A Randomized, Placebo-Controlled Trial of Abacavir Intensification in HIV-1–Infected Adults With Virologic Suppression on a Protease Inhibitor–Containing Regimen

HIV Clinical Trials, 01/17/2011

Hammer SM et al. – The strategy of intensification with abacavir in patients who are virologically suppressed on a stable antiretroviral regimen does not confer a clinical or virologic benefit. As antiretroviral regimens have become more potent since this trial was completed, it will be even more difficult to prove that late intensification of already virologically suppressed patients will add benefit. However, studies are warranted with drugs with new mechanisms of action to determine whether the level of persistent viremia below 50 copies/ mL can be further reduced and what influence this may have on latent HIV reservoirs.

http://www.mdlinx.com/family-medicine/sdoc-article.cfm/3448375

Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

Abstract
Background: The psychosocial development of pediatric HIV patients has not been extensively evaluated. The
study objectives were to evaluate whether emotional and social functions are differentially associated with HIVrelated
complications.
Methods: A matched case-control study design was conducted. The case group (n = 20) consisted of vertically
infected children with HIV (aged 3-18 years) receiving HAART in Greece. Each case was matched with two randomly
selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify
patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities
Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to
evaluate emotional adjustment and social skills. The Fisher’s exact test, student’s t-test, and Wilcoxon rank sum test
were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups.
Results: HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging
abnormalities with respect to either age at HAART initiation (p = 0.306) or months of HAART treatment (p = 0.964).
While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy
peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027) and Practical (p = 0.042)
Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both
Abnormal Emotional Symptoms (p = 0.047) and Hyperactivity scores (p = 0.0009). In contrast, HIV patients with
neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033).
Conclusions: HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with
respect to their emotional and activity spheres, while HIV patients with neuroimaging abnormalities are more likely
to present with compromised social skills. Due to the limited sample size and age distribution of the study
population, further studies should investigate the psychosocial development of pediatric HIV patients following the
disclosure of their condition.

http://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdfhttp://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdf

Markers of atherosclerosis and inflammation and mortality in patients with HIV infection☆

Este es un artículo que nos hace ver la realidad de la atención integral en los pacientes que viven con VIH.

Espero que les sea útil

Saludos 

Dr. Carlos Erazo

http://www.atherosclerosis-journal.com/article/PIIS0021915010009135/abstract?rss=yes

Abstract 

Objective

HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. Surrogate marker studies suggest an increased prevalence of vascular abnormalities in HIV infection. We examined the association of all-cause mortality in HIV-infected patients with carotid artery intima-media thickness (cIMT) and high-sensitivity C-reactive protein (hsCRP).

Design and methods

Baseline risk factors, cIMT and hsCRP were prospectively measured in 327 HIV-infected participants. Follow-up time with median of 3.1 years was calculated from baseline to death or censored dated 7/31/07. Cox Proportional Hazards models were used to study risk factors associated with mortality.

Results

Thirty-eight (11.6%) of participants have died since study enrollment. cIMT was significantly higher in those who died and decedents were significantly more likely to have cIMT above the 75th percentile. Those who died had higher hsCRP than those alive and more had hsCRP values above 3mg/L. CD4 count was lower and log10 viral load was higher in decedents, but antiretroviral regimens were similar in both groups. cIMT and hsCRP levels were significantly associated with mortality (HR=2.74, 95% CI 1.26–5.97, p=0.01; HR=2.38, 95% CI 1.15–4.9, p=0.02).

Conclusions

Our study demonstrated a strong association of carotid IMT and hsCRP with all-cause death in this HIV-infected population despite being similar with respect to exposure to antiretroviral medications. Together these surrogate markers may be indices of chronic inflammation and unfavorable outcomes in HIV-positive patients.