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Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users.

https://arctichealth.org/en/permalink/ahliterature183497
Source
CMAJ. 2003 Sep 30;169(7):656-61
Publication Type
Article
Date
Sep-30-2003
Author
Evan Wood
Julio S G Montaner
Benita Yip
Mark W Tyndall
Martin T Schechter
Michael V O'Shaughnessy
Robert S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC. ewood@hivnet.ubc.ca
Source
CMAJ. 2003 Sep 30;169(7):656-61
Date
Sep-30-2003
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active
British Columbia
CD4 Lymphocyte Count
Female
HIV Infections - blood - drug therapy - etiology
HIV-1
Humans
Male
Patient compliance
RNA, Viral - blood - drug effects
Substance Abuse, Intravenous
Abstract
The benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV infection are well documented, but concerns regarding access and adherence to HAART are growing. We evaluated virological responses to HAART among HIV-1 infected patients who were injection drug users (IDUs) in a population-based setting where HIV/AIDS care is delivered free of charge.
We evaluated previously untreated HIV-1 infected men and women who initiated HAART between Aug. 1, 1996, and July 31, 2000, and who were followed until Mar. 31, 2002, in a province-wide HIV treatment program. We used Kaplan-Meier methods and Cox proportional hazards regression in our evaluation of time to suppression (i.e., less than 500 copies/mL) and rebound (i.e., 500 copies/mL or more) of plasma HIV-1 RNA, with patients stratified according to whether or not they had a history of injection drug use.
Overall, 1422 patients initiated HAART during the study period, of whom 359 (25.2%) were IDUs. In Kaplan-Meier analyses, the cumulative suppression rate at 12 months after initiation of HAART was 70.8% for non-IDUs and 51.4% for IDUs (p 0.1).
Non-IDUs and IDUs had similar rates of HIV-1 RNA suppression and rebound after the initiation of HAART, once lower levels of adherence were taken into account. Nevertheless, the lower virological response rates among IDUs suggest that, unless interventions are undertaken to improve adherence, these patients may experience elevated rates of disease progression and use of medical services in our setting.
Notes
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PubMed ID
14517122 View in PubMed
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Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature135422
Source
AIDS Care. 2011 Aug;23(8):980-7
Publication Type
Article
Date
Aug-2011
Author
Seonaid Nolan
M-J Milloy
Ruth Zhang
Thomas Kerr
Robert S Hogg
Julio S G Montaner
Evan Wood
Author Affiliation
BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Source
AIDS Care. 2011 Aug;23(8):980-7
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - statistics & numerical data
Canada
Cohort Studies
Drug Users - psychology
Female
HIV Infections - blood - drug therapy - psychology
Humans
Kaplan-Meier Estimate
Male
Medication Adherence
Middle Aged
Patient compliance
Proportional Hazards Models
RNA, Viral - blood - drug effects
Substance Abuse, Intravenous
Treatment Outcome
Young Adult
Abstract
HIV-positive individuals who use injection drugs (IDU) may have lower rates of adherence to highly active antiretroviral therapy (ART). However, previous studies of factors associated with adherence to ART among IDU have been limited primarily to samples drawn from clinical settings and in areas with financial barriers to healthcare.We evaluated patterns of ART adherence and rates of plasma HIV RNA response among a Canadian cohort of community-recruited IDU. Using data from a community-recruited cohort of antiretroviral-naive HIV-infected IDU, we investigated ART adherence patterns based on prescription refill compliance and factors associated with time to plasma HIV-1 RNA suppression (
PubMed ID
21480010 View in PubMed
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Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda.

https://arctichealth.org/en/permalink/ahliterature291297
Source
AIDS Behav. 2017 Nov; 21(Suppl 2):204-215
Publication Type
Journal Article
Date
Nov-2017
Author
Stephen B Asiimwe
Robin Fatch
Gregory Patts
Michael Winter
Christine Lloyd-Travaglini
Nneka Emenyonu
Winnie Muyindike
Allen Kekibiina
Elena Blokhina
Natalia Gnatienko
Evgeny Kruptisky
Debbie M Cheng
Jeffrey H Samet
Judith A Hahn
Author Affiliation
Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda. asiimwesteve@gmail.com.
Source
AIDS Behav. 2017 Nov; 21(Suppl 2):204-215
Date
Nov-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Alcohol Drinking - adverse effects - epidemiology
Alcoholic Beverages - adverse effects
Beer
Disease Progression
Female
HIV Infections - blood - drug therapy - virology
Humans
Male
Middle Aged
RNA, Viral - blood
Risk
Russia - epidemiology
Substance Abuse, Intravenous - epidemiology
Uganda
Viral Load
Wine
Young Adult
Abstract
In HIV-infected drinkers, alcohol types more likely to cause inflammation could plausibly increase the risk of HIV disease progression. We therefore assessed the association between alcohol type and plasma HIV RNA level (HIV viral load) among HIV-infected drinkers not on antiretroviral therapy (ART) in Russia and Uganda. We analyzed the data of participants from cohorts in Russia and Uganda and assessed their HIV viral load at enrollment by the alcohol type predominantly consumed. We defined predominant alcohol type as the alcohol type contributing >50% of total alcohol consumption in the 1 month (Russia) or 3 months (Uganda) prior to enrollment. Using multiple linear regression, we compared log10 HIV viral load by predominant alcohol type, controlling for age, gender, socioeconomic status, total number of standard drinks, frequency of drinking =6 drinks/occasion, and in Russia, history of injection drug use. Most participants (99.2% of 261 in Russia and 98.9% of 352 in Uganda) predominantly drank one alcohol type. In Russia, we did not find evidence for differences in viral load levels between drinkers of fortified wine (n = 5) or hard liquor (n = 49), compared to drinkers of beer/low-ethanol-content cocktails (n = 163); however, wine/high-ethanol-content cocktail drinkers (n = 42) had higher mean log10 viral load than beer/low-ethanol-content cocktail drinkers (ß = 0.38, 95% CI 0.07-0.69; p = 0.02). In Uganda, we did not find evidence for differences in viral load levels between drinkers of locally-brewed beer (n = 41), commercially-distilled spirits (n = 38), or locally-distilled spirits (n = 43), compared to drinkers of commercially-made beer (n = 218); however, wine drinkers (n = 8) had lower mean log10 HIV viral load (ß = -0.65, 95% CI -1.36 to 0.07, p = 0.08), although this did not reach statistical significance. Among HIV-infected drinkers not yet on ART in Russia and Uganda, we observed an association between the alcohol type predominantly consumed and the HIV viral load level in the Russia sample. These exploratory results suggest that, in addition to total number of drinks and drinking patterns, alcohol type might be a dimension of alcohol use that merits examination in studies of HIV and alcohol related outcomes.
Notes
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PubMed ID
28856539 View in PubMed
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Becoming a "treatment success": what helps and what hinders patients from achieving and sustaining undetectable viral loads.

https://arctichealth.org/en/permalink/ahliterature169246
Source
AIDS Patient Care STDS. 2006 May;20(5):326-34
Publication Type
Article
Date
May-2006
Author
Victoria Alfonso
Josie Geller
Nicole Bermbach
Anne Drummond
Julio S G Montaner
Author Affiliation
Canadian HIV Clinical Trials Network, St. Paul's Hospital/BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada. valfonso@cfenet.ubc.ca
Source
AIDS Patient Care STDS. 2006 May;20(5):326-34
Date
May-2006
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - psychology
British Columbia - epidemiology
Cost of Illness
Drug Administration Schedule
Female
HIV Infections - blood - drug therapy - epidemiology - virology
Humans
Interviews as Topic
Male
Middle Aged
Qualitative Research
Task Performance and Analysis
Treatment Outcome
Treatment Refusal - statistics & numerical data
Urban Health Services - utilization
Viral Load
Abstract
Highly active antiretroviral therapy (HAART) adherence research has focused predominantly on individuals with less than optimal clinical outcomes; therefore, little is known about the experiences of individuals who sustain undetectable viral loads. The present study used a qualitative method to explore how individuals who have sustained undetectable viral loads account for their success, and to identify challenges, as well as possible needs, for continued success. Participants were 20 patients at an outpatient infectious disease clinic in an urban center. Participants completed two 60-minute interviews. The Critical Incident Technique was used to identify and classify critical incidents linked with sustaining treatment success. Of the 438 critical incidents collected, 316 were identified as helpful and 122 were identified as unhelpful. Helpful categories included resolving ambivalence, using personal strengths, and fostering helpful relationships. Unhelpful categories were mood, lack of social support, financial difficulties, and medication factors. Doing well on antiretroviral therapy is a dynamic process that requires ongoing attention from both the patient and care provider. The results of this study highlight the efforts of patients to maintain their health and remind care providers not to assume that patients are not facing continuous challenges. Findings from the present study suggest that psychosocial factors do contribute to improved clinical outcomes in patients taking HAART.
PubMed ID
16706707 View in PubMed
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Clindamycin resistant emm33 Streptococcus pyogenes emerged among invasive infections in Helsinki metropolitan area, Finland, 2012 to 2013.

https://arctichealth.org/en/permalink/ahliterature269550
Source
Euro Surveill. 2015;20(18)
Publication Type
Article
Date
2015
Author
A K Pesola
R. Sihvonen
L. Lindholm
A. Pätäri-Sampo
Source
Euro Surveill. 2015;20(18)
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Clindamycin - pharmacology
Drug Resistance, Bacterial - genetics
Erythromycin - pharmacology
Female
Finland
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Phenotype
Streptococcal Infections - blood - drug therapy - epidemiology
Streptococcus pyogenes - drug effects - genetics - isolation & purification
Urban Population
Abstract
In 2012, blood, skin and soft tissue infections caused by clindamycin resistant Streptococcus pyogenes (group A streptococcus; GAS) appeared to be increasing in the Helsinki metropolitan area. We compared monthly percentages of clindamycin resistant isolates in the area between 2012 and 2013, with those in 2010 and 2011. Resistance frequency in terms of patient age was also studied. We reviewed the medical records of bacteraemic cases in 2012 and 2013 and linked the data to emm types. To inform on the emm distribution among GAS isolated from skin and soft tissue infections during the epidemic, GAS isolates of one month (March 2013) were emm typed. For GAS blood, skin, and soft tissue isolates taken together, the proportions of clindamycin resistant isolates were significantly higher in 2012 and 2013 (23% and 17%, respectively) compared with the two previous years (3%, p
PubMed ID
25990232 View in PubMed
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Driveline infections in patients supported with a HeartMate II: incidence, aetiology and outcome.

https://arctichealth.org/en/permalink/ahliterature134820
Source
Scand Cardiovasc J. 2011 Oct;45(5):273-8
Publication Type
Article
Date
Oct-2011
Author
Tobias Bomholt
Claus Moser
Kaare Sander
Søren Boesgaard
Lars Køber
Peter Skov Olsen
Peter Bo Hansen
Svend-Aage Mortensen
Finn Gustafsson
Author Affiliation
Rigshospitalet, Department of Cardiology, University Hospital of Copenhagen, Denmark.
Source
Scand Cardiovasc J. 2011 Oct;45(5):273-8
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - therapeutic use
Biological Markers - blood
C-Reactive Protein - analysis
Chi-Square Distribution
Denmark - epidemiology
Escherichia coli - isolation & purification
Escherichia coli Infections - blood - drug therapy - epidemiology - microbiology
Female
Heart Failure - therapy
Heart-Assist Devices - adverse effects
Humans
Incidence
Kaplan-Meier Estimate
Leukocyte Count
Male
Middle Aged
Predictive value of tests
Prosthesis Design
Prosthesis-Related Infections - blood - epidemiology - microbiology - therapy
Retrospective Studies
Risk assessment
Risk factors
Sensitivity and specificity
Staphylococcal Infections - blood - drug therapy - epidemiology - microbiology
Staphylococcus aureus - isolation & purification
Treatment Outcome
Young Adult
Abstract
To investigate the incidence and outcome of driveline infections in patients supported with a continuous flow left ventricular assist device (HeartMate II (HMII)) and to study the microbiological aetiology.
Retrospective analysis of 31 patients who received an implantation of a HMII. Follow-up was from implantation to either device explantation, death or closure of the study. Clinical signs of infections were divided into superficial, deep or systemic and compared to culture and gram stain, the clinical course and infectious parameters.
The incidence of driveline infections was 1.65 episodes per patient per year. Staphylococcus aureus and Escherichia coli were the most common bacterial aetiology. More than two weeks of treatment was required in 81% of the patients. In terms of detecting superficial driveline infections, leucocyte count demonstrated a sensitivity of 27% and C-reactive protein (CRP) a sensitivity of 28%. In 22 cases of driveline infections plasma pro-calcitonin was found to be normal.
Driveline infections are common in HMII recipients but primarily remain superficial and are reasonably easy to manage. Infectious agents mostly originate from the skin and gastrointestinal tract. Blood biomarkers did not appear to be helpful in detecting driveline infections.
PubMed ID
21539474 View in PubMed
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Evidence for polymicrobic flora translocating in peripheral blood of HIV-infected patients with poor immune response to antiretroviral therapy.

https://arctichealth.org/en/permalink/ahliterature135256
Source
PLoS One. 2011;6(4):e18580
Publication Type
Article
Date
2011
Author
Esther Merlini
Francesca Bai
Giusi Maria Bellistrì
Camilla Tincati
Antonella d'Arminio Monforte
Giulia Marchetti
Author Affiliation
Department of Medicine, Surgery and Dentistry, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy.
Source
PLoS One. 2011;6(4):e18580
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active
CD4-Positive T-Lymphocytes - immunology
DNA, Ribosomal - metabolism
Female
HIV Infections - blood - drug therapy - immunology - microbiology
Humans
Immunity - immunology
Lymphopenia - complications - immunology - microbiology
Male
Metagenome
Middle Aged
Abstract
In advanced HIV infection, the homeostatic balance between gastrointestinal indigenous bacteria and gut immunity fails and microbes are able to overcome the intestinal barrier and gain the systemic circulation. Because microbial translocation is not fully controlled by antiviral therapy and is associated with inefficient CD4+ reconstitution, we investigated the profile of translocating bacteria in peripheral blood of 44 HIV-infected patients starting therapy with advanced CD4+ T-lymphopenia and displaying poor CD4+ recovery on virologically suppressive HAART. According to CD4+ reconstitution at 12-months HAART, patients were considered Partial Immunological Responders, PIRs (CD4+=250/µl, n?=?29) and Immunological non Responders, INRs (CD4+
Notes
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PubMed ID
21494598 View in PubMed
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Immunologic markers of AIDS progression: consistency across five HIV-infected cohorts. Multicohort Analysis Project Workshop. Part I.

https://arctichealth.org/en/permalink/ahliterature217872
Source
AIDS. 1994 Jul;8(7):911-21
Publication Type
Article
Date
Jul-1994
Source
AIDS. 1994 Jul;8(7):911-21
Date
Jul-1994
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Antiviral agents - therapeutic use
Biological Markers - analysis
CD4 Lymphocyte Count
Cohort Studies
Comorbidity
Databases, Factual
Disease Progression
District of Columbia - epidemiology
Female
HIV Antibodies - blood
HIV Infections - blood - drug therapy - epidemiology - immunology
HIV Seropositivity
Homosexuality, Male
Humans
Immunoglobulin A - blood
Italy - epidemiology
Life tables
London - epidemiology
Male
Middle Aged
New York City - epidemiology
Ontario - epidemiology
Prognosis
Regression Analysis
Risk
Risk factors
Scotland - epidemiology
Sex Factors
Sexual Behavior
Substance Abuse, Intravenous - epidemiology
Survival Analysis
Time Factors
Zidovudine - therapeutic use
beta 2-Microglobulin - analysis
Abstract
To provide background on five HIV-infected cohorts with documented seroconversion times and serum immunoglobulin (Ig) A and beta 2-microglobulin (beta 2M), CD4+ cell count and haemoglobin levels. To give a relative risks (RR) regression summary of the prognostic value of serial CD4+ cell count, IgA, beta 2M and haemoglobin measurements for clinical AIDS, and to examine whether cofactors such as current age, sex and exposure category affect these RR.
The Multicohort Analysis Project (MAP) workshop was an international collaboration which brought statisticians, immunologists and clinicians from the five cohorts to work together for 10 days. A predefined restricted database was made available by each cohort for the workshop.
The Medical Research Council (MRC) Biostatistics Unit, Cambridge, UK hosted the MAP workshop from 19 to 30 April 1993.
MAP workshop database comprised 1744 patients with documented HIV seroconversion times, with 407 women, over 900 injecting drug users (IDU) and over 500 homosexual men; 363 patients had AIDS and there were 308 deaths.
Descriptive statistics on survival and progression to clinical AIDS by cohort and exposure category, CD4+ cell count at AIDS diagnosis and pre-AIDS zidovudine therapy. RR summarizing the joint prognostic significance of serial markers and cofactors such as age, sex and exposure category for progression to clinical AIDS.
Slower progression to AIDS for IDU [95% confidence interval (CI), 0.35-0.71] and heterosexuals (95% CI, 0.19-0.98) compared with homosexual men was confirmed after adjusting for current age-group and serial CD4+ cell counts. CD4+ cell counts at AIDS diagnosis were much higher among homosexual men before than after 1988 (median, 150 and 90 x 10(6)/l, respectively). Little zidovudine use was observed among AIDS cases diagnosed before 1988 (2%) but increased use was recorded after 1988 and 1989 (24%) and even greater use after 1990 (59%). Low serial CD4+ cell count, haemoglobin levels and high serum IgA and beta 2M levels were associated with an increased risk of progression to AIDS. CD4+ cell count always provided prognostic information in addition to other markers; IgA and beta 2M (95% CI, 1.23-1.50 and 105-1.51, respectively) were jointly prognostic. beta 2M did not provide significant extra information (95% CI, 0.91-1.47) to the combination of serial CD4+ cell count and IgA, although haemoglobin did (95% CI: 0.74-0.91 for 10 g/l increase in haemoglobin). Interactions between cofactors, particularly exposure category and serial markers, were used to test for modifications in RR. The association between AIDS risk and serial CD4+ cell count was weaker, and with elevated IgA stronger, for homosexual men; RR associated with high beta 2M values were lower for IDU, in whom beta 2M may be elevated for reasons other than HIV disease.
IgA and beta 2M, which can be measured in small volumes of stored blood, are jointly predictive of progression to AIDS. Results were broadly consistent between cohorts representing different age-groups, seroconversion periods and exposure categories. Some regression effect modifications by exposure category were noted, however, which merit further independent study.
PubMed ID
7946100 View in PubMed
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35 records – page 1 of 4.