1
|
Ambrosioni J, Díaz NA, Marzolini C, Dragovic G, Imaz A, Calcagno A, Luque S, Curran A, Troya J, Tuset M, Khoo S, Burger D, Cortés CP, Naous N, Molto J. Outcomes of Drug Interactions Between Antiretrovirals and Co-Medications, Including Over-the-Counter Drugs: A Real-World Study. Infect Dis Ther 2024; 13:609-617. [PMID: 38372897 DOI: 10.1007/s40121-024-00935-0] [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: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION The objective was to characterize real-world outcomes of drug-drug interactions (DDIs) between antiretrovirals (ARVs) and other drugs, including over-the-counter medications (OTC), and treatment outcomes in clinical practice. METHODS www.clinicalcasesDDIs.com is an open-access website for healthcare providers to consult and briefly describe real-world clinical cases on DDI with ARVs. We reviewed all the clinical cases reported to the website between March 2019 and May 2023. RESULTS A total of 139 cases were reported, mostly involving ritonavir or cobicistat (boosters; 74 cases), unboosted integrase inhibitors (InSTI; 29 cases), and non-nucleoside reverse transcriptase inhibitors (NNRTI; 23 cases). Central nervous system drugs (29 cases) and cardiovascular drugs (19 cases) were the most frequently described co-medications. Notably, OTC medications were implicated in 27 cases, including mineral supplements (11 cases), herbals (8 cases), weight loss drugs (4 cases), anabolic steroids (3 cases), and recreational drugs (1 case). OTC acted as the perpetrator drug in 21 cases, leading to loss of ARV efficacy in 17 instances (mineral supplements in 10 cases, weight loss drugs in 4 cases, herbals in 3 cases). Additionally, toxicity was reported in 4 out of 6 cases where OTC was considered the victim drug of the DDI (anabolic steroids in 3 cases, MDMA in 1 case). CONCLUSIONS Frequent unwanted outcomes resulting from DDIs between ARVs and OTC medications underscore the importance of integrating non-prescription drugs into medication reconciliation. The real-world data available through www.clinicalcasesDDIs.com serves as a valuable resource for assessing the clinical relevance of DDIs.
Collapse
Affiliation(s)
- Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic- Fundacio de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Natalia Anahí Díaz
- Infectious Diseases Service, Hospital Cuenca Alta, Cañuelas, Argentina
- Infectious Diseases Service, Hospital Mariano y Luciano de La Vega, Moreno, Argentina
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland
- Service of Clinical Pharmacology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo Di Savoia Hospital, University of Turin, 10149, Turin, Italy
| | - Sonia Luque
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Adrian Curran
- University Hospital Vall D'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jesus Troya
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Montse Tuset
- Department of Pharmacy, Hospital Clínic Barcelona, Barcelona, Spain
| | - Saye Khoo
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - David Burger
- Department of Pharmacy, Radboud Institute for Medical Innovation (RIMI), RadboudUMC, Nijmegen, The Netherlands
| | | | - Nadia Naous
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jose Molto
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
- Fundació Lluita Contra Les Infeccions. Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
2
|
Oprea C, Quirke S, Ianache I, Bursa D, Antoniak S, Bogdanic N, Vassilenko AI, Aimla K, Matulionyte R, Rukhadze N, Harxhi A, Fleischhans L, Lakatos B, Sedlacek D, Dragovic G, Verhaz A, Yancheva N, Acet O, Protopapas K, Kowalska JD. HIV disease metrics and COVID-19 infection severity and outcomes in people living with HIV in central and eastern Europe. HIV Med 2024; 25:343-352. [PMID: 38014768 DOI: 10.1111/hiv.13578] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND To date there remains much ambiguity in the literature regarding the immunological interplay between SARS-CoV-2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID-19 severity in this cohort. METHODS We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID-19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID-19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1. RESULTS The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID-19 diagnosis was 605 cells/μL [interquartile range (IQR) 409-824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001). CONCLUSION We can conclude that detectable HIV viral load was an independent risk factor for severe COVID-19 illness and can be used as a prognostic indicator in this cohort.
Collapse
Affiliation(s)
- Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University for Medicine and Pharmacy, Bucharest, Romania
| | - Siobhan Quirke
- Department of Medicine, Galway University Hospital, Galway, Ireland
| | - Irina Ianache
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University for Medicine and Pharmacy, Bucharest, Romania
| | - Dominik Bursa
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department, Gromashevsky Institute of Epidemiology and Infectious Diseases, Kyiv, Ukraine
| | - Nikolina Bogdanic
- University Hospital for Infectious Diseases, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Anne I Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, Minsk, Belarus
| | | | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, Tbilisi, Georgia
| | - Arjan Harxhi
- University Hospital Center of Tirana, Infectious Disease Service, Tirana, Albania
| | - Lukáš Fleischhans
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka Hospital, Prague, Czech Republic
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Budapest, Hungary
| | - Dalibor Sedlacek
- Charles University, Faculty of Medicine in Plzeň, University Hospital Plzeň, Plzen, Czech Republic
| | - Gordana Dragovic
- Faculty of Medicine, University of Belgrade, Department of Pharmacology, Clinical Pharmacology and Toxicology, Belgrade, Serbia
| | - Antonija Verhaz
- Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, Sofi, Bulgaria
| | - Oguzhan Acet
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Konstantinos Protopapas
- University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
3
|
Bukic E, Dragovic G, Toljic B, Obradovic B, Jadzic J, Jevtovic D, Milasin JM. TERT single nucleotide polymorphism rs2736098 but not rs2736100 is associated with telomere length in HIV-infected patients on cART. Mol Biol Rep 2024; 51:147. [PMID: 38236501 DOI: 10.1007/s11033-023-08967-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Continuous application of "combination antiretroviral therapy" (cART) has transformed Human immunodeficiency virus (HIV) infection into a manageable chronic disease; however, due to lasting inflammation and cumulative toxicity, progressive pathophysiological changes do occur and potentially lead to accelerated aging, among others, contributing to telomere shortening. The single nucleotide polymorphisms (SNP) rs2736100 and rs2736098 are particularly important for human telomerase (TERT) gene expression. The objective of this study was to evaluate the effects of clinical parameters and single nucleotide polymorphisms in TERT (rs2736100 and rs2736098) on telomere length in HIV-infected patients. METHODS AND RESULTS This cross-sectional study included 176 patients diagnosed with HIV infection. Relative telomere length (RTL) was determined by real-time polymerase chain reaction (qPCR), whereas genotyping was performed by polymerase chain reaction, followed by restriction fragment length polymorphism analysis (PCR-RFLP). The mean age of the patients (p = .904), time since HIV diagnosis (p = .220), therapy-related variables such as the cART regimen (0.761), and total cART duration (p = .096) did not significantly affect RTL. TERT rs2736100 genotype showed no association with RTL. However, TERT rs2736098 heterozygotes (GA) had significantly longer telomeres (P = .049) than both homozygotes (GG and AA). CONCLUSIONS Our findings support the fact that cellular aging in HIV-infected patients is influenced by the TERT rs2736098 polymorphism.
Collapse
Affiliation(s)
- Ena Bukic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bosko Toljic
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Bozana Obradovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Jadzic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Infectious and Tropical Diseases Hospital, University Clinical Center Serbia, Belgrade, Serbia
| | - Jelena M Milasin
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| |
Collapse
|
4
|
Caixas U, Tariq S, Morello J, Dragovic G, Lourida G, Hachfeld A, Nwokolo N. Comorbidities and menopause assessment in women living with HIV: a survey of healthcare providers across the WHO European region. AIDS Care 2024; 36:107-114. [PMID: 37321982 DOI: 10.1080/09540121.2023.2216008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACTWomen living with HIV are reaching older age and experiencing menopause and age-related comorbidities. Data suggest that women living with HIV experience earlier menopause and more menopausal symptoms and age-related comorbidities compared to women without HIV. However, there are no guidelines on the screening for and management of age-related comorbidities and events in women living with HIV. Moreover, little is known about provision of care to this population across Europe. We surveyed 121 HIV healthcare providers in 25 World Health Organization European countries to ascertain screening practices for, and management of, menopause, psychosocial and sexual well-being and age-related comorbidities in women with HIV. Most respondents screened for diabetes, cardiovascular disease (CVD) risk factors and poor mental health at least annually. Low bone mineral density (BMD) was regularly checked but less than once a year. Fewer regularly screened for sexual well-being and intimate partner violence. Menstrual pattern and menopausal symptoms in women aged 45-54 were assessed by 67% and 59% of respondents. 44% stated that they were not confident assessing menopausal status and/or symptoms. CVD, diabetes, low BMD and poor mental health were managed mainly within HIV clinics, whereas menopause care was mainly provided by gynaecology or primary care. Most respondents stated a need for HIV and menopause guidelines. In conclusion, we found that whilst metabolic risk factors and poor mental health are regularly screened for, psychosocial and sexual well-being and menopausal symptoms could be improved. This highlights the need for international recommendations and clinician training to ensure the health of this population.
Collapse
Affiliation(s)
- Umbelina Caixas
- Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Judit Morello
- iNOVA4Health, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital, London, UK
- ViiV Healthcare, Brentford, UK
| |
Collapse
|
5
|
Bukic E, Milasin J, Toljic B, Jadzic J, Jevtovic D, Obradovic B, Dragovic G. Association between Combination Antiretroviral Therapy and Telomere Length in People Living with Human Immunodeficiency Virus. Biology (Basel) 2023; 12:1210. [PMID: 37759609 PMCID: PMC10525818 DOI: 10.3390/biology12091210] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Long-term exposure to combination antiretroviral therapy (cART) may be associated with accelerated ageing. Telomere length is considered to be reliable aging biomarker. The aim of this study was to compare patients' relative telomere length (RTL) between and within different cART classes and to estimate the impact of certain HIV-related variables on RTL. The study was conducted in 176 HIV-infected male patients receiving cART, with ≤50 copies HIV RNA/mL plasma. RTL was determined from mononuclear cells by quantitative polymerase chain reaction. Standard statistical tests and unsupervised machine learning were performed. The mean RTL was 2.50 ± 1.87. There was no difference (p = 0.761) in RTL between therapeutic groups: two nucleoside reverse transcriptase inhibitors as the backbone treatment, combined with either integrase inhibitor, protease inhibitor, or non-nucleoside reverse transcriptase inhibitor (NNRTI). Machine learning results suggested duration of HIV infection, CD4+ T-cell count, and cART, including NNRTI, as potentially significant variables impacting RTL. Kendall's correlation test excluded duration of HIV infection (p = 0.220) and CD4+ T-cell count (p = 0.536) as significant. The Mann-Whitney test confirmed that cART containing NNRTI impacted RTL (p = 0.018). This was the first study to show that patients using efavirenz within cART had significantly shorter telomeres than patients using nevirapine.
Collapse
Affiliation(s)
- Ena Bukic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade Faculty of Medicine, 11000 Belgrade, Serbia
| | - Jelena Milasin
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Bosko Toljic
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jadzic
- Center of Bone Biology, University of Belgrade Faculty of Medicine, 11000 Belgrade, Serbia
| | - Djordje Jevtovic
- Infective and Tropical Diseases Hospital, University of Belgrade Faculty of Medicine, 11000 Belgrade, Serbia
| | - Bozana Obradovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade Faculty of Medicine, 11000 Belgrade, Serbia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade Faculty of Medicine, 11000 Belgrade, Serbia
| |
Collapse
|
6
|
Obradovic B, Roberts O, Owen A, Milosevic I, Milic N, Ranin J, Dragovic G. Expression of CYP2B6 Enzyme in Human Liver Tissue of HIV and HCV Patients. Medicina (Kaunas) 2023; 59:1207. [PMID: 37512019 PMCID: PMC10385124 DOI: 10.3390/medicina59071207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections present significant public health challenges worldwide. The management of these infections is complicated by the need for antiviral and antiretroviral therapies, which are influenced by drug metabolism mediated by metabolic enzymes and transporters. This study focuses on the gene expression of CYP2B6, CYP3A4, and ABCB1 transporters in patients with HIV, HCV, and HIV/HCV co-infection, aiming to assess their potential association with the choice of therapy, patohistological and clinical parameters of liver damage such as the stage of liver fibrosis, serum levels of ALT and AST, as well as the grade of liver inflammation and other available biochemical parameters. Materials and Methods: The study included 54 patients who underwent liver biopsy, divided into HIV-infected, HCV-infected, and co-infected groups. The mRNA levels of CYP2B6, CYP3A4, and ABCB1 was quantified and compared between the groups, along with the analysis of liver fibrosis and inflammation levels. Results: The results indicated a significant increase in CYP2B6 mRNA levels in co-infected patients, a significant association with the presence of HIV infection with an increase in CYP3A4 mRNA levels. A trend towards downregulation of ABCB1 expression was observed in patients using lamivudine. Conclusions: This study provides insight into gene expression of CYP2B6 CYP3A4, and ABCB1 in HIV, HCV, and HIV/HCV co-infected patients. The absence of correlation with liver damage, inflammation, and specific treatment interventions emphasises the need for additional research to elucidate the complex interplay between gene expression, viral co-infection, liver pathology, and therapeutic responses in these particular patients population.
Collapse
Affiliation(s)
- Bozana Obradovic
- University of Belgrade, Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, 11000 Belgrade, Serbia
| | - Owain Roberts
- University of Buckingham Medical School, Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Andrew Owen
- Centre of Excellence in Long-Acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
| | - Ivana Milosevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Natasa Milic
- University of Belgrade, Faculty of Medicine, Department of Medical Statistics & Informatics, 11000 Belgrade, Serbia
| | - Jovan Ranin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Gordana Dragovic
- University of Belgrade, Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, 11000 Belgrade, Serbia
| |
Collapse
|
7
|
Aimla K, Kowalska JD, Matulionyte R, Mulabdic V, Vassilenko A, Bolokadze N, Jilich D, Antoniak S, Oprea C, Balayan T, Harxhi A, Papadopoulos A, Lakatos B, Vasylyev M, Begovac J, Yancheva N, Streinu-Cercel A, Verhaz A, Gokengin D, Dragovic G, Sojak L, Skrzat-Klapaczyńska A. Vaccination against HBV and HAV as Mode of Hepatitis Prevention among People Living with HIV-Data from ECEE Network Group. Vaccines (Basel) 2023; 11:vaccines11050980. [PMID: 37243084 DOI: 10.3390/vaccines11050980] [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: 03/12/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Viral hepatitis C (HCV) and viral hepatitis B (HBV) are common co-infections in people living with HIV (PLWH). All PLWH should be vaccinated against HBV and hepatitis A (HAV) and treated for HBV and HCV. We aimed to compare testing, prophylaxis and treatment of viral hepatitis in PLWH in Central and Eastern Europe (CEE) in 2019 and 2022. (2) Methods: Data was collected through two on-line surveys conducted in 2019 and 2022 among 18 countries of the Euroguidelines in CEE (ECEE) Network Group. (3) Results: In all 18 countries the standard of care was to screen all PLWH for HBV and HCV both years; screening of HAV was routine in 2019 in 54.5% and in 2022 47.4% of clinics. Vaccination of PLWH against HAV was available in 2019 in 16.7%, in 2022 in 22.2% countries. Vaccination against HBV was available routinely and free of charge in 50% of clinics both in 2019 and 2022. In HIV/HBV co-infected the choice of NRTI was tenofovir-based in 94.4% of countries in both years. All clinics that responded had access to direct-acting antivirals (DAAs) but 50% still had limitations for treatment. (4) Conclusions: Although testing for HBV and HCV was good, testing for HAV is insufficient. Vaccination against HBV and especially against HAV has room for improvement; furthermore, HCV treatment access needs to overcome restrictions.
Collapse
Affiliation(s)
- Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Justyna Dominika Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Anna Vassilenko
- City Clinical Hospital of Infectious Diseases, 220002 Minsk, Belarus
| | - Natalie Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, 18000 Prague, Czech Republic
| | - Sergii Antoniak
- Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | | | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, Medical University of Tirana, 1000 Tirana, Albania
| | - Antonios Papadopoulos
- HIV Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Botond Lakatos
- National Instititue of Hematology and Infectious Diseases, National Center of HIV, 1097 Budapest, Hungary
| | - Marta Vasylyev
- Lviv Regional Public Health Center, HIV Unit, 79000 Lviv, Ukraine
| | - Josip Begovac
- University Hospital of Infectious Diseases, 10000 Zagreb, Croatia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Medical University of Sofia, 1606 Sofia, Bulgaria
| | - Anca Streinu-Cercel
- National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
| | - Antonija Verhaz
- Clinic for Infectious Diseases Republic of Srpska Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, 35100 Izmir, Turkey
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, 833 05 Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| |
Collapse
|
8
|
Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
Collapse
Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
| |
Collapse
|
9
|
Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, Begovac J, Cicic A, Dragovic G, Harxhi A, Aimla K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Sojak L, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Kowalska J. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines (Basel) 2023; 11:vaccines11010122. [PMID: 36679967 PMCID: PMC9867039 DOI: 10.3390/vaccines11010122] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.
Collapse
Affiliation(s)
- Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye
- HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye
- Correspondence: or
| | - Dominik Bursa
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Agata Skrzat-Klapaczynska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Ivailo Alexiev
- Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Elena Arsikj
- University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0025, Armenia
| | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alma Cicic
- Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania
| | - Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Botond Lakatos
- Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - Dalibor Sedlacek
- HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic
| | - Lubomir Sojak
- Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer’s University Hospital, 2412 Bratislava, Slovakia
| | - Janez Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus
| | - Marta Vasylyev
- Astar Medical Center, 79054 Lviv, Ukraine
- Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands
| | - Antonija Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases—Sofia, Medical University Sofia, 1431 Sofia, Bulgaria
| | - Oleg Yurin
- Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia
| | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| |
Collapse
|
10
|
Papadopoulos A, Thomas K, Protopapas K, Antonyak S, Begovac J, Dragovic G, Gökengin D, Aimla K, Krasniqi V, Lakatos B, Mardarescu M, Matulionyte R, Mulabdic V, Oprea C, Panteleev A, Sedláček D, Sojak L, Skrzat-Klapaczyńska A, Vassilenko A, Yancheva N, Yurin O, Horban A, Kowalska JD. HIV treatment strategies across Central, Eastern and Southeastern Europe: New times, old problems. HIV Med 2022; 24:462-470. [PMID: 36196025 DOI: 10.1111/hiv.13416] [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: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. RESULTS In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. CONCLUSIONS In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.
Collapse
Affiliation(s)
- Antonios Papadopoulos
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sergii Antonyak
- Gromashevsky Institute of Epidemiology and Infectious Diseases, Viral Hepatitis and AIDS Department, Kiev, Ukraine
| | - Josip Begovac
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Deniz Gökengin
- Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | | | - Valbon Krasniqi
- Infectious Diseases Clinic, University Clinical Center at Kosovo, Prishtina, Kosovo
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Budapest, Hungary
| | - Mariana Mardarescu
- National Institute for Infectious Diseases Matei Bals, Bucharest, Romania
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Carol Davila University of Medicine and Pharmacy, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | | | - Dalibor Sedláček
- Department of Infectious Diseases and Travel Medicine, Charles University of Prague, Prague, Czech Republic
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, Academic L. Derer's University Hospital, Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Vassilenko
- Republican Scientific and Practical Center for Medical Technologies, Global Fund Grant Management Department, Belarusian State Medical University, Minsk, Belarus
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Oleg Yurin
- Central Research Institute of Epidemiology, Moskow, Russia
| | - Andrzej Horban
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
11
|
Matłosz B, Skrzat-Klapaczyńska A, Antoniak S, Balayan T, Begovac J, Dragovic G, Gusev D, Jevtovic D, Jilich D, Aimla K, Lakatos B, Matulionyte R, Panteleev A, Papadopoulos A, Rukhadze N, Sedláček D, Stevanovic M, Vassilenko A, Verhaz A, Yancheva N, Yurin O, Horban A, Kowalska JD. Chronic Kidney Disease and Nephrology Care in People Living with HIV in Central/Eastern Europe and Neighbouring Countries-Cross-Sectional Analysis from the ECEE Network. Int J Environ Res Public Health 2022; 19:12554. [PMID: 36231850 PMCID: PMC9565150 DOI: 10.3390/ijerph191912554] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft-Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients' noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance.
Collapse
Affiliation(s)
- Bartłomiej Matłosz
- HIV Outpatient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department, Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0002, Armenia
| | - Josip Begovac
- School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, 10000 Zagreb, Croatia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Denis Gusev
- Botkin’s Infectious Disease Hospital, First Saint-Petersburg State Medical University Named after I.P. Pavlov, 197022 Saint-Petersburg, Russia
| | - Djordje Jevtovic
- Infectious Disease Hospital, Belgrade University School of Medicine, 11000 Belgrade, Serbia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka Hospital, 18000 Prague, Czech Republic
| | - Kerstin Aimla
- West Tallinn Central Hospital, 10111 Tallinn, Estonia
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, 1007 Budapest, Hungary
| | - Raimonda Matulionyte
- Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | | | - Antonios Papadopoulos
- University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, 112482 Tblisi, Georgia
| | - Dalibor Sedláček
- Faculty of Medicine in Plzeň, University Hospital Plzeň, Charles University, 30599 Plzen, Czech Republic
| | - Milena Stevanovic
- University Clinic for Infectious Diseases and Febrile Conditions, 1000 Skopje, North Macedonia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, 220004 Minsk, Belarus
| | - Antonija Verhaz
- Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease, 1000 Sofia, Bulgaria
| | - Oleg Yurin
- Central Research Institute of Epidemiology, Federal AIDS Centre, 101000 Moscow, Russia
| | - Andrzej Horban
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Justyna D. Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| |
Collapse
|
12
|
Kusic Milicevic J, Vidakovic R, Andjelkovic Apostolovic M, Apostolovic B, Ostojic A, Markovic R, Djurkovic V, Trbojevic Stankovic J, Jemcov T, Dragovic G. MO750: Dialysate Magnesium Impact on Progression of Coronary Artery Calcification. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac079.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg.
METHOD
This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up.
RESULTS
Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P < 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P < 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P < 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P <0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P < 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22; P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively.
CONCLUSION
Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.
Collapse
Affiliation(s)
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia
- Faculty of Medicine, University in Belgrade, Belgrade, Serbia
| | - Marija Andjelkovic Apostolovic
- Department of Medical Statistics and Informatics, Medical Faculty, University of Nis, Nis, Serbia
- Public Health Institute, Nis, Serbia
| | | | - Ana Ostojic
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Rodoljub Markovic
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | | | - Jasna Trbojevic Stankovic
- Faculty of Medicine, University in Belgrade, Belgrade, Serbia
- Department of Dialysis, Clinical Hospital Centre ‘’Dr Dragisa Misovic—Dedinje’, Belgrade, Serbia
| | - Tamara Jemcov
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
- Faculty of Medicine, University in Belgrade, Belgrade, Serbia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University in Belgrade, Belgrade, Serbia
| |
Collapse
|
13
|
Amele S, Sandri AK, Rodger A, Vandekerckhove L, Benfield T, Milinkovic A, Duvivier C, Stellbrink HJ, Sambatakou H, Chkhartishvili N, Caldeira L, Laguno M, Domingo P, Wandeler G, Gisinger M, Kuzovatova E, Dragovic G, Knysz B, Matulionyte R, Rockstroh JK, Lundgren JD, Mocroft A, Peters L. HCV reinfection after HCV therapy among HIV/HCV-coinfected individuals in Europe. HIV Med 2021; 23:684-692. [PMID: 34882940 DOI: 10.1111/hiv.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/02/2021] [Revised: 09/22/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Although direct-acting antivirals (DAAs) can clear HCV in nearly all HIV/HCV-coinfected individuals, high rates of reinfection may hamper efforts to eliminate HCV in this population. We investigated reinfection after sustained virological response (SVR) in HIV/HCV-coinfected individuals in Europe. METHODS Factors associated with odds of reinfection by 2 years after SVR in EuroSIDA participants with one or more HCV-RNA test and 2 years follow-up were assessed using logistic regression. RESULTS Overall, 1022 individuals were included. The median age was 50 (interquartile range: 43-54 years), and most were male (78%), injection drug users (52%), and received interferon (IFN)-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7-8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11-0.38; 0.43, 95% CI: 0.22-0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis. CONCLUSIONS Among HIV/HCV-coinfected individuals in Europe, 7.3% were reinfected with HCV within 24 months of achieving SVR, with evidence suggesting that this is decreasing over time and with use of newer HCV regimens. Harm reduction to reduce reinfection and surveillance to detect early reinfection with an offer of treatment are essential to eliminate HCV.
Collapse
Affiliation(s)
- Sarah Amele
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | - Thomas Benfield
- Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Claudine Duvivier
- AP-HP - Necker Enfants Malades Hospital, Infectious Diseases Department; Necker Pasteur Center for Infectious Diseases and Tropical Medicine; Université de Paris; IHU Imagine, Paris, France
| | | | | | | | - Luis Caldeira
- Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal
| | | | - Pere Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute, Nizhny Novgorod, Russia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.,CHIP, Rigshospitalet, Copenhagen, Denmark
| | | | | |
Collapse
|
14
|
Lakatos B, Kowalska J, Antoniak S, Gokengin D, Begovac J, Vassilenko A, Wasilewski P, Fleischhans L, Jilich D, Matulionyte R, Kase K, Papadopoulus A, Rukhadze N, Harxhi A, Hofman S, Dragovic G, Vasyliev M, Verhaz A, Yancheva N, Oprea C. Retrospective evaluation of an observational cohort by the Central and Eastern Europe Network Group shows a high frequency of potential drug-drug interactions among HIV-positive patients receiving treatment for coronavirus disease 2019 (COVID-19). HIV Med 2021; 23:693-700. [PMID: 34859557 DOI: 10.1111/hiv.13214] [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: 08/24/2021] [Revised: 10/10/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this international multicentre study was to review potential drug-drug interactions (DDIs) for real-life coadministration of combination antiretroviral therapy (cART) and coronavirus disease 2019 (COVID-19)-specific medications. METHODS The Euroguidelines in Central and Eastern Europe Network Group initiated a retrospective, observational cohort study of HIV-positive patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data were collected through a standardized questionnaire and DDIs were identified using the University of Liverpool's interaction checker. RESULTS In total, 524 (94.1% of 557) patients received cART at COVID-19 onset: 117 (22.3%) were female, and the median age was 42 (interquartile range 36-50) years. Only 115 (21.9%) patients were hospitalized, of whom 34 required oxygen therapy. The most frequent nucleoside reverse transcriptase inhibitor (NRTI) backbone was tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide (TAF) with lamivudine or emtricitabine (XTC) (79.3%) along with an integrase strand transfer inhibitor (INSTI) (68.5%), nonnucleoside reverse transcriptase inhibitor (NNRTI) (17.7%), protease inhibitor (PI) (13.7%) or other (2.5%). In total, 148 (28.2%) patients received COVID-19-specific treatments: corticosteroids (15.7%), favipiravir (7.1%), remdesivir (3.1%), hydroxychloroquine (2.7%), tocilizumab (0.6%) and anakinra (0.2%). In total, 62 DDI episodes were identified in 58 patients (11.8% of the total cohort and 41.9% of the COVID-19-specific treatment group). The use of boosted PIs and elvitegravir accounted for 43 DDIs (29%), whereas NNRTIs were responsible for 14 DDIs (9.5%). CONCLUSIONS In this analysis from the Central and Eastern European region on HIV-positive persons receiving COVID-19-specific treatment, it was found that potential DDIs were common. Although low-dose steroids are mainly used for COVID-19 treatment, comedication with boosted antiretrovirals seems to have the most frequent potential for DDIs. In addition, attention should be paid to NNRTI coadministration.
Collapse
Affiliation(s)
- Botond Lakatos
- HIV Center, National Institute of Hematology and Infectious Diseases, South Pest Central Hospital, Budapest, Hungary
| | - Justyna Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department at the Gromashevsky Institute of Epidemiology and Infectious Diseases, Kyiv, Ukraine
| | - Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Josip Begovac
- School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, Zagreb, Croatia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, Minsk, Belarus
| | - Piotr Wasilewski
- 4th Department, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | - Lukas Fleischhans
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Bulovka, Czech Republic
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Bulovka, Czech Republic
| | - Raimonda Matulionyte
- Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Antonios Papadopoulus
- Medical School, National and Kapodistrian University of Athens, University General Hospital Attikon, Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, Tbilisi, Georgia
| | - Arjan Harxhi
- Infectious Disease Service, University Hospital Center of Tirana, Tirana, Albania
| | - Sam Hofman
- Faculty of Medicine in Plzeň, Charles University, University Hospital Plzeň, Plzeň, Czech Republic
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Antonija Verhaz
- Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, Republika Srpska, Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, Sofi, Bulgaria
| | - Cristiana Oprea
- Carol Davila University of Medicine and Pharmacy, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | | |
Collapse
|
15
|
Jilich D, Skrzat-Klapaczyńska A, Fleischhans L, Bursa D, Antoniak S, Balayan T, Begovac J, Cicic A, Dragovic G, Goekengin D, Harxhi A, Kase K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Tomazic J, Tovba L, Soják Ľ, Vassilenko A, Yancheva N, Yurin O, Kowalska J. National strategies for vaccination against COVID-19 in people living with HIV in Central and Eastern European region. HIV Med 2021; 23:546-552. [PMID: 34704331 PMCID: PMC8653080 DOI: 10.1111/hiv.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/16/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
Introduction People living with HIV (PLWH) are at higher risk of poorer COVID‐19 outcomes. Vaccination is a safe and effective method of prevention against many infectious diseases, including COVID‐19. Here we investigate the strategies for national COVID‐19 vaccination programmes across central and eastern Europe and the inclusion of PLWH in vaccination programmes. Methods The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of infectious diseases from 24 countries in the region. Between 1 November 2020 and 19 March 2021 the group proceeded an on‐line survey consisting of 20 questions. Results Twenty‐two countries (out of 24 invited) participated in the survey and 20/22 countries in the period between December 2020 and March 2021 had already started their COVID‐19 vaccination programme. In total, seven different vaccines were used by participating countries. In 17/21 countries (81%), vaccinated persons were centralized within the national registry. In 8/21 countries (38%) PLWH were prioritized for vaccination (the Czech Republic, Greece, Hungary, Lithuania, Montenegro, Romania, Slovakia, Slovenia) and the Czech Republic, Greece and Serbia had put in place national guidelines for vaccination of PLWH. In 14/20 countries (70%) vaccination was only provided by designated centres. Eighteen respondents (18/21; 85.7%) reported that they planned to follow up HIV patients vaccinated against COVID‐19, mainly by measuring antibody levels and checking COVID‐19 incidence (11/21; 52.3%). Conclusions This survey‐based study suggests that there are significant differences in terms of prioritizing PLWH, the types of vaccines used, vaccination coverage, and the development and implementation of a vaccination programmes within the region. Regardless of heterogenicity and existing barriers within the region, systematic vaccination in PLWH should have the highest priority, especially in those with severe immunodeficiency, risk factors, and in the elderly, aiming for prompt and high vaccination coverage.
Collapse
Affiliation(s)
- David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Prague, Czech Republic
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Lukas Fleischhans
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Prague, Czech Republic
| | - Dominik Bursa
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department at the Gromashevsky Institute of Epidemiology and Infectious Diseases, Kyiv, Ukraine
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan, Armenia
| | - Josip Begovac
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Alma Cicic
- Institute for Public Health of Montenegro, Podgorica, Montenegro
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine; University of Belgrade, Belgrade, Serbia
| | | | - Arjan Harxhi
- University Hospital Center of Tirana, Infectious Disease Service, Tirana, Albania
| | | | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Budapest, Hungary
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Antonios Papadopoulos
- University General Hospital Attikon - Medical School - National and Kapodistrian University of Athens, Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, Tbilisi, Georgia
| | - Janez Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Lida Tovba
- USMF Nicolae Testemitanu, Chisinau, Moldova
| | - Ľubomír Soják
- Department of Infectology and Geographical Medicine, Center for Treatment of HIV/AIDS Patients, Academic L. Dérer's University Hospital, Bratislava, Slovakia
| | - Anne Vassilenko
- Republican Scientific and Practical Center for Medical Technologies, Global Fund Grant Management Department, Minsk, Belarus
| | - Nina Yancheva
- Department for AIDS. Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, Sofia, Bulgaria
| | - Oleg Yurin
- Central Research Institute of Epidemiology, Moskov, Russia
| | - Justyna Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
16
|
Kusic Milicevic J, Vidakovic R, Andjelkovic Apostolovic M, Apostolovic B, Ostojic A, Markovic R, Djurkovic V, Trbojević Stanković J, Jemcov T, Dragovic G. MO748CORONARY ARTERY CALCIUM SCORE IN ASYMPTOMATIC PATIENTS RECEIVING CHRONIC HAEMODIALYSIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab097.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Vascular calcification has been reported to be an independent predictor of all-cause mortality and cardiovascular (CV) events in patients with end-stage renal disease. Even in previously asymptomatic patients, early years of haemodialysis (HD) are associated with high CV morbidity and mortality rates. Thus, it is important to precisely and timely identify individuals at risk of coronary artery disease (CAD) who would benefit from further CV treatment. Coronary artery calcium score (CACS) is an accurate tool for noninvasive assessment of CAD. This study aimed to evaluate CACS in asymptomatic HD patients in early years of treatment.
Method
This multicentric observational study included 60 patients receiving chronic HD for less than 4 years, with neither signs nor symptoms of CV disease. All patients underwent multislice computed tomography to identify coronary artery calcifications according to the standard procedure. CACS was calculated by the Agatston method individually for the left main, left circumflex, left anterior descending, and right coronary arteries and then summed to calculate the total CACS for each patient. Patients were distributed based on CACS: group 1 with CACS = 0, group 2 with CACS ranging from 1 to 400, and group 3 with CACS > 400.
Results
Nine patients (89% men) had CACS = 0, 34 (47% men) had CACS 1-400, and 17 (76.5% men) had CACS > 400 (χ2 = 7.467; p = 0.024). The mean age was 51±7, 61±12 and 64±8 years in groups 1, 2 and 3, respectively (p = 0.016). Patients in group 1 were significantly younger than patients in group 2 (p = 0.046) and group 3 (p = 0.012). The highest percentage of men was observed in group 1 (x2 = 7,668; p = 0.022). Other investigated demographic characteristics (dialysis vintage, body mass index, smoking history, family CV history, systolic and diastolic blood pressure), comorbidities (hypertension, diabetes, hyperparathyroidism, hyperlipidemia) and therapy (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, vitamin D, CaCO3, dialysate-magnesium concentration) did not differ significantly between the investigated groups. CACS showed statistically significant negative correlation with the serum iron (σ = - 0.351; p = 0.007), while other laboratory parameters (including calcium phosphate product) did not show statistically significant correlations.
Conclusion
Older age and low serum iron are associated with higher CACS in asymptomatic patients in the early years of HD. Therefore, these patients should be closely monitored for the early signs of CV disease.
Collapse
Affiliation(s)
| | - Radosav Vidakovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Belgrade, Serbia
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Marija Andjelkovic Apostolovic
- Medical Faculty University of Nis, Department of Medical statistics and Informatics, Nis, Serbia
- Public Health Institute, Nis, Serbia
| | | | - Ana Ostojic
- Clinical Hospital Centre Zemun, Department of Nephrology, Belgrade, Serbia
| | - Rodoljub Markovic
- Clinical Hospital Centre Zemun, Department of Nephrology, Belgrade, Serbia
| | | | - Jasna Trbojević Stanković
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Clinical Hospital Centre ”Dr Dragisa Misovic - Dedinje”, Department of Dialysis, Belgrade, Serbia
| | - Tamara Jemcov
- Clinical Hospital Centre Zemun, Department of Nephrology, Belgrade, Serbia
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Gordana Dragovic
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Belgrade, Serbia
| |
Collapse
|
17
|
Kusic Milicevic J, Vidakovic R, Markovic R, Andjelkovic Apostolovic M, Korac M, Trbojevic Stankovic J, Jemcov T, Neskovic AN, Dragovic G. Cardiovascular risk assessment and coronary artery calcification burden in asymptomatic patients in the initial years of hemodialysis. Ther Apher Dial 2021; 26:64-70. [PMID: 33675568 DOI: 10.1111/1744-9987.13641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/01/2021] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022]
Abstract
The specific tool for cardiovascular risk assessment in hemodialysis population has not yet been proposed, despite high prevalence of cardiovascular morbidity, and mortality in clinically asymptomatic patients. Coronary artery calcium score (CACS), as a reliable predictor of future cardiovascular events, might be a valuable approach. We sought to evaluate coronary artery calcification burden and its association with clinical and laboratory parameters in asymptomatic patients who recently initiated hemodialysis. The cross-sectional study included 60 asymptomatic patients receiving chronic hemodialysis for no longer than 48 months. CACS was assessed by cardiac computed tomography. Intima-media thickness (IMT) of both common carotid and femoral arteries were measured using ultrasonography. The mean total CACS was 160.50 (443). Patients' age correlated significantly with CACS (σ = 0.367; P = 0.004), carotid (σ = 0.375; P = 0.004) and femoral IMT (σ = 0.323; P = 0.013). Patients with CACS = 0 were significantly younger than patients with CACS >400: 52.4 ± 7.91 vs. 63.88 ± 8.37 years old, respectively (P = 0.034). In patients receiving dialysis for longer than 24 months CACS, femoral and carotid IMT were higher than in those dialyzed for less than 24 months; however, none has reached significance. There was a significant positive correlation between CACS and right (σ = 0.312; P = 0.018) and left (σ = 0.521; P < 0.001) femoral IMT, while not with carotid. CACS showed significant negative correlation with the serum iron (σ = -0.351; P = 0.007). Calcification burden varies significantly in asymptomatic patients in early years of dialysis. It correlates with patients' age and tends to increase with dialysis vintage. Femoral IMT might be useful for cardiovascular risk stratification in asymptomatic patients who recently initiated hemodialysis.
Collapse
Affiliation(s)
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rodoljub Markovic
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Marija Andjelkovic Apostolovic
- Department of Medical Statistics and Informatics, Medical Faculty, University of Nis, Nis, Serbia.,Public Health Institute, Nis, Serbia
| | - Mihajlo Korac
- Department of Radiology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Jasna Trbojevic Stankovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Dialysis, Clinical Hospital Centre "Dr Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Tamara Jemcov
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Dragovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Pharmacology, Clinical Pharmacology and Toxicology, Belgrade, Serbia
| |
Collapse
|
18
|
Vasic D, Dragovic G, Jevtovic D, Salemovic D, Radmili O, Rancic Z. MISC 1. Femoral Arteries Are a Better Indicator Than Carotid Arteries of Cardiovascular Risk in HIV/AIDS Patients. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Dragovic G, Nikolic K, Dimitrijevic B, Jevtovic D, Salemovic D, Tomanovic N, Boricic I. Severe hepatotoxicity induced by efavirenz in a treatment-naïve, low body mass index HIV-infected, female patient with no hepatitis and other virus co-infections. Ultrastruct Pathol 2019; 43:220-223. [PMID: 31578116 DOI: 10.1080/01913123.2019.1673862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Combined antiretroviral therapy (cART) consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI), such as efavirenz, is still the first-line treatment in resource-limited settings. However, efavirenz has shown strong prominence of disadvantages with variance in plasma concentration and central nervous side effects. Our study presents HIV infected, drug naïve, female patient with relatively low BMI, CYP2B6 516G>T (rs3745274) genotype with high efavirenz plasma concentration. In this case report, the patient was admitted at the hospital 6 months after cART initiation with drug-induced severe hepatotoxicity. Furthermore, pathophysiological findings proved confluent parenchymal necrosis after aspiration liver biopsy, with mild to moderate inflammation in portal tracts with focal interface hepatitis. All other possible causes were excluded. Thus, we conclude that efavirenz has a potential harmful effect in patients with low BMI, specific genotyping and interindividual pharmacokinetics affecting high plasma concentration.
Collapse
Affiliation(s)
- Gordana Dragovic
- Department for Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Nikolic
- Department for Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bozana Dimitrijevic
- Department for Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtovic
- School of Medicine, The HIV-AIDS Center, Hospital for Infectious and Tropical Diseases "Dr Kosta Todorovic", University of Belgrade, Belgrade, Serbia
| | - Dubravka Salemovic
- School of Medicine, The HIV-AIDS Center, Hospital for Infectious and Tropical Diseases "Dr Kosta Todorovic", University of Belgrade, Belgrade, Serbia
| | - Nada Tomanovic
- Department of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Boricic
- Department of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
20
|
Kusic J, Markovic R, Dragovic G. SP459TOTAL SERUM AND INTRA-ERYTHROCYTE MAGNESIUM CONCENTRATIONS IN HAEMODIALYSIS PATIENTS USING DIFFERENT DIALYSATE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jovana Kusic
- Clinical Hospital Centre Zemun, Belgrade, Serbia
| | | | | |
Collapse
|
21
|
Lukic R, Djukic M, Soldatovic I, Orlic NK, Ardalic D, Dragovic G, Mikovic Z. Prediction of preeclampsia using extreme first-trimester PAPP-A, free βhCG and uterine artery Doppler in resource limited settings. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3534.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
22
|
Siljic M, Salemovic D, Cirkovic V, Pesic-Pavlovic I, Todorovic M, Ranin J, Dragovic G, Jevtovic D, Stanojevic M. High Frequency of Human Leukocyte Antigen-B*57:01 Allele Carriers among HIV-Infected Patients in Serbia. Intervirology 2017; 60:43-47. [PMID: 28772259 DOI: 10.1159/000477810] [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: 01/26/2017] [Accepted: 05/27/2017] [Indexed: 11/19/2022] Open
Abstract
Abacavir is an effective antiretroviral drug and one of the most commonly used nucleoside reverse transcriptase inhibitors in Serbia. А percentage of the treated patients experience a potentially life-threatening hypersensitivity reaction, which was shown to be associated with the presence of the class I MHC allele, HLA-B*57:01; hence genotyping for HLA-B*57:01 prior to starting abacavir is nowadays recommended in international HIV treatment guidelines. In Serbia, this testing became available in 2013. This study was designed to estimate the prevalence of the HLA-B*57:01 allele in Serbian HIV-1-infected patients. The presence of the HLA-B*57:01 allele was analyzed in 273 HIV-1-infected patients aged 18 years or more, who were abacavir naïve. Buccal swab samples were obtained from all participants and assayed for the presence of HLA-B*57:01 using a commercially available HLA-B*57:01 real-time PCR kit. The presence of the HLA-B*57:01 allele was found in 22 of 273 tested individuals (8%; 95% CI 5.4-11.9%). This is the first study that estimated the HLA-B*57:01 prevalence among HIV-infected patients in Serbia. The very high prevalence of HLA-B*57:01 found in our study strongly supports HLA-B*57:01 genotyping, which should be implemented prior to the initiation of an abacavir-containing therapy to reduce the risk of potentially life-threatening hypersensitivity reactions.
Collapse
Affiliation(s)
- Marina Siljic
- University of Belgrade School of Medicine, Belgrade, Serbia
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Srdic D, Khawla AM, Soldatovic I, Nikolic J, Jevtovic D, Nair D, Dragovic G. Correlation of Leptin, Adiponectin, and Resistin Levels in Different Types of Lipodystrophy in HIV/AIDS Patients. Metab Syndr Relat Disord 2017; 15:153-159. [PMID: 28339344 DOI: 10.1089/met.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Leptin, adiponectin, and resistin may play an important role in the development of lipodystrophy (LD) in HIV/AIDS patients. The aim of this study was to correlate levels of leptin, adiponectin, and resistin between HIV/AIDS patients with LD and without lipodystrophy (non-LD), as well as between subgroups of LD [lipoatrophy (LA), lipohypertrophy (LH), and mixed fat redistribution (MFR)] and non-LD patients. METHODS Cross-sectional study of 66 HIV/AIDS patients. Serum levels of leptin, adiponectin, and resistin were measured. The associations between adipocytokine levels and metabolic variables were estimated by Spearman correlation. Analysis of covariance with bootstrapping method was used to examine the relationship between adiponectin and leptin and lipodystrophy categories. RESULTS The LD was observed in 29 (44%) patients, while 15 (52%) of them had LA, 4 (14%) had LH, and 10 (34%) patients had MFR. No significant differences regarding leptin, adiponectin, and resistin levels, between LD and non-LD patients, were observed. LH patients had significantly higher levels of leptin and adiponectin in comparison with non-LD patients (P = 0.039, P = 0.011, respectively). Within the LD group, LA patients had significantly lower levels of leptin (LA vs. LH, P = 0.020; LA vs. MFR, P = 0.027), while LH patients had significantly higher levels of adiponectin (LH vs. LA, P = 0.027; LH vs. MFR, P = 0.028). Correlation of adiponectin with LD remains significant in the LH subgroup after adjustment for age, body mass index, cystatin-C, plasminogen activator inhibitor-1 (PAI-1), and interferon gamma (IFN-γ) (P = 0.001). CONCLUSIONS Adiponectin and leptin levels differ significantly between LH patients and non-LD patients, as well as between the LD subgroups. Adiponectin may be a more useful marker of LD in HIV/AIDS patients.
Collapse
Affiliation(s)
- Danica Srdic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Al Musalhi Khawla
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Ivan Soldatovic
- 3 Institute for Biomedical Statistics, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Jelena Nikolic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Djordje Jevtovic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Devaki Nair
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Gordana Dragovic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
| |
Collapse
|
24
|
Alexiev I, Dimitrova R, Gancheva A, Kostadinova A, Stoycheva M, Nikolova D, Elenkov I, Tilișcan C, Predescu M, Păunescu B, Streinu-Cercel A, Săndulescu O, Șchiopu CM, Hristache M, Brîndușe LA, Streinu-Cercel A, Todorovic M, Siljic M, Salemovic D, Nikolic V, Pesic-Pavlovic I, Ranin J, Jevtovic D, Stanojevic M, Tudor AM, Vlad D, Mărdărescu M, Petrea S, Petre C, Neagu-Drăghicenoiu R, Ungurianu R, Cibea A, Chirilă O, Anghelina C, Coserea I, Krikelli PA, Pavlitina E, Psichogiou M, Lamnisos D, Williams L, Korobchuk A, Skaathun B, Smyrnov P, Schneider J, Sypsa V, Paraskevis D, Hatzakis A, Friedman SR, Nikolopoulos GK, Dragović G, Srdić D, Khawla AM, Soldatović I, Nikolić J, Jevtović D, Nair D, Temereanca A, Rosca A, Ene L, Soontornniyomkij B, Diaconu C, Dita C, Achim C, Ruta S, Benea Ș, Moroti R, Jipa R, Manea E, Stan A, Benea E, Oțelea D, Hristea A, Hristea A, Lăpădat I, Jipa R, Moroti R, Benea Ș, Antonică D, Panait I, Petre R, Kowalska JD, Pietraszkiewicz E, Grycner E, Firlag-Burkacka E, Horban A, Vlaicu O, Bănică L, Paraschiv S, Tudor AM, Moroti R, Oțelea D, Dimitrijević B, Soldatović I, Jevtović Đ, Kusić J, Salemović D, Ranin J, Dragović G, Florea D, Bădicuț I, Rafila A, Camburu C, Histrea A, Frățilă M, Oțelea D, Gmizic I, Salemovic D, Pesic-Pavlovic I, Siljic M, Nikolic V, Djonin-Nenezic M, Milosevic I, Brmbolic B, Stanojevic M, Streinu-Cercel A, Săndulescu O, Neguț AC, Predescu M, Mărdărescu A, Săndulescu M, Streinu-Cercel A, Pérez AB, Chueca N, Álvarez M, Alados JC, Rivero A, Vera F, Delgado M, Salmeron J, Jiménez M, Blanco MJ, Diago M, Garcia-deltoro M, Alvarez M, Téllez F, García F, Tănase D, Manea E, Bacruban R, Florea D, Oțelea D, Rafila A, Mărdărescu M, Hristea A, Grgic I, Planinic A, Santak M, Gorenec L, Lepej SZ, Vince A, Manea E, Hristea A, Benea Ș, Moroti R, Tănase D, Niculae CM, Merisor S, Jipa R, Paraskevis D, Kostaki E, Nikolopoulos GK, Sypsa V, Psichogiou M, Paraskeva D, Skoutelis A, Malliori M, Friedman SR, Hatzakis A, Hackiewicz M, Zabek P, Firlag-Burkacka E, Horban A, Kowalska JD, Lunar MM, Mlakar J, Poljak M, Bănică L, Martin E, Gheorghiță V, Petrescu A, Oțelea D, Popescu CI, Paraschiv S, Neaga E, Ovidiu V, Juncu A, Bănică L, Paraschiv S, Oțelea D, Popescu CI, Luca A, Lazăr F, Luca AE, Ene L, Achim C, Gingăraş C, Anton ȘA, Rădoi R, Tetradov S, Țârdei G, Nica M, Capşa RA, Achim CL, Oprea C, Ene L, Szymańska B, Gawron N, Pluta A, Łojek E, Firląg-Burkacka E, Horban A, Bornstein R, Burcoș O, Erscoiu SM, Cojanu FB, Toderan A, Nica M, Popa IC, Ceaușu E, Calistru PI, Arbune M, Alexandrache M, Arbune AA, Voinescu DC, Diaconu IA, Stratan L, Aramă V, Nichita L, Diaconu A, Negru A, Orfanu A, Leuștean A, Ion DA, Ianache I, Oprea C, Leuștean A, Popescu C, Orfanu A, Negru A, Catana R, Murariu C, Diaconu IA, Rădulescu M, Tilișcan C, Aramă V, Marincu I, Poptelecan P, Bică V, Lazăr F, Tirnea L, Ianache I, Rădoi R, Nica M, Țârdei G, Ene L, Ceaușu E, Calistru P, Oprea C, Osoianu I, Halacu A, Stoian AC, Dumitrescu F, Diaconescu I, Cupșa A, Giubelan L, Ionescu L, Niculescu I, Chiriac C, Șincu N, Kezdi IZ, Georgescu A, Țilea B, Girbovan C, Incze A, Fodor A, Cibea A, Mărdărescu M, Petre C, Drăghicenoiu R, Ungurianu R, Tudor AM, Vlad D, Matei C, Dumea E, Petcu LC, Cambrea SC, Dumitrescu F, Cupsa A, Stoian AC, Giubelan L, Niculescu I, Diaconescu I, Hurezeanu D, Dragonu L, Cotulbea M, Erscoiu SM, Popa IC, Stroie D, Ionescu P, Duță N, Dobrea C, Voican I, Ceaușu E, Calistru PI, Lazăr F, Giubelan L, Cupșa A, Diaconescu I, Dumitrescu F, Hurezeanu D, Dragonu L, Niculescu I, Stoian AC, Obretin O, Stănescu M, Jianu M, Gorenec L, Lepej SZ, Grgic I, Planinic A, Bes JI, Vince A, Begovac J, Horga LE, Itu C, Horga LE, David-Aldea LA, Ciorogar A, Jianu C, Lupșe M, Caramangiu I, Roșca O, Cialma M, Ardeleanu A, Marincu I, Jipa R, Manea E, Benea Ș, Lăpădat I, Irimescu N, Panait I, Niculae C, Hristea A, Kusic J, Jevtovic D, Salemovic D, Ranin J, Dimitrijevic B, Dragovic G, Aldea-David LA, Manciuc C, Nicolau C, Prisăcariu L, Largu A, Mărdărescu M, Streinu-Cercel A, Petre C, Iancu M, Vintilă S, Vitelaru D, Ionel I, Șchiopu CM, Mărdărescu AH, Micsanschi P, Holban T, Bîstrițchi I, Pârțână L, Nagîț A, Popovici S, Talmaci M, Cucerova I, Mitrescu SG, Mihalcea D, Caramangiu I, Roșca O, Maricu I, Negru A, Munteanu D, Aramă V, Mihăilescu R, Diaconu I, Catana R, Popescu C, Orfanu A, Leuștean A, Rădulescu M, Tilișcan C, Năstase R, Molagic V, Duport I, Dragomirescu C, Aramă ȘS, Negruț NM, Niță VE, Munteanu DI, Mihăilescu R, Diaconu I, Negru A, Popescu C, Aramă V, Orfanu A, Popescu C, Leuștean A, Negru A, Catana R, Diaconu I, Tilișcan C, Aramă V, Aramă SȘ, Pavlovia IP, Salemovic D, Ranin J, Jevtovic D, Roșca O, Ardeleanu A, Caramangiu I, Desaga D, Bică V, Mitrescu S, Marincu I, Siljic M, Salemovic D, Nikolic V, Jevtovic D, Pesic-Pavlovic I, Ranin J, Todorovic M, Stanojevic M, Șincu NI, Georgescu A, Țilea B, Kezdi IZ, Incze A, Gârbovan C, Chiriac CL, Luca AE, Lazăr F, Luca A, Ene L, Rădoi R, Talnariu A, Suciu S, Achim C, Iacob DG, Florea D, Iacob S, Arbune M, Drăgănescu M, Iancu A, Moroti R, Niculae CM, Merisor S, Manea E, Benea S, Stan A, Hrisca R, Jipa R, Tanase D, Hristea A, Grgic I, Planinic A, Gorenec L, Lepej SZ, Vince A. Proceedings of The 8th Romanian National HIV/AIDS Congress and The 3rd Central European HIV Forum : Sibiu, Romania. 5-7 May 2016. BMC Infect Dis 2016; 16 Suppl 3:290. [PMID: 27356504 PMCID: PMC4928154 DOI: 10.1186/s12879-016-1480-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
O1 HIV-1 diversity in Bulgaria (current molecular epidemiological picture) Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Asya Kostadinova, Mariyana Stoycheva, Daniela Nikolova, Ivaylo Elenkov O2 Knowledge, attitudes and practices of the general population on HIV/AIDS, hepatitis B and C in Romania Cătălin Tilișcan, Mioara Predescu, Bogdan Păunescu, Anca Streinu-Cercel, Oana Săndulescu, Claudiu Mihai Șchiopu, Mădălina Hristache, Lăcrămioara Aurelia Brîndușe, Adrian Streinu-Cercel O3 The prevalence of human leukocyte antigen-B*57:01 allele carriers and CXCR4 tropism among newly diagnosed HIV infected patients in Serbia Marija Todorovic, Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Ivana Pesic-Pavlovic, Jovan Ranin, Djordje Jevtovic, Maja Stanojevic O4 HIV transmission among stable serodiscordant couples from the former Pediatric Cohort follow up in the National Institute of Infectious Diseases Ana Maria Tudor, Delia Vlad, Mariana Mărdărescu, Sorin Petrea, Cristina Petre, Ruxandra Neagu-Drăghicenoiu, Rodica Ungurianu, Alina Cibea, Odette Chirilă, Cristian Anghelina, Ileana Coserea O5 Unemployment is associated with syringe sharing among people who inject drugs in Greece Pantelia-Amalia Krikelli, Eirini Pavlitina, Mina Psichogiou, Demetris Lamnisos, Leslie Williams, Anya Korobchuk, Britt Skaathun, Pavlo Smyrnov, John Schneider, Vana Sypsa, Dimitrios Paraskevis, Angelos Hatzakis, Samuel R. Friedman, Georgios K. Nikolopoulos O6 Correlation of adipocytokine levels in different types of lipodystrophy in HIV/AIDS patients Gordana Dragović, Danica Srdić, Al Musalhi Khawla, Ivan Soldatović, Jelena Nikolić, Djordje Jevtović, Devaki Nair O7 IP10 – a possible biomarker for the progression of HIV infection Aura Temereanca, Adelina Rosca, Luminita Ene, Benchawa Soontornniyomkij, Carmen Diaconu, Claudia Dita, Cristian Achim, Simona Ruta O8 A permanent challenge: persistent low viremia in HIV positive patients on ART Șerban Benea, Ruxandra Moroti, Raluca Jipa, Eliza Manea, Andrada Stan, Elisabeta Benea, Dan Oțelea, Adriana Hristea O9 Infections in IDUs according to their HIV status Adriana Hristea, Irina Lăpădat, Raluca Jipa, Ruxandra Moroti, Șerban Benea, Doina Antonică, Irina Panait, Roxana Petre O10 Trends in combined antiretroviral therapy used in methadone program integrated with HIV care - 20 years of experience Justyna D. Kowalska, Ewa Pietraszkiewicz, Ewa Grycner, Ewa Firlag-Burkacka, Andrzej Horban O11 Extracellular cyclophilin A – inflammatory mediator in HIV infected patients Ovidiu Vlaicu, Leontina Bănică, Simona Paraschiv, Ana-Maria Tudor, Ruxandra Moroti, Dan Oțelea O12 High cardiovascular disease risk in Serbian population, an issue of concern Bojana Dimitrijević, Ivan Soldatović, Đorđe Jevtović, Jovana Kusić, Dubravka Salemović, Jovan Ranin, Gordana Dragović O13 Genotypic rifampicin resistance in HIV/ tuberculosis coinfected patients from a tertiary level infectious diseases hospital Dragoș Florea, Ioana Bădicuț, Alexandru Rafila, Cornel Camburu, Adriana Histrea, Mihaela Frățilă, Dan Oțelea O14 Occurrence of residual HCV RNA in liver and peripheral blood mononuclear cells among patients with chronic hepatitis C infection and/or HCV/HIV coinfection after IFN-based therapy Ivana Gmizic, Dubravka Salemovic, Ivana Pesic-Pavlovic, Marina Siljic, Valentina Nikolic, Miljana Djonin-Nenezic, Ivana Milosevic, Branko Brmbolic, Maja Stanojevic O15 Romanian nationwide screening for infection with HIV and hepatitis B and C viruses Anca Streinu-Cercel, Oana Săndulescu, Alina Cristina Neguț, Mioara Predescu, Alexandra Mărdărescu, Mihai Săndulescu, Adrian Streinu-Cercel O16 Treatment emergent variants to combined direct antiviral agents therapy against hepatitis C virus Ana Belen Pérez, Natalia Chueca, Marta Álvarez, Juan Carlos Alados, Antonio Rivero, Francisco Vera, Marcial Delgado, Javier Salmeron, Miguel Jiménez, Maria José Blanco, Moises Diago, Miguel Garcia-deltoro, Marta Alvarez, Francisco Téllez, Federico García O17 Clinical and epidemiological aspects in tuberculosis/HIV coinfected patients Diana Tănase, Eliza Manea, Rodica Bacruban, Dragoș Florea, Dan Oțelea, Alexandru Rafila, Mariana Mărdărescu, Adriana Hristea O18 Resistance to NS3 protease inhibitors in persons with chronic hepatitis C infected with hepatitis C virus subtype 1a from Croatia Ivana Grgic, Ana Planinic, Maja Santak, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince O19 Analysis of a simplified diagnostic score for tuberculous meningitis in HIV-infected adults with meningitis Eliza Manea, Adriana Hristea, Șerban Benea, Ruxandra Moroti, Diana Tănase, Cristian M. Niculae, Simona Merisor, Raluca Jipa O20 Molecular tracing of the origin of HIV-1 infection among persons who inject drugs in Athens: a phyloethnic study Dimitrios Paraskevis, Evangelia Kostaki, Georgios K. Nikolopoulos, Vana Sypsa, Mina Psichogiou, Dimitra Paraskeva, Athanassios Skoutelis, Meni Malliori, Samuel R. Friedman, Angelos Hatzakis O21 The dynamics of virological response to HIV-1 infection and antiretroviral therapy initiation in patients with and without HLA-B*5701 Allele Malgorzata Hackiewicz, Piotr Zabek, Ewa Firlag-Burkacka, Andrzej Horban, Justyna Dominika Kowalska O22 Increase in the numbers of non-B subtypes and potential recombinant forms circulating among Slovenian MSM in the recent years Maja M. Lunar, Jana Mlakar, Mario Poljak O23 Genotyping intrahost polymorphisms in hepatitis C virus E2 protein associated with resistance to antibody neutralization Leontina Bănică, Eliza Martin, Valeriu Gheorghiță, Andrei Petrescu, Dan Oțelea, Costin-Ioan Popescu, Simona Paraschiv O24 Genotyping of HCV NS3 protease inhibitors resistance and phenotyping of rare double resistance mutations in HCV cell culture system Emil Neaga, Vlaicu Ovidiu, Andrei Juncu, Leontina Bănică, Simona Paraschiv, Dan Oțelea, Costin-Ioan Popescu O25 Employment status controls the relationship between neurocognitive impairment and depression in a cohort of young HIV-infected adults since childhood Adrian Luca, Florin Lazăr, Anca Elena Luca, Luminița Ene, Cristian Achim O26 Predictors of survival in parenterally-infected HIV positive children and youth diagnosed with progressive multifocal leukoencephalopathy Cosmina Gingăraş, Ștefan Adrian Anton, Roxana Rădoi, Simona Tetradov, Grațiela Țârdei, Maria Nica, Razvan Alexandru Capşa, Cristian L. Achim, Cristiana Oprea, Luminița Ene O27 Neurocognitive and brain functioning in HIV-infected young MSM treated with cART Bogna Szymańska, Natalia Gawron, Agnieszka Pluta, Emilia Łojek, Ewa Firląg – Burkacka, Andrzej Horban, Robert Bornstein, et HARMONIA3 Study Group O28 Clinical value of RT-PCR detection of Toxoplasma gondii DNA in cerebrospinal fluid Olivia Burcoș, Simona Manuela Erscoiu, Filofteia Bănicioiu Cojanu, Andreea Toderan, Maria Nica, Ionuț Cristian Popa, Emanoil Ceaușu, Petre Iacob Calistru O29 Characteristics of sleep disorders in Romanian adults infected with human immunodeficiency virus Manuela Arbune, Mirela Alexandrache, Anca-Adriana Arbune, Doina-Carina Voinescu O30 Diagnosing neuroHIV: the rift between clinicians and pathologists Ioan-Alexandru Diaconu, Laurențiu Stratan, Victoria Aramă, Luciana Nichita, Alexandra Diaconu, Anca Negru, Alina Orfanu, Anca Leuștean, Daniela Adriana Ion O31 A challenging neurological complication in a HIV-infected young woman with multiple opportunistic infections Irina Ianache, Cristiana Oprea O32 Brain abscess with uncertain etiology in a late-presenter HIV infected patient Anca Leuștean, Cristina Popescu, Alina Orfanu, Anca Negru, Remulus Catana, Cristina Murariu, Ioan-Alexandru Diaconu, Mihaela Rădulescu, Cătălin Tilișcan, Victoria Aramă O33 Cerebral toxoplasmosis and left crural monoparesis with fatal evolution in a noncompliant patient with AIDS C3 Iosif Marincu, Patricia Poptelecan, Valeria Bică, Florin Lazăr, Livius Tirnea O34 Opportunistic infections still a problem in HIV-infected patients in cART era: a Romanian single center experience Irina Ianache, Roxana Rădoi, Manuela Nica, Grațiela Țârdei, Luminița Ene, Emanoil Ceaușu, Petre Calistru, Cristiana Oprea P1: Epidemiological aspects of co-infection of HIV/TB in Moldova Iurie Osoianu, Ala Halacu P2 Perinatal exposure at HIV infection in Oltenia region Andreea Cristina Stoian, Florentina Dumitrescu, Iulian Diaconescu, Augustin Cupșa, Lucian Giubelan, Loredana Ionescu, Irina Niculescu P3 Women living with HIV in Mureș county Carmen Chiriac, Nina Șincu, Iringo Zaharia Kezdi, Anca Georgescu, Brândușa Țilea, Cristina Girbovan, Andrea Incze, Andrea Fodor P4 Late diagnosis of HIV infection in children - a challenge for Romania Alina Cibea, Mariana Mărdărescu, Cristina Petre, Ruxandra Drăghicenoiu, Rodica Ungurianu, Ana Maria Tudor, Delia Vlad, Carina Matei P5 Cirrhosis Assessment in Patients Co-infected HIV-Hepatitis B Virus Elena Dumea, Lucian Cristian Petcu, Simona Claudia Cambrea P6 HIV late presenters in Craiova Regional Center, Romania Florentina Dumitrescu, Augustin Cupsa, Andreea Cristina Stoian, Lucian Giubelan, Irina Niculescu, Iulian Diaconescu, Dan Hurezeanu, Livia Dragonu, Mioara Cotulbea P7 Some aspects of malignancies in patients HIV / AIDS Simona Manuela Erscoiu, Ionuț Cristian Popa, Denisa Stroie, Petronela Ionescu, Nedeea Duță, Camelia Dobrea, Irina Voican, Emanoil Ceaușu, Petre Iacob Calistru P8 Factors associated with resilience among people living with HIV in Romania Florin Lazăr P9 Fever in HIV-infected patients: a thorny problem to be solved by the clinicians Lucian Giubelan, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Dan Hurezeanu, Livia Dragonu, Irina Niculescu, Andreea Cristina Stoian, Oana Obretin, Mariana Stănescu, Mihai Jianu P10 Th1, Th2, Th9, Th17 and Th22 cytokines in acute and chronic HIV-1 infection Lana Gorenec, Snjezana Zidovec Lepej, Ivana Grgic, Ana Planinic, Janja Iscic Bes, Adriana Vince, Josip Begovac P11 Dyslipidemia in HIV-infected patients treated with protease inhibitors – case report Luminița Elena Horga P12 Why use less treatment for the metabolic abnormalities in HIV patients-too many drugs? Corina Itu, Luminița Elena Horga, Laura Augusta David-Aldea, Anca Ciorogar, Cristian Jianu, Mihaela Lupșe P13 Sacral Herpes Zoster, with hyperalgesic form, in a patient with C3 stage HIV infection Iuliana Caramangiu, Ovidiu Roșca, Monica Cialma, Andreea Ardeleanu, Iosif Marincu P14 Factors associated with in-hospital mortality in tuberculous and cryptococcal meningitis Raluca Jipa, Eliza Manea, Șerban Benea, Irina Lăpădat, Nicoleta Irimescu, Irina Panait, Cristian Niculae, Adriana Hristea P15 Lipodystrophy: still present adverse event in resource-limited settings Jovana Kusic, Djordje Jevtovic, Dubravka Salemovic, Jovan Ranin, Bozana Dimitrijevic, Gordana Dragovic P16 TB and HIV coinfected patient, an emergent challenge - case report Laura-Augusta Aldea-David P17 Efficacy of prophylactic antiretroviral treatment in new-born infants from HIV-positive mothers in 2012-2014, for the North-Eastern part of Romania Carmen Manciuc, Cristina Nicolau, Liviu Prisăcariu, Alexandra Largu P18 Surveillance of mother to child transmission of HIV in Romania – 31 December 2015 Mariana Mărdărescu, Adrian Streinu-Cercel, Cristina Petre, Marieta Iancu, Sanda Vintilă, Daniela Vitelaru, Iosif Ionel, Claudiu Mihai Șchiopu, Alexandra-Henriette Mărdărescu P19 The antiretroviral therapy failure and the need to select the effective treatment in the Republic of Moldova Pavel Micsanschi, Tiberiu Holban, Ina Bîstrițchi, Lucia Pârțână, Angela Nagîț, Svetlana Popovici, Maria Talmaci, Irina Cucerova P20 Disseminated cryptococcosis in a patient with C3 HIV stage and multiresistant to antiretroviral therapy with lethal evolution Sorina Georgiana Mitrescu, Dana Mihalcea, Iulia Caramangiu, Ovidiu Roșca, Iosif Maricu P21 Aspects of tuberculosis infection in HIV-positive patients from Romania – our experience Anca Negru, Daniela Munteanu, Victoria Aramă, Raluca Mihăilescu, Ioan Diaconu, Remulus Catana, Cristina Popescu, Alina Orfanu, Anca Leuștean, Mihaela Rădulescu, Cătălin Tilișcan, Raluca Năstase, Violeta Molagic, Irina Duport, Cristina Dragomirescu, Ștefan Sorin Aramă P22 Dyslipidemia in HIV-infected patients Nicoleta M Negruț P23 Challenges in the management of an HIV seropositive patient with psoriasis undergoing immunomodulator therapy Violeta Elena Niță, Daniela Ioana Munteanu, Raluca Mihăilescu, Ioan Diaconu, Anca Negru, Cristina Popescu, Victoria Aramă P24 Acute peritonitis as a sign of IRIS in an HIV-infected patient with MAC latent infection Alina Orfanu, Cristina Popescu, Anca Leuștean, Anca Negru, Remulus Catana, Ioan Diaconu, Cătălin Tilișcan, Victoria Aramă, Sorin Ștefan Aramă P25 The virologic outcome of the treatment of chronic hepatitis B among HIV co-infected patients on HAART Ivana Pesic Pavlovia, Dubravka Salemovic, Jovan Ranin, Djordje Jevtovic P26 A case of HIV encephalopathy with aphasia, agnosia, apraxia and right homonymous hemianopsia Ovidiu Roșca, Andreea Ardeleanu, Iulia Caramangiu, Daniela Desaga, Valerica Bică, Sorina Mitrescu, Iosif Marincu P27 Molecular footprints on human immunodeficiency virus -1 genome and association with phylogenetic clustering among subtype B infected patients in Serbia Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Djordje Jevtovic, Ivana Pesic-Pavlovic, Jovan Ranin, Marija Todorovic , Maja Stanojevic P28 Neurosyphilis and human immunodeficiency virus infection: double challenge Nina-Ioana Șincu, Anca Georgescu, Brândușa Țilea, Iringo Zaharia Kezdi, Andrea Incze, Cristina Gârbovan, Carmen Lucia Chiriac P29 Differences between HIV-infected adults since childhood and non HIV-infected persons on managing everyday life Anca Elena Luca, Florin Lazăr, Adrian Luca, Luminița Ene, Roxana Rădoi, Adina Talnariu, Silvia Suciu, Cristian Achim P30 Molecular detection of Bartonella quintana in a HIV immunodepressed patient with fever and isolated lymphadenopathy - Case report Diana Gabriela Iacob, Dragoș Florea, Simona Iacob P31 Present epidemiological characteristics of HIV/AIDS newly diagnosed cases in South-Eastern Romania Manuela Arbune, Miruna Drăgănescu, Alina Iancu P32 The gender’s preferences among opportunists? Ruxandra Moroti, Cristian M Niculae, Simona Merisor, Eliza Manea, Serban Benea, Andrada Stan, Raluca Hrisca, Raluca Jipa, Diana Tanase, Adriana Hristea P33 Polymorphism of interleukin-28B gene in persons with chronic hepatitis C from Croatia Ivana Grgic, Ana Planinic, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince
Collapse
|
25
|
Abstract
Peripheral neuropathy (PN) is a well-known adverse effect of treatment with nucleoside reverse transcriptase inhibitors (NRTIs). We performed a prospective follow-up study in HIV-infected patients on antiretroviral therapy containing NRTIs. The objective of this study was to examine the incidence of PN among patients using NRTI drugs. Data were obtained using medical records of patients continuously monitored for the efficacy and toxicity of antiretroviral therapy. The incident cases of PN were examined. Incidence rates of PN were calculated for each antiretroviral regimen that included zidovudine, zalcitabine, lamivudine, didanosine (ddI), stavudine (d4T) or didanosine+ stavudine. Poisson regression was used to compare the relative risk of PN for each regimen. A total of 112 HIV-infected patients were treated with at least one NRTI-containing regimen. Thirty-two cases of PN were recorded. The lowest incidence rate (IR) of 0.13 per 100 person-years occurred in patients treated with didanosine. The highest IR for PN occurred with the didanosine+stavudine combination (IR=0.18 per 100 person-years). Compared to didanosine alone, the relative risk of PN was 1.77 (95%CI, 0.52–2.12) for stavudine, and 1.76 (95%CI, 0.95–2.49) for didanosine+stavudine. Other risk factors for PN included a low CD4 cell count and female sex. Our data show that the risk of PN is almost twice as high when stavudine is used alone or in combination with didanosine. The use of stavudine alone or in combination with didanosine should probably not be routinely recommended if other treatment options are available.
Collapse
Affiliation(s)
- Gordana Dragovic
- Institute of Clinical Pharmacology, School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro.
| | | |
Collapse
|
26
|
Dragovic G, Smith CJ, Jevtovic D, Dimitrijevic B, Kusic J, Youle M, Johnson MA. Choice of first-line antiretroviral therapy regimen and treatment outcomes for HIV in a middle income compared to a high income country: a cohort study. BMC Infect Dis 2016; 16:106. [PMID: 26939611 PMCID: PMC4778345 DOI: 10.1186/s12879-016-1443-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background The range of combination antiretroviral therapy (cART) regimens available in many middle-income countries differs from those suggested in international HIV treatment guidelines. We compared first-line cART regimens, timing of initiation and treatment outcomes in a middle income setting (HIV Centre, Belgrade, Serbia - HCB) with a high-income country (Royal Free London Hospital, UK - RFH). Methods All antiretroviral-naïve HIV-positive individuals from HCB and RFH starting cART between 2003 and 2012 were included. 12-month viral load and CD4 count responses were compared, considering the first available measurement 12-24 months post-cART. The percentage that had made an antiretroviral switch for any reason, or for toxicity and the percentage that had died by 36 months (the latest time at which sufficient numbers remained under follow-up) were investigated using standard survival methods. Results 361/597 (61 %) of individuals initiating cART at HCB had a prior AIDS diagnosis, compared to 337/1763 (19 %) at RFH. Median pre-ART CD4 counts were 177 and 238 cells/mm3 respectively (p < 0.0001). The most frequently prescribed antiretrovirals were zidovudine with lamivudine (149; 25 %) and efavirenz [329, 55 %] at HCB and emtricitabine with tenofovir (899; 51 %) and efavirenz [681, 39 %] at RFH. At HCB, a median of 2 CD4 count measurements in the first year of cART were taken, compared to 5 at RFH (p < 0.0001). Median (IQR) CD4 cell increase after 12 months was +211 (+86, +359) and +212 (+105, +318) respectively. 287 (48 %) individuals from HCB and 1452 (82 %) from RFH had an available viral load measurement, of which 271 (94 %) and 1280 (88 %) were <400 copies/mL (p < 0.0001). After 36 months, comparable percentages had made at least one antiretroviral switch (77 % HCB vs. 78 % RFH; p = 0.23). However, switches for toxicity/patient choice were more common at RFH. After 12 and 36 months of cART 3 % and 8 % of individuals died at HCB, versus 2 % and 4 % at RFH (p < 0.0001). Conclusion In middle-income countries, cART is usually started at an advanced stage of HIV disease, resulting in higher mortality rates than in high income countries, supporting improved testing campaigns for early detection of HIV infection and early introduction of newer cART regimens.
Collapse
Affiliation(s)
- Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Colette J Smith
- UCL Research Department of Infection and Population Health, Royal Free Campus, 1st Floor, Rowland Hill Street, London, NW3 2PF, UK.
| | - Djordje Jevtovic
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Bozana Dimitrijevic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Jovana Kusic
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Mike Youle
- Department of HIV Medicine, Royal Free London Hospital, London, UK.
| | | |
Collapse
|
27
|
Dragovic G, Smith C, Jevtovic D, Youle M, Back D. Influence of liver fibrosis stage on nevirapine plasma concentration in HIV-infected patients with chronic hepatitis C virus. BMC Infect Dis 2014. [PMCID: PMC4071948 DOI: 10.1186/1471-2334-14-s4-o17] [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
|
28
|
Jevtović D, Dragovic G, Salemović D, Ranin J, Kušić J, Marinković J, Djurković-Djaković O. Treatment outcome of HAART-treated patients in a resource-limited setting: the Belgrade Cohort Study. Biomed Pharmacother 2014; 68:391-5. [PMID: 24486106 DOI: 10.1016/j.biopha.2014.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/26/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION We evaluated the effects of highly-active-antiretroviral-therapy (HAART) in a resource-limited settings. METHODS A cross-sectional study was performed in patients who had initiated HAART at the HIV/AIDS-Center, Belgrade, Serbia. Treatment response was considered favorable in case of the achievement of undetectable HIVRNA plasma-viral-load (pVL<50 copies/μL), and with the CD4+ T-cell counts increased above 350cells/μL. The treatment failure was defined as pVL over 1.7 log10 copies/mL, regardless of immunological improvement. RESULTS Eight hundred and forty HIV infected patients were followed-up for 8.2±3.4years. Out of 697 patients available for follow-up, 113 (16.2%) patients died, 44 (6.3%) experienced treatment failure, while 540 (77.5%) had sustained undetectable viremia. In 419 (60.1%) favorable treatment response was achieved, while the dissociation between immunological and virological responses to HAART occurred in 121 (14.4%). A baseline CD4+ T-cell counts above 200 cells/μL was the single independent predictor of a favorable treatment response (HR=2, 95%CI=1.69-2.61, P=0.001), while pre-treatment with ART, HCV co-infection and AIDS at the time of treatment initiation, were all factors preventing a favorable response (HR=0.27, 95%CI=0.19-0.36, P=0.001; HR=0.75, 95%CI=0.56-0.95, P=0.02; HR=0.73, 95%CI=0.17-0.95, P=0.018, respectively). A sustained viral suppression was an independent predictor of survival (HR=0.2, 95% CI 0.07-0.61, P=0.004). HAART treated HIV-infected patients who reach and maintain undetectable viremia, have an 80% probability of a 14-years survival (P=0.08, log-rank). CONCLUSION If patient with advanced HIV-related immunodeficiency reach and maintain optimal viral suppression during HAART, regardless of the level of immune recovery, and if they continue to maintain this, their prognosis may be fairly good even in the resource-limited settings.
Collapse
Affiliation(s)
- Djordje Jevtović
- Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia.
| | - Gordana Dragovic
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Dr Subotica1/III, P.O. Box 38, 11129 Belgrade, Serbia.
| | - Dubravka Salemović
- Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia
| | - Jovan Ranin
- Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia
| | - Jovana Kušić
- Infectious and Tropical Diseases Hospital, HIV/AIDS Department, University of Belgrade School of Medicine, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgradee, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | |
Collapse
|
29
|
Abstract
Pancreatitis is a well-described complication of human immunodeficiency virus (HIV) itself and its combination antiretroviral therapy. Historically, this has been predominantly associated with the usage of nucleoside reverse transcriptase inhibitors such as didanosine and stavudine, but only rarely with the usage of protease inhibitors via the induction of hypertriglyceridemia. Pancreatitis rates in HIV/AIDS population may have been exceedingly high because of the comorbid conditions prevalent in HIV/AIDS patients (e.g. ethanol use and biliary disease), and the use of non-combination antiretroviral therapy medications such as pentamidine, corticosteroids, ketoconazole, sulphonamides, metronidazole, isoniazid and opportunistic infections (e.g. cytomegalovirus, cryptosporidiosis, mycobacterial disease). In resource limited settings, where didanosine and stavudine are widely available in cheaper generic fixed dose combinations it is likely that their usage will remain in the first line HIV treatment in common. In such settings management or estimation of a patient's risk of pancreatitis still remains an issue of concern.
Collapse
Affiliation(s)
- Gordana Dragovic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
30
|
Dragovic G, Jevtovic D. The role of nucleoside reverse transcriptase inhibitors usage in the incidence of hyperlactatemia and lactic acidosis in HIV/AIDS patients. Biomed Pharmacother 2012; 66:308-11. [PMID: 22658063 DOI: 10.1016/j.biopha.2011.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/28/2011] [Indexed: 12/25/2022] Open
Abstract
Hyperlactatemia and lactic acidosis (LA) are among the most dangerous and life-threatening side effect that occurs during therapy with some nucleoside reverse transcriptase inhibitors (NRTIs), mainly didanosine (ddI) and stavudine (d4T), also known as d-drugs. Therefore, we performed a prospective, follow-up study and aimed to examine the incidence rates (IR) and rate ratios (RR) of hyperlactatemia and LA for each NRTI. Three hundred and ninety-six HIV-patients were included in final analysis comprising 783.8 person-years of follow-up. Between 1st January 2000 and 1st January 2008, 19 cases of hyperlactatemia and 15 cases of LA were recorded. Between regimens with the significant impact for developing hyperlactatemia and LA the lowest IR was for didanosine (IR=2.87 per 100 person-years, 95%CI=0.45-9.25 and IR=4.31 per 100 person-years, 95%CI=1.07-13.91, respectively), and the highest for didanosine+stavudine (IR=10.17 per 100 person-years, 95%CI=1.02-19.76 and IR=7.39 per 100 person-years, 95%CI=1.02-13.05, respectively). Compared to didanosine alone the RR of hyperlactatemia was 2.67 (95%CI=1.11-12.52) for stavudine, and 4.06 (95%CI=1.31-15.48) for didanosine+stavudine. The RR of LA was 3.12 (95%CI=1.13-10.65) for stavudine, and 5.13 (95%CI=1.54-13.37) for didanosine+stavudine in comparison with didanosine alone. Other risk factors for AP were CD4 cell count less than 200 cells/mm³ and female sex. Our results suggest that the use of stavudine alone or in combination with didanosine should not be used as first-line therapy, especially in patients with CD4 cell count less than 200 cells/mm³ and females if other treatment options are available.
Collapse
Affiliation(s)
- Gordana Dragovic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Dr Subotica 1/III, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | | |
Collapse
|
31
|
Dragovic G, Jevtovic D. Prevalence of Hyperlactatemia in HIV-Infected Patients Taking Antiretroviral Drugs. Drug Saf 2006. [DOI: 10.2165/00002018-200629100-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
32
|
Dragovic G, Jevtovic D. Risk of Liver Toxicity in HIV/HCV Coinfected Patients with Advanced Chronic Liver Disease Receiving Nevirapine (Viramune??) or Lopinavir/Ritonavir (Kaletra??). Drug Saf 2006. [DOI: 10.2165/00002018-200629100-00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
33
|
Abstract
Acute pancreatitis (AP) is a well-known adverse effect of nucleoside reverse transcriptase inhibitors (NRTIs). Therefore, we performed a prospective, cohort study to examine the incidence rates (IRs) and rate ratios (RRs) of AP for each NRTI. A total of 116 HIV patients were included in the final analysis comprising 445.6 person-years of follow-up. Twelve cases of AP were recorded. The lowest IR for AP was for didanosine (ddI) (IR=0.03 per 100 person-years, 95% confidence interval [CI] = 0.01-0.05), and the highest for ddI + stavudine (d4T) (IR = 0.08, 95% CI = 0.07-012). Compared with ddI alone, the RR of AP was 2.21 (95% CI = 1.32-9.31) for d4T, and 3.13 (95% CI = 1.43-12.56) for ddI + d4T. Other risk factors for AP were CD4 cell count <200 cells/mm(3) and female sex. Our results suggest that the use of d4T alone or combined with ddI should not be used as first-line therapy, especially in women or patients with CD4-cell count <200 cells/mm(3).
Collapse
Affiliation(s)
- G Dragovic
- Department of Clinical Pharmacology, Pharmacology and Toxicology, School of Medicine, University of Belgrade, Dr Subotica, 1/III, PO Box 840, Belgrade, Serbia and Montenegro.
| | | | | |
Collapse
|