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Marin RC, Behl T, Negrut N, Bungau S. Management of Antiretroviral Therapy with Boosted Protease Inhibitors-Darunavir/Ritonavir or Darunavir/Cobicistat. Biomedicines 2021; 9:biomedicines9030313. [PMID: 33803812 PMCID: PMC8003312 DOI: 10.3390/biomedicines9030313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
A major challenge in the management of antiretroviral therapy (ART) is to improve the patient's adherence, reducing the burden caused by the high number of drugs that compose the treatment regimens for human immunodeficiency virus positive (HIV+) patients. Selection of the most appropriate treatment regimen is responsible for therapeutic success and aims to reduce viremia, increase the immune system response capacity, and reduce the incidence rate and intensity of adverse reactions. In general, protease inhibitor (PI) is one of the pillars of regimens, and darunavir (DRV), in particular, is frequently recommended, along with low doses of enzyme inhibitors as cobicistat (COBI) or ritonavir (RTV), by the international guidelines. The potential of clinically significant drug interactions in patients taking COBI or RTV is high due to the potent inhibitory effect on cytochrome CYP 450, which attracts significant changes in the pharmacokinetics of PIs. Regardless of the patient or type of virus, the combined regimens of DRV/COBI or DRV/RTV are available to clinicians, proving their effectiveness, with a major impact on HIV mortality/morbidity. This study presents current information on the pharmacokinetics, pharmacology, drug interactions, and adverse reactions of DRV; it not only compares the bioavailability, pharmacokinetic parameters, immunological and virological responses, but also the efficacy, advantages, and therapeutic disadvantages of DRV/COBI or DRV/RTV combinations.
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Affiliation(s)
- Ruxandra-Cristina Marin
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Correspondence: ; Tel.: +40-726-776-588
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Kaur S. U, Oyeyemi BF, Shet A, Gopalan BP, D. H, Bhavesh NS, Tandon R. Plasma metabolomic study in perinatally HIV-infected children using 1H NMR spectroscopy reveals perturbed metabolites that sustain during therapy. PLoS One 2020; 15:e0238316. [PMID: 32866201 PMCID: PMC7458310 DOI: 10.1371/journal.pone.0238316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Perinatally HIV-infected children on anti-retroviral treatment (ART) are reported to have metabolic abnormalities such as dyslipidemia, lipodystrophy, and insulin resistance which potentially increase the risk of diabetes, kidney, liver and cardiovascular disease. OBJECTIVE To elucidate HIV-mediated metabolic complications that sustain even during ART in perinatally HIV-infected children. METHOD We have carried out metabolic profiling of the plasma of treatment-naïve and ART-suppressed perinatally HIV-infected children and uninfected controls using 1H nuclear magnetic resonance (NMR) spectroscopy followed by statistical analysis and annotation. RESULT Validated multivariate analysis showed clear distinction among our study groups. Our results showed elevated levels of lactate, glucose, phosphoenolpyruvic acid, propionic acid, 2-ketobutyric acid and tricarboxylic acid (TCA) cycle metabolites in untreated HIV-infected children compared to uninfected controls. ART normalized the levels of several metabolites, however the level of lactate, phosphoenolpyruvic acid, oxoglutaric acid, oxaloacetic acid, myoinositol and glutamine remained upregulated despite ART in HIV-infected children. Pathway analysis revealed perturbed propanoate metabolism, amino acid metabolism, glycolysis and TCA cycle in untreated and ART-suppressed HIV-infected children. CONCLUSION Developing therapeutic strategies targeting metabolic abnormalities may be beneficial for preventing diabetes, cardiovascular disease or other associated complications in perinatally HIV-infected children.
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Affiliation(s)
- Urvinder Kaur S.
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Bolaji Fatai Oyeyemi
- Transcription Regulation Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Bindu Parachalil Gopalan
- Division of Infectious Diseases, St. John’s Research Institute, St. John’s National Academy of health Sciences, Bangalore, India
- School of Integrative Health Sciences, University of Trans-Disciplinary Health Sciences and Technology (TDU), Bangalore, India
| | - Himanshu D.
- Department of Medicine, King Georges Medical University, Lucknow, India
| | - Neel Sarovar Bhavesh
- Transcription Regulation Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Ravi Tandon
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
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Arango-Slingsby C, Vinasco-Sánchez LG, Orozco-Hernández JP, Enríquez-Calvache A, Rodríguez-Ballesteros MF, Franco-Herrera D, Marín-Rincón HA. Tuberculosis diseminada en una adolescente con diabetes mellitus tipo 1: un caso inusual que imita una enfermedad autoinmune. IATREIA 2020. [DOI: 10.17533/udea.iatreia.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La tuberculosis es una de las principales causas de mortalidad en el mundo, a pesar de los múltiples controles y estrategias del tratamiento. La forma diseminada corresponde al 5 % de las presentaciones. Reportamos el primer caso en la literatura de una paciente adolescente con diabetes mellitus tipo 1 y tuberculosis diseminada quien presentó síntomas constitucionales asociados con un dolor lumbar, inicialmente interpretado como sacroileítis no infecciosa y una probable enfermedad inflamatoria intestinal.
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Delery E, Bohannon DG, Irons DL, Allers C, Sugimoto C, Cai Y, Merino KM, Amedee AM, Veazey RS, MacLean A, Kuroda MJ, Kim WK. Lack of susceptibility in neonatally infected rhesus macaques to simian immunodeficiency virus-induced encephalitis. J Neurovirol 2019; 25:578-588. [PMID: 31119711 PMCID: PMC6751025 DOI: 10.1007/s13365-019-00755-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/15/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
Abstract
Despite combination antiretroviral therapies making HIV a chronic rather than terminal condition for many people, the prevalence of HIV-associated neurocognitive disorders (HAND) is increasing. This is especially problematic for children living with HIV. Children diagnosed HAND rarely display the hallmark pathology of HIV encephalitis in adults, namely infected macrophages and multinucleated giant cells in the brain. This finding has also been documented in rhesus macaques infected perinatally with simian immunodeficiency virus (SIV). However, the extent and mechanisms of lack of susceptibility to encephalitis in perinatally HIV-infected children remain unclear. In the current study, we compared brains of macaques infected with pathogenic strains of SIV at different ages to determine neuropathology, correlates of neuroinflammation, and potential underlying mechanisms. Encephalitis was not found in the macaques infected within 24 h of birth despite similar high plasma viral load and high monocyte turnover. Macaques developed encephalitis only when they were infected after 4 months of age. Lower numbers of CCR5-positive cells in the brain, combined with a less leaky blood-brain barrier, may be responsible for the decreased virus infection in the brain and consequently the absence of encephalitis in newborn macaques infected with SIV.
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MESH Headings
- Age Factors
- Animals
- Animals, Newborn
- Blood-Brain Barrier/immunology
- Blood-Brain Barrier/pathology
- Blood-Brain Barrier/virology
- Brain Stem/immunology
- Brain Stem/pathology
- Brain Stem/virology
- Capillary Permeability/immunology
- Disease Resistance
- Encephalitis, Viral/genetics
- Encephalitis, Viral/immunology
- Encephalitis, Viral/pathology
- Encephalitis, Viral/virology
- Frontal Lobe/immunology
- Frontal Lobe/pathology
- Frontal Lobe/virology
- Gene Expression
- Macaca mulatta/virology
- Macrophages/immunology
- Macrophages/pathology
- Macrophages/virology
- Monocytes/immunology
- Monocytes/pathology
- Monocytes/virology
- RNA, Viral/genetics
- RNA, Viral/metabolism
- Receptors, CCR5/genetics
- Receptors, CCR5/immunology
- Receptors, Virus/genetics
- Receptors, Virus/immunology
- Simian Acquired Immunodeficiency Syndrome/genetics
- Simian Acquired Immunodeficiency Syndrome/immunology
- Simian Acquired Immunodeficiency Syndrome/pathology
- Simian Acquired Immunodeficiency Syndrome/virology
- Simian Immunodeficiency Virus/pathogenicity
- Simian Immunodeficiency Virus/physiology
- Viral Load
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Affiliation(s)
- Elizabeth Delery
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology & Immunology, Tulane Medical School, New Orleans, LA, USA
| | - Diana G Bohannon
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Derek L Irons
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Chie Sugimoto
- Tulane National Primate Research Center, Covington, LA, USA
- Dokkyo Medical University, Tochigi, Japan
| | - Yanhui Cai
- Tulane National Primate Research Center, Covington, LA, USA
- The Wistar Institute, Philadelphia, PA, USA
| | | | - Angela M Amedee
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | | | - Andrew MacLean
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology & Immunology, Tulane Medical School, New Orleans, LA, USA
- Tulane Brain Institute, New Orleans, LA, USA
- Tulane Center for Aging, New Orleans, LA, USA
| | - Marcelo J Kuroda
- Tulane National Primate Research Center, Covington, LA, USA
- University of California Davis, Davis, CA, USA
| | - Woong-Ki Kim
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, USA.
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Sarkar S, Selvaraj K, Krishnamurthy S, Balasundaram A, Lakshminarayanan S. Caregivers' perspectives on disclosure, care, and treatment among pediatric HIV/AIDS patients in South India: A qualitative study. Ind Psychiatry J 2018; 27:219-225. [PMID: 31359975 PMCID: PMC6592199 DOI: 10.4103/ipj.ipj_54_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rollout of antiretroviral therapy (ART) has helped to achieve the increased life span among pediatric HIV patients. The psychosocial aspects of parents or caregivers can affect the treatment adherence in children and the disease outcome. AIMS AND OBJECTIVES This study aims at understanding the perspectives on disclosure of HIV status, stigma, antiretroviral treatment, and compliance among caregivers of children attending ART clinic in South India and to explore the barriers to treatment-seeking behavior. MATERIALS AND METHODS This facility-based qualitative study was carried out among caregivers of pediatric HIV patients <15 years of age. In-depth interview was conducted on caregivers after informed consent in the absence of the child, focusing on stigma, disclosure of HIV status to children, adherence, and coping strategies followed by the parents. The complete interviews were transcribed in English, and content analysis was done to identify the emergence of codes. Interview was conducted among mothers of affected child. The disease status of the children was known only to the parents and not to the children themselves (excepting one) or siblings. Parents intended to keep it confidential for the affected children as long as possible. Nevertheless, to maintain adherence and to prevent disclosure of HIV status, mothers traveled to this ART center from very far places, medical records were hidden, and tablets were removed from the strips and said to be medicines for energy and protection. CONCLUSION Mothers of HIV-positive children faced many difficulties to prevent the disclosure of the diagnosis from the affected children and others, which is not very conducive to adherence to the ART regimen. Effective disclosure strategies to manage this emotionally vulnerable group are an urgent need.
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Affiliation(s)
- Sonali Sarkar
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India.,Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Abyramy Balasundaram
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Nasopharyngeal Pneumococcal Colonization and Impact of a Single Dose of 13-Valent Pneumococcal Conjugate Vaccine in Indian Children With HIV and Their Unvaccinated Parents. Pediatr Infect Dis J 2018; 37:451-458. [PMID: 28961675 DOI: 10.1097/inf.0000000000001800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection increases risk of invasive disease from Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV) prevent invasive disease and acquisition of vaccine type (VT) pneumococcus in the nasopharynx. OBJECTIVE To look at the safety and impact of one dose of PCV13 on acquisition of VT pneumococcal carriage in Indian children with HIV. METHOD We conducted a cohort study in families of HIV-infected children (CLH) and families of HIV-uninfected children (HUC) in West Bengal. All children received one dose of PCV13. Nasopharyngeal swabs were collected from children and parents at baseline and 2 months after vaccination. RESULT One hundred and fifteen CLH and 47 HUC received one dose of PCV13. Fifty-eight percent of CLH were on antiretroviral therapy (ART), and the median nadir CD4 count was 287. There were no significant adverse events in either group. HUC had more VT colonization than CLH-55% versus 23% of all pneumococcal isolates. HIV infection doubled the risk of nonvaccine serotype colonization (P = 0.03). There was no difference in acquisition of VT isolates in CLH (4.4%) and HUC (4.5%) post-PCV13; however, older CLH (>5 years) had decreased clearance of VT strains. ART made no difference in pneumococcal colonization at baseline or after PCV13; however, CLH with higher nadir CD4 counts before starting ART were less likely to have VT colonization post-PCV13 (prevalence ratio, 0.2; 95% confidence interval: 0.1-0.5). CONCLUSION While there was no difference in acquisition of VT nasopharyngeal carriage of pneumococcus in CLH and HUC after one dose of PCV13, earlier access to ART may impact response to PCV13 in CLH.
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7
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Impact of Haemophilus influenzae Type B Conjugate Vaccines on Nasopharyngeal Carriage in HIV-infected Children and Their Parents From West Bengal, India. Pediatr Infect Dis J 2016; 35:e339-e347. [PMID: 27753766 DOI: 10.1097/inf.0000000000001266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In addition to reducing Haemophilus influenzae type b (Hib) disease in vaccinated individuals, the Hib conjugate vaccine (HibCV) has indirect effects; it reduces Hib disease in unvaccinated individuals by decreasing carriage. Human immunodeficiency virus (HIV)-infected children are at increased risk for Hib disease and live in families where multiple members may have HIV. The aim of this study is to look at the impact of 2 doses of the HibCV on nasopharyngeal carriage of Hib in HIV-infected Indian children (2-15 years) and the indirect impact on carriage in their parents. METHODS This prospective cohort study was conducted in HIV-infected and HIV-uninfected families. Nasopharyngeal swabs were collected from children and parents before and after vaccination. HIV-infected children 2-15 years of age got two doses of HibCV and were followed up for 20 months. Uninfected children 2-5 years of age got 1 dose of HibCV as catch-up. RESULTS 123 HIV-infected and 44 HIV-uninfected children participated. Baseline colonization in HIV-infected children was 13.8% and dropped to 1.8% (P = 0.002) at 20 months. Baseline carriage in HIV-uninfected children was 4.5% and dropped to 2.3% after vaccination (P = 0.3). HIV-infected parents had 12.3 times increased risk of Hib carriage if their child was colonized (P = 0.04) and had 9.3 times increased risk if their child had persistent colonization postvaccine (P = 0.05). No parent of HIV-uninfected children had Hib colonization at any point. Pneumococcal colonization was associated with increased Hib colonization. CONCLUSION Making the HibCV available to HIV-infected children could interrupt Hib carriage in high-risk families.
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Arya BK, Bhattacharya SD, Sutcliffe CG, Saha MK, Bhattacharyya S, Niyogi SK, Moss WJ, Panda S, Das RS, Mallick M, Mandal S. Immunogenicity and safety of two doses of catch-up immunization with Haemophilus influenzae type b conjugate vaccine in Indian children living with HIV. Vaccine 2016; 34:2267-74. [PMID: 26988256 DOI: 10.1016/j.vaccine.2016.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/01/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Children living with HIV are at increased risk of disease from Haemophilus influenzae type b (Hib). Data are limited on the immunogenicity of a two-dose, catch-up schedule for Hib conjugate vaccine (HibCV) among HIV-infected children accessing antiretroviral therapy (ART) late. OBJECTIVES The objectives of the study were to: (1) evaluate baseline immunity to Hib and the immunogenicity and safety of two doses of HibCV among HIV-infected Indian children; and (2) document the threshold antibody level required to prevent Hib colonization among HIV-infected children following immunization. METHODS We conducted a prospective cohort study among HIV-infected children 2-15 years of age and HIV-uninfected children 2-5 years of age. HIV-infected children received two doses of HibCV and uninfected children received one. Serum anti-Hib PRP IgG antibodies were measured at baseline and two months after immunization in the HIV-infected children. Nasopharyngeal (NP) swabs were collected at baseline and follow-up. RESULTS 125 HIV-infected and 44 uninfected children participated. 40% of HIV-infected children were receiving ART and 26% had a viral load >100,000 copies/mL. The geometric mean concentration of serum anti-Hib PRP antibody increased from 0.25 μg/mL at baseline to 2.65 μg/mL after two doses of HibCV, representing a 10.6-fold increase (p<0.0001). 76% percent of HIV-infected children mounted an immune response. Moderate or severe immune suppression, trimethoprim/sulfamethoxazole prophylaxis, and lower baseline antibody levels were associated with lower post-vaccine serum anti-Hib PRP IgG antibodies. A serum anti-Hib PRP IgG antibody level ≥ 3.3 μg/mL was protective against Hib NP colonization. There were no differences in adverse events between HIV-infected and uninfected children. CONCLUSION Including a catch-up immunization schedule for older HIV infected children in countries introducing Hib vaccines is important. Older HIV-infected children with delayed access to ART and without suppressed viral loads mounted an adequate immune response following two doses of HibCV.
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Affiliation(s)
- Bikas K Arya
- School of Medical Science and Technology, Indian Institute of Technology (IIT) - Kharagpur, India
| | | | - Catherine G Sutcliffe
- International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Malay K Saha
- National HIV Reference Laboratory/Division of Virology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | | | - Swapan Kumar Niyogi
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - William J Moss
- International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samiran Panda
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - Ranjan Saurav Das
- School of Medical Science and Technology, Indian Institute of Technology (IIT) - Kharagpur, India
| | - Mausom Mallick
- National HIV Reference Laboratory/Division of Virology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - Sutapa Mandal
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
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Sangeeta T, Anjali M, Silky M, Kosambiya JK, Shah VB. Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant. Indian J Sex Transm Dis AIDS 2015; 35:109-13. [PMID: 26396444 DOI: 10.4103/0253-7184.142404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program. METHODS At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters. RESULTS Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm(3) and not at established cut-off of CD4 350 cells/mm(3). This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively. CONCLUSIONS Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
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Affiliation(s)
- Trivedi Sangeeta
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
| | - Modi Anjali
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Modi Silky
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
| | - J K Kosambiya
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - V B Shah
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
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Abstract
The latest HIV-1 protease inhibitor (PI) darunavir (Prezista™) has a high genetic barrier to resistance development and is active against wild-type HIV and HIV strains no longer susceptible to some older PIs. Ritonavir-boosted darunavir, as a component of antiretroviral therapy (ART), is indicated for the treatment of HIV-1 infection in adult and paediatric patients (aged ≥3 years), with or without treatment experience (details vary depending on region of approval). Several open-label or partially-blinded trials have evaluated the efficacy of ritonavir-boosted darunavir ART regimens for up to 192 weeks in these settings. In treatment-naïve adults, once-daily boosted darunavir was no less effective in establishing virological suppression than once- or twice-daily boosted lopinavir, yet was more effective at maintaining suppression long term. Moreover, treatment-experienced adults with no darunavir resistance-associated mutations (RAMs) had no less effective viral load suppression with once-daily than with twice-daily boosted darunavir. In treatment-experienced adults, including some with multiple major PI RAMs, twice-daily boosted darunavir was more effective than twice-daily boosted lopinavir or boosted control PIs in reducing viral load, and provided virological benefit as part of a salvage regimen in those with few remaining treatment options. Boosted darunavir also reduced viral load when administered once-daily in treatment-naïve adolescents or twice-daily in treatment-experienced children and adolescents. Boosted darunavir is generally well tolerated, with gastrointestinal disturbances and lipid abnormalities among the most common tolerability issues. It has a lipid profile more favourable than that of boosted lopinavir in terms of total cholesterol and triglyceride changes and, when administered once daily, its lipid effects are generally similar to those of boosted atazanavir. Thus, boosted darunavir is a useful option for the ART regimens of adult and paediatric patients with HIV-1 infection.
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Shahapur PR, Bairy I. Clinico-Immunological Profile of Children Infected with HIV Through Vertical Transmission, in Southern India. J Clin Diagn Res 2014; 8:DC09-11. [PMID: 25120978 DOI: 10.7860/jcdr/2014/7419.4443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 04/21/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Karnataka, being "High Prevalent State" of southern India, the HIV infection among antenatal women has crossed 1%. There are very few reports available with CD4 count and stage wise clinical spectrum among children. The clinical spectrum among HIV infected infants and children vary in different areas of the world. Hence it is important to know the spectrum of opportunistic infections and their respective CD4 count among HIV infected children of our locality. MATERIALS AND METHODS The opportunistic infections among 31 paediatric seropositive patients were evaluated. These all patients were classified as per CDC guide lines into stage I, stage II, and stage III based on CD4 counts of > 1000cells/μl, 500-999 cells/μl,<500cells/μl respectively. The opportunistic infections were diagnosed by standard laboratory investigations. Clinical spectrum presented by each stage children was documented. RESULTS Children in stage I were 5(16.1%),stage II 14(45.1%) and stage III 12(38.7%). Oral candidiasis (29%) was the commonest, followed by recurrent respiratory tract infection (25.8%), tubercular lymphadenitis (16.1%) and chronic diarrhoea (12.9%). CONCLUSION The present study showed the children with higher CD4 count had few infections and children with lower CD4 count presented with multiple opportunistic infections. This study also showed vertical transmission as the sole mode of transmission.
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Affiliation(s)
- Praveen R Shahapur
- Professor, Department of Microbiology, BLDE University's Shri.B.M.Patil Medical College Bijapur, Karnataka, India
| | - Indira Bairy
- Professor, Department of Microbiology, Director Student Affairs, Manipal University , Manipal, India
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12
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Anthropometry and body composition of vertically HIV-infected children and adolescents under therapy with and without protease inhibitors. Public Health Nutr 2014; 18:1255-61. [PMID: 25115797 DOI: 10.1017/s1368980014001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although the benefits of highly active antiretroviral therapy (HAART) have been documented, it is thought to be associated to disturbances in nutritional status. These disturbances may occur early in life and are poorly understood. The present study aimed to investigate the relationship between anthropometric parameters and body composition of perinatally HIV-infected children and adolescents under HAART, according to use and non-use of protease inhibitors. DESIGN Cross-sectional study undertaken between August and December 2007. Demographic, socio-economic, clinical and anthropometric data were collected from the patients. The χ 2 test, Wilcoxon rank sum test (Mann-Whitney) and t test were used to compare the following variables between users and non-users of protease inhibitors: age, gender, per capita income, HAART exposure, antiretroviral therapy adopted in the last three years, CD4 count, viral load, pubertal stage, nutritional status (BMI-for-age, height-for-age, waist and neck circumferences, triceps skinfold thickness, body fat percentage, upper-arm fat area and upper-arm muscle area). SETTING An HIV/AIDS out-patient clinic, São Paulo, Brazil. SUBJECTS One hundred and fifteen patients (children and adolescents aged 6-19 years). RESULTS Protease inhibitors users had a higher prevalence of stunting (P=0.03), lower BMI (P=0.03) and lower percentage of body fat (P=0.05) compared with non-users. There was no statistically significant difference between the HAART regimens and measurements of fat adiposity. CONCLUSIONS The findings of the study suggest that children and adolescents under protease inhibitors are at higher risk of growth and development deviations, but not at risk of body fat redistribution.
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Sangeeta T, Anjali M, Silky M, Kosambiya JK, Shah VB. Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant. Indian J Sex Transm Dis AIDS 2014. [PMID: 26396444 PMCID: PMC4553837 DOI: 10.4103/2589-0557.142404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program. METHODS At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters. RESULTS Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm(3) and not at established cut-off of CD4 350 cells/mm(3). This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively. CONCLUSIONS Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
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Affiliation(s)
- Trivedi Sangeeta
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
| | - Modi Anjali
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India,Address for correspondence: Dr. Anjali Modi, E-8, Quarters, New Civil Campus, Surat, Gujarat, India. E-mail:
| | - Modi Silky
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
| | - J. K. Kosambiya
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - V. B. Shah
- Department of Paediatrics, Government Medical College, Surat, Gujarat, India
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Mayer K. The evolving Indian AIDS epidemic: hope & challenges of the fourth decade. Indian J Med Res 2012; 134:739-41. [PMID: 22310809 PMCID: PMC3284084 DOI: 10.4103/0971-5916.92618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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