13 research outputs found
Population-Based Hematologic and Immunologic Reference Values for a Healthy Ugandan Population
To assess the validity of the reference values for hematologic and immunologic indices currently used in Africa, we evaluated blood samples from 3,311 human immunodeficiency virus (HIV)-negative Ugandans aged 1 week to 92 years. Erythrocyte, hemoglobin, and hematocrit levels and mean corpuscular volume all significantly increased with age (P < 0.001) and were independent of gender until the age of 13 years, after which the levels were higher in males than in females (P < 0.001). White blood cell, neutrophil, lymphocyte, basophil, and monocyte counts significantly declined with age until the age of 13 years (P < 0.001), with no differences by gender, while platelet counts declined with age (P < 0.001) and showed differences by gender only among adults older than age 24 years. CD4(+)- and CD8(+)-cell counts declined with age until the age of 18 years; thereafter, females had higher counts than males. The absolute values for many of these parameters differed from those reported for populations outside Africa, suggesting that it may be necessary to develop tables of reference values for hematologic and immunologic indices specific for the African population. This may be particularly important with regard to CD4(+)-cell counts among children because significant differences in absolute and percent CD4(+)-cell counts exist between the values for Western populations and the values for the population evaluated in our study. These differences could influence the decision to initiate antiretroviral therapy among children infected with HIV
Transmission of drug-resistant HIV-1 in Europe remains limited to single classes
Background: The spread of drug-resistant HIV-1 might compromise the future success of current first-line regimens.status: publishe
Transmission of drug-resistant HIV-1 in Europe remains limited to single classes
Background: The spread of drug-resistant HIV-1 might compromise the
future success of current first-line regimens.
Objective: To analyse the extent and impact of transmission of
drug-resistant HIV-1 variants in Europe.
Design and methods: The European prospective programme (SPREAD)
collected demographic, clinical and virological data from 1245 HIV-1
-infected individuals in 17 countries diagnosed in 2002-2003. The
potential impact of transmitted drug resistance mutations (TDRMs) on
therapy response was determined by using genotypic interpretation
algorithms.
Results: The overall prevalence of viruses with drug-resistance
mutations was 9.1% [96/1050; 95% confidence interval: 7.5-11.1]. The
majority (71 %) harboured only a single amino acid substitution with
limited effect on predicted drug susceptibility. Mutations associated
with resistance to nucleoside reverse transcriptase inhibitors were
observed most frequently [57/1050 (5.4%)], followed by mutations
related to protease inhibitors [32/1050 (3.0%)] and mutations related
to non-nucleoside reverse transcriptase inhibitors (NNRTIs) [27/1050
(2.6%)]. In some cases, however, resistance was quite extensive. Four
individuals were infected with viruses with reduced susceptibility to
all nucleoside reverse transcriptase inhibitors, 3 to all protease
inhibitors and 20 to both NNRTIs. Remarkably, in one individual, the
resistance pattern was so extensive that none of the available current
antiretroviral drugs was predicted to be fully active.
Conclusion: The prevalence of TDRM-HIV is quite prominent (9.1%) but
did not increase in comparison with a large retrospective European
study. Particularly the presence of single NNRTI mutations may impact
the efficacy of the first-line regimens. Continuous prospective
monitoring remains indicated to explore the patterns and factors
contributing to the transmission of TDRMs as well as the potential
clinical consequences. (C) 2008 Wolters Kluwer Health Lippincott
Williams & Wilkin
Patterns of Transmitted HIV Drug Resistance in Europe Vary by Risk Group
BACKGROUND:
In Europe, a continuous programme (SPREAD) has been in place for ten years to study transmission of drug resistant HIV. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported.
METHODS:
HIV-1 patients newly diagnosed in 27 countries from 2002 through 2007 were included. Inclusion was representative for risk group and geographical distribution in the participating countries in Europe. Trends over time were calculated by logistic regression.
RESULTS:
From the 4317 patients included, the majority was men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals (1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more often from Western Europe origin, infected with subtype B virus, and recently infected (<1 year) (p<0.001). The prevalence of TDRM was highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%) and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant increase in resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in heterosexual patients (p = 0.68 and p = 0.14, respectively).
CONCLUSIONS:
MSM showed to have significantly higher TDRM prevalence compared to heterosexuals and IDU. The increasing NNRTI resistance in MSM is likely to negatively influence the therapy response of first-line therapy, as most include NNRTI drugs.status: publishe
Patterns of Transmitted HIV Drug Resistance in Europe Vary by Risk Group
Background: In Europe, a continuous programme (SPREAD) has been in place
for ten years to study transmission of drug resistant HIV. We analysed
time trends of transmitted drug resistance mutations (TDRM) in relation
to the risk behaviour reported.
Methods: HIV-1 patients newly diagnosed in 27 countries from 2002
through 2007 were included. Inclusion was representative for risk group
and geographical distribution in the participating countries in Europe.
Trends over time were calculated by logistic regression.
Results: From the 4317 patients included, the majority was
men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals
(1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more
often from Western Europe origin, infected with subtype B virus, and
recently infected (<1 year) (p<0.001). The prevalence of TDRM was
highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%)
and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside
reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in
MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant
increase in resistance to non-nucleoside reverse transcriptase
inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors
was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in
heterosexual patients (p = 0.68 and p = 0.14, respectively).
Conclusions: MSM showed to have significantly higher TDRM prevalence
compared to heterosexuals and IDU. The increasing NNRTI resistance in
MSM is likely to negatively influence the therapy response of first-line
therapy, as most include NNRTI drugs
Transmission of Drug-Resistant HIV-1 Is Stabilizing in Europe
The SPREAD Programme investigated prospectively the time trend from
September 2002 through December 2005 of transmitted drug resistance
(TDR) among 2793 patients in 20 European countries and in Israel with
newly diagnosed human immunodeficiency virus type 1 (HIV-1) infection.
The overall prevalence of TDR was 8.4% (225 of 2687 patients; 95%
confidence interval [CI], 7.4%-9.5%), the prevalence of nucleoside
reverse-transcriptase inhibitor (NRTI) resistance was 4.7% (125 of 2687
patients; 95% CI, 3.9%-5.5%), the prevalence of nonucleoside
reverse-transcriptase inhibitor (NNRTI) resistance was 2.3% (62 of 2687
patients; 95% CI, 1.8%-2.9%), and the prevalence of protease
inhibitor (PI) resistance was 2.9% (79 of 2687 patients; 95% CI,
2.4%-3.6%). There was no time trend in the overall TDR or in NRTI
resistance, but there was a statistically significant decrease in PI
resistance (P = .04) and in NNRTI resistance after an initial increase
(P = .02). We found that TDR appears to be stabilizing in Europe,
consistent with recent reports of decreasing drug resistance and
improved viral suppression in patients treated for HIV-1 infection