Revista de SIDA e investigación clínica

Spinal epidural lipomatosis (SEL) is an abnormal accumulation of normal adipose tissue in the extradural space within the spinal canal that can lead to notable spinal cord compression. It is most commonly reported in patients receiving chronic glucocor¬ticoids. Other causes can include obesity and hypercortisolism. Unusually, SEL may occur in human immunodeficiency virus (HIV)-infected patients, and has been attributed to the lipodystrophy and altered fat metabolism associated with antiretrovirals. We describe a 56-year-old, HIV-infected, non-obese woman with satisfactory immunovirological indices on combined antiretroviral therapy who developed debilitating back pain initially attributed to osteoarthritis. A thorough neurological work-up with magnetic resonance imaging (MRI) led to the diagnosis of rapidly progressive SEL that was not associated with any of its common etiologies.

Objective: Adiponectin is a plasma protein with anti-inflammatory and anti-atherogenic effects. Low levels of circulating adiponectin have been reported in HIV-infected patients. However, there are no studies in India on adiponectin levels in HIV-infected antiretroviral-treated and treatment-naïve subjects. Therefore, we estimated adiponectin levels in HIV-positive individuals and investigated their associations with antiretroviral therapy (ART) and lipid profile.

Materials and methods: Consenting HIV-infected and non-infected men and women were recruited from Namakkal district, Tamilnadu, India. A semi structured questionnaire was administered in the local language (Tamil) to all patients which included socio-demographics, and details on ART. Fasting blood samples were collected and anthropometric measurements obtained. Serum adiponectin levels and lipid profile levels were determined.

Results: Adiponectin levels were measured in 139 individuals of whom sixty four individuals were on ART, 36 were ART naïve, and 39 were HIV-negative subjects. HIV-infected patients had significantly lower adiponectin levels than the HIV-uninfected (p=0.000). HIV-positive patients had a 17.92-fold decrease in adiponectin values when compared to HIV-negative controls. Also, patients on ART had a 21-fold decrease in adiponectin levels when compared to ARTnaïve patients. Moreover, patient’s currently or previously receiving stavudine treatment had a 3.8-fold decrease in adiponectin levels when compared to those who had never received stavudine. Regarding lipid profile, high density lipoprotein (HDL) - cholesterol was positively associated with adiponectin (p=0.004) while very low density lipoprotein (VLDL) - cholesterol (p=0.017) and triglycerides (p=0.017) showed a negative association in patients on ART. Adiponectin concentration in patients on ART with dyslipidemia was significantly decreased as compared to those without dyslipidemia (p=0.030).

Conclusion: Serum adiponectin levels were lower in this HIV-infected South Indian population as compared to HIVnegative controls. Stavudine seemed to influence adiponectin levels. The significant association between ART-induced hypoadiponectinemia and adverse changes in lipid profile suggests a higher risk of atherosclerosis in this population.

Introduction: The HIV infection rate has fallen sharply among pregnant women in the Republic of Congo (ROC), declining from 4.2% in 2003 to 2.5% in 2013. However, the rate of HIV vertical transmission observed in Congo is about 34% and the mortality rate of children born to HIV-positive mothers is high. Since the implementation of the program for the Prevention of Mother-to-Child HIV Transmission (PMTCT) in 2002, all prevention activities are based on the collaboration with Ambulatory Treatment Centers (CTA) and the Kento-Mwana project. The Ministry of Health in the ROC is in the process of establishing a new PMTCT strategy to reach a country-wide coverage.

Objective: This review aims at examining the implementation of PMTCT in the ROC.

Methodology: We searched for papers in the PubMed database with keywords related to Congo, HIV, PMTCT and pregnancy. Results were then manually curated. The subset of PubMed papers was enriched with reports from WHO, UNAIDS, UNICEF and from Congolese health institutions (written in English or in French).

Finding: Maternal HIV infection remains a public health concern, not only for pregnant women but also for children whose vertical transmission could be canceled if adapted therapeutic strategies are applied. The challenges are still many to come to an elimination of pediatric HIV, including the refusal of HIV testing by pregnant women and the difficulty in obtaining HIV PCR tests. It is therefore imperative for the Ministry of Health in the ROC to establish a national PMTCT strategy to cover most of the health facilities in the country

Objectives: We evaluated the HIV-1 subtype diversity, clinical, genetic and epidemiological profiles of a cohort of long-term non-progressor (LTNPs) followed-up at a referral hospital in southern Brazil.

Methods: This prospective study included patients who had more than eight years of HIV-1 diagnosis without antiretroviral therapy (ART). Clinical and epidemiological profiles of LTNPs were obtained from interviews and medical records. Periodic blood draws were taken to determine HIV-1 genetic variability and host genetic patterns.

Results: The study included 22 LTNPs, corresponding to 1.57% of patients followed-up at the Infectious Diseases Division. The gender distribution was nearly homogeneous, median age was 45 years; 18% were elite controllers, 23% were viremic controllers and 59% were non-viremic controllers. Three out of 22 patients were heterozygous for the CCR5Δ32 genotype. In most study patients, receptor use was consistent with an R5 phenotype. HIV-1 genotyping showed subtype C in 50% (11/22) of patients, subtype B in 32% (7/22), and the recombinant forms BF and BC in 14% (3/22) and 4% (1/22), respectively. There was a significant association of subtype C with female patients, and LTNPs patients infected with subtype C had lower viral loads compared with those infected with subtype B.

Conclusions: The HIV/AIDS epidemic in Brazil is complex, and there are variations in the subtype distribution. This is the first study of LTNPs in the southern region of Brazil, and the data obtained will help to characterize this group and aid in determining the probable mechanisms associated with delayed clinical progression.

Background: Renal impairment is increasingly reported among HIV-Infected patients and has been associated to an increased chance of cardiovascular disease and death. Therefore, early identification of this problem could help to reduce morbidity and mortality among these individuals. The objective of the study was to determine the prevalence and associated factors with mild decrease in renal function of HIV-infected patients on highly-active antiretroviral therapy (HAART) and undetectable viral load in Brazil.

Methods: Individuals between 18-70 years of age with time on HAART ≥ 12 months, viral load < 50 copies/mm3, and CD4 ≥ 200 cells/mm3, were consecutively enrolled at the outpatient clinic of Hospital de Clínicas de Porto Alegre, Brazil. Exclusion criteria were chronic kidney disease, pregnancy and known hepatic disease. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration equation. Mild decrease in renal function was defined as an estimated glomerular filtration rate between 89-60 mL/min/1.73m2, for a period of at least 3 months.

Results: From the total of 213 enrolled volunteers, 193 were included in the final analysis. The mean age was 41.5 years, 102 were men (52.6%), and 156 (80.4%) were euro-descendants. Mild renal decline was diagnosed in 33.5% of the patients. Every other year of life (RR=1.05, 95%CI 1.03-1.06, p<0.001) and being euro-descendant (RR=1.94; 95%CI 1.07-3.78; p=0.049) were associated to mild decreases, whereas high body mass index (BMI) (RR=1.04, 95% CI 1.013-1007, p<0,001) was associated to normal function.

Conclusions: Mild decrease in renal function was extremely common and more than expected in our cohort (33.5%) which deserves further attention while assisting HIV-positive individuals.

Progressive multifocal leukoencephalopathy has long been described as the sole feature of JC virus (JCV) infection of the central nervous system. Over the past decade, its spectrum has extended to new forms of encephalopathy, notably affecting neurons. We describe an HIV-infected patient with worsening cerebellar symptoms, progressive cerebellar atrophy and a hot-cross-bun sign attributed to JCV–granule-cell neuronopathy (GCN), and 20 years of follow-up.

Background: Studies have consistently demonstrated that statin therapy reduces CHD-related mortality, but HIVinfected individuals are frequently undertreated for hyperlipidemia. Therefore, we sought to: 1. determine whether the numbers of patients recommended for statin therapy differed using the 2004 and 2013 guidelines; 2. evaluate the proportion of recommended patients who were actually receiving statins; and 3. evaluate the factors associated with statin prescription.

Methods: Conducted cross-sectional analysis of a retrospective cohort. 100 patients receiving care at an academic inner-city HIV clinic in 2008 were reviewed. The atherosclerotic vascular disease (ASCVD) risk score was calculated using the 2013 Pooled Cohort Equation and the 2004 and 2013 guidelines were applied to evaluate numbers of patients recommended for statin therapy. Proportions were used to report patients receiving statins among those who were recommended for treatment and several unadjusted logistic regression analyses were performed to identify factors associated with utilization of statins in recommended patients.

Results: 81 participants were included in the final analysis. Substantially larger numbers of HIV-infected individuals were recommended to receive statin therapy for CHD risk reduction when applying the 2013 guidelines compared to the 2004 guidelines, but less than half received statins for primary prevention as recommended. Prescription of statins was not associated with either ASCVD risk score or many traditional CHD risk factors. Diabetes mellitus was associated with increased odds of receiving statin therapy whereas hepatitis C co-infection and current smoking status were associated with decreased odds of receiving statins.

Conclusions: There is an increased, large and unmet need to increase statin use for prevention of CHD. Underutilization of statins was most pronounced among HIV-hepatitis C co-infected patients and HIV-infected smokers.

Introduction: As much as 60% of children born in Nigeria are delivered by unskilled traditional birth attendants. It imperative for traditional birth attendants and similar cadre of health care providers in resource-limited settings to be knowledgeable and have the ability to deploy evidence based practices in the prevention of mother to child transmission of HIV if the goal of an AIDS free generation will be achieved. The successful linkage of evidence with practice in sub-Saharan Africa and other resource limited settings will translate into the reduction of MTCT of HIV as has been achieved in other parts of the world.

Methods: A cross-sectional survey of 142 traditional birth attendants. The research was based on diffusion of innovation theory. Practices related to prevention of mother to child transmission of HIV were evaluated relative to national guidelines. Linear mixed modelling was used to evaluate the association between PMTCT practices and training on prevention of mother to child transmission of HIV.

Results: Most traditional birth attendants were knowledgeable and had good practices relating to prevention of mother to child transmission of HIV. However, significant gaps in HIV exposed infant care; infant feeding practices and harmful traditional practices exist.

Conclusions: Traditional birth attendants have a role in the prevention of mother to child transmission of HIV. Evidence-based practices that are related to maternal HIV transmission are being taken from research and policy into patient care domains; though there are some gaps in vital practices. Innovative strategic interventions are very essential to enhance participation of TBAs in the PMTCT of HIV.

Proximal tubular dysfunction (PTD) is a frequent complication of HIV-infected patients and lack of early biomarkers for PTD has impaired our ability to intervene in a timely manner. In this present study, we tested if interleukin- 18 (IL-18) is a predictive biomarker for PTD in HIV-infected patients on tenofovir (TDF) and Non-tenofovir (N-TDF) antiretroviral therapy and taking as control HIV treatment naïve patients. Exclusion criteria included pre-existing renal insufficiency and nephrotoxin used. Serial urine samples were analyzed by enzyme-linked immunosorbent assay for IL-18 in 254 HIV- infected patients at three different points (at baseline, at 4 weeks and at 12 weeks of fellow-up). Using eGFR values, marked decreased in kidney function was detected only at 12 weeks in the TDF regimen group (p=0.003) as compared to other study groups. In contrast, urine IL-18 increased at a much early time (at 4 weeks) particularly in the TDF regimen group (p=0.000) follow by the naïve group (p=0.02) and continued to increase up to 12 weeks of follow up. This marked elevation is believed to be progressive. Our results indicate that IL-18 is an early, predictive biomarker of PTD and that this biomarker may allow for the reliable early diagnosis of PTD at all times in HIV-infected patients on TDF at risk of proximal tubular dysfunction, much before the rise in serum creatinine