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7-oxo-DHEA enhances impaired M. tuberculosis-specific T cell responses during HIV-TB coinfection
(2020-01-06) Vecchione, María Belén; Laufer, Natalia; Omar, Sued; Corti, Marcelo; Salomon, Horacio; Quiroga, Maria Florencia
Background Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB), affecting approximately one third of the world’s population. Development of an adequate immune response will determine disease progression or progress to chronic infection. Risk of developing TB among human immunodeficiency virus (HIV)-coinfected patients (HIV-TB) is 20–30 times higher than those without HIV infection, and a synergistic interplay between these two pathogens accelerates the decline in immunological functions. TB treatment in HIV-TB coinfected persons is challenging and it has a prolonged duration, mainly due to the immune system failure to provide an adequate support for the therapy. Therefore, we aimed to study the role of the hormone 7-oxo-dehydroepiandrosterone (7-OD) as a modulator of anti-tuberculosis immune responses in the context of HIV-TB coinfection. Methods A cross-sectional study was conducted among HIV-TB patients and healthy donors (HD). We characterized the ex vivo phenotype of CD4 + T cells and also evaluated in vitro antigen-specific responses by Mtb stimulation of peripheral blood mononuclear cells (PBMCs) in the presence or absence of 7-OD. We assessed lymphoproliferative activity, cytokine production and master transcription factor profiles. Results Our results show that HIV-TB patients were not able to generate successful anti-tubercular responses in vitro compared to HD, as reduced IFN-γ/IL-10 and IFN-γ/IL-17A ratios were observed. Interestingly, treatment with 7-OD enhanced Th1 responses by increasing Mtb-induced proliferation and the production of IFN-γ and TNF-α over IL-10 levels. Additionally, in vitro Mtb stimulation augmented the frequency of cells with a regulatory phenotype, while 7-OD reduced the proportion of these subsets and induced an increase in CD4 + T-bet+ (Th1) subpopulation, which is associated with clinical data linked to an improved disease outcome. Conclusions We conclude that 7-OD modifies the cytokine balance and the phenotype of CD4 + T cells towards a more favorable profile for mycobacteria control. These results provide new data to delineate novel treatment approaches as co-adjuvant for the treatment of TB.
A Comparison of Seven Cox Regression-Based Models to Account for Heterogeneity Across Multiple HIV Treatment Cohorts in Latin America and the Caribbean
(2015-5) Giganti, Mark J.; Luz, Paula M.; Caro-Vega, Yanink; Cesar, Carina; Padgett, Denis; Koenig, Serena; Echevarria, Juan; McGowan, Catherine C; Shepherd, Bryan E
Many studies of HIV/AIDS aggregate data from multiple cohorts to improve power and generalizability. There are several analysis approaches to account for cross-cohort heterogeneity; we assessed how different approaches can impact results from an HIV/AIDS study investigating predictors of mortality. Using data from 13,658 HIV-infected patients starting antiretroviral therapy from seven Latin American and Caribbean cohorts, we illustrate the assumptions of seven readily implementable approaches to account for across cohort heterogeneity with Cox proportional hazards models, and we compare hazard ratio estimates across approaches. As a sensitivity analysis, we modify cohort membership to generate specific heterogeneity conditions. Hazard ratio estimates varied slightly between the seven analysis approaches, but differences were not clinically meaningful. Adjusted hazard ratio estimates for the association between AIDS at treatment initiation and death varied from 2.00 to 2.20 across approaches that accounted for heterogeneity; the adjusted hazard ratio was estimated as 1.73 in analyses that ignored across cohort heterogeneity. In sensitivity analyses with more extreme heterogeneity, we noted a slightly greater distinction between approaches. Despite substantial heterogeneity between cohorts, the impact of the specific approach to account for heterogeneity was minimal in our case study. Our results suggest that it is important to account for across cohort heterogeneity in analyses, but that the specific technique for addressing heterogeneity may be less important. Because of their flexibility in accounting for cohort heterogeneity, we prefer stratification or meta-analysis methods, but we encourage investigators to consider their specific study conditions and objectives.
A global call for action to include gender in research impact assessment
(2016-07-19) Ovseiko, Pavel V; Greenhalgh, Trisha; Adam, Paula; Grant, Jonathan; Hinrichs-Krapels, Saba; Graham, Kathryn E; Valentine, Pamela A; Sued, Omar; Boukhris, Omar F; Al Olaqi, Nada M; Al Rahbi, Idrees S; Dowd, Anne-Maree; Bice, Sara; Heiden, Tamika L; Fischer, Michael D; Dopson, Sue; Norton, Robyn; Pollitt, Alexandra; Wooding, Steven; Balling, Gert V; Jakobsen, Ulla; Kuhlmann, Ellen; Klinge, Ineke; Pololi, Linda H; Jagsi, Reshma; Lawton Smith, Hele; Etzkowitz, Henry; Nielsen, Mathias W; Carrion, Carme; Solans‐Domènech, Maite; Vizcaino, Esther; Naing, Lin; Cheok, Quentin HN; Eckelmann, Baerbel; Simuyemba, Moses C; Msiska, Temwa; Declich, Giovanna; Edmunds, Laurel D; Kiparoglou, Vasiliki; Buchan, Alison MJ; Williamson, Catherine; Lord, Graham M; Channon, Keith M; Surender, Rebecca; Buchan, Alastair M
Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.
A Novel Educational Strategy Targeting Health Care Workers in Underserved Communities in Central America to Integrate HIV into Primary Medical Care
(2012) Flys, Theresa; González, Ricardo; Sued, Omar; Suarez Conejero, Jose; Kestler, Eduardo; Sosa, Nelson; McKenzie-White, Jane; Monzon, Irma Irene; Torres, Carmen; Page, Kathleen
Background: Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. Methods: The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Results: Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001). The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001). A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. Conclusion: This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.
A phase 4, single-arm, open-label, pilot study of maraviroc, raltegravir and darunavir/r in HIV-1 adults with triple class failure: TERCETO study
(2012) Patterson, Patricia; Magneres, Claudia; Sued, Omar; Fink, Valeria; Figueroa, Maria Ines; Cesar, Carina; Gun, Ana; Cahn, Pedro; Krolewiecki, Alejandro J.
The purpose of this phase 4, single-arm, open-label study was to evaluate the safety, tolerability, efficacy, antiviral and immunological activity of maraviroc (MVC) in combination with raltegravir (RGV) and darunavir/r (DRV/r) in adult HIV-1 infected patients (pts) with limited treatment options. HIV-1 pts with documented virologic triple class failure or multi-drug class resistance defined as the presence of Q151 complex, 69 insertion complex and/or≥3 TAMs for NRTIs and K103N, G190S+Y181C or Y188L mutants for NNRTIs and≥3 RAMs (L10F/I/R/V; M46I/L; I54V/M/L; V82A/F/T/S; I84V; L90M) for protease inhibitors (PIs) were offered a triple drug regimen consisting of MVC 150 mg BID, RGV 400 mg BID and DRV/r 600/100 mg BID. Safety, lipid profile and virologic efficacy were evaluated at week 4, 12, 24, 36 and 48. Between January 2010 and March 2012, 27 pts were enrolled. Screening failure rate was 52% due to undetectable viral load (pVL) or non R5 tropism type (Trofile™). Despite being heavily pre-treated pts, only 26% had negative tropism test at SCR. Baseline characteristics of 13 included pts were: 77% male, median age 43 years (IQR: 40.1–48.6), 38% had a prior AIDS-defining condition. Median BSL pVL was 23,350 cps/mL (4.4 log10) (IQR: 11,236–55,785) and median CD4 was 222 cells/mm3 (IQR: 179–318). Median time on NRTIs, NNRTIs and PIs were 10.7 (8.6–13.7), 1.7 (1.3–7.6) and 5.4 (4.7–10) years respectively. Pts had received a median of 2 PIs (IQR: 2–3). 8/13 pts showed thymidine analogue-associated mutations (TAMs), and≥2 were present in 5/13. Detectable NNRTI resistance-associated mutations (RAMs) were present in 10/13 patients. 9/13 had≥4 primary PI RAMs. At 48 weeks, 2 pts had discontinued therapy (OIs related death (cryptococcal meningitis)=1, withdrawn from the study on W36 due to blips despite not achieving criteria for virologic failure=1) and the remaining pts (11/13) achieved undetectable pVL and increased CD4 in 133 cell/mm3 from BSL (IQR: 81–174.5). Median total cholesterol levels increased from 162 mg/dL (IQR: 135-188) to 215 mg/dL (IQR: 182–237) between BSL/W48; median change in cholesterol levels: 40 mg/dL (IQR: 6.5-66). Salvage therapy including MVC, RGV and DRV/r achieved sustained reductions in pVL (<50 copies/mL) through 48 weeks of therapy in this pilot study with no treatment limiting toxicity.
A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts
(2016-04-04) Althoff, Keri N; Rebeiro, Peter F; Hanna, David B; Padgett, Denis; Horberg, Michael A; Grinsztejn, Beatriz; Abraham, Alison G; Hogg, Robert; Gill, M John; Wolff, Marcelo J; Mayor, Angel; Rachlis, Anita; Williams, Carolyn; Sterling, Timothy R; Kitahata, Mari M; Buchacz, Kate; Thorne, Jennifer E; Cesar, Carina; Cordero, Fernando M; Rourke, Sean B; Sierra-Madero, Juan; Pape, Jean W; Cahn, Pedro; McGowan, Catherine
A Randomized Clinical Trial Comparing Nelfinavir Or Nevirapine Associated to Zidovudine/Lamivudine in HIV-Infected Naive Patients (The Combine Study)
(2002-07) Podzamczer, Daniel; Ferrer, Elena; Consiglio, Ezequiel; Mariá Gatell, José; Perez, Pepa; Perez, José Luis; Luna, Elena; González, Alicia; Pedrol, Enric; Lozano, Luisa; Ocaña, Imma; Llibre, Josep María; Casiró, Arnaldo; Aranda, Miquel; Barrufet, Pilar; Martínez-Lacasa, Javier; Miró, José María; Badía, Xavier; Casado, Alfonso; Lupo, Sergio; Cahn, Pedro; Maños, Manel; Estela, Jordi; The Combine Study Team (Members Listed In Appendix)
Background Non-nucleoside reverse transcriptase inhibitor-containing regimens may be a valid alternative to protease inhibitor-containing regimens for initial antiretroviral therapy, but to date few studies comparing these two strategies have been performed. Objective To evaluate the efficacy and safety of nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients. Design Randomized, open-label, multicentre trial. Setting Twelve centres in Spain (9) and Argentina (3). Patients One hundred and forty-two HIV-infected naive patients without AIDS. Interventions Patients received combivir (zidovudine 300 mg/lamivudine 150 mg, twice-daily) plus either nelfinavir (1250 mg) twice-daily (zidovudine/lamivudine/nelfinavir, n=70) or nevirapine (200 mg) twice-daily (zidovudine/lamivudine/nevirapine, n=72), and were followed for 12 months. The primary endpoint was the proportion of patients with a plasma HIV-1 RNA (pVL) of less than 200 copies/ml by PCR at 12 months. pVL of less than 20 copies/ml (PCR), changes in CD4 counts, clinical progression and adverse events were also evaluated. Efficacy was assessed using intent-to-treat (ITT) (missing=failure) and on-treatment analysis. Results At 12 months in the ITT analysis the proportion of patients with pVL below 200 copies/ml was 60% (95% CI 48.5–71.5) in the zidovudine/lamivudine/nelfinavir arm and 75% (95% CI 65–85) in the zidovudine/lamivudine/nevirapine arm (P=0.06), and the proportion below 20 copies/ml was 50% (95% CI 38.3–61.7) and 65% (95% CI 54.2–76.2), respectively (P=0.06). No differences were found when comparing the subgroup of patients with baseline pVL of more than 100 000 copies/ml. A gain of +173 and +162 CD4 cells/mm3, respectively, was observed. Zidovudine/lamivudine/nelfinavir was discontinued in 21% of patients, and zidovudine/lamivudine/ nevirapine in 25%, due to toxicity (P>0.2). Conclusions Our results suggest that zidovudine/ lamivudine/nevirapine is at least as effective as zidovudine/lamivudine/nelfinavir as first-line therapy for HIV disease.
A Randomized, Open-Label Study of a Nucleoside Analogue Reverse Transcriptase Inhibitor-Sparing Regimen in Antiretroviral-Naive HIV-Infected Patients
(2009-03) Harris, Marianne; Côté, Hélène; Ochoa, Claudia; Allavena, Clotilde; Negredo, Eugenia; Thorne, Anona; Cahn, Pedro; Raffi, Francois; Clotet, Bonaventura; Singer, Joel; Montaner, Julio; The CTN 177 Study Team
A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care
(2022-06) Sued, Omar; Cecchini, Diego; Rolón, María José; Calanni, Liliana; David, Daniel; Lupo, Sergio; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen M.; Alcaide, Maria Luisa; Rodriguez, Violeta J.; Mantero, Alejandro; Jones, Deborah L.
Background Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, p = 0·027), and self-efficacy (B = 0·063, p = 0·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted.
Abacavir Once or Twice Daily Combined With Once-Daily Lamivudine and Efavirenz for the Treatment of Antiretroviral-Naive HIV-Infected Adults: Results of the Ziagen Once Daily in Antiretroviral Combination Study
(2005-04-01) Moyle, Graeme J; DeJesus, Edwin; Cahn, Pedro; Castillo, Steve A; Zhao, Henry; Gordon, David N; Craig, Charles; Scott, Trevor R
The long intracellular half-life of abacavir (ABC) supports its once-daily use, and this would be expected to simplify treatment if ABC could be given as part of a complete once-daily regimen. A randomized double-blind clinical trial compared the efficacy and safety of 600 mg of ABC administered once daily (n = 384) versus 300 mg of ABC administered twice daily (n = 386) in combination with 300 mg of lamivudine (3TC) and 600 mg of efavirenz (EFV) administered once daily in antiretroviral-naive patients over 48 weeks. The baseline median plasma HIV-1 RNA level was 4.89 log10 copies/mL (44% with viral load >100,000 copies/mL), and the median CD4+ cell count was 262 cells/mm3. ABC administered once daily was non-inferior to the twice-daily regimen, with 66% and 68% of patients in these respective treatment arms achieving a confirmed plasma HIV-1 RNA level <50 copies/mL (95% confidence interval: −8.4%, 4.9%). The ABC once-daily and twice-daily regimens were similar with respect to infrequency of virologic failure (10% vs. 8%), emergence of resistance mutations, CD4+ cell increases from baseline (median, 188 vs. 200 cells/mm3), safety profile, and incidence of ABC-related hypersensitivity reactions (9% vs. 7%). ABC administered once daily in combination with 3TC and EFV administered once daily was non-inferior to the ABC twice-daily dosing schedule when combined with 3TC and EFV over 48 weeks. Current clinical management of HIV-1 disease necessitates use of a multidrug regimen generally including 2 nucleoside reverse transcriptase inhibitors (NRTIs) and a third agent.1 Good adherence to potent antiretroviral therapy is critical in achieving a successful outcome. High pill burdens, dosing frequencies, risk of adverse events (AEs), drug interactions, and inconvenient dietary restrictions all potentially affect adherence and, ultimately, treatment efficacy.2,3 Patient preference surveys suggest that persons with HIV may prefer compact once-daily regimens if the efficacy and tolerability of these regimens are similar to those of the twice-daily standard of care regimens.3 Some antiretroviral drugs that have half-lives suitable for administration once a day (OAD) cannot be used together because of drug interactions and dietary restrictions. An expansion in the number of antiretroviral drugs approved for OAD dosing increases the potential for OAD therapy to become the preferred initial therapy. The NRTI abacavir (ABC) has demonstrated durable efficacy as a component of numerous regimens administered at a dose of 300 mg twice daily.4-6 A multidrug combination of 300 mg of ABC administered twice daily with lamivudine (3TC) and efavirenz (EFV) has been compared with 300 mg of zidovudine (ZDV) administered twice daily with 3TC and EFV and has resulted in similarly potent and durable virologic suppression (<50 copies/mL), superior CD4+ cell recovery, and good tolerability, including an improved hematologic profile over 48 weeks.7 Recent pharmacokinetic studies in HIV-1-infected adults have shown that the active drug moiety of ABC, carbovir triphosphate (CBV-TP), has a long intracellular half-life (>20 hours) that would support OAD dosing of 600 mg of ABC.8-10 A small clinical study in which 600 mg of ABC administered OAD was compared with 300 mg of ABC 300 administered twice daily suggested that ABC could be administered OAD and supported further investigation of this dosing schedule.11 The Ziagen Once Daily in Antiretroviral Combination (ZODIAC) therapy study was a noninferiority clinical trial conducted over 48 weeks that compared the efficacy and safety of triple drug therapy with 600 mg of ABC administered OAD versus 300 mg of ABC administered twice daily, combined with OAD 3TC and EFV, in the treatment of antiretroviral-naive adults.
Abordaje psicológico de personas con VIH. Sistematización de la experiencia de atención psicosocial de Fundación Huésped
(Fundación Huésped, 2013) Arístegui, Inés; Pemoff, Raquel; Flighelman, Mariana; Warth, Silvia; Vergani, Franca; Zalazar, Virginia; Rapagnani, Liliana; Mercado, Arturo
Esta guía es el resultado de la experiencia adquirida, los aprendizajes alcanzados y los desafíos enfrentados, en todos estos años de trabajo, por el equipo de salud mental de Fundación Huésped. Consideramos este cuadernillo como una forma de compartir nuestra experiencia y esperamos sea una herramienta de ayuda para aquellos colegas que transitan por caminos similares. Sin embargo, no creemos que ésta sea la única forma de trabajar en esta temática. Aquí compartiremos, los que según nuestra experiencia, son algunos patrones comunes de comportamientos, sentimientos, pensamientos y situaciones que viven las personas con VIH - destacando la necesidad de atender a la individualidad de cada persona y su contexto – y el abordaje que utilizamos para atender su problemática. Es importante mencionar que las experiencias que estamos compartiendo aquí, se ajustan a la particularidad de las vivencias de las personas con VIH, más allá del marco teórico con el que cada profesional trabaje. Esta guía, elaborada desde el trabajo realizado por varios profesionales que han conformado este equipo y en colaboración con otras disciplinas, brindan un marco claro para la práctica, en un campo complejo de intervención.
Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina
(2021-02-03) Zalazar, Virginia; Frola, Claudia; Gun, Ana; Radusky, Pablo; Panis, Natalia k; Cardozo, Nadir F; Fabian, Solange; Duarte, Mariana I; Aristegui, Ines; Cahn, Pedro; Sued, Omar
Background: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. Methods: A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. Results: We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. Conclusions: Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.
Acceptability of HIV Pre-exposure Prophylaxis (PrEP) Among People Who Inject Drugs (PWID) in a Canadian Setting
(2015) Escudero, Daniel; Kerr, Thomas; Wood, Evan; Nguyen, Paul; Lurie, Mark; Sued, Omar; Marshall, Brandon
A recent clinical trial provided evidence that pre-exposure prophylaxis (PrEP) has the potential to prevent HIV infection among people who inject drugs (PWID). We examined willingness to use PrEP among HIV-negative PWID in Vancouver, Canada (n = 543) to inform PrEP implementation efforts. One third (35.4 %) expressed willingness to use PrEP, with adjusted models indicating that younger age, no regular employment, requiring help injecting, engaging in sex work, and reporting multiple recent sexual partners were positively associated with willingness to use PrEP. Although willingness to use PrEP was low, PrEP was acceptable to some PWID at heightened risk for HIV infection.
Acute HIV Seroconversion Presenting with Active Tuberculosis and Associated with High Levels of T-Regulatory Cells
(2011) Sued, Omar; Quiroga, Maria F.; Socias, Maria E.; Turk, Gabriela; Salomon, Horacio; Cahn, Pedro
A patient with well-defined acute HIV infection who developed concomitant pulmonary tuberculosis during the retroviral acute syndrome is reported here. In this patient high levels of T-regulatory cells (Tregs) and a low proliferation response to M. tuberculosis were initially detected, which normalized throughout follow-up. This case calls for the consideration of tuberculosis in patients in the early stages of HIV, and emphasizes the need for further study of the potential causal relationship between Treg cells and the risk of TB reactivation in HIV patients.
Acute meningoencephalitis due to human immunodeficiency virus type 1 infection in 13 patients: Clinical description and follow-up
(2008) Villar del Saz, Sergi; Sued, Omar; Falcó, Vicenç; Agüero, Francisco; Crespo, Manuel; Pumarola, Teresa; Curran, Andrea; Gatell, Jose; Pahissa, Alberto; Miro, Jose M.; Ribera, Esteban
The objective of this study is to describe a series of cases of severe meningitis caused by human immunodeficiency virus type 1 (HIV-1) occurring during primary infection or after antiretroviral treatment interruption. In an observational cohort study, 13 patients with clinical diagnosis of meningitis or meningoencephalitis were reviewed. Ten cases occurred during primary HIV-1 infection and 3 after antiretroviral therapy (ART) withdrawal. Demographic parameters, clinical presentation and outcome, and laboratory and cerebrospinal fluid (CSF) parameters were recorded. The risk factor for HIV-1 infection acquisition was sexual transmission in all cases. The most frequent systemic symptoms were fever (12/13) and headeache (9/13). Among neurologic symptoms, focal signs appeared in seven patients (53.8%), confusion in six (46.2%), and agitation in five (38.5%). The median CD4 cell count was 434 cells/mm3. In all cases, CSF was a clear lymphocytaire fluid with normal glucose levels. Cranial computerized tomography was performed in seven patients, with a normal result in all of them; brain magnetic resonance in eight patients was normal in five cases and showing cortical atrophy, limbic encephalitis, and leptomeningeal enhancement in one patient each. The electroencephalographs (EEG) just showed diffuse dysfunction in three cases. ART was started in 11 patients. HIV RNA load at 12 months was <50 copies/ml in all treated patients. The 13 patients recovered without neurologic sequela. Meningitis or meningoencephalitis during primary HIV-1 infection or after ART cessation are unusual but sometimes a life-threatening manifestation. Although all patients tend to recover and the necessity of ART is not well established, some data suggest its potential benefit in these patients.
Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters
(2011) Socias, Maria E.; Sued, Omar; Laufer, Natalia; Lázaro, Maria E.; Mingrone, Hugo; Remondegui, Claudio; Figueroa, Maria Ines; Cesar, Carina; Gun, Ana; Turk, Gabriela; Bouzas, Maria B.; Kavasery, Rosanna; Krolewiecki, Alejandro J.; Perez, Hector; Salomon, Horacio; Pryluka, Damian
Background Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial. Methods Our objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients. Results Among 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively. Conclusions In Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
Adaptación del Inventario de Crecimiento Postraumático en personas con VIH de Buenos Aires, Argentina
(2023-12) Radusky, Pablo; Mikulic, Isabel M.
El crecimiento postraumático (CPT) involucra cambios psicológicos positivos resultantes de enfrentarse con circunstancias altamente desafiantes. El Inventario de Crecimiento Postraumático (ICPT) es el instrumento más difundido para su medición. Una proporción considerable de las personas con VIH experimenta algún grado de CPT como consecuencia del diagnóstico, lo que se asocia a una mejor salud mental y física. El objetivo fue adaptar el ICPT para su uso en personas con VIH del Área Metropolitana de Buenos Aires (AMBA), Argentina. Una versión preliminar, lingüística y conceptualmente equivalente a la original fue administrada a una muestra de 100 personas con VIH adultas del AMBA. El análisis factorial confirmatorio demostró que el modelo original de cinco dimensiones es el que muestra un mejor ajuste. De manera consistente con la evidencia internacional, las participantes de género femenino exhibieron puntuaciones significativamente más elevadas de CPT, lo que puede interpretarse como evidencia externa de validez. Se verificó la confiabilidad por consistencia interna de la escala y sus dimensiones mediante los coeficientes alfa y omega ordinal, obteniendo valores entre aceptables y excelentes. Esta versión del ICPT demostró adecuadas propiedades psicométricas y ajuste cultural para su uso en personas con VIH del AMBA.
AIDS 2006 and beyond
(2006-10-28) Cahn, Pedro; McClure, Craig
The International AIDS Society (IAS) commends Richard Horton (Aug 26, p 716)1 for his provocative analysis of the XVI International AIDS Conference (AIDS 2006), which took place this past August in Toronto, Canada. Critical analysis and debate—two of the hallmarks of the conference—can only strengthen our collective response to this crisis. Yet Horton's claims that the conference is “disengaged”, and that the opportunity to produce a road map for the future was “squandered”, as outlined in the ten points of his Comment, merit a response from the IAS as lead organiser of these meetings.
Análisis de la accesibilidad y la calidad de atención de la salud para la población lesbiana, gay, trans y bisexual (LGBT) en cinco regiones sanitarias de la Provincia de Buenos Aires
(Fundación Huésped; Ministerio de Salud de la Provincia de Buenos Aires, 2017) Arístegui, Inés; Lucas, Mar; Agriano, Mariel Orive; Villalba, Lucas; Cardozo, Nadir; Zalazar, Virginia; Radusky, Pablo; Pecheny, Mario; Christel, Lucas; Neer, Anahí Farji; Godoy, Gabriel; Fernández, Sandra; Mertehikian, Yasmín; Ortega, Julián; Weisbrot, Vikki; Marentes, Maxi
Antiretroviral Drugs for Preventing Mother-to-Child Transmission of HIV: A Review of Potential Effects on HIV-Exposed but Uninfected Children
(2011) Heidari, Shirin; Mofenson, Lynne; Cotton, Mark F.; Marlink, Richard; Cahn, Pedro; Katabira, Elly
Objective Antiretroviral drugs (ARVs) can prevent HIV mother-to-child transmission (PMTCT), but in utero ARV exposure may be associated with neurologic symptoms due to mitochondrial toxicity (MT). We sought to identify the currently recommended PMTCT regimen that optimally balances risks of pediatric HIV infection and neurologic MT. Design Published MTCT and MT data were used in a decision analytic model of MTCT among women in sub-Saharan Africa. Methods We investigated the HIV and MT risks associated with no ARV prophylaxis and five recommended regimens ranging from single-dose nevirapine to 3-drug ART. Sensitivity analyses varied all parameters, including infant feeding strategy and the disability of MT relative to HIV. Results Provision of no ARVs is the least effective and least toxic strategy, with 18-month HIV risk of 30.4% and MT risk of 0.2% (breastfed infants). With increasing drug number and duration, HIV risk decreases markedly (to 4.9% with 3-drug ART), but MT risk also increases (to 2.2%, also with 3-drug ART). Despite increased toxicity, 3-drug ART minimizes total adverse pediatric outcomes (HIV plus MT), unless the highest published risks are true for both HIV and MT, or the disability from MT exceeds 6.4 times that of HIV infection. Conclusions The risk of pediatric MT from effective PMTCT regimens is at least an order of magnitude lower than the risk of HIV infection associated with less effective regimens. Concern regarding MT should not currently limit the use of 3-drug ART for PMTCT where it is available.

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