A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Yearly number of patients diagnosed with primary HIV-1 infection in France estimated by a capture-recapture approach

We used a two-source capture-recapture method to estimate the number of patients diagnosed at the time of primary HIV infection in France between 1999 and 2002. The sources were the French PRIMO cohort and the French Hospital Database on HIV. The estimated number of patients was 325 per year, which represents only 5% (approximately 6000 cases) of all new cases diagnosed each year and only 8% of all new infections (approximately 4000 cases).

Once-daily dosing of saquinavir soft-gel capsules and ritonavir combination in HIV-1-infected patients (IMEA015 study)

This was a prospective pilot study evaluating a saquinavir (SQV) soft-gel capsules (SGC)/ritonavir (RTV)-containing once-daily regimen over a follow-up of 3 months. The primary end-point was to determine the number of patients both remaining on treatment at month 3 and with trough SQV plasma concentration 24 h after the last intake (C24h) exceeding the inhibition of 95% of viral replication in vitro (IC95). The secondary end-points were to investigate the immuno-virological efficacy and safety of SQV-SGC/RTV once daily, and to explore SQV concentrations in peripheral blood mononuclear cells (PBMCs). Twenty-three antiretroviral-naive and 17 protease inhibitors (PIs) experienced HIV-1-infected patients with plasma HIV-1 RNA level below 200 copies/ml were enrolled. They were assigned to SQV-SGC/RTV (1600/100 mg once daily) combined with nucleoside and/or non-nucleoside reverse transcriptase inhibitors. In a subgroup of 13 patients, both plasma and intracellular SQV concentrations were determined. By intent to treat analysis the percentage of success at month 3 was 87.5% (confidence interval: 73.2-95.8%) with 78.3% in naive and 100% in PI-experienced patients. SQV C24h and intracellular concentrations [median (range, n)] were 241 ng/ml (40-1209, 35) and 323 ng/ml (168-475, 12), respectively. Intracellular concentrations showed an accumulation of SQV in PBMCs persisting during 24 h. Neither immunological nor virological failure was observed. Clinical and biological tolerance was acceptable in all patients but three with adverse effects leading to discontinuation. These data confirmed the short-term efficacy of SQV-SGC/RTV once-daily regimen based on SQV therapeutic drug monitoring.

Once-Daily Dosing of Saquinavir Soft-Gel Capsules and Ritonavir Combination in HIV-1-Infected Patients (Imea015 Study)

This was a prospective pilot study evaluating a saquinavir (SQV) soft-gel capsules (SGC)/ritonavir (RTV)-containing once-daily regimen over a follow-up of 3 months. The primary end-point was to determine the number of patients both remaining on treatment at month 3 and with trough SQV plasma concentration 24 h after the last intake (C24h) exceeding the inhibition of 95% of viral replication in vitro (IC95). The secondary end-points were to investigate the immuno-virological efficacy and safety of SQV-SGC/RTV once daily, and to explore SQV concentrations in peripheral blood mononuclear cells (PBMCs). Twenty-three antiretroviral-naive and 17 protease inhibitors (PIs) experienced HIV-1-infected patients with plasma HIV-1 RNA level below 200 copies/ml were enrolled. They were assigned to SQV-SGC/RTV (1600/100 mg once daily) combined with nucleoside and/or non-nucleoside reverse transcriptase inhibitors. In a subgroup of 13 patients, both plasma and intracellular SQV concentrations were determined. By intent to treat analysis the percentage of success at month 3 was 87.5% (confidence interval: 73.2–95.8%) with 78.3% in naive and 100% in PI-experienced patients. SQV C24h and intracellular concentrations [median (range, n)] were 241 ng/ml (40–1209, 35) and 323 ng/ml (168–475, 12), respectively. Intracellular concentrations showed an accumulation of SQV in PBMCs persisting during 24 h. Neither immunological nor virological failure was observed. Clinical and biological tolerance was acceptable in all patients but three with adverse effects leading to discontinuation. These data confirmed the short-term efficacy of SQV-SGC/RTV once-daily regimen based on SQV therapeutic drug monitoring.

This work was presented in part at the 2nd International Conference on Clinical Pharmacology of HIV Infection, Noordwijk, the Netherlands, 2-4 April 2001 (Abstract 3.16); and at the 1st International Conference on HIV Pathogenesis & Treatment, Buenos Aires, Argentina, 8–11 July 2001 (Abstract 344).

Pulmonary capillary blood volume in patients with probable pulmonary Kaposi's sarcoma

BACKGROUND

An increase in pulmonary capillary blood volume secondary to angiogenesis has been described in Kaposi's sarcoma. The value of the pulmonary capillary blood volume as an early marker of pulmonary Kaposi's sarcoma was evaluated.

METHODS

In a prospective study 45 HIV positive patients (nine asymptomatic for Kaposi's sarcoma, 29 with cutaneous or mucocutaneous Kaposi's sarcoma, and seven with pulmonary Kaposi's sarcoma), underwent pulmonary function tests and determination of transfer capacity for carbon monoxide (TLCO) with its components, pulmonary capillary volume and membrane factor.

RESULTS

Total lung capacity (TLC), TLCO, and its components were similar in the three groups. TLCO was normal in patients with pulmonary Kaposi's sarcoma and no changes in membrane factor or pulmonary capillary volume were observed.

CONCLUSION

Pulmonary function tests and pulmonary capillary volume alone are not useful for identifying patients with pulmonary Kaposi's sarcoma.

Pulmonary function tests in HIV-infected patients

OBJECTIVE

To evaluate alterations in lung function during the course of HIV infection.

DESIGN

Total lung capacity (TLC), the ratio of forced expiratory volume in one second to vital capacity (FEV1/VC), the carbon monoxide transfer factor (TLCO) and the alveolar-arterial oxygen gradient [delta (A-a)O2] were determined in this retrospective study.

PATIENTS

Pulmonary function tests (PFT) were performed on 331 patients at various stages of HIV infection. Patients with a history of intravenous drug use or Kaposi's sarcoma were excluded.

RESULTS

No significant differences were observed between the results for asymptomatic patients and those with AIDS-related complex (ARC). TLC, delta (A-a)O2 and TLCO were greatly altered in patients with acute Pneumocystis carinii pneumonia (PCP). No significant differences were observed in the TLC, delta(A-a)O2 or TLCO results between AIDS patients with no history of PCP and those with a history of a single episode of PCP. TLCO was significantly lower (P < 0.001) in AIDS patients with one previous episode of PCP than in the patients with ARC. Interestingly, both TLC and TLCO were significantly lower in the AIDS patients with no history of PCP than in the patients with ARC. Follow-up of 28 patients at different stages of HIV infection confirmed the alteration of PFT results in the late stages.

CONCLUSIONS

The reasons for alterations in PFT results in PCP-free AIDS patients remain to be determined. Our findings suggest that PFT can provide valuable information throughout the course of HIV infection, particularly with regard to the indication for bronchoalveolar lavage.