HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)
TL;DR: Individuals coinfected with HIV-1 and HBV, especially those with low CD4+ nadir counts, are at increased risk for liver-related mortality, underscoring the importance of prevention, identification, and comprehensive management of hepatitis B in people infected withAIDS.
About: This article is published in The Lancet.The article was published on 2002-12-14. It has received 1056 citations till now. The article focuses on the topics: HBsAg & Coinfection.
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TL;DR: These guidelines have been written to assist physicians and other health care providers in the recognition, diagnosis, and management of patients chronically infected with the hepatitis B virus (HBV).
2,790 citations
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TL;DR: The 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for Management of Chronic Hepatitis B is now posted online at www.aasld.org, and the recommendation for first-line oral antiviral medications has been changed to tenofovir or entecavir, and adefovir has been moved to second-line Oral antiviral medication.
2,696 citations
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Huldrych F. Günthard1, Judith A. Aberg2, Joseph J. Eron3, Jennifer F Hoy4, Amalio Telenti5, Constance A. Benson6, David M. Burger7, Pedro Cahn8, Joel E. Gallant, Marshall J. Glesby9, Peter Reiss10, Michael S. Saag11, David L. Thomas12, Donna M. Jacobsen, Paul A. Volberding13 •
University of Zurich1, Icahn School of Medicine at Mount Sinai2, University of North Carolina at Chapel Hill3, Monash University4, University Hospital of Lausanne5, University of California, San Diego6, Radboud University Nijmegen7, University of Buenos Aires8, Cornell University9, University of Amsterdam10, University of Alabama at Birmingham11, Johns Hopkins University School of Medicine12, University of California, San Francisco13
TL;DR: This report provides guidelines for when to initiate antiretroviral therapy, selection of appropriate initial regimens, patient monitoring, when to change therapy, and what regimens to use when changing.
Abstract: Context New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)–infected adults in resource-rich settings. Objective To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. Data Sources, Study Selection, and Data Extraction Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society–USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. Data Synthesis Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. Conclusion New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.
2,357 citations
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Shiv Kumar Sarin, Manoj Kumar, George K. K. Lau, Zaigham Abbas1, Henry Lik-Yuen Chan2, Chien-Jen Chen3, Ding-Shinn Chen3, Huey-Ling Chen3, Pei-Jer Chen3, Rong-Nan Chien4, Abdul Kadir Dokmeci5, Edward Gane6, J L Hou, Wasim Jafri7, Jidong Jia8, J. H. Kim, Ching-Lung Lai9, Hon Cheung Lee10, Seng Gee Lim11, Chun-Jen Liu3, Stephen Locarnini, M. Al Mahtab12, Rosmawati Mohamed13, Masao Omata, Jun Yong Park14, Teerha Piratvisuth15, Barjesh Chander Sharma, Jose D. Sollano16, Fu-Sheng Wang, Lai Wei17, Man-Fung Yuen9, Shusen Zheng18, Jia-Horng Kao3 •
Sindh Institute of Urology and Transplantation1, The Chinese University of Hong Kong2, National Taiwan University3, Memorial Hospital of South Bend4, Ankara University5, Auckland City Hospital6, Aga Khan University7, Capital Medical University8, University of Hong Kong9, Asan Medical Center10, University Health System11, Bangabandhu Sheikh Mujib Medical University12, University of Malaya13, Yonsei University14, Prince of Songkla University15, University of Santo Tomas16, Peking University17, Zhejiang University18
TL;DR: The final clinical practice guidelines and recommendations for the optimal management of chronic HBV infection are presented here, along with the relevant background information.
Abstract: Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.
1,787 citations
Cites background from "HIV-1, hepatitis B virus, and risk ..."
...Clinical observational studies have demonstrated that HIV/HBV-coinfected patients may have faster progression of hepatic fibrosis and a higher risk of cirrhosis, end-stage liver disease, and HCC than HBVmonoinfected patients [395, 404]....
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TL;DR: The most recent version of the guidelines for the prevention and treatment of opportunistic infections (OI) in HIV-infected adults and adolescents was published in 2002 and 2004, respectively as mentioned in this paper.
Abstract: This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults (i.e., persons aged >/=18 years) and adolescents (i.e., persons aged 13--17 years), last published in 2002 and 2004, respectively. It has been prepared by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by clinicians and other health-care providers, HIV-infected patients, and policy makers in the United States. These guidelines address several OIs that occur in the United States and five OIs that might be acquired during international travel. Topic areas covered for each OI include epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. These guidelines were developed by a panel of specialists from the United States government and academic institutions. For each OI, a small group of specialists with content-matter expertise reviewed the literature for new information since the guidelines were last published; they then proposed revised recommendations at a meeting held at NIH in June 2007. After these presentations and discussion, the revised guidelines were further reviewed by the co-editors; by the Office of AIDS Research, NIH; by specialists at CDC; and by HIVMA of IDSA before final approval and publication. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of OIs, especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent Mycobacterium tuberculosis (TB) infection; 4) updated information concerning drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel. This report includes eleven tables pertinent to the prevention and treatment of OIs, a figure that pertains to the diagnois of tuberculosis, a figure that describes immunization recommendations, and an appendix that summarizes recommendations for prevention of exposure to opportunistic pathogens.
1,534 citations
References
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TL;DR: What do you do to start reading statistical methods in cancer research vol ii the design and analysis of cohort studies?
Abstract: What do you do to start reading statistical methods in cancer research vol ii the design and analysis of cohort studies? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. It's not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this statistical methods in cancer research vol ii the design and analysis of cohort studies.
4,226 citations
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TL;DR: The strongest factors independently associated with HCV infection were illegal drug use and high-risk sexual behavior, and poverty, having had 12 or fewer years of education, and having been divorced or separated were independently associated.
Abstract: Background Because many persons with chronic hepatitis C virus (HCV) infection are asymptomatic, population-based serologic studies are needed to estimate the prevalence of the infection and to develop and evaluate prevention efforts. Methods We performed tests for antibody to HCV (anti-HCV) on serum samples from 21,241 persons six years old or older who participated in the third National Health and Nutrition Examination Survey, conducted during 1988 through 1994. We determined the prevalence of HCV RNA by means of nucleic acid amplification and the genotype by means of sequencing. Results The overall prevalence of anti-HCV was 1.8 percent, corresponding to an estimated 3.9 million persons nationwide (95 percent confidence interval, 3.1 million to 4.8 million) with HCV infection. Sixty-five percent of the persons with HCV infection were 30 to 49 years old. Seventy-four percent were positive for HCV RNA, indicating that an estimated 2.7 million persons in the United States (95 percent confidence interval, ...
3,014 citations
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TL;DR: In coinfected patients, a low CD4 count, alcohol consumption rate, and age at HCV infection are associated with a higher liver fibrosis progression rate, while HIV seropositivity accelerates HCV‐related liver Fibrosis progression.
1,232 citations
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TL;DR: The Multicenter AIDS Cohort Study was designed to elucidate the natural history of the infection causing acquired immunodeficiency syndrome (AIDS), identify risk factors for occurrence and clinical expression of the virus, and establish a repository of biologic specimens for future study.
Abstract: The Multicenter AIDS Cohort Study was designed to elucidate the natural history of the infection causing acquired immunodeficiency syndrome (AIDS), identify risk factors for occurrence and clinical expression of the infection, and establish a repository of biologic specimens for future study. A variety of recruitment techniques, including special assurance of confidentiality, were used to enroll participants. Nearly 5,000 homosexual men volunteered for semiannual interview, physical examination, and laboratory testing in four metropolitan areas. A significant majority of these men in each center (69-83%) reported having 50 or more lifetime sexual partners, and over 80% had engaged in receptive anal intercourse with at least some of their partners in the previous two years. By the time of the participants' initial evaluation (April 1984-April 1985), infection with the human immunodeficiency virus (HIV) had occurred in higher proportions of men in Los Angeles (51%) and Chicago (43%) than in Baltimore/Washington, DC (31%) and Pittsburgh (21%), presumably as a result of the higher number of partners and proportion with whom these men had engaged in high-risk practices (e.g., receptive anal intercourse). Follow-up evaluations are underway in this comprehensive longitudinal investigation of HIV infection.
1,146 citations
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TL;DR: The data indicate that use of ritonavir may increase risk of severe hepatotoxicity, and does not support withholding protease inhibitor therapy from persons coinfected with hepatitis B or C virus.
Abstract: ContextUse of antiretroviral drugs, including protease inhibitors, for treatment
of human immunodeficiency virus (HIV) infection has been anecdotally associated
with hepatotoxicity, particularly in persons coinfected with hepatitis C or
B virus.ObjectivesTo ascertain if incidence of severe hepatotoxicity during antiretroviral
therapy is similar for all antiretroviral drug combinations, and to define
the role of chronic viral hepatitis in its development.DesignProspective cohort study.SettingUniversity-based urban HIV clinic.PatientsA total of 298 patients who were prescribed new antiretroviral therapies
between January 1996 and January 1998, 211 (71%) of whom received protease
inhibitors as part of combination therapy (median follow-up, 182 days) and
87 (29%) of whom received dual nucleoside analog regimens (median follow-up,
167 days). Chronic hepatitis C and B virus infection was present in 154 (52%)
and 8 (2.7%) patients, respectively.Main Outcome MeasureSevere hepatotoxicity, defined as a grade 3 or 4 change in levels of
serum alanine aminotransferase and aspartate aminotransferase, evaluated before
and during therapy.ResultsSevere hepatotoxicity was observed in 31 (10.4%) of 298 patients (95%
confidence interval [CI], 7.2%-14.4%). Ritonavir use was associated with a
higher incidence of toxicity (30%; 95% CI, 17.9%-44.6%). However, no significant
difference was detected in hepatotoxicity incidence in other treatment groups,
ie, nucleoside analogs (5.7%; 95% CI, 1.2%-12.9%), nelfinavir (5.9%; 95% CI,
1.2%-16.2%), saquinavir (5.9%; 95% CI, 0.15%-28.7%), and indinavir (6.8%;
95% CI, 3.0%-13.1%). Although chronic viral hepatitis was associated with
an increased risk of severe hepatotoxicity among patients prescribed nonritonavir
regimens (relative risk, 3.7; 95% CI, 1.0-11.8), most patients with chronic
hepatitis C or B virus infection (88%) did not experience significant toxic
effects. Rate of severe toxicity with use of any protease inhibitor in patients
with hepatitis C infection was 12.2% (13/107; 95% CI, 6.6%-19.9%). In multivariate
logistic regression, only ritonavir (adjusted odds ratio [AOR], 8.6; 95% CI,
3.0-24.6) and a CD4 cell count increase of more than 0.05 × 109/L (AOR, 3.6; 95% CI, 1.0-12.9) were associated with severe hepatotoxicity.
No irreversible outcomes were seen in patients with severe hepatotoxicity.ConclusionsOur data indicate that use of ritonavir may increase risk of severe
hepatotoxicity. Although hepatotoxicity may be more common in persons with
chronic viral hepatitis, these data do not support withholding protease inhibitor
therapy from persons coinfected with hepatitis B or C virus.
948 citations
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