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In a randomized comparison of nevirapine or abacavir with zidovudine plus lamivudine, routine viral load monitoring was not performed, yet 27% of individuals with viral failure at week 48 experienced resuppression by week 96 without switching. This supports World Health Organization recommendations that suspected viral failure should trigger adherence counseling and repeat measurement before a treatment switch is considered.

Our study confirms lopinavir/ ritonavir-based second-line regimen but with a high rate of toxicities.

Our results suggest that EasyCD4 may be used with high positive and negative predictive value in resource-limited settings.

Background Laboratory-based monitoring of antiretroviral therapy is essential but adds a significant cost to HIV care. The World Health Organization 2006 guidelines support the use of CD4 lymphocyte count (CD4) to define treatment failure in resource-limited settings. Methods We compared CD4 obtained on replicate samples from 497 HIV-positive Ugandans (before and during ART) followed for 18 months by 2 manual bead-based assays, Dynabeads (Dynal Biotech), and Cytospheres (Beckman Coulter) with those generated by flow cytometry at the Infectious Diseases Institute in Kampala, Uganda. Results We tested 1671 samples (123 before ART) with Dynabeads and 1444 samples (91 before ART) with Cytospheres. Mean CD4 was 231 cells/mm3 (SD, 139) and 239 cells/mm3 (SD, 140) by Dynabeads and flow cytometry, respectively. Mean CD4 was 186 cells/mm3 (SD, 101) and 242 cells/mm3 (SD, 136) by Cytospheres and flow cytometry, respectively. The mean difference in CD4 count by flow cytometry versus Dynabeads were 8.8 cells/mm3 (SD, 76.0) and versus Cytospheres were 56.8 cells/mm3 (SD, 85.8). The limits of agreement were -140.9 to 158.4 cells/mm3 for Dynabeads and -112.2 to 225.8 cells/mm3 for Cytospheres. Linear regression analysis showed higher correlation between flow cytometry and Dynabeads (r = 0.85, r2 = 0.73, slope = 0.85, intercept = 28) compared with the correlation between flow cytometry and Cytospheres (r = 0.78, r2 = 0.60, slope = 0.58, intercept = 45). Area under the receiver operating characteristics curve to predict CD4 <200 cells/mm3 was 0.928 for Dynabeads and 0.886 for Cytospheres. Conclusion Although Dynabeads and Cytospheres both underestimated CD4 lymphocyte count compared with flow cytometry, in resource-limited settings with low daily throughput, manual bead-based assays may provide a less expensive alternative to flow cytometry.

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We evaluated the pharmacokinetics of lopinavir-ritonavir with and without nonnucleoside reverse transcriptase inhibitors (NNRTIs) in Ugandan adults. The study design was a three-period crossover study ( respectively, and the apparent oral clearance (CL/F) values were reduced by 58% and 1%, respectively. For nevirapine, the geometric mean lopinavir AUC 0-12 (%CV) values were 112.9 g ⅐ h/liter (30%), 68.1 g ⅐ h/liter (53%), and 61.5 g ⅐ h/liter (52%), respectively, with corresponding GMR values of 1.66 (90% CI, 1.46 to 1.88; P < 0.001) and 0.90 (90% CI, 0.77 to 1.06; P ‫؍‬ 0.27), respectively, and the CL/F was reduced by 57% and 7%, respectively. Higher values for the lopinavir concentration at 12 h (C 12 ) were observed with 3 tablets and efavirenz-nevirapine (P ‫؍‬ 0.04 and P ‫؍‬ 0.0005, respectively), and marginally lower C 12 values were observed with 2 tablets and efavirenz-nevirapine (P ‫؍‬ 0.08 and P ‫؍‬ 0.26, respectively). These data suggest that 2 tablets of lopinavir-ritonavir BD may be inadequate when dosed with NNRTIs in Ugandan adults, and the dosage should be increased by the addition of an additional adult tablet or a half-dose tablet (100/25 mg), where available.When efavirenz (a CYP450 inducer) and lopinavir-ritonavir (metabolized by CYP450) are coadministered, a decrease in lopinavir plasma concentrations has been observed (8). In theory, this could lead to subtherapeutic lopinavir concentrations, the development of virological failure, and, potentially, the emergence of resistance mutations, particularly in the absence of viral load monitoring. Therefore, an increase from the standard dose of 3 capsules (400 mg of lopinavir/100 mg of ritonavir [400/100 mg]) to 4 capsules (533/133 mg) twice daily was recommended during the coadministration of lopinavir-ritonavir capsules (Kaletra) with nonnucleoside reverse transcriptase inhibitors (NNRTIs) in HIV-infected patients.A solid formulation of lopinavir-ritonavir tablets (Aluvia tablets; based on Meltrex technology) is now approved for the treatment of HIV infection. Each tablet contains 200 mg/50 mg lopinavir-ritonavir, so the standard dose is 2 tablets (rather than 3 capsules) twice daily (BD). The tablets are preferred to the capsules because of heat stability, a lack of a food effect, and lower pill burden. However, there are few data on the pharmacokinetic (PK) interactions between NNRTIs and lopinavir-ritonavir tablets, particularly in African populations, and the previously recommended 533/133-mg twice-daily capsule dose cannot be achieved with 200/50-mg tablets. In the United States, original recommendations for lopinavir-ritonavir tablets with NNRTIs were 400/100 mg twice daily, but a dose of 600/150 mg twice daily was to be considered if decreased lopinavir susceptibility was suspected. In Europe, a dose of 600/150 mg twice daily with close monitoring was recommended. These recommendations were based on two healthy-volunteer studies that found that the administration of lopinavir-ritonavir tablets at 400/100

Abstract:The effect of chloroquine in the treatment of psoriasis remains controversial. Treatment of psoriasis in HIV infection is not well described. Chloroquine has been shown to have direct effects on both the Human Immunodeficiency Virus (HIV) and on the psoriasis disease process. The effect of chloroquine in HIV infected patients with psoriasis has not been well studied.We report on the effect of chloroquine on psoriasis-like lesions in three HIV infected patients who were not on antiretroviral therapy. Three consecutive HIV positive patients with CD4 cell count below 200cells/mm 3 had unequivocal improvement of their psoriasis-like lesions after 2 weeks of a daily dose of 150mg of chloroquine.In conclusion, chloroquine may be useful in the treatment of psoriasis-like lesions in patients with HIV infection particularly in resource poor settings. Ideally, a controlled clinical trial will be needed to confirm this.