Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CD4 Lymphocyte Count”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources
PubMed1992

Population-based study of measles and measles immunization in human immunodeficiency virus-infected children.

This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.

Child↗
PubMed1994

Immune-based interventions in perinatal human immunodeficiency virus infection.

Essentially all new cases of human immunodeficiency virus (HIV) infection in infants and young children occur as a consequence of exposure to HIV either in utero, intrapartum or postpartum during breast feeding. Currently it is estimated that the majority of vertical transmission of HIV occurs at or near the time of birth. Based on what is known about the biology of perinatal HIV transmission, the HIV burden of the mother, effectiveness of her immune response and that of her fetus/infant and the integrity of the placental "barrier" are likely to play important roles in this process. The role of impaired immunologic control of HIV is gaining recognition as a potential key element in the pathophysiology of perinatal HIV transmission. In most studies to date, advanced maternal disease and low CD4 lymphocyte count have been associated with increased risk of vertical HIV transmission. In addition some studies have indicated that low maternal titers of antibodies to certain V3 loop epitopes may have a similar effect on vertical transmission. Cellular immune responses, which are known to play an important role in host defense against HIV, appear to be impaired in infants after exposure to HIV, especially those responses involving the development of cytotoxic lymphocytes. Mounting evidence suggests that enhancement of humoral and/or cellular immune responses in pregnant women and exposed infants is a logical and potentially feasible approach to interruption of perinatal transmission (an approach similar to that utilized for perinatally acquired hepatitis B virus infection). Studies are now in progress to assess HIV hyperimmune globulin and envelope HIV vaccines in pregnant woman and HIV-exposed infants.

AIDS Vaccines↗
PubMed1994

Phytohemagglutinin-inducible p24 in peripheral blood mononuclear cells as a predictor of human immunodeficiency virus type 1 vertical transmission and infant clinical status.

We sought to determine whether the detectability of phytohemagglutinin-inducible p24 (PHA-p24) in short term cultures of peripheral blood mononuclear cells correlates with an increased risk of vertical transmission among human immunodeficiency virus type 1 (HIV-1)-infected pregnant women and more severe symptomatology among HIV-1-infected infants. The assay for PHA-p24 was performed on specimens obtained from HIV-1-infected women during their pregnancy and from infants during the first 6 months of life. Infants were followed prospectively to determine HIV-1 infection outcome and symptomatology. Among PHA-p24 positive women 9 of 19 (47.4%) gave birth to HIV-1-infected infants compared with 4 of 25 (16.0%) of PHA-p24-negative women (P = 0.02). Among women who tested PHA-p24-positive and had a CD4+ lymphocyte count < 500 cells/mm3, 8 of 15 (53.3%) gave birth to HIV-1-infected infants compared with 4 of 26 (15.4%) not meeting these conditions (P = 0.01). Among HIV-1-infected infants 4 of 5 (80%) of those testing PHA-p24-positive by one month of age developed an opportunistic infection or encephalopathy by 12 months of age, compared with none of the 11 infants testing PHA-p24-negative (P = 0.003). We conclude that PHA-p24 may be a useful in vitro measure for increased risk of vertical transmission among HIV-1-infected pregnant women and increased risk for rapid development of severe disease among HIV-1-infected infants.

Female↗
PubMed2000

Human immunodeficiency virus-infected adolescents: a descriptive study of older children in New York City, Los Angeles County, Massachusetts and Washington, DC.

BACKGROUND: Children infected with HIV are entering adolescence with challenging and changing medical and social needs. Through chart review we describe certain medical and social characteristics of adolescents who acquired HIV as children. METHODS: HIV-infected children 12 years of age and older in 1995 were monitored through the Pediatric Spectrum of HIV Disease study from four US sites. In addition to standard 6-month medical chart reviews, a special chart abstraction in 1997 collected available psychosocial and sexual history information. RESULTS: A total of 131 adolescents HIV-infected as children were studied: 52 infected perinatally; 44 infected through a contaminated blood transfusion; 30 through receipt of contaminated blood products for hemophilia; and 5 with unknown transmission mode. Mean age at last medical contact was 15.5 years, 67% were Hispanic or African-American, 12% were employed, 66% attended regular school, 66% knew their HIV status and 48% (8% for the perinatally infected) lived with their biologic mother. Information on sexual activity showed that 18% had sexual relations, 28% did not and for 53% sexual activity was not recorded in the medical chart. Four percent used illicit drugs, which along with sexual activity showed a positive association with age. Forty-two percent had an AIDS-defining opportunistic infection, and 56% had a recent CD4+ lymphocyte count <200 cells/microl. CONCLUSIONS: Adolescents in this study represent a heterogeneous group of surviving HIV-infected children some of whom are sexually active and potential sources of HIV transmission. Clinicians who treat HIV-infected and high risk adolescents face the challenges of providing care and prevention services appropriate to adolescent development.

Adolescent↗
PubMed2001

Combination therapy with saquinavir soft gelatin capsules in children with human immunodeficiency virus infection.

OBJECTIVES: To evaluate the pharmacokinetics, tolerance, safety and antiviral activity of the HIV protease inhibitor, saquinavir, formulated as soft gelatin capsules (SQV-SGC), given in combination with nucleoside antiretroviral agents (NRTIs) with or without nelfinavir in HIV-infected children. METHODS: This was an open label study of HIV-infected children ages 3 to 16 years, conducted in two parts. In Part 1 of the study 14 children were treated orally with SQV-SGC (initially given in three 33-mg/kg doses daily; dosage adjusted to 50 mg/kg three times daily based on initial pharmacokinetics) and two NRTIs. Addition of nelfinavir was permitted for children who did not achieve a predetermined steady state target plasma saquinavir exposure. In Part 2 a new group of 13 children received SQV-SGC (33 mg/kg three times daily) in combination with nelfinavir and one or two NRTIs. Pharmacokinetics were assessed after the first dose and 4 weeks into treatment (steady state). Patients were treated for 72 and 48 weeks in Parts 1 and 2, respectively. RESULTS: Most adverse events were mild; the most commonly reported were diarrhea, abdominal discomfort and headache. Two children were withdrawn from the study because of adverse events (one each of nausea and dysphagia) related to the study treatment. There were no deaths or serious adverse events attributed to the study medication. Steady state saquinavir area under the plasma concentration vs. time curves (AUC24) were 6,210 and 11,010 ng/h/ml for Parts 1 and 2, respectively. Compared with baseline measurements median changes in plasma HIV RNA concentrations were -2.12 log10 copies/ml [5 of 14 (36%) with HIV RNA <50 copies/ml) (Week 72)] and -2.58 log10 copies/ml [8 of 13 (62%) <50 copies/ml) (Week 48)] in Parts 1 and 2, respectively. The median changes in CD4+ lymphocyte count were +292 and +154 cells/microl for Parts 1 and 2, respectively. Genotypic resistance assays revealed a low frequency of saquinavir-associated resistance mutations after 48 weeks of therapy, with only 2 of 27 children having substitutions at positions 48V and/or 90M. CONCLUSIONS: Combination therapy with SQV-SGC was well-tolerated and safe in HIV-infected children, and antiviral activity was observed. Saquinavir plasma concentrations were lower than expected, particularly for Part 1 (SQV-SGC plus NRTIs), but addition of nelfinavir increased saquinavir exposures.

Administration, Oral↗
PubMed1990

Disseminated histoplasmosis in patients with AIDS.

Disseminated histoplasmosis was diagnosed in 36 (4%) of 980 patients with AIDS seen at Parkland Memorial Hospital in Dallas, Texas before September 30, 1989. Diagnostic sensitivity of blood culture plus examination of peripheral smear was 88%; sensitivity of bone marrow aspiration and blood culture was 80%. Median CD4 lymphocyte count at diagnosis was 33/cu mm. Median actuarial survival from the date histoplasmosis was diagnosed was 188 days. Thirteen (36%) of the 36 patients died before adequate antifungal therapy could be administered, while 13 survived long enough to receive 1,500 mg of amphotericin B; actuarial survival of the latter group from the date 1,500 mg of amphotericin B had been infused was 47% at 1 year. The substantial early mortality of AIDS-associated disseminated histoplasmosis and the modestly encouraging survival of those who were diagnosed in time to receive adequate therapy raise the issues of surveillance, prophylaxis, and empiric therapy for this infection in selected HIV-positive patients.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Relationship between efficacy, tolerance, and plasma drug concentration of ritonavir in children with advanced HIV infection.

The relationship between ritonavir plasma concentration, efficacy, and tolerance was evaluated in 31 children with advanced HIV infection who were receiving a triple therapy with ritonavir as protease inhibitor. Median CD4+ lymphocyte count and median viral load before the initiation of ritonavir-containing combination therapy were 1320 cells/mL and 5 log10 copies/mL, respectively. Ritonavir was given at a dose ranging from 300 to 450 mg/m2 twice daily. The median follow-up of triple therapy was 19 months. Response was defined as a drop of viremia of more than 1 log. Plasma drug levels were determined twice during the observation period: after at least 4 weeks and after 3 months of combined treatment. Samples were collected before (residual) and 2 hours (T2) after drug intake. Cholesterol, triglycerides, alanine transaminase, aspartate transaminase, and gamma-glutamyl transpeptidase were assessed at the same time. The median values of ritonavir residual and T2 levels were 1.64 mg/L and 5.9 mg/L at observation 1 and 3.35 mg/L and 6.29 mg/L at observation 2, respectively. According to virologic response, median residual concentrations of ritonavir were 3.17, 2.52, and 1.04 mg/L for the complete, the partial, and the no-response groups. The authors observed a wide intersubject variability of ritonavir concentrations with an increase in residual levels between the two observation periods. Residual levels were correlated with virologic response whereas there was no direct association between T2 levels and long-term response. Patients with complete or partial response displayed statistically significantly higher residual concentrations than the no-response group. No correlation could be demonstrated between elevated plasma drug concentrations and abnormal cholesterol or triglycerides values. These results emphasize the importance of a sustained high ritonavir concentration to achieve optimal treatment efficacy. Furthermore, these results prove the clinical benefit of therapeutic drug monitoring and could potentially improve patient evaluation in terms of treatment efficacy, compliance, and viral resistance.

Adolescent↗
PubMed1997

Management of nutritional alterations and issues concerning quality of life.

Malnutrition is common in human immunodeficiency virus (HIV) infection and plays an important role in morbidity and mortality. Malnutrition can affect hospitalizations, disease complications, quality of life, and survival, and has adverse clinical consequences that may be independent of CD4 lymphocyte count. There have been recent advances in knowledge concerning the pathogenesis of malnutrition and the nature of weight loss in HIV patients. The onset of body cell mass depletion may occur early in the infection and predate significant immune deficiency, implying that the virus itself may be involved. Hypogonadism, a common finding in HIV patients, is associated with body composition changes and is involved in body cell mass depletion. In addition, intestinal dysfunction and malabsorption contribute to weight loss in HIV patients. Several studies have evaluated the use of appetite stimulants, enteral and parenteral nutritional support, anabolic agents, and other agents in the management of weight loss and malnutrition in HIV patients. Results of a randomized trial comparing total parenteral nutrition (TPN) and an oral semi-elemental diet (SED) in AIDS patients with malabsorption indicate that the TPN group consumed more calories and gained more weight than the SED group, but the gain was due to increased body fat. The effect of nutritional support on malnutrition and weight loss in HIV patients and potential secondary benefits to quality of life, physical and mental performance, immune function, and disease progression require further study.

Anabolic Agents↗
PubMed1997

Insurance type and satisfaction with medical care among HIV-infected men.

Patient satisfaction is a valuable indicator of the quality of medical care. We assessed the impact of type of health insurance on satisfaction with seven aspects of medical care among 593 HIV-infected men without AIDS, drawn from three sites in San Francisco, California and Denver, Colorado. After adjustment for site of medical care, patient age, race, income, education, and CD4 lymphocyte count, there were few differences in satisfaction between men with fee-for-service and those with managed care insurance. Men with fee-for-service insurance were significantly more satisfied with their interpersonal relations with their clinicians (p = 0.01) but less satisfied with their finances (p = 0.0001) than persons with managed care. Uninsured men were significantly less satisfied with several aspects of care than insured persons. There were no significant differences in satisfaction between men with managed care and those with public insurance. HIV-infected persons who have a choice of insurance should carefully weigh their options, recognizing the implicit trade-offs between types of insurance. Those who choose fee-for-service insurance can expect to be more satisfied with interpersonal relations with their medical providers but less satisfied with financial aspects of their plans. Efforts to address the low satisfaction of uninsured persons are needed.

Adult↗
PubMed1998

Low dihydrotestosterone and weight loss in the AIDS wasting syndrome.

24 consecutive AIDS patients with wasting, and who had never received anabolic therapies, were evaluated to determine their profile of sex hormones and whether transformation of testosterone (T) to the nuclear androgen, dihydrotestosterone (DHT), was impaired. Eleven (46%) patients had normal testosterone and DHT (group I), 10 (42%) had normal testosterone but low DHT (group II), and 3 (12%) had low testosterone and low DHT (group III). Age, prior opportunistic complications, symptoms, serum albumin, hemoglobin levels, and CD4 lymphocyte counts were similar in the groups. DHT was significantly lower (22.2 +/- 6.8 microg/dl) in group II compared with group I (50.8 +/- 15.3 microg/dl). The ratio of T/DHT, a measure of the conversion of testosterone to DHT, in group I was 15.1 +/- 3.5, which was within the range for eugonadal young men. In group II, the ratio was 22.3 +/- 1.5, indicating a defect in generation of DHT. Patients in group II had lost 9.2 +/- 3.5 kg compared with 5.6 +/- 2.6 kg in group I (p = .015). Thus, a syndrome of low DHT with normal testosterone was associated with significantly greater weight loss than in patients with normal testosterone and DHT. Further studies are needed to clarify whether low DHT is a result of AIDS wasting or is causally related to weight loss and whether androgen therapy in the form of DHT could reverse some of the metabolic changes associated with AIDS wasting.

Adult↗
PubMed1998

Chorioamnionitis and pregnancy outcome in HIV-infected African women. Pregnancy and HIV Study Group.

OBJECTIVE: To assess the role of chorioamnionitis (CAM) on pregnancy outcome in HIV-1-infected (HIV-positive) pregnant women, treated for sexually transmitted diseases (STDs), during the last trimester of pregnancy in Kigali, Rwanda. METHODS: At inclusion in a prospective cohort, from July 1992 to August 1993, 561 pregnant women between 24 and 28 weeks were systematically screened for HIV infection, STDs, anemia, malaria, and hepatitis B infection; a CD4 lymphocyte count was performed. Until delivery, each woman enrolled had a monthly clinical follow-up with STD treatment when needed. The pregnancy outcome was recorded. Diagnosis of CAM was based on histologic examination of the placenta. RESULTS: Among the 275 placentas of HIV-negative women and 286 placentas of HIV-positive women examined, CAM was diagnosed (CAM-positive) in 27 HIV-positive women (9.8%) and in 28 HIV-negative women (9.8%). No statistical association was found between CAM and the following variables, independent of the HIV serostatus: age, parity, hepatitis B, anemia, STDs, and immune deficiency. Among HIV-negative women, CAM was significantly associated with prematurity (relative risk [RR] = 3.0; 95% confidence interval [CI] = 1.5-6.3), stillbirth (RR = 4.2; 95% CI = 1.6-11.0) and premature rupture of membranes (RR = 2.9; 95% CI = 1.4-6.1). Among HIV-positive women, early neonatal mortality was the only adverse outcome associated with CAM (RR = 2.0; 95% CI = 1.6-11.0). CONCLUSIONS: In our study, the prevalence of CAM was low and no risk factor of CAM was identified, a probable consequence of the control factor of STDs. CAM was strongly associated with adverse pregnancy outcomes in HIV-infected women, reflecting a possible deleterious effect of HIV.

Chorioamnionitis↗
PubMed1999

Effect of antiviral drugs used to treat cytomegalovirus end-organ disease on subsequent course of previously diagnosed Kaposi's sarcoma in patients with AIDS.

OBJECTIVE: To evaluate the association of ganciclovir (GCV) and foscarnet (PFA) therapy with the outcome of previously diagnosed Kaposi's sarcoma (KS) after initiating antiviral therapy for cytomegalovirus (CMV) end-organ disease. DESIGN: Retrospective study. METHODS: KS progression was defined as a clinically obvious increase in size of baseline cutaneous or mucosal lesions, a new diagnosis of visceral KS, or initiation of a new systemic antineoplastic regimen or radiation therapy to treat KS. Multivariate analyses of risk of KS progression were calculated for prior duration of KS before initiating CMV treatment, treatment with PFA or GCV, number of weeks treated with PFA or GCV, absolute CD4 lymphocyte count at time of CMV-related disease diagnosis, diagnosis of KS prior to 1991, visceral KS, prior systemic chemotherapy, and prior radiation therapy. RESULTS: Among 66 patients who received > or = 14 days PFA (N=20) or only GCV (N=46), median time to progression of KS was 211 days (95% confidence interval [CI], 46-578) for patients who received PFA versus 22 days (95% CI, 15-41) for those who received only GCV (p < .001). In the stepwise multivariate analysis, only prior visceral KS (rate ratio [RR]=2.80; 95% CI, 1.07-7.35) and foscarnet therapy (RR = 0.24; 95% CI, 0.11-0.53) were significantly associated with risk of KS progression. CONCLUSION: PFA may be an effective therapy for AIDS-related KS; prospective trials are indicated.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Prevalence and predictive value of overweight in an urban HIV care clinic.

OBJECTIVE: To determine the prevalence and predictive value of overweight in an urban HIV clinic. METHODS: Medical records of all new adult, nonpregnant registrants in 1996 in an urban HIV clinic with at least one height and weight measurement were reviewed. Body mass index (BMI) at clinic enrollment was calculated, and prevalence of overweight was thus determined. The subsequent clinical course of the overweight group was compared with that of a randomly selected group of gender-stratified non-overweight patients. RESULTS: At baseline, 12.6% of men and 32.5% of women were overweight. Female gender and lack of AIDS diagnosis were independently associated with overweight. More than one half of women and 19.6% of men were overweight at some point during the study. Providers were more likely to properly acknowledge underweight than overweight. Among patients without AIDS, there was a trend toward slower disease progression and lower viral load in overweight patients, despite similar baseline CD4+ lymphocyte counts and similar time to initiation of highly active antiretroviral therapy. In multivariate proportional hazards analyses, lower baseline BMI and falling BMI during follow-up were independently predictive of progression to AIDS. CONCLUSIONS: Overweight was a common and underrecognized finding, particularly among women. Overweight patients may progress more slowly to AIDS than non-overweight patients.

Adult↗
PubMed1999

Adherence to guidelines for antiretroviral therapy and for preventing opportunistic infections in HIV-infected adults and adolescents in Ryan White-funded facilities in the United States.

To determine adherence by health care providers to guidelines for antiretroviral therapy and for prevention of opportunistic infections (OIs) in adults with HIV infection in federally funded facilities in the United States, we reviewed records of HIV-infected adults (>13 years) in 11 Ryan White Title III facilities in four states for information on eight standard-of-care recommendations during November 1996 through September 1997. Eligibility required a visit to the facility within 6 months before record abstraction and a lowest CD4+ lymphocyte count <500 cells/microl. Reviews were completed for 148 patients in Maryland, 355 in New York, 370 in Georgia, and 538 in Illinois. Adherence to prevention measures by health care providers was >85% for HIV plasma RNA testing, prescription of antiretroviral therapy, Pneumocystis carinii pneumonia (PCP) prophylaxis, anti-Toxoplasma antibody testing, and obtaining Papanicolaou (Pap) smears but lower (69%-80%) for Mycobacterium avium complex (MAC) prophylaxis, tuberculin skin testing (TST), and pneumococcal vaccination. Adherence was similar by patient age, gender, racial/ethnic group, urban versus rural, and hospital versus clinic setting but was generally lower for injecting drug users (IDUs) than for patients with other HIV exposures (p < .05 by multivariate analysis for TST, anti-Toxoplasma antibody testing, Pap smear, and measurement of HIV plasma RNA). Adherence by health care providers to guidelines for preventing OIs in these federally funded facilities is generally high but could be improved for some prevention measures, for instance, MAC prophylaxis, TST, and pneumococcal vaccination, especially for IDUs.

AIDS-Related Opportunistic Infections↗
PubMed1999

Treatment of AIDS-related cutaneous Kaposi's sarcoma with topical alitretinoin (9-cis-retinoic acid) gel. Panretin Gel North American Study Group.

BACKGROUND: Kaposi's sarcoma (KS) is the most frequent malignancy in patients with HIV. Given the promise that retinoids show in the treatment of various hyperproliferative skin disorders and in vitro evidence of inhibition of proliferation of KS cells, a randomized, controlled clinical trial was conducted. METHODS AND RESULTS: A 12-week, multicenter, randomized, double-blind, vehicle-controlled safety and efficacy evaluation of topical alitretinoin 0.1% gel applied to cutaneous KS lesions was conducted in HIV-infected patients. The primary efficacy endpoint was the patient's response rate, as determined by evaluating six index lesions representative of the patient's overall KS cutaneous disease using AIDS Clinical Trials Group (ACTG) response criteria applied to topical therapy. Of 268 patients entered in the blinded treatment phase of the study (alitretinoin group, n = 134; vehicle group, n = 134), 47 patients (35%) treated with alitretinoin 0.1% gel had a positive response, compared with 24 patients (18%) treated with vehicle gel. Of 184 patients receiving open-label alitretinoin treatment following the blinded phase of the trial, 90 patients (49%) met criteria for a positive response. This superior efficacy of alitretinoin gel over vehicle gel was maintained when the data were adjusted or analyzed for age, race, Kamofsky scores, baseline CD4+ lymphocyte counts, number of raised lesions at baseline, and aggregate area of index lesions. Alitretinoin 0.1% gel was superior to vehicle gel regardless of the number of concurrent antiretroviral therapies. Most adverse events were mild to moderate in severity, limited to the application site, and reversible on reduction in frequency or suspension of application. Relatively few patients (7%) discontinued alitretinoin therapy because of to related adverse events. CONCLUSIONS: The results show that alitretinoin gel application is safe and generally well tolerated, and they indicate the superiority of alitretinoin 0.1% gel over vehicle gel in the treatment of cutaneous AIDS-related KS lesions.

AIDS-Related Opportunistic Infections↗
PubMed1999

Human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus) infection in men receiving treatment for HIV-1 infection.

OBJECTIVE: To determine the prevalence of human herpesvirus 8 (HHV-8) infection in men treated for HIV-1 infection in Denver, Colorado. DESIGN: Cross-sectional analysis METHODS: Blood samples were obtained from 216 HIV-1-infected men. Antibody to latency-associated nuclear antigen (LANA) was detected by an immunofluorescent assay and the presence of HHV-8 in peripheral blood mononuclear cells (PBMC) was detected by polymerase chain reaction amplification. RESULTS: Among HIV-1-infected men who did not have Kaposi's sarcoma (KS), prevalence of HHV-8 infection was 46% (95% confidence interval [CI], 0.39-0.52). LANA seropositivity was common both among subjects with KS and subjects without KS (69% versus 42%; p = .06), but detection of HHV-8 DNA in peripheral blood was strongly associated with a diagnosis of KS (44% versus 10%; p = .001). In a univariate analysis of study subjects without KS, neither the odds of LANA seropositivity nor detection of HHV-8 DNA in PBMC was significant for CD4+ lymphocyte count, HIV-1 virus load, the use of three drug antiretroviral regimens or the prior occurrence of non-KS AIDS-related conditions. CONCLUSION: Although antibodies to HHV-8 are common among HIV-1-infected men, detection of HHV-8 DNA in PBMC is uncommon and is associated with a diagnosis of Kaposi's sarcoma.

AIDS-Related Opportunistic Infections↗
PubMed1999

A comparison of exposure groups in the EuroSIDA study: starting highly active antiretroviral therapy (HAART), response to HAART, and survival.

BACKGROUND: Concerns have been raised that intravenous drug users may be less likely to start highly active antiretroviral therapy (HAART) and that adherence to therapy may be poor among this group of patients. Given the decreased mortality and incidence of AIDS-defining illnesses among patients with HIV who start HAART, this may lead to a poorer prognosis among intravenous drug users. PURPOSE: To compare homosexual men, intravenous drug users, and heterosexuals in EuroSIDA, a prospective European cohort of 7331 patients with HIV in terms of starting a HAART treatment regimen, immunologic and virologic response to therapy, and survival. METHODS: 6645 patients were included in this analysis. Logistic regression and Cox proportional hazards models were used to investigate the factors associated with use of HAART regimens and survival following recruitment to the EuroSIDA study. RESULTS: In a multivariate logistic regression model, intravenous drug users were significantly less likely to be receiving HAART at recruitment to EuroSIDA (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.37-0.62; p<.0001) when compared with homosexual men. Similarly, during follow-up, intravenous drug users were at a 27% reduced risk of starting HAART, after adjustment for other factors related to starting HAART (relative hazard [RH], 0.73; 95% CI, 0.64-0.82; p<.0001). There were no differences between heterosexual and homosexual patients, and similar results were found within regions of Europe (South, Central and Northern). Among those patients who started HAART, there were no significant differences between exposure groups in CD4 lymphocyte count response to HAART or virologic response to HAART. After adjustment for factors related to survival, intravenous drug users were at a small, but nonsignificant increased risk of death compared with homosexuals (RH 1.16; 95% CI, 0.99-1.38; p = .074). CONCLUSIONS: Intravenous drug users were significantly less likely to start HAART, but among those who did, response to therapy was similar to that of other exposure groups. There were no differences in risk of death. If intravenous drug users continue to use HAART less commonly than other exposure groups, it may result in a poorer prognosis, a different spectrum of AIDS-defining illnesses, and differential long-term clinical needs.

Adult↗
PubMed2000

Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens.

BACKGROUND: Adherence to prescribed medications is a central feature of good clinical HIV care, but little is known about the factors associated with multidrug antiretroviral adherence, or about how such adherence is related to plasma HIV suppression. METHODS: We collected data from 133 HIV-infected adults receiving antiretroviral therapy. Study subjects completed customized adherence self-report instruments and provided blood samples to measure plasma HIV-1 RNA concentrations and CD4+ lymphocyte counts. Regression models were used to determine the independent predictors of antiretroviral adherence and plasma HIV concentration, and the relationships between the two. RESULTS: Adherence was poor (average, <80% antiretrovirals/day) in 28% (95% confidence interval [CI], 20%-36%), fair (80%-99% per day) in 23% (95% CI, 15%-30%), and excellent (100% per day) in 50% (95% CI, 41%-58%) of study subjects. Mean decreases in HIV-1 concentration from highest-ever levels were 1.3, 1.6, and 2.0 log10 copies/ml in these three groups, respectively (chi2; p < .02). Two-stage least squares regression demonstrated a -1.3 log difference in viral load associated with each category improvement in adherence. In multivariate models, confidence in medication-taking ability, or perceived self-efficacy, and convenience of the medication regimen, or "fit" with routine and daily activities, were also associated with greater medication adherence (odds ratios [OR] 5.3; 95% CI, 2.4-11.8, and 9.0; 95% CI, 1.8-45.3, respectively). The latter was also independently associated with a lower plasma HIV concentration (p < .02). CONCLUSIONS: Nonadherence to combination antiretroviral medications is common and is associated with increased levels of plasma HIV. Programs and clinical efforts to improve medication taking should strive to integrate medications better into patients' daily routines and to improve patients' confidence in their ability to take medications correctly.

Adolescent↗