Immune recovery vitritis

Introduction Immune recovery vitritis (IRV) is symptomatic vitritis of > 1+ severity associated with inactive cytomegalovirus (CMV) retinitis. It is an opportunistic infection of the eye, in the patients who suffer from AIDS, and is treated with a highly active antiretroviral therapy (HAART). As a result of this therapy, there is an immune reconstitution in the body and inflammation of the vitreous body. Objective The aim of the study was to show the incidence of IRV in patients treated with HAART. Method A retrospective study was conducted in patients who suffered from CMV retinitis. Twenty-one were treated with HAART and had the diagnosis of CMV retinitis, as well. All of them were examined by the same ophthalmologist who peformed slit lamp examination with mydriasis and indirect ophthalmoscopy. Results Nine of 21 patients developed IRV as a complication of HAART, two had cystoid macular edema (CMO). Conclusion CMV retinitis develops when the number of CD4+ T lymphocytes drops below 50/mm3. This results in necrotic retinitis which, if untreated, leads to complete loss of vision. With the introduction of HAART, we learned that the reconstitution of immune status was achieved as well as life expectancy, but there was a dramatic decline in the opportunistic infection, including CMV retinitis, as well. With the immune reconstitution, the inflammation develops in the eye, known as IRV. Sometimes, it is necessary to treat this condition, but in the case of our patients, the inflammation was mild, and no treatment was necessary

Pharmacogenetics of antiretroviral drugs

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Long-term survival of HIV-infected patients treated with highly active antiretroviral therapy in Serbia and Montenegro

Background Highly active antiretroviral therapy (HAART) has dramatically changed the prognosis of HIV disease, even in terminally ill patients. Although these patients may survive many years after the diagnosis of AIDS if treated with HAART, some still die during treatment. Methods A retrospective study in a cohort of 481 HIV-infected patients treated with HAART between January 1998 and December 2005 was conducted to compare subgroups of long-term survivors (LTSs) and patients who died during treatment. Results A total of 48 patients survived for more than 72 months (mean 83.8 +/- standard deviation 5.6 months). Thirty patients died during treatment (mean 35.3 +/- 25.0 months), of whom nine died from non-AIDS-related causes, 18 died from AIDS-related causes, and three died as a result of HAART toxicity. Although LTSs were significantly (P=0.015) younger at HAART initiation, age below 40 years was not a predictor of long-term survival. The subgroups did not differ in the proportion of clinical AIDS cases at HAART initiation, in the prevalence of hepatitic C virus (HCV) coinfection, or in pretreatment and end-of-follow-up CD4 cell counts. In contrast, the viral load achieved during treatment was lower in the survivors (P=0.03), as was the prevalence of hepatitis B virus (HBV) coinfection (P=0.03). Usage of either protease inhibitor (PI)-containing regimens [odds ratio (OR) 9.0, 95% confidence interval (CI) 2.2-35.98, P lt 0.001] or all three drug classes simultaneously (OR 7.4, 95% CI 2.2-25.1, P lt 0.001) was associated with long-term survival. Drug holidays incorporated in structured treatment interruption (STI) were also associated with a good prognosis (OR 14.9, 95% CI 2.9-75.6, P lt 0.001). Conclusion Long-term survival was associated with PI-based HAART regimens and lower viraemia, but not with the immunological status either at baseline or at the end of follow up. STI when CD4 counts reach 350 cells/mu L, along with undetectable viraemia, was a strong predictor of long-term survival

Postexposure prophylaxis against hepatitis B, hepatitis C and human immunodeficiency virus infection in healthcare workers

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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

Lipodystrophy induced by combination antiretroviral therapy in HIV/AIDS patients: A Belgrade cohort study

Background/Aim. Highly active antiretroviral therapy (HAART) has led to dramatic reductions in mortality and morbidity of HIV/AIDS-patients. Lipodystrophy, a syndrome including peripheral fat wasting and central obesity, is well-documented side effect of HAART. The aim of this study was to evaluate the incidence of lipodystrophy, and to determine its risk ratios in a HIV/AIDS cohort. Methods. This cross-sectional study included all antiretroviral-naive HIV/AIDS patients commencing HAART from October 1, 2001 to October 1, 2010, in the HIV/AIDS Center, Institute of Infectious and Tropical Diseases, Belgrade, Serbia. Univariate and stepwise multivariate logistic regression analyses were used to determine the odds ratios (OR) with the confidence interval (CI) of 95%, in order to establish the relative risk for lipodystrophy. The Kaplan-Meier-method was used to determine the probability of development lipodystrophy over time. All statistical analyses were performed using SPSS software version using 0.05 as a p-treshold for the significance. Results. This study included 840 HIV/AIDS patients, 608 women and 232 men, followed for 5.6 ± 2.8 years. The prevalence of lipodystrophy was 69.2%. Univariate and stepwise multivariate regression analysis identified that the female gender, hepatitis C coinfection, AIDS diagnosis prior to HAART initiation, nucleoside-reverse-transcriptase-inhibitors and proteaseinhibitors based regimens had a high risk for developing lipodystrophy in HIV/AIDS-patients (OR = 1.6, 95% CI = 1.1-3.49, p = 0.04; OR = 3.31, 95% CI = 1.4 - 3.8, p < 0.01; OR = 3.7, 95% CI = 1.7 - 6.1, p < 0.01; OR = 2.1, 95% CI = 1.7 - 3.3, p < 0.01; OR = 6.1, 95% CI = 4.1 - 9.7, p < 0.01, respectively). Conclusion. Despite much greater life expectancy of HIV/AIDSpatients, treatment-related toxicities still remain a major concern. Monitoring of lipodystrophy, as side effect of HAART, is particularly important. [Projekat Ministarstva nauke Republike Srbije, br. 175024 i “European AIDS Treatment Network” (NEAT): LSHPCT - 2006-037570 within the FP 6 program

The Prognosis of Pediatric AIDS in Serbia

To determine the outcome of HIV infection in children in a resource-limited setting, a retrospective analysis of a series of 51 pediatric cases from the Serbian cohort of HIV infected patients was performed. Twenty seven patients died in the pre-HAART era, but mono/dual antiretroviral treatment had significantly (p=0.046) prolonged survival. Of the total of 24 HAART-treated patients, 10 had clinical AIDS before HAART initiation. The mean baseline CD4 cell count was 193.9 +/- 170.0/mm(3). After a mean follow-up of 72.6 +/- 44 months, a favorable response was recorded in 62.5%, treatment failure (defined as non-achievement of undetectable viremia) in 20.8%, and a discrepant virological and immunological response (achievement of undetectable viremia but without a rise in CD4 cell counts adequate for age) in 16.7% patients. No patients died, and there were only three hospital admissions after commencing HAART. Five immune restoration inflammatory syndrome episodes were recorded, of which four were due to BCG-osis. Lipodystrophy and hyperlipidemia occurred in 18.2% and 26.3% patients, respectively. We conclude that even in suboptimal facilities, the prognosis of HIV disease among children on HAART may be rather good. The metabolic syndrome seems to emerge as an important issue among long-term surviving children on HAART

Herpes zoster as an immune restoration disease in AIDS patients during therapy including protease inhibitors

A prospective study to evaluate the incidence of herpes zoster (HZ) as an immune restoration disease in patients with AIDS during highly active antiretroviral therapy (HAART) was conducted in a series of 115 patients diagnosed with AIDS initiated on HAART between 1 January 2000 and 31 July 2001. Of these, a single dermatomal HZ episode occurred in 14 (12%) patients within one and 15 months of HAART (median eight months). The HZ patients were similar to the non-HZ patients in age, sex, and HIV transmission risk factor, but had a more advanced disease. Compared with the baseline values, the viral loads significantly (P lt 0.01) decreased, while the mean CD4 + T-cell counts increased by almost four-fold (P lt 0.01) in both groups at the time of the HZ episode (or equivalent in non-HZ), but remained below 400/mL in the HZ patients. HZ during HAART is an immunopathological consequence of the improvement of the host immune response, correlating with the beginning of immune restoration

The metabolic syndrome, an epidemic among HIV-infected patients on HAART

Background: HAART has dramatically changed the prognosis of AIDS, but has led to long-term toxicities of antiretroviral drugs. A major chronic complication is the metabolic syndrome (MS), including hyperlipidemia, lipodystrophy (LD), and impaired glucose metabolism. Methods: A cross-sectional study of a series of 582 patients from the Serbian HIV/AIDS cohort, treated with HAART for a mean period of 3.3 +/- 2.1 years (range 1-10), was performed to evaluate the prevalence and risk factors for MS during HAART. Results: The prevalence of LID was 29.1%, with a 100% probability of development after 10 years of treatment. Risk factors for LD included female gender(OR 1.7, 95% CI 1.0-2.7, P = 0.02), age gt 40 (OR 1.7,95% CI 1.1-2.7, P = 0.01) and AIDS at HAART initiation (OR 1.9,95% CI 1.2-2.2, P lt 0.01), as well as prolonged usage of NRTIs (OR 2.7, 95% CI 1.6-4.5, P lt 0.01). The NNRTI-based regimens were less likely to induce LD than those PI-based (OR 1.87, 95% CI 1.2-2.9 vs. OR 3.7, 95% CI 2.3-6.1, respectively). Hyperlipidemia occurred in 47% of the patients, and was associated with male gender (OR 2.2, 95% CI 1.4-3.5, P lt 0.01) and prolonged usage of PI + NNRTI HAART (OR 3.0, 95% CI 1.8-4.9, P lt 0.01). In contrast, regimens composed of 2 NRTI + NNRTI were less likely to induce hyperlipidemia (OR 0.4, 95% CI 0.3-0.7, P = 0.03). Glucose intolerance and/or diabetes mellitus was recorded in 9.6%, if with AIDS at HAART initiation (OR 3.7, 95% CI 1.2-11.4, P lt 0.01), male gender (OR 5.2, 95% CI 1.8-15.1, P lt 0.01) and age gt 40 (OR 2.6, 95% CI 1.1-6.3, P = 0.02). Conclusion: MS seems an inevitable consequence of long-term successful HAART

Reduction of fines in recycled paper white water via cellulase enzymes

Due to the high wastepaper recyclability and water-loop system closure, packaging paper mills struggle with increased fines, causing runnability issues. Cellulase enzymes are a preferred treatment choice for the improvement of the pulp refining in stock preparation area but are not widely used or easy to introduce in the production process. Different cellulase enzymes were tested, and those with the highest activity were introduced to the white-water (WW) samples with the aim to reduce fines content as potentially new enzyme applications on the paper machine. The first portion of the study involved the development of an experiment model to find and confirm the optimal enzyme process parameters (40 °C, pH 5.7, reaction time 3 h, and 0.18% v/v enzyme addition) for laboratory made white-water. The second portion of the study included turbidity, colloidal charge, flow cytometry (FCM), and chemical oxygen demand (COD) analysis on industrial and laboratory made white-water samples at optimized process parameters. Obtained results corresponded to reduced fines content in white-water samples, which justified commercial usage of cellulase enzymes on recycled paper machine short loop and potentially increased machine runnability without negative influence on wastewater treatment plant