07 May 2009
Plasma Levels of Bacterial DNA Correlate with Immune Activation and the Magnitude of Immune Restoration in Persons with Antiretroviral-Treated HIV Infection.
Jiang W et al. J Infect
Dis 2009;199:1177–85.
• The study compared plasma levels of LPS in individuals with chronic HIV infection and uninfected individuals by measuring bacterial 16S rDNA.
• Plasma levels of 16S rDNA were significantly higher in HIV-infected than in uninfected individuals and they correlated with LPS levels.
• Higher levels of 16S rDNA were associated with higher levels of T-cell activation and with lower levels of CD4 T-cell restoration during ART. ART reduces but does not fully normalize plasma levels of bacterial 16S rDNA.
• Conclusion: The results are consistent with the importance of microbial translocation in immunodeficiency and T-cell homeostasis in chronic HIV infection.
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14 May 2009
Comparison of glomerular filtration rate estimates vs. 24-h creatinine clearance in HIV-positive patients.
Ravasi G et al.
HIV Med 2009;10:219–28.
• This study compared kidney function estimates (Cockcroft-Gault [CG], original and simplified modification of diet in renal disease [MDRD] equations) with measured 24-hour creatinine clearance (CrCl) in HIV-positive individuals.
• In a univariate analysis, male gender, CD4 nadir, hepatitis B virus co-infection, blood urea nitrogen (BUN) and current CD4 cell count showed a significant positive correlation (p<0.2) with the difference between measured 24-h CrCl and either CG or simplified MDRD estimates. In a multivariate analysis, only BUN showed a significant positive correlation (p<0.05).
• Conclusions: Estimates of kidney function were lower than 24-hour CrCl measurements. CG and simplified MDRD estimates showed a satisfactory correlation.
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24 August 2009
Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis.
Gupta RK, Hill A, Sawyer AW, Cozzi-Lepri A et al.
Lancet Infect Dis. 2009;9:409–17.
• This meta-analysis assessed the effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations by reviewing studies reporting resistance in patients infected with HIV and a CD4 count of <200 cells/μL treated with two NRTIs and an NNRTI.
• Resistance at VF to NNRTIs at 48 weeks was 88.3% (95% CI: 82.2–92.9) in infrequently monitored patients, compared with 61.0% (95% CI: 48.9–72.2) in frequently monitored patients (p<0.001).
• Lamivudine resistance was 80.5% (95% CI: 72.9–86.8) and 40.3% (95% CI: 29.1–52.2) in infrequently and frequently monitored patients, respectively (p<0.001).
• The prevalence of at least one thymidine analogue mutation was 27.8% (95% CI: 21.2–35.2) and 12.1% (95% CI: 5.9–21.4), respectively (p<0.001).
• Genotypic resistance at 48 weeks to lamivudine, NRTIs and NNRTIs was substantially higher in patients who were less frequently monitored.
• Conclusion: There is a need for cheap point-of-care VL tests to identify early viral failures and limit the emergence of resistance.
Link
11 January 2010
Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial.
DART Trial Team.
Lancet [Epub ahead of print
• This study investigated the possible long-term effects on clinical outcomes of routine toxicity and efficacy monitoring of HIV+ patients receiving ART in Uganda and Zimbabwe.
• HIV+ adults with CD4 counts >200 cells/μL starting ART were randomly assigned to laboratory and clinical monitoring or clinically driven monitoring.
• The primary endpoints were new WHO stage 4 HIV events or death and serious adverse events.
• In the clinically driven monitoring group, 459 (28%) patients versus 356 (21%) in the laboratory and clinical monitoring had a new WHO stage 4 event or died (p=0.0001) and 283 (17%) versus 260 (16%) patients had a new serious adverse event (HR 1.12 [95% CI: 0.94–1.32]; p=0.19).
• Conclusions: ART can be delivered safely without routine laboratory monitoring. Differences in disease progression suggest a role for CD4-cell count monitoring to guide the switch to second-line treatment from the second year of ART.
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