scholarly journals Determinants of Viral Resuppression or Persistent Virologic Failure After Initial Failure With Second-Line Antiretroviral Treatment Among Asian Children and Adolescents With HIV

2019 ◽  
Vol 9 (2) ◽  
pp. 253-256
Author(s):  
Sirinya Teeraananchai ◽  
Stephen J Kerr ◽  
Monica Gandhi ◽  
Viet Chau Do ◽  
Lam Van Nguyen ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Protease Inhibitor ◽  
Antiretroviral Treatment ◽  
Virologic Failure ◽  
Second Line ◽  
Hiv Rna ◽  
Immunodeficiency Virus ◽  
Asian Children ◽  
Perinatally Acquired

Abstract Of 56 children with perinatally acquired human immunodeficiency virus (HIV) who had been prescribed second-line protease inhibitor–based antiretroviral therapy and had ≥1 previous episode of viral failure (HIV RNA, ≥1000 copies/mL), 46% had ≥1, 34% had ≥2, and 23% had ≥3 consecutive episodes of viral failure during the 2 years of follow-up. Two of these children experienced a major protease inhibitor mutation.

scholarly journals The Successful Application of a National Peer Advisory Committee for Physicians Who Provide Salvage Regimens to Heavily Antiretroviral-Experienced Patients in Mexican Human Immunodeficiency Virus Clinics

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Juan J. Calva ◽  
Juan Sierra-Madero ◽  
Luis E. Soto-Ramírez ◽  
Pedro Aguilar-Salinas
Keyword(s):  
Human Immunodeficiency Virus ◽  
Advisory Committee ◽  
Virologic Failure ◽  
Clinical Skills ◽  
Virologic Response ◽  
Routine Practice ◽  
Salvage Regimen ◽  
Hiv Rna ◽  
Immunodeficiency Virus

Background.  Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients. Methods.  We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22–43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of <200 copies per mL, followed by levels above this threshold) during the follow-up assessment using an observed-failure competing risks regression analysis. Results.  A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4). The probabilities of virologic failure were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively. Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4+ T-cell count was 162 cells per mL (IQR = 45–304 cells per mL). Conclusions.  In routine practice, a high rate of patients with extensive ARV experience, who received an optimized salvage regimen recommended by a peer advisory committee, achieved a long-term sustained virologic response and immune reconstitution.

Excessive Weight Gain Associated With Dolutegravir Initiation in a 10-Year-Old Female With Perinatally Acquired Human Immunodeficiency Virus: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
J Li ◽  
E H Yusuf ◽  
A L Agwu
Keyword(s):  
Human Immunodeficiency Virus ◽  
Weight Gain ◽  
Antiretroviral Treatment ◽  
Review Of The Literature ◽  
Excessive Weight Gain ◽  
Excessive Weight ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
Short And Long Term

Abstract Children with perinatally acquired human immunodeficiency virus (PHIV) face a lifetime of combination antiretroviral treatment that often includes dolutegravir (DTG). DTG, an integrase strand inhibitor that has been linked to weight gain in adults, is increasingly being used in children. Understanding its potential short- and long-term sequelae in children is critically important. We report a case of excessive weight gain in a child with PHIV on DTG and provide a brief literature review.

scholarly journals COVID-19 in people living with human immunodeficiency virus: A case series of 33 patients

2020 ◽  
Author(s):  
Georg Härter ◽  
Christoph D. Spinner ◽  
Julia Roider ◽  
Markus Bickel ◽  
Ivanka Krznaric ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Protease Inhibitor ◽  
Antiretroviral Treatment ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Special Population ◽  
Excess Morbidity ◽  
Immunodeficiency Virus

AbstractData on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic is still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population. Three out of 32 patients with documented outcome died (9%). However, 91% of the patients recovered and 76% have been classified as mild cases, indicating that there is no excess morbidity and mortality among PLWH with symptomatic COVID-19. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen, and 4 on the protease inhibitor darunavir.

Older Children and Adolescents Living With Perinatally Acquired Human Immunodeficiency Virus Infection

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 657-663
Author(s):  
Samuel Grubman ◽  
Elaine Gross ◽  
Nancy Lerner-Weiss ◽  
Myriam Hernandez ◽  
George D. McSherry ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Children And Adolescents ◽  
Late Onset ◽  
Medical Center ◽  
Symptomatic Disease ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
The Mean

Objective. To describe the clinical, immunologic, and psychosocial characteristics of children living with perinatally-acquired human immunodeficiency virus (HIV) infection beyond the age of 9 years. Methods. This is a descriptive cohort study of 42 surviving perinatally infected children older than 9 years followed at the Children's Hospital Acquired Immunodeficiency Syndrome (AIDS) Program (part of a university-based inner city medical center) as of June 1993. The study is based on medical record data of clinical, immunologic, and psychosocial parameters. Results. The cohort includes 20 boys and 22 girls with a mean age of 136 months. The mean age at diagnosis of HIV infection was 88 months, and 59.5% were asymptomatic at the time of diagnosis. Currently, after a mean follow-up period of 48 months from diagnosis, 23.8% remain asymptomatic, 19.1% have non-AIDS-defining HIV-related symptoms, and 57.1% have AIDS; 85.7% of the cohort did not develop HIV-related symptoms until after 48 months of age (late-onset prolonged survivors). There was an average annual decline of 71.4 CD4+ cells/µL in the cohort from the ages of 7 to 16 years, and 21.4% have a current CD4+ lymphocyte count of greater than 500 cells/µL, 28.6% between 200 and 500 cells/µL, and 50% less than 200 cells/µL; 76% are orphaned as a result of maternal death, with the majority of the cohort (60%) cared for by extended family members. Disclosure of diagnosis has occurred in 57.1%. The vast majority of the cohort (76%) are attending regular school, with the remainder in special education. Conclusions. Although close to one quarter of the children and adolescents ages 9 to 16 years living with perinatally acquired HIV infection described in this cohort remain asymptomatic and have a relatively intact immune system, the remainder are living with significant HIV-related symptoms, many of which are chronic in nature and have an impact on daily living. The children in this cohort had both significant immunologic deterioration and symptomatic disease progression during the mean follow-up period of 48 months from the time of diagnosis with HIV infection.

scholarly journals Diverse Human Immunodeficiency Virus–1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings

2019 ◽  
Vol 71 (7) ◽  
pp. e170-e177 ◽  
Author(s):  
Carole L Wallis ◽  
Michael D Hughes ◽  
Justin Ritz ◽  
Raquel Viana ◽  
Carlos Silva de Jesus ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Cd4 T Cell ◽  
Second Line ◽  
Drug Classes ◽  
Immunodeficiency Virus ◽  
Third Line ◽  
Second Line Antiretroviral Therapy

Abstract Background Human immunodeficiency virus (HIV) drug resistance profiles are needed to optimize individual patient management and to develop treatment guidelines. Resistance profiles are not well defined among individuals on failing second-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Methods Resistance genotypes were performed during screening for enrollment into a trial of third-line ART (AIDS Clinical Trials Group protocol 5288). Prior exposure to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs and confirmed virologic failure on a protease inhibitor–containing regimen were required. Associations of drug resistance with sex, age, treatment history, plasma HIV RNA, nadir CD4+T-cell count, HIV subtype, and country were investigated. Results Plasma HIV genotypes were analyzed for 653 screened candidates; most had resistance (508 of 653; 78%) to 1 or more drugs. Genotypes from 133 (20%) showed resistance to at least 1 drug in a drug class, from 206 (32%) showed resistance to at least 1 drug in 2 drug classes, and from 169 (26%) showed resistance to at least 1 drug in all 3 commonly available drug classes. Susceptibility to at least 1 second-line regimen was preserved in 59%, as were susceptibility to etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line regimen was significantly higher among women, younger individuals, those with higher nadir CD4+ T-cell counts, and those who had received lopinavir/ritonavir, but was lower among prior nevirapine recipients. Conclusions Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance testing and newer antiretrovirals for the optimal management of third-line ART in LMIC.

scholarly journals Interleukin-1 Receptor Antagonist Gene Polymorphism and Circulating Levels of Human Immunodeficiency Virus Type 1 RNA in Brazilian Women

2001 ◽  
Vol 75 (13) ◽  
pp. 6242-6244 ◽  
Author(s):  
Steven S. Witkin ◽  
Iara M. Linhares ◽  
Stefan Gerber ◽  
Marie E. Caetano ◽  
Alusio C. Segurado
Keyword(s):  
Human Immunodeficiency Virus ◽  
Receptor Antagonist ◽  
Antiretroviral Treatment ◽  
Interleukin 1 ◽  
Hiv Rna ◽  
Interleukin 1 Receptor Antagonist ◽  
Immunodeficiency Virus ◽  
Circulating Levels ◽  
Hiv Seropositive

ABSTRACT Interleukin-1 receptor antagonist (IL-1ra) gene polymorphisms in 83 human immunodeficiency virus (HIV)-seropositive women were evaluated. Fourteen of the subjects (16.9%) were homozygous for IL-1ra allele 2 (IL-1RN*2). These women had a lower median level of HIV RNA than did women homozygous for allele 1 (IL-1RN*1) (P = 0.01) or heterozygous for both alleles (P = 0.04). Among 46 subjects not receiving antiretroviral treatment, HIV levels were also reduced in IL-1RN*2 homozygous individuals (P< 0.05). There was no relation between IL-1ra alleles and CD4 levels.

scholarly journals Long-Term Safety and Efficacy of Dolutegravir in Treatment-Experienced Adolescents With Human Immunodeficiency Virus Infection: Results of the IMPAACT P1093 Study

2019 ◽  
Vol 9 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Rolando M Viani ◽  
Theodore Ruel ◽  
Carmelita Alvero ◽  
Terry Fenton ◽  
Edward P Acosta ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Adverse Events ◽  
Virologic Failure ◽  
Resistance Testing ◽  
Background Regimen ◽  
Immunodeficiency Virus ◽  
Grade 3 ◽  
Hiv 1

Abstract Background P1093 is an ongoing phase I/II multicenter open-label study of dolutegravir plus an optimized background regimen in age-defined pediatric cohorts; here we report the long-term safety and virologic efficacy outcomes for the oldest cohort. Methods The study enrolled human immunodeficiency virus type 1 (HIV-1)–infected treatment-experienced adolescents aged 12 to &lt;18 years, with an HIV-1 RNA level ≥1000 copies/mL . Cumulative safety and HIV-1 RNA outcomes were assessed once the last enrolled participant reached 144 weeks of follow-up. Results Among 23 adolescents enrolled, 16 remained in the study at least 144 weeks; the median follow-up was 153 weeks (range, 55–193 weeks). Dolutegravir was well tolerated, with grade 3 clinical adverse events in 5 participants, grade 3 laboratory abnormalities in 3, and grade 4 laboratory abnormalities in 1; none of the adverse events or abnormalities were judged to be treatment related. In an-intent-to-treat analysis, an HIV-1 RNA level &lt;400 copies/mL at week 144 was achieved in 43% (10 of 23 participants; 95% confidence interval, 23.2%–65.5%); in addition, 35% (8 of 23; 16.4%–57.3%) had an HIV-1 RNA level &lt;50 copies/mL. Nine participants (39%) discontinued study treatment before 144 weeks, but none because of adverse events or drug intolerance. All participants with sustained virologic control had excellent adherence; most who experienced virologic failure had adherence levels &lt;90%. HIV-1 genotypic drug resistance testing was available at time of failure from 6 participants; 1 had evolution in integrase resistance with E138T, S147G, and R263K mutations at week 192 and phenotypic dolutegravir resistance of a 5.1-fold change. Conclusions Dolutegravir plus an optimized background regimen seemed safe, well tolerated, and efficacious in this cohort of treatment-experienced HIV-1-infected adolescents. Adherence remains problematic in this population. Clinical Trials Registration NCT01302847.

scholarly journals Treatment Switch to Dolutegravir With 2 Nucleoside Reverse-Transcriptase Inhibitors (NRTI) in Comparison to Continuation With Protease Inhibitor/Ritonavir Among Patients With Human Immunodeficiency Virus at Risk for Prior NRTI Resistance: A Cohort Analysis of Real-World Data

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Mohamed N’dongo Sangaré ◽  
Jean-Guy Baril ◽  
Alexandra de Pokomandy ◽  
Steve Ferreira Guerra ◽  
Mabel Carabali ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Protease Inhibitor ◽  
Reverse Transcriptase ◽  
Virologic Failure ◽  
Cox Model ◽  
Cohort Analysis ◽  
Transcriptase Inhibitor ◽  
Real World Data ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background Switching antiretroviral regimens when human immunodeficiency virus (HIV) viremia is controlled for a new regimen is challenging when there is the potential for prior nucleoside reverse-transcriptase inhibitor (NRTI) resistance. The objective was to study virologic outcomes after switching to dolutegravir compared with remaining on a boosted protease inhibitor (protease inhibitor/ritonavir [PI/r]) regimen in people with HIV (PWH) with prior documented virologic failure and/or exposure to mono/dual NRTIs. Methods We used the Quebec HIV Cohort including 10 219 PWH whose data were collected at 4 sites in Montreal, Canada. We included all PWH with documented virologic failure or exposure to mono/dual NRTI therapy who were virologically suppressed on a PI/r-based regimen for at least 6 months on or after January 1, 2014 (n = 532). A marginal structural Cox model analysis was used to estimate the effect of the switch to dolutegravir on virologic outcome compared with remaining on PI/r. The outcome was defined as 2 consecutive viral loads (VLs) &gt;50 copies/mL or 1 VL &gt;50 copies/mL if it occurred at the last VL available. Results Among 532 eligible participants, 216 (40.6%) had their regimen switched to dolutegravir with 2 NRTIs, whereas 316 (59.4%) remained on the PI/r with 2 NRTIs. The weighted hazard ratio for the effect of dolutegravir switch on virologic failure compared with patients whose regimen remained on PI/r was 0.57 (95% confidence interval, 0.21–1.52). Conclusions We did not find evidence of an increased risk for virologic failure after switching to dolutegravir from PI/r among patients with previous virologic failure or prior exposure to mono/dual NRTI.

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