Assisted reproduction in HIV positive couples


ABSTRACT

HIV-discordant couples are significantly increasing. The availability of new and more effective antiretroviral drugs has resulted in HIV discordant couples increasingly and a growing demand of parenting. We followed HIV discordant couples with an integrated multidisciplinary project of assisted reproductive technology (ART) to prevent horizontal transmission.
Women of childbearing age are HIV positive have significant complications in gynecological and reproductive health, but the availability of new and more effective antiretroviral agents, has prompted new possibilities for women HIV positive resulting in demand for maternity. The reproductive assistance to HIV positive women in almost all European countries is extremely difficult due to problems of structures, ethics, legal issues and prejudices.
The PMA techniques and in particular the ICSI provide HIV-positive couples to a safe and highly effective way to achieve pregnancy.


Articolo presente in – HAART and correlated pathologies n. 12

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Gammaglutamyltranspeptidase (gamma-GT) Levels before Treatment are Predictive of Tipranavir Interruption in ART Multiexperienced HIV-1-Infected Patients


ABSTRACT
The Italian Tipranavir EUP/EAP study was an observational study involving nine Italian centres that enrolled three class drug-experienced patients who consecutively entered the EUP/EAP TPV programs. The Cox model performed to assess the risk correlates of interrupting TPV included sex, age, HIV risk factors, HBV/HCV status, use of T20,CD4, HIV-RNA, ALT, γ-GT, cholesterol, triglycerides, glucose levels determination before starting TPV.
The study enrolled 175 patients followed up for a median time of 30 weeks (range 3-68). TPV was interrupted by 46 patients (16 for intolerance, 14 for immuno-virological failure, four for disease progression – including two deceased – 12 for patient decision).
The factors independently associated with treatment interruption for any cause were previous ART duration (OR 1.18, 95%CI 1.03-1.35, p=0.016 per each additional year) and γ-GT BL (grade 2 vs 0: OR 6.31, 95%CI 2.49-16.4, p< 0.0001). The γ-GT BL median level in the 16 patients who interrupted TPV for intolerance was 122 IU/L (range: 11-352). Both γ-GT and ALT were significantly increased at interruption compared to BL (p=0.041 and p=0.016 respectively, Wilcoxon test). A transient protective effect against γ-GT and TG increase was observed in patients receiving T20 with TPV (p=0.034 and p=0.027 respectively at week 12 in a Cox model assessing the risk of increasing one toxicity grade). γ-GT level seems to be relevant and more sensitive than ALT/AST level or HBV/HCV status in predicting the risk of TPV interruption. Unreported alcohol abuse could be considered a potential cofactor limiting the effectiveness and safety of TPV/RTV treatment.
Keywords: HIV-1; Tipranavir; Gamma-GT; Treatment Interruption.


Articolo presente in – HAART and correlated pathologies n. 1

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