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P133 Proteinuria in tenofovir-treated patients with HIV infection
Friday, June 19, 2009 Results: 264 (52.8%) out of 500 clients were females and average distance from the clinic was 15km. Mean age was 34.3 years with only 93 (18.6%) of the 500 clients above 40 years of age. Mean CD4 was 133.2 cells/mm3 , 200 (40%) of the 500 clients had no source of income at all. 185 of the 500 clients were on Combivir/Niverapine, 171 on Triomune and 21% on Combivir/Efavirenz. 414.5 (82.9%) of clients defaulted drugs in the first 6 months, 16.8% between 6months and 1 year while only 0.3% defaulted drugs after 1 year. Among the married clients, only 46.3% had disclosed their HIV status to their spouses. For the reasons given for poor adherence; 235.5 (47.1%) clients were not committed to treatment, 21.4% lacked funds to pick drugs, 50 (10%) defaulted due to side effects, 64 (12.8%) gave no reason, 14 (2%) confessed they had not disclosed their status, while the rest interrupted treatment due to medical reasons. Conclusions: Chances for poor adherence to HAART are more in clients with a low social economic status, those who have not disclosed to their spouses, and those who have just initiated antiretroviral drugs. Distance from the health unit did not have any effect on adherence. There is need for more counseling, closer follow up and additional support for such clients to help them achieve the desired adherence. P133 Proteinuria in tenofovir-treated patients with HIV infection S. McKenna1 *, G. Evans2 , C. White2 , J. Martinez-Cajas2 , T. Stevenson1 , J. Ekborn2 , C. Fuller2 , W. Wobeser2 . 1 Kingston General Hospital, Kingston, Canada, 2 Queen’s University, Kingston, Canada Objective: Tenofovir-associated renal effects manifest as a spectrum from acute renal failure to microalbuminuria. Proteinuria in HIV infection is predominantly of low molecular weight and tubular origin; its significance is not well understood. While it is recognized that individuals may have other risk factors in addition to HIV infection, the frequency of proteinuria while on tenofovir therapy is not well appreciated. Methods: We undertook a cross-sectional comparative cohort study to estimate the proportion of patients with proteinuria receiving tenofovir-containing and non-tenofovir-containing antiretroviral therapy (T-ART and non-T-ART, respectively). We controlled for the presence of diabetes, co-infection with Hepatitis B or C, use of angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and HIV viral load and CD4 T-lymphocyte count. Consecutive patients on ART attending our outpatient HIV clinic were evaluated with either a 24-hour urine collection for protein or both urinary protein/creatinine (PCR) and urinary albumin/creatinine (ACR) ratios. The proportion of patients with proteinuria was determined and a logistic multivariate regression analysis was performed to control for the presence of confounders. Results: 60 of 154 (39%) of the patients treated at our clinic were receiving T-ART, 74 of 154 (48%) were receiving non-T-ART and 20 of 154 (13%) were not on any ART. Thirty percent of patients in each of the T-ART and non-T-ART groups were coinfected with Hepatitis C (18 of 60 patients and 22 of 74 patients, respectively). Four of 60 patients (7%) in the T-ART group and 9 of 74 patients (12%) in the non-TART group were receiving concomitant ACEI or ARB therapy. To date, proteinuria has been detected in three of the patients in the T-ART group, of which one has co-existent diabetes. Complete results will be available at the time of presentation. Conclusions: The frequency of tenofovir-associated proteinuria in an outpatient HIV population will be determined. Information regarding the most useful screening test for proteinuria in this population will be gathered. As suggested by the literature, there may be an opportunity to prevent the development or slow the progression of chronic kidney disease by identifying those patients who would benefit from more frequent monitoring and/or further interventions, including referral to a nephrologist.
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HIV and AIDS: Clinical HIV and Opportunistic Infections P134 Photodynamic therapy of oral candidiasis in HIV-positive patients G. Cadastro1 *, E. Giovani1 . 1 Paulista University, Paulista, Brazil Introduction: The conventional treatments for candidiasis include therapies that promote serious adverse effects to patients. Recent studies indicate the use of red laser emission associated with a blue photosensibilizer as an actual method for reducing microbes. Objective: To evaluate the efficacy of the photodynamic therapy in the treatment of oral candidiasis in HIV patients. Material and Methods: HIV/AIDS patients with macroscopic signs of candidiasis. Cytology was performed in the first consultation to reach diagnosis and new collection after the application of the photodynamic therapy, and in the 7th and 21st days to evaluate the effectiveness of the therapy. After collecting the cytology the blue metilene photosensibilizer agent was applied in the concentration of 0.1 mg/ml with a sterile swab on the extension of the injury, then a unique application of the low intensity laser is applied (Gallium and Aluminum Arsenate GaAlAs) at 790 nm and 30 mW of power, for 2 minutes and 20 seconds in a punctual application in order to cover all areas of clinic injury, generating an energy density of 4 J/cm2 . Results: 27 patients, average age of 45.3 years, 24 patients (88.8%) males and 3 (11.1%) female. 15 patients (55.5%) HOM and 12 (44.4%) HET. 15 patients (55.5%) Caucasian and 12 (44.4%) black. 27 patients (100%) with various forms of candidiasis (50.5% pseudomembranous, 41.4% erythematous, and 8.1% angular cheilitis). Other manifestations beyond the oral candidiasis: 3 patients (11.1%) herpes simplex, 3 (11.1%) with ulcers, 3 (11.1%) with spinocellular carcinoma, 3 (11.1%) with hyperplasia. 15 patients were observed (55.5%) with harmful habits (smoking/alcohol). As for CD4 T-lymphocytes: 18 patients (66.6%) between 200 to 499 cel/mm3 of blood, 6 (22.2%) above 500 cel/mm3 , and 3 (11.1%) below 199 cel/mm3 of blood. 18 patients (66.6%) making use of HAART and 9 patients (33.3) not using. The response to treatment by photodynamic therapy has been demonstrated successful in 27 patients (100%), which in the 7th or 21st day confirmed total absence of clinical and cytological lesions. Conclusion: The photodynamic therapy is shown as an effective alternative method for the inactivation of the presence of fungal lesions, avoiding adverse side effects and providing comfort, well being and improvement in the patient’s quality of life. P135 Atazanavir (ATZ)-associated urolithiasis P. Koblic1 *, W. Gold1 , C. Laporte2 , G. Zhang2 , T. Marr1 , T. Lee1 . 1 University Health Network, Toronto, Canada, 2 University of Ottawa at the Ottawa Hospital and the Ottawa Health Research Institute, Ottawa, Canada Objective: To describe an important but uncommon complication of antiretroviral therapy with ATZ. Methods: A 57-year-old man with chronic HIV infection (CD4 = 1098/microlitre, viral load <50 copies/mL) reported an 11-month history of painless stones per urethra with chalky urethral discharge. He also reported dysuria but denied colic and fever. Eleven months prior, he was treated for acute renal failure attributed to enterococcal pyelonephritis. His father had a history of renal colic. His antiretroviral therapy included abacavir, lamivudine (3TC) and ritonavir (RIT)boosted atazanavir (ATZ) (100/300 mg), which he had been receiving for 17 months. Previously, he received indinavir (IDV) for 10 years that was discontinued due to rash. He had normal renal function. A full metabolic evaluation was normal. The calculi were sent for composition analysis by validated liquid chromatography/mass spectrometry/mass spectrometry method (LC/MS/MS). Results: Nine samples were analyzed and 37 65% (by weight) was determined to be unmetabolized ATZ. RIT was detected in only trace amounts.
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HIV and AIDS: Clinical HIV and Opportunistic Infections P134 Photodynamic therapy of oral candidiasis in HIV-positive patients G. Cadastro1 *, E. Giovani1 . 1 Paulista University, Paulista, Brazil Introduction: The conventional treatments for candidiasis include therapies that promote serious adverse effects to patients. Recent studies indicate the use of red laser emission associated with a blue photosensibilizer as an actual method for reducing microbes. Objective: To evaluate the efficacy of the photodynamic therapy in the treatment of oral candidiasis in HIV patients. Material and Methods: HIV/AIDS patients with macroscopic signs of candidiasis. Cytology was performed in the first consultation to reach diagnosis and new collection after the application of the photodynamic therapy, and in the 7th and 21st days to evaluate the effectiveness of the therapy. After collecting the cytology the blue metilene photosensibilizer agent was applied in the concentration of 0.1 mg/ml with a sterile swab on the extension of the injury, then a unique application of the low intensity laser is applied (Gallium and Aluminum Arsenate GaAlAs) at 790 nm and 30 mW of power, for 2 minutes and 20 seconds in a punctual application in order to cover all areas of clinic injury, generating an energy density of 4 J/cm2 . Results: 27 patients, average age of 45.3 years, 24 patients (88.8%) males and 3 (11.1%) female. 15 patients (55.5%) HOM and 12 (44.4%) HET. 15 patients (55.5%) Caucasian and 12 (44.4%) black. 27 patients (100%) with various forms of candidiasis (50.5% pseudomembranous, 41.4% erythematous, and 8.1% angular cheilitis). Other manifestations beyond the oral candidiasis: 3 patients (11.1%) herpes simplex, 3 (11.1%) with ulcers, 3 (11.1%) with spinocellular carcinoma, 3 (11.1%) with hyperplasia. 15 patients were observed (55.5%) with harmful habits (smoking/alcohol). As for CD4 T-lymphocytes: 18 patients (66.6%) between 200 to 499 cel/mm3 of blood, 6 (22.2%) above 500 cel/mm3 , and 3 (11.1%) below 199 cel/mm3 of blood. 18 patients (66.6%) making use of HAART and 9 patients (33.3) not using. The response to treatment by photodynamic therapy has been demonstrated successful in 27 patients (100%), which in the 7th or 21st day confirmed total absence of clinical and cytological lesions. Conclusion: The photodynamic therapy is shown as an effective alternative method for the inactivation of the presence of fungal lesions, avoiding adverse side effects and providing comfort, well being and improvement in the patient’s quality of life. P135 Atazanavir (ATZ)-associated urolithiasis P. Koblic1 *, W. Gold1 , C. Laporte2 , G. Zhang2 , T. Marr1 , T. Lee1 . 1 University Health Network, Toronto, Canada, 2 University of Ottawa at the Ottawa Hospital and the Ottawa Health Research Institute, Ottawa, Canada Objective: To describe an important but uncommon complication of antiretroviral therapy with ATZ. Methods: A 57-year-old man with chronic HIV infection (CD4 = 1098/microlitre, viral load <50 copies/mL) reported an 11-month history of painless stones per urethra with chalky urethral discharge. He also reported dysuria but denied colic and fever. Eleven months prior, he was treated for acute renal failure attributed to enterococcal pyelonephritis. His father had a history of renal colic. His antiretroviral therapy included abacavir, lamivudine (3TC) and ritonavir (RIT)boosted atazanavir (ATZ) (100/300 mg), which he had been receiving for 17 months. Previously, he received indinavir (IDV) for 10 years that was discontinued due to rash. He had normal renal function. A full metabolic evaluation was normal. The calculi were sent for composition analysis by validated liquid chromatography/mass spectrometry/mass spectrometry method (LC/MS/MS). Results: Nine samples were analyzed and 37 65% (by weight) was determined to be unmetabolized ATZ. RIT was detected in only trace amounts.