41 research outputs found
An analysis of drug resistance among people living with HIV/AIDS in Shanghai, China
<div><p>Background</p><p>Understanding the mechanisms of drug resistance can facilitate better management of antiretroviral therapy, helping to prevent transmission and decrease the morbidity and mortality of people living with HIV/AIDS. However, there is little data about transmitted drug resistance and acquired drug resistance for HIV/AIDS patients in Shanghai.</p><p>Methods</p><p>A retrospective cohort study of HIV-infected patients who visited the Department of Infectious Disease from June 2008 to June 2015 was conducted in Shanghai, China. Logistic regression analysis was performed to analyze risk factors for drug resistance among HIV-infected people with virological failure. The related collected factors included patient age, gender, marital status, infection route, baseline CD4 count, antiretroviral therapy regimens, time between HIV diagnosis and initiating antiretroviral therapy. Factors with p<0.1 in the univariate logistic regression test were analyzed by multivariate logistic regression test.</p><p>Results</p><p>There were 575 subjects selected for this study and 369 participated in this research. For the antiretroviral therapy drugs, the rates of transmitted drug resistance and acquired drug resistance were significantly different. The non-nucleoside reverse transcriptase inhibitor (NNRTI) had the highest drug resistance rate (transmitted drug resistance, 10.9%; acquired drug resistance, 53.3%) and protease inhibitors (PIs) had the lowest drug resistance rate (transmitted drug resistance, 1.7%; acquired drug resistance, 2.7%). Logistic regression analysis found no factors that were related to drug resistance except marital status (married status for tenofovir: odds ratio = 6.345, 95% confidence interval = 1.553–25.921, P = 0.010) and the time span between HIV diagnosis and initiating antiretroviral therapy (≤6M for stavudine: odds ratio = 0.271, 95% confidence interval = 0.086–0.850, P = 0.025; ≤6M for didanosine: odds ratio = 0.284, 95% confidence interval = 0.096–0.842, P = 0.023; ≤6M for tenofovir: odds ratio = 0.079, 95% confidence interval = 0.018–0.350,P<0.001).</p><p>Conclusion</p><p>NNRTI had a higher DR rate compared with nucleoside reverse transcriptase inhibitor (NRTI) and PIs, consequently, LPV/r was a reasonable choice for patients with NNRTI drugs resistance in China. Only married status and a time span≤6 month between the HIV confirmed date and the time initiating antiretroviral therapy were risk factors for TDF drug resistance. Both baseline HIV-RNA load and resistance test is crucial for TDR diagnosis, and frequent monitoring of HIV-RNA load is crucial for ADR identification and intervention. Treatment adherence still plays a positive role on the outcome of ART.</p></div
Logistic Regression Analysis for All Drug Resistance Factors in the ART-experienced Group.
<p>Few participants used TDF and few participants had ≤12M between ART to DR testing, so these were not included in the logistic regression analysis for AZT drug resistance. Significant results are shown in bold.</p
TDR and ADR of ART drugs most frequently used in China.
<p>TDR and ADR of ART drugs most frequently used in China.</p
Anti-Retroviral Therapy Decreases but Does Not Normalize Indoleamine 2,3-Dioxygenase Activity in HIV-Infected Patients
<div><p>Background</p><p>Indoleamine 2,3-dioxygenase (IDO), which is mainly expressed in activated dendritic cells, catabolizes tryptophan to kynurenine and other downstream catabolites. It is known to be an immune mediator in HIV pathogenesis. The impact of anti-retroviral therapy on its activity has not been well established.</p><p>Methods</p><p>We measured systemic IDO activity (the ratio of plasma kynurenine to tryptophan) in HIV-infected patients before and after highly active antiretroviral therapy (HAART) and its association with a microbial translocation marker, soluble CD14 (sCD14).</p><p>Results</p><p>Among 76 participants, higher baseline IDO activity was associated with lower CD4<sup>+</sup> T cell counts (<i>P</i><0.05) and higher plasma sCD14 levels (<i>P</i><0.001). After 1 year of HAART, IDO activity decreased significantly (<i>P</i><0.01), but was still higher than in healthy controls (<i>P</i><0.05). The baseline IDO activity did not predict CD4<sup>+</sup> T cell recovery after 1 year of therapy. The percentages of myeloid and plasmacytoid dendritic cells were not correlated with IDO activity.</p><p>Conclusions</p><p>IDO activity is elevated in HIV-infected patients, which is partially associated with microbial translocation. HAART reduced, but did not normalize the activity of IDO.</p></div
The mean hemoglobin level among men and women according to CD4 count.
<p>The numbers of men with CD4 counts of <50, 50–199, 200–349, and ≥350 cells/mm<sup>3</sup> were 604, 474, 272, and 126, respectively. The numbers of women with CD4 counts of <50, 50–199, 200–349, and ≥350 cells/mm<sup>3</sup> were 192, 137, 98, and 45, respectively. One-way ANOVA was used to compare hemoglobin levels among patients with different CD4 count. The mean hemoglobin level showed an increasing trend with increasing CD4 count (<i>P</i><0.001 overall, men, and women).</p
The Kaplan-Meier curve analysis for the first 12 months cART modification
<p>The Kaplan-Meier curve analysis for the first 12 months cART modification</p
Clinical characteristics of study groups.
<p>IQR, interquartile range; NRTIs, nucleoside reverse transcriptase inhibitors; NNRTIs, non-nucleoside reverse transcriptase inhibitors; PIs, protease inhibitors; N/A, not available; NA, not applicable.</p