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October 2004

A Significant Proportion of HIV-Infected Patients Admitted to Hospital Have Immunosuppression as a Result of Failure of Highly Active Antiretroviral Therapy

Manavi K, McMillan A

Objectives: To investigate the immunological and virological features of patients on highly active antiretroviral therapy (HAART) admitted to a tertiary care center.

Methods: A retrospective study was carried out on HIV-infected patients on HAART admitted to the Regional Infectious Disease Unit in Edinburgh between June 2002 and July 2003.

Results: A total of 125 patients who had been on HAART for at least six months were admitted during the study period. The frequencies of hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection were 52 percent (78 of 150 patients) and 48 percent (72 of 150 patients), respectively (P>0.05 for comparison of frequencies of hepatitis B and C). Of patients who had been on HAART for at least six months, 50 percent (63 of 125 patients) were immunosuppressed and had significantly higher bed-days (3-12) compared with those with CD4 counts >200 cells/mL (P<0.002). Among immunosuppressed patients, 38 percent (24 of 63) had undetectable viral load after at least six months of therapy. Those patients were mostly (67 percent) intravenous drug users and had a significantly higher median age (43 years; range 38 to 47 years) than other patients (P<0.001).

Conclusions: Earlier start of HAART and addition of interleukin (IL)-2 to the treatment regimens of patients at risk of slow CD4 T-cell count recovery may reduce the duration of their subsequent hospital admissions. [HIV Med 2004;5(5):360-363.]

Impact of Highly Active Antiretroviral Therapy on Anemia and Relationship Between Anemia and Survival in a Large Cohort of HIV-Infected Women: Women's Interagency HIV Study

Berhane K, Karim R, Cohen MH, et al.

Background: Anemia is common in HIV-infected individuals and may be associated with decreased survival.

Objective: To ascertain the impact of highly active antiretroviral therapy (HAART) on anemia and the relationship between anemia and overall survival in HIV-infected women.

Methods: A prospective multicenter study of HIV-1 infection in women. Visits occurred every six months, including a standardized history, physical examination, and comprehensive laboratory evaluation. The setting was a university-affiliated clinic at six sites in the United States. Participants were 2,056 HIV-infected women from the Women's Interagency HIV Study (WIHS). The outcome measure was anemia, defined as hemoglobin (Hb) <12 g/dL. Survival analysis was based on overall mortality during the follow-up period.

Results: Among HIV-infected women who were not anemic at baseline, 47 percent became anemic by 3.5 years of follow-up. On multivariate analysis, the use of HAART was associated with resolution of anemia even when used for only six months (odds ratio [OR] = 1.45; P<0.05). In the multivariate model, a CD4 count <200 cells/mL (OR = 0.56; P<0.001); HIV-1 RNA level >50,000 copies/mL (OR = 0.65; P<0.001), and mean corpuscular volume (MCV) value <80 fL (OR = 0.40; P<0.001) were also associated with an inability to correct anemia. Similarly, use of HAART for 12 months or more was associated with a protective effect against development of anemia (OR = 0.71; P<0.001). Among HIV-infected women, anemia was independently associated with decreased survival (hazard ratio [HR] = 2.58; P<0.001). Other factors associated with decreased survival included a CD4 cell count <200 cells/mL (HR = 5.83; P<0.001), HIV-1 RNA level >50,000 copies/mL (HR = 2.12; P<0.001), and clinical diagnosis of AIDS (HR = 2.83; P<0.001).

Conclusions: Anemia is an independent risk factor for decreased survival among HIV-infected women. HAART for as little as six months is associated with resolution of anemia. [J Acquir Immune Defic Syndr 2004;37(2):1245-1252.]

A Case-Control Study of Syphilis Among Men Who Have Sex With Men in New York City: Association With HIV Infection

Paz-Bailey G, Meyers A, Blank S, et al.

Objective: The objective of this study was to determine factors associated with syphilis among men who report sex with other men in New York City.

Design: We conducted a case-control study among 88 men who reported sex with men in the previous year, 18 to 55 years old and diagnosed with primary or secondary syphilis during 2001; and 176 control subjects frequently matched by age and type of health provider.

Results: HIV prevalence among syphilis cases was 48 percent compared with 15 percent among control subjects (P<0.001). Variables associated with syphilis in a multivariate model were HIV infection (odds ratio [OR], 7.3; 95 percent confidence interval [CI], 3.5-15.4), income greater than US$30,000 per year (OR, 2.7; CI, 1.4-5.2), and barebacking (OR, 2.6; CI, 1.4-4.8). The median time since HIV diagnosis for HIV-positive was six years for cases and seven years for control subjects (P = 0.70). Among HIV-infected participants, syphilis cases were more likely than control subjects to report being on antiretroviral therapy (69 percent versus 44 percent, P = 0.05) and to report having undetectable viral load (58 percent versus 24 percent, P = 0.02).

Conclusion: HIV infection was strongly associated with syphilis in this study. High-risk behavior reported by both cases and control subjects indicates the potential for increased HIV transmission. [Sex Transm Dis 2004;31(10):581-587.]

Antenatal Screening for HIV: Are Those Who Refuse Testing at Higher Risk Than Those Who Accept Testing?

Boxall EH, Smith N

Background: The UK Department of Health recommends that all pregnant women are offered screening for infection with human immunodeficiency virus (HIV) and had encouraged maternity units to achieve uptake targets of 90 percent by the end of 2002. Many maternity units fail to meet this target and there is concern that those women who are still refusing testing may include a higher proportion of women at high risk of infection. In consequence, those infected with HIV are not being identified and are not receiving the antiviral treatment, which would be of benefit to them and reduce the risk of transmission of HIV to their babies.

Methods: A retrospective audit of HIV screening uptake in women who were found to be infected with hepatitis B virus (HBV) and in those who were not infected with HBV was carried out in order to explore further the characteristics of "acceptors" and "refusers" of HIV screening.

Results: The overall uptake rate of HIV screening in the West Midlands population served by the National Blood Service was 60 percent in 2001 and 74 percent in 2002. The prevalence of HBV infection was found to be twice as high (0.39 percent) in those who had refused an HIV test compared with those who had accepted a test (0.21 percent) (P = 0.022).

Conclusion: There is good evidence that women refusing HIV antenatal screening have a higher prevalence of another blood-borne virus, indicating clearly that further effort must be made to increase the screening uptake and fully integrate HIV screening with other antenatal tests. [J Public Health 2004;26(3):285-7.]

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This article was provided by International Association of Physicians in AIDS Care. It is a part of the publication IAPAC Monthly.