Article

The role of HIV in serious diseases other than AIDS

AIDS (London, England) (Impact Factor: 6.56). 12/2008; 22(18):2409-18. DOI: 10.1097/QAD.0b013e3283174636
Source: PubMed
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    ABSTRACT: This study reviews recent trends of HIV inpatient admissions in two HIV centres in Europe. Chelsea and Westminster Hospital, London (UK) and four infectious diseases departments in Liguria, Italy (IT) collected data on inpatient HIV admissions from January to December 2012, including patient demographic, discharge diagnoses, CD4, viral load (VL) and combined anti-retroviral therapy (cART). Rate of patient admissions per 100 years was 6.12 for IT and 12.91 for UK (number of admissions UK=474, IT=257), 66.8% (n=488) of admissions had a VL under 400 copies/ml with 83.6% (n=611) of admissions were on cART. Median age was 47 years old. Mortality rate was 10.2% in IT and 2.8% in UK. Hepatitis C co-infection occurred in 64.6% of patients (n=166) in IT and 13.5% (n=64) in UK. Commonest diagnoses were infectious diseases (29.1%), respiratory diseases (16.6%) and neoplasms (15.0%). Majority of inpatients were taking cART and had a suppressed VL. The complications of Hepatitis C co-infection has a major impact on mortality rates and inpatient case load in Italy, and may cause similar patterns in London where rates are increasing. In the UK, a wider range of diagnoses is seen, requiring specialist input and working with other specialties. Copyright © 2015. Published by Elsevier Ltd.
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    ABSTRACT: Objectives The proportion of people living with HIV/AIDS in the ageing population (> 50 years old) is increasing. We aimed to explore the relationship between older age and treatment outcomes in HIV-positive persons from the Asia Pacific region.Methods Patients from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD) were included in the analysis. We used survival methods to assess the association between older age and all-cause mortality, as well as time to treatment modification. We used regression analyses to evaluate changes in CD4 counts after combination antiretroviral therapy (cART) initiation and determined the odds of detectable viral load, up to 24 months of treatment.ResultsA total of 7142 patients were included in these analyses (60% in TAHOD and 40% in AHOD), of whom 25% were > 50 years old. In multivariable analyses, those aged > 50 years were at least twice as likely to die as those aged 30–39 years [hazard ratio (HR) for 50–59 years: 2.27; 95% confidence interval (CI) 1.34–3.83; HR for > 60 years: 4.28; 95% CI 2.42–7.55]. The effect of older age on CD4 count changes was insignificant (p-trend = 0.06). The odds of detectable viral load after cART initiation decreased with age (p-trend = < 0.0001). The effect of older age on time to first treatment modification was insignificant (p-trend = 0.21). We found no statistically significant differences in outcomes between AHOD and TAHOD participants for all endpoints examined.Conclusions The associations between older age and typical patient outcomes in HIV-positive patients from the Asia Pacific region are similar in AHOD and TAHOD. Our data indicate that ‘age effects’ traverse the resource-rich and resource-limited divide and that future ageing-related findings might be applicable to each setting.
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    ABSTRACT: A cure for HIV is still greatly needed and has become a global research priority. A unique subset of HIV-infected individuals who spontaneously control HIV exists, and these are known as 'elite controllers'. They may represent a natural model for a 'functional cure' in which there is long term control of viral replication and remission from symptoms of HIV infection in the absence of antiretroviral therapy. However, controllers have evidence of ongoing inflammation, CD4(+) T cell depletion, and perhaps even inflammation-associated cardiovascular disease, suggesting that this natural long term virologic control may be coming at an immunologic and clinical cost. These individuals may continue to provide continued insights into mechanisms of host control; however, they may not represent the best model of a functional cure, if we believe that a cure should require a disease-free (and not just a treatment-free) state. Copyright © 2014. Published by Elsevier Ltd.
    Trends in Microbiology 12/2014; 23(2). DOI:10.1016/j.tim.2014.11.003 · 9.81 Impact Factor

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