Gloria Huerta-García

Dyslipidemia and Fasting Glucose Impairment among HIV-InfectedPatients 48-Weeks after the First Antiretroviral Regimen

Background: People infected with human immunodeficiency virus (HIV) develop lipid and glucose metabolic alterations, which predisposes them to cardiovascular disease. The aim of this study was to evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment after 48 weeks of initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen. Method: Retrospective cohort of HIV-1 infected patients attending in the AIDS clinic of five centers of the country, between February 2009 and March 2013. Lipids (total cholesterol and triglycerides) and fasting glucose, were collected prior and 48 weeks after starting ART. We assessed risk factors for dyslipidemia and fasting glucose. To adjust for the effects of potential confounders of metabolic alterations we used logistic regression model. Results: During the study, 223 patients on ART were evaluated. Median age was 34 years [interquartile range (IQR): 28-43]. Of the total patients, 201 (90%) were men. Most common OBR regimens were tenofovir/emtricitabine (TDF/FTC), and efavirenz (EFV) in 42%, abacavir/lamivudine (ABC/3TC) +EFV in 16.6% and TDF/FTC+nevirapine (NVP) in 11.7% patients. Cumulative incidence per 1,000 patients/year of glucose ≥ 100 mg/dL was 233.1, total cholesterol >200 mg/dL was 273.5 and tryglicerides >200 mg/dL was 372.2. The proportion of patients with hypertriglyceridemia (>200 mg/dL) at 48 weeks of ART initiation was 37.2% (95% CI: 31.1-43.7%), hypercholesterolemia (>200 mg/dL) 32.3% (95% CI: 26.5-38.6%) and impairment of fasting glucose (IFG) (>100 mg/dL) 23.3% (95% CI: 18.2-29.2%), After adjustment in a logistic regression model for IFG, EFV-containing regimen OR 2.9 (95%CI 1.12-7.45); p=0.027; for hypertriglyceridemia, age >40 years old OR=1.9 (95% CI: 1.01-3.63); p=0.044, ABC/LAM-containing regimen OR=2.69 (95% CI: 1.42-5.09); p=0.002 and LPV/r-containing regimen OR=5.04 (95% CI 2.32-10.92); p=0.001 were significant; finally, for hypercholesterolemia age >40 years old OR=2.4 (95% CI: 1.15- 4.9); p=0.004 and ABC/3TC-containing regimen OR=1.87 (95% CI: 1.01-3.49); p=0.05 remain significant. Conclusion: These data show high risk of cumulative incidence of IFG and dyslipidemia after initiation of ART. Age >40 years old, ABC/3TC and LPV/r-containing regimens were independent factors to develop dyslipidemia and EFV-containing regimen for IFG in this cohort.

Genotype-guided antiretroviral regimens in children with multidrug-resistant HIV-1 infection

Background:Genotyping tests were developed to attenuate the impact of viral resistance. Information about the efficacy in genotype base antiretroviral therapy in children is rare and even more in low- and middle-income countries.Methods:Sixteen children with antiretroviral therapy (ART) failure and triple-class drug-resistant viruses were included in this study. Protease and retrotranscriptase genotypes were available for all patients. Switch of ART regimen was guided by genotyping data. The primary end point was virological suppression (<50 copies/ml) and immunological improvement after 48 wk of treatment with the new ART regimen.Results:The median age of the patients was 14.5 y (interquartile range (IQR) 11–16.5). Median HIV-1 RNA viral load was 4.2 log10 (IQR: 3.4–4.8). The primary end point was found in 11 children (69%), and 13 children (81%) had an HIV-1 RNA viral load <200 copies/ml. Median (IQR) for the baseline CD4+ cell count was 382 cells/μl (281–686 cells/μl), whereas after 48 wk of treatment with the new ART regimen, it was 640 cells/μl (361–936 cells/μl) (P < 0.001).Conclusion:Darunavir/ritonavir, raltegravir, and etravirine were well tolerated in the present pediatric population. These drugs provide good options for children exposed to extensive ART. Regimens guided by genotyping data were effective for children who had ART failure and multidrug-resistant HIV-1 infection.

Anal intraepithelial neoplasia among HIV-positive men who have sex with men

Neoplasia is the second most common cause of mortality in HIV patients. The prevalence of anal cancer among men who have sex with men (MSM) has continued to increase since the introduction of antiretroviral therapy. We screened 94 HIV-infected MSM patients. We found high-grade squamous intraepithelial lesions (HSIL) in six of the patients. The calculated prevalence of HSIL was 6.4% (95% confidence interval: 2.9-13.2). The study and implementation of screening programs for high-risk groups is a priority.

Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico

Our objective was to determine the seroprevalence of syphilis among HIV-infected patients in a tertiary care hospital in Mexico City. A cross-sectional study was developed, and 318 HIV-positive patients were evaluated from January to February 2013 at Hospital de Infectología, National Medical Center ‘La Raza’ (a tertiary care hospital specialising in infectious diseases in Mexico City). Laboratory data were screened for the detection of antibodies against Treponema pallidum. Patients completed a questionnaire relating to socio-demographic data and factors associated with syphilis. Of the 318 patients, 83% were men. The mean age ± SD was 36 ± 11 years; 52% were men who have sex with men and 47% had undertaken higher education. The overall seroprevalence of syphilis among these patients was 25% (95% confidence interval 21%, 30%). Men who have sex with men had a significantly higher seroprevalence (30% vs. 15%, p = 0.009). We conclude that, in Mexico, there is a high seroprevalence of syphilis antibodies in HIV-infected patients and that men who have sex with men are the group most affected.