HIV/AIDS Clinical Care for January 10, 2011

Buenos días este es una copia de los temarios recibidos sobre VIH/SIDA, publicados en Journal Watch, que quiero compartir con ustedes.

Cada uno de los artículos tienen sus referencias para que puedan buscarlos y leerlos. 

Saludos 

Dr. Carlos Erazo

 

"SUMMARY AND COMMENT

Curing HIV? Free!

January 10, 2011 | Rajesh T. Gandhi, MD

An HIV-infected man who underwent stem-cell transplantation for leukemia continues to be free of the virus more than 3.5 years later, without any antiretroviral therapy.

Reviewing: Allers K et al. Blood 2010 Dec 8;

DRUG WATCH

New Formulation of Etravirine; Label Changes for Darunavir and d4T

January 10, 2011 | Paul E. Sax, MD

Etravirine is now available in a 200-mg tablet, darunavir is approved for once-daily dosing in some treatment-experienced patients, and the d4T label no longer calls for dose reduction to prevent toxicity.

SUMMARY AND COMMENT

Structural Cardiac Abnormalities Appear to Persist Despite ART

January 10, 2011 | Abigail Zuger, MD

Echocardiographic abnormalities were prevalent but mostly mild in a cohort of HIV-infected patients, the majority of whom were receiving ART.

Reviewing: Mondy K et al. Clin Infect Dis 2011 Feb 1; 52:378

SUMMARY AND COMMENT

Antiretrovirals and Cognitive Function

January 10, 2011 | Rajesh T. Gandhi, MD

The extent to which individual antiretrovirals penetrate the central nervous system may influence whether those drugs improve cognitive function, but the jury's still out.

Reviewing: Smurzynski M et al. AIDS 2010 Nov 30;""

Pandemic Flu Offers Clue to Better Vaccines

Buenos días 

Este es un artículo sobre la gripe pandémica publicado en http://www.medpagetoday.com, interesante en cuanto a la vacuna.

 Al final tenemos el link donde fué publicado originalmente y pueden ver un video sobre el tema.

Saludos 

Dr. Carlos Erazo

By Michael Smith, North American Correspondent, MedPage Today Published: January 10, 2011 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

The pandemic H1N1 influenza may have helped researchers solve a long-standing problem: how to make a flu vaccine that protects against multiple strains. Such a vaccine is "the holy grail of influenza vaccinology," according to Patrick Wilson, PhD, of the University of Chicago, and colleagues. But researchers have been frustrated because each influenza strain is just different enough from previous strains that a new vaccine has been needed every year, he told MedPage Today. On the face of it, the 2009 pandemic strain was no improvement -- it was markedly different from all earlier H1N1 strains, and vaccines had to be painstakingly developed in the same way the seasonal flu vaccines are made. Action Points   Explain that researchers found broadly cross-reactive antibodies to more than the rapidly changing hemagglutinin protein when analyzing blood from patients who had H1N1 pandemic influenza infection. Note that the investigators suggested that these antibodies arose from memory B cells and could provide an avenue for development of a cross-protective influenza vaccine that might not have to be administered yearly. But, Wilson and colleagues reported in the Jan. 10 issue of the Journal of Experimental Medicine, the very novelty of the virus may have opened the door to better vaccines. An analysis of immune responses of a handful of patients infected with the pandemic strain, Wilson and colleagues reported, allowed the researchers to isolate and clone antibodies that not only neutralized the 2009 virus, but also a range of other H1N1 strains, including the highly pathogenic 1918 strain. "The surprise was, when we made these antibodies, that they were unusually broadly reactive," Wilson said. Current vaccines target a section of the viral hemagglutinin protein, the so-called globular head, which is highly variable. But more than half of the antibodies found by the researchers bound to regions in the stalk of the protein, which is thought to be more highly conserved, Wilson said. Interestingly, however, some antibodies found in the study did bind to the head of the protein and even they were broadly neutralizing, suggesting that their binding regions are also highly conserved over time, Wilson said. Using those highly conserved regions, it might be possible to create a flu vaccine that would protect year after year, he said. "With the proper immunogen," the researchers argued, "the long-sought development of a pan-influenza vaccine might be possible." Wilson and colleagues are currently analyzing immune responses to the monovalent H1N1 vaccine to see if the vaccinated people have similar antibodies to those who actually had the infection, he said. The origin of the antibodies, the researchers think, may be memory B cells in the patients that were created during previous exposures to different flu strains -- a small part of a host of responses to various antigens, including the usual suspects on the globular head. Evidence for that, they said, may be the fact that the cells have highly mutated immunoglobulin genes, indicating extensive affinity maturation, the process that over time improves how well antibodies match an antigen. The novel pandemic strain, however, was sufficiently different that only the rare antibodies to the conserved regions had targets, so they were preferentially amplified. Interestingly, Wilson and colleagues said, the one antibody they found that is highly specific for the pandemic strain was derived from the patient with the most severe illness. The specificity combined with the severity of the illness suggests, they said, that he had no preexisting immunity to previous strains. As a sidelight on the discovery, the monoclonal antibodies created by the researchers appear to have both preventive and therapeutic possibilities in mice. Given before infection, the researchers found, they were highly effective at preventing death in animals from a lethal dose of a mouse-adapted version of the H1N1 pandemic strain. On the other hand, mice injected with a lethal dose of the pandemic strain could be rescued by a bolus of antibodies, even as much as 60 hours after infection, and well after they had developed symptoms, the researchers reported. In one experiment, mice were given the antibodies 48 hours after infection. But six days after infection, the virus was either undetectable or barely detectable. Meanwhile, control animals had all died by day seven or eight, they reported. The study was supported by the National Institutes of Health, the Northeast Biodefense Center, and the National Foundation for Cancer Research. The authors said they had no financial or commercial conflicts of interest.

http://www.medpagetoday.com/InfectiousDisease/SwineFlu/24253?utm_content=GroupCL&utm_medium=email&impressionId=1294731282824&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=188864

Human Immunodeficiency Virus (HIV) types Western blot (WB) band profiles as potential surrogate markers of HIV disease progression and predictors of vertical transmission in a cohort of infected but antiretroviral therapy naive pregnant women in Harare, Zimbabwe

Este artículo es muy interesante, espero que lo disfruten.
Saludos

Dr. Carlos Erazo


"Abstract
Background: Expensive CD4 count and viral load tests have failed the intended objective of
enabling access to HIV therapy in poor resource settings. It is imperative to develop simple,
affordable and non-subjective disease monitoring tools to complement clinical staging efforts
of inexperienced health personnel currently manning most healthcare centres because of brain
drain. Besides accurately predicting HIV infection, sequential appearance of specific bands of
WB test offers a window of opportunity to develop a less subjective tool for monitoring
disease progression.
Methods: HIV type characterization was done in a cohort of infected pregnant women at 36
gestational weeks using WB test. Student-t test was used to determine maternal differences in
mean full blood counts and viral load of mothers with and those without HIV gag antigen
bands. Pearson Chi-square test was used to assess differences in lack of bands appearance
with vertical transmission and lymphadenopathy.
Results: Among the 64 HIV infected pregnant women, 98.4 % had pure HIV-1 infection and
one woman (1.7%) had dual HIV-1/HIV-2 infections. Absence of HIV pol antigen bands was
associated with acute infection, p=0.002. All women with chronic HIV-1 infection had
antibody reactivity to both the HIV-1 envelope and polymerase antigens. However, antibody
reactivity to gag antigens varied among the women, being 100%, 90%, 70% and 63% for p24,
p17, p39 and p55, respectively. Lack of antibody reactivity to gag p39 antigen was associated
with disease progression as confirmed by the presence of lymphadenopathy, anemia, higher
viral load, p=0.010, 0.025 and 0.016, respectively. Although not statistically significant,
women with p39 band missing were 1.4 times more likely to transmit HIV-1 to their infants.Conclusion: Absence of antibody reactivity to pol and gag p39 antigens was associated with
acute infection and disease progression, respectively. Apart from its use in HIV disease
diagnosis, WB test could also be used in conjunction with simpler tests like full blood counts
and patient clinical assessment as a relatively cheaper disease monitoring tool required prior
to accessing antiretroviral therapy for poor resource settings. However, there is also need to
factor in the role of host-parasite genetics and interactions in disease progression."
 Este es el link para acceder el pdf completo y gratuito.

http://www.biomedcentral.com/content/pdf/1471-2334-11-7.pdf

Dynamics and Constraints of Early Infant Diagnosis of HIV Infection in Rural Kenya.

Buenos días con todos, aqui un  nuevo artículo realcionado con VIH/SIDA.

Saludos 

Dr. Carlos Erazo

AIDS Behav. 2011 Jan 7. [Epub ahead of print]

Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, Awuondo KK, Mutinda MN, Molyneux CS, Berkley JA.

Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108, Kenya.

Abstract

A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.

Link:    http://www.ncbi.nlm.nih.gov/pubmed/21213034