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.
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.
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.
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.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
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.
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.
Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.