HIV treatment outcomes among people who inject drugs in Victoria, Australia.

Background: People who inject drugs (PWID) are a key population affected by HIV. We assessed the effectiveness of HIV treatment among a clinical cohort of people living with HIV (PLHIV) diagnosed and referred for community-based antiretroviral therapy (ART) in Victoria, Australia.

Methods: HIV notification data from a central statewide registry were matched with HIV clinical data from two large HIV treatment centers in Melbourne.

C-reactive protein as a predictor of cardiovascular risk in HIV-infected individuals.

Unlabelled: Background In some studies HIV infection confers approximately two-fold higher risk of cardiac events compared with the general population. C-reactive protein (CRP) is a well-characterised biomarker of cardiac events in the general population and is also elevated in patients with HIV infection. The aim of this study was to determine the predictive value of CRP for cardiac events in HIV-infected individuals.

HIV replication is associated with increased severity of liver biopsy changes in HIV-HBV and HIV-HCV co-infection.

Histological parameters were assessed in liver biopsies (n = 48) performed in patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in order to evaluate factors which were associated with significant liver disease. Necroinflammation and fibrosis was scored by the Ishak classification system, and binary logistic regression analysis was used to assess HIV and antiretroviral-related determinants of necroinflammation and fibrosis. A total of 46 biopsies were included; 33 were from HIV-positive patients co-infected with HCV and 15 biopsies were from HIV-positive patients co-infected with HBV.

High levels of psychological distress in MSM are independent of HIV status.

This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS).

Down-regulation of intra-hepatic T-cell signaling associated with GB virus C in a HCV/HIV co-infected group with reduced liver disease.

Background & Aims: Studies have shown that GB virus C (GBV-C) infection leads to reduced liver disease in hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co-infection. Considering that the underlying mechanism(s) are unknown, we aim to identify differential gene and protein expression associated with GBV-C in HCV/HIV co-infection that may be responsible for reduced liver disease.

Methods: Liver, peripheral blood mononuclear cells (PBMCs), and plasma samples were collected from 43 HCV/HIV patients.

Efavirenz plasma concentrations did not predict cessation of therapy due to neuropsychiatric symptoms in a large randomized trial.

To assess whether trial participants who ceased efavirenz (EFV) because of neuropsychiatric events had elevated plasma concentrations, we performed a retrospective case-control study. EFV levels were measured by high-performance liquid chromatography in stored plasma from 35 cases and 75 matched controls. All had taken EFV for at least 4 weeks.

Poor baseline immune function predicts an incomplete immune response to combination antiretroviral treatment despite sustained viral suppression.

Objectives: To determine the prevalence and predictors of an incomplete immune response in patients with sustained viral suppression after starting their first or second combination antiretroviral treatment (cART) regimen.

Methods: All patients were recruited to the Australian HIV Observational Database (AHOD) by March 2006. Data were analyzed to assess the prevalence of an incomplete immune response (<350 cells/microL) in the 12-24 months after starting the first or second cART regimen.

The anti-HIV activity of entecavir: a multicentre evaluation of lamivudine-experienced and lamivudine-naive patients.

Background: Entecavir, an antiviral with potent anti-hepatitis B virus activity, was recently shown to have anti-HIV activity in three patients and the ability to select for the lamivudine-resistant HIV polymerase mutation M184V in a patient with prior antiretroviral therapy.

Objectives: To further characterize entecavir's anti-HIV activity and identify risk factors for selection of the M184V.

Design: Retrospective cohort study.

Testing rates for sexually transmitted infections among HIV-infected men who have sex with men attending two different HIV services.

This study compares the testing rates of bacterial sexually transmitted infections (STIs) among HIV-positive men who have sex with men (MSM) attending two HIV clinics in Melbourne. Data on STI testing over a 12-month period were obtained for all HIV-positive MSM who attended the clinics between January and March 2006. Screening rates for bacterial STIs were significantly higher at a sexual health clinic (n = 254) compared with an infectious diseases clinic (n = 351), whether this was measured according to: at least one STI test being performed for chlamydia, gonorrhoea or syphilis (69% vs.

Incidence of putative HIV superinfection and sexual practices among HIV-infected men who have sex with men.

Objectives: To determine the upper limit for the incidence of clinically important HIV superinfection among HIV-infected men who have sex with men (MSM) and its relationship with engagement in unsafe sexual practices.

Methods: This was a retrospective cohort and nested case-control study. Electronic files of all HIV-infected MSM not on antiretroviral therapy were reviewed.

Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS.

Background: The present study investigated the prevalence of depression in HIV-positive individuals and its association with adherence to highly active antiretroviral therapy (HAART).

Methods: HIV-positive (n = 80) and HIV-negative (n = 20) participants were assessed for depression and adherence via clinical interview and self-reporting.

Results: Fourteen percent of the HIV-seropositive group met the criteria for current mood disorder compared with 5% of controls.

Reduction in hepatitis C-related liver disease associated with GB virus C in human immunodeficiency virus coinfection.

Background & Aims: It has been reported that GB virus C infection (GBV-C) leads to improved morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. However, GBV-C has no effect on the course of liver disease in hepatitis C virus (HCV) monoinfection. The aim of the study was to determine the influence of GBV-C infection on liver disease in patients with HCV/HIV coinfection.

Hepatitis C in psychiatry inpatients: testing rates, prevalence and risk behaviours.

Objective: Estimates for the prevalence of hepatitis C among people with a serious mental illness are high compared with the general population. High-risk behaviours commonly associated with mental illness may contribute to the estimated increased prevalence. This study aims to assess the contribution of risk behaviours to blood-borne virus infection in psychiatric populations in Australia, and to determine whether a pre- and post-test education and counselling program increases the number of patients willing to be tested for hepatitis C.

Statins Blunt HAART-Induced CD4 T-Cell Gains but Have No Long-Term Effect on Virologic Response to HAART.

Background: Statins are increasingly used in HIV-infected patients, but the effect of their immunomodulatory properties on antiretroviral-induced immune reconstitution is unknown.

Methods: The authors compared 6-month and 1-year changes in CD4 T-cell count, plasma HIV ribonucleic acid (RNA), and serum lipids in 69 HIV-infected patients receiving statins and 127 controls matched by age, nadir CD4 T-cell count, and hepatitis C serostatus. All patients were receiving highly active antiretroviral therapy (HAART).

Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts.

Objective: To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).

Design: Longitudinal observational study before and after interventions.

Setting: The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).

The prevalence and risk behaviours associated with the transmission of blood-borne viruses among ethnic-Vietnamese injecting drug users.

Objective: To measure the prevalence and determinants of blood-borne virus (BBV) transmission in ethnic Vietnamese injecting drug users (IDUs).

Methods: The study was conducted in Melbourne, Australia, in 2003. It was a cross-sectional design with participants recruited from street-based illicit drug markets predominately using a snowball technique.

The evidence for a change in antenatal HIV screening policy in Australia.

Australia is one of the few developed countries without routine antenatal HIV screening, despite having the resources to undertake such a screening program and the availability of antiretroviral therapy. National policy recommends that only women with identified risk factors should be offered testing; however, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that all pregnant women be offered HIV testing as part of their antenatal care. Knowledge of a woman's HIV status during pregnancy allows interventions to improve her health and reduce the risk of transmission of HIV to her child.

Assisted reproduction for HIV-infected couples.

Many HIV-infected individuals are in relationships with HIV-uninfected partners and desire to have children. This review focuses on the issue of reproductive choices for these couples, in particular assisted reproductive technologies, and summarises the published outcome data currently available. The results thus far from assisted reproductive technologies in optimising pregnancy outcomes and reducing heterosexual and perinatal HIV transmission are promising.

Skeletal myopathy associated with nucleoside reverse transcriptase inhibitor therapy: potential benefit of coenzyme Q10 therapy.

Zidovudine (ZDV) has been associated with 'ragged-red' fibre myopathy, due to its effects on myocyte mitochondria. Usually this is reversible with cessation of ZDV. We report a 52-year-old man, who in 1985 developed ragged-red fibre myopathy 14 years after diagnosis of HIV infection while on effective ZDV-based combination antiretroviral therapy (ART).

Virological significance, prevalence and genetic basis of hypersusceptibility to nonnucleoside reverse transcriptase inhibitors.

Nonnucleoside reverse transcriptase inhibitors (NNRTI) are used to treat HIV-infected individuals in combination with nucleoside analogues (NRTI) and protease inhibitors. Long-term treatment with antiretroviral agents results in the emergence of strains with decreased susceptibility (resistance) to the drugs and is one of the major factors in loss of drug efficacy. Conversely, there have been recent reports of HIV strains with increased susceptibility (hypersusceptibility) to NNRTIs.

HIV infection and high-density lipoprotein: the effect of the disease vs the effect of treatment.

HIV infection is commonly associated with hypoalphalipoproteinemia. It is not clear how much the HIV infection and/or treatment contribute to the changes in high-density lipoprotein (HDL) levels. Blood lipids of HIV-positive males were assessed in a retrospective study.

Nature of depression in patients with HIV/AIDS.

Objective: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS.

A study to investigate the impact of the initiation of highly active antiretroviral therapy on the hepatitis C virus viral load in HIV/HCV-coinfected patients.

Changes in the hepatitis C virus (HCV) viral load (VL) were assessed in a retrospective study of 50 HIV/HCV-coinfected patients who initiated highly active antiretroviral therapy (HAART). Most patients responded to HAART [during the first 6 months, plasma HIV VL fell by a mean 1.39 log10, becoming undetectable (<400 copies/ml) in 22% and CD4+ T cells increased by a mean of 100 cells/microl], but surprisingly, 27 (54%) showed some rise and 25 (50%) showed a significant increase in the HCV VL.

The molecular epidemiology of HIV type 1 among Vietnamese Australian injecting drug users in Melbourne, Australia.

The proportion of human immunodeficiency virus type 1 (HIV-1) among Vietnamese injecting drug users (IDUs) in Melbourne, Australia exceeds that of the background population. To investigate the molecular epidemiology of HIV-1 among this group, the C2-V4 region of the HIV-1 envelope was directly sequenced from 11 Vietnamese Australians and 19 non-Vietnamese Australian controls. A significant difference in the distribution of the HIV-1 subtypes was demonstrated, with greater than 50% of Vietnamese Australian IDU shown to be infected with CRF01_AE-the predominant subtype in Southeast Asia, rather than subtype B, which dominates the Australian epidemic and which was found in 89.

Immune reconstitution hepatitis in HIV and hepatitis B coinfection, despite lamivudine therapy as part of HAART.

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection occurs commonly. The introduction of antiretroviral therapy can result in immune reconstitution hepatitis. We describe 2 coinfected patients who developed clinical flares of HBV disease, despite the inclusion of lamivudine, a drug with anti-HBV activity, in their HAART regimens.