Discordant immunological response in HIV-positive patients on non-nucleoside reverse transcriptase inhibitor-based regimens.
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Anti-HIV Agents↗
Biomedical subjects
Fredy Suter
Publications and source records attributed to Fredy Suter.
African sleeping sickness in tourists returning from Tanzania: the first 2 Italian cases from a small outbreak among European travelers.
A recent cluster of cases of African trypanosomiasis in humans (HAT) has been reported in tourists (most of whom were European) returning from Tanzania; we describe the first 2 patients (both of whom were Italian travelers) with HAT, who have been treated successfully. Because neither vaccine nor drug prophylaxis is currently recommended and/or available for persons traveling to areas of endemicity, physicians should be alerted about this uncommon but potentially life-threatening disease.
Adult↗
Once-a-day HAART: dream or reality?
A constant and nearly absolute adherence is required to ensure a successful long-lasting outcome of highly active antiretroviral therapy (HAART). Pill burden and regimen complexity are important contributors to adherence problems. The most significant treatment-related strategy to improve adherence may be the reduction in the number and frequency of pills to be taken every day. If one accepts the concept that once-daily therapy is likely to benefit patients, then the issue turns to whether we have adequate drugs to implement once-daily HAART. There is quite a difference between using a once-a-day drug within an HAART regimen and designing an HAART regimen that is dosed once daily. To date, studies that explore the feasibility of once-a-day HAART regimens are still few, mostly exploratory, not controlled, and performed in a limited number of patients. However, most data are consistent one with the other, and evidence on the utility of such regimens is growing. Once-daily therapy cannot be the answer to all the questions that complex and life-long therapies give rise to, but it could be a further choice that can meet the needs of many patients. The range of once-daily options is expanding rapidly, and the patients' request for easier therapies that are respectful of their lifestyle could be fulfilled.
Anti-HIV Agents↗
Factors associated with the failure of HIV-positive persons to return for scheduled medical visits.
PURPOSE: To assess in an HIV-positive cohort the cumulative probability of failing to return for scheduled medical visits and to address the factors associated with follow-up discontinuation. METHOD: This was a hospital-based cohort study conducted from January 1985 through September 1999. Out of 3,300 HIV-1 infected patients, 1,680 patients with CD4 count <500 cells/mL or with AIDS diagnosis were included in the analysis because they received scheduled medical visits for follow-up at our center. Baseline visit was the first visit when patients met the criteria for enrollment. The main outcome measure was failure to return for scheduled medical visits for at least 12 consecutive months. RESULTS: The probability of returning decreased rapidly in the first months after the baseline visit. After 1 year since enrollment, 25% of patients failed to return and after 2 years 34% of patients failed to return. Most patients who failed to return for visits (78%) discontinued their follow-up within 6 months since enrollment. In multivariate analysis, patients in the intravenous drug use (IDU) category were most likely to fail to return for scheduled appointments, as were patients with higher CD4 count (CD4 >50 cells/microL) or patients without AIDS diagnosis. Patients with shorter follow-up had a higher risk of failing to return (odds ratio [OR]: 0.12, 0.36, 0.45, and 0.74 for >36, 24-36, 12-24, and 6-12 months of follow-up respectively vs. <6 months). Patients who were enrolled in more recent years had a higher compliance to follow-up visits (OR: 0.33, 0.63, and 0.61 for > or = 1997, 1995-1996, and 1988-1994 vs. <1988). CONCLUSION: Patients in the IDU category, patients without AIDS diagnosis, or patients with higher CD4 counts are more likely to miss medical appointments and discontinue their follow-up. More recently enrolled patients have a lower risk of failing to return. It is possible that the recent and more effective anti-HIV treatment played a major role in increasing adherence to follow-up.
Adolescent↗
Simpler regimens may enhance adherence to antiretrovirals in HIV-infected patients.
BACKGROUND: Optimal adherence to highly active antiretroviral therapy (HAART) is necessary to achieve the best and the most durable benefit. Many factors may influence compliance to such demanding regimens, and their identification may help in the design of strategies to enhance adherence. PURPOSE: To assess the factors associated with lower compliance to therapy, the causes of nonadherence, and the relation of nonadherence with virologic response. METHOD: We performed an observational, cross-sectional study on HIV-infected patients (pts) receiving unrestricted HAART and attending our clinic from January to May 2001. Pts completed a self-administered (ACTG modified) questionnaire on adherence to their therapy. Virologic response was defined as undetectable viral load at the time of interview. A regression model was used to determine predictors of adherence. RESULTS: 597 out of 623 pts (95.8%) completed the survey. Mean age was 38.2 years (range, 18-79). A total of 448 pts (75.0%) were men, 323 (54.1%) were intravenous drug users, 196 (32.8%) were heterosexuals, 76 (12.7%) were men who have sex with men. Mean time on therapy was 49.3 months (range, 4-145). All pts were on stable therapy (> 4 months), 173 pts (29%) were on their first HAART regimen, 309 pts (51.7%) were on NNRTI-based regimen, and 288 pts (48.2%) were on a PI-containing treatment. A total of 304 pts (50.9%) were categorized as adherent (p = .024). Multiple logistic regression showed that older age (p = .002), lower number of pills (p = .024), fewer daily doses (p = .002), and shorter time on therapy (p < .001) were factors associated with adherent behavior. Forgetfulness (59.3%), being away from home (50.2%), and problems with schedule (37.6%) were the most frequent causes of nonadherence. Adherent pts were more likely to have undetectable viral load than nonadherent pts (76.5% vs. 55.3%; p <.0001). CONCLUSION: Younger age, higher number of pills, higher frequency of doses, and longer time on therapy were predictors of nonadherent behavior. Optimal adherence correlated with the best virologic response. Simpler regimens with a lower number of pills and doses may help patients' compliance to therapy.
Adolescent↗
Quadruple-drug induction HAART in advanced HIV infection.
A randomized controlled study exploring an induction-maintenance strategy was performed with a quadruple-drug regimen: zidovudine/lamivudine/abacavir/nevirapine. The study was prematurely interrupted due to the high proportion of adverse events. The median time on protocol-defined therapy was 110 days; 13/28 (46%) patients interrupted therapy and 2/6 tested patients selected praecox viral mutants. Despite this, we observed a significant (p </= .001) increment of CD4. The theoretical advantages of induction-maintenance strategies are tempered by an increased risk of adverse experiences.
Adult↗
Antiretroviral therapy in chronic liver disease: focus on HIV/HCV coinfection--statements of the First Italian Consensus Workshop.
Hepatitis C virus common transmission routes and HCV coinfection is frequent in persons living with HIV. Liver enzyme elevation following the initiation of antiretroviral therapy is frequently seen in HIV-infected patients with chronic liver disease, particularly those with chronic hepatitis C. This complication may lead to treatment discontinuation, complicating HIV therapeutic management. Multiple factors influence the risk of liver toxicity under antiretroviral therapy, including the specific drug in use (e.g. use of full doses of ritonavir), and environmental factors (e.g. alcohol abuse). However a beneficial effect of antiretroviral therapy on liver disease has been supported by some studies. Despite increasing knowledge of HCV/HIV coinfection, there is no clear consensus on how to treat HIV in HCV-coinfected patients An Italian group of experts were invited to discuss in detail the current risks and implications of antiretroviral treatment in HIV-infected persons with chronic hepatitis C, and their main conclusions are summarized in this consensus document.
Anti-HIV Agents↗