Background. Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected ...people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load. Methods. Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. AIDS-defining event or AIDS-related death and severe non-AIDS-defining event or non-AIDS-related death were taken as clinical progression end points. Independent predictors of CMV were identified by multivariable logistic regression. Probabilities of reaching the end points were estimated by survival analyses. Results. A total of 6111 subjects were included, of whom 5119 (83.3%) were CMV IgG positive at baseline. Patients with CMV IgG positivity at baseline were more likely to develop a severe non-AIDS-defining event/non-AIDS-related death (adjusted hazard ratio HR, 1.53 95% confidence interval {CI}, 1.08-2.16. In particular, CMV seropositivity was an independent risk factor for cardiovascular and cerebrovascular diseases (adjusted HR, 2.27 95% CI, .97-5.32). Conclusions. In our study population, CMV/HIV coinfection was associated with the risk of severe non-AIDS-defining events/non-AIDS-related death, especially with cardiovascular and cerebrovascular events, independently of other prognostic factors. This finding supports a potential independent role of CMV coinfection in vascular/degenerative organ disorders in HIV-infected subjects.
Highlights • Invasive fungal infections are a major cause of mortality in HIV/AIDS patients globally. • HIV/AIDS has multiple complex effects on antifungal immunity. • The current global response to ...this neglected epidemic needs to be improved. • There is a pressing need for access to better diagnostics and to new and existing drugs.
Thirty years after AIDS was first recognized, the American South constitutes the epicenter of the United States' epidemic. Southern states claim the highest rates of new infections, the most ...AIDS-related deaths, and the largest number of adults and adolescents living with the virus. Moreover, the epidemic disproportionately affects African American communities across the region. Using the history of HIV in North Carolina as a case study, Stephen Inrig examines the rise of AIDS in the South in the period from the early spread and discovery of the disease through the late nineties.Drawing on epidemiological, archival, and oral history sources, Inrig probes the social determinants of health that put poor, rural, and minority communities at greater risk of HIV infection in the American South. He also examines the difficulties that health workers and AIDS organizations faced in reaching those communities, especially in the early years of the epidemic. His analysis provides an important counterweight to most accounts of the early history of the disease, which focus on urban areas and the spread of AIDS in the gay community. As one of the first historical studies of AIDS in a southern state,North Carolina and the Problem of AIDSprovides powerful insight into the forces and factors that have made AIDS such an intractable health problem in the American South and the greater United States.
The overview summarizes the evaluation of community responses (15 studies, including 11 evaluations carried out in 8 countries). It presents the evaluation questions, the methodology, the key results ...achieved by community responses along the continuum of prevention, treatment, care and support, and the resulting policy and programmatic implications. Before the scale-up of the international response to the AIDS pandemic, community responses in developing countries played a crucial role in providing services and care for those affected. This study is the first comprehensive, mixed-method evaluation of the impact of that response. The evaluation finds that community response can be effective at increasing knowledge of HIV, promoting social empowerment, increasing access to and use of HIV services, and even decreasing HIV incidence, all through the effective mobilization of limited resources. By effectively engaging with this powerful community structure, future HIV and AIDS programs can ensure that communities continue to contribute to the global response to HIV and AIDS.
Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. In order to help develop global strategies and priorities for prevention ...and treatment, it is important to estimate the burden of cryptococcal meningitis.
Global burden of disease estimation using published studies.
We used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 United Nations Programme on HIV/AIDS HIV population estimate for each region to estimate cryptococcal meningitis cases. To estimate deaths, we assumed a 9% 3-month case-fatality rate among high-income regions, a 55% rate among low-income and middle-income regions, and a 70% rate in sub-Saharan Africa, based on studies published in these areas and expert opinion.
Published incidence ranged from 0.04 to 12% per year among persons with HIV. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases; range, 144 000-1.3 million). Median incidence was lowest in Western and Central Europe and Oceania (</=0.1% each). Globally, approximately 957 900 cases (range, 371 700-1 544 000) of cryptococcal meningitis occur each year, resulting in 624 700 deaths (range, 125 000-1 124 900) by 3 months after infection.
This study, the first attempt to estimate the global burden of cryptococcal meningitis, finds the number of cases and deaths to be very high, with most occurring in sub-Saharan Africa. Further work is needed to better define the scope of the problem and track the epidemiology of this infection, in order to prioritize prevention, diagnosis, and treatment strategies.
Antibodies capable of neutralizing HIV-1 often target variable regions 1 and 2 (V1V2) of the HIV-1 envelope, but the mechanism of their elicitation has been unclear. Here we define the developmental ...pathway by which such antibodies are generated and acquire the requisite molecular characteristics for neutralization. Twelve somatically related neutralizing antibodies (CAP256-VRC26.01-12) were isolated from donor CAP256 (from the Centre for the AIDS Programme of Research in South Africa (CAPRISA)); each antibody contained the protruding tyrosine-sulphated, anionic antigen-binding loop (complementarity-determining region (CDR) H3) characteristic of this category of antibodies. Their unmutated ancestor emerged between weeks 30-38 post-infection with a 35-residue CDR H3, and neutralized the virus that superinfected this individual 15 weeks after initial infection. Improved neutralization breadth and potency occurred by week 59 with modest affinity maturation, and was preceded by extensive diversification of the virus population. HIV-1 V1V2-directed neutralizing antibodies can thus develop relatively rapidly through initial selection of B cells with a long CDR H3, and limited subsequent somatic hypermutation. These data provide important insights relevant to HIV-1 vaccine development.
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Dostopno za:
DOBA, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite widespread concerns about HIV incidence in pregnant and postpartum women, there are few data from Africa on HIV acquisition in breastfeeding and subsequent mother-to-child transmission. We ...measured HIV incidence in a prospective cohort of 413 peripartum and breastfeeding women who tested HIV-negative during pregnancy. In 377 woman-years accrued postpartum (median duration of follow-up, 1 year), there were seven women infected after delivery (postpartum incidence, 1.86/100 person-years; 95% confidence interval 0.88–3.89) with transmission to 2/7 (28%) infants.
From the very beginning of the epidemic, AIDS was linked to punishment. Calls to punish people living with HIV-mostly stigmatized minorities-began before doctors had even settled on a name for the ...disease. Punishing Disease looks at how HIV was transformed from sickness to badness under the criminal law and investigates the consequences of inflicting penalties on people living with disease. Now that the door to criminalizing sickness is open, what other ailments will follow? With moves in state legislatures to extend HIV-specific criminal laws to include diseases such as hepatitis and meningitis, the question is more than academic.
Workable Sisterhood is an empirical look at sixteen HIV-positive women who have a history of drug use, conflict with the law, or a history of working in the sex trade. What makes their experience ...with the HIV/AIDS virus and their political participation different from their counterparts of people with HIV? Michele Tracy Berger argues that it is the influence of a phenomenon she labels "intersectional stigma," a complex process by which women of color, already experiencing race, class, and gender oppression, are also labeled, judged, and given inferior treatment because of their status as drug users, sex workers, and HIV-positive women. The work explores the barriers of stigma in relation to political participation, and demonstrates how stigma can be effectively challenged and redirected.
Many practical clinical questions regarding the management of human immunodeficiency virus (HIV)—associated neurocognitive disorder (HAND) remain unanswered. We sought to identify and develop ...practical answers to key clinical questions in HAND management. Sixty-six specialists from 30 countries provided input into the program, which was overseen by a steering committee. Fourteen questions were rated as being of greatest clinical importance. Answers were drafted by an expert group based on a comprehensive literature review. Sixty-three experts convened to determine consensus and level of evidence for the answers. Consensus was reached on all answers. For instance, good practice suggests that all HIV patients should be screened for HAND early in disease using standardized tools. Follow-up frequency depends on whether HAND is already present or whether clinical data suggest risk for developing HAND. Worsening neurocognitive impairment may trigger consideration of antiretroviral modification when other causes have been excluded. The Mind Exchange program provides practical guidance in the diagnosis, monitoring, and treatment of HAND.
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