HIV Medicine
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Influence of noninjecting and injecting drug use on mortality, retention in the cohort, and antiretroviral therapy, in participants in the <scp>S</scp>wiss <scp>HIV</scp> Cohort Study Objectives We studied the influence of noninjecting and injecting drug use on mortality, dropout rate, and the course of antiretroviral therapy (ART ), in the S wiss HIV Cohort Study (SHCS ). Methods Cohort participants, registered prior to A pril 2007 and with at least one drug use questionnaire completed until M ay 2013, were categorized according to their self‐reported drug use behaviour. The probabilities of death and dropout were separately analysed using multivariable competing risks proportional hazards regression models with mutual correction for the other endpoint. Furthermore, we describe the influence of drug use on the course of ART . Results A total of 6529 participants (including 31% women) were followed during 31 215 person‐years; 5.1% participants died; 10.5% were lost to follow‐up. Among persons with homosexual or heterosexual HIV transmission, noninjecting drug use was associated with higher all‐cause mortality [subhazard rate (SHR ) 1.73; 95% confidence interval (CI ) 1.07–2.83], compared with no drug use. Also, mortality was increased among former injecting drug users (IDUs ) who reported noninjecting drug use (SHR 2.34; 95% CI 1.49–3.69). Noninjecting drug use was associated with higher dropout rates. The mean proportion of time with suppressed viral replication was 82.2% in all participants, irrespective of ART status, and 91.2% in those on ART . Drug use lowered adherence, and increased rates of ART change and ART interruptions. Virological failure on ART was more frequent in participants who reported concomitant drug injections while on opiate substitution, and in current IDUs , but not among noninjecting drug users. Conclusions Noninjecting drug use and injecting drug use are modifiable risks for death, and they lower retention in a cohort and complicate ART .
HIV Medicine - Tập 16 Số 3 - Trang 137-151 - 2015
HIV‐1 subtypes in Spain: a retrospective analysis from 1995 to 2003 Objective To perform a retrospective analysis of all HIV‐1 non‐B variants circulating in Spain from 1995 to 2003 and extend their virological characterization. Methods Samples from a total of 396 HIV‐infected subjects with epidemiological suspicion of being infected with non‐B clades were analysed during the study period. Subtyping was carried out on the protease (PR ), reverse transcriptase (RT ) and envelope (env ) genes. Results PR sequences belonging to non‐B subtypes were recognized in 43.2% of cases (23A, 13C, 6D, 3F, 118G, 3H, 4J and 1U). Subtype G and AG recombinants were the most frequent variants (69%), and were found most often in subjects from West and Central Africa. Up to 70% of pol (PR, RT ) sequences belonging to subtype G harboured env sequences belonging to clade A (55%), B (13.8%) or K (3.4%). Nearly half were mosaic GA viruses, and a few were CRF14_BG viruses. Up to 14 new recombinant viruses, which could not be assigned to previously described circulating recombinant forms (CRFs), were found. Conclusions There is great diversity in the HIV‐1 variants and recombinant viruses circulating in Spain. Non‐B sequences may be underestimated if only the env region is examined in phylogenetic analyses. Drug resistance testing provides the advantage of pol subtyping, and its additional use for this purpose should be encouraged.
HIV Medicine - Tập 6 Số 5 - Trang 313-320 - 2005
The effect of injecting drug use history on disease progression and death among HIV‐positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis Background We examined whether determinants of disease progression and causes of death differ between injecting drug users (IDUs) and non‐IDUs who initiate combination antiretroviral therapy (cART). Methods The ART Cohort Collaboration combines data from participating cohort studies on cART‐naïve adults from cART initiation. We used Cox models to estimate hazard ratios for death and AIDS among IDUs and non‐IDUs. The cumulative incidence of specific causes of death was calculated and compared using methods that allow for competing risks. Results Data on 6269 IDUs and 37 774 non‐IDUs were analysed. Compared with non‐IDUs, a lower proportion of IDUs initiated cART with a CD4 cell count <200 cells/μL or had a prior diagnosis of AIDS. Mortality rates were higher in IDUs than in non‐IDUs (2.08 vs. 1.04 per 100 person‐years, respectively; P <0.001). Lower baseline CD4 cell count, higher baseline HIV viral load, clinical AIDS at baseline, and later year of cART initiation were associated with disease progression in both groups. However, the inverse association of baseline CD4 cell count with AIDS and death appeared stronger in non‐IDUs than in IDUs. The risk of death from each specific cause was higher in IDUs than non‐IDUs, with particularly marked increases in risk for liver‐related deaths, and those from violence and non‐AIDS infection. Conclusion While liver‐related deaths and deaths from direct effects of substance abuse appear to explain much of the excess mortality in IDUs, they are at increased risk for many other causes of death, which may relate to suboptimal management of HIV disease in these individuals.
HIV Medicine - Tập 13 Số 2 - Trang 89-97 - 2012
Concomitant use of gastric acid‐reducing agents is frequent among HIV‐1‐infected patients receiving protease inhibitor‐based highly active antiretroviral therapy<sup>*</sup> Objective The aim of the study was to assess the frequency of the concurrent use of gastric acid‐reducing agents among HIV‐1‐infected patients treated with highly active antiretroviral therapy (HAART) combinations. Methods An anonymous, semistructured, self‐administered questionnaire was consecutively distributed among HIV‐1‐infected patients at routine visits to specialized HIV clinics. The questionnaire contained 17 items asking specifically for information on current antiretroviral treatments and the use of gastric acid‐reducing agents as well as demographic data. Results A total of 424 patients in 12 centres participated in the study: 85% were male, 88% were of German nationality, 82% were >35 years of age and 201 (47.4%) were receiving a protease inhibitor (PI)‐containing HAART regimen. Of these, 74 (37%) had received an acid‐reducing drug within the previous 6 months and 43 (58%) were currently still on it. Two‐thirds of patients (64.9%) were treated with proton‐pump inhibitors (pantoprazole, omeprazole or esomeprazole) and 56% of patients on PI‐containing regimens had been taking these drugs for longer than 2 months and up to a maximum of 3 years. The majority of patients (77%) had received the prescription for the acid‐reducing drugs from their HIV specialist and the remaining patients had received over the counter (OTC) medication or prescriptions from other medical personnel. Conclusions A substantial subset of patients treated with HAART combinations, including those on PI‐containing regimens, were using concomitant acid‐reducing drugs, most often proton‐pump inhibitors. As negative drug–drug interactions between some of the (boosted) PIs and gastric acid‐reducing agents have recently been reported, HIV physicians should take this into account when prescribing PI‐containing HAART combinations in order to avoid an additional risk of treatment failure.
HIV Medicine - Tập 8 Số 4 - Trang 220-225 - 2007
Clinical characteristics of monkeypox virus infections among men with and without <scp>HIV</scp>: A large outbreak cohort in Germany Abstract Background Since May 2022, increasing numbers of monkeypox virus (MPXV) infections have been reported from across Europe and North America. Studies, mainly from Africa, have suggested a higher risk for severe MPXV cases in people living with HIV. Methods This was a retrospective study of all confirmed MPXV infections observed in the participating centres since 19 May 2022. We conducted a chart review to evaluate clinical characteristics, comorbidities, and coinfections, including HIV, viral hepatitis, and sexually transmitted infections (STIs). Results By 30 June 2022, a total of 546 MPXV infections were reported from 42 German centres. All patients were men who have sex with men (MSM), of whom 256 (46.9%) were living with HIV, mostly with a preserved immune system and with viral suppression. In total, 232 (42.5%) MSM were also taking HIV pre‐exposure prophylaxis (PrEP) and 58 (10.6%) MSM had no known HIV infection or PrEP use. The median age was 39 years (range 20–67), and comorbidities were rare. However, 52.4% and 29.4% of all patients had been diagnosed with at least one STI within the last 6 months or within the last 4 weeks, respectively. The most frequent localizations of MPXV infection were genital (49.9%) and anal (47.9%), whereas fever (53.2%) and lymphadenopathy (42.6%) were the most frequent general symptoms. The hospitalization rate was low (4.0%), and no fatal course was observed. The clinical picture showed no apparent differences between MSM with or without HIV. Conclusions In this preliminary cohort analysis from a current large outbreak among MSM in Germany, the clinical picture of MPXV infection did not differ between MSM with and without HIV infection. Severe courses were rare and hospitalization rates were low. However, most patients were relatively healthy, and only a few people living with HIV were viremic or severely immunosuppressed.
HIV Medicine - Tập 24 Số 4 - Trang 389-397 - 2023
Outcome of smoking cessation counselling of <scp>HIV</scp>‐positive persons by <scp>HIV</scp> care physicians Objectives Smoking is the most prevalent modifiable risk factor for cardiovascular diseases among HIV ‐positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling. Methods The S wiss HIV C ohort S tudy (SHCS ) is a multicentre prospective observational database. Our single‐centre intervention at the Z urich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians' checklist for semi‐annual documentation of their counselling. Smoking status was then compared between participants at the Z urich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse. Results Between A pril 2000 and D ecember 2010, 11 056 SHCS participants had 121 238 semi‐annual visits and 64 118 person‐years of follow‐up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Z urich centre from N ovember 2007 to D ecember 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR ) 1.23; 95% confidence interval (CI ) 1.07–1.42; P OR 0.75; 95% CI 0.61–0.92; P SHCS institutions. The effect of the intervention was stronger than the calendar time effect (OR 1.19 vs. 1.04 per year, respectively). Middle‐aged participants, injecting drug users, and participants with psychiatric problems or with higher alcohol consumption were less likely to stop smoking, whereas persons with a prior cardiovascular event were more likely to stop smoking. Conclusions An institution‐wide training programme for HIV care physicians in smoking cessation counselling led to increased smoking cessation and fewer relapses.
HIV Medicine - Tập 13 Số 7 - Trang 387-397 - 2012
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