Journal of AIDS & Clinical Research

We present here a case of progressive visual loss and convulsions in a 45 year old male immuno-compromised patient with pulmonary tuberculosis. He was subsequently diagnosed as Progressive Multifocal Leukoencephalopathy (PML) based on Magnetic Resonance Imaging, cerebrospinal fluid and clinical findings.

Introduction: During the past decade, the incidence of gonorrhoea has increased in Spain, mainly affecting the community of men who have sex with men. The objective of the present study was to describe the cases of gonococcal infection at a referral centre for sexually transmitted diseases in Madrid, as well as the factors associated with co-infection by the human immunodeficiency virus. Methods: A retrospective cross-sectional study was performed of all of the cases of gonococcal infection that were diagnosed in 2010 at the Sandoval Health Centre of Madrid. Clinical histories, diagnostic tests, and sociodemographic and risk-behaviour questionnaires were analysed. Results: Eighty-three per cent of the patients who were diagnosed with gonorrhoea were men who had engaged in sex with men, and 29% tested positive by serological screening for HIV. In the multiple logistic regression model the following factors were associated with the HIV co-infection: having a positive history of one or more sexually transmitted diseases (OR=57.44; 95% CI: 6.78-486.50), having a stable partner who was HIV-positive (OR=23.13; 95% CI: 2.44-219.36), having a concomitant syphilis diagnosis (OR=8.88; 95% CI: 1.90-41.37), having engaged in unprotected, insertive anal intercourse (OR=6.10; 95% CI: 2.52-14.76), and having engaged in high-risk sexual contacts while under the influence of alcohol or other drugs (OR=2.73; 95% CI: 1.13-6.62). Conclusions: In the present study, a greater incidence of gonococcal infection and HIV co-infection was observed in men who had engaged in sex with men. Therefore, greater emphasis should be placed on the routine screening for sexually transmitted diseases and the targeting of education and health-promotion initiatives to highrisk communities

Objective. With the advent of highly active anti-retroviral therapy, HIV disease has become a chronic condition, but with a number of metabolic complications including insulin resistance and diabetes mellitus, dyslipidemia and hypertension and an increased incidence of atherosclerosis. The aim of the current study was to test the safety and efficacy of chromium picolinate for HIV- associated insulin resistance. Materials/Methods: The study was a randomized, double-blind, placebo-controlled trial with subjects receiving 500μg of chromium picolinate or placebo twice daily for two months. HIV- infected subjects were selected based on a fasting concentration of plasma glucose greater than 5.5mmol/L or a plasma glucose concentration of greater than 7.7mmol/L (but less than 11mmol/L) 2h after oral ingestion of 75g of glucose. Insulin sensitivity was assessed with a hyper-insulinemic-euglycemic clamp and glucose tolerance was assessed with the oral glucose tolerance test. Subjects were monitored closely for alterations in viral load, CD4+ cells, hemoglobin and hematocrit, kidney and liver function, and fasting lipid profiles. Results: Forty-three subjects were enrolled and 39 completed the protocol (20 in the chromium-supplemented and 19 in the placebo arm). Following chromium-supplementation, there were no significant changes in either insulin sensitivity or glucose tolerance. There was a significant improvement in serum HDL cholesterol concentration in the group supplemented with chromium. Conclusions: Chromium picolinate supplementation at this level was well-tolerated, but overall was not an effective therapy for insulin resistance in these HIV-infected subjects.

Background: Guadeloupe is the region of France with the second highest prevalence of HIV. Methods: To determine the risk factors for being lost to follow-up (LFU), a retrospective cohort study of 2,732 patients followed between 1988 and 2009 was conducted, and determined which variables were related to being LFU, i.e. permanently disappearing from HIV clinics or coming back after more than one year of missed appointments. Results: The incidence rate for permanent follow-up interruption was 9 per 100 person-years (8.3-9.7 personyears). The median time of LFU was 6.4 years (interquartile range 3-16.9 years). Cox modelling showed that the younger age groups (HR: 1.60[1.30-2.10], p=0.000) and patients diagnosed before 1997 (HR: 4.80[3.50-6.50], p=0.000) were significantly more likely to be permanently LFU. However, patients treated with HAART had a lower risk of being LFU (HR: 0.63[0.51-0.80], p=0.000). Conclusion: These results suggest that some patients may have died. They also allow to quantify the magnitude of a major yet often under-recognized problem and to identify its predictors in the context of Guadeloupe. This could help clinicians improve patient retention.

Objective: To examine the effects of GSTM1 null-allele polymorphism on oxidative stress and disease progression in HIV infected and HIV/hepatitis C (HCV) co-infected adults.

Methods: HIV-infected and HIV/HCV co-infected participants aged 40-60 years old with CD4 cell count >350 cells/ μl, were recruited. GSTM1 genotype was determined by quantitative PCR. Oxidative stress (mitochondrial 8-oxo-2’- deoxyguanosine [8-oxo-dG], malondialdehyde [MDA], oxidized glutathione and Complexes I and IV), apoptosis and HIV disease (CD4 count and viral load) markers were measured. Gene copies were not quantified, thus the Hardy- Weinberg formula was not applicable.

Results: Of the 129 HIV-infected participants, 58 were HIV/HCV co-infected. GSTM1 occurred in 66% (62/94) in those of African descent, and 33% (11/33) of the Caucasians. Those with GSTM1 coding for the functional antioxidant enzyme Glutathione S-transferase (GST), had higher CD4 cell count (β=3.48, p=0.034), lower HIV viral load (β=-0.536, p=0.018), and lower mitochondrial 8-oxo-dG (β=-0.28, p=0.03). ART reduced oxidative stress in the participants with the GSTM1 coding for the functional antioxidant enzyme. HIV/HCV co-infected participants with the GSTM1 coding for the functional antioxidant enzyme also had lower HIV viral load, lower 8-oxo-dG and lower rate of apoptosis, but also higher oxidized glutathione. Alcohol consumption was associated with lower HIV viral load but higher oxidized glutathione in those with the GSTM1 genotype coding for the functional antioxidant enzyme.

Conclusion: The GSTM1 genotype coding for the functional antioxidant enzyme is associated with lower HIV disease severity, and with lower oxidative stress, compared to GSTM1 null-allele polymorphism. HCV co-infection and alcohol use may be associated with increased oxidative stress even in the presence of the GSTM1 coding for the functional antioxidant enzyme. The null-gene, on the contrary, appears to have a detrimental effect on immune function, viral load control, and antioxidant status, suggesting a potential benefit from antioxidants in HIV infected patients with the defective gene.

Background: Young Black men who have sex with men and transgender persons (YBMSMT) aged 13-29 carry the nation’s highest burden of new HIV infections. Studies indicate that YBMSMT have poor retention in care, which is associated with reduced medication adherence and increased virologic failure.

Objective: Project nGage is a randomized controlled (RCT) trial evaluating the feasibility and preliminary efficacy of a brief, dyadic intervention designed to promote adherence to HIV primary care in safety-net clinics. Network visualization is used to identify and engage a support confidant (SC) from participants\\\' social networks. A social work interventionist then meets with the SC and SC-participant dyad to activate and maintain HIV-specific social support.

Methods: Project nGage is operating in two phases. In Phase I, the Team refined study protocols based on pilot testing. In Phase II, 94 HIV infected YBMSMT ages 16-29 will be recruited, enrolled and randomly assigned to receive Project nGage or treatment as usual (TAU). The primary outcome is appointment attendance; the secondary outcomes are medication adherence and viral load. Results: Implementation challenges include coordinating sites, managing dyadic intervention logistics, and recruiting non-adherent patients or those who have fallen out of care. The team continues to address implementation issues as the study progresses.

Conclusions: Project nGage is addressing a gap in HIV care-related research by focusing on supportive relationships as a mechanism through which to promote retention in care. Pending study results, a larger RCT would compare the relative effectiveness of the Project nGage intervention versus TAU over 18 to 24 months.