Survival after introduction of HAART in people with known duration of HIV-1 infection

doi:10.1016/S0140-6736(00)02069-9

The Lancet

Volume 355, Issue 9210, 1 April 2000, Pages 1158-1159

https://doi.org/10.1016/S0140-6736(00)02069-9 Get rights and content

Summary

We compared survival from HIV-1 seroconversion before and during the periods of highly-active antiretroviral therapy (HAART). Survival expectations were substantially better for HIV-1-infected individuals in 1997–98 (HAART period) compared with those in 1986–96 (pre-HAART period). Estimated survival 10 years from seroconversion was also substantially better in the later period.

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Obesity rates are rising in HIV-infected populations; however, the putative role of highly active antiretroviral therapy (HAART) in the development of endothelial and cardiovascular derangements in the presence of pre-existing overweight/obesity is unclear. Although dual peroxisome proliferator-activated receptors-alpha/gamma (PPARα/γ) stimulation mitigates HAART-induced metabolic dysfunction, vascular effects are unresolved. To investigate whether HAART induces vascular dysfunction in obesity and to explore the underlying mechanisms of PPARα/γ stimulation, male Wistar rats were placed on a high-calorie diet for 16 weeks. After 10 weeks, HAART (lopinavir/ritonavir, azidothymidine/lamivudine) with/without PPARα/γ agonist, Saroglitazar, was administered daily for six weeks. Excised thoracic aorta rings were subjected to isometric tension studies and Western blot measurements. HAART+Saroglitazar-treated obese animals recorded lower adiposity indices (4.3 ± 0.5%) vs. HAART only-treated obese rats (5.6 ± 0.3%; p < .01). Maximum acetylcholine-induced vasorelaxation (R_max), was lower in obese+HAART group (76.10 ± 3.58%) vs. obese control (101.40 ± 4.75%; p < .01). However, R_max was improved in obese+ HAART+Saroglitazar (101.00 ± 3.12%) vs. obese+HAART rats (p < .001). The mean LogEC₅₀ was improved in obese+HAART+Saroglitazar vs. obese+HAART group; p = .003. Improved endothelial function in obese+ HAART+Saroglitazar group was associated with upregulation of eNOS, PKB/Akt and downregulated p22-phox expression vs. obese+HAART group. Therefore, PPARα/γ stimulation attenuated HAART-induced endothelial dysfunction by upregulating vasoprotective eNOS, PKB/Akt signaling and downregulating pro-oxidative p22-phox expression.
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Citation Excerpt :
HIV infection destroys the immune system and induces AIDS, which, in turn, increases disastrous opportunistic infections and cancer [2]. The development of highly active antiretroviral therapy (HAART) in 1997, however, transformed HIV infection from a rapidly fatal condition into a chronic disease [3]. This significantly reduced the number of HIV-related comorbidities, reduced mortality, and gave patients a nearly normal lifespan [4].
Evidence about the optimal timing for total hip replacement (THR) in HIV-positive patients is scant.
Preoperative criteria: cluster of differentiation 4 (CD4) counts > 200 cells/mm³ and an undetectable HIV virus load before THR, improve infection rates, aseptic loosenings, and functional outcomes.
We recruited 16 HIV-positive patients who had undergone 25 THRs between 2003 and 2015. None had hemophilia, and none were intravenous drug users (IVDUs).
Their mean age was 41.2 years (range: 24–60); minimum follow-up was 12 months (mean: 64.6); mean duration of prophylactic antibiotics was 2.9 days (range: 1–5); and mean hospital length of stay was 6.0 days (range: 4–11). No patients were treated with subsequent oral antibiotics. The mean preoperative CD4 count was 464.1 ± 237.0 (range: 235–904) cells/mm³. There were no early superficial surgical site infections, late periprosthetic joint infections, or aseptic loosenings. Post-surgery Harris Hip score was significantly (p < 0.001) better.
A preoperative CD4 count > 200 cell/mm³ and an undetectable HIV virus load might indicate optimal timing for elective THRs in HIV-positive patients without hemophilia and not IVDUs.
IV, retrospective or historical series.
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Citation Excerpt :
The human immunodeficiency virus (HIV) attacks the immune system of its host and may cause acquired immunodeficiency syndrome (AIDS). However, the course of the HIV infection changed dramatically with the introduction of highly active antiretroviral therapy (HAART), which reduced patient mortality and morbidity and transitioned AIDS from an acute to a chronic disease.1 In a 2010 study, an examination of the specific causes of mortality in HIV-positive patients found that only 49.5% of deaths were AIDS-related, and the proportion of deaths classified as AIDS-related decreased with increasing duration of HAART.2
Human Immunodeficiency Virus positive subjects present impairment in muscle function, neural activation, balance, and gait. In other populations, all of these factors have been associated with muscle strength asymmetry.
To investigate the existence of muscle strength asymmetry between dominant and non-dominant lower limbs and to determine the hamstrings-to-quadriceps strength ratio in Human Immunodeficiency Virus positive subjects.
In this cross-sectional study, 48 subjects were included (22 men and 26 women; mean age 44.6 years), all of them under highly active antiretroviral therapy. They performed isokinetic strength efforts at speeds of 60°/s and 180°/s for knee extension and flexion in concentric-concentric mode.
Peak torque was higher (p < 0.01) at 60°/s for quadriceps (193, SD = 57 vs. 173, SD = 55% body mass) and hamstrings (97, SD = 36 vs. 90, SD = 37% body mass) in dominant compared to non-dominant. Similarly, peak torque was higher at 180°/s (quadriceps 128, SD = 44 vs. 112, SD = 42; hamstrings 64, SD = 24 vs. 57, SD = 26% body mass) in dominant. Average power was also higher for all muscle groups and speeds, comparing dominant with non-dominant. The hamstrings-to-quadriceps ratio at 60°/s was 0.50 for dominant and 0.52 for non-dominant, and at 180°/s, it was 0.51 for both limbs, with no significant difference between them. The percentage of subjects with strength asymmetry ranged from 46 to 58%, depending upon muscle group and speed analyzed.
Human Immunodeficiency Virus positive subjects present muscle strength asymmetry between lower limbs, assessed through isokinetic dynamometry.
Mid-term outcomes in HIV-positive patients after primary total hip or knee arthroplasty
2014, Journal of Arthroplasty
We hypothesized that infection rates following total joint arthroplasty (TJA) in those with the human immunodeficiency virus (HIV) without hemophilia or drug use would be similar to rates in HIV-negative patients. Records at an urban HIV referral hospital were searched for patients who underwent primary total hip and knee arthroplasty from 2003 to 2010. The primary outcome was revision for infection. 372 HIV-negative and 22 HIV-positive TJA patients met inclusion criteria. The HIV-positive group had more deep infections than the HIV-negative group (9.1% v 2.2%, P = 0.102). There were no infections in those with AIDS-defining CD4 counts. Those with HIV may have a higher risk of developing a deep infection. A low CD4 count is not an absolute contraindication to TJA in HIV positive patients.

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Research LettersSurvival after introduction of HAART in people with known duration of HIV-1 infection

Summary

Lancet

Seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a pooled cohort analysis

Lancet

Research Letters
Survival after introduction of HAART in people with known duration of HIV-1 infection