VIH todavía sigue aumentando, parece que la mortalidad intrahospitalaria ha sufrido un cambio desde 2003 (AU)
Liver-related disease has increased as a cause of hospitalization and in-hospital death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART). Better clinical management of these diseases may contribute to decreasing their incidence. Admissions due to liver-related disease in HIV-infected patients in our institution increased from 2.9% in 1998-1999 to 11.3% in 2004-2005 (P = 0.001). In-hospital deaths due to this cause increased from 2.7%in 1998-1999 to 26% in 2002-2003 (P = 0.02), with a subsequent decrease to 22% in 2004-2005. Hospitalization of HIV-infected patients for liver-related disease continues to increase, whereas the rate of in-hospital deaths from this cause appears to have changed since 2003 (AU)
Subject(s)
Humans , Liver Diseases/epidemiology , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Liver Diseases/chemically induced , Antiretroviral Therapy, Highly Active/adverse effects , Anti-Retroviral Agents/adverse effects , HIV Infections/complications , Hospital MortalitySubject(s)
Anti-Bacterial Agents/adverse effects , Cardiotonic Agents/pharmacology , Clarithromycin/adverse effects , Digoxin/pharmacology , Drug-Related Side Effects and Adverse Reactions/etiology , Aged , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/therapy , Female , Humans , Intestinal Mucosa/metabolism , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Male , Female , Aged , Humans , Intestines , Clarithromycin , Oncogene Proteins, Fusion , Leukemia, Myeloid , Gene Rearrangement , Treatment Outcome , Cardiotonic Agents , Anti-Bacterial Agents , DigoxinABSTRACT
BACKGROUND AND OBJECTIVE: Our goal was to investigate the kinetics of serum IgG antibodies against Bartonella spp. in patients with cat-scratch disease and in HIV-infected indiviuals. PATIENTS AND METHOD: Sequential determinations were made in seven patients with cat scratch disease and in seven HIV-infected individuals who were seropositive for this bacteria. RESULTS: In five patients from each group, serum antibodies fell under the positivity threshold within two years. Two HIV coinfected patients harbored Bartonella spp. DNA in bone marrow. CONCLUSIONS: These results suggest that the finding of a positive titer of serum IgG against Bartonella spp. is a marker of acute or recent infection.
Subject(s)
Antibodies, Bacterial/blood , Bartonella/immunology , Cat-Scratch Disease/complications , Cat-Scratch Disease/immunology , HIV Infections/microbiology , Immunoglobulin G/blood , Adolescent , Adult , Bone Marrow/microbiology , DNA, Bacterial/analysis , Female , HIV Infections/complications , HIV Infections/immunology , Humans , Male , Middle AgedABSTRACT
FUNDAMENTO Y OBJETIVO: Conocer la dinámica de anticuerpos IgG frente a Bartonella spp.en pacientes con enfermedad por arañazo de gato y en individuos infectados por el VIH. PACIENTES Y MÉTODO: Se realizaron determinaciones secuenciales de los mismos en 7 pacientes con enfermedad por arañazo de gato y en 7 individuos asintomáticos infectados por el virus de la inmunodeficiencia humana (VIH) y seropositivos para dicho microorganismo. RESULTADOS: En 5 pacientes de cada grupo se negativizaron los anticuerpos antes de transcurridos dos años de haberse observado el título más alto. En dos individuos infectados por el VIH se detectó ADN de Bartonella spp. en la médula ósea. CONCLUSIONES: Estos resultados indican que el hallazgo de un título positivo de IgG frente a Bartonella spp. es un marcador de infección aguda o reciente (AU)
