Marked improvement in survival among adult Croatian AIDS patients after the introduction of highly active antiretroviral treatment

We compared the survival of patients following the first AIDS event in Croatia from the period 1986-1996 to the period 1997-2000. A total of 72 (81.8%) out of 88 patients from 1986-1996 and 18 (32.1%) out of 56 from 1997-2000 died. Survival following the first AIDS-defining illness markedly improved in the period 1997-2000 compared to the period 1986-1996 (adjusted Hazard Ratio (HR) for patients surviving more than 6 months: 0.11, 95% confidence interval (95% CI) = 0.04-0.29). A CD4+ cell count of < 100 x 10(6)/L was an independent risk factor for patients surviving up to 2 years (adjusted HR = 1.96, 95% CI = 1.1-3.43, p = 0.02). Patients with tuberculosis or fungal infections had a longer survival when compared to other diagnosis (adjusted HR = 0.53, 95% CI = 0.32-0.90, p = 0.01). However, despite dramatic survival benefit of combination antiretroviral therapy, mortality at six months following the first AIDS event was similar in the two study periods and the one-year probability of death was still substantial (27.2%) in the period 1997-2000

Dilated Cardiomyopathy in an Adult Human Immunodeficinecy Virus Type 1-Infected Patient Treated with an Abacavir-Containing Antiretroviral Regimen

Bolesnik zaražen HIV-om, star 54 godine, razvio je srčano zatajenje. Ehokardiografski nalaz je pokazao da se radi o dilatativnoj kardiomiopatiji (DKM), sve četiri srčane komore bile su proširene uz nisku ejekcijsku frakciju lijevog ventrikla od 20%. Radilo se o bolesniku koji je 31 mjesec ranije započeo s antiretrovirusnim liječenjem, kombinacijom lijekova koja je sadržavala abakavir, bez prethodno provedenog HLA-B*5701 testiranja. Tijekom uzimanja antiretrovirusnih lijekova, nije bilo znakova sistemne reakcije preosjetljivosti te je nastavljena primjena abakavira i nakon što se saznalo da je bolesnik pozitivan na alel HLA B*5701. U vrijeme DKM bolesnik je imao nemjerljivu HIV viremiju, a broj njegovih CD4 limfocita je bio 669/μL krvi. Bolesnik je liječen uobičajenom terapijom za zatajenje srca, a abakavir je bio zamijenjen raltegravirom što je polučilo zadovoljavajući klinički učinak. Tijekom sljedećih mjeseci, njegova srčana funkcija se postupno oporavljala, a nakon dvije godine bolesnikov je oporavak bio potpun. Naš prikaz upućuje na mogućnost povezanosti primjene abakavira s dilatativnom kardiomiopatijom u bolesnika s dobro kontroliranom HIV infekcijom.A54-year-old adult human immunodeficiency virus type 1 (HIV-1) infected patient developed cardiac failure. Echocardiographic findings were consistent with dilated cardiomyopathy (DCM); 4-chamber dilatation and a low left ventricular ejection fraction of 20% were present. The patient was given an abacavir-containing antiretroviral drug combination 31 months ago without HLA- B*5701 testing. There was no systemic hypersensitivity reaction and abacavir was not changed when it became known that he was positive for the HLA-B*5701 allele. At the time of DCM the patient had an undetectable viral load and his CD4 cell count was 669/μL. The patient was given standard treatment for heart failure and abacavir was replaced with raltegravir. In the following months his cardiac function gradually improved and after two-years his recovery was complete. Our case report suggests that abacavir could be associated with DCM in patients with well controlled HIV-infection

Progressive multifocal leukoencephalopathy (PML) in HIV-infected patients – a case report and review of patients treated at the University Hospital for Infectious Diseases in Zagreb

U četrdesetogodišnje bolesnice s postupnim i progresivnim razvojem neuroloških simptoma dijagnosticirana je HIV-bolest uz veoma izraženu imunodeficijenciju. Na temelju neuroloških simptoma (motorni deficiti, kognitivni poremećaji, poremećaji govora, vida, tonusa muskulature, smetnje koordinacije) te slikovnih radioneuroloških tehnika postavljena je klinička dijagnoza progresivne multifokalne leukoencefalopatije (PML). Naknadno je dijagnoza PML potvrđena pozitivnim nalazom reakcije lančane polimeraze (PCR) na JC virus u likvoru. Bolesnica je liječena antiretrovirusnim lijekovima uz ostalu simptomatsku i suportivnu terapiju. Unatoč određenom poboljšanju laboratorijskih parametara stečene imunodeficijencije na provedeno liječenje tijekom pet mjeseci bolest je nezadrživo napredovala do smrtnog ishoda. Do sada je u 20-godišnjem razdoblju u našoj Klinici liječeno ukupno 11 bolesnika s HIV-bolešću u kojih je na temelju kliničko-neuroloških manifestacija i neuroradioloških pretraga postavljena dijagnoza PML. Detalji su prikazani u tablici 2. U spomenutom slučaju po prvi put je u Hrvatskoj etiološka dijagnoza potvrđena dokazom JC virusa u cerebrospinalnom likvoru.HIV-infection with advanced immunodeficiency was diagnosed in a forty-year-old female patient with gradual and progressive development of neurological symptoms. Based on neurological symptoms (cognitive and motor deficits, speech, vision and muscular tonus disorders, coordination disturbances) as well as neuroradiological imaging, progressive multifocal leukoencephalopathy (PML) was diagnosed. Subsequently, the diagnosis of PML was confirmed with positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for JC virus. The patient was treated with antiretroviral drugs together with other symptomatic and supportive therapy. Despite somewhat improved laboratory parameters of acquired immunodeficiency after five-month therapy, the disease continued to progress and resulted in fatal outcome. In the last 20 years, altogether 11 HIV-infected patients were diagnosed with PML in our hospital based on clinical/neurological manifestations and neuroradiologic imaging findings. The details are presented in Table 2. In described case, for the first time in Croatia, the etiological diagnosis was confirmed with JC virus detection in the CSF

Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy

Aim To compare four cardiovascular disease (CVD) risk models and to assess the prevalence of eligibility for lipid lowering therapy according to the 2013 American College of Cardiology/ American Heart Association (ACC/AHA) guidelines, European AIDS Clinical Society Guidelines (EACS), and European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS) guidelines for CVD prevention in HIV infected patients on antiretroviral therapy. Methods We performed a cross-sectional analysis of 254 consecutive HIV infected patients aged 40 to 79 years who received antiretroviral therapy for at least 12 months. The patients were examined at the HIV-treatment centers in Belgrade and Zagreb in the period February-April 2011. We compared the following four CVD risk models: the Framingham risk score (FRS), European Systematic Coronary Risk Evaluation Score (SCORE), the Data Collection on Adverse Effects of Anti-HIV Drugs study (DAD), and the Pooled Cohort Atherosclerotic CVD risk (ASCVD) equations. Results The prevalence of current smoking was 42.9%, hypertension 31.5%, and hypercholesterolemia (>6.2 mmol/L) 35.4%; 33.1% persons were overweight, 11.8% were obese, and 30.3% had metabolic syndrome. A high 5-year DAD CVD risk score (>5%) had substantial agreement with the elevated (≥7.5%) 10-year ASCVD risk equation score (kappa = 0.63). 21.3% persons were eligible for statin therapy according to EACS (95% confidence intervals [CI], 16.3% to 27.4%), 25.6% according to ESC/EAS (95% CI, 20.2% to 31.9%), and 37.9% according to ACC/AHA guidelines (95% CI, 31.6 to 44.6%). Conclusion In our sample, agreement between the high DAD CVD risk score and other CVD high risk scores was not very good. The ACC/AHA guidelines would recommend statins more often than ESC/EAS and EACS guidelines. Current recommendations on treatment of dyslipidemia should be applied with caution in the HIV infected population

Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy

BACKGROUND: Although considered an essential tool for monitoring the effect of combination antiretroviral treatment (CART), HIV-1 RNA (viral load, VL) testing is greatly influenced by cost and availability of resources. ----- OBJECTIVES: To examine whether HIV infected patients who were initially successfully treated with CART have less frequent monitoring of VL over time and whether CART failure and other HIV-disease and sociodemographic characteristics are associated with less frequent VL testing. ----- METHODS: The study included patients who started CART in the period 1999-2004, were older than 18 years, CART naive, had two consecutive viral load measurements of <400 copies/ml after 5 months of treatment and had continuous CART during the first 15 months. The time between two consecutive visits (days) was the outcome and associated factors were assessed using linear mixed models. ----- RESULTS: We analyzed a total of 128 patients with 1683 visits through December 2009. CART failure was observed in 31 (24%) patients. When adjusted for the follow-up time, the mean interval between two consecutive VL tests taken in patients before CART failure (155.2 days) was almost identical to the interval taken in patients who did not fail CART (155.3 days). On multivariable analysis, we found that the adjusted estimated time between visits was 150.9 days before 2003 and 177.6 in 2008/2009. A longer time between visits was observed in seafarers compared to non-seafarers; the mean difference was 30.7 days (95% CI, 14.0 to 47.4; p<0.001); and in individuals who lived more than 160 kilometers from the HIV treatment center (mean difference, 16 days, p=0.010). ----- CONCLUSIONS: Less frequent monitoring of VL became common in recent years and was not associated with failure. We identified seafarers as a population with special needs for CART monitoring and delivery

Validation study of mHealth technology in HIV to improve empowerment and healthcare utilisation: research and innovation to generate evidence for personalised care (EmERGE)

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