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Background:
The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression.
Methods:
A total of 3,780 patients from the EuroSIDA study under follow-up after 2001 with a current CD4(+) T-cell count ≤200...
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Some long-term non-progressors (LTNPs) have decreasing CD4 ⁺ T cell counts and progress to AIDS. Exploring which subsets of CD4 ⁺ T cell decreasing and the determinants associated with the decay in these patients will improve disease progression surveillance and provide further understanding of HIV pathogenesis.
Methods
Twenty-five LTNP...
The number of CD4 lymphocytes defines the evolutional stage of HIV-infection and is the most important for a reliable estimation of the individual risk of developing AIDS. However, it is difficult to predict the degree of immune reconstitution during antiretroviral therapy, as it varies significantly from one person to another. Further investigatio...
Background:
The impact of low levels of HIV RNA (low-level viremia; LLV) during combination antiretroviral therapy (cART) on clinical outcomes is unclear. We explored the associations between LLV and all-cause mortality, AIDS, and serious non-AIDS events (SNAE).
Methods:
We grouped individuals starting cART 1996-2017 (identified from the Swedish...
Human immunodeficiency virus (HIV) and cancer have been intimately linked since the first cases of HIV were identified after investigation of unusually high rates of Kaposi's sarcoma in patients without other risk factors. HIV not only impairs the immune system but also drives a chronic inflammatory response. The significance of the chronic inflamm...
Background
Existing literature mostly investigated the relationship of acute or short-term glucocorticoid exposure to HIV disease progression using cortisol levels in serum, saliva, or urine. Data are limited on the relationship of long-term glucocorticoid exposure to HIV disease progression. This study examined whether hair glucocorticoid levels,...
Citations
... Factors that affect mortality may be divided into clinical factors, such as gender or age; virological factors, such as the HIV subtype [20][21][22], viraemia at diagnosis and continuous suppression [23,24]; immunological factors, such as nadir CD4 lymphocyte count or immune recovery; and genetic factors, such as variants in human leukocyte antigen genes [25]and other genes [13]. This study was novel as it was a multi-centre study with a comprehensive analysis of the effect of immune restoration on the survival of PLWH. ...
Introduction
In recent years, a reduction in the life expectancy gap between people living with HIV (PLWH) and the general population has been observed, irrespective of CD4 lymphocyte count, due to widespread access to antiretroviral treatment. The increase in the life expectancy of PLWH has increased awareness of both the ageing process and gender discrepancies in immune restoration and survival.
Materials and Methods
Longitudinal data were collected for 2240 patients followed up at the Hospital for Infectious Diseases in Warsaw, Poland (n = 1482), and the Department of Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland (n = 758). Immune restoration was measured from the time of starting combination antiretroviral therapy until achieving 500 CD4 lymphocytes/μL, 800 CD4 lymphocytes/μL, and CD4/CD8 lymphocyte ratios of > 0.8 and > 1.0. Full recovery was achieved when the patient was restored to both 800 CD4 lymphocytes/μL and a CD4/CD8 lymphocyte ratio > 1.0.
Results
For all endpoints, immune restoration had a protective effect by reducing mortality. Patients who achieved immune restoration had a greater chance of reduced mortality than those who did not achieve immune restoration: for CD4 count > 500 cells/μL, HR = 5.4 (interquartile range: 3.09–9.41), p < 0.001; for CD4 > 800 cells/μL, HR = 5.37 (2.52–11.43), p < 0.001; for CD4/CD8 ratio > 0.8, HR = 3.16 (1.81–5.51), p < 0.001; for CD4/CD8 ratio > 1.0, HR = 2.67 (1.49–5.24), p = 0.001, and for full immune recovery, HR = 3.62 (1.63–8.04), p = 0.002.
Conclusions
Immune restoration remains a powerful factor in improving the survival of PLWH, regardless of the speed of recovery.
... One important question that has not been answered yet is whether or not osteoarthritis is more common and/or occurs at a younger age in this population in comparison with the general population. If so, this may have a significant impact on the overall benefit of cART [7][8][9][10][11]. Accentuated aging and early onset of selected non-infectious diseases in HIV-1-positive adults result in an increasing prevalence of pain (of various nature) in this population. ...
Background
Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.
Methods
We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.
Results
In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17–1.58]), time under specialist care (OR 2.25 [95%CI:1.42–35.7]), time on ART (OR2.96 [95%CI:1.60–5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06–1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92–8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014–0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06–1.55]).
Conclusions
The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
... One important question that has not been answered yet is whether or not osteoarthritis is more common and/or occurs at a younger age in this population in comparison with the general population. If so, this may have a significant impact on the overall benefit of cART [7,8,9]. Accentuated aging and early onset of selected non-infectious, non-communicable diseases in HIV-1-positive adults result in an increasing prevalence of pain (of various nature) in this population. ...
Background. Chronic pain in HIV-positive patients is a serious health problem that limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. We have attempted to answer the question if aging is more stronger risk factor for chronic pain in HIV-infected patients, than antiretroviral therapy (ART). Methods. This study was prospective, observational, cross-sectional study, including consecutive HIV-infected patients under specialist care. During their routine visit all patients reporting any pain were asked to fill in the Brief Pain Inventory (BPI) form and were subject to a brief examination performed by a physician who afterwards completed a Douleur Neuropathique en 4 Questions form (DN4). Logistic regression models were used to identify factors associated with chronic pain occurrence. Results. A total of 196 HIV-positive subjects, 96 (48.9% of the study group) of them reporting pain within the week prior to enrollment. The reported pain was mostly (75%) limited to a single area of the body (most commonly to the lower limbs). Pain duration was reported to be >6 months previous to study enrollment by 57 subjects (59.4% of those reporting pain). The patients with and without pain differed significantly in terms of age at study inclusion (with the median age of 45.3 years in the pain group vs. 39.6 years in the no pain group; p=0.0002); median duration of specialist care (10.8 years vs. 4.9 years, respectively; p=0.0008), median nadir CD4+ cell counts (168 cells/mcL vs. 253 cells/mcL), median duration of ART (8.5 years vs. 3.4 years; p=0.0046), viral rebound after complete suppression (5.1% vs. 38.3%; p=0.018), as well as previous treatment with zidovudine (44.6% vs. 30.5%; p=0.063) and ‘D’ drugs (33.9% vs. 11%; p=0.0004). Conclusions. The prevalence of chronic pain in the studied population of HIV-positive Polish patients was high in comparison with other HIV-positive and HIV-negative patient populations. The most prominent risk factor for chronic pain in the study group was age, which poses an important clinical and epidemiological problem due to the aging of the HIV-positive population.
... Thus far, the CD4+ cell count has been recognized and widely used as a marker for HIV-related disease progression. Conclusions from the present study indicate that the existence of munogenicity phenotype [23][24][25][26][27] . In the setting of untreated HIV infection, the CD4+/CD8+ cell ratio predicts progression to AIDS 24 . ...
... An inverse correlation between CD4+ cell counts and the presence of oral mucosal lesions in HIV-infected patients has been reported 8,21,25,26 . Similarly, the present study has found a significant inverse correlation between CD4+ cell counts and the prevalence of oral lesions in HIV-infected patients. ...
Objectives:
The objective of this study was to investigate the presence of oral lesions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in a descriptive cross-sectional study, and to establish their presence according to levels of CD4+ cells (including the CD4+/CD8+ cell ratio).
Materials and Methods:
A total of 75 patients infected with HIV were included. Oral lesions were observed and classified using World Health Organization classification guidelines. Potential correlations between the presence and severity of oral lesions and CD4+ cells, including the CD4+/CD8+ cell ratio, were studied.
Results:
The most frequent oral lesion detected was oral pseudomembranous candidiasis (80.0%), followed by periodontal disease (40.0%), herpetic lesions (16.0%), hairy leukoplakia (16.0%), gingivitis (20.0%), oral ulceration (12.0%), Kaposi’s sarcoma (8.0%), and non-Hodgkin’s lymphoma (4.0%). The CD4+ count was <200 cells/mm3 in 45 cases (60.0%), between 200-500 cells/mm3 in 18 cases (24.0%), and >500 cells/mm3 in 12 cases (16.0%). The mean CD4+ count was 182.18 cells/mm3. The mean ratio of CD4+/CD8+ cells was 0.26. All patients showed at least one oral manifestation.
Conclusion:
There was no correlation between the CD4+/CD8+ cell ratio and the presence of oral lesions. The severity of the lesions was more pronounced when the CD4+ cell count was less than 200 cells/mm3.
... Numerous studies have documented the dramatic decline in the incidence of HIV-related OIs among cohorts of patients with reliable access to effective ART [9][10][11][12][13]. By suppressing plasma HIV RNA levels and by increasing CD4 cell counts, ART reduces the risk of developing HIV-associated OIs and malignancies [14]. ...
... More than half of all HIV-infected persons in the United States live in 12 urban areas where access to care is especially uneven [16][17][18][19]. Extensive studies of the various steps in the "HIV treatment cascade"-from diagnosis of infection to suppression of plasma HIV RNA-have documented that in the United States, both as a whole and regionally, <25% of HIV-infected individuals are aware they are infected, linked and retained in continuous care, prescribed effective ART and OI prophylaxis (when indicated), and virologically suppressed [13,14,[16][17][18][19][20][21]. The reasons for this stunning gap are numerous. ...
In May 2013, a revised and updated version of the Centers for Disease Control and Prevention/National Institutes of Health/HIV
Medicine Association Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents
was released online. These guidelines, since their inception in 1989, have been widely accessed in the United States and abroad.
These guidelines have focused on the management of HIV/AIDS-related opportunistic infections that occur in the United States.
In other parts of the world, the spectrum of complications may be different and the resources available for diagnosis and
management may not be identical to those in the United States. The sections that have been most extensively updated are those
on immune reconstitution inflammatory syndrome, tuberculosis, hepatitis B, hepatitis C, human papillomavirus, and immunizations.
The guidelines will not be published in hard copy form. This document will be revised as needed throughout each year as new
data become available.
... Malignancies (n = 23, 27%) were also the most common causes of death. 42 (17%) fatal or non-fatal non-AIDS events occurred in ID patients (rate 53/1,000PYFU [95% CI 38-72]) vs. 199 (83%) in patients without ID (rate 19/1,000PYFU [95% CI [16][17][18][19][20][21]) p,0.001 ( Figure 2). ...
... Previous analyses of EuroSIDA data demonstrated that current CD4 count is a significant predictor of the risk of non-AIDS events although the association was less strong than that found for AIDS events [11,17]. More specifically, it was previously shown, that those with a current CD4 count of ,200 cells/ml and with suppressed viraemia on cART have lower rates of AIDS and, to a lesser extent, non-AIDS events compared to patients with ongoing viral replication [18]. The potential independent role of ID had not been investigated in this analysis. ...
The impact of immunosuppression despite virological suppression (immuno-virological discordance, ID) on the risk of developing fatal and non-fatal AIDS/non-AIDS events is unclear and remains to be elucidated.
Patients in EuroSIDA starting at least 1 new antiretroviral drug with CD4<350 cells/µl and viral load (VL)>500 copies/mL were followed-up from the first day of VL< = 50 copies/ml until a new fatal/non-fatal non-AIDS/AIDS event. Considered non-AIDS events included non-AIDS malignancies, pancreatitis, severe liver disease with hepatic encephalopathy (>grade 3), cardio- and cerebrovascular events, and end-stage renal disease. Patients were classified over time according to whether current CD4 count was above (non-ID) or below (ID) baseline level. Relative rates (RR) of events were calculated for ID vs. non-ID using adjusted Poisson regression models.
2,913 patients contributed 11,491 person-years for the analysis of non-AIDS. 241 pre-specified non-AIDS events (including 84 deaths) and 89 AIDS events (including 10 deaths) occurred. The RR of developing pre-specified non-AIDS events for ID vs. non-ID was 1.96 (95% CI 1.37-2.81, p<0.001) in unadjusted analysis and 1.43 (0.94-2.17, p = 0.095) after controlling for current CD4 count. ID was not associated with the risk of AIDS events (aRR 0.76, 95% CI 0.41-1.38, p = 0.361).
Compared to CD4 responders, patients with immuno-virological discordance may be at increased risk of developing non-AIDS events. Further studies are warranted to establish whether in patients with ID, strategies to directly modify CD4 count response may be needed besides the use of ART.
Background. Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.
Methods. We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.
Results. In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17-1.58]), time under specialist care (OR 2.25 [95%CI:1.42-35.7]), time on ART (OR2.96 [95%CI:1.60-5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06-1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92-8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014-0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06-1.55]).
Conclusions. The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
Background. Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.
Objectives: The purpose of this study was to determine the prevalence of chronic pain in the HIV-infected population remaining under continuous specialist care, as well as the underlying causative factors of such pain.
Methods. We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.
Results. In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17-1.58]), time under specialist care (OR 2.25 [95%CI:1.42-35.7]), time on ART (OR2.96 [95%CI:1.60-5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06-1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92-8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014-0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06-1.55]).
Conclusions. The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
Background. Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.
Methods. We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form andDouleur Neuropathique en 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.
Results. In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body..In univariate logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17-1.58]), time under specialist care (OR 2.25 [95%CI:1.42-35.7]), time on ART (OR2.96 [95%CI:1.60-5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06-1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92-8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014-0.75]). In multivariate analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06-1.55]).
Conclusions. The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
Background Chronic pain in HIV-positive patients is a serious health problem that limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained.Methods During their routine visit patients were asked to fill in a general information form and the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) form. All patients reporting any pain were additionally asked to fill in the Brief Pain Inventory (BPI) form and were subject to a brief examination performed by a physician who afterwards completed a Douleur Neuropathique en 4 Questions form (DN4). Logistic regression models were used to identify factors associated with chronic pain occurrence.Results A total of 196 HIV-positive subjects, 96 (48.9% of the study group) of subjects reporting pain within the week prior to enrollment. The reported pain was mostly (75%) limited to a single area of the body (most commonly to the lower limbs). Pain duration was reported to be >6 months previous to study enrollment by 57 subjects (59.4% of those reporting pain). Most subjects were undergoing combination antiretroviral therapy (cART).Conclusions The prevalence of chronic pain in the studied population of HIV-positive Polish patients was high in comparison with other HIV-positive and HIV-negative patient populations. The most prominent risk factor for chronic pain in the study group was age, which poses an important clinical and epidemiological problem due to the aging of the HIV-positive population. It is imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
