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Enichen E, Adams RB, Demmig-Adams B. Physical Activity as an Adjunct Treatment for People Living with HIV? Am J Lifestyle Med 2023; 17:502-517. [PMID: 37426740 PMCID: PMC10328202 DOI: 10.1177/15598276221078222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
This review evaluates physical activity as a candidate for an adjunct treatment, in conjunction with antiretroviral therapy (ART), for people living with HIV (PLWH). Evidence is summarized that chronic, non-resolving inflammation (a principal feature of immune system dysfunction) and a dysfunctional state of the gut environment are key factors in HIV infection that persist despite treatment with ART. In addition, evidence is summarized that regular physical activity may restore normal function of both the immune system and the gut environment and may thereby ameliorate symptoms and non-resolving inflammation-associated comorbidities that burden PLWH. Physicians who care for PLWH could thus consider incorporating physical activity into treatment plans to complement ART. It is also discussed that different types of physical activity can have different effects on the gut environment and immune function, and that future research should establish more specific criteria for the design of exercise regimens tailored to PLWH.
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Affiliation(s)
- Elizabeth Enichen
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA, (EE, BDA); Physical Therapy of Boulder, Boulder, CO, USA, (RBA)
| | - Robert B. Adams
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA, (EE, BDA); Physical Therapy of Boulder, Boulder, CO, USA, (RBA)
| | - Barbara Demmig-Adams
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA, (EE, BDA); Physical Therapy of Boulder, Boulder, CO, USA, (RBA)
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Mayasi Ngongo N, Kamangu Ntambwe E, Situakibanza Nani-Tuma H, Mbula Mambimbi M, Mandina Ndona M, Longokolo Mashi M, Bepouka Izizag B, Lukiana T, Odio Ossam J, Mangala Sonzi D, Maes N, Moutschen M, El Moussaoui M, Darcis G. Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020. Open Forum Infect Dis 2023; 10:ofad242. [PMID: 37363052 PMCID: PMC10287095 DOI: 10.1093/ofid/ofad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Background Antiretroviral therapy (ART) expansion and viral load as a treatment monitoring approach have increased the demand for viral load testing. Many hurdles affect the coverage, quality, and use of viral load results. Estimates of viral load monitoring and viral suppression rates are needed to assess the performance of ART programs and improve human immunodeficiency virus (HIV) management outcomes. Methods People with HIV (PWH) viral load monitoring data were routinely collected in 84 health facilities in Kinshasa, Democratic Republic of the Congo (DRC), between 2013 and 2020. The number of PWH under ART, the number of participants with at least 1 viral load test result, the rate of viral suppression (defined as ≤1000 HIV ribonucleic acid copies per mL), and the mean turnaround time from sample collection to release of viral load test results were collected together with clinical data. Results A total of 14 057 PWH were included in the analysis. People with HIV were mainly enrolled after the "test and treat" implementation. The patients were followed for a median period of 27 months. The proportion of PWH with at least 1 available viral load largely increased in recent years. The delay from sample collection to release of viral load test results decreased overtime, from 35 days in 2018 to 16 days in 2020. Pregnancy and advanced HIV disease were associated with a lower chance of viral suppression. Conclusions There has been considerable success in increasing viral load access for all PWH under therapy in DRC. Nevertheless, viral load testing should be intensified with a particular effort to be made in groups at higher risk of viral failure.
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Affiliation(s)
- Nadine Mayasi Ngongo
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
| | - Erick Kamangu Ntambwe
- Department of Molecular Biology of Basic Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza Nani-Tuma
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula Mambimbi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina Ndona
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo Mashi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ben Bepouka Izizag
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tuna Lukiana
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jérôme Odio Ossam
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Donatien Mangala Sonzi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nathalie Maes
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Liège, Belgium
| | - Michel Moutschen
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
- AIDS Reference Laboratory, University of Liège, Liège, Belgium
| | - Majdouline El Moussaoui
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Gilles Darcis
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
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Azamar-Alonso A, Mbuagbaw L, Smaill F, Bautista-Arredondo SA, Costa AP, Tarride JE. Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study. Int J STD AIDS 2022; 33:363-373. [PMID: 35118929 PMCID: PMC8958557 DOI: 10.1177/09564624211067036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy. Methods A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation. Results We found a lower proportion of people with VF in 2014–2017 compared with 2008–2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48–0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014–2017, but not before. Conclusion This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014–2017, compared to 2008–2013 and the odds of VF were reduced.
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Affiliation(s)
- Amilcar Azamar-Alonso
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Gilead Sciences Inc., Foster City, CA, United States
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, Hamilton, ON, Canada
| | - Fiona Smaill
- ChB Department of Pathology and Molecular Medicine, Faculty of Health Sciences, 3710McMaster University, Hamilton, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada.,McMaster Chair in Health Technology Management Hamilton, Hamilton, ON, Canada
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Guedes DDS, Carvalho AZFTD, Lima ICVD, Cunha GHD, Galvão MTG, Farias ODO. Vulnerability of women with human immunodeficiency virus to cervical cancer. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the vulnerabilities of women with human immunodeficiency virus to cervical cancer. Methods: Cross-sectional study carried out in a clinic with 152 adult women with HIV, by means of the application of a structured form comprising several types of vulnerability. Results: Related to individual vulnerability, were prevalent the age above 29 years (87.5%), education higher than eight years of study (53.3%) and family income lower than two minimum wages (94.1%). The majority reported active sexual life (81.6%) and non-use of condoms (57.2%). Regarding the social vulnerability, 56.6% were unemployed. About programmatic vulnerability, 44.0% of women underwent a prevention exam in a period of more than one year. Women with more schooling (p = 0.007), employed (p = 0.000) and that did not use illicit drugs (p = 0.000) underwent the preventive exam in proper frequency. Conclusion: In this study, were identified individual, social and programmatic vulnerabilities for cervical cancer in women with HIV.
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Redman KN, Karstaedt AS, Scheuermaier K. Increased CD4 counts, pain and depression are correlates of lower sleep quality in treated HIV positive patients with low baseline CD4 counts. Brain Behav Immun 2018; 69:548-555. [PMID: 29452219 DOI: 10.1016/j.bbi.2018.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/12/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022] Open
Abstract
Poor sleep quality leads to increased immune activation and immune activation leads to worse sleep quality. South African HIV positive patients typically have delayed start of treatment, which has been associated with CD4+ effector T cells being more spontaneously activated in chronically treated patients. This cross-sectional study investigated whether subjective sleep quality was associated with CD4+ T lymphocyte reconstitution in treated South African HIV+ patients. One hundred and thirty-nine treated HIV+ patients (109 F, age average (SD) = 43 (9)) were recruited from Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, South Africa. Participants completed questionnaires evaluating their subjective sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth sleepiness scale), pain, and depression severity (Beck Depression Inventory). Univariate and multivariate analyses were run to determine the correlates of sleep quality in this population. Patients had been on antiretroviral treatment for about 4 years and had increased their CD4 counts from a median at baseline of 82 to 467 cells/µL. They had overall poor sleep quality (average (SD) PSQI = 7.7 (±5), 61% reporting PSQI > 5, a marker of lower sleep quality), 41% had clinical depression (average (SD) BDI = 17 (±12)) and 55% reported pain. In two separate multivariate analyses, both the overall CD4 count increase from baseline (p = 0.0006) and higher current CD4 counts (p = 0.0007) were associated with worse sleep quality, when adjusting for depression severity (p < 0.001), daytime sleepiness (p = 0.01) and the presence of pain (p < 0.01). In this cohort of treated South African HIV positive patients, poor sleep quality was associated with higher current CD4 counts, when adjusting for depression severity, daytime sleepiness and pain. Further studies should investigate the temporal relationship between HIV-related poor sleep quality and underlying immune activation.
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Affiliation(s)
- K N Redman
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - A S Karstaedt
- Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - K Scheuermaier
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
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