Journal of AIDS & Clinical Research

The cytochrome P450 isoform that is primarily involved in the metabolism of darunavir is CYP3A4. Drugs that modulate this enzyme would then be expected to alter the pharmacokinetics of darunavir.Phenobarbital, a traditional antiepileptic has been shown to have broad induction effects on CYP450 and glucuronidation systems and would be expected to affect any drug, including antiretrovirals that are handled by these systems. We report a case in which we believe decreased serum concentrations of darunavir may have been a result of a drug interaction with phenobarbital.

Background: Zinc deficiency is prevalent in HIV and hyperglycemic patients. Antiretroviral therapy (ART) is a treatment to control HIV progression; however it increases the risk for hyperglycemia. The objective of this study was to assess the plasma zinc levels in hyperglycemic people living with HIV (PLWH).

Methods: Secondary analysis was conducted on the data from the Miami Adult Studies in HIV (MASH) cohort in Florida. Patients were categorized into hyperglycemic group (fasting blood glucose ≥100 mg/dL) and normal group (<100 mg/dL).

Results: Plasma zinc status and CD4 levels were lower in the hyperglycemic group, however the difference was not significant. There was a greater percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%).

Discussion: Although not statistically significant, related biomarkers such as plasma zinc levels and CD4 levels were lower in the hyperglycemic group. This may be due to the role zincplays in the immune system. Due to the fact that there was a higher percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%), it is important to monitor and manage blood glucose levels to minimize complications. Our findings along with previous findings suggest that zinc supplementation may benefit hyperglycemic PLWH.

As many as 40-50% of persons living with HIV (PLWH) who once were in HIV care are no longer in care. It is estimated that these individuals account for over 60% of HIV transmissions. So, preventing the leaving of care and re-engaging PLWH with care are crucial if the HIV epidemic is to be brought under control.Clinicians can improve retention by keeping in close contact with patients. Governmental public health agencies have great expertise in finding and engaging in care persons with sexually transmitted infections. This expertise can be used to re-engage PLWH with HIV care, but it can only be utilized if the agencies know that someone is out of care. Data on who has left care are in the hands of HIV providers. This requires a close working relationship between HIV providers and public health agencies.

Annual HIV testing is recommended for high-risk populations in the United States, to identify HIV infections early and provide timely linkage to treatment. However, heterosexuals at high risk for HIV, due to their residence in urban areas of high poverty and elevated HIV prevalence, test for HIV less frequently than other risk groups, and late diagnosis of HIV is common. Yet the factors impeding HIV testing in this group, which is predominantly African American/Black and Latino/Hispanic, are poorly understood. The present study addresses this gap. Using a systematic community-based sampling method, venue-based sampling (VBS), we estimate rates of lifetime and recent (past year) HIV testing among high-risk heterosexuals (HRH), and explore a set of putative multi-level barriers to and facilitators of recent testing, by gender. Participants were 338 HRH African American/Black and Latino/Hispanic adults recruited using VBS, who completed a computerized structured assessment battery guided by the Theory of Triadic Influence, comprised of reliable/valid measures on socio-demographic characteristics, HIV testing history, and multi-level barriers to HIV testing. Logistic regression analysis was used to identify factors associated with HIV testing within the past year. Most HRH had tested at least once (94%), and more than half had tested within the past year (58%), but only 37% tested annually. In both men and women, the odds of recent testing were similar and associated with structural factors (better access to testing) and sexually transmitted infection (STI) testing and diagnosis. Thus VBS identified serious gaps in rates of annual HIV testing among HRH. Improvements in access to high-quality HIV testing and leveraging of STI testing are needed to increase the proportion of HRH testing annually for HIV. Such improvements could increase early detection of HIV, improve the long-term health of individuals, and reduce HIV transmission by increasing rates of viral suppression.

Objective: HIV-infected (HIV+) individuals may have differential risk of diabetes mellitus (DM) compared to the general population, and the optimal diagnostic algorithm for DM in HIV+ persons remains unclear. We aimed to assess the utility of oral glucose tolerance testing (OGTT) for DM diagnosis in a cohort of women with or at risk for HIV infection.

Methods: Using American Diabetic Association DM definitions, DM prevalence and incidence were assessed among women enrolled in the Women’s Interagency HIV Study. DM was defined by 2-hour OGTT ≥ 200 mg/dL (DM_ OGTT) or a clinical definition (DM_C) that included any of the following: (i) anti-diabetic medication use or self-reported DM confirmed by either fasting glucose (FG) ≥126 mg/dL or HbA1c ≥ 6.5%, (ii) FG ≥ 126 mg/dL confirmed by a second FG ≥ 126 mg/dL or HbA1c 6.5%, or (iii) HbA1c 6.5% confirmed by FG ≥ 126 mg/dL cohort.

Results: Overall, 390 women (285 HIV+, median age 43 years; 105 HIV-, median age 37 years) were enrolled between 2003-2006. Over half of all women were African American. Using DM_C, DM prevalence rates were 5.6% and 2.8% among HIV+ and HIV- women, respectively. Among HIV+ women, adding DM_OGTT to DM_C increased DM prevalence from 5.6% to 7.4%, a 31% increase in the number of diabetes cases diagnosed (p=0.02). In HIV- women, no additional cases were diagnosed by DM-OGTT.

Conclusion: In HIV+ women, OGTT identified DM cases that were not identified by a standardized clinical definition. Further investigation is needed to determine whether OGTT should be considered as an adjunctive tool for DM diagnosis in the setting of HIV infection.

Purpose: This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal.

Methods: 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt.

Results: 65.1% of the men found at least one sensory aspect of semen to be “fairly” or “very” arousing, compared to 10.2% being “not very” or “not at all” aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual “bottom,” being better educated, being HIV-positive, and being more depressed.

Conclusions: Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.

Objectives: HIV-infected patients suffer from both physical and mental health symptoms and treatment of both symptoms is important. The 8-week Mindfulness Based Cognitive Therapy (henceforth MBCT) was originally developed for both mental and physical symptoms and is easy to implement. It is unknown, however, whether the addition of MBCT to psychiatric care as usual is effective in the long term and feasible for this group of patients. We measured depressive and anxiety symptoms, suicidal thoughts and fatigue in HIV-infected patients receiving psychiatric care as usual with or without MBCT, at intake and after one year.

Methods: The study was conducted at the outpatient clinic for HIV and Mental Health at GGZ inGeest in Amsterdam, the Netherlands, between March 2006 and September 2009. MBCT was offered as a group therapy in addition to individual care as usual to all (N=208) patients in their first year of psychiatric treatment.

Results: In the research period, 58 patients opted for the MBCT and 150 did not. Twenty patients did not complete the MBCT and questionnaires of both time points were available from 22 patients with and from 60 patients without MBCT. During their first year of psychiatric care, patients in both treatment groups showed significant improvement on depressive and anxiety symptoms, suicidal thoughts and fatigue.

Conclusion: Measured after one year, the addition of MBCT to psychiatric care as usual for HIV-infected patients had no measurable added effect on the treatment of depressive and anxiety symptoms, suicidal thoughts and fatigue. The present study was an explorative study to investigate the role of additional MBCT to psychiatric care as usual. It seems that general addition of MBCT is not feasible in this group of patients. However, further research, for example in a randomized controlled trial (RCT) is necessary to confirm the resu

Background: Deficient interferon (IFN)-α production of plasmacytoid DCs (pDCs) from HIV-1-infected individuals in response to virus or toll-like receptor (TLR) stimulation has been reported. pDCs express TLR7 and TLR9, but whether and how the TLR pathway contributes to the deficiency has not been well addressed.

Methods: Twenty-six subjects with HIV-1 infection were recruited from a chronic HIV-1 infection (CHI) cohort of men who have sex with men (MSM) and 15 HIV-1 negative healthy MSM were used as normal controls (NCs). Maturation markers (CD80, CD86, CD83, CD40, CCR7), TLR7 and TLR9, nuclear factor κB (NF-κB) and interferon regulatory factor 7 (IRF7) expression were detected using surface and intracellular multicolor flow cytometry. Intracellular IFN-α production of pDCs was measured in response to R848 (TLR7 agonist) and ODN2216 (TLR9 agonist), respectively.

Results: IFN-α production of pDCs with treatment of R848, but not ODN2216, from MSM with CHI was significantly lower than that of NCs. There was no significant difference in maturation marker expression between MSM with CHI and NCs. The expression of TLR7 and TLR9 on pDCs of MSM with CHI was significantly up-regulated. The expression of IRF7, a downstream signaling protein in the TLR7/9 signaling pathway, was significantly down-regulated as compared with that of NCs. NF-κB expression of pDCs of MSM with CHI were similar to that of NCs.

Conclusions: These results indicated that decreased IRF7 expression might contribute to deficient IFN-α production in MSM with CHI, suggesting efforts to increase the expression of IRF7 might resume the function of pDCs in individuals with CHI.