Background:AIDS-related death and disease rates have declined in the highly active antiretroviral therapy (HAART) era and remain low; however, current causes of death in HAART-treated patients remain ill defined.Objective:To describe mortality trends and causes of death among HIV-infected patients i

Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study.

Context Guidelines for antiretroviral therapy are important for clinicians worldwide given the complexity of the field and the varied clinical situations in which these agents are used. The International AIDS Society–USA panel has updated its recommendations as warranted by new developments in the field. Objective To provide physicians and other human immunodeficiency virus (HIV) clinicians with current recommendations for the use of antiretroviral therapy in HIVinfected adults in circumstances for which there is relatively unrestricted access to drugs and monitoring tools. The recommendations are centered on 4 key issues: when to start antiretroviral therapy; what to start; when to change; and what to change. Antiretroviral therapy in special circumstances is also described. Data Sources and Study Selection A 16-member noncompensated panel was appointed, based on expertise in HIV research and patient care internationally. Data published or presented at selected scientific conferences from mid 2004 through May 2006 were identified and reviewed by all members of the panel. Data Extraction and Synthesis Data that might change previous guidelines were identified and reviewed. New guidelines were drafted by a writing committee and reviewed by the entire panel. Conclusions Antiretroviral therapy in adults continues to evolve rapidly, making delivery of state-of-the-art care challenging. Initiation of therapy continues to be recommended in all symptomatic persons and in asymptomatic persons after the CD4 cell count falls below 350/µL and before it declines to 200/µL. A nonnucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with low-dose ritonavir each combined with 2 nucleoside (or nucleotide) reverse transcriptase inhibitors is recommended with choice being based on the individual patient profile. Therapy should be changed when toxicity or intolerance mandate it or when treatment failure is documented. The virologic target for patients with treatment failure is now a plasma HIV-1 RNA level below 50 copies/mL. Adherence to antiretroviral therapy in the short-term and the long-term is crucial for treatment success and must be continually reinforced.

https://www.usherbrooke.ca/microbiologie-infectiologie/fileadmin/sites/microbiologie-infectiologie/documents/Cours-residents/21-10-2009/APP6.pdf

Treatment for adult HIV infection : 2006 recommendations of the international AIDS society-USA panel

Background: The risk of diabetes mellitus (DM) in human immunodeficiency virus (HIV)–infected patients receiving highly active antiretroviral therapy (HAART) has not been well defined. Methods: We conducted an analysis in the Multicenter AIDS Cohort Study to determine the prevalence and incidence of DM in this cohort of HIV-infected and HIVseronegative men. Prevalence analysis included 1278 men (710 HIV seronegative and 568 HIV infected, 411 receiving HAART) with fasting glucose concentration determinations at baseline. Incidence analysis included 680 of these 1278 men who at the baseline visit had a fasting glucose concentration of 98 mg/dL (5.4 mmol/L) or less, no self-reported history of DM, and no selfreported use of antidiabetic medication. Diabetes mellitus was defined as a fasting glucose concentration of 126 mg/dL (7 mmol/L) or higher, self-reported diagnosis of DM, or self-reported use of antidiabetic medication. Results: Fifty-seven (14%) of the 411 HIV-infected men using HAART at the baseline visit had prevalent DM compared with 33 (5%) of the 711 HIV-seronegative men (prevalence ratio =4 .6; 95% confidence interval, 3.07.1, adjusted for age and body mass index[calculated as weight in kilograms divided by the square of height in meters]). The rate of incident DM was 4.7 cases per 100 person-years among HIV-infected men using HAART compared with 1.4 cases per 100 person-years among HIVseronegative men (rate ratio=4.11; 95% confidence interval, 1.85-9.16, adjusted for age and body mass index), during the 4-year observation period, based on a median follow-up of 2.3 years. Conclusion: The incidence of DM in HIV-infected men with HAART exposure was greater than 4 times that of HIV-seronegative men, representing a risk that is higher than previous estimates. Arch Intern Med. 2005;165:1179-1184

/pdf/antiretroviral-therapy-and-the-prevalence-and-incidence-of-2cn65wpppf.pdf

Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study.

Context Guidelines for antiretroviral therapy are important for clinicians worldwide given the complexity of the field and the varied clinical situations in which these agents are used. The International AIDS Society-USA panel has updated its recommendations as warranted by new developments in the field. Objective To provide physicians and other human immunodeficiency virus (HIV) clinicians with current recommendations for the use of antiretroviral therapy in HIV-infected adults in circumstances for which there is relatively unrestricted access to drugs and monitoring tools. The recommendations are centered on 4 key issues: when to start antiretroviral therapy; what to start; when to change; and what to change. Antiretroviral therapy in special circumstances is also described. Data sources and study selection A 16-member noncompensated panel was appointed, based on expertise in HIV research and patient care internationally. Data published or presented at selected scientific conferences from mid 2004 through May 2006 were identified and reviewed by all members of the panel. Data extraction and synthesis Data that might change previous guidelines were identified and reviewed. New guidelines were drafted by a writing committee and reviewed by the entire panel. Conclusions Antiretroviral therapy in adults continues to evolve rapidly, making delivery of state-of-the-art care challenging. Initiation of therapy continues to be recommended in all symptomatic persons and in asymptomatic persons after the CD4 cell count falls below 350/microL and before it declines to 200/microL. A nonnucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with low-dose ritonavir each combined with 2 nucleoside (or nucleotide) reverse transcriptase inhibitors is recommended with choice being based on the individual patient profile. Therapy should be changed when toxicity or intolerance mandate it or when treatment failure is documented. The virologic target for patients with treatment failure is now a plasma HIV-1 RNA level below 50 copies/mL. Adherence to antiretroviral therapy in the short-term and the long-term is crucial for treatment success and must be continually reinforced.

Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society--USA panel.

ContextSubstantial changes in the field of human immunodeficiency virus (HIV)
treatment have occurred in the last 2 years, prompting revision of the guidelines
for antiretroviral management of adults with established HIV infection.ObjectiveTo update recommendations for physicians who provide HIV care regarding
when to start antiretroviral therapy, what drugs to start with, when to change
drug regimens, and what drug regimens to switch to after therapy fails.Data SourcesEvidence was identified and reviewed by a 16-member noncompensated panel
of physicians with expertise in HIV-related basic science and clinical research,
antiretroviral therapy, and HIV patient care. The panel was designed to have
broad US and international representation for areas with adequate access to
antiretroviral management.Study SelectionEvidence considered included published basic science, clinical research,
and epidemiological data (identified by experts in the field or extracted
through MEDLINE searches using terms relevant to antiretroviral therapy) and
abstracts from HIV-oriented scientific conferences between July 2002 and May
2004.Data ExtractionData were reviewed to identify any information that might change previous
guidelines. Based on panel discussion, guidelines were drafted by a writing
committee and discussed by the panel until consensus was reached.Data SynthesisFour antiretroviral drugs recently have been made available and have
broadened the options for initial and subsequent regimens. New data allow
more definitive recommendations for specific drugs or regimens to include
or avoid, particularly with regard to initial therapy. Recommendations are
rated according to 7 evidence categories, ranging from I (data from prospective
randomized clinical trials) to VII (expert opinion of the panel).ConclusionFurther insights into the roles of drug toxic effects, drug resistance,
and pharmacological interactions have resulted in additional guidance for
strategic approaches to antiretroviral management.

Treatment for adult HIV infection: 2004 recommendations of the International AIDS Society-USA Panel.

To identify clinical factors associated with the incidence of HIV-1-associated lipoatrophy, HIV-1-infected patients in the HIV Outpatient Study (HOPS) were prospectively evaluated for clinical signs of lipoatrophy at two visits about 21 months apart. Development of lipoatrophy was analyzed in stratified and multivariate analyses for its relationship to immunologic, virologic, clinical, and drug treatment information for each patient. Of 337 patients with no lipoatrophy at Survey 1, 44 (13.1%) developed moderate or severe lipoatrophy between the two surveys. In multivariate analyses, significant risk factors for incident lipoatrophy were white race (OR = 5.2; 95% CI: 1.9-17.1; p =.003), CD4 T-lymphocyte count at Survey 2 less than 100 cells/mm 3 (OR = 4.2; 95% CI: 1.3-13.1; p =.013), and body mass index (BMI) less than 24 kg/m 2 (OR = 2.4; 95% CI: 1.1-5.4; p =.024). Analyses that controlled for the severity of HIV illness demonstrated no significant association with use of or time on any antiretroviral agent or class of agents and the development of lipoatrophy. Some host factors and factors associated with previous or current severity of HIV infection, especially CD4 T-lymphocyte cell count, appeared to have the strongest association with incidence of lipoatrophy.

Peggy Zellner

Papers

Incidence of and risk factors for lipoatrophy (abnormal fat loss) in ambulatory HIV-1-infected patients.