Maria Jose Miguez-Burbano

Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy

The increased risk of developing lung diseases in cigarette smokers has been well recognized. The association between smoking and the risk of developing pulmonary infections in HIV‐1‐infected patients, however, which has not been established, was evaluated in the present study. Twenty‐seven cases with lower respiratory infections (15 Pneumocystis carinii pneumonia (PCP), 12 TB cases) were compared with 27 age, gender, socio‐economic and HIV status‐matched patients, without history of respiratory diseases. Medical history and physical examinations were obtained every 6 months. Blood was drawn for CD4 and viral load measurements. A substantial number of HIV+ smokers who developed PCP (one‐third) had been on highly active retroviral therapy (HAART) for more than 6 months and prophylaxis had been discontinued. Multivariate analyses indicated that in HIV‐infected people, after controlling for HIV status and antiretrovirals, cigarette smoking doubled the risk for developing PCP (p =0.01). Multivariate analyses demonstrated that long‐term smoking also increased the risk (2×) of developing tuberculosis (p =0.04). Moreover, daily tobacco use seemed to attenuate by 40% the immune and virological response to antiretroviral therapies. These findings indicate that tobacco use significantly increases the risk of pulmonary diseases in HIV infected subjects and has a potential deleterious impact on antiretroviral treatment.

Impact of a Selenium Chemoprevention Clinical Trial on Hospital Admissions of HIV-Infected Participants

Abstract Purpose: To evaluate the impact of selenium chemoprevention (200μg/day) on hospitalizations in HIV-positive individuals. Method: Data were obtained from 186 HIV+ men and women participating in a randomized, double-blind, placebo-controlled selenium clinical trial (1998-2000). Supplements were dispensed monthly, and clinical evaluations were conducted every 6 months. Inpatient hospitalizations, hospitalization costs, and rates of hospitalization were determined 2 years before and during the trial. Results: At enrollment, no significant differences in CD4 cell counts or viral burden were observed between the two study arms. Fewer placebo-treated participants were using antiretrovirals (p < .05). The total number of hospitalizations declined from 157 before the trial to 103 during the 2 year study. A marked decrease in total admission rates (RR = 0.38; p = .002) and percent of hospitalizations due to infection/100 patients for those receiving selenium was observed (p = .01). As a result, the cost for hospitalization decreased 58% in the selenium group, compared to a 30% decrease in the placebo group (p = .001). In the final analyses, selenium therapy continued to be a significant independent factor associated with lower risk of hospitalization (p = .001). Conclusion: Selenium supplementation appears to be a beneficial adjuvant treatment to decrease hospitalizations as well as the cost of caring for HIV-1--infected patients.PURPOSE To evaluate the impact of selenium chemoprevention (200 microg/day) on hospitalizations in HIV-positive individuals. METHOD Data were obtained from 186 HIV+ men and women participating in a randomized, double-blind, placebo-controlled selenium clinical trial (1998-2000). Supplements were dispensed monthly, and clinical evaluations were conducted every 6 months. Inpatient hospitalizations, hospitalization costs, and rates of hospitalization were determined 2 years before and during the trial. RESULTS At enrollment, no significant differences in CD4 cell counts or viral burden were observed between the two study arms. Fewer placebo-treated participants were using antiretrovirals (p <.05). The total number of hospitalizations declined from 157 before the trial to 103 during the 2 year study. A marked decrease in total admission rates (RR = 0.38; p =.002) and percent of hospitalizations due to infection/100 patients for those receiving selenium was observed (p =.01). As a result, the cost for hospitalization decreased 58% in the selenium group, compared to a 30% decrease in the placebo group (p =.001). In the final analyses, selenium therapy continued to be a significant independent factor associated with lower risk of hospitalization (p =.001). CONCLUSION Selenium supplementation appears to be a beneficial adjuvant treatment to decrease hospitalizations as well as the cost of caring for HIV-1-infected patients.

Elevated IgE level in relationship to nutritional status and immune parameters in early human immunodeficiency virus–1 disease☆☆☆★★★

Elevation of IgE has been associated with T-cell dysregulation and with the occurrence of opportunistic infections in patients with acquired immunodeficiency syndrome. The precise cause of IgE overproduction during the early stages of human immunodeficiency virus (HIV)-1 disease, however, has not been established. In light of reports demonstrating that IgE production may be affected by vitamin E levels in an animal model, we evaluated nutritional status in relationship to plasma IgE levels and immune parameters in 100 asymptomatic HIV-1-seropositive and 42 HIV-1-seronegative homosexual men. Approximately 18% of the HIV-1-seropositive population demonstrated biochemical evidence of plasma vitamin E deficiency (< 5 micrograms/ml). Subsequent analysis of available samples indicated a dramatic elevation of IgE levels (308 +/- 112 IU/ml) in vitamin E-deficient seropositive subjects (n = 9) as compared with age and CD4-matched HIV-1-seropositive persons with adequate vitamin E levels (n = 16, 118.1 +/- 41.1 IU/ml) and significantly lower levels (59.5 +/- 15.7 IU/ml) in HIV-1-seronegative men (n = 20, p = 0.01). This effect, which was independent of CD4 cell count, did not appear to be influenced by atopic or gastrointestinal parasitic disease. The low plasma vitamin E levels were related at least in part to dietary intake (r = 0.552, p = 0.01), suggesting that supplementation may be warranted in HIV-1-infected persons in whom vitamin E deficiency develops. Analysis of covariance revealed a strong relationship between IgE levels and CD8 cell counts (p < 0.006), and between IgE level and vitamin E deficiency (p < 0.039).(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life measures in the Miami HIV-1 infected drug abusers cohort: relationship to gender and disease status.

PURPOSE This study examined activity, daily living, health, support, and outlook in HIV+ drug users. METHODS Using the physician-administered Spitzer Index, the study assessed 75 HIV-1 seropositive men (n = 51) and women (n = 24) enrolled in the Miami HIV-1 Infected Drug Abusers Study (MIDAS). RESULTS Total composite scores were significantly lower in the HIV-1 infected women than the men (p = .03). Significant gender differences were observed in activity assessment, independent of disease status, with women six times as likely to have lower activity scores (p = .0038). Most women (45%) in this category were homeless or marginally housed, compared to 11 percent of the men. Additionally, women with low activity scores had less social support than women with high activity scores. Cocaine use was significantly related to reports of normal activity, and varied across genders; more men used cocaine than women (p = .03). Compared to non-AIDS participants, AIDS patients were more likely to have lower scores in health (p = .009) and poorer outlook (p = .03). IMPLICATIONS These findings reveal specific deficits in areas of psychosocial capacity, particularly in HIV-1 infected women who abuse drugs, that may need to be strengthened in order to enhance function and adherence to treatment, as well as well-being.

The esterified plasma fatty acid profile is altered in early HIV-1 infection

Previous studies have shown that alterations in micronutrient utilization occur in patients with Acquired Immune Deficiency Syndrome. In this study, total plasma fatty acid composition was measured in 36 homosexual men infected with the Human Immunodeficiency Virus 1 (HIV-1) and in 17 HIV-1 seronegative homosexual men in order to evaluate differences associated with early HIV-1 infection. Immunologic assessment included CD4 cell number count and lymphocyte blastogenesis in response to the mitogens phytohemagglutinin (PHA) and pokeweed (PWM). The mean total amount of ω6 polyunsaturated fatty acids (18∶2 and 20∶4) was significantly lower in the HIV-1 seropositive subjects (38±8.1% SD) as compared to HIV-1 seronegative subjects (43±4.2%;P=0.0027). This was also reflected in a higher level of total saturated fatty acids (16∶0 and 18∶0) in HIV-1 seropositive subjects (30±2.2%vs. 26±2.8%;P=0.0001). The ratio of linoleic to arachidonic acid (18∶2 to 20∶4) was higher in the HIV-1 seronegative group (6.76±4.88) compared to the HIV-1 seronegative group (4.86±1.37;P=0.0213). The response to PHA in seropositive subjects correlated inversely with total plasma ω6 fatty acids (r=−0.36;P=0.027), and directly with the 18∶2 to 20∶4 ratio (r=0.33;P=0.046). CD4 cell counts and the response to PWM did not correlate with plasma fatty acid levels in HIV-1 seropositive subjects. We conclude that early HIV-1 infection is associated with lower plasma ω6 polyunsaturated fatty acids, notably arachidonic acid, than are controls, and that the changes in the plasma fatty acid profile correlate with some indices of immune function.

HIV-related high risk sexual behaviors and practices among women in Bogota, Colombia

ABSTRACT Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.

Continued High Risk Behaviors in HIV Infected Drug Abusers

ABSTRACT To characterize current risk behaviors of HIV drug abusers in the highly active antiretroviral therapy (HAART) era, socio-demo-graphic, medical and behavioral information were obtained and immune measurements determined. High-risk sexual practices were prevalent. Participants diagnosed before 1995 were 6 times more likely to have unprotected sex with HIV+ partners (p = 0.05) and 11 times more likely to use contaminated needles (p = 0.05) than participants with later diagnosis. Consistent condom use was reported by only 7% of the cohort. Many (43%) of the participants reported multiple HIV+ and HIV-concurrent partners. Most (65%), particularly women (OR = 3, p = 0.02), did so for drugs or money. Despite detectable viral loads, 36% reported unprotected anal sex. Antiretroviral-treated men, compared to non-treated, tended to have unprotected anal sex (OR = 2, p = 0.07). The continued high-risk behaviors of HIV drug users, particularly those diagnosed before 1995 and/or on antiretroviral therapy, indicates an urgent need for new public health strategies.

Alcohol and Race/Ethnicity Elicit Different Changes in Lipid Profiles in HIV-Infected Individuals Receiving Highly Active Antiretroviral Therapy

&NA; This longitudinal study examined the impact of alcohol consumption (88 hazardous and 76 nonhazardous drinkers) and race/ethnicity on lipid profiles in individuals starting highly active antiretroviral therapy (HAART). At baseline, Whites and Hispanics had the most adverse lipid profiles, whereas Blacks had the least atherogenic. Whites and Hispanics showed higher increases in cholesterol (W = 11%; H = 6%), triglycerides (W = 40%; H = 24%), and low‐density lipoprotein (10%) than Blacks (cholesterol = 4%; triglycerides = 9%; low‐density lipoprotein = 4%). Hazardous alcohol consumption was correlated with increased lipids in each group. Hispanics had a clear trait risk for hypertriglyceridemia with HAART (1.9‐fold) and with hazardous drinking (3.2‐fold; p = .04). The highest risk for hypertriglyceridemia was found in heavy drinkers (3.75‐fold; p = .05). Results underscore the importance of an alcohol/race interactive effect on HAART‐associated dyslipidemia and the need for assessment and treatment of alcohol disorders.

Diagnosis of Human Immunodeficiency Virus Infection Using an Immunoglobulin E-Based Assay

ABSTRACT Immunoglobulin assays that are sensitive and specific for detecting human immunodeficiency virus type 1 (HIV-1) infection are especially important in developing countries where PCR and viral culture may not be readily available. Immunoglobulin E (IgE), which is elevated in HIV-1 infection, is the only antibody that does not cross the placenta, making it potentially valuable for viral detection in both children and adults. This study developed an assay for detection of HIV specific IgE antibodies in adults. A total of 170 serum samples from 170 adults (116 HIV positive and 54 HIV negative) were analyzed. Serum or plasma samples were treated by using the protein G affinity method. The HIV status was determined by using two IgG enzyme-linked immunosorbent assays (ELISAs) and one Western blot evaluation. The IgE enzyme immunoassay test for HIV-1 correctly identified the HIV status in 98.8% of the samples (168 of 170). One false-positive and one false-negative test occurred with the IgE ELISA, as well as with the IgG ELISA test but were correctly identified by the IgE test. Analysis of the data demonstrated a high specificity (99%) and sensitivity (99%) of the IgE test, with 95% confidence intervals. The IgE assay appears to be sensitive and specific, suggesting that IgE-specific antibodies offer an effective method to detect HIV-1 infection in adults.

Ignoring the Obvious Missing Piece of Chronic Kidney Disease in HIV: Cigarette Smoking

&NA; The impact of tobacco use on the development of chronic kidney disease (CKD) in people living with HIV (PLWH) has been overlooked, despite remarkably higher rates of smoking in these individuals. The authors examined the association between smoking and the risk of CKD in a case‐controlled study that included 75 PLWH with CKD and 461 PLWH consecutively admitted to the hospital for other causes. Significant differences in gender, race/ethnicity, hypertension, hepatitis B, CD4 cell counts, and smoking between cases and controls were reported, suggesting that these variables may be risk factors for CKD. In logistic regression analyses, smoking (OR = 1.97, p = .003), hypertension (OR = 2), and African ancestry, particularly for Black Caribbeans (OR = 2.6), were independent factors associated with CKD. Moreover, the results pointed to a dose‐response relationship between packs smoked per day and CKD. Smoking was reported to contribute a significant risk for CKD in these subjects.