AIDS-Related Opportunistic Illnesses Occurring After Initiation of Potent Antiretroviral Therapy

Ledergerber, Bruno; Egger, Matthias; Erard, Véronique; Weber, Rainer; Hirschel, Bernard; Furrer, Hansjakob; Battegay, Manuel; Vernazza, Pietro; Bernasconi, Enos; Opravil, Milos; Kaufmann, Daniel E.; Sudre, Philippe; Francioli, P.; Telenti, Amalio

doi:10.1001/jama.282.23.2220

Cited by 438 publications

(297 citation statements)

References 32 publications

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“…Advanced naïve patients should receive an intensive follow-up program, especially during the initial treatment phase (B-II) because the risk of opportunistic infections during the first 12 months is reduced, but not eliminated by cART [24][25][26][27].…”

Section: Opportunistic Diseases and Concomitant Conditionsmentioning

confidence: 99%

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

et al. 2009

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Section: Opportunistic Diseases and Concomitant Conditionsmentioning

confidence: 99%

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

et al. 2009

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“…Based on recent sentinel surveillance data, the national adult prevalence rate is estimated at 6.6% (1). The introduction of highly active antiretroviral therapy (HAART) in 1997 has markedly improved the length of survival and the morbidity of HIV-infected patients through the improvement of the immunodeficiency caused by HIV infection (2)(3)(4)(5)(6)(7)(8)(9)(10). In recent years, the management of human immunodeficiency virus positive individuals has been based on HAART comprising a combination of nucleoside analogue reverse transcriptase inhibitors and at least one protease inhibitor and/or one non-nucleoside analogue reverse transcriptase inhibitor (11).…”

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confidence: 99%

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Wabe¹,

Alemu²

2012

Gaziantep Med J

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The survival benefits of highly active antiretroviral therapy (HAART) in HIV infected patients have been studied well in the developed world. In resource poor settings like Ethiopia such treatment was started only in 2003. As a result, the existing treatment guidelines and recommendations are based on data from the developed world. The objective of this study was to determine the immunological and clinical progress in HIV/AIDS patients in one year data review of patients' card who initiated on HAART in Ethiopia. A retrospective cohort study was done based on past medical records of HIV/AIDS patients, using a structured data collection format. All patient cards of one year data with patients who initiated HAART from October 1, 2006 to November 30, 2007 were included in the study. The data collected was analyzed using SPSS for window version 16.0. The majority of the study population (383, 64.2%) were prescribed zidovudine/lamivudine/neverapine (ZDV/3TC/NVP) regimen initially. Overall functional status change showed that ability to work was increased by 31.5%, being ambulatory decreased by 93.4% and bedridden status decreased by 80%. A total of 240 (46.9%) patients have showed functional status improvement. Average mean weight change of 5.9 kg (increment by 11.9%) was seen during a one year follow-up. The patients showed immunological change from 132.883 mean CD4/mm 3 count to 335.87 mean CD4/mm 3 . About 492 (82.4%) patients present with different type of opportunistic infections (OIs) at start of therapy which dramatically dropped to only 40 (6.7%) patient after one year of receiving HAART. HAART initiation has decreased progression of the diseases and improved the patients' quality of life. Most patients have showed a significant increment in their CD4 count. The restoration of CD4 in turn has improved the clinical status of most patients. Despite the significant progression of health of patients, greater immunological and clinical success should be attained by encouraging patients for effective use of those lifesaving drugs with maximal adherence. 2) başlangıçta zidovudin/lamivudin/neverapin (ZDV/3TC/NVP) tedavisi verilmişti. Genelde fonksiyonel durum değişimi, çalışma yeteneğinin %31.5 arttığını, ayakta tedavi edilmenin %93.4 azaldığını, yatağa bağlı kalma durumunun %80 azaldığını gösterdi. Toplam 240 hasta fonksiyonel durum düzelmesi gösterdi. Bir yıllık izleme sırasında 5.9 kg ortalama ağırlık değişimi (%11.9 artma) gözlendi. Hastalar ortalama 132.883 CD4/mm 3 sayımından ortalama 335.87 CD4/mm 3 'e immünolojik değişim gösterdi. Tedavinin başlamasında farklı tipte fırsatçı enfeksiyonu bulunan yaklaşık 492 (%82.4) hasta, HAART tedavisi başlamasından bir yıl sonra dramatik olarak sadece 40'a (%6.7) düştü. HAART tedavisi başlanması hastalığın ilerlemesini azalttı ve hastaların yaşam kalitesini iyileştirdi. Hastaların çoğu CD4 sayılarında anlamlı artışlar gösterdi. CD4'deki düzelme birçok hastanın klinik durumunu iyileştirdi. Hastaların sağlığındaki anlamlı iyileşmeye karşın, hayat kurtaran bu ilaçlara d...

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“…Also, HIV-infected patients initiating both therapies are more prone to develop transient chest radiographic worsening than HIV-uninfected and HIV-infected patients not on AR therapy 4 . Enhancing host immunity following initiation of AR therapy or its intensification with a protease inhibitor has also been implicated in the emergence of cytomegalovirus retinitis 6 , Mycobacterium avium complex lymphadenitis 14 , development of zoster rash 9 , rapid worsening of Kaposi's sarcoma lesions 7 and development of multiple cerebral lesions compatible with progressive multifocal leukoencephalopathy in AIDS patients 7 .…”

Section: Discussionmentioning

confidence: 99%

Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease

Eyer-Silva

Pinto

Arabe

et al. 2002

Rev. Soc. Bras. Med. Trop.

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The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient. Key-words: AIDS. Antiretroviral therapy. Paradoxical reaction. Tuberculosis. Tuberculous meningitis.Resumo O desenvolvimento de piora clínica paradoxal como resposta ao início do tratamento da tuberculose pode complicar a evolução de pacientes com e sem infecção pelo HIV. Apresentamos uma grave manifestação da chamada reação paradoxal ao tratamento da tuberculose, que revelou doença meníngea previamente silenciosa em um paciente HIV-positivo de 34 anos. Palavras-chaves: AIDS. Meningite tuberculosa. Reação paradoxal. Terapia anti-retroviral. Tuberculose. Concomitantly treating active tuberculosis (TB) and HIV infection is a challenging task. There is a great potential for adverse effects and clinically significant pharmacological interactions. The development of paradoxical clinical worsening on TB treatment may further complicate patient management. We report a life-threatening manifestation of paradoxical worsening following TB treatment initiation in an antiretroviral (AR)-experienced patient. CASE REPORTA 34-year-old HIV-infected male patient with previous experience to the HIV reverse transcriptase inhibitors zidovudine and didanosine, to the HIV protease inhibitor saquinavir and on Pneumocystis carinii prophylaxis developed an enlarging cervical mass associated with a 2-month history of fever, weigh loss and malaise. At that point laboratory evaluation showed mild anemia (hemoglobin 11,3mg/dL), 60 CD4 cells/mm 3 and a plasma HIV viral load of 25,000 copies/mL (all viral load measurements were performed using the nucleic acid sequence-based amplification assay). Chest X-ray was normal. He had never had an opportunistic disorder but was treated for pleural TB during early adulthood. Histopathology disclosed TB lymphadenitis and Mycobacterium tuberculosis grew from the node aspirate. Rifabutin (as an alternative rifamycin to be combined with a protease inhibitor) at a dose of 150mg/day, isoniazid, pyridoxine and pyrazinamide were started and the AR regimen was changed to stavudine, lamivudine and indinavir. He significantly improved and remained well until ten weeks later when recrudescence of fever and severe headache developed. Signs of meningeal irritation were absent, as were cognitive, behavioral or focal neurologic abnormalities. Computed tomography of the brain was normal. Cerebrospinal fluid (CSF) studies revealed marked pleocytosis (220 cells/mm 3 , 71% polymorphonuclear, 29% mononuclear cells), glucose 52mg/dL and elevated protein (156mg/dL) and were negative for acid-fast bacilli, mycobacterial cultures, other infectious agents and neoplastic cells. Ophthalmologic examination disclosed TB choroidal nodules (previous evalu...

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AIDS-Related Opportunistic Illnesses Occurring After Initiation of Potent Antiretroviral Therapy

Cited by 438 publications

References 32 publications

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease

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