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Prevalence of CSF Alzheimer’s disease-like in middle-aged HIV+ individuals

Prevalence of CSF Alzheimer’s disease-like in middle-aged HIV+ individuals

The study aimed at determining the prevalence of Alzheimer’s disease (AD) risk in ageing and chronically HIV-infected (HIV+) persons who are successfully treated with combination antiretroviral therapy (cART). 43 adult males and 1 female with stable chronic HIV disease [aged 57 ± 8 years, HIV duration 20 (5-25) years, undetectable plasma and CSF HIV RNA] were enrolled under a prospective observational study. All underwent standard neuropsychological testing, APOE genotyping and a CSFlumbar puncture to assess CSF Aβ1-42, h-tau and p-tau concentrations. 

To provide external CSF references, we tested 3 HIV-negative controls aged 64±2 and 5 AD patients aged 63±6 years. CSF was examined blind to the AD or HIV-associated neurocognitive disorder (HAND) status and vice versa. Risk for AD was evaluated using published cut-offs, which combines the three CSF biomarkers.

Based on the cut-offs: no elderly controls had a CSF-AD profile; all AD patients had at least one CSF-AD profile. Of the HIV+ individuals, 11.4% had a CSF-AD profile. Logistic regressions showed that APOE ε4/ε4 (p=0.03), having previously diagnosed severe HAND (p<0.03) and having lower current neurocognition (p<.002) were associated with a CSF-AD like profile.

Some patients with chronic HIV disease have 10-fold higher risk for AD based on CSF biomarkers, relative to the general population of the same age. However, it is not clear if this finding has the same clinical significance as in the general population. Known genetic factors for this age group were associated with a CSF-AD like profile, as well as past HAND and lower current neurocognition. Our research argues for renewed research effort to understand the consequences of brain ageing in HIV+ persons. 

Conference: ASHM|HIV|AIDS 2013

AIDS 2013

Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.

Reinvigorating evidence for action and capacity in community HIV programs (REACH Project)

REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.

Men who take more risks avoid HIV testing due to structural barriers

Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.

The impact of immune activation on natural killer cells in the setting of HIV infection

HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.

Delayed HIV diagnoses among gay and bisexual men in Australia

The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.

Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.

Definitions of early first sexual intercourse

Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.