1.Five-Year Review of HIV-Hepatitis B Virus (HBV) Co-Infected Patients in a New York City AIDS Center.
Jong Hun KIM ; George PSEVDOS ; Victoria SHARP
Journal of Korean Medical Science 2012;27(7):830-833
A retrospective review of 4,721 human immunodeficiency virus (HIV)-infected patients, followed at St. Luke's Roosevelt Hospital Center, New York City, was conducted from January 1, 2005 to December 31, 2009. HIV-Hepatitis B virus (HBV) co-infection rate was 218/4,721, 4.6%. Among co-infected patients, 19 patients (19/218, 8.7%) died; 13 patients (13/19, 68.4%) died from non-acquired immune deficiency syndrome (AIDS) defining including 2 patients with liver failure. More non-survivors (5 patients, 5/19, 26.3%) had liver cirrhosis than those who survived (8 patients, 8/199, 4.0%; P = 0.002). There were more patients with positive HBV e antigen (HBeAg) among non-survivors, (12 patients, 12/19, 63.2%) than among survivors (74 patients, 74/199, 37.2%; P = 0.047). HIV-HBV co-infection is associated with increased overall mortality. Therefore, use of dual active antiretrovirals, particularly, tenofovir (TDF) based regimen for optimal suppression of HIV-HBV and immune restoration with prevention of high risk behaviors may contribute to improved outcomes.
Adenine/analogs & derivatives/therapeutic use
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Adult
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Anti-HIV Agents/therapeutic use
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Coinfection/drug therapy/mortality
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Female
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HIV Infections/complications/*diagnosis/drug therapy
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Hepatitis B/complications/*diagnosis/drug therapy
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Hepatitis B e Antigens/blood
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Humans
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Liver Cirrhosis/etiology
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Male
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Middle Aged
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New York City
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Organophosphonates/therapeutic use
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Retrospective Studies
2.Persistence of Protective Hepatitis B Surface Antibody Titers after Successful Double-Dose Hepatitis B Virus Rescue Vaccination in HIV-Infected Patients.
Jong Hun KIM ; George PSEVDOS ; Vanessa GROCE ; Victoria SHARP
Gut and Liver 2012;6(1):86-91
BACKGROUND/AIMS: To assess the durability of protective hepatitis B surface antibody (anti-HBs) titers in HIV-infected patients who responded to double-dose hepatitis B virus (HBV) rescue vaccination. METHODS: A retrospective chart review was performed for HIV-infected patients who received the double-dose HBV rescue vaccination at 0-, 1-, and 2-month intervals after they had failed conventional HBV vaccination series. A protective antibody response was defined as an anti-HBs titer > or =10 mIU/mL. RESULTS: Of 54 HIV-infected patients who received a double-dose HBV rescue vaccination, 44 patients (81.5%) had a positive response and achieved protective anti-HB titers. Of the 44 patients who developed protective anti-HB titers, 33 patients received an evaluation of their anti-HB titers 12 months later. Of the 33 patients, 19 (57.6%) had persistent protective anti-HB titers (persistent responders, PR), and 14 patients (42.4%) lost their protective anti-HB titers (nonpersistent responders, NPR). There were significantly more patients who had an undetectable HIV viral load (<50 copies/mL) at baseline and follow-up in the PR group (11/19, 57.9%) than in the NPR group (3/14, 21.4%, p=0.036). Logistic regression analysis showed that an undetectable HIV viral load at baseline and follow-up (odds ratio, 12.973; 95% confidence interval, 1.189 to 141.515; p=0.036) was associated with PR. CONCLUSIONS: Protective anti-HB titers may decrease over time after successful double-dose HBV rescue vaccination in HIV-infected patients. HIV viral load suppression could improve the persistence of anti-HB titers.
Antibody Formation
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Follow-Up Studies
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Hepatitis
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Hepatitis B
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Hepatitis B virus
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HIV
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Humans
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Logistic Models
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Retrospective Studies
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Vaccination
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Viral Load
3.Factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients: immunosuppression or behaviors.
Jong Hun KIM ; George PSEVDOS ; Jin SUH ; Victoria SHARP
Chinese Medical Journal 2011;124(14):2123-2126
BACKGROUNDRecent studies have reported overall increasing rates of syphilis with a high rate of human immunodeficiency virus (HIV) co-infection. However, there is little information about factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients. We conducted a study to evaluate factors associated with syphilis treatment failure/re-infection in HIV co-infected patients.
METHODSWe reviewed 3542 medical records of HIV-infected patients from January 2005 to December 2007 followed up at HIV Clinic in New York City. Patients were categorized by rapid plasma regain titer (RPR) into success/serofast (4-fold decrease in RPR by 12 months after treatment, RPR conversion to nonreactive, persistently stable reactive RPR with no 4-fold increase), and failure/re-infection (failure to decrease 4 folds in RPR by 12 months after treatment, 4-fold increase in RPR from baseline).
RESULTSAmong a total of 156 patients who met the eligibility criteria, 122 (78.2%) were under success/serofast category, and 34 (21.8%) were under failure/re-infection category. HIV viral load, CD4 cell count, and use of highly active antiretroviral therapy (HAART) were not associated with syphilis treatment failure/re-infection. However, early syphilis stage (OR: 11.036, 95%CI: 2.499 - 48.740, P = 0.002) and high (> 1:64) RPR titers (OR: 715.921, 95%CI: 422.175 - 23 113.396, P < 0.001) were significantly associated.
CONCLUSIONSNo correlations were seen with depressed immune states with syphilis treatment failure and/or re-infection. However, association with early stage syphilis suggests that risky psychological sexual behaviors may be the most important leading factor, emphasizing needs for safe sex education.
Adult ; Antiretroviral Therapy, Highly Active ; methods ; CD4 Lymphocyte Count ; Coinfection ; drug therapy ; immunology ; Female ; HIV Infections ; drug therapy ; immunology ; Humans ; Immunosuppression ; Male ; Middle Aged ; Retrospective Studies ; Syphilis ; drug therapy ; immunology ; Treatment Failure