September 20, 2011
Here's a quick sampling of some of the more clinically relevant HIV-related posters (from a U.S. clinician's standpoint) that were presented at ICAAC 2011 on Monday, Sept. 19. To shake things up after I put yesterday's roundup in ascending order by poster number, the order of these summaries will be in descending order. (Try to keep your hat on.)
CD4:CD8 Ratios Infrequently Recover: A CD4:CD8 ratio roughly in the 1 to 2 range is considered typical of healthy adults, but such a ratio tends to be relatively uncommon among people with HIV. Could highly active antiretroviral therapy (HAART) restore that ratio? A team of Canadian researchers studied the CD4:CD8 ratio of more than 4,500 HIV-infected individuals, 81% of them men, who were taking antiretroviral therapy. After an average of three years of follow-up, just 7% of the volunteers saw their ratio normalize to 1.2 or higher. Those with a normalized ratio appeared to have a somewhat reduced risk of dying or developing an AIDS-defining illness. (Leung et al; poster H1-1409)
Tenofovir-to-Raltegravir Switch for Renal Recovery: Proteinuria increases and glomerular filtration rate (GFR) decreases are sometimes seen among HIV-infected patients taking tenofovir (TDF, Viread), particularly alongside a boosted protease inhibitor (PI). A team of California researchers switched tenofovir/emtricitabine (TDF/FTC, Truvada) for raltegravir (RAL, Isentress) in 21 patients who were also taking a boosted PI. After 24 weeks, 14 of the patients saw urine protein reductions averaging 20 mg/dL and urine protein clearance reductions averaging 122 mg/g. All but one patient saw their GFR increase by an average of 17.5 ml/min. (Bredeek et al; poster H1-1399b)
Neurosyphilis Concerns: HIV-infected people may face a higher risk of neurosyphilis in addition to more typical syphilis infection, according to a German study. An examination of cerebrospinal fluid in 80 HIV/syphilis-coinfected people, almost all of whom were men who have sex with men, found signs of early neurosyphilis infection in 17.5% of the volunteers. Only two-thirds of the volunteers showed any symptoms of early syphilis infection, reinforcing the importance of regular testing even in the absence of clinical symptoms. (Esser et al; poster H1-1396)
Tuberculosis and HIV: This conference offered a couple of important reminders that, even in people with advanced HIV disease and tuberculosis (TB), recovery is possible -- but it really would be nice to diagnose people before they're on death's door, if possible. Thai researchers found a three-year survival rate of 91% among HIV/TB-coinfected people with a baseline CD4+ cell count at or below 75 who began antiretroviral therapy. However, survival jumped to 98% at CD4+ cell counts above 75. People who developed an opportunistic infection after initiating HIV treatment had a nine times higher risk of death. (Punyaratabandhu et al; poster H1-1394)
Cardiovascular Markers: An international coterie of studies attempted to clarify the role of particular biomarkers and measurement systems in signaling inflammation or potential cardiovascular risk in HIV-infected people. Researchers from Italy reported that osteoprotegerin, whose production is stimulated by estrogen and is linked to bone and cardiovascular problems, was less present in HIV-infected men on PIs than in HIV-uninfected men. They also found that carotid intima-media thickness appeared greater in men with lower osteoprotegerin levels, suggesting a protective effect. (D'agostino et al; poster H1-1391)
Meanwhile, researchers in Korea found signs that high levels of sRAGE, or soluble receptor for advanced glycation end products, in the blood appeared to have a protective effect against subclinical atherosclerosis. (Jeong et al; poster H1-1393)
Lastly, over in Spain, researchers attempted to use pulse wave velocity measurements to assess cardiovascular risk in HIV-infected people, but found they often didn't agree with what Framingham risk scores would suggest. (Tenorio et al; poster H1-1392)
For more summaries of clinically relevant, HIV-related posters from ICAAC, check out roundup No. 1.
Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.
Follow Myles on Twitter: @MylesatTheBody.
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