Rate of co-morbidities not related to HIV infection or AIDS among HIV-infected patients, by CD4 count and HAART use status

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2008; 47(8):1102-4. DOI: 10.1086/592115
Source: PubMed


The rate of comorbidities not related to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome
(AIDS) among HIV-infected patients may be higher than expected. We assessed the incidence of comorbidities not related to
HIV infection or AIDS by CD4 cell count and highly active antiretroviral therapy (HAART) use status in an HIV clinical practice.
A total of 2824 patients contributed 9172 person-years of longitudinal data during the period 1997–2006. Among patients with
a CD4 cell count <350 cells/mm3, receipt of HAART was associated with a significantly decreased incidence of comorbidities not related to HIV infection or

7 Reads
  • Source
    • "These include using drugs before sex, IDU, needle sharing, multiple sexual partners, sex with prostitutes, and sex with IDU. Consistent with these findings, many studies that have reported the prevalence of psychosocial problems not only to be common in PLWHA but related to high HIV/AIDS risky behaviors (Farinpour et al., 2003; Cook et al., 2004; Moore et al., 2008; Wyatt et al., 2002; Whetten et al., 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Infection with the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) is still rising globally. In order to develop effective HIV/AIDS risky behavior reduction intervention strategies and to further decrease the spread of HIV/AIDS, it is important to assess the prevalence of psychosocial problems and HIV/AIDS risky behaviors in people living with HIV/AIDS (PLWHA). The objective of this study is to assess the relationship between psychosocial variables and HIV/AIDS risky behaviors among PLWHA. A total of 341 questionnaires were distributed and 326 were fully completed and returned, 96% response rate. The relationships between the identified psychosocial and HIV/AIDS risky behaviors among PLWHA were analyzed using The Moment Structures software version 17.0 (SPSS Inc.) The results indicate that psychosocial health problems were significant predictors of HIV/AIDS risky behaviors in PLWA. Further cross-disciplinary research that addresses the manner in which psychosocial problems and HIV/AIDS risky behaviors interact with each other among PLWHA is needed.
    01/2012; 4(1):8-16.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Serious non-AIDS (SNA) diseases are important causes of morbidity and mortality in the HAART era. We describe development of standard criteria for 12 SNA events for Endpoint Review Committee (ERC) use in START, a multicenter international HIV clinical trial. SNA definitions were developed based upon the following: (1) criteria from a previous trial (SMART), (2) review of published literature, (3) an iterative consultation and review process with the ERC and other content experts, and (4) evaluation of draft SNA criteria using retrospectively collected reports in another trial (ESPRIT). Final criteria are presented for acute myocardial infarction, congestive heart failure, coronary artery disease requiring drug treatment, coronary revascularization, decompensated liver disease, deep vein thrombosis, diabetes mellitus, end-stage renal disease, non-AIDS cancer, peripheral arterial disease, pulmonary embolism, and stroke. Of 563 potential SNA events reported in ESPRIT and reviewed by an ERC, 72% met "confirmed" and 13% "probable" criteria. Twenty-eight percent of cases initially reviewed by the ERC required follow-up discussion (adjudication) before a final decision was reached. HIV clinical trials that include SNA diseases as clinical outcomes should have standardized SNA definitions to optimize event reporting and validation and should have review by an experienced ERC with opportunities for adjudication.
    HIV Clinical Trials 07/2010; 11(4):205-19. DOI:10.1310/hct1104-205 · 2.63 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The failure to increase CD4 T-cell counts in some HAART-treated HIV-infected patients with satisfactory virological responses has been related to low CD4 T-cell production, high turnover and death. However, the relative contribution of these factors is still unclear, strongly limiting the definition of appropriate therapeutic strategies for these patients. A cross-sectional study was designed to evaluate the contribution of thymic activity, microbial translocation, cellular activation and death to CD4 T-cell recovery. We included 230 HIV-infected individuals on suppressive HAART (>2 years); 95 of them were considered 'discordant' (CD4 T-cell count <350 cells/mul) and 135 were considered 'concordant'. Comparative and logistic regression analyses were performed. Discordant patients showed higher levels of activated [human leukocyte antigen (HLA)-DRCD95 and CD38CD45RA] cells in both the CD8 and CD4 T-cell compartments. Notably, the most significant differences were observed in CD4 T cells. Discordant patients showed lower naive CD4 T-cell production (CD45RACD31 cells), higher spontaneous ex-vivo CD4 T-cell death and higher plasma levels of soluble CD14. Multivariate analysis showed that activation and death of CD4 T cells, along with nadir CD4 T-cell counts, were the only predictive factors for poor immune recovery. Moreover, the low correlations found between CD4 T-cell activation or death with thymic output and bacterial translocation suggest that additional factors modulate cellular activation and death and, in turn, CD4 T-cell recovery. CD4 T-cell repopulation during HAART is determined by CD4 T-cell activation and death. Therefore, strategies aimed to reduce these parameters should be envisaged to treat discordant patients.
    AIDS 02/2010; 24(7):959-68. DOI:10.1097/QAD.0b013e328337b957 · 5.55 Impact Factor
Show more


7 Reads
Available from