AIDSWEEKLY Plus; Monday, August 13, 2007
Staff Medical Writers

Study 1: Data detailed in "Transmission rates in consecutive pregnancies exposed to single-dose nevirapine in Soweto, South Africa and Abidjan, Côte d'Ivoire" have been presented. According to recent research from the United States, "Large numbers of women receive single-dose nevirapine (sdNVP) to prevent mother-to-child transmission (MTCT) of HIV; over time, an increasing proportion will return to prevention of MTCT programs for a second pregnancy. Because sdNVP selects resistance in a high percentage of women, we compared the effectiveness of sdNVP in preventing peripartum MTCT in successive pregnancies."

"Prospective cohorts were recruited from MTCT programs in South Africa and Côte d'Ivoire. HIV-1-infected women and their infants exposed to sdNVP in 2 consecutive pregnancies-used alone or with zidovudine (ZDV) or ZDV plus lamivudine-were included. The median age of women at their initial exposure to sdNVP in Soweto (n=120) and Abidjan (n=41) was 26 (interquartile range [IQR]: 22-29) years and 28 (IQR: 24-31) years, respectively, and their median delivery interval was 21 (IQR: 15-29) months and 26 (IQR: 20-32) months, respectively," wrote N.A. Martinson and colleagues, Johns Hopkins University.

The researchers concluded: "Transmission rates in Soweto and in Abidjan were 11.1% and 13.2% for the first pregnancy and 11.1% and 5.4% for the second pregnancy (p=1.000 and p=0.449 for Soweto and Abidjan, respectively, in unpaired analysis). This analysis suggests that the effectiveness of sdNVP when used in successive pregnancies is probably not impaired, possibly because viral resistance selected by prior exposure to sdNVP may wane with time."

Martinson and colleagues published their study in the J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):206-9).

For additional information, contact N.A. Martinson, School of Medicine, Johns Hopkins University, Baltimore, MD USA.

Study 2: Immune reconstitution inflammatory syndrome in the CNS should be suspected in HIV/AIDS patients after HAART initiation accompanied by improved CD4 T cell count and decreased viral load.

In a recent report, researchers in the United States describe "challenges in diagnosis and management of patients with clinical syndromes of immune reconstitution inflammatory syndrome (IRIS) involving the CNS.

"The authors describe three patients with clinically distinct neurologic manifestations of IRIS with HIV infection who presented as diagnostic and therapeutic challenges."

"One patient with cryptococcal meningitis developed acute cerebellitis with mass effect and brainstem compression. Corticosteroid therapy was associated with complete resolution of the cerebellar lesion but the patient developed VZV encephalitis.

"Another patient with progressive multifocal leukoencephalopathy developed subacute progression of focal neurologic deficits associated with contrast enhancing lesions on brain MRI. This patient had spontaneous resolution of the lesion but was left with residual deficits," researchers reported.

"One patient developed a progressive dementing syndrome and deterioration over several months resulting in coma during combination antiretroviral therapy. A brain biopsy in this latter patient showed massive infiltration of T lymphocytes predominantly of the CD8 subtype.

"This patient had a significant improvement with corticosteroids and change in antiretroviral regimen although she was left with residual cognitive impairment," said A. Venkataramana and colleagues at Johns Hopkins University.

The authors concluded, "Immune reconstitution inflammatory syndrome should be suspected in patients who show clinical or radiologic deterioration following initiation of antiretroviral therapy accompanied with improvement in CD4 cell count and viral load. Some patients may respond to a brief course of treatment with corticosteroids."

Venkataramana and colleagues published their study in Neurology (Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients. Neurology. 2006 Aug 8;67(3):383-8).

For additional information, contact A. Nath, Johns Hopkins University, Dept. of Neurology, School Medical, 600 N Wolfe St., Path 509, Baltimore, MD 21287, USA.

Study 3: HAART has enhanced mental health functioning in HIV/AIDS.

"Studies have shown the detrimental effect of HIV disease on quality of life (QOL). Changes in QOL related to the use of highly active antiretroviral therapy (HAART) have been inconsistent and it is unknown how QOL after HAART compares to preinfection levels.

"The objective of this study was to determine the impacts of becoming HIV infected and using HAART on QOL within individuals followed in the Multicenter AIDS Cohort Study (MACS)," scientists writing in the journal Quality of Life Research report.

According to C.L. Liu and colleagues at Johns Hopkins University in Baltimore, "Using the standard Medical Outcome Study SF-36 form, QOL data were collected preseroconversion, postseroconversion but before HAART initiation, and after HAART initiation for 68 seroconverters. The QOL physical health summary score (PHS) and mental health summary score (MHS) were used as outcomes.

"The effects of HIV infection and HAART use on QOL summary scores were determined using random effects mixed linear models after controlling for possible confounders. The clinical significance of QOL change was assessed using the Cohen's effect size method."

"Compared to preseroconversion values," said the authors, "the PHS decreased after seroconversion (mean difference (diff)=-1.62; 95% confidence interval (CI): [-3.20, -0.03]) and after HAART initiation (diff=-4.20; 95% CI: [-5.86, -2.54]) with small to medium effect sizes.

"The score remained significantly lower than prior to HIV infection (diff=-6.16; 95% CI: [-8.09, -4.23]) after being on HAART for more than 4 years. The MHS did not significantly differ upon seroconversion (diff=-1.16; 95% CI: [-3.32, 1.00])."

"After using HAART for more than 4 years," Liu continued, "the MHS was significantly greater than prior to HIV infection (diff=2.93; 95% CI: [0.31, 5.55]) with a small effect size."

Investigators concluded, "The QOL of participants has been dynamic over the HIV disease course. HIV infection deteriorated physical but not mental QOL. In this group, although the PHS following HAART has remained lower than that prior to infection, HAART has enhanced mental health functioning."

Liu and colleagues published their study in Quality of Life Research (Impacts of HIV infection and HAART use on quality of life. Qual Life Res. 2006 Aug;15(6):941-9).

Additional information can be obtained by contacting C.L. Liu, Johns Hopkins University, Bloomberg School Public Health E7139, 615 N Wolfe St., Baltimore, MD 21205, USA.

Keywords: Baltimore, Maryland, United States, HIV/AIDS, HAART, Mental Health, Quality Of Life.

This article was prepared by AIDS Weekly editors from staff and other reports. Copyright 2007, AIDS Weekly via NewsRx.com.

Reference

Martinson NA, Ekouevi DK, Dabis F, et al., Transmission rates in consecutive pregnancies exposed to single-dose nevirapine in Soweto, South Africa and Abidjan, Côte d'Ivoire, J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):206-9.

Venkataramana A, Pardo CA, McArthur JC, et al., Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients, Neurology. 2006 Aug 8;67(3):383-8.

Liu C, Ostrow D, Detels R, et al., Impacts of HIV infection and HAART use on quality of life, Qual Life Res. 2006 Aug;15(6):941-9.

2007-08-13
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