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Fernández I, de Lazzari E, Inciarte A, Diaz-Brito V, Milinkovic A, Arenas-Pinto A, Etcheverrry F, García F, Leal L. Network meta-analysis of post-exposure prophylaxis randomized clinical trials. HIV Med 2020; 22:218-224. [PMID: 33108035 DOI: 10.1111/hiv.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen. METHODS After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events. RESULTS Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events. CONCLUSIONS Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.
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Affiliation(s)
- I Fernández
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Inciarte
- Infectious Diseases Department-HIV Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - V Diaz-Brito
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Milinkovic
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - A Arenas-Pinto
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - F Etcheverrry
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F García
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology, AIDS Research Group, (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - L Leal
- Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology, AIDS Research Group, (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
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Winston A, Stöhr W, Antinori A, Arenas-Pinto A, Llibre JM, Amieva H, Cabié A, Williams I, Di Perri G, Tellez MJ, Rockstroh J, Babiker A, Pozniak A, Raffi F, Richert L. Host and disease factors are associated with cognitive function in European HIV-infected adults prior to initiation of antiretroviral therapy. HIV Med 2015; 17:471-8. [PMID: 26611175 DOI: 10.1111/hiv.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Deficits in cognitive function remain prevalent in HIV-infected individuals. The aim of this European multicentre study was to assess factors associated with cognitive function in antiretroviral therapy (ART)-naïve HIV-infected subjects at the time of enrolment in the NEAT 001/Agence Nationale de Recherche sur le SIDA (ANRS) 143 study. METHODS Prior to starting ART, seven cognitive tests exploring domains including episodic memory, verbal fluency, executive function and psychomotor speed were administered with scores standardized to z-score using the study population sample mean and standard deviation. The primary measure was overall z-score average (NPZ). We assessed associations between baseline factors and test results using multivariable regression models. RESULTS Of 283 subjects with baseline cognitive assessments, 90% were male and 12% of black ethnicity. Median (interquartile range) age, years of education, years of known HIV infection, baseline CD4 count and baseline HIV RNA were 39 (31, 47) years, 13 (11, 17) years, 1 (0, 4) years, 344 (279, 410) cells/μL and 4.74 (4.28, 5.14) log10 HIV-1 RNA copies/mL, respectively. Forty per cent were current smokers. Factors significantly associated with poorer overall cognitive performance in multivariable models included older age, shorter duration of education, black ethnicity, lower height, and lower plasma HIV RNA. CONCLUSIONS In this large, European-wide, ART-naïve population with relatively preserved immunity and early HIV infection, cognitive function scores at the time of ART initiation were associated with demographic and HIV-disease factors.
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Affiliation(s)
- A Winston
- Department of Medicine, Imperial College London, London, UK
| | - W Stöhr
- MRC Clinical Trials Unit at University College London, London, UK
| | - A Antinori
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - A Arenas-Pinto
- MRC Clinical Trials Unit at University College London, London, UK
| | - J M Llibre
- HIV Unit and Lluita contra la SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - H Amieva
- Centre Inserm U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, France
| | - A Cabié
- Department of Infectious and Tropical Diseases and INSERM CIE802, University Hospital of Fort-de-France, Fort-de-France, Martinique, France
| | - I Williams
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London, UK
| | - G Di Perri
- Laboratory of Clinical Pharmacology and Pharmacogenetics (2), Unit of Infectious Diseases, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - M J Tellez
- Infectious Diseases Unit, Internal Medicine, Hospital Clinico Universitario, Madrid, Spain
| | - J Rockstroh
- Department of General Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - A Babiker
- MRC Clinical Trials Unit at University College London, London, UK
| | - A Pozniak
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - L Richert
- Centre Inserm U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, and CIC1401-EC (Clinical Epidemiology), Bordeaux, France
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Matthews GV, Neuhaus J, Bhagani S, Mehta SH, Vlahakis E, Doroana M, Naggie S, Arenas-Pinto A, Peters L, Rockstroh JK. Baseline prevalence and predictors of liver fibrosis among HIV-positive individuals: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:129-36. [DOI: 10.1111/hiv.12241] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- GV Matthews
- Kirby Institute; University of New South Wales; Sydney Australia
| | - J Neuhaus
- Division of Biostatistics; University of Minnesota; Minneapolis MN USA
| | | | - SH Mehta
- John Hopkins University; Baltimore MD USA
| | - E Vlahakis
- Taylor Square Private Clinic; Sydney Australia
| | - M Doroana
- Hospital Santa Maria; Lisbon Portugal
| | - S Naggie
- Duke University School of Medicine; Durham NC USA
| | - A Arenas-Pinto
- MRC Clinical Trials Unit at University College London; London UK
| | - L Peters
- CHIP; Department of Infectious Diseases and Rheumatology; Rigshospitalet; Copenhagen Denmark
| | - JK Rockstroh
- Department of Medicine; University of Bonn; Bonn Germany
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Podlekareva DN, Panteleev AM, Grint D, Post FA, Miro JM, Bruyand M, Furrer H, Obel N, Girardi E, Vasilenko A, Losso MH, Arenas-Pinto A, Cayla J, Rakhmanova A, Zeltina I, Werlinrud AM, Lundgren JD, Mocroft A, Kirk O. Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe. Eur Respir J 2013; 43:166-77. [DOI: 10.1183/09031936.00138712] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Arenas-Pinto A, Weller I, Ekong R, Grant A, Karstaedt A, Telisinghe L, Bolhaar M, Charalambous S, Bradman N, Ingram C. Lack of association between mitochondrial DNA polymorphisms and didexoxynucleoside-induced hyperlactataemia in black-African, HIV-1-infected patients. J Int AIDS Soc 2010. [PMCID: PMC3113104 DOI: 10.1186/1758-2652-13-s4-p96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE To describe the clinical, epidemiological, and biochemical characteristics of published cases of lactic acidosis (LA) and to generate hypotheses concerning risk factors associated with this complication. METHODS Systematic review of cases reported in the medical literature. RESULTS 217 published cases were identified, 90 of which fulfilled the study definition and had sufficient individual data on potential risk factors to be included. The 90 patients had a mean age of 40.1 years (range 16-69) and 53% were female. All 90 patients were taking nucleoside reverse transcriptase inhibitors (NRTI) at the time of the episode. Among the 83 patients with details of their antiretroviral therapy (ART) regimen 51 patients were taking stavudine, 29 zidovudine, 27 didanosine, and 25 lamivudine. Around 50% of the patients had abdominal pain, nausea, or vomiting. Hepatic steatosis was consistently reported (53/90) and in 36 (68%) there was histological evidence. The case fatality rate was 48%. Six cases were rechallenged with NRTI and three developed a further LA episode. Using data on the numbers of HIV infected individuals receiving care in the United States, we estimate that the risk of LA could be 2.5 times higher for women than men. CONCLUSIONS NRTI use and female sex appear to be risk factors for the development of LA. What other factors are involved is still not clear but might include duration of NRTI therapy, specific drug use, and genetic predisposition. A case-control study is needed to better define risk factors for severe LA.
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Affiliation(s)
- A Arenas-Pinto
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, UK.
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Arenas-Pinto A, Certad G, Ferrara G, Castro J, Bello MA, Núñez LT. Association between parasitic intestinal infections and acute or chronic diarrhoea in HIV-infected patients in Caracas, Venezuela. Int J STD AIDS 2003; 14:487-92. [PMID: 12869231 DOI: 10.1258/095646203322025812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A cross sectional survey was conducted to determine the association between enteric parasites and diarrhoea in HIV-infected adults in Caracas. Three hundred and four patients were evaluated: 104 had acute diarrhoea, 113 chronic diarrhoea and 87 were controls. Isopora belli infection was associated with acute (P = 0.022) and chronic diarrhoea (P = 0.003), Entamoeba histolytica/dispar infection was also associated with both acute (P = 0.015) and chronic diarrhoea (P = 0.017). Strongyloides stercoralis (P = 0.003), and Cryptosporidium parvum (P = 0.017) infections were associated mainly with chronic episodes. Weight loss (P < 0.001), a non-infectious factor investigated, was significantly associated with diarrhoea. Eosinophilia, a laboratory parameter studied, was found to be associated with strongyloidiasis (P = 0.001), giardiasis (P = 0.001) and isoporiasis (P = 0.003). In summary, the presence of enteric parasites in HIV-infected patients from tropical urban areas with diarrhoea, with or without significant weight loss, must be considered. Similarly, eosinophilia might suggest parasitic infection in these patients.
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Affiliation(s)
- A Arenas-Pinto
- Cátedra de Parasitología, Escuela de Medicina J.M. Vargas, Universidad Central de Venezuela, Caracas, Venezuela.
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