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1.  HIV Shedding from Male Circumcision Wounds in HIV-Infected Men: A Prospective Cohort Study 
PLoS Medicine  2015;12(4):e1001820.
Background
A randomized trial of voluntary medical male circumcision (MC) of HIV—infected men reported increased HIV transmission to female partners among men who resumed sexual intercourse prior to wound healing. We conducted a prospective observational study to assess penile HIV shedding after MC.
Methods and Findings
HIV shedding was evaluated among 223 HIV—infected men (183 self—reported not receiving antiretroviral therapy [ART], 11 self—reported receiving ART and had a detectable plasma viral load [VL], and 29 self—reported receiving ART and had an undetectable plasma VL [<400 copies/ml]) in Rakai, Uganda, between June 2009 and April 2012. Preoperative and weekly penile lavages collected for 6 wk and then at 12 wk were tested for HIV shedding and VL using a real—time quantitative PCR assay. Unadjusted prevalence risk ratios (PRRs) and adjusted PRRs (adjPRRs) of HIV shedding were estimated using modified Poisson regression with robust variance. HIV shedding was detected in 9.3% (17/183) of men not on ART prior to surgery and 39.3% (72/183) of these men during the entire study. Relative to baseline, the proportion shedding was significantly increased after MC at 1 wk (PRR = 1.87, 95% CI = 1.12–3.14, p = 0.012), 2 wk (PRR = 3.16, 95% CI = 1.94–5.13, p < 0.001), and 3 wk (PRR = 1.98, 95% CI = 1.19–3.28, p = 0.008) after MC. However, compared to baseline, HIV shedding was decreased by 6 wk after MC (PRR = 0.27, 95% CI = 0.09–0.83, p = 0.023) and remained suppressed at 12 wk after MC (PRR = 0.19, 95% CI = 0.06–0.64, p = 0.008). Detectable HIV shedding from MC wounds occurred in more study visits among men with an HIV plasma VL > 50,000 copies/ml than among those with an HIV plasma VL < 400 copies/ml (adjPRR = 10.3, 95% CI = 4.25–24.90, p < 0.001). Detectable HIV shedding was less common in visits from men with healed MC wounds compared to visits from men without healed wounds (adjPRR = 0.12, 95% CI = 0.07–0.23, p < 0.001) and in visits from men on ART with undetectable plasma VL compared to men not on ART (PRR = 0.15, 95% CI = 0.05–0.43, p = 0.001). Among men with detectable penile HIV shedding, the median log10 HIV copies/milliliter of lavage fluid was significantly lower in men with ART—induced undetectable plasma VL (1.93, interquartile range [IQR] = 1.83–2.14) than in men not on ART (2.63, IQR = 2.28–3.22, p < 0.001). Limitations of this observational study include significant differences in baseline covariates, lack of confirmed receipt of ART for individuals who reported ART use, and lack of information on potential ART initiation during follow—up for those who were not on ART at enrollment.
Conclusion
Penile HIV shedding is significantly reduced after healing of MC wounds. Lower plasma VL is associated with decreased frequency and quantity of HIV shedding from MC wounds. Starting ART prior to MC should be considered to reduce male-to-female HIV transmission risk. Research is needed to assess the time on ART required to decrease shedding, and the acceptability and feasibility of initiating ART at the time of MC.
In this prospective cohort study, Aaron Tobian and colleagues examine the associations between male circumcision wound healing, as well as plasma viral load, and HIV shedding from male circumcision wounds.
Editors' Summary
Background
About 35 million people are currently infected with HIV, the virus that causes AIDS by destroying immune system cells, and every year, 2 million more people become HIV-positive. Antiretroviral therapy (ART) can keep HIV in check, but there is no cure for AIDS. Consequently, prevention of HIV acquisition and transmission is an important component of efforts to control the AIDS epidemic. Because HIV is most often spread through unprotected sex with an infected partner, individuals can reduce their risk of becoming HIV-positive by abstaining from sex, by having only one or a few partners, and by using male or female condoms. In addition, three trials undertaken in sub-Saharan Africa a decade ago showed that male circumcision—the surgical removal of the foreskin, a loose fold of skin that covers the head of the penis—can halve the HIV acquisition rate in men. Thus, since 2007, the World Health Organization (WHO) has recommended voluntary medical male circumcision for individuals living in countries with high HIV prevalence as part of its HIV prevention strategy.
Why Was This Study Done?
With the rollout of voluntary medical male circumcision programs, circumcision has become more normative (regarded as acceptable), and HIV-positive men are increasingly requesting circumcision because they want to avoid any stigma associated with being uncircumcised and because circumcision provides health benefits. WHO recommends that, although circumcision should not be promoted for HIV-positive men, voluntary circumcision programs should operate on HIV-positive men if they request circumcision. However, in a trial of circumcision of HIV-infected men, HIV transmission to their female partners increased if the couples had sexual intercourse before the circumcision wound had healed. Moreover, in studies of current male circumcision programs, two-thirds of married men and a third of all men reported that they resumed sexual intercourse before their circumcision wounds had healed. Thus, better understanding of how male circumcision increases HIV transmission to female partners is essential, and improved ways to prevent transmission in the post-surgical period are needed. Here, in a prospective observational study (an investigation that collects data over time from people undergoing a specific procedure), the researchers assess HIV shedding from the penis after circumcision.
What Did the Researchers Do and Find?
The researchers evaluated penile HIV shedding among 223 HIV-infected men (183 men who self-reported not being on ART and 40 men who self-reported being on ART, 29 of whom had no detectable virus in their blood) living in Rakai, Uganda, by examining preoperative and postoperative penile lavage (wash) samples. Viral shedding was detected in 9.3% of the men not on ART before surgery and in 39.3% of these men during the entire study. Relative to baseline, a greater proportion of men shed virus at one, two, and three weeks after circumcision, but a lower proportion shed virus at six and twelve weeks after circumcision. HIV shedding was more frequent among men with a high amount of virus in their blood (a high viral load) than among men with a low viral load. Moreover, the frequency of HIV shedding was lower in visits from men with healed circumcision wounds than in visits from men with unhealed wounds, and in visits from men on ART with no detectable virus in their blood than in visits from men not on ART men. Finally, among men with detectable penile HIV shedding, men on ART with no detectable virus in their blood shed fewer copies of virus than men not on ART.
What Do These Findings Mean?
The findings suggest that healed circumcision wounds are associated with reduced penile HIV shedding in HIV-positive men compared to unhealed circumcision wounds and HIV shedding prior to circumcision In addition, they suggest that a lower HIV viral load in the blood is associated with a decreased frequency and quantity of HIV shedding from circumcision wounds. Because this was an observational study, these findings cannot prove that healed wounds or reduced blood viral load actually caused reduced penile HIV shedding. Moreover, the accuracy of these findings may be affected by the lack of information on ART initiation during follow-up among men not initially on ART and by reliance on ART self-report. Nevertheless, these findings highlight the importance of counseling HIV-positive men undergoing circumcision to avoid sexual intercourse until their circumcision wound heals. In addition, these findings suggest that it might be possible to reduce HIV transmission among HIV-positive men immediately after circumcision by starting these individuals on ART before circumcision. Further research is needed to assess how long before circumcision ART should be initiated and to assess the acceptability and feasibility of initiating ART concurrent with circumcision.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001820.
Information is available from the US National Institute of Allergy and Infectious Diseases on HIV infection and AIDS
NAM/aidsmap provides basic information about HIV/AIDS, summaries of recent research findings on HIV care and treatment, information on male circumcision for the prevention of HIV transmission, and personal stories about living with HIV/AIDS
Information is available from Avert, an international AIDS charity on many aspects of HIV/AIDS, including information on HIV prevention, on voluntary medical male circumcision for HIV prevention, and on HIV/AIDS in sub-Saharan Africa; Avert also provides personal stories about living with HIV/AIDS
The World Health Organization provides information on all aspects of HIV/AIDS (in several languages), including on voluntary medical male circumcision for HIV prevention
The UNAIDS Fast-Track Strategy to End the AIDS Epidemic by 2030 provides up-to-date information about the AIDS epidemic and efforts to halt it
The Clearinghouse on Male Circumcision for HIV Prevention provides up-to-date information and resources on male circumcision for HIV prevention
doi:10.1371/journal.pmed.1001820
PMCID: PMC4412625  PMID: 25919012
2.  HIV Infection and the Risk of Diabetes Mellitus 
AIDS (London, England)  2009;23(10):1227-1234.
Background
The influence of HIV infection on the risk of diabetes is unclear. We determined the association and predictors of prevalent DM in HIV infected and uninfected veterans.
Methods
We determined baseline prevalence and risk factors for diabetes among HIV infected and uninfected veterans in the Veterans Aging Cohort Study. Logistic regression was used to determine the odds of diabetes in HIV infected and uninfected persons.
Results
We studied 3,327 HIV-infected and 3,240 HIV-uninfected subjects. HIV infected subjects were younger, more likely to be black race, male, have HCV coinfection and a lower body mass index (BMI). HIV infected subjects had a lower prevalence of diabetes at baseline (14.9% vs. 21.4%, P<0.0001). After adjustment for known risk factors, HIV infected individuals had a lower risk of diabetes (OR 0.84, 95% CI 0.72-0.97). Increasing age, male gender, minority race, and BMI were associated with an increased risk. The odds ratio for diabetes associated with increasing age, minority race and BMI were greater among HIV infected veterans. HCV coinfection and nucleoside and non-nucleoside reverse transcriptase inhibitor therapy were associated with a higher risk of diabetes in HIV infected veterans.
Conclusion
While HIV infection itself is not associated with increased risk of diabetes, increasing age, HCV coinfection and BMI have a more profound effect upon the risk of diabetes among HIV infected persons. Further, long term ARV treatment also increases risk. Future studies will need to determine whether incidence of DM differs by HIV status.
doi:10.1097/QAD.0b013e32832bd7af
PMCID: PMC2752953  PMID: 19444074
HIV; diabetes; HCV; risk; antiretroviral therapy
3.  Kidney and liver organ transplantation in persons with human immunodeficiency virus 
Executive Summary
Objective
The objective of this analysis is to determine the effectiveness of solid organ transplantation in persons with end stage organ failure (ESOF) and human immunodeficiency virus (HIV+)
Clinical Need: Condition and Target Population
Patients with end stage organ failure who have been unresponsive to other forms of treatment eventually require solid organ transplantation. Similar to persons who are HIV negative (HIV−), persons living with HIV infection (HIV+) are at risk for ESOF from viral (e.g. hepatitis B and C) and non-viral aetiologies (e.g. coronary artery disease, diabetes, hepatocellular carcinoma). Additionally, HIV+ persons also incur risks of ESOF from HIV-associated nephropathy (HIVAN), accelerated liver damage from hepatitis C virus (HCV+), with which an estimated 30% of HIV positive (HIV+) persons are co-infected, and coronary artery disease secondary to antiretroviral therapy. Concerns that the need for post transplant immunosuppression and/or the interaction of immunosuppressive drugs with antiretroviral agents may accelerate the progression of HIV disease, as well as the risk of opportunistic infections post transplantation, have led to uncertainty regarding the overall benefit of transplantation among HIV+ patients. Moreover, the scarcity of donor organs and their use in a population where the clinical benefit of transplantation is uncertain has limited the availability of organ transplantation to persons living with ESOF and HIV.
With the development of highly active anti retroviral therapy (HAART), which has been available in Canada since 1997, there has been improved survival and health-related quality of life for persons living with HIV. HAART can suppress HIV replication, enhance immune function, and slow disease progression. HAART managed persons can now be expected to live longer than those in the pre-HAART era and as a result many will now experience ESOF well before they experience life-threatening conditions related to HIV infection. Given their improved prognosis and the burden of illness they may experience from ESOF, the benefit of solid organ transplantation for HIV+ patients needs to be reassessed.
Evidence-Based Analysis Methods
Research Questions
What are the effectiveness and cost effectiveness of solid organ transplantation in HIV+ persons with ESOF?
Literature Search
A literature search was performed on September 22, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 1996 to September 22, 2009.
Inclusion Criteria
Systematic review with or without a Meta analysis, RCT, Non-RCT with controls
HIV+ population undergoing solid organ transplantation
HIV+ population managed with HAART therapy
Controls include persons undergoing solid organ transplantation who are i) HIV− ii) HCV+ mono-infected, and iii) HIV+ persons with ESOF not transplanted.
Studies that completed and reported results of a Kaplan-Meier Survival Curve analysis.
Studies with a minimum (mean or medium) follow up of 1-year.
English language citations
Exclusion Criteria
Case reports and case series were excluded form this review.
Outcomes of Interest
i) Risk of Death after transplantation
ii) Death censored graft survival (DCGS)
iii) HIV disease progression defined as the post transplant incidence of:
- opportunistic infections or neoplasms,
- CD4+ T-cell count < 200mm3, and
- any detectable level of plasma HIV viral load.
iv) Acute graft rejection,
v) Return to dialysis,
vi) Recurrence of HCV infection
Summary of Findings
No direct evidence comparing an HIV+ cohort undergoing transplantation with the same not undergoing transplantation (wait list) was found in the literature search.
The results of this review are reported for the following comparison cohorts undergoing transplantation:
i) Kidney Transplantation: HIV+ cohort compared with HIV− cohort
ii) Liver Transplantation: HIV+ cohort compared with HIV− negative cohort
iii) Liver Transplantation: HIV+ HCV+ (co-infected) cohort compared with HCV+ (mono-infected) cohort
Kidney Transplantation: HIV+ vs. HIV−
Based on a pooled HIV+ cohort sample size of 285 patients across four studies, the risk of death after kidney transplantation in an HIV+ cohort does not differ to that of an HIV− cohort [hazard ratio (HR): 0.90; 95% CI: 0.36, 2.23]. The quality of evidence supporting this outcome is very low.
Death censored graft survival was reported in one study with an HIV+ cohort sample size of 100, and was statistically significantly different (p=.03) to that in the HIV− cohort (n=36,492). However, the quality of evidence supporting this outcome was determined to be very low. There was also uncertainty in the rate of return to dialysis after kidney transplantation in both the HIV+ and HIV− groups and the effect, if any, this may have on patient survival. Because of the very low quality evidence rating, the effect of kidney transplantation on HIV-disease progression is uncertain.
The rate of acute graft rejection was determined using the data from one study. There was a nonsignificant difference between the HIV+ and HIV− cohorts (OR 0.13; 95% CI: 0.01, 2.64), although again, because of very low quality evidence there is uncertainty in this estimate of effect.
Liver Transplantation: HIV+ vs. HIV−
Based on a combined HIV+ cohort sample size of 198 patient across five studies, the risk of death after liver transplantation in an HIV+ cohort (with at least 50% of the cohort co-infected with HCV+) is statistically significantly 64% greater compared with an HIV− cohort (HR: 1.64; 95% CI: 1.32, 2.02). The quality of evidence supporting this outcome is very low.
Death censored graft survival was reported for an HIV+ cohort in one study (n=11) however the DCGS rate of the contemporaneous control HIV− cohort was not reported. Because of sparse data the quality of evidence supporting this outcome is very low indicating death censored graft survival is uncertain.
Both the CD4+ T-cell count and HIV viral load appear controlled post transplant with an incidence of opportunistic infection of 20.5%. However, the quality of this evidence for these outcomes is very low indicating uncertainty in these effects. Similarly, because of very low quality evidence there is uncertainty in the rate of acute graft rejection among both the HIV+ and HIV− groups
Liver Transplantation: HIV+/HCV+ vs. HCV+
Based on a combined HIV+/HCV+ cohort sample size of 156 from seven studies, the risk of death after liver transplantation is significantly greater (2.8 fold) in a co-infected cohort compared with an HCV+ mono-infected cohort (HR: 2.81; 95% CI: 1.47, 5.37). The quality of evidence supporting this outcome is very low. Death censored graft survival evidence was not available.
Regarding disease progression, based on a combined sample size of 71 persons in the co-infected cohort, the CD4+ T-cell count and HIV viral load appear controlled post transplant; however, again the quality of evidence supporting this outcome is very low. The rate of opportunistic infection in the co-infected cohort was 7.2%. The quality of evidence supporting this estimate is very low, indicating uncertainty in these estimates of effect.
Based on a combined HIV+/HCV+ cohort (n=57) the rate of acute graft rejection does not differ to that of an HCV+ mono-infected cohort (OR: 0.88; 95% CI: 0.44, 1.76). Also based on a combined HIV+/HCV+ cohort (n=83), the rate of HCV+ recurrence does not differ to that of an HCV+ mono-infected cohort (OR: 0.66; 95% CI: 0.27, 1.59). In both cases, the quality of the supporting evidence was very low.
Overall, because of very low quality evidence there is uncertainty in the effect of kidney or liver transplantation in HIV+ persons with end stage organ failure compared with those not infected with HIV. Examining the economics of this issue, the cost of kidney and liver transplants in an HIV+ patient population are, on average, 56K and 147K per case, based on both Canadian and American experiences.
PMCID: PMC3377507  PMID: 23074407
4.  The Risk of Incident Coronary Heart Disease Among Veterans with and without HIV and Hepatitis C 
Background
Whether hepatitis C (HCV) confers additional coronary heart disease (CHD) risk among Human Immunodeficiency Virus (HIV) infected individuals is unclear. Without appropriate adjustment for antiretroviral therapy, CD4 count, and HIV-1 RNA, and substantially different mortality rates among those with and without HIV and HCV infection, the association between HIV, HCV, and CHD may be obscured.
Methods and Results
We analyzed data on 8579 participants (28% HIV+, 9% HIV+HCV+) from the Veterans Aging Cohort Study Virtual Cohort who participated in the 1999 Large Health Study of Veteran Enrollees. We analyzed data collected on HIV and HCV status, risk factors for and the incidence of CHD, and mortality from 1/2000–7/2007. We compared models to assess CHD risk when death was treated as a censoring event and as a competing risk. During the median 7.3 years of follow-up, there were 194 CHD events and 1186 deaths. Compared with HIV−HCV− Veterans, HIV+ HCV+ Veterans had a significantly higher risk of CHD regardless of whether death was adjusted for as a censoring event (adjusted hazard ratio (HR)=2.03, 95% CI=1.28–3.21) or a competing risk (adjusted HR=2.45, 95% CI=1.83–3.27 respectively). Compared with HIV+HCV− Veterans, HIV+ HCV+ Veterans also had a significantly higher adjusted risk of CHD regardless of whether death was treated as a censored event (adjusted HR=1.93, 95% CI=1.02–3.62) or a competing risk (adjusted HR =1.46, 95% CI=1.03–2.07).
Conclusions
HIV+HCV+ Veterans have an increased risk of CHD compared to HIV+HCV−, and HIV−HCV− Veterans.
doi:10.1161/CIRCOUTCOMES.110.957415
PMCID: PMC3159506  PMID: 21712519
viruses; coronary disease; mortality; multi morbidity
5.  Changes in HIV Incidence among People Who Inject Drugs in Taiwan following Introduction of a Harm Reduction Program: A Study of Two Cohorts 
PLoS Medicine  2014;11(4):e1001625.
Kenrad Nelson and colleagues report on the association between HIV incidence and exposure to a national harm-reduction program among people who inject drugs in Taiwan.
Please see later in the article for the Editors' Summary
Background
Harm reduction strategies for combating HIV epidemics among people who inject drugs (PWID) have been implemented in several countries. However, large-scale studies using sensitive measurements of HIV incidence and intervention exposures in defined cohorts are rare. The aim of this study was to determine the association between harm reduction programs and HIV incidence among PWID.
Methods and Findings
The study included two populations. For 3,851 PWID who entered prison between 2004 and 2010 and tested HIV positive upon incarceration, we tested their sera using a BED HIV-1 capture enzyme immunoassay to estimate HIV incidence. Also, we enrolled in a prospective study a cohort of 4,357 individuals who were released from prison via an amnesty on July 16, 2007. We followed them with interviews at intervals of 6–12 mo and by linking several databases. A total of 2,473 participants who were HIV negative in January 2006 had interviews between then and 2010 to evaluate the association between use of harm reduction programs and HIV incidence. We used survival methods with attendance at methadone clinics as a time-varying covariate to measure the association with HIV incidence. We used a Poisson regression model and calculated the HIV incidence rate to evaluate the association between needle/syringe program use and HIV incidence. Among the population of PWID who were imprisoned, the implementation of comprehensive harm reduction programs and a lower mean community HIV viral load were associated with a reduced HIV incidence among PWID. The HIV incidence in this population of PWID decreased from 18.2% in 2005 to 0.3% in 2010. In an individual-level analysis of the amnesty cohort, attendance at methadone clinics was associated with a significantly lower HIV incidence (adjusted hazard ratio: 0.20, 95% CI: 0.06–0.67), and frequent users of needle/syringe program services had lower HIV incidence (0% in high NSP users, 0.5% in non NSP users). In addition, no HIV seroconversions were detected among prison inmates.
Conclusions
Although our data are affected by participation bias, they strongly suggest that comprehensive harm- reduction services and free treatment were associated with reversal of a rapidly emerging epidemic of HIV among PWID.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
About 35 million people worldwide are currently infected with HIV, the virus that causes AIDS, and about 2.3 million people become newly infected every year. HIV is mainly transmitted through unprotected sex with an infected partner. However, people who inject drugs (PWID) have a particularly high risk of HIV infection because blood transfer through needle and syringe sharing can transmit the virus. It is estimated that 5%–10% of all people living with HIV are PWID. Indeed, in some regions of the world the primary route of HIV transmission is through shared drug injection equipment and the prevalence (the proportion of a population that has a specific disease) of HIV infection among PWID is very high. In Asia, for example, more than a quarter of PWID are HIV positive. Because the high prevalence of HIV among PWID poses a global health challenge, bodies such as the Joint United Nations Programme on HIV/AIDS endorse harm reduction strategies to prevent risky injection behaviors among PWID. These strategies include the provision of clean needles and syringes, opioid substitution therapy such as methadone maintenance treatment, and antiretroviral treatment for HIV-positive PWID.
Why Was This Study Done?
Although harm reduction strategies for combating HIV epidemics among PWID have been implemented in several countries, few large-scale studies have examined the association between HIV incidence (the proportion of new cases of HIV in a population per year) and exposure to harm reduction programs among PWID. In this cohort study (an investigation that determines the characteristics of a group of people and then follows them over time), the researchers determine the association between harm reduction programs and HIV incidence among PWID in Taiwan. HIV infections used to be rare among the 60,000 PWID living in Taiwan, but after the introduction of a new HIV strain into the country in 2003, an HIV epidemic spread rapidly. In response, the Taiwanese government introduced a pilot program of harm reduction that included the provision of clean needles and syringes and health education in July 2005. The program was expanded to include methadone maintenance treatment in early 2006 and implemented nationwide in June 2006.
What Did the Researchers Do and Find?
The researchers enrolled two study populations. The first cohort comprised 3,851 PWID who were incarcerated for illicit drug use between 2004 and 2010 and who tested positive for HIV upon admission into prison. By using the BED assay, which indicates whether an HIV infection is recent, the researchers were able to determine the HIV incidence among the prisoners. In 2004, the estimated HIV incidence among prisoners with a history of drug injection was 6.44%. The incidence peaked in 2005 at 18.2%, but fell to 0.3% in 2010.
The second study population comprised 2,473 individuals who were HIV negative on January 1, 2006, and who had been incarcerated for drug use crimes but were released on July 16, 2007, during an amnesty. The researchers regularly interviewed these participants between their release and 2010 about their use of harm reduction interventions, and obtained other data about them (for example, diagnosis of HIV infection) from official databases. Analysis of all these data indicated that, in this cohort, attendance at methadone maintenance treatment clinics and frequent use of needle and syringe services were both associated with a significantly lower HIV incidence.
What Do These Findings Mean?
These findings suggest that the introduction of a comprehensive harm reduction program in Taiwan was associated with a significant reduction in the HIV incidence rate among PWID. These findings must be interpreted with caution, however. First, because the participants in the study were selected from PWID with histories of incarceration, the findings may not be representative of all PWID in Taiwan or of PWID in other countries. Second, PWID who chose to use needle and syringe services or methadone maintenance treatment clinics might have shared other unknown characteristics that affected their risk of HIV infection. Finally, some of the reduction in HIV incidence seen during the study is likely to be associated with the availability of free treatment, which has been offered to all HIV-positive individuals in Taiwan since 1997. Despite these limitations, these findings suggest that countries with a high prevalence and incidence of HIV among PWID should provide comprehensive harm reduction services to their populations to reduce risky drug injection behaviors.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001625.
Information is available from the US National Institute of Allergy and Infectious diseases on HIV infection and AIDS
NAM/aidsmap provides basic information about HIV/AIDS, and summaries of recent research findings on HIV care and treatment
Information is available from Avert, an international AIDS charity, on many aspects of HIV/AIDS, including information on injecting drug users and HIV/AIDS and on harm reduction and HIV prevention (in English and Spanish)
The US National Institute on Drug Abuse also provides information about drug abuse and HIV/AIDS (in English and Spanish)
The 2013 UNAIDS World AIDS Day report provides up-to-date information about the AIDS epidemic and efforts to halt it
Personal stories about living with HIV/AIDS are available through Avert, Nam/aidsmap, and Healthtalkonline
doi:10.1371/journal.pmed.1001625
PMCID: PMC3979649  PMID: 24714449
6.  Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis 
PLoS Medicine  2012;9(7):e1001270.
In a systematic review and meta-analysis, Amitabh Suthar and colleagues investigate the association between antiretroviral therapy and the reduction in the incidence of tuberculosis in adults with HIV infection.
Background
Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection.
Methods and Findings
PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy initiation: (1) less than 200 cells/µl, (2) 200 to 350 cells/µl, (3) greater than 350 cells/µl, and (4) any CD4 count.
Eleven studies met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories: (1) less than 200 cells/µl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/µl (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/µl (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4 count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count category (p = 0.20).
Conclusions
Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV-associated tuberculosis syndemic.
Review Registration
International Prospective Register of Systematic Reviews CRD42011001209
Please see later in the article for the Editors' Summary.
Editors' Summary
Background
Tuberculosis—a contagious bacterial infection— is a global public-health problem. In 2010, 8.8 million people developed active tuberculosis and 1.4 million people died from the disease. Tuberculosis can be cured by taking powerful antibiotics regularly for several months, and between 1995 and 2010, 46 million people with tuberculosis were successfully treated using DOTS—a directly observed antibiotic regimen designed by the World Health Organization (WHO). Now, though, the HIV epidemic is compromising global tuberculosis control efforts. HIV-positive people are very susceptible to tuberculosis because HIV, the virus that causes AIDS, destroys the immune system cells (including CD4 lymphocytes) that normally combat tuberculosis. In 2010, 1.1 million of the new (incident) cases of tuberculosis were among the 34 million people living with HIV, and 350,000 people died of HIV-associated tuberculosis, making tuberculosis the leading cause of death among HIV-positive people. To tackle HIV-associated tuberculosis, which occurs mainly in developing countries, WHO now recommends that HIV and tuberculosis programs use collaborative approaches such as the Three I's for HIV/TB strategy—intensified tuberculosis case-finding among HIV-positive people, isoniazid preventative therapy for HIV-positive people without active tuberculosis, and (tuberculosis) infection control in healthcare facilities, social settings, and households.
Why Was This Study Done?
Despite progress in scaling up the Three I's for HIV/TB strategy, complementary interventions are still needed to prevent tuberculosis in HIV-positive people. Antiretroviral therapy (ART) lowers the viral load of people infected with HIV and restores their immune system function and could, therefore, prevent HIVassociated tuberculosis, in addition to treating HIV infection. WHO recommends ART for all HIV-positive adults with a CD4 count of less than 350 cells/μl of blood and for all HIVpositive, tuberculosis-positive individuals irrespective of their CD4 count. However, the evidence for ART's preventative impact on tuberculosis has not been systematically examined. Here, the researchers undertake a systematic review (a search that uses predefined criteria to identify all the research on a given topic) and a meta-analysis (a statistical method for combining the results of studies) to investigate the impact of ART initiated at various CD4 counts on the development of tuberculosis in HIV-positive adults in developing countries.
What Did the Researchers Do and Find?
The researchers found 11 studies that compared tuberculosis incidence by ART status in HIV-infected adults over periods longer than six months on average in developing countries and undertook meta-analyses of these studies based on four categories of CD4 count at ART initiation (less than 200 cells/μl, 200–350 cells/μl, greater than 350 cells/μl, and any CD4 count). For all these categories, ART was strongly associated with a reduction in the incidence of tuberculosis. For example, the meta-analysis of the two studies that reported on participants in whom ART was initiated at a CD4 count less than 200 cells/μl yielded a hazard ratio (HR) of 0.16. That is, study participants starting ART when their CD4 count was below 200 cells/μl were about one-sixth as likely to develop tuberculosis as participants not receiving ART. In the metaanalysis of all 11 studies, study participants receiving ART were about one-third as likely to develop tuberculosis as study participants receiving no ART, irrespective of their CD4 count (HR 0.35). Importantly, the CD4 count at which ART was initiated did not significantly alter the magnitude of ART's preventive effect on tuberculosis development.
What Do These Findings Mean?
These findings suggest that ART is strongly associated with a reduction in the incidence of tuberculosis in HIV-positive adults in developing countries, whatever the CD4 count at ART initiation. Because most of the studies in this meta-analysis were observational, these results do not show that ART causes a reduction in tuberculosis incidence—other unknown factors shared by the study participants who received ART may be responsible for their lower tuberculosis incidence. Moreover, factors such as variations in diagnostic methods among the studies included in this meta-analysis may have affected the accuracy of these findings. Nevertheless, the key finding that ART is associated with a significant reduction in tuberculosis cases among adults with CD4 counts greater than 350 cells//μl should be considered by healthcare providers, policymakers, and people living with HIV when weighing the benefits and risks of early ART initiation. It also suggests that early ART initiation (in combination with expanded HIV testing) could be a key component of future global and national strategies to control HIV-associated tuberculosis.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001270.
WHO provides information on all aspects of tuberculosis, including information on tuberculosis and HIV, on the Three I's for HIV/TB, and on ART for tuberculosis prevention (some information is in several languages)
The TB/HIV Working Group is part of the Stop TB Partnership, which is working toward tuberculosis elimination; patient stories about tuberculosis/HIV co-infection are also available on their site
The US Centers for Disease Control and Prevention has information about tuberculosis and about tuberculosis and HIV co-infection
The US National Institute of Allergy and Infectious Diseases also has detailed information on all aspects of tuberculosis including HIV-associated tuberculosis
Information is available from Avert, an international AIDS charity, on HIV-related tuberculosis (in English and Spanish), and from Aidsmap, a non-governmental organization, on HIV-associated tuberculosis
doi:10.1371/journal.pmed.1001270
PMCID: PMC3404110  PMID: 22911011
7.  Influences of gender in metabolic syndrome and its components among people living with HIV virus using antiretroviral treatment in Hawassa, southern Ethiopia 
BMC Research Notes  2016;9:145.
Background
Data regarding the influences of gender in metabolic syndrome (MetS) among patients using antiretroviral treatment (ART) in Ethiopia is scarce. The aim of this study was to assess the influences of gender in MetS and its components among HIV-infected patients receiving ART.
Methods
A cross-sectional study was conducted between February 2012 and April 2013. Data on demographic, clinical and anthropometric characteristics were collected from 185 HIV patients using ART. Glucose and lipid profiles were measured from overnight fast blood. The International Diabetes Federation (IDF) and United States national cholesterol education program: adult treatment (US NCEP-ATP) panel III criteria were used to define MetS.
Result
A total number of 185 (36.8 % males and 63.2 % females) participants were recruited in this study. The overall prevalence of MetS was 24.3 and 17.8 %, diagnosed using IDF and NCEP-ATP criteria respectively. Using IDF criteria, MetS was significantly higher in females compared to males (33.3 vs. 8.8 %; p = <0.0001) respectively. Low HDL-c and central obesity were significantly higher MetS components in female compared to males (p = 0.003); and (p = <0.0001, using IDF and NCEP-ATP criteria) respectively. BMI >25 kg/m2 was significantly associated with MetS in both IDF and NCEP-ATP criteria: unadjusted (UOR) and adjusted odds ratio (AOR) with 95 % CI were 3.0 (1.3–6.5) and 3.8 (1.5–9.8); as well as 3.2 (1.4–7.4) and 3.4 (1.4–7.4) respectively. Furthermore age >40 years was significantly associated with MetS using NCEP-ATP: UOR and AOR (95 % CI) were 3.1 (1.2–8.3), and 3.8 (1–13.70) respectively.
Conclusion
Comprehensive medical care approach including with MetS components are a crucial instruments in order to minimize the risk of developing cardiovascular diseases in HIV-infected patients using ART.
doi:10.1186/s13104-016-1953-2
PMCID: PMC4779577  PMID: 26945987
Antiretroviral treatment; Gender; Metabolic syndrome; Cardiovascular risks
8.  Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples 
PLoS Medicine  2012;9(6):e1001251.
In a prospective study, Craig Cohen and colleagues investigate the association between bacterial vaginosis and the risk of female-to-male HIV-1 transmission.
Background
Bacterial vaginosis (BV), a disruption of the normal vaginal flora, has been associated with a 60% increased risk of HIV-1 acquisition in women and higher concentration of HIV-1 RNA in the genital tract of HIV-1–infected women. However, whether BV, which is present in up to half of African HIV-1–infected women, is associated with an increase in HIV-1 transmission to male partners has not been assessed in previous studies.
Methods and Findings
We assessed the association between BV on female-to-male HIV-1 transmission risk in a prospective study of 2,236 HIV-1–seropositive women and their HIV-1 uninfected male partners from seven African countries from a randomized placebo-controlled trial that enrolled heterosexual African adults who were seropositive for both HIV-1 and herpes simplex virus (HSV)-2, and their HIV-1–seronegative partners. Participants were followed for up to 24 months; every three months, vaginal swabs were obtained from female partners for Gram stain and male partners were tested for HIV-1. BV and normal vaginal flora were defined as a Nugent score of 7–10 and 0–3, respectively. To reduce misclassification, HIV-1 sequence analysis of viruses from seroconverters and their partners was performed to determine linkage of HIV-1 transmissions. Overall, 50 incident HIV-1 infections occurred in men in which the HIV-1–infected female partner had an evaluable vaginal Gram stain. HIV-1 incidence in men whose HIV-1–infected female partners had BV was 2.91 versus 0.76 per 100 person-years in men whose female partners had normal vaginal flora (hazard ratio 3.62, 95% CI 1.74–7.52). After controlling for sociodemographic factors, sexual behavior, male circumcision, sexually transmitted infections, pregnancy, and plasma HIV-1 RNA levels in female partners, BV was associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission (adjusted hazard ratio 3.17, 95% CI 1.37–7.33).
Conclusions
This study identified an association between BV and increased risk of HIV-1 transmission to male partners. Several limitations may affect the generalizability of our results including: all participants underwent couples HIV counseling and testing and enrolled in an HIV-1 prevention trial, and index participants had a baseline CD4 count ≥250 cells/mm3 and were HSV-2 seropositive. Given the high prevalence of BV and the association of BV with increased risk of both female HIV-1 acquisition and transmission found in our study, if this association proves to be causal, BV could be responsible for a substantial proportion of new HIV-1 infections in Africa. Normalization of vaginal flora in HIV-1–infected women could mitigate female-to-male HIV-1 transmission.
Trial Registration: ClinicalTrials.com NCT00194519
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Since the first reported case of AIDS in 1981, the number of people infected with HIV, the virus that causes AIDS, has risen steadily. By the end of 2010, 34 million people were living with HIV/AIDS. At the beginning of the epidemic more men than women were infected with HIV. Now, however, 50% of all adults infected with HIV are women and in sub-Saharan Africa, where two-thirds of HIV-positive people live, women account for 59% of people living with HIV. Moreover, among 15–24 year-olds, women are eight times more likely than men to be HIV-positive. This pattern of infection has developed because most people in sub-Saharan Africa contract HIV through unprotected heterosexual sex. The risk of HIV transmission for both men and women in Africa and elsewhere can be reduced by abstaining from sex, by only having one or a few partners, by always using condoms, and by male circumcision. In addition, several studies suggest that antiretroviral therapy (ART) greatly reduces HIV transmission.
Why Was This Study Done?
Unfortunately, in sub-Saharan Africa, only about a fifth of HIV-positive people are currently receiving ART, which means that there is an urgent need to find other effective ways to reduce HIV transmission in this region. In this prospective cohort study (a type of study that follows a group of people for some time to see which personal characteristics are associated with disease development), the researchers investigate whether bacterial vaginosis—a condition in which harmful bacteria disrupt the normal vaginal flora—increases the risk of female-to-male HIV transmission among African couples. Bacterial vaginosis, which is extremely common in sub-Saharan Africa, has been associated with an increased risk of HIV acquisition in women and induces viral replication and shedding in the vagina in HIV-positive women, which may mean that HIV-positive women with bacterial vaginosis are more likely to transmit HIV to their male partners than women without this condition. If this is the case, then interventions that reduce the incidence of bacterial vaginosis might be valuable HIV prevention strategies.
What Did the Researchers Do and Find?
The researchers analyzed data collected from 2,236 heterosexual African couples enrolled in a clinical trial (the Partners in Prevention HSV/HIV Transmission Study) whose primary aim was to investigate whether suppression of herpes simplex virus infection could prevent HIV transmission. In all the couples, the woman was HIV-positive and the man was initially HIV-negative. The female partners were examined every three months for the presence of bacterial vaginosis and the male partners were tested regularly for HIV infection. The researchers also determined whether the men who became HIV-positive were infected with the same HIV strain as their partner to check that their infection had been acquired from this partner. The HIV incidence in men whose partners had bacterial vaginosis was 2.9 per 100 person-years (that is, 2.9 out of every 100 men became HIV-positive per year) whereas the HIV incidence in men whose partners had a normal vaginal flora was 0.76 per 100 person-years. After controlling for factors that might affect the risk of HIV transmission such as male circumcision and viral levels in female partner's blood, the researchers estimated that bacterial vaginosis was associated with a 3.17-fold increased risk of female-to-male HIV transmission in their study population.
What Do These Findings Mean?
These findings suggest that HIV-positive African women with bacterial vaginosis are more than three times as likely to transmit HIV to their male partners as those with a normal vaginal flora. It is possible that some unknown characteristic of the men in this study might have increased both their own risk of HIV infection and their partner's risk of bacterial vaginosis. Nevertheless, because bacterial vaginosis is so common in Africa (half of the women in this study had bacterial vaginosis at least once during follow-up) and because this condition is associated with both female HIV acquisition and transmission, these findings suggest that bacterial vaginosis could be responsible for a substantial proportion of new HIV infections in Africa. Normalization of vaginal flora in HIV-infected women by frequent presumptive treatment with antimicrobials (treatment with a curative dose of antibiotics without testing for bacterial vaginosis) or possibly by treatment with probiotics (live “good” bacteria) might, therefore, reduce female-to-male HIV transmission in sub-Saharan Africa.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001251.
Information is available from the US National Institute of Allergy and infectious diseases on all aspects of HIV infection and AIDS and on bacterial vaginosis
The US Centers for Disease Control and Prevention has information on all aspects of HIV/AIDS, including specific information about HIV/AIDS and women; it also has information on bacterial vaginosis (in English and Spanish)
NAM/aidsmap provides basic information about HIV/AIDS, and summaries of recent research findings on HIV care and treatment, and information on bacterial vaginosis and HIV transmission (in several languages)
Information is available from Avert, an international AIDS nonprofit group on many aspects of HIV/AIDS, including detailed information on HIV and AIDS prevention, on women, HIV and AIDS and on HIV/AIDS in Africa (in English and Spanish); personal stories of women living with HIV are available; the website Healthtalkonline also provides personal stories about living with HIV
More information about the Partners in Prevention HSV/HIV Transmission Study is available
doi:10.1371/journal.pmed.1001251
PMCID: PMC3383741  PMID: 22745608
9.  Do Patterns of Comorbidity Vary by HIV Status, Age, and HIV Severity? 
Patterns of comorbidity among persons with human immunodeficiency virus (HIV) are not well described. We compared comorbidity among veterans with and without HIV infection. The sample consisted of 33,420 HIV-infected veterans and 66,840 HIV-uninfected veterans. We identified and clustered 11 comorbid conditions using validated International Classification of Diseases, 9th Revision, Clinical Modification codes. We defined multimorbidity as the presence of conditions in all clusters. Models restricted to HIV-infected veterans were adjusted for CD4 cell count and viral load. Comorbidity was common (prevalence, 60%–63%), and prevalence varied by HIV status. Differences remained when the veterans were stratified by age. In multivariable analyses, older HIV-infected veterans were more likely to have substance use disorder and multimorbidity. Renal, vascular, and pulmonary diseases were associated with CD4 cell count <200 cells/mm3; hypertension was associated with CD4 cell count >200 cells/mm3. Comorbidity is the rule, and multimorbidity is common among veterans with HIV infection. Patterns of comorbidity differ substantially by HIV status, age, and HIV severity. Primary care guidelines require adaptation for persons with HIV infection.
doi:10.1086/523577
PMCID: PMC3687553  PMID: 18190322
10.  HIV Status, Burden of Comorbid Disease, and Biomarkers of Inflammation, Altered Coagulation, and Monocyte Activation 
We investigated the association between human immunodeficiency virus (HIV) and prevalence of elevated biomarkers of inflammation, altered coagulation, and monocyte activation in a cohort of HIV-infected and uninfected veterans who had a comparable burden of comorbid conditions.
Background. Biomarkers of inflammation, altered coagulation, and monocyte activation are associated with mortality and cardiovascular disease (CVD) in the general population and among human immunodeficiency virus (HIV)–infected people. We compared biomarkers for inflammation, altered coagulation, and monocyte activation between HIV-infected and uninfected people in the Veterans Aging Cohort Study (VACS).
Methods. Biomarkers of inflammation (interleukin-6 [IL-6]), altered coagulation (d-dimer), and monocyte activation (soluble CD14 [sCD14]) were measured in blood samples from 1525 HIV-infected and 843 uninfected VACS participants. Logistic regression was used to determine the association between HIV infection and prevalence of elevated (>75th percentile) biomarkers, adjusting for confounding comorbidities.
Results. HIV-infected veterans had less prevalent CVD, hypertension, diabetes, obesity, hazardous drinking, and renal disease, but more dyslipidemia, hepatitis C, and current smoking than uninfected veterans. Compared to uninfected veterans, HIV-infected veterans with HIV-1 RNA ≥500 copies/mL or CD4 count <200 cells/µL had a significantly higher prevalence of elevated IL-6 (odds ratio [OR], 1.54; 95% confidence interval [CI],1.14–2.09; OR, 2.25; 95% CI, 1.60–3.16, respectively) and d-dimer (OR, 1.97; 95% CI, 1.44–2.71, OR, 1.68; 95% CI, 1.22–2.32, respectively) after adjusting for comorbidities. HIV-infected veterans with a CD4 cell count <200 cells/µL had significantly higher prevalence of elevated sCD14 compared to uninfected veterans (OR, 2.60; 95% CI, 1.64–4.14). These associations still persisted after restricting the analysis to veterans without known confounding comorbid conditions.
Conclusions. These data suggest that ongoing HIV replication and immune depletion significantly contribute to increased prevalence of elevated biomarkers of inflammation, altered coagulation, and monocyte activation. This contribution is independent of and in addition to the substantial contribution from comorbid conditions.
doi:10.1093/cid/cis406
PMCID: PMC3493182  PMID: 22534147
11.  HIV Infection and the Risk of Acute Myocardial Infarction 
JAMA internal medicine  2013;173(8):614-622.
Importance
Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.
Objective
To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.
Design and Setting
Participants in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003, through December 31, 2009.
Participants
After eliminating those with baseline cardiovascular disease, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C infection, body mass index, renal disease, anemia, substance use, CD4 cell count, HIV-1 RNA, antiretroviral therapy, and incidence of AMI.
Main Outcome Measure
Acute myocardial infarction.
Results
We analyzed data on 82 459 participants. During a median follow-up of 5.9 years, there were 871 AMI events. Across 3 decades of age, the mean (95% CI) AMI events per 1000 person-years was consistently and significantly higher for HIV-positive compared with uninfected veterans: for those aged 40 to 49 years, 2.0 (1.6-2.4) vs 1.5 (1.3-1.7); for those aged 50 to 59 years, 3.9 (3.3-4.5) vs 2.2 (1.9-2.5); and for those aged 60 to 69 years, 5.0 (3.8-6.7) vs 3.3 (2.6-4.2) (P < .05 for all). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of incident AMI compared with uninfected veterans (hazard ratio, 1.48; 95% CI, 1.27-1.72). An excess risk remained among those achieving an HIV-1 RNA level less than 500 copies/mL compared with uninfected veterans in time-updated analyses (hazard ratio, 1.39; 95% CI, 1.17-1.66).
Conclusions and Relevance
Infection with HIV is associated with a 50% increased risk of AMI beyond that explained by recognized risk factors.
doi:10.1001/jamainternmed.2013.3728
PMCID: PMC4766798  PMID: 23459863
12.  Risk of Heart Failure With Human Immunodeficiency Virus in the Absence of Prior Diagnosis of Coronary Heart Disease 
Archives of internal medicine  2011;171(8):737-743.
Background
Whether human immunodeficiency virus (HIV) infection is a risk factor for heart failure (HF) is not clear. The presence of coronary heart disease and alcohol consumption in this population may confound this association.
Methods
To determine whether HIV infection is a risk factor for incident HF, we conducted a population-based, retrospective cohort study of HIV-infected and HIV-uninfected veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) and the 1999 Large Health Study of Veteran Enrollees (LHS) from January 1, 2000, to July 31, 2007.
Results
There were 8486 participants (28.2% HIV-infected) enrolled in the VACS-VC who also participated in the 1999 LHS. During the median 7.3 years of follow-up, 286 incident HF events occurred. Age- and race/ethnicity–adjusted HF rates among HIV-infected and HIV-uninfected veterans were 7.12 (95% confidence interval [CI],6.90-7.34) and 4.82 (95% CI, 4.72-4.91) per 1000 person-years, respectively. Compared with HIV-uninfected veterans, those who were HIV infected had an increased risk ofHF (adjusted hazard ratio [HR], 1.81; 95% CI, 1.39-2.36). This association persisted among veterans who did not have a coronary heart disease event or a diagnosis related to alcohol abuse or dependence before the incident HF event (adjusted HR, 1.96; 95% CI, 1.29-2.98). Compared with HIV-uninfected veterans, those who were HIV infected with a baseline Human immunodeficiency virus 1 (HIV-1) RNA level of 500 or more copies/mL had a higher risk of HF (adjusted HR, 2.28; 95% CI, 1.57-3.32), while those with baseline and a recent HIV-1 RNA level less than 500 copies/mL did not (adjusted HR, 1.10; 95% CI, 0.64-1.89; P< .001 for comparison between high and low HIV-1 RNA groups).
Conclusions
Our data suggest that HIV infection is a risk factor for HF. Ongoing viral replication is associated with a higher risk of developing HF.
doi:10.1001/archinternmed.2011.151
PMCID: PMC3687533  PMID: 21518940
13.  Use of lipid lowering agents in rheumatoid arthritis: a population based cohort study 
The Journal of rheumatology  2013;40(7):1082-1088.
Objective
Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality. Lipid-lowering therapy is reportedly underused in patients with RA. However, longitudinal cohort studies comparing the use of lipid-lowering medications in patients with RA vs the general population are lacking.
Methods
Cardiovascular risk factors, lipid measures and use of lipid-lowering agents were assessed in a population-based inception cohort of patients with RA and a cohort of non-RA subjects followed from 1/1/1988 to 12/31/2008. The National Cholesterol Education Program (NCEP) adult treatment panel III (ATP III) guidelines were assessed at the time of each lipid measure throughout follow-up. Time from meeting guidelines to initiation of lipid-lowering agents was assessed using Kaplan-Meier methods.
Results
The study population included 412 RA and 438 non-RA patients with ≥1 lipid measure during follow-up and no prior use of lipid lowering agents. Rates of lipid testing were lower among patients with RA compared to non-RA subjects. Among patients who met NCEP ATP III criteria for lipid-lowering therapy (n=106 RA and n=120 non-RA), only 27% of RA and 26% of non-RA subjects initiated lipid-lowering agents within 2 years of meeting guidelines for initiation.
Conclusions
There was substantial undertreatment in both the RA and non-RA cohorts who met NCEP ATP III criteria for initiation of lipid-lowering agents. Patients with RA did not have as frequent lipid testing as individuals in the general population.
doi:10.3899/jrheum.121302
PMCID: PMC3891914  PMID: 23637326
rheumatoid arthritis; lipids; lipid lowering therapy
14.  HIV Infection and Risk for Incident Pulmonary Diseases in the Combination Antiretroviral Therapy Era 
Rationale: In aging HIV-infected populations comorbid diseases are important determinants of morbidity and mortality. Pulmonary diseases have not been systematically assessed in the combination antiretroviral therapy (ART) era.
Objectives: To determine the incidence of pulmonary diseases in HIV-infected persons compared with HIV-uninfected persons.
Methods: We analyzed data from the Veterans Aging Cohort Study Virtual Cohort, consisting of 33,420 HIV-infected veterans and 66,840 age, sex, race and ethnicity, and site-matched HIV-uninfected veterans. Using Poisson regression, incidence rates and adjusted incidence rate ratios were calculated to determine the association of HIV with pulmonary disease. The Virtual Cohort was merged with the 1999 Veterans Large Health Survey to adjust for self-reported smoking in a nested sample (14%).
Measurements and Main Results: Incident chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and pulmonary fibrosis, as well as pulmonary infections, were significantly more likely among HIV-infected patients compared with uninfected patients in adjusted analyses, although rates of asthma did not differ by HIV status. Bacterial pneumonia and chronic obstructive pulmonary disease were the two most common incident pulmonary diseases, whereas opportunistic pneumonias were less common. Absolute rates of most pulmonary diseases increased with age, although the relative differences between those with and without HIV infection were greatest in younger persons. Chronic obstructive pulmonary disease and asthma, as well as pulmonary infections, were less likely in those with lower HIV RNA levels and use of ART at baseline.
Conclusions: Pulmonary diseases among HIV-infected patients receiving care within the Veterans Affairs Healthcare System in the combination ART era reflect a substantial burden of non–AIDS-defining and chronic conditions, many of which are associated with aging.
doi:10.1164/rccm.201006-0836OC
PMCID: PMC3266024  PMID: 20851926
HIV; respiratory tract diseases; lung diseases, obstructive; pneumonia; pneumonia, bacterial
15.  Prevalence of metabolic syndrome among HIV-infected patients in Ghana: A cross-sectional study 
Background:
Prevalence of metabolic syndrome (MetS) in HIV-infected patients is very limited in the Ghanaian setting and may vary across the globe by the different study populations and criteria used.
Aim:
We investigated the prevalence of MetS among HIV-infected patients receiving highly active antiretroviral therapy (HAART) at the St. Dominic Hospital, Akwatia, Ghana.
Patients and Methods:
This cross-sectional study recruited 433 HIV-infected patients (294 on HAART and 139 HAART-naïve) from the period of February 2013 to December 2013. Information on the demographic, clinical, anthropometric characteristics were obtained and lipid profile for each patient was assessed. MetS was assessed based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), World Health Organization (WHO) and International Diabetes Federation (IDF) criteria.
Results:
The prevalence of MetS was 24.5% according to WHO criteria, 48.3% by NCEP-ATP III criteria, and 42.3% by IDF criteria. In general, participants on HAART were significantly associated with higher prevalence of MetS compared to those without HAART (P < 0.05) irrespective of the criteria used. Prevalence of clustering components of MetS was significantly higher among those on HAART when risk scores of 2 and above were used compared with those not on HAART (P < 0.05).
Conclusion:
HAART recipient developed MetS as indicated by dyslipidemia, high blood pressure, and abnormal body fat. It is incumbent on health giver to incorporate MetS assessment as a part of treatment and management plan in patients receiving HAART.
doi:10.4103/0300-1652.182082
PMCID: PMC4872497  PMID: 27226681
Highly active antiretroviral therapy; HIV patient; metabolic syndrome; prevalence
16.  The 12th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” and the 12th National Infectious Diseases Conference 
Niculae, Cristian-Mihail | Manea, Eliza | Jipa, Raluca | Merisor, Simona | Moroti, Ruxandra | Benea, Serban | Hristea, Adriana | Neguț, Alina Cristina | Săndulescu, Oana | Streinu-Cercel, Anca | Mărculescu, Dana | Andrei, Magdalena Lorena | Ilie, Veronica | Popa, Marcela | Bleotu, Coralia | Chifiriuc, Carmen | Popa, Mircea Ioan | Streinu-Cercel, Adrian | Orfanu, Alina | Popescu, Cristina | Leuștean, Anca | Catană, Remulus | Negru, Anca | Badea, Alexandra | Orfanu, Radu | Tilișcan, Cătălin | Aramă, Victoria | Aramă, Ştefan Sorin | Vișan, Constanța-Angelica | Drăgănescu, Anca-Cristina | Bilașco, Anuța | Kouris, Camelia | Merișescu, Mădălina | Vasile, Magdalena | Slavu, Diana-Maria | Vintilă, Sabina | Osman, Endis | Oprea, Alina | Sandu, Sabina | Luminos, Monica | Orfanu, Alina | Aramă, Victoria | Aramă, Ştefan Sorin | Leuştean, Anca | Catană, Remulus | Negru, Anca | Popescu, Gabriel Adrian | Popescu, Cristina | Stanculete, Ramona Georgiana | Enoiu, Ana Vaduva | Marinescu, Adelina Raluca | Lazureanu, Voichita | Marinescu, Adelina-Raluca | Crișan, Alexandru | Lăzureanu, Voichița | Musta, Virgil | Nicolescu, Narcisa | Laza, Ruxandra | Negru, Anca-Ruxandra | Munteanu, Daniela-Ioana | Mihăilescu, Raluca | Catană, Remulus | Dorobăț, Olga | Rafila, Alexandru | Căpraru, Emilia | Niculescu, Marius | Marinescu, Rodica | Lupescu, Olivera | Predescu, Vlad | Streinu-Cercel, Adrian | Aramă, Victoria | Tălăpan, Daniela | Popescu, Ramona Ștefania | Bradu, Luminița | Florea, Dragoș | Streinu-Cercel, Adrian | Leca, Daniela Anicuta | Bunea, Elena | Teodor, Andra | Miftode, Egidia | Merișescu, Mădălina | Jugulete, Gheorghiță | Streinu-Cercel, Adrian | Florea, Dragoș | Luminos, Monica | Popescu, Ramona Ștefania | Dobrotă, Anamaria | Ilie, Adina | Preoțescu, Liliana Lucia | Hristea, Adriana | Jipa, Raluca | Irimescu, Nicoleta | Panait, Irina | Manea, Eliza | Merisor, Simona | Niculae, Cristian | Tălăpan, Daniela | Gavriliu, Liana Cătălina | Benea, Otilia Elisabeta | Benea, Șerban | Rafila, Alexandru | Dorobăț, Olga | Popoiu, Mona | Dragonu, Livia | Cupşa, Augustin | Diaconescu, Iulian | Niculescu, Irina | Giubelan, Lucian | Dumitrescu, Florentina | Stoian, Andreea Cristina | Guţă, Camelia | Puiu, Simona | Irina, Bunescu | Vallée, Marilyse | Huletsky, Ann | Boudreau, Dominique K. | Bérubé, Ève | Giroux, Richard | Longtin, Jean | Longtin, Yves | Bergeron, Michel G. | Roșculeț, Cleo Nicoleta | Toma, Dalila-Ana | Ciuca, Catrinel | Tălăpan, Daniela | Apostolescu, Cătălin | Rogoz, Andrei | Stangaciu, Andrei | Mitescu, Viorica | Vladoiu, Tudor | Iovănescu, Doina | Oana, Michaela | Costin, Simona | Neguț, Alina Cristina | Săndulescu, Oana | Streinu-Cercel, Anca | Moțoi, Maria Magdalena | Popa, Mircea Ioan | Streinu-Cercel, Adrian | Tălăpan, Daniela | Dorobăț, Olga Mihaela | Popoiu, Mona | Mihai, Alexandru | Iovănescu, Doina | Roşculeț, Cleo | Apostolescu, Cătălin | Popescu, Gabriel-Adrian | Abagiu, Adrian | Moroti-Constantinescu, Ruxandra | Hristea, Adriana | Aramă, Victoria | Benea, Otilia | Simoiu, Mădălina | Bacruban, Rodica | Streinu-Cercel, Adrian | Rafila, Alexandru | Dorobăț, Olga Mihaela | Tălăpan, Daniela | Mihai, Alexandru | Bădicuț, Ioana | Popoiu, Mona | Borcan, Alina | Rafila, Alexandru | Popescu, Gabriel Adrian | Hurmuzache, Mihnea | Enache, Georgiana | Ciocan, Alexandra | Bararu, Mircea | Popazu, Madalina | Iovănescu, Doina Viorica | Roșculeț, Cleo Nicoleta | Rogoz, Andrei | Apostolescu, Cătălin Gabriel | Mitescu, Viorica | Vladoiu, Tudor | Toma, Dalila | Ciuca, Catrinel | Iliescu, Laura | Minzala, Georgiana | Toma, Letitia | Baciu, Mihaela | Tanase, Alina | Orban, Carmen | Pantea, Victor | Placinta, Gheorghe | Cebotarescu, Valentin | Cojuhari, Lilia | Jimbei, Paulina | Popescu, Cristina | Leuștean, Anca | Dragomirescu, Cristina | Orfanu, Alina | Murariu, Cristina | Stratan, Laurențiu | Badea, Alexandra | Tilișcan, Cătălin | Munteanu, Daniela | Năstase, Raluca | Molagic, Violeta | Rădulescu, Mihaela | Catană, Remulus | Aramă, Victoria | Popescu, Cristina | Stratan, Laurențiu | Catană, Remulus | Leuștean, Anca | Dragomirescu, Cristina | Badea, Alexandra | Murariu, Cristina | Năstase, Raluca | Molagic, Violeta | Munteanu, Daniela | Tilișcan, Cătălin | Rădulescu, Mihaela | Orfanu, Alina | Diaconu, Ioan | Negru, Anca | Bodosca, Iulia | Niță, Violeta | Aramă, Victoria | Leuștean, Anca | Aramă, Victoria | Orfanu, Alina | Catană, Remulus | Stratan, Laurențiu | Dragomirescu, Cristina | Murariu, Cristina | Badea, Alexandra | Tilișcan, Cătălin | Munteanu, Daniela | Molagic, Violeta | Năstase, Raluca | Rădulescu, Mihaela | Popescu, Cristina | Popescu, Cristina | Dragomirescu, Cristina | Leuștean, Anca | Murariu, Cristina | Stratan, Laurențiu | Badea, Alexandra | Catană, Remulus | Orfanu, Alina | Năstase, Raluca Mihaela | Molagic, Violeta | Munteanu, Daniela | Tilișcan, Cătălin | Aramă, Victoria | Aramă, Victoria | Catană, Remulus | Dragomirescu, Cristina | Murariu, Cristina | Leuștean, Anca | Stratan, Laurențiu | Badea, Alexandra | Orfanu, Alina | Negru, Anca | Năstase, Raluca | Molagic, Violeta | Munteanu, Daniela | Tilișcan, Cătălin | Rădulescu, Mihaela | Diaconu, Ioan | Niță, Violeta | Bodoșca, Iulia | Popescu, Cristina | Popescu, Cristina | Badea, Alexandra | Leuștean, Anca | Orfanu, Alina | Negru, Anca | Stratan, Laurențiu | Dragomirescu, Cristina | Catană, Remulus | Murariu, Cristina | Molagic, Violeta | Năstase, Raluca | Tilișcan, Cătălin | Munteanu, Daniela | Rădulescu, Mihaela | Diaconu, Ioan | Niță, Violeta | Bodoșca, Iulia | Aramă, Victoria | Popescu, Cristina | Orfanu, Alina | Leuștean, Anca | Badea, Alexandra | Stratan, Laurențiu | Catană, Remulus | Tilișcan, Cătălin | Aramă, Victoria | Popescu, Cristina | Murariu, Cristina | Dragomirescu, Cristina | Leuștean, Anca | Stratan, Laurențiu | Orfanu, Alina | Badea, Alexandra | Catană, Remulus | Negru, Anca | Tilișcan, Cătălin | Munteanu, Daniela | Rădulescu, Mihaela | Molagic, Violeta | Năstase, Raluca Mihaela | Diaconu, Ioan Alexandru | Bodoșca, Iulia | Niță, Violeta | Aramă, Victoria | Erturk, Yagmur | Săndulescu, Oana | Neguț, Alina Cristina | Șchiopu, Claudiu Mihai | Streinu-Cercel, Adrian | Streinu-Cercel, Anca | Molagic, Violeta | Tilișcan, Cătălin | Popescu, Cristina | Mihăilescu, Raluca | Munteanu, Daniela | Năstase, Raluca | Negru, Anca | Tenita, Angelica | Aramă, Victoria | Aramă, Ștefan Sorin | Iacob, Simona Alexandra | Iacob, Diana Gabriela | Luminos, Monica | Streinu-Cercel, Anca | Săndulescu, Oana | Predescu, Mioara | Mărdărescu, Alexandra | Tilișcan, Cătălin | Săndulescu, Mihai | Șchiopu, Claudiu Mihai | Streinu-Cercel, Adrian | Roșculeț, Cleo Nicoleta | Ciuca, Catrinel Olimpia | Toma, Dalila Ana | Apostolescu, Cătălin Gabriel | Rogoz, Andrei | Mitu, Cristina Elena | Stangaciu, Andrei | Mitescu, Viorica Daniela | Vladoiu, Tudor Gheorghe | Iovănescu, Doina Viorica | Săndulescu, Oana | Streinu-Cercel, Anca | Stoica, Monica Andreea | Preoțescu, Liliana Lucia | Manolache, Daniela | Ceapraga, Gabriela Jana | Moțoi, Maria Magdalena | Bradu, Luminița | Ilie, Adina | Mircea, Gabriela | Durbală, Ionel | Streinu-Cercel, Adrian | Russu, Irina | Holban, Tiberiu | Pantilimonov, Tatiana | Chiriacov, Galina | Macvovei, Arcadie | Scorohodico, Elena | Dmitriev, Oleg | Costache, Diana Alexandra | Benea, Anca | Manea, Eliza | Niculae, Cristian | Jipa, Raluca | Hristea, Adriana | Benea, Elisabeta | Moroti, Ruxandra | Benea, Șerban | Mitran, Mihai | Georgescu, Carmen | Mitran, Loredana | Vladareanu, Simona | Magirescu, Andreea Ioana | Andreev, Viorica | Nicolau, Cristina | Largu, Alexandra | Dorobat, Carmen | Manciuc, Carmen | Andreev, Viorica | Magirescu, Andreea Ioana | Isac, Ina | Nicolau, Cristina | Largu, Alexandra | Dorobat, Carmen | Manciuc, Carmen | Șerban, Iulia Gabriela | Resul, Ghiulendan | Marcaș, Consuela | Marincu, Iosif | Poptelecan, Patricia | Trincă, Bogdan | Mitrescu, Sorina | Tudor, Anca | Vlad, Daliborca | Tirnea, Livius | Baydaroglu, Nurcan | Neguț, Alina Cristina | Săndulescu, Oana | Manolache, Daniela | Ceapraga, Gabriela | Stoica, Monica Andreea | Streinu-Cercel, Anca | Streinu-Cercel, Adrian | Manciuc, Carmen | Pagute, Mariana | Nicolau, Cristina | Dorobăț, Carmen | Largu, Alexandra | Diaconu, Ioan-Alexandru | Stratan, Laurențiu | Ion, Daniela | Nichita, Luciana | Popescu, Cristina | Năstase, Raluca | Munteanu, Daniela | Molagic, Violeta | Tilișcan, Cătălin | Rădulescu, Mihaela | Diaconu, Alexandra | Negru, Anca | Orfanu, Alina | Dragomirescu, Cristina | Catană, Remulus | Leuștean, Anca | Duport-Dodot, Irina | Murariu, Cristina | Bodoșca, Iulia | Niță, Violeta | Badea, Alexandra | Aramă, Victoria | Mărdărescu, Mariana | Petre, Cristina | Iancu, Marieta | Ungurianu, Rodica | Cibea, Alina | Drăghicenoiu, Ruxandra | Tudor, Ana Maria | Vlad, Delia | Petrea, Sorin | Matei, Carina | Oțelea, Dan | Crăciun, Carmen | Anghelina, Cristian | Mărdărescu, Alexandra | Dumea, Elena | Streinu-Cercel, Adrian | Rugină, Sorin | Petcu, Lucian Cristian | Halichidis, Stela | Cambrea, Simona Claudia | Chiriac, Carmen | Bodnar, Nina-Ioana | Zaharia-Kezdi, Iringo-Erzsebet | Gîrbovan, Cristina | Incze, Andrea | Georgescu, Anca Meda | Iacob, Simona Alexandra | Iacob, Diana Gabriela | Panaitescu, Eugenia | Luminos, Monica | Cojocaru, Manole | Iacob, Simona Alexandra | Iacob, Diana Gabriela | Luminos, Monica | Laurențiu, Vochita | Andreia, Vochita | Radu, Opreanu | Bogdan, Trinca | Ovidiu, Rosca | Iosif, Marincu | Zamfir, Ramona | Angelescu, Alina | Popa, Alena Andreea | Jipa, Raluca | Moroti, Ruxandra | Hristea, Adriana | Gavriliu, Liana | Benea, Șerban | Benea, Elisabeta | Popa, Alena-Andreea | Ducu, Georgeta | Camburu, Daniela | Cozma, Alina | Podani, Manuela | Dumitriu, Roxana | Gavriliu, Liana | Benea, Șerban | Benea, Elisabeta | Stoian, Andreea Cristina | Dumitrescu, Florentina | Cupșa, Augustin | Giubelan, Lucian | Niculescu, Irina | Ionescu, Loredana | Dragonu, Livia | Abagiu, Adrian Octavian | Stoica, Loredana Nicoleta | Blaga, Catrinel | Koulosousas, Archontis | Ștefănescu, Roxana | Atomoaie, Alice | Paraschiv, Florentina | Duna, Florin Matache | Olteanu, Rodica | Ion, Roxana | Zota, Alexandra | Jaballah, Isra Ennour | Mahfoud, Lara | Preda, Georgeta | Constantin, Magda | Nicolae, Ilinca | Ene, Corina Daniela | Mitran, Mădălina Irina | Benea, Vasile | Tampa, Mircea | Georgescu, Simona Roxana | Bodoșca, Iulia Cristina | Murariu, Cristina | Tilișcan, Cătălin | Aramă, Victoria | Popescu, Cristina | Munteanu, Daniela | Rădulescu, Mihaela | Molagic, Violeta | Năstase, Raluca | Orfanu, Alina | Leuștean, Anca | Catană, Remulus | Negru, Anca | Streinu-Cercel, Adrian | Aramă, Sorin | Caramăngiu, Iuliana | Rosca, Ovidiu | Cialma, Monica | Opreanu, Radu | Vochita, Laurențiu | Marincu, Iosif | Murărescu, Vlad | Palaghiță, Marilena | Neguț, Alina Cristina | Camburu, Cornel | Streinu-Cercel, Adrian | Duşan, Irina | Poptelecan, Patricia | Trincă, Bogdan | Mitrescu, Sorina | Tirnea, Livius | Marincu, Iosif | Nicolescu, Narcisa | Crișan, Alexandru | Lăzureanu, Voichița | Laza, Ruxandra | Musta, Virgil | Marinescu, Adelina-Raluca | Bîrlad, Andreea | Miron, Victor Daniel | Drăgănescu, Anca Cristina | Vișan, Constanța-Angelica | Bilașco, Anuța | Pițigoi, Daniela | Săndulescu, Oana | Luminos, Monica Luminița | Luminos, Monica | Osman, Endis | Vasile, Magdalena | Drăgănescu, Anca Cristina | Vișan, Constanța-Angelica | Bilașco, Anuța | Kouris, Camelia | Șchiopu, Sabina | Merișescu, Mădălina | Luminos, Monica | Drăgănescu, Anca Cristina | Vișan, Constanța-Angelica | Bilașco, Anuța | Kouris, Camelia | Osman, Endis | Vintilă, Sabina | Vasile, Magda | Merișescu, Mădălina | Gavriliu, Liana Cătălina | Benea, Otilia Elisabeta | Angelescu, Alina | Zamfir, Ramona | Camburu, Daniela | Ducu, Georgeta | Cozma, Alina | Dumitriu, Roxana | Podani, Manuela | Benea, Șerban | Ionică, Mihaela | Jugulete, Gheorghiță | Stăncescu, Adina | Popescu, Cristina Elena | Marin, Luminița | Zaharia, Diana | Dumitrescu, Cristina | Tudor, Lucia | Vintilă, Sabina | Vișan, Constanța-Angelica | Drăgănescu, Anca Cristina | Bilașco, Anuța | Vasile, Magda | Merișescu, Mădălina | Kouris, Camelia | Negulescu, Cristina | Osman, Endis | Slavu, Diana-Maria | Vintilă, Sabina | Pițigoi, Daniela | Luminos, Monica | Caliman-Sturdza, Olga Adriana | Roșculeț, Cleo | Ciuca, Catrinel Olimpia | Toma, Dalila | Apostolescu, Cătălin | Rogoz, Andrei | Stangaciu, Andrei | Mitescu, Viorica | Iovănescu, Doina | Camburu, Cornel | Manu, Bogdana | Vaduva-Enoiu, Ana | Stanculete, Ramona Georgiana | Marinescu, Adelina Raluca | Lazureanu, Voichita Elena | Niță, Elena-Violeta | Dumitru, Sînziana | Munteanu, Daniela-Ioana | Negru, Anca Ruxandra | Catană, Remulus | Diaconu, Ioan | Manu, Bogdana | Ionescu, Ligia | Ion, Liliana | Tilișcan, Cătălin | Aramă, Victoria | Iovănescu, Doina Viorica | Roșculeț, Cleo Nicoleta | Rogoz, Andrei | Apostolescu, Cătălin | Mitescu, Viorica | Vladoiu, Tudor | Toma, Dalila | Ciuca, Catrinel | Șerban, Iulia Gabriela | Neacșu, Marioara | Georgescu, Simona Roxana | Benea, Vasile | Ene, Corina Daniela | Tampa, Mircea | Mitran, Cristina Iulia | Nicolae, Ilinca | Pribac, George Ciprian | Prisca, Mirandolina | Ursoiu, Fulvia | Neamtu, Carmen | Totolici, Bogdan | Cotoraci, Coralia | Ardelean, Aurel | Albu, Simona Elena | Carsote, Mara | Miclăuș, Beatrice | Mihai, Diana | Săndulescu, Oana | Vasiliu, Cristina | Vasiliu, Cristina | Carsote, Mara | Gorgoi, Corina | Miclăuș, Beatrice | Mihai, Diana | Săndulescu, Oana | Albu, Simona Elena | Blescun, Amelia | Breaza, Gelu | Vintila, Sabina | Mihai, Felicia | Omer, Meilin | Dragan, Cornel | Pitigoi, Daniela | Ciucu, Mirela | Ionescu, Marius-Dan | Roskanovic, Cristina | Barbu, Valentina | Diaconescu, Iulian | Dumitrescu, Florentina | Niculescu, Irina | Ionică, Mihaela | Zamfir, Ramona-Alexandra | Cozma, Alina | Benea, Otilia Elisabeta | Dumitru, Alexandra-Sînziana | Munteanu, Daniela-Ioana | Niță, Violeta | Popescu, Cristina | Bodosca, Iulia | Tenita, Angelica | Ispas, Viorica | Aramă, Victoria | Benea, Vasile | Georgescu, Simona Roxana | Tampa, Mircea | Leahu, Diana Oana | Safta, Cristina Maria | Benea, Mihaela Anca | Săndulescu, Oana | Munteanu, Octavian | Bohâlțea, Roxana | Trașcă, Livia | Cîrstoiu, Monica | Iovănescu, Doina Viorica | Roșculeț, Cleo Nicoleta | Rogoz, Andrei | Apostolescu, Cătălin Gabriel | Mitescu, Viorica Daniela | Vladoiu, Tudor Gheorghe | Toma, Dalila | Ciuca, Catrinel | Georgescu, Mădălina | Pițigoi, Daniela | Ivanciuc, Alina Elena | Lazar, Mihaela | Ionescu, Teodora | Cherciu, Carmen Maria | Țecu, Cristina | Mihai, Maria Elena | Nițescu, Maria | Bacruban, Rodica | Azamfire, Delia | Dumitrescu, Aura | Ianosik, Elena | Leca, Daniela | Duca, Elena | Teodor, Andra | Bejan, Codrina | Ceaușu, Emanoil | Florescu, Simin-Aysel | Popescu, Corneliu | Târdei, Grațiela | Juganariu, Codrina | Lupulescu, Emilia | Rodina, Ligia | Cocuz, Maria Elena | Jugulete, Gheorghiță | Stăncescu, Adina | Popescu, Cristina Elena | Marin, Luminița | Zaharia, Diana | Dumitrescu, Cristina | Osman, Endis | Niculescu, Irina | Cupșa, Augustin | Diaconescu, Iulian | Dumitrescu, Florentina | Dragonu, Livia | Stoian, Andreea | Giubelan, Lucian | Roskanovic, Cristina | Zamfir, Ramona-Alexandra | Ionica, Mihaela | Benea, Otilia-Elisabeta | Sîrbu, Maria-Cristina | Dobrotă, AnaMaria | Neguț, Alina Cristina | Duda, Roxana | Bacruban, Rodica | Pițigoi, Daniela | Dragomirescu, Cristiana Cerasella | Tălăpan, Daniela | Dorobăț, Olga | Streinu-Cercel, Adrian | Streinu-Cercel, Anca | Ionica, Mihaela | Zamfir, Ramona-Alexandra | Cozma, Alina | Benea, Otilia Elisabeta | Fendrihan, Sergiu | Scortan, Ecaterina | Popa, Mircea Ioan | Popescu, Corneliu P. | Benea, Șerban N. | Petcu, Andra E. | Hristea, Adriana | Abagiu, Adrian | Podea, Iuliana A. | Jipa, Raluca E. | Ducu, Georgeta | Hrișcă, Raluca M. | Florea, Dragoș | Nica, Manuela | Manea, Eliza | Merișor, Simona | Nicolae, Cristian M. | Florescu, Simin A. | Dumitru, Irina M. | Ceaușu, Emanoil | Rugină, Sorin | Moroti, Ruxandra V. | Pițigoi, Daniela | Ionescu, Teodora | Săndulescu, Oana | Nițescu, Maria | Nițescu, Bogdan | Mustaţă, Iulia Monica | Boldeanu, Sorina Claudia | Furtunescu, Florentina | Streinu-Cercel, Adrian | Iacob, Diana Gabriela | Iacob, Simona Alexandra | Gheorghe, Mihaela | Slavcovici, Adriana | Tripon, Raluca | Iubu, Roxana | Marcu, Cristian | Sabou, Mihaela | Muntean, Monica | Chiriac, Ion | Holban, Tiberiu | Tazlavanu, Liviu | Jipa, Raluca | Manea, Eliza | Cernat, Roxana | Iringo, Kezdi | Vâță, Andrei | Arbune, Manuela | Moisil, Teodora | Hristea, Adriana | Ene, Corina-Daniela | Nicolae, Ilinca | Georgescu, Roxana Simona | Ene, Corina-Daniela | Ene, Cosmin-Victor | Georgescu, Roxana Simona | Ciortea, Marilena | Dulgheru, Lucreția | Nicolae, Ilinca | Luca, Mihaela Cătălina | Harja-Alexa, Ioana-Alina | Nemescu, Roxana | Popazu, Mădălina | Luca, Andrei Ștefan | Bancescu, Gabriela | Dabu, Bogdan | Bancescu, Adrian | Manea, Eliza | Jipa, Raluca | Hristea, Adriana | Ilie, Adina Elena | Pohrib, Săftica-Mariana | Neguț, Alina Cristina | Tache, Maria-Sabina | Moțoi, Maria Magdalena | Săndulescu, Oana | Iliescu, Ion Aurel | Streinu-Cercel, Adrian | Tecu, Cristina | Mihai, Maria-Elena | Lazăr, Mihaela | Cherciu, Carmen | Ivanciuc, Alina | Pițigoi, Daniela | Lupulescu, Emilia | Paliu, Mirela | Curescu, Manuela | Cerbu, Bianca | Marincu, Iosif | Mihai, Maria Elena | Cherciu, Carmen Maria | Ivanciuc, Alina Elena | Tecu, Cristina | Lupulescu, Emilia | Bunescu, Irina | Holban, Tiberiu | Pasnin, Ana | Semeniuc, Stela | Popovici, Raisa | Chiriacov, Galina
BMC Infectious Diseases  2016;16(Suppl 4):31-76.
Table of contents
A1 The outcome of patients with recurrent versus non-recurrent pneumococcal meningitis in a tertiary health-care hospital in Bucharest
Cristian-Mihail Niculae, Eliza Manea, Raluca Jipa, Simona Merisor, Ruxandra Moroti, Serban Benea, Adriana Hristea
A2 Influence of bacteriophages on sessile Gram-positive and Gram-negative bacteria
Alina Cristina Neguț, Oana Săndulescu, Anca Streinu-Cercel, Dana Mărculescu, Magdalena Lorena Andrei, Veronica Ilie, Marcela Popa, Coralia Bleotu, Carmen Chifiriuc, Mircea Ioan Popa, Adrian Streinu-Cercel
A3 The utility of inflammatory biomarkers in the prognostic evaluation of septic patients – past, present and future
Alina Orfanu, Cristina Popescu, Anca Leuștean, Remulus Catană, Anca Negru, Alexandra Badea, Radu Orfanu, Cătălin Tilișcan, Victoria Aramă, Ştefan Sorin Aramă
A4 Etiologic and clinical features of bacterial meningitis in infants
Constanța-Angelica Vișan, Anca-Cristina Drăgănescu, Anuța Bilașco, Camelia Kouris, Mădălina Merișescu, Magdalena Vasile, Diana-Maria Slavu, Sabina Vintilă, Endis Osman, Alina Oprea, Sabina Sandu, Monica Luminos
A5 The diagnostic and prognostic role of neutrophil to lymphocyte count ratio in sepsis
Alina Orfanu, Victoria Aramă, Ştefan Sorin Aramă, Anca Leuştean, Remulus Catană, Anca Negru, Gabriel Adrian Popescu, Cristina Popescu
A6 Whooping cough in a HIV positive patient
Ramona Georgiana Stanculete, Ana Vaduva Enoiu, Adelina Raluca Marinescu, Voichita Lazureanu
A7 Cronobacter sakazakii sepsis in varicella patient
Adelina-Raluca Marinescu, Alexandru Crișan, Voichița Lăzureanu, Virgil Musta, Narcisa Nicolescu, Ruxandra Laza
A8 Anaerobes an underdiagnosed cause of prosthesis joint infection
Anca-Ruxandra Negru, Daniela-Ioana Munteanu, Raluca Mihăilescu, Remulus Catană, Olga Dorobăț, Alexandru Rafila, Emilia Căpraru, Marius Niculescu, Rodica Marinescu, Olivera Lupescu, Vlad Predescu, Adrian Streinu-Cercel, Victoria Aramă, Daniela Tălăpan
A9 Streptococcus pneumoniae meningitis presenting with normal CSF – case presentation
Ramona Ștefania Popescu, Luminița Bradu, Dragoș Florea, Adrian Streinu-Cercel
A10 Extrapulmonary manifestations of infection with Mycoplasma pneumoniae – study on 24 cases
Daniela Anicuta Leca, Elena Bunea, Andra Teodor, Egidia Miftode
A11 The molecular diagnosis of severe bacterial sepsis in pediatric population
Mădălina Merișescu, Gheorghiță Jugulete, Adrian Streinu-Cercel, Dragoș Florea, Monica Luminos
A12 Acute Staphylococcus aureus endocarditis with multiple septic complications in a patient with diabetes mellitus – case presentation
Ramona Ștefania Popescu, Anamaria Dobrotă, Adina Ilie, Liliana Lucia Preoțescu
A13 Is Streptococcus suis meningitis an under-diagnosed zoonosis?
Adriana Hristea, Raluca Jipa, Nicoleta Irimescu, Irina Panait, Eliza Manea, Simona Merisor, Cristian Niculae, Daniela Tălăpan
A14 Klebsiella pneumoniae isolated from blood. Antimicrobial resistance – past and present
Liana Cătălina Gavriliu, Otilia Elisabeta Benea, Șerban Benea, Alexandru Rafila, Olga Dorobăț, Mona Popoiu
A15 Antibiotics resistance in Staphylococcus aureus isolated from blood cultures
Livia Dragonu, Augustin Cupşa, Iulian Diaconescu, Irina Niculescu, Lucian Giubelan, Florentina Dumitrescu, Andreea Cristina Stoian, Camelia Guţă, Simona Puiu
A16 Predominance of CTX-M enzymes in extended-spectrum β-lactamase-producing Enterobacteriaceae in two hospitals of Quebec City
Bunescu Irina, Marilyse Vallée, Ann Huletsky, Dominique K. Boudreau, Ève Bérubé, Richard Giroux, Jean Longtin, Yves Longtin, Michel G. Bergeron
A17 Postoperative meningoencephalitis with Acinetobacter baumannii XDR – a therapeutic challenge - Case report
Cleo Nicoleta Roșculeț, Dalila-Ana Toma, Catrinel Ciuca, Daniela Tălăpan, Cătălin Apostolescu, Andrei Rogoz, Andrei Stangaciu, Viorica Mitescu, Tudor Vladoiu, Doina Iovănescu
A18 Septic arthritis with Burkholderia cepacia
Michaela Oana, Simona Costin
A19 A novel approach for managing hard-to-treat infections
Alina Cristina Neguț, Oana Săndulescu, Anca Streinu-Cercel, Maria Magdalena Moțoi, Mircea Ioan Popa, Adrian Streinu-Cercel
A20 Nineteen months surveillance for multidrug resistant organisms (MDRO) by detecting asymptomatic colonization
Daniela Tălăpan, Olga Mihaela Dorobăț, Mona Popoiu, Alexandru Mihai, Doina Iovănescu, Cleo Roşculeț, Cătălin Apostolescu, Gabriel-Adrian Popescu, Adrian Abagiu, Ruxandra Moroti-Constantinescu, Adriana Hristea, Victoria Aramă, Otilia Benea, Mădălina Simoiu, Rodica Bacruban, Adrian Streinu-Cercel, Alexandru Rafila
A21 Antimicrobial resistance of Gram-positive cocci isolated from clinical specimens in the National Institute of Infectious Diseases “Prof Dr. Matei Balș” between 2009–2015
Olga Mihaela Dorobăț, Daniela Tălăpan, Alexandru Mihai, Ioana Bădicuț, Mona Popoiu, Alina Borcan, Alexandru Rafila
A22 The high percentage of carbapenem-resistant Gram-negative bacilli in Romania: an analysis and some proposals
Gabriel Adrian Popescu
A23 Etiological, clinical and therapeutic considerations on 78 cases of healthcare associated meningitis or ventriculitis admitted in the “Sf. Parascheva” infectious diseases clinical hospital, Iași, from 2011 to 2015
Mihnea Hurmuzache, Georgiana Enache, Alexandra Ciocan, Mircea Bararu, Madalina Popazu
A24 Nosocomial infection dynamics in an Intensive Care Department – an overview (epidemiological and clinical monitoring, advanced therapeutic intervention).
Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz Cătălin Gabriel Apostolescu, Viorica Mitescu, Tudor Vladoiu, Dalila Toma, Catrinel Ciuca
A25 Safety and efficacy of interferon free treatment in patients with HCV chronic hepatitis- experience of a single Internal Medicine center
Laura Iliescu, Georgiana Minzala, Letitia Toma, Mihaela Baciu, Alina Tanase, Carmen Orban
A26 Viusid in treatment of chronic viral hepatitis B and C
Victor Pantea, Gheorghe Placinta, Valentin Cebotarescu, Lilia Cojuhari, Paulina Jimbei
A27 The management of hyperbilirubinemia in HCV cirrhotic patients who underwent therapy with direct acting antivirals
Cristina Popescu, Anca Leuștean, Cristina Dragomirescu, Alina Orfanu, Cristina Murariu, Laurențiu Stratan, Alexandra Badea, Cătălin Tilișcan, Daniela Munteanu, Raluca Năstase, Violeta Molagic, Mihaela Rădulescu, Remulus Catana, Victoria Aramă
A28 The efficacy of ombitasvir-paritaprevir/ritonavir, dasabuvir and ribavirin in patients with genotype 1 HCV compensated cirrhosis
Cristina Popescu, Laurențiu Stratan, Remulus Catana, Anca Leuștean, Cristina Dragomirescu, Alexandra Badea, Cristina Murariu, Raluca Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Mihaela Rădulescu, Alina Orfanu, Ioan Diaconu, Anca Negru, Iulia Bodosca, Violeta Niță, Victoria Aramă
A29 The efficacy of direct acting antivirals regimen without ribavirin in HCV genotype 1b infected patients with compensated cirrhosis
Anca Leuștean, Victoria Aramă, Alina Orfanu, Remulus Catana, Laurențiu Stratan, Cristina Dragomirescu, Cristina Murariu, Alexandra Badea, Cătălin Tilișcan, Daniela Munteanu, Violeta Molagic, Raluca Năstase, Mihaela Rădulescu, Cristina Popescu
A30 Liver decompensation during ombitasvir-paritaprevir/ritonavir-dasabuvir and ribavirin regimen in HCV infected patients with Child-Pugh A cirrhosis
Cristina Popescu, Cristina Dragomirescu, Anca Leuștean, Cristina Murariu, Laurențiu Stratan, Alexandra Badea, Remulus Catană, Alina Orfanu, Raluca Mihaela Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Victoria Aramă
A31 The safety of direct acting antivirals in HCV compensated cirrhotic patients - an interim analysis
Victoria Aramă, Remulus Catană, Cristina Dragomirescu, Cristina Murariu, Anca Leuștean, Laurențiu Stratan, Alexandra Badea, Alina Orfanu, Anca Negru, Raluca Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Mihaela Rădulescu, Ioan Diaconu, Violeta Niță, Iulia Bodoșca, Cristina Popescu
A32 The access of patients with HCV compensated cirrhosis to the National Program of therapy with direct acting antivirals
Cristina Popescu, Alexandra Badea, Anca Leuștean, Alina Orfanu, Anca Negru, Laurențiu Stratan, Cristina Dragomirescu, Remulus Catană, Cristina Murariu, Violeta Molagic, Raluca Năstase, Cătălin Tilișcan, Daniela Munteanu, Mihaela Rădulescu, Ioan Diaconu, Violeta Niță, Iulia Bodoșca, Victoria Aramă
A33 Severe reactivation of chronic hepatitis B after discontinuation of nucleos(t)ide analogues – a case series
Cristina Popescu, Alina Orfanu, Anca Leuștean, Alexandra Badea, Laurențiu Stratan, Remulus Catană, Cătălin Tilișcan, Victoria Aramă
A34 The dynamic of hematological disorders during direct acting antivirals therapy for HCV compensated cirrhosis
Cristina Popescu, Cristina Murariu, Cristina Dragomirescu, Anca Leuștean, Laurențiu Stratan, Alina Orfanu, Alexandra Badea, Remulus Catană, Anca Negru, Cătălin Tilișcan, Daniela Munteanu, Mihaela Rădulescu, Violeta Molagic, Raluca Mihaela Năstase, Ioan Alexandru Diaconu, Iulia Bodoșca, Violeta Niță, Victoria Aramă
A35 Behaviors, attitudes and risk factors for viral hepatitis in international medical students vs. the general population in Romania
Yagmur Erturk, Oana Săndulescu, Alina Cristina Neguț, Claudiu Mihai Șchiopu, Adrian Streinu-Cercel, Anca Streinu-Cercel
A36 Characteristics of hepatitis C virus reactivation due to immunosuppressive therapy in Romanian HCV infected patients with hematological malignancies
Violeta Molagic, Cătălin Tilișcan, Cristina Popescu, Raluca Mihăilescu, Daniela Munteanu, Raluca Năstase, Anca Negru, Angelica Tenita, Victoria Aramă, Ștefan Sorin Aramă
A37 The dynamic IFN-gamma serum levels during successful peginterferon-a 2a/ribavirin therapy in HCV chronic infection
Simona Alexandra Iacob, Diana Gabriela Iacob, Monica Luminos
A38 Overlapping risk factors for transmission of HBV, HCV and HIV in the general population in Romania
Anca Streinu-Cercel, Oana Săndulescu, Mioara Predescu, Alexandra Mărdărescu, Cătălin Tilișcan, Mihai Săndulescu, Claudiu Mihai Șchiopu, Adrian Streinu-Cercel
A39 Acute hepatitis - an uncommon neurological complication
Cleo Nicoleta Roșculeț, Catrinel Olimpia Ciuca, Dalila Ana Toma, Cătălin Gabriel Apostolescu, Andrei Rogoz, Cristina Elena Mitu, Andrei Stangaciu, Viorica Daniela Mitescu, Tudor Gheorghe Vladoiu, Doina Viorica Iovănescu
A40 Regression of liver fibrosis following sustained virological response in patients with chronic HCV infection and cirrhosis
Oana Săndulescu, Anca Streinu-Cercel, Monica Andreea Stoica, Liliana Lucia Preoțescu, Daniela Manolache, Gabriela Jana Ceapraga, Maria Magdalena Moțoi, Luminița Bradu, Adina Ilie, Gabriela Mircea, Ionel Durbală, Adrian Streinu-Cercel
A41 Preliminary results of treatment with sofosbuvir and daclatasvir of patients with chronic hepatitis C
Irina Russu, Tiberiu Holban, Tatiana Pantilimonov, Galina Chiriacov, Arcadie Macvovei, Elena Scorohodico, Oleg Dmitriev
A42 HIV-syphilis coinfection
Diana Alexandra Costache, Anca Benea, Eliza Manea, Cristian Niculae, Raluca Jipa, Adriana Hristea, Elisabeta Benea, Ruxandra Moroti, Șerban Benea
A43 Thrombophilia – additional risk factor for the evolution of pregnancy in HIV-positive patients
Mihai Mitran, Carmen Georgescu, Loredana Mitran, Simona Vladareanu
A44 The incidence of oropharyngeal candidiasis in hospitalized HIV infected pediatric Romanian cohort between 1 January - 31 December 2015
Andreea Ioana Magirescu, Viorica Andreev, Cristina Nicolau, Alexandra Largu, Carmen Dorobat, Carmen Manciuc
A45 TB incidence in HIV infected patients during the year of 2015
Viorica Andreev, Andreea Ioana Magirescu, Ina Isac, Cristina Nicolau, Alexandra Largu, Carmen Dorobat, Carmen Manciuc
A46 Retrospective analysis of HIV/AIDS deaths recorded in the Clinical Infectious Diseases Hospital, Constanța in the period 01 January 2014–30 June 2016. Epidemiological considerations.
Iulia Gabriela Șerban, Ghiulendan Resul, Consuela Marcaș
A47 Acute liver failure with favorable evolution in an HIV-HBV coinfected patient
Iosif Marincu, Patricia Poptelecan, Bogdan Trincă, Sorina Mitrescu, Anca Tudor, Daliborca Vlad, Livius Tirnea
A48 Lifestyle impact on HIV management
Nurcan Baydaroglu, Alina Cristina Neguț, Oana Săndulescu, Daniela Manolache, Gabriela Ceapraga, Monica Andreea Stoica, Anca Streinu-Cercel, Adrian Streinu-Cercel
49. HIV positive mothers newborns - clinical experience from January 2012 to June 2016
Carmen Manciuc, Mariana Pagute, Cristina Nicolau, Carmen Dorobăț, Alexandra Largu
A50 Rediscovering HIV-associated progressive multifocal leukoencephalopathy and HIV encephalopathy: clinical suspicion and subsequent brain autopsies
Ioan-Alexandru Diaconu, Laurențiu Stratan, Daniela Ion, Luciana Nichita, Cristina Popescu, Raluca Năstase, Daniela Munteanu, Violeta Molagic, Cătălin Tilișcan, Mihaela Rădulescu, Alexandra Diaconu, Anca Negru, Alina Orfanu, Cristina Dragomirescu, Remulus Catană, Anca Leuștean, Irina Duport-Dodot, Cristina Murariu, Iulia Bodoșca, Violeta Niță, Alexandra Badea, Victoria Aramă
A51 Antenatal surveillance of pregnant women with risk behavior and its impact on mother-to-child HIV transmission in Romania
Mariana Mărdărescu, Cristina Petre, Marieta Iancu, Rodica Ungurianu, Alina Cibea, Ruxandra Drăghicenoiu, Ana Maria Tudor, Delia Vlad, Sorin Petrea, Carina Matei, Dan Oțelea, Carmen Crăciun, Cristian Anghelina, Alexandra Mărdărescu
A52 Noninvasive assessments (APRI, Fib-4, transient elastography) of fibrosis in patients with HIV and HIV/HBV infection
Elena Dumea, Adrian Streinu-Cercel, Sorin Rugină, Lucian Cristian Petcu, Stela Halichidis, Simona Claudia Cambrea
A53 Undetectable HIV viral load – the main goal in the management of HIV-infected patients
Carmen Chiriac, Nina-Ioana Bodnar, Iringo-Erzsebet Zaharia-Kezdi, Cristina Gîrbovan, Andrea Incze, Anca Meda Georgescu
A54 LPS serum levels and correlation with immunological, virological and clinical outcome in HIV infected patients
Simona Alexandra Iacob, Diana Gabriela Iacob, Eugenia Panaitescu, Monica Luminos, Manole Cojocaru
A55 LL37 human cathelicidin serum levels are positively correlated with IFN gamma and alanine aminotransferase level in HCV infection
Simona Alexandra Iacob, Diana Gabriela Iacob, Monica Luminos
A56 Early diagnosis of pulmonary tuberculosis in a non-compliant HIV/AIDS late presenter patient
Vochita Laurențiu, Vochita Andreia, Opreanu Radu, Trinca Bogdan, Rosca Ovidiu, Marincu Iosif
A57 Evolution of antiretroviral regimens in naϊve patients in 2016
Ramona Zamfir, Alina Angelescu, Alena Andreea Popa, Raluca Jipa, Ruxandra Moroti, Adriana Hristea, Liana Gavriliu, Șerban Benea, Elisabeta Benea
A58 The unfavorable risk factors for HIV infected persons with positive blood cultures hospitalized at the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” in 2015
Alena-Andreea Popa, Georgeta Ducu, Daniela Camburu, Alina Cozma, Manuela Podani, Roxana Dumitriu, Liana Gavriliu, Șerban Benea, Elisabeta Benea
A59 Epidemiological aspects of HIV infection in Oltenia region
Andreea Cristina Stoian, Florentina Dumitrescu, Augustin Cupșa, Lucian Giubelan, Irina Niculescu, Loredana Ionescu, Livia Dragonu
A60 HIV risk behaviors and prevalence among patients in methadone maintenance therapy (MMT) from Arena center, Bucharest
Adrian Octavian Abagiu, Loredana Nicoleta Stoica, Catrinel Blaga, Archontis Koulosousas, Roxana Ștefănescu, Alice Atomoaie, Florentina Paraschiv, Florin Matache Duna
A61 Therapeutic options in a case of severe psoriasis associated with both HIV infection and hepatitis C virus previously treated with fumaric acid esters
Rodica Olteanu, Roxana Ion, Alexandra Zota, Isra Ennour Jaballah, Lara Mahfoud, Georgeta Preda, Magda Constantin
A62 Prevalence of autoantibodies against gangliosides in asymptomatic HIV-infected patients
Ilinca Nicolae, Corina Daniela Ene, Mădălina Irina Mitran, Vasile Benea, Mircea Tampa, Simona Roxana Georgescu
A63 Subclinical inflammation in HIV-infected patients undergoing antiretroviral therapy – a cross sectional study
Iulia Cristina Bodoșca, Cristina Murariu, Cătălin Tilișcan, Victoria Aramă, Cristina Popescu, Daniela Munteanu, Mihaela Rădulescu, Violeta Molagic, Raluca Năstase, Alina Orfanu, Anca Leuștean, Remulus Catană, Anca Negru, Adrian Streinu-Cercel, Sorin Aramă
A64 Severe Guillain-Barré syndrome occurring after chickenpox with favorable evolution
Iuliana CAramăngiu, Ovidiu Rosca, Monica Cialma, Radu Opreanu, Laurențiu Vochita, Iosif Marincu
A65 Echovirus 30 infection with pulmonary and cardiac complications – case report
Vlad Murărescu, Marilena Palaghiță, Alina Cristina Neguț, Cornel Camburu, Adrian Streinu-Cercel
A66 Herpetic encephalitis with favorable evolution in an adult immunocompetent patient
Irina Duşan, Patricia Poptelecan, Bogdan Trincă, Sorina Mitrescu, Livius Tirnea, Iosif Marincu
A67 Clinical-evolutional aspects in present-day measles
Narcisa Nicolescu, Alexandru Crișan, Voichița Lăzureanu, Ruxandra Laza, Virgil Musta, Adelina-Raluca Marinescu, Andreea Bîrlad
A68 Pneumococcal superinfection in children with influenza
Victor Daniel Miron, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Daniela Pițigoi, Oana Săndulescu, Monica Luminița Luminos
A69 Varicella complicated with transverse myelitis - case presentation
Monica Luminos, Endis Osman, Magdalena Vasile, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Camelia Kouris, Sabina Șchiopu, Mădălina Merișescu
A70 Clinical forms of enterovirus infections during the summer season of 2016
Monica Luminos, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Camelia Kouris, Endis Osman, Sabina Vintilă, Magda Vasile, Mădălina Merișescu
A71 Face off – HIV and lymphoma – case series presentation
Liana Cătălina Gavriliu, Otilia Elisabeta Benea, Alina Angelescu, Ramona Zamfir, Daniela Camburu, Georgeta Ducu, Alina Cozma, Roxana Dumitriu, Manuela Podani, Șerban Benea, Mihaela Ionică
A72 Coxsackie infection complicated by pancytopenia – pediatric case report
Gheorghiță Jugulete, Adina Stăncescu, Cristina Elena Popescu, Luminița Marin, Diana Zaharia, Cristina Dumitrescu, Lucia Tudor, Sabina Vintilă
A73 Viral respiratory infections in children in the season 2015–2016
Constanța-Angelica Vișan, Anca Cristina Drăgănescu, Anuța Bilașco, Magda Vasile, Mădălina Merișescu, Camelia Kouris, Cristina Negulescu, Endis Osman, Diana-Maria Slavu, Sabina Vintilă, Daniela Pițigoi, Monica Luminos
A75 The severity of A H1N1 Influenza infection in the 2015–2016 season
Cleo Roșculeț, Catrinel Olimpia Ciuca, Dalila Toma, Cătălin Apostolescu, Andrei Rogoz, Andrei Stangaciu, Viorica Mitescu, Doina Iovănescu, Cornel Camburu, Bogdana Manu
A76 Acute respiratory distress syndrome in a child with measles
Ana Vaduva-Enoiu, Ramona Georgiana Stanculete, Adelina Raluca Marinescu, Voichita Elena Lazureanu
A77 Management challenges of right-sided infectious endocarditis in an HIV positive patient – case presentation
Elena-Violeta Niță, Sînziana Dumitru, Daniela-Ioana Munteanu, Anca Ruxandra Negru, Remulus Catană, Ioan Diaconu, Bogdana Manu, Ligia Ionescu, Liliana Ion, Cătălin Tilișcan, Victoria Aramă
A78 Bacterial infection in critical patients with severe A H1N1 influenza virus infection (epidemiology, development, therapeutic decisions)
Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz, Cătălin Apostolescu, Viorica Mitescu, Tudor Vladoiu, Dalila Toma, Catrinel Ciuca
A79 Epidemiological aspects of severe acute respiratory infection cases (SARI) in the season 2015–2016, in the Clinical Hospital of Infectious Diseases – Constanța, Romania
Iulia Gabriela Șerban, Marioara Neacșu
A80Overexpression of IL-6 trans signaling pathway in viral infections
Simona Roxana Georgescu, Vasile Benea, Corina Daniela Ene, Mircea Tampa, Cristina Iulia Mitran, Ilinca Nicolae
A81 Acute viral hepatitis B with persistent HBsAg – description and evolution
George Ciprian Pribac, Mirandolina Prisca, Fulvia Ursoiu, Carmen Neamtu, Bogdan Totolici, Coralia Cotoraci, Aurel Ardelean
A82 Prevalence of cervical pathogens in a population of pregnant female patients monitored in a tertiary care hospital in Bucharest, Romania
Simona Elena Albu, Mara Carsote, Beatrice Miclăuș, Diana Mihai, Oana Săndulescu, Cristina Vasiliu
A83 Prevalence of group B Streptococcus during pregnancy in a cohort of patients monitored in a tertiary care hospital in Bucharest, Romania
Cristina Vasiliu, Mara Carsote, Corina Gorgoi, Beatrice Miclăuș, Diana Mihai, Oana Săndulescu, Simona Elena Albu
A84 Infectious hematoma in the gastrocnemius muscle – case presentation
Amelia Blescun, Gelu Breaza
A85 Reflections towards the underexplored HTLV Romanian viral circulation - adult T‐cell leukemia/lymphomas, a case series
Sabina Vintila, Felicia Mihai, Meilin Omer, Cornel Dragan, Daniela Pitigoi
A86 A febrile confusion syndrome with acute onset – case presentation
Mirela Ciucu, Marius-Dan Ionescu, Cristina Roskanovic, Valentina Barbu, Iulian Diaconescu, Florentina Dumitrescu, Irina Niculescu
A87 Retrobulbar optic neuritis in a HIV-positive patient - case report
Mihaela Ionică, Ramona-Alexandra Zamfir, Alina Cozma, Otilia Elisabeta Benea
A88 A rare presentation of Q fever – case presentation
Alexandra-Sînziana Dumitru, Daniela-Ioana Munteanu, Violeta Niță, Cristina Popescu, Iulia Bodosca, Angelica Tenita, Viorica Ispas, Victoria Aramă
A89 Tinea incognita – case presentation
Vasile Benea, Simona Roxana Georgescu, Mircea Tampa, Diana Oana Leahu, Cristina Maria Safta, Mihaela Anca Benea
A90 Incidence and risk factors associated with TORCH infections during pregnancy
Oana Săndulescu, Octavian Munteanu, Roxana Bohâlțea, Livia Trașcă, Monica Cîrstoiu
A91 Acute respiratory failure in critical patients with sepsis
Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz, Cătălin Gabriel Apostolescu, Viorica Daniela Mitescu, Tudor Gheorghe Vladoiu, Dalila Toma, Catrinel Ciuca
A92 Cochleo-vestibular deficit secondary to Granulicatella elegans meningitis
Mădălina Georgescu
A93 Influenza 2015/2016 – clinical, epidemiological and virological characteristics of cases admitted in three infectious diseases hospitals
Daniela Pițigoi, Alina Elena Ivanciuc, Mihaela Lazar, Teodora Ionescu, Carmen Maria Cherciu, Cristina Țecu, Maria Elena Mihai, Maria Nițescu, Rodica Bacruban, Delia Azamfire, Aura Dumitrescu, Elena Ianosik, Daniela Leca, Elena Duca, Andra Teodor, Codrina Bejan, Emanoil Ceaușu, Simin-Aysel Florescu, Corneliu Popescu, Grațiela Târdei, Codrina Juganariu, Emilia Lupulescu
A94 Severe complications of varicella requiring hospitalization in previously healthy children in Brașov county
Ligia Rodina, Maria Elena Cocuz
A95 Clinical forms of Clostridium difficile colitis in children
Gheorghiță Jugulete, Adina Stăncescu, Cristina Elena Popescu, Luminița Marin, Diana Zaharia, Cristina Dumitrescu, Endis Osman
A96 Community-acquired pneumonia – demographic, clinical and etiological aspects
Irina Niculescu, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Livia Dragonu, Andreea Stoian, Lucian Giubelan, Cristina Roskanovic
A97 Acute myocarditis in an adult patient with chickenpox - Case report
Ramona-Alexandra Zamfir, Mihaela Ionica, Otilia-Elisabeta Benea
A98 Caustic oropharyngeal wound with acute group F streptococcal superinfection mimicking diphtheria – case report and differential diagnosis
Maria-Cristina Sîrbu, AnaMaria Dobrotă, Alina Cristina Neguț, Roxana Duda, Rodica Bacruban, Daniela Pițigoi, Cristiana Cerasella Dragomirescu, Daniela Tălăpan, Olga Dorobăț, Adrian Streinu-Cercel, Anca Streinu-Cercel
A99 Clostridium difficile infection in HIV-positive patients admitted in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” in 2015
Mihaela Ionica, Ramona-Alexandra Zamfir, Alina Cozma, Otilia Elisabeta Benea
A100 Title: Epidemiology of Candida oral infections (stomatitis) in Romania
Sergiu Fendrihan, Ecaterina Scortan, Mircea Ioan Popa
A101 Anthrax case series in south-eastern Romania
Corneliu P Popescu, Șerban N Benea, Andra E Petcu, Adriana Hristea, Adrian Abagiu, Iuliana A Podea, Raluca E Jipa, Georgeta Ducu, Raluca M Hrișcă, Dragoș Florea, Manuela Nica, Eliza Manea, Simona Merișor, Cristian M Nicolae, Simin A Florescu, Irina M Dumitru, Emanoil Ceaușu, Sorin Rugină, Ruxandra V Moroti
A102 Knowledge, risk perception and attitudes of healthcare workers at the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” regarding Ebola
Daniela Pițigoi, Teodora Ionescu, Oana Săndulescu, Maria Nițescu, Bogdan Nițescu, Iulia Monica Mustaţă, Sorina Claudia Boldeanu, Florentina Furtunescu, Adrian Streinu-Cercel
A103 A case of abdominopelvic actinomycosis with successful short-term antibiotic treatment
Diana Gabriela Iacob, Simona Alexandra Iacob, Mihaela Gheorghe
A104 A case of pneumonia caused by Raoultella planticola
Iulian Diaconescu, Irina Niculescu, Floretina Dumitrescu, Lucian Giubelan
A105 Vitamin D deficiency and sepsis in childhood
Adriana Slavcovici, Raluca Tripon, Roxana Iubu, Cristian Marcu, Mihaela Sabou, Monica Muntean
A106 The clinical and epidemiological aspects and prophylaxis of Lyme disease among patients who presented with tick bites to the Clinical Infectious Disease Hospital “Toma Ciorbă”
Ion Chiriac, Tiberiu Holban, Liviu Tazlavanu
A107 Drug-resistant tuberculosis in HIV infected patients
Raluca Jipa, Eliza Manea, Roxana Cernat, Kezdi Iringo, Andrei Vâță, Manuela Arbune, Teodora Moisil, Adriana Hristea
A108 Kidney injury molecule-1 and urinary tract infections
Corina-Daniela Ene, Ilinca Nicolae, Roxana Simona Georgescu
A109 The impact of microbiological agents on serum gangliosides in patients with benign prostate hyperplasia
Corina-Daniela Ene, Cosmin-Victor Ene, Roxana Simona Georgescu, Marilena Ciortea , Lucreția Dulgheru, Ilinca Nicolae
A110 Toxocariasis - the experience of the Iași Infectious Diseases Hospital between 2013–2015
Mihaela Cătălina Luca, Ioana-Alina Harja-Alexa, Roxana Nemescu, Mădălina Popazu, Andrei Ștefan Luca
A111 Species of anaerobic Gram-positive cocci involved in odontogenic abscesses
Gabriela Bancescu, Bogdan Dabu, Adrian Bancescu
A112 Clostridium difficile infection recurrences
Eliza Manea, Raluca Jipa, Adriana Hristea
A113 Differential diagnosis of staphylococcal and tuberculous osteodiscitis – case report
Adina Elena Ilie, Săftica-Mariana Pohrib, Alina Cristina Neguț, Maria-Sabina Tache, Maria Magdalena Moțoi, Oana Săndulescu, Ion Aurel Iliescu, Adrian Streinu-Cercel
A114 Severe clinical forms of respiratory syncytial virus infections
Cristina Tecu, Maria-Elena Mihai, Mihaela Lazăr, Carmen Cherciu, Alina Ivanciuc, Daniela Pițigoi, Emilia Lupulescu
A115 Acinetobacter baumannii postoperative sepsis associated with Clostridium difficile enterocolitis in an immune suppressed elderly patient
Mirela Paliu, Manuela Curescu, Bianca Cerbu, Iosif Marincu
A116 Risk factors and their impact on psychopathology and quality of life among people living with HIV/AIDS in Romania
Fulvia Ursoiu, Mirandolina Prișcă, George Ciprian Pribac
A117 Antivirals susceptibility of influenza viruses circulating in Romania
Maria Elena Mihai, Carmen Maria Cherciu, Alina Elena Ivanciuc, Cristina Tecu, Emilia Lupulescu
A118 Retrospective study of hospitalized cases of sepsis at the Hospital Clinic of Infectious Diseases “Toma Ciorbă”
Irina Bunescu, Tiberiu Holban, Ana Pasnin, Stela Semeniuc, Raisa Popovici, Galina Chiriacov
doi:10.1186/s12879-016-1877-4
PMCID: PMC5103241
17.  Relationship Between Alcohol Use Categories and Noninvasive Markers of Advanced Hepatic Fibrosis in HIV-Infected, Chronic Hepatitis C Virus–Infected, and Uninfected Patients 
Advanced hepatic fibrosis was present with nonhazardous alcohol consumption and increased with higher alcohol use categories across groups stratified by HIV and chronic hepatitis C virus (HCV) status. All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients.
Background. It is unclear if the risk of liver disease associated with different levels of alcohol consumption is higher for patients infected with human immunodeficiency virus (HIV) or chronic hepatitis C virus (HCV). We evaluated associations between alcohol use categories and advanced hepatic fibrosis, by HIV and chronic HCV status.
Methods. We performed a cross-sectional study among participants in the Veterans Aging Cohort Study who reported alcohol consumption at enrollment (701 HIV/HCV-coinfected; 1410 HIV-monoinfected; 296 HCV-monoinfected; 1158 HIV/HCV-uninfected). Alcohol use category was determined by the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire and alcohol-related diagnoses and was classified as nonhazardous drinking, hazardous/binge drinking, or alcohol-related diagnosis. Advanced hepatic fibrosis was defined by FIB-4 index >3.25.
Results. Within each HIV/HCV group, the prevalence of advanced hepatic fibrosis increased as alcohol use category increased. For each alcohol use category, advanced hepatic fibrosis was more common among HIV-infected than uninfected (nonhazardous: 6.7% vs 1.4%; hazardous/binge: 9.5% vs 3.0%; alcohol-related diagnosis: 19.0% vs 8.6%; P < .01) and chronic HCV-infected than uninfected (nonhazardous: 13.6% vs 2.5%; hazardous/binge: 18.2% vs 3.1%; alcohol-related diagnosis: 22.1% vs 6.5%; P < .01) participants. Strong associations with advanced hepatic fibrosis (adjusted odds ratio [95% confidence interval]) were observed among HIV/HCV-coinfected patients with nonhazardous drinking (14.2 [5.91–34.0]), hazardous/binge drinking (18.9 [7.98–44.8]), and alcohol-related diagnoses (25.2 [10.6–59.7]) compared with uninfected nonhazardous drinkers.
Conclusions. Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with higher alcohol use categories, and was more prevalent among HIV-infected and chronic HCV-infected patients than uninfected individuals. All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients.
doi:10.1093/cid/ciu097
PMCID: PMC4001286  PMID: 24569533
alcohol; liver fibrosis; HIV; hepatitis C; FIB-4
18.  Measuring Coverage in MNCH: Population HIV-Free Survival among Children under Two Years of Age in Four African Countries 
PLoS Medicine  2013;10(5):e1001424.
Background
Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children ≤24 mo of age in Cameroon, Côte D'Ivoire, South Africa, and Zambia.
Methods and Findings
We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo. We tested consenting mothers with rapid HIV antibody tests and tested the children of seropositive mothers with HIV DNA PCR or rapid antibody tests. Our primary outcome was 24-mo HIV-free survival, estimated with survival analysis. In an individual-level analysis, we evaluated the effectiveness of various PMTCT regimens. In a community-level analysis, we evaluated the relationship between HIV-free survival and community PMTCT coverage (the proportion of HIV-exposed infants in each community that received any PMTCT intervention during gestation or breastfeeding). We also compared our community coverage results to those of a contemporaneous study conducted in the facilities serving each sampled community. Of 7,985 surveyed children under 2 y of age, 1,014 (12.7%) were HIV-exposed. Of these, 110 (10.9%) were HIV-infected, 851 (83.9%) were HIV-uninfected, and 53 (5.2%) were dead. HIV-free survival at 24 mo of age among all HIV-exposed children was 79.7% (95% CI: 76.4, 82.6) overall, with the following country-level estimates: Cameroon (72.6%; 95% CI: 62.3, 80.5), South Africa (77.7%; 95% CI: 72.5, 82.1), Zambia (83.1%; 95% CI: 78.4, 86.8), and Côte D'Ivoire (84.4%; 95% CI: 70.0, 92.2). In adjusted analyses, the risk of death or HIV infection was non-significantly lower in children whose mothers received a more complex regimen of either two or three antiretroviral drugs compared to those receiving no prophylaxis (adjusted hazard ratio: 0.60; 95% CI: 0.34, 1.06). Risk of death was not different for children whose mothers received a more complex regimen compared to those given single-dose nevirapine (adjusted hazard ratio: 0.88; 95% CI: 0.45, 1.72). Community PMTCT coverage was highest in Cameroon, where 75 of 114 HIV-exposed infants met criteria for coverage (66%; 95% CI: 56, 74), followed by Zambia (219 of 444, 49%; 95% CI: 45, 54), then South Africa (152 of 365, 42%; 95% CI: 37, 47), and then Côte D'Ivoire (3 of 53, 5.7%; 95% CI: 1.2, 16). In a cluster-level analysis, community PMTCT coverage was highly correlated with facility PMTCT coverage (Pearson's r = 0.85), and moderately correlated with 24-mo HIV-free survival (Pearson's r = 0.29). In 14 of 16 instances where both the facility and community samples were large enough for comparison, the facility-based coverage measure exceeded that observed in the community.
Conclusions
HIV-free survival can be estimated with community surveys and should be incorporated into ongoing country monitoring. Facility-based coverage measures correlate with those derived from community sampling, but may overestimate population coverage. The more complex regimens recommended by the World Health Organization seem to have measurable public health benefit at the population level, but power was limited and additional field validation is needed.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
For a pregnant woman who is HIV-positive, the discrepancy across the world in outlook for mother and child is stark. Mother-to-child transmission of HIV during pregnancy is now less than 1% in many high-income settings, but occurs much more often in low-income countries. Three interventions have a major impact on transmission of HIV to the baby: antiretroviral drugs, mode of delivery, and type of infant feeding. The latter two are complex, as the interventions commonly used in high-income countries (cesarean section if the maternal viral load is high; exclusive formula feeding) have their own risks in low-income settings. Minimizing the risks of transmitting HIV through effective drug regimes therefore becomes particularly important. Monitoring progress on reducing the incidence of mother-to-child HIV transmission is essential, but not always easy to achieve.
Why Was This Study Done?
A research group led by Stringer and colleagues recently reported a study from four countries in Africa: Cameroon, Côte D'Ivoire, South Africa, and Zambia. The study showed that even in the health facility setting (e.g., hospitals and clinics), only half of infants whose mothers were HIV-positive received the minimum recommended drug treatment (one dose of nevirapine during labor) to prevent HIV transmission. Across the population of these countries, it is possible that fewer receive antiretroviral drugs, as the study did not include women who did not access health facilities. Therefore, the next stage of the study by this research group, reported here, involved going into the communities around these health facilities to find out how many infants under two years old had been exposed to HIV, whether they had received drugs to prevent transmission, and what proportion were alive and not infected with HIV at two years old.
What Did the Researchers Do and Find?
The researchers tested all consenting women who had delivered a baby in the last two years in the surrounding communities. If the mother was found to be HIV-positive, then the infant was also tested for HIV. The researchers then calculated how many of the infants would be alive at two years and free of HIV infection.
Most mothers (78%) agreed to testing for themselves and their infants. There were 7,985 children under two years of age in this study, of whom 13% had been born to an HIV-positive mother. Less than half (46%) of the HIV-positive mothers had received any drugs to prevent HIV transmission. Of the children with HIV-positive mothers, 11% were HIV-infected, 84% were not infected with HIV, and 5% had died. Overall, the researchers estimated that around 80% of these children would be alive at two years without HIV infection. This proportion differed non-significantly between the four countries (ranging from 73% to 84%). The researchers found higher rates of infant survival than they had expected and knew that they might have missed some infant deaths (e.g., if households with infant deaths were less likely to take part in the study).
The researchers found that their estimates of the proportion of HIV-positive mothers who received drugs to prevent transmission were fairly similar between their previous study, looking at health facilities, and this study of the surrounding communities. However, in 14 out of 16 comparisons, the estimate from the community was lower than that from the facility.
What Do These Findings Mean?
This study shows that it would be possible to estimate how many infants are surviving free of HIV infection using a study based in the community, and that these estimates may be more accurate than those for studies based in health facilities. There are still a large proportion of HIV-positive mothers who are not receiving drugs to prevent transmission to the baby. The authors suggest that using two or three drugs to prevent HIV may help to reduce transmission.
There are already community surveys conducted in many low-income countries, but they have not included routine infant testing for HIV. It is now essential that organizations providing drugs, money, and infrastructure in this field consider more accurate means of monitoring incidence of HIV transmission from mother to infant, particularly at the community level.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001424.
The World Health Organization has more information on mother-to-child transmission of HIV
The United Nations Children's Fund has more information on the status of national PMTCT responses in the most affected countries
doi:10.1371/journal.pmed.1001424
PMCID: PMC3646218  PMID: 23667341
19.  Impaired Hepatitis C Virus-Specific T Cell Responses and Recurrent Hepatitis C Virus in HIV Coinfection 
PLoS Medicine  2006;3(12):e492.
Background
Hepatitis C virus (HCV)-specific T cell responses are critical for spontaneous resolution of HCV viremia. Here we examined the effect of a lymphotropic virus, HIV-1, on the ability of coinfected patients to maintain spontaneous control of HCV infection.
Methods and Findings
We measured T cell responsiveness by lymphoproliferation and interferon-γ ELISPOT in a large cohort of HCV-infected individuals with and without HIV infection. Among 47 HCV/HIV-1-coinfected individuals, spontaneous control of HCV was associated with more frequent HCV-specific lymphoproliferative (LP) responses (35%) compared to coinfected persons who exhibited chronic HCV viremia (7%, p = 0.016), but less frequent compared to HCV controllers who were not HIV infected (86%, p = 0.003). Preservation of HCV-specific LP responses in coinfected individuals was associated with a higher nadir CD4 count (r2 = 0.45, p < 0.001) and the presence and magnitude of the HCV-specific CD8+ T cell interferon-γ response (p = 0.0014). During long-term follow-up, recurrence of HCV viremia occurred in six of 25 coinfected individuals with prior control of HCV, but in 0 of 16 HIV-1-negative HCV controllers (p = 0.03, log rank test). In these six individuals with recurrent HCV viremia, the magnitude of HCV viremia following recurrence inversely correlated with the CD4 count at time of breakthrough (r = −0.94, p = 0.017).
Conclusions
These results indicate that HIV infection impairs the immune response to HCV—including in persons who have cleared HCV infection—and that HIV-1-infected individuals with spontaneous control of HCV remain at significant risk for a second episode of HCV viremia. These findings highlight the need for repeat viral RNA testing of apparent controllers of HCV infection in the setting of HIV-1 coinfection and provide a possible explanation for the higher rate of HCV persistence observed in this population.
HIV infection impairs the immune response to HCV. Even individuals who have cleared HCV infection remain at significant risk for a second episode of HCV viremia.
Editors' Summary
Background.
Because of shared transmission routes (contaminated needles, contaminated blood products, and, to a lesser extent, unprotected sex), a large proportion of HIV-infected individuals (estimates range between 25% and 33%) are also infected with the hepatitis C virus (HCV). In most but not all individuals infected with HCV, the virus infection is chronic and causes liver disease that can eventually lead to liver failure. Disease progress is slow; it often takes decades until infected individuals develop serious liver disease. In people infected with both HCV and HIV, however, liver disease caused by HCV often appears sooner and progresses faster. As highly active antiretroviral therapy (HAART) and prophylaxis of opportunistic infections increase the life span of persons living with HIV, HCV-related liver disease has become a major cause of hospital admissions and deaths among HIV-infected persons.
Why Was This Study Done?
A sizable minority of people who are infected with HCV manage to control the virus and never get liver disease, and scientists have found that these people somehow mounted a strong immune response against the hepatitis C virus. CD4+ T cells, the very immune cells that are infected and destroyed by HIV, play an important role in this immune response. The goal of the present study was to better understand how infection with HIV compromises the specific immune response to HCV and thereby the control of HCV disease progression.
What Did the Researchers Do and Find?
The researchers recruited four groups of patients, 94 in total, all of whom were infected with HCV. Two groups comprised patients who were infected with HIV as well as HCV, with either high or undetectable levels of HCV (30 patients in each group). The two other groups included patients not infected with HIV, either with high or undetectable levels of HCV (17 patients in each group). The researchers focused on the individuals who, despite coinfection with HIV, were able to control their HCV infection. They found that those individuals managed to maintain relatively high levels of CD4+ T cells that specifically recognize HCV. However, a quarter of these patients (six out of 25) failed to keep HCV levels down for the entire observation period of up to 2.5 years; their blood levels of HCV rose substantially, most likely due to recurrence of the previously suppressed virus (the researchers could not be certain that none of the patients had become infected again after a new exposure to HCV-contaminated blood, but there was no evidence that they had engaged in risky behavior). The rise of HCV levels in the blood of the relapsed patients coincided with a drop in overall CD4+ T cell numbers. Following relapse in these individuals, HCV did not return to undetectable levels during the study. During the same period none of the 16 HIV-uninfected people with controlled HCV infection experienced a recurrence of detectable HCV.
What Do These Findings Mean?
Despite the relatively small numbers of patients, these results suggest that recurrence of HCV after initial control of the virus is more likely in people who are coinfected with HIV, and that HCV control is lost when CD4+ T cell counts fall. This is one more reason to test all HIV-positive patients for HCV coinfection. Coinfected patients, even those who seem to be controlling HCV and would not automatically receive HCV treatment, should be regularly tested for a rise of HCV levels. In addition, maintaining CD4+ T cells at a high level might be particularly important for those patients, which means that doctors might consider starting HAART therapy earlier than is generally recommended for HIV-infected individuals. Additional studies are needed to support these recommendations, however, especially as this study did not follow the patients long enough to determine the consequences of the observed loss of control of HCV.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030492.
AIDS Treatment Data Network factsheet on HIV/HCV coinfection
US CDC factsheet on HIV/HCV coinfection
American Liver Foundation, information on HIV and HCV
MedlinePlus pages on HCV
doi:10.1371/journal.pmed.0030492
PMCID: PMC1705826  PMID: 17194190
20.  Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis 
PLoS Medicine  2014;11(2):e1001608.
Alison Drake and colleagues conduct a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy and the postpartum period and to compare mother-to-child HIV transmission risk among women with incident versus chronic infection.
Please see later in the article for the Editors' Summary
Background
Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection.
Methods and Findings
We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0–4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001). Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5–2.1) or postpartum women (HR 1.1, 95% CI 0.6–1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2–3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2–4.4). However, the small number of studies limited power to detect associations and sources of heterogeneity.
Conclusions
Pregnancy and the postpartum period are times of persistent HIV risk, at rates similar to “high risk” cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Worldwide, about 3.4 million children younger than 15 years old (mostly living in sub-Saharan Africa) are infected with HIV, the virus that causes AIDS by gradually destroying immune system cells, thereby leaving infected individuals susceptible to other serious infections. In 2012 alone, 230,000 children (more than 700 every day) were newly infected with HIV. Most HIV infections among children are the result of mother-to-child HIV transmission (MTCT) during pregnancy, delivery, or breastfeeding. The rate of MTCT (and deaths among HIV-positive pregnant women from complications related to HIV infection) can be greatly reduced by testing women for HIV infection during pregnancy (antenatal HIV testing), treating HIV-positive women with antiretroviral drugs (ARVs, powerful drugs that control HIV replication and allow the immune system to recover) during pregnancy, delivery, and breastfeeding, and giving ARVs to their newborn babies.
Why Was This Study Done?
The World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have developed a global plan that aims to move towards eliminating new HIV infections among children by 2015 and towards keeping their mothers alive. To ensure the plan's success, the incidence of HIV (the number of new infections) among women and the rate of MTCT must be reduced by increasing ARV uptake by mothers and their infants for the prevention of MTCT. However, the risk of HIV infection among pregnant women and among women who have recently given birth (postpartum women) is poorly understood because, although guidelines recommend repeat HIV testing during late pregnancy or at delivery in settings where HIV infection is common, pregnant women are often tested only once for HIV infection. The lack of retesting represents a missed opportunity to identify pregnant and postpartum women who have recently acquired HIV and to prevent MTCT by initiating ARV therapy. In this systematic review (a study that uses predefined criteria to identify all the research on a given topic) and meta-analysis (a study that uses statistical methods to combine the results of several studies), the researchers estimate maternal HIV incidence during pregnancy and the postpartum period, and compare the risk of MTCT among women with incident (new) and chronic (long-standing) HIV infection.
What Did the Researchers Do and Find?
The researchers identified 47 studies (35 undertaken in Africa) that examined recent HIV acquisition by women during pregnancy and the 12-month postpartum period. They used random effects statistical models to estimate the pooled HIV incidence rate and cumulative HIV incidence (the number of new infections per number of people at risk), and the association between pregnancy/postpartum status and HIV incidence and MTCT risk and rates. The pooled HIV incidence rate among pregnant/postpartum women estimated from 19 studies (all from sub-Saharan Africa) that reported HIV incidence rates was 3.8/100 person-years. The pooled cumulative HIV incidence was significantly higher in African countries than in non-African countries (3.6% and 0.3%, respectively; a “significant” difference is one that is unlikely to arise by chance). In the five studies that provided suitable data, the risk of HIV acquisition was similar in pregnant, postpartum, and non-pregnant/non-postpartum women. Finally, among African women, the risk of MTCT was 2.9-fold higher during the postpartum period among those who had recently acquired HIV than among those with chronic HIV infection, and 2.3-fold higher during the pregnancy/postpartum periods combined.
What Do These Findings Mean?
These results suggest that women living in regions where HIV infection is common are at high risk of acquiring HIV infection during pregnancy and the postpartum period and that mothers who acquire HIV during pregnancy or postpartum are more likely to pass the infection on to their offspring than mothers with chronic HIV infections. However, the small number of studies included in this meta-analysis and the use of heterogeneous research methodologies in these studies may limit the accuracy of these findings. Nevertheless, these findings have important implications for the global plan to eliminate HIV infections in children. First, they suggest that women living in regions where HIV infection is common should be offered repeat HIV testing (using sensitive methods to enhance early detection of infection) during pregnancy and in the postpartum period to detect incident HIV infections, and should be promptly referred to HIV care and treatment. Second, they suggest that prevention of HIV transmission during pregnancy and postpartum should be prioritized, for example, by counseling women about the need to use condoms to prevent transmission during this period of their lives.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001608.
Information is available from the US National Institute of Allergy and Infectious Diseases on HIV infection and AIDS
NAM/aidsmap provides basic information about HIV/AIDS and summaries of recent research findings on HIV care and treatment
Information is available from Avert, an international AIDS charity, on many aspects of HIV/AIDS, including information on children and HIV/AIDS and on the prevention of mother-to-child transmission of HIV (in English and Spanish)
The 2013 UNAIDS World AIDS Day Report provides information about the AIDS epidemic and efforts to halt it; the 2013 UNAIDS Progress Report on the Global Plan provides information on progress towards eliminating new HIV infections among children; the UNAIDS Believe it. Do it website provides information about the campaign to support the UNAIDS global plan
Personal stories about living with HIV/AIDS, including stories from young people infected with HIV, are available through Avert, NAM/aidsmap, and Healthtalkonline
doi:10.1371/journal.pmed.1001608
PMCID: PMC3934828  PMID: 24586123
21.  Association between Time on Protease Inhibitors and the Incidence of Squamous Cell Carcinoma of the Anus among U.S. Male Veterans 
PLoS ONE  2015;10(12):e0142966.
Protease inhibitors (PIs) have been shown to have anti-tumor activity in addition to their antiretroviral properties. We sought to assess the association between PI use and the incidence of squamous cell carcinoma of the anus (SCCA) in HIV-infected individuals. We performed a retrospective cohort study among male US veterans diagnosed with HIV who were diagnosed between 1985 and 2010, using the Veterans Affairs HIV Clinical Case Registry (CCR). We calculated hazards ratios associated with PI use (both as percent time on PI and as 12-month intervals of PI use), utilizing time-dependent Cox models. We adjusted for risk factors, including age, race, year of enrolment into CCR, recent and nadir CD4, and percent time undetectable HIV viral load. A total of 28, 886 HIV-infected men met inclusion criteria. Of these, 373 were newly diagnosed with SCCA during the study period. In multivariate analysis, increasing percent time on PIs was associated with an increased risk of SCCA (aHR 1.07; 95% CI = 1.03–1.10 per 10% increase in time on PI). Poor immunologic recovery and virologic control, a history of condylomata acuminata, and CCR enrolment in the late combined antiretroviral therapy era were also associated with increased SCCA risk. Increasing percent time on a PI-based combined antiretroviral therapy regimen may be associated with an increased risk of developing SCCA in HIV-infected male US veterans. Future studies, better accounting for HIV control and treatment compliance, are necessary to further clarify this association.
doi:10.1371/journal.pone.0142966
PMCID: PMC4668039  PMID: 26629701
22.  Mother-to-Child Transmission of Hepatitis C Virus (HCV) Among HIV/HCV-Coinfected Women 
Background
Maternal human immunodeficiency virus (HIV) coinfection has been associated with increased hepatitis C virus (HCV) mother-to-child transmission (MTCT). We hypothesized that HCV/HIV-coinfected women with well-controlled HIV disease would not have increased HCV MTCT.
Methods
The NISDI Perinatal and LILAC cohorts enrolled HIV-infected pregnant women and their infants in Latin America and the Caribbean. This substudy evaluated the HCV infection status of mothers at participating sites and their live born, singleton infants who had a 6-month postnatal visit by December 31, 2008. Mothers who were anti-HCV-positive, or who had CD4 counts (cells/mm3) <200 with detectable HCV RNA, were considered HCV-infected. All HCV-infected women were tested for HCV RNA. Infants with HCV RNA were considered HCV-infected.
Results
Of 1042 enrolled women, 739 (71%) mother-infant pairs met the inclusion criteria. Of the 739 women, 67 (9%) were anti-HCV-positive and 672 anti-HCV-negative [68 (10%) with CD4 counts <200; of these, 3 (4.4%) were HCV RNA-positive]. Therefore, our study population comprised 70 HCV-infected (47 with HCV RNA) and 669 HCV-uninfected women (and their infants). Factors associated with maternal HCV infection included unemployment (odds ratio [OR] = 2.58); tobacco (OR = 1.73) or marijuana (OR = 3.88) use during pregnancy; enrollment HIV viral load ([VL] copies/mL) ≥10 000 (OR = 2.27); HIV clinical disease stage C (OR = 2.12); and abnormal alanine aminotransferase (OR = 4.24) or aspartate aminotransferase (OR = 11.98). Four of 47 infants (8.5%) born to HCV-viremic women were HCV-infected, and all 4 mothers had HIV VL <1000 at hospital discharge after delivery.
Conclusions
HCV MTCT among HIV/HCV-coinfected women with well-controlled HIV disease may be lower than reported in other coinfected populations. Studies with longer infant follow-up are needed.
doi:10.1093/jpids/pis091
PMCID: PMC4502757  PMID: 26199724
Mother-to-Child Transmission; HCV; HIV/HCV Coinfection
23.  Proceedings of The 8th Romanian National HIV/AIDS Congress and The 3rd Central European HIV Forum 
Alexiev, Ivailo | Dimitrova, Reneta | Gancheva, Anna | Kostadinova, Asya | Stoycheva, Mariyana | Nikolova, Daniela | Elenkov, Ivaylo | Tilișcan, Cătălin | Predescu, Mioara | Păunescu, Bogdan | Streinu-Cercel, Anca | Săndulescu, Oana | Șchiopu, Claudiu Mihai | Hristache, Mădălina | Brîndușe, Lăcrămioara Aurelia | Streinu-Cercel, Adrian | Todorovic, Marija | Siljic, Marina | Salemovic, Dubravka | Nikolic, Valentina | Pesic-Pavlovic, Ivana | Ranin, Jovan | Jevtovic, Djordje | Stanojevic, Maja | Tudor, Ana Maria | Vlad, Delia | Mărdărescu, Mariana | Petrea, Sorin | Petre, Cristina | Neagu-Drăghicenoiu, Ruxandra | Ungurianu, Rodica | Cibea, Alina | Chirilă, Odette | Anghelina, Cristian | Coserea, Ileana | Krikelli, Pantelia-Amalia | Pavlitina, Eirini | Psichogiou, Mina | Lamnisos, Demetris | Williams, Leslie | Korobchuk, Anya | Skaathun, Britt | Smyrnov, Pavlo | Schneider, John | Sypsa, Vana | Paraskevis, Dimitrios | Hatzakis, Angelos | Friedman, Samuel R. | Nikolopoulos, Georgios K. | Dragović, Gordana | Srdić, Danica | Khawla, Al Musalhi | Soldatović, Ivan | Nikolić, Jelena | Jevtović, Djordje | Nair, Devaki | Temereanca, Aura | Rosca, Adelina | Ene, Luminita | Soontornniyomkij, Benchawa | Diaconu, Carmen | Dita, Claudia | Achim, Cristian | Ruta, Simona | Benea, Șerban | Moroti, Ruxandra | Jipa, Raluca | Manea, Eliza | Stan, Andrada | Benea, Elisabeta | Oțelea, Dan | Hristea, Adriana | Hristea, Adriana | Lăpădat, Irina | Jipa, Raluca | Moroti, Ruxandra | Benea, Șerban | Antonică, Doina | Panait, Irina | Petre, Roxana | Kowalska, Justyna D. | Pietraszkiewicz, Ewa | Grycner, Ewa | Firlag-Burkacka, Ewa | Horban, Andrzej | Vlaicu, Ovidiu | Bănică, Leontina | Paraschiv, Simona | Tudor, Ana-Maria | Moroti, Ruxandra | Oțelea, Dan | Dimitrijević, Bojana | Soldatović, Ivan | Jevtović, Đorđe | Kusić, Jovana | Salemović, Dubravka | Ranin, Jovan | Dragović, Gordana | Florea, Dragoș | Bădicuț, Ioana | Rafila, Alexandru | Camburu, Cornel | Histrea, Adriana | Frățilă, Mihaela | Oțelea, Dan | Gmizic, Ivana | Salemovic, Dubravka | Pesic-Pavlovic, Ivana | Siljic, Marina | Nikolic, Valentina | Djonin-Nenezic, Miljana | Milosevic, Ivana | Brmbolic, Branko | Stanojevic, Maja | Streinu-Cercel, Anca | Săndulescu, Oana | Neguț, Alina Cristina | Predescu, Mioara | Mărdărescu, Alexandra | Săndulescu, Mihai | Streinu-Cercel, Adrian | Pérez, Ana Belen | Chueca, Natalia | Álvarez, Marta | Alados, Juan Carlos | Rivero, Antonio | Vera, Francisco | Delgado, Marcial | Salmeron, Javier | Jiménez, Miguel | Blanco, Maria José | Diago, Moises | Garcia-deltoro, Miguel | Alvarez, Marta | Téllez, Francisco | García, Federico | Tănase, Diana | Manea, Eliza | Bacruban, Rodica | Florea, Dragoș | Oțelea, Dan | Rafila, Alexandru | Mărdărescu, Mariana | Hristea, Adriana | Grgic, Ivana | Planinic, Ana | Santak, Maja | Gorenec, Lana | Lepej, Snjezana Zidovec | Vince, Adriana | Manea, Eliza | Hristea, Adriana | Benea, Șerban | Moroti, Ruxandra | Tănase, Diana | Niculae, Cristian M. | Merisor, Simona | Jipa, Raluca | Paraskevis, Dimitrios | Kostaki, Evangelia | Nikolopoulos, Georgios K. | Sypsa, Vana | Psichogiou, Mina | Paraskeva, Dimitra | Skoutelis, Athanassios | Malliori, Meni | Friedman, Samuel R. | Hatzakis, Angelos | Hackiewicz, Malgorzata | Zabek, Piotr | Firlag-Burkacka, Ewa | Horban, Andrzej | Kowalska, Justyna Dominika | Lunar, Maja M. | Mlakar, Jana | Poljak, Mario | Bănică, Leontina | Martin, Eliza | Gheorghiță, Valeriu | Petrescu, Andrei | Oțelea, Dan | Popescu, Costin-Ioan | Paraschiv, Simona | Neaga, Emil | Ovidiu, Vlaicu | Juncu, Andrei | Bănică, Leontina | Paraschiv, Simona | Oțelea, Dan | Popescu, Costin-Ioan | Luca, Adrian | Lazăr, Florin | Luca, Anca Elena | Ene, Luminița | Achim, Cristian | Gingăraş, Cosmina | Anton, Ștefan Adrian | Rădoi, Roxana | Tetradov, Simona | Țârdei, Grațiela | Nica, Maria | Capşa, Razvan Alexandru | Achim, Cristian L. | Oprea, Cristiana | Ene, Luminița | Szymańska, Bogna | Gawron, Natalia | Pluta, Agnieszka | Łojek, Emilia | Firląg-Burkacka, Ewa | Horban, Andrzej | Bornstein, Robert | Burcoș, Olivia | Erscoiu, Simona Manuela | Cojanu, Filofteia Bănicioiu | Toderan, Andreea | Nica, Maria | Popa, Ionuț Cristian | Ceaușu, Emanoil | Calistru, Petre Iacob | Arbune, Manuela | Alexandrache, Mirela | Arbune, Anca-Adriana | Voinescu, Doina-Carina | Diaconu, Ioan-Alexandru | Stratan, Laurențiu | Aramă, Victoria | Nichita, Luciana | Diaconu, Alexandra | Negru, Anca | Orfanu, Alina | Leuștean, Anca | Ion, Daniela Adriana | Ianache, Irina | Oprea, Cristiana | Leuștean, Anca | Popescu, Cristina | Orfanu, Alina | Negru, Anca | Catana, Remulus | Murariu, Cristina | Diaconu, Ioan-Alexandru | Rădulescu, Mihaela | Tilișcan, Cătălin | Aramă, Victoria | Marincu, Iosif | Poptelecan, Patricia | Bică, Valeria | Lazăr, Florin | Tirnea, Livius | Ianache, Irina | Rădoi, Roxana | Nica, Manuela | Țârdei, Grațiela | Ene, Luminița | Ceaușu, Emanoil | Calistru, Petre | Oprea, Cristiana | Osoianu, Iurie | Halacu, Ala | Stoian, Andreea Cristina | Dumitrescu, Florentina | Diaconescu, Iulian | Cupșa, Augustin | Giubelan, Lucian | Ionescu, Loredana | Niculescu, Irina | Chiriac, Carmen | Șincu, Nina | Kezdi, Iringo Zaharia | Georgescu, Anca | Țilea, Brândușa | Girbovan, Cristina | Incze, Andrea | Fodor, Andrea | Cibea, Alina | Mărdărescu, Mariana | Petre, Cristina | Drăghicenoiu, Ruxandra | Ungurianu, Rodica | Tudor, Ana Maria | Vlad, Delia | Matei, Carina | Dumea, Elena | Petcu, Lucian Cristian | Cambrea, Simona Claudia | Dumitrescu, Florentina | Cupsa, Augustin | Stoian, Andreea Cristina | Giubelan, Lucian | Niculescu, Irina | Diaconescu, Iulian | Hurezeanu, Dan | Dragonu, Livia | Cotulbea, Mioara | Erscoiu, Simona Manuela | Popa, Ionuț Cristian | Stroie, Denisa | Ionescu, Petronela | Duță, Nedeea | Dobrea, Camelia | Voican, Irina | Ceaușu, Emanoil | Calistru, Petre Iacob | Lazăr, Florin | Giubelan, Lucian | Cupșa, Augustin | Diaconescu, Iulian | Dumitrescu, Florentina | Hurezeanu, Dan | Dragonu, Livia | Niculescu, Irina | Stoian, Andreea Cristina | Obretin, Oana | Stănescu, Mariana | Jianu, Mihai | Gorenec, Lana | Lepej, Snjezana Zidovec | Grgic, Ivana | Planinic, Ana | Bes, Janja Iscic | Vince, Adriana | Begovac, Josip | Horga, Luminița Elena | Itu, Corina | Horga, Luminița Elena | David-Aldea, Laura Augusta | Ciorogar, Anca | Jianu, Cristian | Lupșe, Mihaela | Caramangiu, Iuliana | Roșca, Ovidiu | Cialma, Monica | Ardeleanu, Andreea | Marincu, Iosif | Jipa, Raluca | Manea, Eliza | Benea, Șerban | Lăpădat, Irina | Irimescu, Nicoleta | Panait, Irina | Niculae, Cristian | Hristea, Adriana | Kusic, Jovana | Jevtovic, Djordje | Salemovic, Dubravka | Ranin, Jovan | Dimitrijevic, Bozana | Dragovic, Gordana | Aldea-David, Laura-Augusta | Manciuc, Carmen | Nicolau, Cristina | Prisăcariu, Liviu | Largu, Alexandra | Mărdărescu, Mariana | Streinu-Cercel, Adrian | Petre, Cristina | Iancu, Marieta | Vintilă, Sanda | Vitelaru, Daniela | Ionel, Iosif | Șchiopu, Claudiu Mihai | Mărdărescu, Alexandra-Henriette | Micsanschi, Pavel | Holban, Tiberiu | Bîstrițchi, Ina | Pârțână, Lucia | Nagîț, Angela | Popovici, Svetlana | Talmaci, Maria | Cucerova, Irina | Mitrescu, Sorina Georgiana | Mihalcea, Dana | Caramangiu, Iulia | Roșca, Ovidiu | Maricu, Iosif | Negru, Anca | Munteanu, Daniela | Aramă, Victoria | Mihăilescu, Raluca | Diaconu, Ioan | Catana, Remulus | Popescu, Cristina | Orfanu, Alina | Leuștean, Anca | Rădulescu, Mihaela | Tilișcan, Cătălin | Năstase, Raluca | Molagic, Violeta | Duport, Irina | Dragomirescu, Cristina | Aramă, Ștefan Sorin | Negruț, Nicoleta M. | Niță, Violeta Elena | Munteanu, Daniela Ioana | Mihăilescu, Raluca | Diaconu, Ioan | Negru, Anca | Popescu, Cristina | Aramă, Victoria | Orfanu, Alina | Popescu, Cristina | Leuștean, Anca | Negru, Anca | Catana, Remulus | Diaconu, Ioan | Tilișcan, Cătălin | Aramă, Victoria | Aramă, Sorin Ștefan | Pavlovia, Ivana Pesic | Salemovic, Dubravka | Ranin, Jovan | Jevtovic, Djordje | Roșca, Ovidiu | Ardeleanu, Andreea | Caramangiu, Iulia | Desaga, Daniela | Bică, Valerica | Mitrescu, Sorina | Marincu, Iosif | Siljic, Marina | Salemovic, Dubravka | Nikolic, Valentina | Jevtovic, Djordje | Pesic-Pavlovic, Ivana | Ranin, Jovan | Todorovic, Marija | Stanojevic, Maja | Șincu, Nina-Ioana | Georgescu, Anca | Țilea, Brândușa | Kezdi, Iringo Zaharia | Incze, Andrea | Gârbovan, Cristina | Chiriac, Carmen Lucia | Luca, Anca Elena | Lazăr, Florin | Luca, Adrian | Ene, Luminița | Rădoi, Roxana | Talnariu, Adina | Suciu, Silvia | Achim, Cristian | Iacob, Diana Gabriela | Florea, Dragoș | Iacob, Simona | Arbune, Manuela | Drăgănescu, Miruna | Iancu, Alina | Moroti, Ruxandra | Niculae, Cristian M. | Merisor, Simona | Manea, Eliza | Benea, Serban | Stan, Andrada | Hrisca, Raluca | Jipa, Raluca | Tanase, Diana | Hristea, Adriana | Grgic, Ivana | Planinic, Ana | Gorenec, Lana | Lepej, Snjezana Zidovec | Vince, Adriana
BMC Infectious Diseases  2016;16(Suppl 3):290.
O1 HIV-1 diversity in Bulgaria (current molecular epidemiological picture)
Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Asya Kostadinova, Mariyana Stoycheva, Daniela Nikolova, Ivaylo Elenkov
O2 Knowledge, attitudes and practices of the general population on HIV/AIDS, hepatitis B and C in Romania
Cătălin Tilișcan, Mioara Predescu, Bogdan Păunescu, Anca Streinu-Cercel, Oana Săndulescu, Claudiu Mihai Șchiopu, Mădălina Hristache, Lăcrămioara Aurelia Brîndușe, Adrian Streinu-Cercel
O3 The prevalence of human leukocyte antigen-B*57:01 allele carriers and CXCR4 tropism among newly diagnosed HIV infected patients in Serbia
Marija Todorovic, Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Ivana Pesic-Pavlovic, Jovan Ranin, Djordje Jevtovic, Maja Stanojevic
O4 HIV transmission among stable serodiscordant couples from the former Pediatric Cohort follow up in the National Institute of Infectious Diseases
Ana Maria Tudor, Delia Vlad, Mariana Mărdărescu, Sorin Petrea, Cristina Petre, Ruxandra Neagu-Drăghicenoiu, Rodica Ungurianu, Alina Cibea, Odette Chirilă, Cristian Anghelina, Ileana Coserea
O5 Unemployment is associated with syringe sharing among people who inject drugs in Greece
Pantelia-Amalia Krikelli, Eirini Pavlitina, Mina Psichogiou, Demetris Lamnisos, Leslie Williams, Anya Korobchuk, Britt Skaathun, Pavlo Smyrnov, John Schneider, Vana Sypsa, Dimitrios Paraskevis, Angelos Hatzakis, Samuel R. Friedman, Georgios K. Nikolopoulos
O6 Correlation of adipocytokine levels in different types of lipodystrophy in HIV/AIDS patients
Gordana Dragović, Danica Srdić, Al Musalhi Khawla, Ivan Soldatović, Jelena Nikolić, Djordje Jevtović, Devaki Nair
O7 IP10 – a possible biomarker for the progression of HIV infection
Aura Temereanca, Adelina Rosca, Luminita Ene, Benchawa Soontornniyomkij, Carmen Diaconu, Claudia Dita, Cristian Achim, Simona Ruta
O8 A permanent challenge: persistent low viremia in HIV positive patients on ART
Șerban Benea, Ruxandra Moroti, Raluca Jipa, Eliza Manea, Andrada Stan, Elisabeta Benea, Dan Oțelea, Adriana Hristea
O9 Infections in IDUs according to their HIV status
Adriana Hristea, Irina Lăpădat, Raluca Jipa, Ruxandra Moroti, Șerban Benea, Doina Antonică, Irina Panait, Roxana Petre
O10 Trends in combined antiretroviral therapy used in methadone program integrated with HIV care - 20 years of experience
Justyna D. Kowalska, Ewa Pietraszkiewicz, Ewa Grycner, Ewa Firlag-Burkacka, Andrzej Horban
O11 Extracellular cyclophilin A – inflammatory mediator in HIV infected patients
Ovidiu Vlaicu, Leontina Bănică, Simona Paraschiv, Ana-Maria Tudor, Ruxandra Moroti, Dan Oțelea
O12 High cardiovascular disease risk in Serbian population, an issue of concern
Bojana Dimitrijević, Ivan Soldatović, Đorđe Jevtović, Jovana Kusić, Dubravka Salemović, Jovan Ranin, Gordana Dragović
O13 Genotypic rifampicin resistance in HIV/ tuberculosis coinfected patients from a tertiary level infectious diseases hospital
Dragoș Florea, Ioana Bădicuț, Alexandru Rafila, Cornel Camburu, Adriana Histrea, Mihaela Frățilă, Dan Oțelea
O14 Occurrence of residual HCV RNA in liver and peripheral blood mononuclear cells among patients with chronic hepatitis C infection and/or HCV/HIV coinfection after IFN-based therapy
Ivana Gmizic, Dubravka Salemovic, Ivana Pesic-Pavlovic, Marina Siljic, Valentina Nikolic, Miljana Djonin-Nenezic, Ivana Milosevic, Branko Brmbolic, Maja Stanojevic
O15 Romanian nationwide screening for infection with HIV and hepatitis B and C viruses
Anca Streinu-Cercel, Oana Săndulescu, Alina Cristina Neguț, Mioara Predescu, Alexandra Mărdărescu, Mihai Săndulescu, Adrian Streinu-Cercel
O16 Treatment emergent variants to combined direct antiviral agents therapy against hepatitis C virus
Ana Belen Pérez, Natalia Chueca, Marta Álvarez, Juan Carlos Alados, Antonio Rivero, Francisco Vera, Marcial Delgado, Javier Salmeron, Miguel Jiménez, Maria José Blanco, Moises Diago, Miguel Garcia-deltoro, Marta Alvarez, Francisco Téllez, Federico García
O17 Clinical and epidemiological aspects in tuberculosis/HIV coinfected patients
Diana Tănase, Eliza Manea, Rodica Bacruban, Dragoș Florea, Dan Oțelea, Alexandru Rafila, Mariana Mărdărescu, Adriana Hristea
O18 Resistance to NS3 protease inhibitors in persons with chronic hepatitis C infected with hepatitis C virus subtype 1a from Croatia
Ivana Grgic, Ana Planinic, Maja Santak, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince
O19 Analysis of a simplified diagnostic score for tuberculous meningitis in HIV-infected adults with meningitis
Eliza Manea, Adriana Hristea, Șerban Benea, Ruxandra Moroti, Diana Tănase, Cristian M. Niculae, Simona Merisor, Raluca Jipa
O20 Molecular tracing of the origin of HIV-1 infection among persons who inject drugs in Athens: a phyloethnic study
Dimitrios Paraskevis, Evangelia Kostaki, Georgios K. Nikolopoulos, Vana Sypsa, Mina Psichogiou, Dimitra Paraskeva, Athanassios Skoutelis, Meni Malliori, Samuel R. Friedman, Angelos Hatzakis
O21 The dynamics of virological response to HIV-1 infection and antiretroviral therapy initiation in patients with and without HLA-B*5701 Allele
Malgorzata Hackiewicz, Piotr Zabek, Ewa Firlag-Burkacka, Andrzej Horban, Justyna Dominika Kowalska
O22 Increase in the numbers of non-B subtypes and potential recombinant forms circulating among Slovenian MSM in the recent years
Maja M. Lunar, Jana Mlakar, Mario Poljak
O23 Genotyping intrahost polymorphisms in hepatitis C virus E2 protein associated with resistance to antibody neutralization
Leontina Bănică, Eliza Martin, Valeriu Gheorghiță, Andrei Petrescu, Dan Oțelea, Costin-Ioan Popescu, Simona Paraschiv
O24 Genotyping of HCV NS3 protease inhibitors resistance and phenotyping of rare double resistance mutations in HCV cell culture system
Emil Neaga, Vlaicu Ovidiu, Andrei Juncu, Leontina Bănică, Simona Paraschiv, Dan Oțelea, Costin-Ioan Popescu
O25 Employment status controls the relationship between neurocognitive impairment and depression in a cohort of young HIV-infected adults since childhood
Adrian Luca, Florin Lazăr, Anca Elena Luca, Luminița Ene, Cristian Achim
O26 Predictors of survival in parenterally-infected HIV positive children and youth diagnosed with progressive multifocal leukoencephalopathy
Cosmina Gingăraş, Ștefan Adrian Anton, Roxana Rădoi, Simona Tetradov, Grațiela Țârdei, Maria Nica, Razvan Alexandru Capşa, Cristian L. Achim, Cristiana Oprea, Luminița Ene
O27 Neurocognitive and brain functioning in HIV-infected young MSM treated with cART
Bogna Szymańska, Natalia Gawron, Agnieszka Pluta, Emilia Łojek, Ewa Firląg – Burkacka, Andrzej Horban, Robert Bornstein, et HARMONIA3 Study Group
O28 Clinical value of RT-PCR detection of Toxoplasma gondii DNA in cerebrospinal fluid
Olivia Burcoș, Simona Manuela Erscoiu, Filofteia Bănicioiu Cojanu, Andreea Toderan, Maria Nica, Ionuț Cristian Popa, Emanoil Ceaușu, Petre Iacob Calistru
O29 Characteristics of sleep disorders in Romanian adults infected with human immunodeficiency virus
Manuela Arbune, Mirela Alexandrache, Anca-Adriana Arbune, Doina-Carina Voinescu
O30 Diagnosing neuroHIV: the rift between clinicians and pathologists
Ioan-Alexandru Diaconu, Laurențiu Stratan, Victoria Aramă, Luciana Nichita, Alexandra Diaconu, Anca Negru, Alina Orfanu, Anca Leuștean, Daniela Adriana Ion
O31 A challenging neurological complication in a HIV-infected young woman with multiple opportunistic infections
Irina Ianache, Cristiana Oprea
O32 Brain abscess with uncertain etiology in a late-presenter HIV infected patient
Anca Leuștean, Cristina Popescu, Alina Orfanu, Anca Negru, Remulus Catana, Cristina Murariu, Ioan-Alexandru Diaconu, Mihaela Rădulescu, Cătălin Tilișcan, Victoria Aramă
O33 Cerebral toxoplasmosis and left crural monoparesis with fatal evolution in a noncompliant patient with AIDS C3
Iosif Marincu, Patricia Poptelecan, Valeria Bică, Florin Lazăr, Livius Tirnea
O34 Opportunistic infections still a problem in HIV-infected patients in cART era: a Romanian single center experience
Irina Ianache, Roxana Rădoi, Manuela Nica, Grațiela Țârdei, Luminița Ene, Emanoil Ceaușu, Petre Calistru, Cristiana Oprea
P1: Epidemiological aspects of co-infection of HIV/TB in Moldova
Iurie Osoianu, Ala Halacu
P2 Perinatal exposure at HIV infection in Oltenia region
Andreea Cristina Stoian, Florentina Dumitrescu, Iulian Diaconescu, Augustin Cupșa, Lucian Giubelan, Loredana Ionescu, Irina Niculescu
P3 Women living with HIV in Mureș county
Carmen Chiriac, Nina Șincu, Iringo Zaharia Kezdi, Anca Georgescu, Brândușa Țilea, Cristina Girbovan, Andrea Incze, Andrea Fodor
P4 Late diagnosis of HIV infection in children - a challenge for Romania
Alina Cibea, Mariana Mărdărescu, Cristina Petre, Ruxandra Drăghicenoiu, Rodica Ungurianu, Ana Maria Tudor, Delia Vlad, Carina Matei
P5 Cirrhosis Assessment in Patients Co-infected HIV-Hepatitis B Virus
Elena Dumea, Lucian Cristian Petcu, Simona Claudia Cambrea
P6 HIV late presenters in Craiova Regional Center, Romania
Florentina Dumitrescu, Augustin Cupsa, Andreea Cristina Stoian, Lucian Giubelan, Irina Niculescu, Iulian Diaconescu, Dan Hurezeanu, Livia Dragonu, Mioara Cotulbea
P7 Some aspects of malignancies in patients HIV / AIDS
Simona Manuela Erscoiu, Ionuț Cristian Popa, Denisa Stroie, Petronela Ionescu, Nedeea Duță, Camelia Dobrea, Irina Voican, Emanoil Ceaușu, Petre Iacob Calistru
P8 Factors associated with resilience among people living with HIV in Romania
Florin Lazăr
P9 Fever in HIV-infected patients: a thorny problem to be solved by the clinicians
Lucian Giubelan, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Dan Hurezeanu, Livia Dragonu, Irina Niculescu, Andreea Cristina Stoian, Oana Obretin, Mariana Stănescu, Mihai Jianu
P10 Th1, Th2, Th9, Th17 and Th22 cytokines in acute and chronic HIV-1 infection
Lana Gorenec, Snjezana Zidovec Lepej, Ivana Grgic, Ana Planinic, Janja Iscic Bes, Adriana Vince, Josip Begovac
P11 Dyslipidemia in HIV-infected patients treated with protease inhibitors – case report
Luminița Elena Horga
P12 Why use less treatment for the metabolic abnormalities in HIV patients-too many drugs?
Corina Itu, Luminița Elena Horga, Laura Augusta David-Aldea, Anca Ciorogar, Cristian Jianu, Mihaela Lupșe
P13 Sacral Herpes Zoster, with hyperalgesic form, in a patient with C3 stage HIV infection
Iuliana Caramangiu, Ovidiu Roșca, Monica Cialma, Andreea Ardeleanu, Iosif Marincu
P14 Factors associated with in-hospital mortality in tuberculous and cryptococcal meningitis
Raluca Jipa, Eliza Manea, Șerban Benea, Irina Lăpădat, Nicoleta Irimescu, Irina Panait, Cristian Niculae, Adriana Hristea
P15 Lipodystrophy: still present adverse event in resource-limited settings
Jovana Kusic, Djordje Jevtovic, Dubravka Salemovic, Jovan Ranin, Bozana Dimitrijevic, Gordana Dragovic
P16 TB and HIV coinfected patient, an emergent challenge - case report
Laura-Augusta Aldea-David
P17 Efficacy of prophylactic antiretroviral treatment in new-born infants from HIV-positive mothers in 2012-2014, for the North-Eastern part of Romania
Carmen Manciuc, Cristina Nicolau, Liviu Prisăcariu, Alexandra Largu
P18 Surveillance of mother to child transmission of HIV in Romania – 31 December 2015
Mariana Mărdărescu, Adrian Streinu-Cercel, Cristina Petre, Marieta Iancu, Sanda Vintilă, Daniela Vitelaru, Iosif Ionel, Claudiu Mihai Șchiopu, Alexandra-Henriette Mărdărescu
P19 The antiretroviral therapy failure and the need to select the effective treatment in the Republic of Moldova
Pavel Micsanschi, Tiberiu Holban, Ina Bîstrițchi, Lucia Pârțână, Angela Nagîț, Svetlana Popovici, Maria Talmaci, Irina Cucerova
P20 Disseminated cryptococcosis in a patient with C3 HIV stage and multiresistant to antiretroviral therapy with lethal evolution
Sorina Georgiana Mitrescu, Dana Mihalcea, Iulia Caramangiu, Ovidiu Roșca, Iosif Maricu
P21 Aspects of tuberculosis infection in HIV-positive patients from Romania – our experience
Anca Negru, Daniela Munteanu, Victoria Aramă, Raluca Mihăilescu, Ioan Diaconu, Remulus Catana, Cristina Popescu, Alina Orfanu, Anca Leuștean, Mihaela Rădulescu, Cătălin Tilișcan, Raluca Năstase, Violeta Molagic, Irina Duport, Cristina Dragomirescu, Ștefan Sorin Aramă
P22 Dyslipidemia in HIV-infected patients
Nicoleta M Negruț
P23 Challenges in the management of an HIV seropositive patient with psoriasis undergoing immunomodulator therapy
Violeta Elena Niță, Daniela Ioana Munteanu, Raluca Mihăilescu, Ioan Diaconu, Anca Negru, Cristina Popescu, Victoria Aramă
P24 Acute peritonitis as a sign of IRIS in an HIV-infected patient with MAC latent infection
Alina Orfanu, Cristina Popescu, Anca Leuștean, Anca Negru, Remulus Catana, Ioan Diaconu, Cătălin Tilișcan, Victoria Aramă, Sorin Ștefan Aramă
P25 The virologic outcome of the treatment of chronic hepatitis B among HIV co-infected patients on HAART
Ivana Pesic Pavlovia, Dubravka Salemovic, Jovan Ranin, Djordje Jevtovic
P26 A case of HIV encephalopathy with aphasia, agnosia, apraxia and right homonymous hemianopsia
Ovidiu Roșca, Andreea Ardeleanu, Iulia Caramangiu, Daniela Desaga, Valerica Bică, Sorina Mitrescu, Iosif Marincu
P27 Molecular footprints on human immunodeficiency virus -1 genome and association with phylogenetic clustering among subtype B infected patients in Serbia
Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Djordje Jevtovic, Ivana Pesic-Pavlovic, Jovan Ranin, Marija Todorovic , Maja Stanojevic
P28 Neurosyphilis and human immunodeficiency virus infection: double challenge
Nina-Ioana Șincu, Anca Georgescu, Brândușa Țilea, Iringo Zaharia Kezdi, Andrea Incze, Cristina Gârbovan, Carmen Lucia Chiriac
P29 Differences between HIV-infected adults since childhood and non HIV-infected persons on managing everyday life
Anca Elena Luca, Florin Lazăr, Adrian Luca, Luminița Ene, Roxana Rădoi, Adina Talnariu, Silvia Suciu, Cristian Achim
P30 Molecular detection of Bartonella quintana in a HIV immunodepressed patient with fever and isolated lymphadenopathy - Case report
Diana Gabriela Iacob, Dragoș Florea, Simona Iacob
P31 Present epidemiological characteristics of HIV/AIDS newly diagnosed cases in South-Eastern Romania
Manuela Arbune, Miruna Drăgănescu, Alina Iancu
P32 The gender’s preferences among opportunists?
Ruxandra Moroti, Cristian M Niculae, Simona Merisor, Eliza Manea, Serban Benea, Andrada Stan, Raluca Hrisca, Raluca Jipa, Diana Tanase, Adriana Hristea
P33 Polymorphism of interleukin-28B gene in persons with chronic hepatitis C from Croatia
Ivana Grgic, Ana Planinic, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince
doi:10.1186/s12879-016-1480-8
PMCID: PMC4928154  PMID: 27356504
24.  Human immunodeficiency virus infection, cardiovascular risk factor profile and risk for acute myocardial infarction 
Background
Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV infected (HIV+) patients. We assessed the association between HIV and incident AMI within CVDRF strata.
Methods
Cohort
81322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study-Virtual Cohort (prospective study of HIV+ and matched HIV− veterans). Veterans were followed from first clinical encounter on/after 4/1/2003 until AMI/death/last follow-up date (12/31/2009).
Predictors
HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood-pressure (BP), BP medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ non-optimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs.
Outcome
Incident AMI (defined using enzyme, EKG clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates). Statistics: Cox models adjusted for demographics, comorbidity, and substance use.
Results
858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared to HIV− veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared to HIV− veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0 95%CI: 1.0–3.9, p=0.044).
Conclusion
The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared to HIV− veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.
doi:10.1097/QAI.0000000000000419
PMCID: PMC4441201  PMID: 25588033
HIV; optimal cardiovascular health; myocardial infarction
25.  Antihelminthics in helminth-endemic areas: effects on Hiv disease progression 
Background
Helminth infections, such as soil-transmitted helminths, schistosomiasis, onchocerciasis, and lymphatic filariasis, are prevalent in many countries where human immunodeficiency virus (HIV) infection is also common. There is some evidence from observational studies that HIV and helminth co-infection may be associated with higher viral load and lower CD4+ cell counts. Treatment of helminth infections with antihelminthics (deworming drugs) may have benefits for people living with HIV beyond simply clearance of worm infections.
This is an update of a Cochrane Review published in 2009 and we have expanded it to include outcomes of anaemia and adverse events.
Objectives
To evaluate the effects of deworming drugs (antihelminthic therapy) on markers of HIV disease progression, anaemia, and adverse events in children and adults.
Search methods
In this review update, we searched online for published and unpublished studies in the Cochrane Library, MEDLINE, EMBASE, CENTRAL, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICRTP), ClinicalTrials.gov, and the WHO Global Health Library up to 29 September 2015. We also searched databases listing conference abstracts, scanned reference lists of articles, and contacted the authors of included studies.
Selection criteria
We searched for randomized controlled trials (RCTs) that compared antihelminthic drugs with placebo or no intervention in HIV-positive people.
Data collection and analysis
Two review authors independently extracted data and assessed trials for eligibility and risk of bias. The primary outcomes were changes in HIV viral load and CD4+ cell count, and secondary outcomes were anaemia, iron deficiency, adverse events, and mortality events. We compared the effects of deworming using mean differences, risk ratios (RR), and 95% confidence intervals (CIs). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Main results
Eight trials met the inclusion criteria of this review, enrolling a total of 1612 participants. Three trials evaluated the effect of providing antihelminthics to all adults with HIV without knowledge of their helminth infection status, and five trials evaluated the effects of providing deworming drugs to HIV-positive individuals with confirmed helminth infections. Seven trials were conducted in sub-Saharan Africa and one in Thailand.
Antihelminthics for people with unknown helminth infection status
Providing antihelminthics (albendazole and praziquantel together or separately) to HIV-positive adults with unknown helminth infection status may have a small suppressive effect on mean viral load at six weeks but the 95% CI includes the possibility of no effect (difference in mean change −0.14 log10 viral RNA/mL, 95% CI −0.35 to 0.07, P = 0.19; one trial, 166 participants, low quality evidence).
Repeated dosing with deworming drugs over two years (albendazole every three months plus annual praziquantel), probably has little or no effect on mean viral load (difference in mean change 0.01 log10 viral RNA, 95% CI: −0.03 to −0.05; one trial, 917 participants, moderate quality evidence), and little or no effect on mean CD4+ count (difference in mean change 2.60 CD4+ cells/µL, 95% CI −10.15 to 15.35; P = 0.7; one trial, 917 participants, low quality evidence).
Antihelminthics for people with confirmed helminth infections
Treating confirmed helminth infections in HIV-positive adults may have a small suppressive effect on mean viral load at six to 12 weeks following deworming (difference in mean change −0.13 log10 viral RNA, 95% CI −0.26 to −0.00; P = 0.04; four trials, 445 participants, low quality evidence). However, this finding is strongly influenced by a single study of praziquantel treatment for schistosomiasis. There may also be a small favourable effect on mean CD4+ cell count at 12 weeks after deworming in HIV-positive populations with confirmed helminth infections (difference in mean change 37.86 CD4+ cells/µL, 95% CI 7.36 to 68.35; P = 0.01; three trials, 358 participants, low quality evidence).
Adverse events and mortality
There is no indication that antihelminthic drugs impart additional risks in HIV-positive populations. However, adverse events were not well reported (very low quality evidence) and trials were underpowered to evaluate effects on mortality (low quality evidence).
Authors' conclusions
There is low quality evidence that treating confirmed helminth infections in HIV-positive adults may have small, short-term favourable effects on markers of HIV disease progression. Further studies are required to confirm this finding. Current evidence suggests that deworming with antihelminthics is not harmful, and this is reassuring for the routine treatment of confirmed or suspected helminth infections in people living with HIV in co-endemic areas.
Further long-term studies are required to make confident conclusions regarding the impact of presumptively deworming all HIV-positive individuals irrespective of helminth infection status, as the only long-term trial to date did not demonstrate an effect.
Antihelminthics in helminth endemic areas: effects on HIV infection
This Cochrane Review summarizes trials that evaluated the benefits and potential risks of providing deworming drugs (antihelminthics) to people infected with human immunodeficiency virus (HIV). After we searched for relevant trials up to 29 September 2015 we included eight trials that enrolled 1612 participants.
What are deworming drugs and why might they delay HIV disease progression
Deworming drugs are used to treat a variety of human helminth infections, such as soil-transmitted helminths, schistosomiasis, onchocerciasis, and lymphatic filariasis. In areas where these infections are common, the World Health Organization currently recommends that targeted populations are routinely treated every six to 12 months without prior confirmation of an individual's infection status. The use of empiric therapy, or treating all at-risk populations presumptively, is preferred to test-and-treat strategies because deworming drugs are inexpensive and well tolerated. Additionally, a strategy of testing before treatment is considered less cost-effective given that available diagnostic tests are relatively expensive and can exhibit poor sensitivity.
Helminth infections are known to affect the human immune system. In people with HIV, some studies have suggested that helminth infections may reduce the number of CD4+ cells (which are a critical part of the immune response to HIV) and compromise a person's ability to control HIV viral replication. Thus, treatment of helminth infections could have important benefits for people living with HIV beyond the benefits observed in the general population as a result of deworming.
What the evidence in this review suggests
Treating all HIV-positive adults with deworming drugs without knowledge of their helminth infection status may have a small suppressive effect on viral load at six weeks (low quality evidence), but repeated dosing over two years appears to have little or no effect on either viral load (moderate quality evidence) or CD4+ cell count (low quality evidence). These findings are based on two included studies.
Providing deworming drugs to HIV-positive adults with diagnosed helminth infection may result in a small suppressive effect on mean viral load at six to 12 weeks (low quality evidence) and a small favourable effect on mean CD4+ cell count at 12 weeks (low quality evidence). However, these findings are based on small studies and are strongly influenced by a single study of praziquantel for schistosomiasis. Further studies from different settings and populations are needed for confirmation.
Adverse events were not well reported (very low quality evidence), and trials were too small to evaluate the effects on mortality (low quality evidence). However there is no suggestion that deworming drugs are harmful for HIV-positive individuals.
doi:10.1002/14651858.CD006419.pub4
PMCID: PMC4963621  PMID: 27075622

Results 1-25 (1520875)