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Biomedical subjects

Vincent Lo Re

Publications and source records attributed to Vincent Lo Re.

18 recordsLinked to original sources
PubMed2007

Prevalence, risk factors, and outcomes for occult hepatitis B virus infection among HIV-infected patients.

BACKGROUND: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in individuals with HBV core antibodies (anti-HBc) but without HBV surface antigen (HBsAg). The prevalence of occult HBV in HIV-infected patients remains controversial, and the risk factors and clinical significance are unknown. OBJECTIVES: To determine the prevalence, risk factors, and clinical significance of occult HBV among HIV-infected patients. Hypothesized risk factors include chronic hepatitis C virus (HCV), CD4 count < 200 cells/mm, HIV RNA level >1000 copies/mL, and lack of use of anti-HBV antiretrovirals. METHODS: We examined randomly selected HBsAg/anti-HBc HIV-infected patients in the Penn Center for AIDS Research Adult/Adolescent Database and Specimen Repository. HBV DNA was qualitatively detected using a transcription-mediated amplification assay. Risk factors and transaminases were ascertained at the time sera were collected. RESULTS: A total of 699 HBsAg/anti-HBc HIV-infected patients were identified. Of 179 randomly selected subjects, 17 (10%; 95% confidence interval [CI]: 5% to 14%) had occult HBV. Differences in the prevalence of HBV surface antibody (anti-HBs) between those with (7 [41%]) and without (94 [58%]) occult HBV were not statistically significant (P = 0.3). An HIV RNA level >1000 copies/mL (adjusted odds ratio [OR] = 4.88, 95% CI: 1.01 to 30.26) and the absence of chronic HCV (adjusted OR = 0.26, 95% CI: 0.05 to 0.95) were associated with occult HBV. Occult HBV did not increase the risk of transaminitis (adjusted OR = 0.42, 95% CI: 0.12 to 1.45). CONCLUSIONS: Occult HBV occurred in a sizable proportion of HIV-infected patients and was associated with detectable HIV and the absence of chronic HCV. It did not increase the risk of transaminitis. The presence of anti-HBs does not rule out occult HBV. Future studies should examine the long-term clinical implications of occult HBV in HIV-infected patients.

Adult↗
PubMed2007

Incidence and risk factors for weight loss during dual HIV/hepatitis C virus therapy.

BACKGROUND: Clinical observations suggest that patients with HIV/hepatitis C virus (HCV) may lose body weight during dual therapy, but this has not been confirmed analytically. OBJECTIVES: To determine if the incidence and degree of weight loss among patients with HIV/HCV receiving highly active antiretroviral therapy (HAART) and pegylated (PEG)-interferon plus ribavirin were greater than in (1) HCV-monoinfected patients receiving PEG-interferon plus ribavirin and (2) HIV-monoinfected patients receiving HAART. Risk factors for weight loss among patients with HIV/HCV were also examined. METHODS: A retrospective cohort study was performed among HIV/HCV-coinfected, HCV-monoinfected, and HIV-monoinfected patients. Body weights were assessed up to 6 months before and up to 12 months after initiation of HCV therapy (HIV/HCV-coinfected and HCV-monoinfected subjects) and over 18 months on HAART (HIV-monoinfected subjects). The primary outcome was clinically significant weight loss (> or =5% of baseline weight). RESULTS: Of 192 subjects, 63 had HIV/HCV, 64 had HCV alone, and 65 had HIV alone. Clinically significant weight loss occurred in 48 (76%) subjects with HIV/HCV versus 25 (39%) subjects with HCV (P < 0.001) and 2 (3%) subjects with HIV (P < 0.001), yielding adjusted hazard ratios (HRs) of 2.76 (95% confidence interval [CI]: 1.67 to 4.55) and 38.5 (95% CI: 8.5 to 174.7), respectively. Receipt of more than 2 nucleoside reverse transcriptase inhibitors increased the risk of clinically significant weight loss (adjusted HR = 8.17, 95% CI: 2.37 to 28.20). CONCLUSIONS: The incidence of weight loss is greater in dually treated patients with HIV/HCV than in treated HCV- or HIV-monoinfected patients. Prospective studies should evaluate additional risk factors for weight loss and changes in body composition to elucidate the mechanism for this weight loss.

Adult↗
PubMed2006

A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression.

BACKGROUND: High levels of antiretroviral therapy adherence are important for human immunodeficiency virus type 1 (HIV-1) suppression, yet the magnitude of adherence required to maintain it is less well characterized. Furthermore, methods to accommodate changes in adherence over time are lacking. In the present study, our objective was to determine the magnitude of antiretroviral therapy adherence needed to maintain HIV-1 suppression by use of a time-updated adherence measure that has the potential to be of use in a clinical setting. METHODS: We examined a population-based cohort of HIV-1-infected subjects > or =18 years of age, residing in British Columbia, Canada, who started receiving antiretroviral therapy between 1 August 1996 and 30 September 2003, who had at least 2 consecutive viral loads <500 copies/mL and who had prescriptions filled at least 3 times during a follow-up period ending 30 September 2004. Virological failure was defined as the second of 2 consecutive viral loads >1000 copies/mL. Cox proportional hazards model was used to determine the relationship between virological failure and refill-based, time-updated surrogate measure of adherence. RESULTS: Among the 1634 participants > or =18 years of age who initiated triple combination therapy during the study, 606 virological failure events were identified. In multivariate analyses, subjects with < or =95% adherence were 1.66 (95% confidence interval, 1.38-2.01) times more likely to experience virological failure than those with >95% adherence. CONCLUSIONS: The highest levels of antiretroviral therapy adherence are associated with higher rates of maintained virological suppression. This simple, dynamic surrogate measure of adherence overcomes the limitation of single-point-in-time calculations of adherence and may be useful in real time to determine whether an individual is exhibiting incomplete adherence.

Adult↗
PubMed2006

Out-of-pocket costs of HAART limit HIV treatment responses in Botswana's private sector.

A large number of HIV-infected patients in sub-Saharan Africa pay out-of-pocket for HAART. This analysis from Botswana indicates that higher median out-of-pocket regimen costs to patients for the initial 30 days of HAART are associated with failure to achieve a viral load< 400 copies/ml [US$32; interquartile range (IQR), 20-84 compared with US$22; (IQR, 17-36), P = 0.001]. HAART costs should be minimized as scale-up efforts in sub-Saharan Africa progress.

Adult↗
PubMed2006

Erectile dysfunction in an urban HIV-positive population.

The International Index of Erectile Function (five-item version) was used to assess the prevalence and risk factors of erectile dysfunction (ED) in an HIV-positive urban population of men. The prevalence of ED was found to be 74%. Age, CD4 count, history of opportunistic infections, highly active antiretroviral therapy (HAART) use, and serum testosterone level were not significantly associated with ED in this study. These results emphasize the high prevalence of ED in HIV-positive men.

Adult↗
PubMed2006

William Pepper Jr, MD (1843-1898): portrait of a nineteenth-century medical educator.

Dr William Pepper Jr was a prominent Philadelphia physician whose contributions to medicine in the late 19th century are not widely known. As a young physician he rose in stature rapidly due to his abilities as a diagnostician, teacher, writer and researcher. His primary interest, however, was to improve the education of physicians. He orchestrated the creation of America's first university-controlled teaching hospital, the Hospital of the University of Pennsylvania, enabling substantial improvements in clinical training. Pepper later became Provost of the University of Pennsylvania and ambitiously transformed the curriculum of the medical school, providing greater basic science and clinical training. He also worked to establish several institutes and museums in Philadelphia in order to promote academic pursuits, particularly in medicine. William Pepper Jr was one of the 19th century's foremost medical educators and his accomplishments helped reshape the way medicine was taught throughout the United States.

Epidemiology↗
PubMed2004

Travel immunizations.

Advising travelers on vaccine-preventable illnesses is increasingly becoming the responsibility of primary care physicians. The approach to vaccine recommendations should be based on a thorough assessment of the risks for travel-related diseases, the time available before trip departure, and current knowledge of the epidemiology of vaccine-preventable diseases. Routine childhood vaccinations should be reviewed in all travelers and updated as necessary. Yellow fever vaccination may be required for entry by countries that lie within a yellow fever zone or for travelers coming from an endemic area to prevent introduction of the disease. Immunization against hepatitis B virus should be considered in travelers who expect to have close contact with local populations that have high rates of hepatitis B transmission. Japanese encephalitis vaccine should be offered to travelers who plan prolonged trips to rural areas in southeast Asia or the Indian subcontinent during the transmission season. Typhoid fever immunization is recommended for travelers who may be exposed to potentially contaminated food and drink. Preexposure rabies vaccination should be considered in travelers who plan a prolonged duration of stay in a remote area or who engage in activities that might involve working near animals or that could attract animals. Physicians should be aware of the adverse events and contraindications associated with each travel vaccine.

Humans↗
PubMed2004

Identifying the vector of Lyme disease.

Lyme disease is the most common vector-borne illness in the United States. It is caused by the spirochete Borrelia burgdorferi, which is transmitted by the deer tick. Deer ticks have a four-stage life cycle (egg, larva, nymph, and adult), and nymphal ticks transmit B. burgdorferi to humans more frequently than adult ticks. Transmission of this spirochete typically requires a minimum of 24 to 48 hours of tick attachment. Early stages of Lyme disease are characterized by a hallmark rash, erythema migrans. The overall risk of acquiring Lyme disease is low in a person who has a deer tick bite. If erythema migrans develops at the site of the bite, treatment may include doxycycline in persons who are at least eight years of age. Administration of amoxicillin is appropriate for pregnant women or children younger than eight years. For those who are allergic to these medications, cefuroxime axetil may be used.

Animals↗
PubMed2004

Natural history of patients with low-level HIV viremia on antiretroviral therapy.

Ultrasensitive assays for HIV RNA have identified a significant number of patients with persistent low-level viremia despite antiretroviral therapy. The clinical implications of maintaining antiretroviral therapy during low-level HIV viremia remain unclear. The primary objective of this study was to determine the rate and risk factors for virological increase in subjects with low-level HIV viremia who did not change antiretroviral therapy. Between July 1998 and February 2002, we retrospectively observed 79 HIV-infected adults with low-level HIV viremia (between 50 and 500 copies per milliliter) who had been on a stable antiretroviral regimen for at least 3 months and continued that regimen for at least 3 more months. Virologic increase, defined as HIV RNA levels greater than 1000 copies per milliliter, was observed in 29 of the 79 (37%) subjects. The CD4 cell counts decreased by a median of 1.8 cells/mm(3) per month (interquartile range [IQR], -19.6 to 2.3 cells/mm3) in this group but increased by a median of 0.5 cells/mm3 per month (IQR, -6.3 to 5.8 cells/mm3) in the 50 subjects who did not experience virologic increase. A Kaplan-Meier estimate showed that at 3 years of follow-up, approximately 40% of the observed cohort had not experienced virologic increase. There was a higher rate of virologic increase per log increase in HIV viral load at entry into the cohort (adjusted hazards ratio [HR] 3.7; 95% confidence interval [CI], 1.1 to 12.6). Subjects of white race were also more likely to experience virological increase (adjusted HR 2.6; CI, 1.2 to 5.8). Maintenance of antiretroviral therapy despite low-level HIV viremia provided sustained immunological benefit over a 2-year period in approximately two thirds of our cohort. Higher initial HIV RNA levels and white race were predictors for virologic increase.

Adult↗
PubMed2004

Anemia during treatment of hepatitis C in HIV-infected patients.

Anemia is a significant adverse effect of current hepatitis C treatment and may be a particular problem for HIV-infected patients, in whom there is a high prevalence of disease- or drug-related anemia at baseline. Hepatitis C treatment-induced anemia in HIV-HCV-coinfected patients can lead to ribavirin dose reduction or premature discontinuation of hepatitis C therapy, limiting sustained virologic response rates. Mean decreases in hemoglobin levels during hepatitis C treatment appear to be less in HIV-HCV-coinfected patients than in HCV-monoinfected patients, but any decrease in hemoglobin level may be more of a problem for coinfected patients. Thus, close monitoring of the hemoglobin level and appropriate management of the anemia that may develop in HIV-infected patients during hepatitis C therapy is essential.

Anemia↗
PubMed2003

Fever in the returned traveler.

With the rising popularity of international travel to exotic locations, family physicians are encountering more febrile patients who recently have visited tropical countries. In the majority of cases, the fever is caused by a common illness such as tracheobronchitis, pneumonia, or urinary tract infection. However, fever in returned travelers always should raise suspicion for a severe or potentially life-threatening tropical infection. In addition to the usual medical history, physicians should obtain a careful travel history, a description of accommodations, information about pretravel immunizations or chemoprophylaxis during travel, a sexual history, and a list of exposures and risk factors. The extent and type of lymphadenopathy are important diagnostic clues. Altered mental status with fever is an alarm symptom and requires urgent evaluation and treatment. Malaria must be considered in patients who traveled even briefly within an endemic area. Enteric fever is treated with fluoroquinolones, dengue fever with supportive measures only, leptospirosis with penicillin or doxycycline, and rickettsial infections with doxycycline.

Dengue↗
PubMed2003

Prevention of malaria in travelers.

Malaria is a major international public health problem, responsible for considerable morbidity and mortality around the world each year. As travel to tropical locations increases, U.S. physicians are being asked more frequently to provide recommendations for malaria prevention. An organized approach to reducing the risk of acquiring this disease is necessary. Physicians must review the itineraries of their patients in detail, paying particularly close attention to travel within malaria-endemic areas and drug-resistant zones. Appropriate chemoprophylaxis must be chosen to reduce the risk of acquiring malaria. It also is important to provide advice on the use of protective measures that reduce the risk of mosquito bites. Finally, travelers should be instructed to seek medical attention immediately if symptoms of the disease develop during or after the trip.

Antimalarials↗
PubMed2003

Eosinophilic meningitis.

Eosinophilic meningitis is a rare clinical entity that can be useful in narrowing the differential diagnosis of central nervous system disease. It is defined by the presence of 10 or more eosinophils/microL in the cerebrospinal fluid (CSF) or a CSF eosinophilia of at least 10%. The most common cause is invasion of the central nervous system by helminthic parasites, particularly Angiostrongylus cantonensis, but other infections as well as noninfectious conditions may also be associated. This review describes the etiologies of eosinophilic meningitis, focusing primarily on the helminths that cause CSF eosinophilia.

Angiostrongylus cantonensis↗
PubMed2003

Hypereosinophilia associated with cardiac rhabdomyosarcoma.

Hypereosinophilia, defined as an absolute eosinophil count exceeding 1,500/mm(3), is caused by a limited number of disorders. Its association with malignancy is a rare occurrence that typically denotes extensive metastasis and a poor prognosis. Several theories have been proposed to explain the hypereosinophilia associated with malignancy, focusing on the production of eosinophilopoietic cytokines by tumors. We describe a patient with hypereosinophilia associated with a cardiac rhabdomyosarcoma, review the etiologies of hypereosinophilia, and discuss the possible mechanisms.

Adult↗