ABSTRACT
BACKGROUND: Nephropathy complicates the course and adversely impacts on the prognosis of HIV-infected patients. We examined trends and correlates of all-cause nephropathy (ACN). METHODS: Correlates of and trends in ACN were examined in the entire Adult/Adolescent Spectrum of HIV Disease longitudinal observational cohort. Patients were enrolled and followed in the cohort for a median period of 3 years between January 1990 and December 2003 in 11 US metropolitan areas. RESULTS: The incidence of ACN rose among HIV-infected individuals through the mid-1990s, then declined. The proportion of patients with ACN at the time of death increased over the study period. Black race, injection-drug use (IDU), indinavir, hypertension, diabetes, decreased CD4+ lymphocyte count, increased viral load, and increased age were all highly associated with ACN. DISCUSSION: Nephropathy represents an important health disparity impacting HIV-infected blacks and IDU with implications for mortality.
Subject(s)
AIDS-Associated Nephropathy/epidemiology , AIDS-Associated Nephropathy/ethnology , Adolescent , Adult , Black or African American/statistics & numerical data , Age Factors , CD4 Lymphocyte Count , Chi-Square Distribution , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Incidence , Longitudinal Studies , Male , Middle Aged , Proportional Hazards Models , Risk Factors , Substance Abuse, Intravenous/epidemiology , United States/epidemiology , Viral LoadABSTRACT
Efavirenz, a nonnucleoside reverse transcriptase inhibitor, is a highly effective and widely prescribed antiretroviral agent. It is recommended as first-line treatment of human immunodeficiency virus (HIV) infection. The standard dose of efavirenz is 600 mg/day; however, adverse central nervous system effects limit its use. Few data citing use of efavirenz at lower doses have been published. We describe a 35-year-old man with HIV infection whose virologic suppression was maintained after 18 months of treatment with efavirenz 400 mg/day. Genetic testing for cytochrome P450 (CYP) 2B6 showed that the patient was a heterozygous variant; patients with this polymorphism tend to have higher plasma efavirenz concentrations and slower plasma efavirenz clearance (prolonged elimination half-lives). Therapeutic drug monitoring also supported the dose reduction in this patient. Even with the 400-mg dose, the patient's plasma trough concentrations exceeded the upper limit of the therapeutic range. However, as he remained completely asymptomatic with this dose, no further dose reduction was necessary. This case report provides evidence that reduced efavirenz doses may be effective in the treatment of HIV infection. In addition, this case demonstrates that pharmacogenetic and pharmacokinetic testing combined with therapeutic drug monitoring may be used to guide reduced-dose, efavirenz-based therapy.
Subject(s)
Anti-HIV Agents/therapeutic use , Benzoxazines/therapeutic use , HIV Infections/drug therapy , Adult , Alkynes , Aryl Hydrocarbon Hydroxylases/genetics , Cyclopropanes , Cytochrome P-450 CYP2B6 , Drug Monitoring , Humans , Male , Oxidoreductases, N-Demethylating/genetics , Polymorphism, GeneticABSTRACT
A wide array of diagnoses must be considered when a patient with advanced liver disease and human immunodeficiency virus (HIV) infection presents with hypoxemia. It is important to entertain the possibility of hepatopulmonary syndrome (HPS) in such patients, a diagnosis that must be confirmed with a contrast-enhanced echocardiogram (bubble study). We describe a case of HPS diagnosed in a patient with HIV infection and chronic liver disease and review the literature on HPS.
Subject(s)
HIV Infections/complications , Hepatitis C, Chronic/complications , Hepatopulmonary Syndrome/virology , Adult , Echocardiography , Hepatopulmonary Syndrome/diagnostic imaging , Hepatopulmonary Syndrome/therapy , Humans , MaleABSTRACT
Localized or regional necrotizing lymphadenitis is an extremely uncommon manifestation of herpes simplex virus (HSV) infection. We report a case of necrotizing HSV lymphadenitis in a patient with both common variable immunodeficiency and natural killer cell deficiency and review the literature on this unusual complication of HSV infection.
