Browsing by Author "Kusic, Jovana (56014110700)"

Background: The range of combination antiretroviral therapy (cART) regimens available in many middle-income countries differs from those suggested in international HIV treatment guidelines. We compared first-line cART regimens, timing of initiation and treatment outcomes in a middle income setting (HIV Centre, Belgrade, Serbia - HCB) with a high-income country (Royal Free London Hospital, UK - RFH). Methods: All antiretroviral-naïve HIV-positive individuals from HCB and RFH starting cART between 2003 and 2012 were included. 12-month viral load and CD4 count responses were compared, considering the first available measurement 12-24 months post-cART. The percentage that had made an antiretroviral switch for any reason, or for toxicity and the percentage that had died by 36 months (the latest time at which sufficient numbers remained under follow-up) were investigated using standard survival methods. Results: 361/597 (61 %) of individuals initiating cART at HCB had a prior AIDS diagnosis, compared to 337/1763 (19 %) at RFH. Median pre-ART CD4 counts were 177 and 238 cells/mm3 respectively (p < 0.0001). The most frequently prescribed antiretrovirals were zidovudine with lamivudine (149; 25 %) and efavirenz [329, 55 %] at HCB and emtricitabine with tenofovir (899; 51 %) and efavirenz [681, 39 %] at RFH. At HCB, a median of 2 CD4 count measurements in the first year of cART were taken, compared to 5 at RFH (p < 0.0001). Median (IQR) CD4 cell increase after 12 months was +211 (+86, +359) and +212 (+105, +318) respectively. 287 (48 %) individuals from HCB and 1452 (82 %) from RFH had an available viral load measurement, of which 271 (94 %) and 1280 (88 %) were <400 copies/mL (p < 0.0001). After 36 months, comparable percentages had made at least one antiretroviral switch (77 % HCB vs. 78 % RFH; p = 0.23). However, switches for toxicity/patient choice were more common at RFH. After 12 and 36 months of cART 3 % and 8 % of individuals died at HCB, versus 2 % and 4 % at RFH (p < 0.0001). Conclusion: In middle-income countries, cART is usually started at an advanced stage of HIV disease, resulting in higher mortality rates than in high income countries, supporting improved testing campaigns for early detection of HIV infection and early introduction of newer cART regimens. © 2016 Dragovic et al.

BACKGROUND:: Genetic factors have been associated with efavirenz (EFV) plasma concentrations in different populations. In this study, we investigated the effects of CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), CAR c.152-1089T>C (rs3003596), and smoking status in a cohort of Serbian patients with HIV. METHODS:: Patients with HIV positive, all whites, were recruited from the HIV/AIDS Center at the Infectious and Tropical Diseases Hospital, University of Belgrade Teaching Hospital, Belgrade, Serbia. Mid dose (10-14 hours after dose) EFV plasma concentration was determined using a validated liquid chromatography/tandem mass spectrometry method. Genotyping for CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), and CAR c.152-1089T>C (rs3003596) was conducted using allelic discrimination real-time polymerase chain reaction assay. One-way analysis of variance, Mann-Whitney test, Pearson or Spearman correlation, and multiple linear regression were used for data analysis. RESULTS:: Minor allele frequencies were similar to frequencies reported in other European populations. The overall mean (95% confidence interval) plasma EFV concentration was 2800 ng/mL (2460-3140). Significant differences between patients based on CYP2B6 516G>T (rs3745274) genotypes were observed: GG (n = 60), 2320 (range, 2160-2480) ng/mL; GT (n = 30), 3230 (range, 2790-3670) ng/mL; and TT (n = 2), 10,700 (range, 6170-15,300) ng/mL (P = 2.0 × 10). In multivariate linear regression analysis, CYP2B6 516G>T (rs3745274) [β = 1770 (1230 to 2310) ng/mL, P < 0.0001] and smoking status [β = -464 (-1250 to -43.3) ng/mL, P = 0.038] were independently associated with plasma EFV concentrations. CONCLUSIONS:: The effects of CYP2B6 516G>T (rs3745274) and smoking status on EFV plasma concentration in the Serbian population have been established for the first time. © 2014 by Lippincott Williams & Wilkins.

BACKGROUND:: Genetic factors have been associated with efavirenz (EFV) plasma concentrations in different populations. In this study, we investigated the effects of CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), CAR c.152-1089T>C (rs3003596), and smoking status in a cohort of Serbian patients with HIV. METHODS:: Patients with HIV positive, all whites, were recruited from the HIV/AIDS Center at the Infectious and Tropical Diseases Hospital, University of Belgrade Teaching Hospital, Belgrade, Serbia. Mid dose (10-14 hours after dose) EFV plasma concentration was determined using a validated liquid chromatography/tandem mass spectrometry method. Genotyping for CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), and CAR c.152-1089T>C (rs3003596) was conducted using allelic discrimination real-time polymerase chain reaction assay. One-way analysis of variance, Mann-Whitney test, Pearson or Spearman correlation, and multiple linear regression were used for data analysis. RESULTS:: Minor allele frequencies were similar to frequencies reported in other European populations. The overall mean (95% confidence interval) plasma EFV concentration was 2800 ng/mL (2460-3140). Significant differences between patients based on CYP2B6 516G>T (rs3745274) genotypes were observed: GG (n = 60), 2320 (range, 2160-2480) ng/mL; GT (n = 30), 3230 (range, 2790-3670) ng/mL; and TT (n = 2), 10,700 (range, 6170-15,300) ng/mL (P = 2.0 × 10). In multivariate linear regression analysis, CYP2B6 516G>T (rs3745274) [β = 1770 (1230 to 2310) ng/mL, P < 0.0001] and smoking status [β = -464 (-1250 to -43.3) ng/mL, P = 0.038] were independently associated with plasma EFV concentrations. CONCLUSIONS:: The effects of CYP2B6 516G>T (rs3745274) and smoking status on EFV plasma concentration in the Serbian population have been established for the first time. © 2014 by Lippincott Williams & Wilkins.

Lactic acidosis is the most serious, sometimes life-threatening, adverse effect of nucleoside reverse transcriptase inhibitor (NRTI) usage in HIV infected patients. The reported incidence rate of lactic acidosis due to an NRTI based regimen is low, but the fatality rate is estimated at around 60 - 80% in those HIV-infected patients who develop lactic acidosis during NRTI usage. The mechanism of NRTI induced lactic acidosis is based on inhibition of mitochondrial DNA polymerase - γ and consequent mitochondrial depletion and deficit in the respiratory chain function. All NRTIs may interact with polymerase - γ, but dideoxynucleosides, such as stavudine (d4T), zalcitabine (ddC) and didanosine (ddI), also known as d-drugs, are the most potent. In resource limited settings, where d-drugs still remain the first line treatment option, the highest incidence of NRTI-induced lactic acidosis is due to stavudine (d4T), followed by didanosine (ddI) usage. Lactic acidosis developed even more frequently when stavudine and didanosine were prescribed together. Zidovudine (AZT) could potentially induce lactic acidosis, while significant events are not reported with other NRTI drugs, such as lamivudine, abacavir and tenofovir. Risk factors associated with lactic acidosis are female sex, advanced HIV-1 induced immunodeficiency, obesity and prolonged duration of NRTI-based antiretroviral treatment. Renal and liver abnormalities, especially hepatitis B and hepatitis C virus coinfection, are associated with a higher incidence of lactic acidosis. Lactic acidosis induced with NRTI usage is treated by NRTI withdrawal, especially in life-threatening clinical conditions with serum lactate level of 5 mmol/L and higher. Within several days the outcome is favourable in most cases. Recovery is complete, especially when no other d-drug is re-administered. Even though current HIV/AIDS treatment guidelines discourage the usage of ddrugs, national HIV treatment guidelines from low-middle income countries are still unable to abandon these drugs. Thus, NRTI-associated lactic acidosis is still issue of concern in the resource limited settings. © 2014 by Nova Science Publishers, Inc. All rights reserved.