The Second-Line study provided a unique opportunity to examine the lipodystrophy syndrome and cardiovascular disease (CVD) risk in participants randomised to r/LPV+RAL as an alternate N(t)RTI-sparing treatment option in adults (>16 years) failing first-line NNRTI+2N(t)RTI therapy.
Methods: This sub-study of 108 LPV/+RAL and 102 LPV/r+2-3N(t)RTIs SECONDLINE participants was conducted at 8 sites across South Africa, India, Thailand, Malaysia and Argentina. Whole body dual energy x-ray absorptiometry was performed at baseline and week 48. Data were obtained to calculate the Metabolic Syndrome and Framingham CVD risk score. Changes in body fat, lipids, Metabolic Syndrome and CVD risk were compared between arms using linear and binomial logistic regression. Associations between percent change in limb fat and risk factors measured at baseline were assessed by backwards stepwise multivariate linear regression. Analyses were adjusted for gender, body mass index and smoking status.
Results: The mean (95%CI) percent increase in limb fat mass over 48 weeks was 15.7% (5.4, 25.9) in the r/LPV+N(t)RTI arm and 21.1% (11.1, 31.1) in the r/LPV+RAL arm, with no significant difference between treatment arms (-5.42% (-13.7, 2.9), p=0.20). Increases in total body fat mass and trunk fat mass were also similar between groups. Total:HDL cholesterol ratio was significantly higher in the RAL arm (mean difference: 0.4 (1.4); p=0.0288), no other differences in lipid parameters were observed. There were no statistically significant differences in CVD risk or Metabolic Syndrome between the two regimens. The baseline predictors of increased limb fat were high viral load, high insulin and participant’s not taking lipid lowering treatment.
Conclusion: In patients switching to second line therapy, r/LPV combined with RAL demonstrated similar improvements to limb fat as an N(t)RTI + r/LPV regimen, but a worse total:HDL cholesterol ratio over 48 weeks.
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.
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.
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 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.
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.