[Show abstract][Hide abstract] ABSTRACT: To better characterize the relationship between body mass index (BMI) and CD4+ T-lymphocyte recovery in HIV disease.
We analyzed the association between baseline BMI and CD4+ T-lymphocyte increases, as well as the association between BMI and immune activation (CD38 and HLA-DR co-expression on CD4+ and CD8+ T-lymphocytes), in male HIV-infected patients who achieved viral suppression on antiretroviral therapy (ART).
Baseline BMI predicted change in CD4+ T-lymphocyte count at weeks 96 ( P = .03, n = 461) and 144 ( P = .005, n = 357) but not at week 48 ( P = .38, n = 558). Relative to men with a normal BMI, overweight and obese men had increases at week 144 that were 35 and 113 cells/ mm3 higher, respectively, while underweight men had CD4+ T-lymphocyte increases that were 94 cells/mm3 lower. No significant correlations between baseline BMI and cellular immune activation were seen.
BMI predicts CD4+ T-lymphocyte gains in men started on ART.
HIV Clinical Trials 07/2011; 12(4):222-7. DOI:10.1310/HCT1204-222 · 2.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Centers for Disease Control and Prevention (CDC) recommends offering HIV testing to persons admitted to emergency departments (EDs). Whether by opt-in or opt-out, many EDs (including our own) have found a seroprevalence of 0.8-1.5% when rapid testing is offered. The true seropositivity rate is unknown. We performed a retrospective chart analysis upon all patients presenting to our ED over a 2-week period in the fall of 2007 who had serum drawn as a part of their emergency care. Demographics and clinical characteristics were linked via de-identified serum, which was sent for HIV testing. Nine hundred fifty nine patients had sera available for rapid HIV testing. One hundred twenty one (13%) samples were reactive via the OraQuick(®) test (OraSure Technologies, Bethlehem, PA), a point of care rapid antibody test. Due to concerns about the appropriateness of sera as substrate for the OraQuick(®) technology, reactive samples were retested via standard enzyme immunoassay (EIA)/Western blot. One hundred twelve analyzable samples were retested-38 were positive and 27 of these were from patients who reported a history of HIV infection. The rate of undiagnosed HIV infection was 1.2% (11/914 potentially analyzable samples). Of all patients with HIV in our ED, 29% of them were presumably unaware of their diagnosis. In conclusion, HIV seroprevalence in our urban ED is high, and a large fraction of the patients appears to be unaware of the infection.
AIDS patient care and STDs 02/2011; 25(4):207-11. DOI:10.1089/apc.2010.0196 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Randomized controlled trials with highly active antiretroviral therapy (HAART) have demonstrated over 70% virologic success rates, although patients in an inner city HIV setting likely have lower virologic success.
We studied the outcome of all treatment-naive patients beginning HAART in our urban clinic in Philadelphia, Pennsylvania. The primary outcome was virologic success at 12 months for all patients who were initiated on HAART. Secondary outcomes included virologic success at 12 months for only those who remained in care and the determination of which demographics influenced virologic success.
Between 2003 and 2005, 109 patients were initiated on HAART: 39% women, 79% African American, 17% Hispanic, median CD4+ count 120 cells/mm3, and HIV-1 RNA 4.9 log10 copies/mL. Twenty-two were lost to follow-up after HAART initiation. Of the 87 who remained in care, 41 maintained a HIV-1 RNA <400 copies/mL through 12 months on their initial HAART regimen. Emerging drug resistance was documented in 7 of 87 patients. NNRTI-based HAART was significantly associated with greater virologic failure due to emerging resistance compared to a PI-based regimen.
Our retrospective study demonstrates the difficulties in administering successful HIV care to an urban population, and efforts to help patients overcome barriers to consistent medical care must be a priority.
HIV Clinical Trials 05/2008; 9(3):186-91. DOI:10.1310/hct0903-186 · 2.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Several randomized controlled trials with highly active antiretroviral therapy (HAART) demonstrated over 70% virologic success rates. Patients in an inner city HIV clinic may have lower virologic success rates due to comorbidities and other limitations.
Methods: HIV+ adults naive to HAART were retrospectively evaluated over a 3-year period. The primary goal was to assess virologic failure rates in an intent-to-treat analysis. Secondary goals included virologic failure based on an as-treated analysis and demographic factors influencing virologic success.
Results: Of 174 HAART-naive patients presenting to the clinic 2003-05, 109 patients were initiated on HAART. Baseline characteristics of 109 patients: 39% women, 79% African American (AA), 17% Latino; median (range) CD4 count 120 (0-743) cells/mm3, HIV-1 RNA 4.9 (2.9-5.8) log10 copies/ml. Reported modes of HIV transmission: 58% heterosexual, 20% MSM, and 14% IVDU. HAART included NNRTIs in 39%, boosted PIs in 53%, unboosted PIs in 6%, and 3 NRTIs in 2%. Twenty-two patients (20%) were lost to follow-up after HAART initiation. Of 109 patients initiated on HAART, 41 patients (38%) acheived virologic success at 12 months. Of 87 patients who remained in care, 47%experienced virologic success based on as-treated analysis. The only factor statistically associated with virologic success was age >50 years (OR=2.71, 95% CI 1.01-7.36: p=0.04). Factors showing a trend for success included AA compared to Latino patients, and male gender. Virologic failure due to emerging drug resistance was documented in 15/87 patients (17%). NNRTI-based HAART was significantly associated with virologic failure due to emerging resistance (13/15) (OR 9.78, 95% CI 1.85-58.8; p=0.001).
Conclusions: This retrospective analysis supports the hypothesis that inner city HIV patients have lower virologic success rates than seen in randomized controlled clinical studies. Failure on therapy was a greater problem than loss to follow-up,though both were important.
Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
[Show abstract][Hide abstract] ABSTRACT: Background: Major advances have allowed simplification of initial regimens for treatment of HIV, and one of the most commonly prescribed regimens is tenofovir, emtricitabine and efavirenz (Atripla). The prevalence of drug-resistant HIV-1 has been reported in different cities in the United States; however the prevalence of HIV resistance in treatment-naïve patients in Philadelphia is unknown.
Methods: Baseline genotypes of all treatment-naïve patients between 2004-2006 at Temple University Hospital-an inner city clinic in Philadelphia were reviewed. The clinic is an affiliate of a 600-bed tertiary teaching hospital, servicing a predominantly minority population. Rates of mutations were noted by year and by class of medication.
Results: 165 antiretroviral naïve patients entering our clinic had baseline genotypes performed. 22 (13%) had baseline resistance to currently available antiretrovirals. 6 (3.6%) in the NRTI class, 4 (2.4%) in the PI class, and 13 (7.9%) in the NNRTI class. During the period 2004-2005, resistance rates were: 1 of 92 (1%) in the NRTI class, 6 (6.5%) in the NNRTI class and 1 (1%) in the PI class. However in 2006, 5 of 73 (7%) had NRTI resistance, 7 of 73 (9.6%) had NNRTI resistance and 2 of 73 (3%) had PI resistance. The overall resistance rates in 2006 were 19%. The increase from 04/05 to 06 was 2 fold.
Conclusions: While the prevalence of HIV resistance appeared to be low from 2004-2005, the prevalence during 2006 showed an alarming increase. Although PI resistance remained stable, increases in NRTI and NNRTI resistance were noted. In 2006, 1 out of 5 new patients were already resistant to at least one of the components of the commonly prescribed regimen, Atripla. Careful review of baseline resistance is necessary before initiating this very convenient HAART regimen. Because resistance rates are fluid, continued surveillance to assess resistance, in addition to following this trend locally and nationally is extremely important.
Infectious Diseases Society of America 2007 Annual Meeting; 10/2007