Table of Contents

• Health-Related Quality of Life After One Year of Highly Active Antiretroviral Therapy
• CD8 T-Cell Numbers Predict the Response to Antiviral Therapy in HIV-1-Infected Children
• Influence of Coinfection With Hepatitis C Virus on Morbidity and Mortality Due to Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy
• The Absence of HIV Seropositivity Contrasts With a High Prevalence of Markers of Sexually Transmitted Infections Among Registered Female Sex Workers in Toliary, Madagascar
• Discrepant Results in the Interpretation of HIV-1 Drug-Resistance Genotypic Data Among Widely Used Algorithms

Health-Related Quality of Life After One Year of Highly Active Antiretroviral Therapy

P. Carrieri et al.

[The researchers] investigated the impact of the first year of highly active antiretroviral therapy (HAART) on health-related quality of life (HRQL). Medical data for patients in the French APROCO cohort were collected at enrollment (M0) and month 12 (M12). A self-administered questionnaire gathered information about HRQL (Medical Outcome Study 36-Item Short Form Health Survey) and toxicity-related symptoms. Using the twenty-fifth percentile of HRQL scales in the French population as a threshold, patients with normal values in at least three mental and three physical scales were considered to have a "normal HRQL." Of the 1,053 patients followed through M12, HRQL data at M0 and M12 were available for 654. Among the 233 patients with a normal baseline HRQL, 63 (27 percent) experienced a deterioration of HRQL at M12. Among the 421 patients with a low baseline HRQL, 121 achieved a normal HRQL at M12. Logistic regression showed that factors independently associated with a normal HRQL at M12 were normal baseline HRQL, baseline CD4 count <500 cells/mm³, time since HIV diagnosis less than eight years, undetectable HIV-RNA at M12, and lower number of self-reported symptoms at M12. An assessment of HRQL should be integrated to efficacy outcomes to evaluate and compare long-term strategies properly and to optimize the durability of response to antiretroviral therapy. [JAIDS 2003;32(1):38-47.]

CD8 T-Cell Numbers Predict the Response to Antiviral Therapy in HIV-1-Infected Children

S. Resino et al.

[The researchers'] objective was to study the probability of achieving undetectable viral load levels in HIV-1-infected children after 36 months of highly active antiretroviral therapy (HAART). A prospective, multicenter, longitudinal study in 41 HIV-1-infected children on HAART was undertaken. Viral load was quantified using standard molecular assay. CD4 and CD8 T-cell subsets were determined by flow cytometry. The probability of achieving undetectable viral load was determined using Kaplan-Meier curves according to groups by percentage CD8 at baseline (CD8 <25 percent or >25 percent). Lower baseline CD8 T-cell levels conditioned a less effective virological response to HAART in children, independent of baseline CD4 T-cell numbers and viral load levels. A greater number of children (81 percent) from CD8 >25 percent group than from the CD8 <25 percent (40 percent) presented undetectable viral load levels ( p=0.013). Additionally, the CD8 >25 percent group showed a 4.5-fold higher (95 percent confidence interval: 1.1-19.2) relative proportion for achieving viral load <400 copies/mL than the CD8 <25 percent group (p=0.039). We concluded that monitoring CD8 T-cell numbers may be valuable in deciding when to start HAART in vertically HIV-1-infected children. [Pediatr Res 2003;53(2):309-312.]

Influence of Coinfection With Hepatitis C Virus on Morbidity and Mortality Due to Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy

E.M. Tedaldi et al.

To ascertain the impact of hepatitis C virus (HCV) infection on human immunodeficiency virus (HIV) disease progression and associated death in the era of highly active antiretroviral therapy (HAART), we examined mortality rates, the presence of other diseases, and antiretroviral use in an observational cohort of 823 HIV-infected patients with and without HCV coinfection during the period of January 1996 through June 2001. Analyses were used to compare patient characteristics, comorbid conditions, and survival durations in HIV-infected and HIV-HCV-coinfected patients. HIV-HCV-coinfected persons did not have a statistically greater rate of acquired immunodeficiency syndrome or of renal or cardiovascular disease, but they did have more cases of cirrhosis and transaminase elevations. There were proportionately more deaths in the HIV-HCV-coinfected group. Age, baseline CD4 count, and duration of HAART were significantly associated with survival, but HCV infection was not. HAART use was a strong predictor of increased duration of survival, suggesting that treatment is more important to survival than is HCV coinfection status. [Clin Infect Dis 2003;36(3):363-367.]

The Absence of HIV Seropositivity Contrasts With a High Prevalence of Markers of Sexually Transmitted Infections Among Registered Female Sex Workers in Toliary, Madagascar

S. Xueref et al.

In a cross-sectional study in 1998, [the researchers] assessed human immunodeficiency virus (HIV) and syphilis infections and their risk factors among the 316 registered female sex workers (FSWs) of Toliary, southwest Madagascar. No case of HIV infection was detected, but 18.4 percent of registered FSWs had syphilis. Only half of these women regularly used condoms. In a multiple logistic regression analysis, risk factors for syphilis infection were multiple clients per week and, paradoxically, regular use of condoms. The variables associated with irregular use of condoms were younger ages of registered FSWs, multiple clients per week and Malagasy clients. The high prevalence of syphilis infection associated with irregular use of condoms might facilitate a very fast spread of HIV infection among these FSWs. Promotion of condom use and surveillance of sexually transmitted infections and HIV infection incidence are needed in the south of Madagascar. [Trop Med Int Health 2003;8(1):60-66.]

Discrepant Results in the Interpretation of HIV-1 Drug-Resistance Genotypic Data Among Widely Used Algorithms

G.H. Kijak et al.

The aim of this study was to assess the concordance on the interpretation of HIV-1 drug-resistance genotypic data by three widely used algorithms: Stanford University Database (SU), TruGene (Visible Genetics, Canada) (VG) and VirtualPhenotype (Virco, Belgium) (VP). Genotypic data from 293 HIV-1-infected individuals with treatment failure was interpreted for 14 antiretroviral drugs by the three algorithms. Complete concordant results among the three systems for all the drugs studied were found in 40/293 (13.7 percent) samples. Low concordance in the interpretation was observed for most nucleoside reverse transcriptase inhibitors (NRTIs), while results agreed highly for all nonnucleoside reverse transcriptase inhibitors (NNRTIs) and most protease inhibitors (PIs). In pair-wise comparisons, discordant interpretations between SU and VP were found in over 50 percent of the samples for didanosine, zalcitabine, stavudine and abacavir, and the level of disagreement between VG and VP exceeded 40 percent for the same drugs. Major discrepancies (high-level resistance interpretation by one algorithm with sensitive interpretation by another) were observed between VG and VP in over 10 percent of the cases for didanosine, zalcitabine, stavudine and abacavir. On the other hand, the three algorithms had concordant results for lamivudine in over 90 percent of the cases. This work demonstrates the great level of discordance in the interpretation of genotyping results among algorithms, clearly showing the necessity for clinical validation. Moreover, these results suggest that a joint effort from the scientific community as well as national and international HIV societies is needed to achieve a consensus for the interpretation of genotypic data. [HIV Med 2003;4(1):72-78.]