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Issue No.
24
| May 29, 2009
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AIDSinfo.nih.gov is pleased to provide you with a weekly update of highlights about what has happened in the world of HIV/AIDS treatment, prevention, and research. We hope you find this encapsulated view of HIV/AIDS news useful.
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Study: Intensified HAART Does not Reduce HIV Viral Load
"In HIV-1-infected individuals on currently recommended antiretroviral therapy (ART), viremia is reduced to <50 copies of HIV-1 RNA per milliliter, but low-level residual viremia appears to persist over the lifetimes of most infected individuals. There is controversy over whether the residual viremia results from ongoing cycles of viral replication. To address this question, we conducted 2 prospective studies to assess the effect of ART intensification with an additional potent drug on residual viremia in 9 HIV-1-infected individuals on successful ART. By using an HIV-1 RNA assay with single-copy sensitivity, we found that levels of viremia were not reduced by ART intensification with any of 3 different antiretroviral drugs (efavirenz, lopinavir/ritonavir, or atazanavir/ritonavir). The lack of response was not associated with the presence of drug-resistant virus or suboptimal drug concentrations. Our results suggest that residual viremia is not the product of ongoing, complete cycles of viral replication, but rather of virus output from stable reservoirs of infection."
Study: Lopinavir/Ritonavir Monotherapy as Maintenance Therapy Is as Effective as Continued HAART
"The OK04 trial has shown that 48 weeks of lopinavir-ritonavir monotherapy with reintroduction of nucleosides as needed was noninferior to continuation of triple therapy with 2 nucleosides and lopinavir-ritonavir in patients with prior stable suppression. However, it is still uncertain if this experimental strategy can maintain suppression in the long term.... At 96-week[s] lopinavir/ritonavir monotherapy with reintroduction of nucleosides as needed was noninferior to continuation of triple therapy. Incidence of adverse events leading to treatment discontinuation was significantly lower with monotherapy."
Study: Atazanavir Safe in Patients with End-Stage Liver Disease
"No data are available on the use of atazanavir (ATV) in patients with end-stage liver disease (ESLD), and guidelines discourage its use in this setting. The objective of our study was to evaluate the efficacy and safety of unboosted ATV in patients infected with HIV and suffering from ESLD who had been screened for orthotopic liver transplantation....Unboosted ATV treatment did not worsen liver disease and was able to maintain or gain immuno-virological eligibility for OLT(x) in all patients, with a limited effect on unconjugated bilirubin. These results suggest that ATV is an easy-to-use drug in patients with ESLD."
Study: HIV Viral Load Affects Kidney Function
"After multivariable adjustment, HIV infection was associated with higher odds of both clinical decline...and clinical improvement [in kidney function]. Among HIV-infected participants, a decrease in HIV viral load during follow-up was independently associated with clinical improvement; conversely, higher baseline and an increase in viral load during follow-up were associated with clinical decline. No individual antiretroviral drug or drug class appeared to be substantially associated with clinical decline or improvement....The extent of viremic control had a strong association with longitudinal changes in kidney function."
Study: Cervical Cancer Screenings in HIV-Infected Women in the United States
"HIV-infected women are at increased risk of cervical cytologic abnormalities. HIV treatment guidelines recommend annual Papanicolaou (Pap) tests for HIV-infected women. We assessed screening prevalence and associated factors among HIV-infected women....Of 2417 women, 556 (23.0%) did not report receiving a Pap test during the past year. Not having a Pap test was associated with increasing age...and most recent CD4 count of <200 cells per microliter...or unknown....Odds of a missed Pap test increased for women whose most recent pelvic exam was not performed at their usual source of HIV care....Nearly 1 in 4 women did not receive an annual Pap test. HIV care providers should ensure that HIV-infected women receive annual Pap tests, recognizing that missed Pap tests are more likely among older women and women with low CD4 cell counts. Integrating HIV and gynecologic care and educating clinicians about recommendations may increase screening."
Review: Real-World Consequences of HIV-Associated Neuropsychological Impairment
"This review focuses on the 'real world' implications of infection with HIV/AIDS from a neuropsychological perspective. Relevant literature is reviewed which examines the relationships between HIV-associated neuropsychological impairment and employment, driving, medication adherence, mood, fatigue, and interpersonal functioning. Specifically, the relative contributions of medical, cognitive, psychosocial, and psychiatric issues on whether someone with HIV/AIDS will be able to return to work, adhere to a complicated medication regimen, or safely drive a vehicle will be discussed."
Review: Treatment of HIV/AIDS Patients with Psychiatric Disorders
"Psychiatric disorders are common among patients with HIV/AIDS, and psychopharmacologic treatment is a cornerstone of management....This paper reviews the literature on psychopharmacologic treatments of key psychiatric disorders in HIV/AIDS as well as differential diagnosis and drug-drug interactions."
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