[Influence of highly active antiretroviral therapy on the evolution of AIDS-associated Kaposi's sarcoma]

Characteristics of HIV-1-associated Kaposi's sarcoma among women and men in South Africa

Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.

[Oral manifestations of HIV infection]

Oral manifestations of HIV infection are sometimes the first sign of the disease and often indicate its progression to acquired immune deficiency syndrome (AIDS), thus it is important for health professionals (physicians and dentist) to possess adequate knowledge of these lesions. Improvements in antiretroviral treatments, especially with the incorporation of HAART therapy, have produced a gradual reduction in the prevalence of HIV-associated oral lesions. On the other hand, the increased life expectancy of HIV-positive patients has led to their greater presence at our clinics, implying the need for continuous updating in the diagnosis and treatment of these processes. Using the consensus classification (EEC-Clearinghouse, 1993) we reviewed the diagnostic criteria and current treatment protocols for the different HIV infection related oral lesions in both adults and children.

[Responses to antiretroviral treatments in vertically HIV-1-infected children]

BACKGROUND AND OBJECTIVE

Our goal was to determine the probability of achieving a fall-off of viral load (VL) and an increase of CD4+T-lymphocytes by 36 months from the initiation of antiretroviral therapy (ART) in a cohort of HIV-infected children according to their baseline data.

PATIENTS AND METHOD

This was retrospective multicenter observational study of virologic and immunologic markers in 128 HIV-1-vertically infected children on ART: 55 HIV-infected children on combination therapy (CT), and 73 HIV-infected children on highly active antiretroviral therapy (HAART). Viral load (VL) was quantified using a standard molecular assay. CD4+ and CD8+ T-cells subsets were determined by flow cytometry.

RESULTS

The median time for a 10% rise of CD4+ T-lymphocytes was 35.7 months (95% confidence interval [95% CI], 15.5-55.9) after starting CT, and 11 months (95% CI, 7,7-14.3) after starting HAART. The median time for a VL fall to < 400 copies/ml was 29.6 months (95% CI, 9.4-49.7) after starting CT, and the median time for a VL fall to < 400 copies/ml was 10.9 months (95% CI, 0-21.9) after starting HAART. A 10% increase of CD4+ T-cells over baseline was associated with HAART, low CD4+ T-cells and high VL. On the other hand, a VL fall lower than 400 copies/ml was associated with HAART and low baseline VL.

CONCLUSIONS

Our data indicate that HAART was better than CT in the control of VL and CD4+ T-cell increase. Also, baseline CD4+ T-cell and VL values helped to determine the response to ART in HIV-1 infected children.

[Opportunistic episodes in patients infected with the human immunodeficiency virus during the first 6 months of HAART]

BACKGROUND

We aimed at analysing the incidence and characteristics of opportunistic events (OE) within a few months after starting highly active antiretroviral therapy (HAART) in HIV infected patients.

PATIENTS AND METHOD

Retrospective study of HIV infected outclinic patients attended in a HIV/AIDS reference hospital in Madrid, who initiated HAART during the second semester of 1998, with a baseline CD4 cell count 250 x 10(6) cells/l. We recorded the incidence of OE within 6 months after beginning HAART and analysed virological and immunological parameters, sociodemographic variables and types of antiretroviral treatment.

RESULTS

The study included 269 patients. Twenty-one (7.8%) OE were recorded. At the onset of HAART, the mean CD4 cell count in these 21 patients was 137 (92) x 10(6)/land the median viral load was 24,043 cop/ml. At the time of OE diagnosis, these parameters were 218 (114) x 10(6)/l (p = 0.012) and < 500 cop/ml, respectively. OE were distributed as follows: herpes zoster, 9 cases (43%), Pneumocystis carinii pneumonia, 5 cases (24%), Kaposi sarcoma,3 cases (14%) and tuberculosis, cerebral toxoplasmosis, cytomegalovirus retinitis, and non-Hodgkin lymphoma, 1 case each. Overall, 78% of OE occurred within first 4 months after beginning HAART. In addition, an OE was developed by 8% patients treated with NRTI and PI, 2% treated with NRTI and NNRTI, and 10% treated with NRTI,NNRTI and PI (p = 0.44).

CONCLUSIONS

HIV-infected subjects with low CD4 counts are prone to develop OE within the first few moths after beginning HAART. An inflammatory response to latent antigens due to the immune recovery might explain this fact.