ObjectivesRenal disease is a common and serious complication in HIV-infected patients. MethodsA retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997 (early HAART) and 2004. ResultsData for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). ConclusionAs a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.Keywords: chronic kidney disease, haemodialysis, HIV-associated nephropathy, renal failure, renal replacement therapy Accepted 18 July 2012 IntroductionThe prevention and treatment of cardiovascular, liver and kidney diseases have increasingly been the focus of attention in attempts to reduce the morbidity and mortality of HIV-infected individuals [1]. In the USA, HIV-associated ESRD has become epidemic among Black patients [11,12]. Black individuals are more prone to kidney disease than any other ethnic group in the general [13,14] and HIV-infected populations, possibly as a consequence of predisposing genetic polymorphisms [15]. The risk of ESRD in Black HIV-infected individuals has been reported to be three-to six-fold higher than in Caucasian HIV-infected patients [7,16,17], reflecting the susceptibility of Black patients to develop HIVAN. The introduction of highly active antiretroviral therapy (HAART) has reduced the incidence of HIVAN and ESRD among Black patients [18][19][20], but the prevalence of ESRD is projected to further increase [11,12]. Earlier studies, mainly from the USA, concluded that, almost exclusively in Black patients, HIVAN is one of the major causes of ESRD [6,21,22], but histologica...

ObjectivesThe aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. MethodsThere were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. ResultsIn our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P < 0.001), from 26.1% to 75%, leading to obstetric changes, including an increase in the rate of vaginal deliveries (P < 0.001), from no vaginal births to 50%. The preterm delivery rate decreased significantly (P < 0.001), from 79.2% to 8.3%. There were no significant changes in the rate of GDM, pre-eclampsia, PROM or preterm contractions. ConclusionsIn the 11 years of our analysis, there was a significant reduction in the rate of preterm deliveries and an increase in the vaginal delivery rate, possibly reflecting changes in treatment policies in the same period and the availability of more effective antiretroviral therapy options. The rates of complications such as GDM, pre-eclampsia, preterm contractions, PROM and postnatal complications were stable over the 11 years, but were still increased compared with the general population.

Atazanavir/ritonavir steady-state pharmacokinetics was comparable in men and women, despite gender-related significant differences in atazanavir dose/body weight. The administration of atazanavir/ritonavir is pharmacokinetically safe; 95% of all trough samples were above the recommended plasma concentration of 150 ng/mL.

Background-The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear.Methods-We analyzed data on 20,379 treatment-naive HIV-1-infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of followup, 1844 AIDS events, and 1005 deaths).Results-Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART).Conclusions-Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART.

Several studies have shown beneficial effects of recombinant human growth hormone (r-hGH) in reducing visceral adipose tissue (VAT) in HIV-1-infected patients with lipodystrophy. MethodsPatients were randomized to r-hGH 4 mg daily (group A) or three times per week (group B) over 12 weeks, followed by a 2 mg daily maintenance dose for 12 weeks. Magnetic resonance imaging (MRI) scans were performed to assess body composition. ResultsA total of 26 subjects were included in the study. VAT was reduced overall by 35.1 cm 2 (29.5%) at week 12 and by 49 cm 2 (39.9%) at week 24, respectively, compared with baseline (Po0.001 for both comparisons). By week 12, VAT was reduced by 27 and 29% (A vs B; P 5 0.47) while facial fat was reduced by 3.3 and 2.6 cm 2 in groups A and B, respectively (P 5 0.96). Over 24 weeks, VAT was reduced by 42 and 38% (P 5 0.35) and facial fat by 3.2 and 2.4 cm 2 in groups A and B, respectively (P 5 0.91), compared with baseline. There was a greater increase in high-density lipoprotein (HDL) in group A than in group B (4.9 vs 2.4 mg/dL in week 12 and 7.1 vs À 0.4 mg/dL in week 24; P 5 0.03). Fasting insulin levels increased, whereas glucose and insulin measured in oral glucose tolerance tests remained unchanged. Drug-related side effects were transient and reversible, but more common in group A (67%) than in group B (29%). ConclusionsThis study confirms reports that r-hGH effectively reduces VAT, with a relatively small reduction of facial and limb fat.Keywords: growth hormone, lipodystrophy, magnetic resonance imaging, visceral adipose tissue, visceral adiposity IntroductionIn recent years, HIV-associated lipodystrophy syndrome has become a major challenge in the treatment of HIV disease. This syndrome involves intra-abdominal (visceral) adiposity, development of antero-and dorsocervical fat pads (buffalo hump), breast enlargement and symmetric lipomatosis as signs of fat accumulation, and loss of subcutaneous fat from the face, limbs, trunk and buttocks [1][2][3][4][5]. All of these changes can occur alone or in combination. To date, the exact pathogenesis of the broad spectrum of these common, disfiguring body shape changes, which can occur at any stage of treated HIV 397 infection, is not completely understood. Visceral adiposity, one of the hallmarks of HIV-associated lipodystrophy syndrome, is a known independent risk factor for insulin resistance and cardiovascular complications [6][7][8] and is therefore a major concern as a potential long-term complication of highly active antiretroviral therapy (HAART). Recent studies suggest an increase of cardiovascular and cerebrovascular events associated with the duration of HAART, although some results are contradictory [9][10][11][12][13][14][15][16]. Several studies using various antiretroviral treatment strategies failed to completely resolve or prevent HIV-associated lipodystrophy. Furthermore, expensive and time-consuming three-dimensional imaging techniques such as computed tomography or magnetic resonance imaging (MRI) are needed to disting...