Showing papers by "Umesh G. Lalloo published in 2008"

Class-Sparing Regimens for Initial Treatment of HIV-1 Infection

Abstract: Background The use of either efavirenz or lopinavir–ritonavir plus two nucleoside reverse-transcriptase inhibitors (NRTIs) is recommended for initial therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection, but which of the two regimens has greater efficacy is not known. The alternative regimen of lopinavir– ritonavir plus efavirenz may prevent toxic effects associated with NRTIs. Methods In an open-label study, we compared three regimens for initial therapy: efavirenz plus two NRTIs (efavirenz group), lopinavir–ritonavir plus two NRTIs (lopinavir–ritonavir group), and lopinavir–ritonavir plus efavirenz (NRTI-sparing group). We randomly assigned 757 patients with a median CD4 count of 191 cells per cubic millimeter and a median HIV-1 RNA level of 4.8 log 10 copies per milliliter to the three groups. Results At a median follow-up of 112 weeks, the time to virologic failure was longer in the efavirenz group than in the lopinavir–ritonavir group (P = 0.006) but was not significantly different in the NRTI-sparing group from the time in either of the other two groups. At week 96, the proportion of patients with fewer than 50 copies of plasma HIV-1 RNA per milliliter was 89% in the efavirenz group, 77% in the lopinavir–ritonavir group, and 83% in the NRTI-sparing group (P = 0.003 for the comparison between the efavirenz group and the lopinavir–ritonavir group). The groups did not differ significantly in the time to discontinuation because of toxic effects. At virologic failure, antiretroviral resistance mutations were more frequent in the NRTIsparing group than in the other two groups. Conclusions Virologic failure was less likely in the efavirenz group than in the lopinavir–ritonavir group. The virologic efficacy of the NRTI-sparing regimen was similar to that of the efavirenz regimen but was more likely to be associated with drug resistance. (ClinicalTrials.gov number, NCT00050895.)

Hepatitis C virus seropositivity in a South African Cohort of HIV co-infected, ARV naïve patients is associated with renal insufficiency and increased mortality.

Abstract: HIV is known to affect the epidemiology transmission pathogenesis and natural history of HCV infection whilst studies on the effects of HCV on HIV have shown conflicting results and are confounded by the influence of intravenous drug use and antiretroviral therapy. This study was conducted in KwaZulu-Natal Province in South Africa where HIV is predominantly a sexually transmitted infection. Intravenous drug use is rare in this region and the study population was naive to antiretroviral therapy. For this study specimens from selected sentinel sites submitted to a central laboratory for routine HIV testing were screened for anti-HCV IgG antibodies. HIV positive HCV-positive patients were compared to HIV-positive HCV-negative patients in a subgroup of patients within this cohort in order to determine if HCV sero-prevalence was associated with clinical outcomes in a linked anonymous retrospective chart survey. The prevalence of HCV was 6.4% and that of HIV 40.2% (n = 1937). There was a significantly higher prevalence of HCV among HIV infected patients as compared to HIV negative patients (13.4% vs. 1.73% respectively) (n = 1937 P < 0.001). HCV-HIV co-infected patients had significantly increased mortality (8.3 vs. 21%) (n = 162 P < 0.02). A significant association was found between HCV serostatus and abnormal urea levels (15.4 vs. 7.3 mmol/L n = 134 P < 0.001) and creatinine levels (252.2 vs. 144.4 micromol/L n = 134 P < 0.01). This study has found that hepatitis C co-infection is more common in HIV positive individuals and is associated with an increased mortality and renal morbidity. (authors)

Managing tuberculosis and HIV in sub-Sahara Africa.

Abstract: Tuberculosis (TB) and HIV represent a deadly duo in sub-Sahara Africa, a region most affected by both diseases The HIV epidemic has aggravated already strained and frequently poorly performing TB control programs These programs face numerous challenges, and novel, regionally appropriate solutions need to be developed In the context of TB, some challenges include the rapid diagnosis of active TB in the face of paucibacillary lung disease and atypical presentations with HIV/AIDS, lack of clinical expertise, poor contact tracing, limited laboratory facilities, delayed recognition of drug-resistant TB, increased workload of health care workers, erratic drug supplies, inadequate isolation facilities, and environmental and personal protection in drug-resistant cases Similar problems exist in the context of HIV but are aggravated by the need for complex antiretroviral drug regimens and lifelong treatment Treating both conditions invites drug interactions and toxic effects that are common to both HIV and TB treatment and the vexing question of when to introduce antiretroviral treatment in subjects with active TB Combining HIV and TB care has the potential to bring additional infrastructural and human resources to the respective programs, with synergistic benefits

Second assessment of NeuroAIDS in Africa

Abstract: In July of 2006, the National Institute of Mental Health (NIMH) Center for Mental Health Research on AIDS (CMHRA) sponsored the second conference on the Assessment of NeuroAIDS in Africa, which was held in Arusha, Tanzania. The conference mission was to address the regional variations in epidemiology of HIV-related neurological disorders as well as the assessment and diagnosis of these disorders. Participants discussed and presented data regarding the relevance and translation of neuroAIDS assessment measures developed in resource intensive settings and the challenges of neuro-assessment in Africa, including the applicability of current tools, higher prevalence of confounding diseases, and the complexity of diverse cultural settings. The conference presentations summarized here highlight the need for further research on neuroAIDS in Africa and methods for assessing HIV-related neurological disorders.

Survival after massive intentional overdose of paraquat

Abstract: To the Editor: Survival following oral ingestion of a large volume of paraquat is rare. Our patient ingested approximately 200 ml of paraquat and survived, following aggressive intervention. He developed oral pharyngeal ulceration, acute lung injury, haematemesis, haemoptysis and renal failure. He was treated with a combination of pulse methylprednisolone, vitamins C and E, and N-acetylcysteine. We propose a rationale for high-dose antioxidant treatment in addition to corticosteroids and intensive care.