[AIDS Study Group/Spanish AIDS Consensus Plan Document on sexually transmitted infections in HIV-infected patients]

Polypharmacy among HIV infected people aged 50 years or older

Introduction:

Although HAART cannot eradicate HIV, it suppresses viral replication, resulting in a progressive reduction in HIV-related morbidity and mortality. The increase in life expectancy for HIV-infected patients has turned this disease into a chronic disease and, therefore, to the appearance of comorbidities. At the same time there is an increase in the use of concomitant medication, making HIV-infected patient a polymedicated patient.

Objective:

To determine the degree of polypharmacy and to describe clinically relevant drug interactions, as well as the comorbidities and adherence to HAART in HIV + patients over 50 years.

Methods:

Observational, transversal study. Patients ≥50 years on HAART ambulatory were included. The variables were collected: aged, sex, VL, CD4, comorbidities, ARV, concomitant medication, herbal products and adherence. Patients who did not sign informed consent were excluded.

Results:

Were included 154 patients ≥50 years on HAART. The presence of polypharmacy, defined as the use of 5 or more medications including HAART, was 40.3%. 73.4% of the patients had concomitant medication: lipid-lowering agents (33.8%), anxiolytics / sedatives (28.6%), proton-pump inhibitors (26.0%) antihypertensive agents (23.4%). 102 relevant interactions were recorded, finding statistically significant differences in relation to the presence of polypharmacy and pharmacologic drugs classes (p <0.001).

Conclusion:

The prevalence of polypharmacy among HIV+ patients ≥50 years is high. Comorbidities, interactions and drugs associated were similar to those described in the literature. It is necessary to establish priorities in relation to drug interactions with polypharmacy and a correct approach to the pathologies that may develop.

Antiretroviral therapy as a factor protective against anal dysplasia in HIV-infected males who have sex with males

Objectives

Chronic infection with oncogenic HPV genotype is associated with the development of anal dysplasia. Antiretroviral therapy (ART) has been shown to decrease the incidence of cervical carcinoma in women with HIV. We sought to: 1) describe the prevalence and grade of anal dysplasia and HPV infection in our study subjects; 2) analyze the grade of correlation between anal cytology, PCR of high-risk HPV, and histology; 3) identify the factors associated with the appearance of ≥AIN2 lesions.

Design

Cross-sectional, prospective study.

Methods

A cohort of HIV-positive males (n = 140, mean age  = 37 years) who have sex with males (MSM) had epidemiological, clinical and analytical data collected. Anal mucosa samples were taken for cytology, HPV PCR genotyping, and anoscopy for histological analysis.

Results

Within the cohort, 77.1% were being treated with ART, 8.5% anoscopy findings were AIN2, and 11.4% carcinoma in situ; 74.2% had high-risk (HR), 59.7% low-risk (LR) HPV genotypes and 46.8% had both. The combination of cytology with PCR identifying HR-HPV better predicts the histology findings than either of these factors alone. Logistic regression highlighted ART as a protective factor against ≥AIN2 lesions (OR: 0.214; 95%CI: 0.054–0.84). Anal/genital condylomas (OR: 4.26; 95%CI: 1.27–14.3), and HPV68 genotype (OR: 10.6; 95%CI: 1.23–91.47) were identified as risk factors.

Conclusions

In our cohort, ART has a protective effect against dysplastic anal lesions. Anal/genital warts and HPV68 genotype are predictors of ≥AIN2 lesions. Introducing PCR HPV genotype evaluation improves screening success over that of cytology alone.

[Non-AIDS defining malignancies, or the sleeping giant: an update]

Non-AIDS defining malignancies (NADM) are a very heterogeneous group of cancers with increasing importance in subjects with HIV infection. They develop in patients that are younger than general population and their clinical manifestations are usually atypical, with higher tumour grades, more aggressive clinical behaviour and metastatic disease. The outcome is poor, with rapid progression, a high rate of relapse, and a poor response to treatment. There are several factors that influence their development: HIV infection, chronic immunosuppression, and co-infection with some oncogenic viruses. The most frequent NADM are those associated with human papillomavirus infection, lung cancer, hepatic cancer, and Hodgkin lymphoma. Their management is based on three essential points: the treatment of the specific malignancy, the use of antiretroviral therapy, and the prophylaxis and treatment of opportunistic infections. The two factors significantly associated with prevention of NADM are a CD4+ lymphocyte count more than 500/mm(3), and an undetectable viral load.