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Zhang L, Yu H, Luo H, Rong W, Meng X, Du X, Tan X. HIV/AIDS-Related Knowledge and Attitudes Among Chinese College Students and Associated Factors: A Cross-Sectional Study. Front Public Health 2022; 9:804626. [PMID: 35096751 PMCID: PMC8790097 DOI: 10.3389/fpubh.2021.804626] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years, adolescent has become one of the high-risk groups for HIV. Meanwhile, good HIV awareness and positive attitude are essential for HIV prevention. This study aims to evaluate the extent to which college students understand HIV and their attitudes toward HIV-infected patients, as well as the correlative factors. The data used in this study came from a cross-sectional survey. An anonymous online questionnaire was used to investigate the demographic characteristics, HIV/AIDS-related knowledge, and attitudes toward HIV-infected patients of 17,678 students from a university in Henan. Descriptive statistics, Chi-square test and logistic regression were used to analyze differences and connections between variables in SPSS version 25.0. Participants' HIV/AIDS-related knowledge awareness rate was 80.8%. Levels of students' HIV/AIDS-related knowledge correlated with their gender, nationality, marital status, and their grade (p < 0.01). Female students [OR = 0.757, 95% CI (0.699-0.820)] and minority students (OR = 0.717, 95% CI (0.619-0.832)] had insufficient HIV health education knowledge. Meanwhile, male students (OR = 0.845, 95% CI (0.773-0.924)], and students with good HIV knowledge (OR unaware-ness/awareness = 2.385, 95% CI (2.111-2.694)] were more likely to hold a positive attitude toward HIV-infected patients. The relevant education departments should strengthen and promote the education of AIDS transmission and prevention. Many college students still hold negative attitude toward HIV-infected patients. The government should further make efforts to eliminate social discrimination in HIV-infected patients and lead people to approach HIV-infected patients fairly.
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Affiliation(s)
- Ling Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Hang Yu
- School of Public Health, Wuhan University, Wuhan, China
| | - Hong Luo
- Youth League Committee, North China University of Water Resources and Electric Power, Zhengzhou, China
| | - Wenlong Rong
- Youth League Committee, North China University of Water Resources and Electric Power, Zhengzhou, China
| | - Xianxin Meng
- Youth League Committee, North China University of Water Resources and Electric Power, Zhengzhou, China
| | - Xiaoan Du
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, China
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2
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Viljoen L, Bond VA, Reynolds LJ, Mubekapi‐Musadaidzwa C, Baloyi D, Ndubani R, Stangl A, Seeley J, Pliakas T, Bock P, Fidler S, Hayes R, Ayles H, Hargreaves JR, Hoddinott G. Universal HIV testing and treatment and HIV stigma reduction: a comparative thematic analysis of qualitative data from the HPTN 071 (PopART) trial in South Africa and Zambia. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:167-185. [PMID: 33085116 PMCID: PMC7894283 DOI: 10.1111/1467-9566.13208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Despite continued development of effective HIV treatment, expanded access to care and advances in prevention modalities, HIV-related stigma persists. We examine how, in the context of a universal HIV-testing and treatment trial in South Africa and Zambia, increased availability of HIV services influenced conceptualisations of HIV. Using qualitative data, we explore people's stigma-related experiences of living in 'intervention' and 'control' study communities. We conducted exploratory data analysis from a qualitative cohort of 150 households in 13 study communities, collected between 2016 and 2018. We found that increased availability of HIV-testing services influenced conceptualisations of HIV as normative (non-exceptional) and the visibility of people living with HIV (PLHIV) in household and community spaces impacted opportunities for stigma. There was a shift in community narratives towards individual responsibility to take up (assumingly) widely available service - for PLHIV to take care of their own health and to prevent onward transmission. Based on empirical data, we show that, despite a growing acceptance of HIV-related testing services, anticipated stigma persists through the mechanism of shifting responsibilisation. To mitigate the responsibilisation of PLHIV, heath implementers need to adapt anti-stigma messaging and especially focus on anticipated stigma.
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Affiliation(s)
- Lario Viljoen
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
- Department of Sociology and Social AnthropologyStellenbosch UniversityStellenboschSouth Africa
| | - Virginia A. Bond
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
- Global Health and Development DepartmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lindsey J. Reynolds
- Department of Sociology and Social AnthropologyStellenbosch UniversityStellenboschSouth Africa
| | - Constance Mubekapi‐Musadaidzwa
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Dzunisani Baloyi
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Rhoda Ndubani
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
| | - Anne Stangl
- International Center for Research on WomenWashingtonDCUSA
| | - Janet Seeley
- Global Health and Development DepartmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Sarah Fidler
- Imperial College NIHR BRCImperial College LondonLondonUK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - James R. Hargreaves
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Graeme Hoddinott
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
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Duthaler U, Berger B, Erb S, Battegay M, Letang E, Gaugler S, Natamatungiro A, Mnzava D, Donzelli M, Krähenbühl S, Haschke M. Using dried blood spots to facilitate therapeutic drug monitoring of antiretroviral drugs in resource-poor regions. J Antimicrob Chemother 2019; 73:2729-2737. [PMID: 30052975 DOI: 10.1093/jac/dky254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives We evaluated whether dried blood spots (DBS) are suitable to monitor combined ART when samples are collected in rural Tanzania and transported over a long distance to a specialized bioanalytical laboratory. Methods Plasma and DBS samples were collected in Tanzania from study patients treated with nevirapine, efavirenz or lopinavir. In addition, plasma, whole blood and DBS samples were obtained from a cohort of HIV patients at the site of the bioanalytical laboratory in Switzerland. DBS samples were analysed using a fully automated LC-MS/MS method. Results Comparison of DBS versus plasma concentrations of samples obtained from the bridging study in Switzerland indicated an acceptable bias only for nevirapine (18.4%), whereas for efavirenz and lopinavir a pronounced difference of -47.4% and -48.1% was found, respectively. Adjusting the DBS concentrations by the haematocrit and the fraction of drug bound to plasma proteins removed this bias [efavirenz +9.4% (-6.9% to +25.7%), lopinavir +2.2% (-20.0% to +24.2%)]. Storage and transportation of samples from Tanzania to Switzerland did not affect the good agreement between plasma and DBS for nevirapine [-2.9% (-34.7% to +29.0%)] and efavirenz [-9.6% (-42.9% to +23.8%)]. For lopinavir, however, adjusted DBS concentrations remained considerably below [-32.8% (-70.4% to +4.8%)] corresponding plasma concentrations due to decay of lopinavir in DBS obtained under field conditions. Conclusions Our field study shows that the DBS technique is a suitable tool for therapeutic drug monitoring in resource-poor regions; however, sample stability remains an issue for certain analytes and therefore needs special consideration.
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Affiliation(s)
- Urs Duthaler
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Benjamin Berger
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Stefan Erb
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Basel, Basel, Switzerland
| | - Emili Letang
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Ifakara Health Institute, Ifakara, Tanzania
| | | | | | | | - Massimiliano Donzelli
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital, Bern, Switzerland.,Institute of Pharmacology, University of Bern, Bern, Switzerland
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Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study. SAHARA J 2018; 15:138-145. [PMID: 30257611 PMCID: PMC6161614 DOI: 10.1080/17290376.2018.1527244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p < .01). At 24 months, retention rates for community-based ART and standard of care were 73.1% and 44.0%, respectively (p < .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p < .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.
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Agarwal A, Invernizzi A, Acquistapace A, Riva A, Agrawal R, Jain S, Aggarwal K, Gupta V, Dogra MR, Singh R. Analysis of Retinochoroidal Vasculature in Human Immunodeficiency Virus Infection Using Spectral-Domain OCT Angiography. Ophthalmol Retina 2017; 1:545-554. [PMID: 31047450 DOI: 10.1016/j.oret.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the retinochoroidal vascular alterations in patients with human immunodeficiency virus (HIV) infection using en face OCT angiography (OCTA). DESIGN Cross-sectional study. PARTICIPANTS Twenty-six patients with HIV infection (5 women, with and without HIV retinopathy) were included in the study. Nineteen healthy participants (7 women) with no known ocular disease were recruited as healthy controls. METHODS Multimodal imaging was performed using OCTA (Optovue RTVue XR Avanti; Optovue, Inc, Fremont, CA), enhanced-depth imaging OCT (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), color fundus photography, and fluorescein angiography (FA). Vessel flow density (VFD) was calculated automatically by the OCTA software. Morphologic changes in the retinochoroidal vasculature in the posterior pole on OCTA were assessed by 2 trained independent graders and were compared with the findings on clinical examination and other imaging techniques. MAIN OUTCOME MEASURES Prevalence of microvascular alterations on OCTA among patients with HIV and differences in the VFD in different macular sectors compared with healthy controls. RESULTS Among all eyes with clinically detectable HIV retinopathy, there was evidence of retinal vascular telangiectasia, capillary loops, and increased intercapillary spacing. The mean VFD values were lower among patients with HIV retinopathy compared with those with HIV and no retinopathy and healthy controls (both P < 0.05). Foveal avascular zone area was abnormally enlarged among patients with HIV compared with healthy controls (P = 0.05). Five eyes (23.53%) without clinical or angiographic evidence of retinopathy demonstrated retinal vascular telangiectasia and increased intercapillary spacing on OCTA. The inner choroidal vasculature appeared to be mostly unaffected in HIV. CONCLUSIONS OCT angiography provides noninvasive high-resolution imaging of the retinochoroidal vascular network in patients with HIV. Compared with conventional imaging, OCTA can demonstrate precise microvascular structural alterations in the retinal vessels and seems to be a sensitive tool in detecting HIV retinopathy.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandra Acquistapace
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Agostino Riva
- Department of Clinical Sciences, Luigi Sacco Hospital, Section of Infectious and Tropical Diseases, University of Milan, Milan, Italy
| | - Rupesh Agrawal
- Department of Ophthalmology; National Healthcare Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Sahil Jain
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Okoboi S, Ekwaru PJ, Campbell JD, Egessa A, King R, Bakanda C, Muramuzi E, Kaharuza F, Malamba S, Moore DM. No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project. BMC Public Health 2016; 16:101. [PMID: 26830678 PMCID: PMC4736157 DOI: 10.1186/s12889-016-2781-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared clinical outcomes among HIV-infected participants receiving ART who were randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in Tororo, Uganda. METHODS Beginning in May 2003, participants with CD4 cell counts <250 cells/μL or WHO stage 3 or 4 disease were randomized to clinical monitoring alone, clinical monitoring plus quarterly CD4 cell counts (CD4-only); or clinical monitoring, quarterly CD4 cell counts and quarterly VL testing (CD4-VL). In 2007, individuals in clinical monitoring arm were re-randomized to the other two arms and all participants were followed until March 31, 2009. We used Cox Proportional Hazard models to determine if study arm was independently associated with the development of opportunistic infections (OIs) or death. RESULTS We randomized 1211 participants to the three original study arms and 331 surviving participants in the clinical monitoring arm were re-randomized to the CD4-VL and CD4 only arms. At enrolment the median age was 38 years and the median CD4 cell count was 134 cells/μL. Over a median of 5.2 years of follow-up, 37 deaths and 35 new OIs occurred in the VL-CD4 arm patients, 39 deaths and 42 new OIs occurred in CD4-only patients. We did not observe an association between monitoring arm and new OIs or death (AHR =1.19 for CD4-only vs. CD4-VL; 95 % CI 0.82-1.73). CONCLUSION We found no differences in clinical outcomes associated with the addition of quarterly VL monitoring to quarterly CD4 cell count monitoring.
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Affiliation(s)
- Stephen Okoboi
- The AIDS Support Organization-TASO, Headquarters, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda.
| | | | | | - Aggrey Egessa
- The AIDS Support Organization-TASO, Headquarters, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda.
| | | | - Celestin Bakanda
- The AIDS Support Organization-TASO, Headquarters, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda.
| | - Emmy Muramuzi
- Makerere University School of Public Health, Kampala, Uganda.
| | - Frank Kaharuza
- Makerere University School of Public Health, Kampala, Uganda.
| | - Samuel Malamba
- Makerere University School of Public Health, Kampala, Uganda.
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,University of British Columbia, Vancouver, Canada.
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Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey TR, Fregonese F, Leurent B, Collins IJ, Techapornroong M, Banchongkit S, Buranabanjasatean S, Halue G, Nilmanat A, Luekamlung N, Klinbuayaem V, Chutanunta A, Kantipong P, Bowonwatanuwong C, Lertkoonalak R, Leenasirimakul P, Tansuphasawasdikul S, Sang-a-gad P, Pathipvanich P, Thongbuaban S, Wittayapraparat P, Eiamsirikit N, Buranawanitchakorn Y, Yutthakasemsunt N, Winiyakul N, Decker L, Barbier S, Koetsawang S, Sirirungsi W, McIntosh K, Thanprasertsuk S, Lallemant M. Switching HIV treatment in adults based on CD4 count versus viral load monitoring: a randomized, non-inferiority trial in Thailand. PLoS Med 2013; 10:e1001494. [PMID: 23940461 PMCID: PMC3735458 DOI: 10.1371/journal.pmed.1001494] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/27/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Viral load (VL) is recommended for monitoring the response to highly active antiretroviral therapy (HAART) but is not routinely available in most low- and middle-income countries. The purpose of the study was to determine whether a CD4-based monitoring and switching strategy would provide a similar clinical outcome compared to the standard VL-based strategy in Thailand. METHODS AND FINDINGS The Programs for HIV Prevention and Treatment (PHPT-3) non-inferiority randomized clinical trial compared a treatment switching strategy based on CD4-only (CD4) monitoring versus viral-load (VL). Consenting participants were antiretroviral-naïve HIV-infected adults (CD4 count 50-250/mm(3)) initiating non-nucleotide reverse transcriptase inhibitor (NNRTI)-based therapy. Randomization, stratified by site (21 public hospitals), was performed centrally after enrollment. Clinicians were unaware of the VL values of patients randomized to the CD4 arm. Participants switched to second-line combination with confirmed CD4 decline >30% from peak (within 200 cells from baseline) in the CD4 arm, or confirmed VL >400 copies/ml in the VL arm. Primary endpoint was clinical failure at 3 years, defined as death, new AIDS-defining event, or CD4 <50 cells/mm(3). The 3-year Kaplan-Meier cumulative risks of clinical failure were compared for non-inferiority with a margin of 7.4%. In the intent to treat analysis, data were censored at the date of death or at last visit. The secondary endpoints were difference in future-drug-option (FDO) score, a measure of resistance profiles, virologic and immunologic responses, and the safety and tolerance of HAART. 716 participants were randomized, 356 to VL monitoring and 360 to CD4 monitoring. At 3 years, 319 participants (90%) in VL and 326 (91%) in CD4 were alive and on follow-up. The cumulative risk of clinical failure was 8.0% (95% CI 5.6-11.4) in VL versus 7.4% (5.1-10.7) in CD4, and the upper-limit of the one-sided 95% CI of the difference was 3.4%, meeting the pre-determined non-inferiority criterion. Probability of switch for study criteria was 5.2% (3.2-8.4) in VL versus 7.5% (5.0-11.1) in CD4 (p=0.097). Median time from treatment initiation to switch was 11.7 months (7.7-19.4) in VL and 24.7 months (15.9-35.0) in CD4 (p=0.001). The median duration of viremia >400 copies/ml at switch was 7.2 months (5.8-8.0) in VL versus 15.8 months (8.5-20.4) in CD4 (p=0.002). FDO scores were not significantly different at time of switch. No adverse events related to the monitoring strategy were reported. CONCLUSIONS The 3-year rates of clinical failure and loss of treatment options did not differ between strategies although the longer-term consequences of CD4 monitoring would need to be investigated. These results provide reassurance to treatment programs currently based on CD4 monitoring as VL measurement becomes more affordable and feasible in resource-limited settings. TRIAL REGISTRATION ClinicalTrials.govNCT00162682 Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Gonzague Jourdain
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Sophie Le Cœur
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Unité Mixte de Recherche 196, Centre Français de la Population et du Développement, (INED-IRD-Paris V University), Paris, France
| | - Nicole Ngo-Giang-Huong
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Tim R. Cressey
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Federica Fregonese
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Baptiste Leurent
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Intira J. Collins
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | - Guttiga Halue
- Phayao Provincial Hospital, Ministry of Public Health, Phayao, Thailand
| | | | | | | | | | - Pacharee Kantipong
- Chiangrai Prachanukroh Hospital, Ministry of Public Health, Chiang Rai, Thailand
| | | | - Rittha Lertkoonalak
- Maharat Nakhon Ratchasima Hospital, Ministry of Public Health, Nakhon Ratchasima, Thailand
| | | | | | | | | | | | | | - Naree Eiamsirikit
- Samutprakarn Hospital, Ministry of Public Health, Samutprakarn, Thailand
| | | | | | - Narong Winiyakul
- Regional Health Promotion Centre 6, Ministry of Public Health, Khon Kaen, Thailand
| | - Luc Decker
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sylvaine Barbier
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Suporn Koetsawang
- Family Health Research Center, Mahidol University, Bangkok, Thailand
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kenneth McIntosh
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Marc Lallemant
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
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8
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Calmy A, Balestre E, Bonnet F, Boulle A, Sprinz E, Wood R, Delaporte E, Messou E, McIntyre J, El Filali KM, Schechter M, Kumarasamy N, Bangsberg D, McPhail P, Van Der Borght S, Zala C, Egger M, Thiébaut R, Dabis F. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings. BMC Infect Dis 2012; 12:147. [PMID: 22742573 PMCID: PMC3573925 DOI: 10.1186/1471-2334-12-147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART. Method Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART. Results 3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12. Conclusion In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART.
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Mermin J, Ekwaru JP, Were W, Degerman R, Bunnell R, Kaharuza F, Downing R, Coutinho A, Solberg P, Alexander LN, Tappero J, Campbell J, Moore DM. Utility of routine viral load, CD4 cell count, and clinical monitoring among adults with HIV receiving antiretroviral therapy in Uganda: randomised trial. BMJ 2011; 343:d6792. [PMID: 22074711 PMCID: PMC3213241 DOI: 10.1136/bmj.d6792] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the use of routine laboratory monitoring in terms of clinical outcomes among patients receiving antiretroviral therapy (ART) in Uganda. DESIGN Randomised clinical trial SETTING A home based ART programme in rural Uganda. PARTICIPANTS All participants were people with HIV who were members of the AIDS Support Organisation. Participants had CD4 cell counts <250 cells × 10(6)/L or World Health Organization stage 3 or 4 disease. INTERVENTIONS Participants were randomised to one of three different monitoring arms: a viral load arm (clinical monitoring, quarterly CD4 counts, and viral load measurements), CD4 arm (clinical monitoring and CD4 counts), or clinical arm (clinical monitoring alone). MAIN OUTCOME MEASURES Serious morbidity (newly diagnosed AIDS defining illness) and mortality. RESULTS 1094 participants started ART; median CD4 count at baseline was 129 cells × 10(6)/L. Median follow-up was three years. In total, 126 participants died (12%), 148 (14%) experienced new AIDS defining illnesses, and 61(6%) experienced virological failure, defined as two consecutive viral loads >500 copies/mL occurring more than three months after the start of ART. After adjustment for age, sex, baseline CD4 count, viral load, and body mass index, the rate of new AIDS defining events or death was higher in the clinical arm than the viral load arm (adjusted hazard ratio 1.83, P = 0.002) or the CD4 arm (1.49, P = 0.032). There was no significant difference between the CD4 arm and the viral load arm (1.23, P = 0.31). CONCLUSION In patients receiving ART for HIV infection in Uganda, routine laboratory monitoring is associated with improved health and survival compared with clinical monitoring alone. Trial registration Clinical Trials NCT00119093.
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Affiliation(s)
- Jonathan Mermin
- Global AIDS Program, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
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Pooled nucleic acid testing to detect antiretroviral treatment failure in Mexico. J Acquir Immune Defic Syndr 2011; 56:e70-4. [PMID: 21124228 DOI: 10.1097/qai.0b013e3181ff63d7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Similar to other resource-limited settings, cost restricts availability of viral load monitoring for most patients receiving antiretroviral therapy in Tijuana, Mexico. We evaluated if a pooling method could improve efficiency and reduce costs while maintaining accuracy. METHODS We evaluated 700 patient blood plasma specimens at a reference laboratory in Tijuana for detectable viremia, individually and in 10 × 10 matrix pools. Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing. RESULTS Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of >90% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39% to 42%. These methods would have saved between $13,223 and $14,308 for monitoring this cohort. CONCLUSIONS Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.
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Dried Blood Spot HIV-1 RNA Quantification Using Open Real-Time Systems in South Africa and Burkina Faso. J Acquir Immune Defic Syndr 2010; 55:290-8. [DOI: 10.1097/qai.0b013e3181edaaf5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Santilli V, Mora N, Aquilani A, Tchidjou HK, Pontrelli G, De Vito R, Lombardi A, Bernardi S, Palma P. Burkitt's lymphoma mimicking EBV disease as first sign of vertical HIV infection in an adolescent. Ital J Pediatr 2010; 36:34. [PMID: 20416074 PMCID: PMC2873400 DOI: 10.1186/1824-7288-36-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/23/2010] [Indexed: 11/19/2022] Open
Abstract
Burkitt's Lymphoma (BL) rarely represents the first clinical manifestation of vertical HIV infection in adolescent in Western Europe. We report the case of a 17 year-old boy with two week history of fever and enlarged cervical lymph nodes firstly misdiagnosed as EBV infection, subsequently diagnosed as Burkitt's Lymphoma and vertical HIV infection.
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Affiliation(s)
- Veronica Santilli
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Nadia Mora
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Angela Aquilani
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Hyppolite K Tchidjou
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Pontrelli
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Rita De Vito
- Unit of Anatomical Pathology- Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Stefania Bernardi
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Paolo Palma
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
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Koethe JR, Westfall AO, Luhanga DK, Clark GM, Goldman JD, Mulenga PL, Cantrell RA, Chi BH, Zulu I, Saag MS, Stringer JSA. A cluster randomized trial of routine HIV-1 viral load monitoring in Zambia: study design, implementation, and baseline cohort characteristics. PLoS One 2010; 5:e9680. [PMID: 20300631 PMCID: PMC2837376 DOI: 10.1371/journal.pone.0009680] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 02/23/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The benefit of routine HIV-1 viral load (VL) monitoring of patients on antiretroviral therapy (ART) in resource-constrained settings is uncertain because of the high costs associated with the test and the limited treatment options. We designed a cluster randomized controlled trial to compare the use of routine VL testing at ART-initiation and at 3, 6, 12, and 18 months, versus our local standard of care (which uses immunological and clinical criteria to diagnose treatment failure, with discretionary VL testing when the two do not agree). METHODOLOGY Dedicated study personnel were integrated into public-sector ART clinics. We collected participant information in a dedicated research database. Twelve ART clinics in Lusaka, Zambia constituted the units of randomization. Study clinics were stratified into pairs according to matching criteria (historical mortality rate, size, and duration of operation) to limit the effect of clustering, and independently randomized to the intervention and control arms. The study was powered to detect a 36% reduction in mortality at 18 months. PRINCIPAL FINDINGS From December 2006 to May 2008, we completed enrollment of 1973 participants. Measured baseline characteristics did not differ significantly between the study arms. Enrollment was staggered by clinic pair and truncated at two matched sites. CONCLUSIONS A large clinical trial of routing VL monitoring was successfully implemented in a dynamic and rapidly growing national ART program. Close collaboration with local health authorities and adequate reserve staff were critical to success. Randomized controlled trials such as this will likely prove valuable in determining long-term outcomes in resource-constrained settings. TRIAL REGISTRATION Clinicaltrials.gov NCT00929604.
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Affiliation(s)
- John R. Koethe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
| | | | - Dora K. Luhanga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Gina M. Clark
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jason D. Goldman
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Benjamin H. Chi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Isaac Zulu
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Michael S. Saag
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Jeffrey S. A. Stringer
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
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Rouet F, Foulongne V, Viljoen J, Steegen K, Becquart P, Valéa D, Danaviah S, Segondy M, Verhofstede C, Van de Perre P. Comparison of the Generic HIV Viral Load® assay with the Amplicor™ HIV-1 Monitor v1.5 and Nuclisens HIV-1 EasyQ® v1.2 techniques for plasma HIV-1 RNA quantitation of non-B subtypes: The Kesho Bora preparatory study. J Virol Methods 2010; 163:253-7. [DOI: 10.1016/j.jviromet.2009.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 08/13/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND To develop less costly methods to virologically monitor patients receiving antiretroviral therapy, we evaluated methods that use pooled blood samples and quantitative information available from viral load assays to monitor a cohort of patients on first-line antiretroviral therapy for virologic failure. METHODS We evaluated 150 blood samples collected after 6 months of therapy from participants enrolled in a San Diego primary infection program between January 1998 and January 2007. Samples were screened for virologic failure with individual viral load testing, 10 x 10 matrix pools and minipools of five samples. For the pooled platforms (matrix and minipools), we used a search and retest algorithm based on the quantitative viral load data to resolve samples that remained ambiguous for virologic failure. Viral load thresholds were more than 500 and more than 1500 copies/ml for the matrix and more than 250 and more than 500 copies/ml for the minipool. Efficiency, accuracy and result turnaround times were evaluated. RESULTS Twenty-three percent of cohort samples were detectable at more than 50 HIV RNA copies/ml. At an algorithm threshold of more than 500 HIV RNA copies/ml, both minipool and matrix methods used less than half the number of viral load assays to screen the cohort, compared with testing samples individually. Both pooling platforms had negative predictive values of 100% for viral loads of more than 500 HIV RNA copies/ml and at least 94% for viral loads of more than 250 HIV RNA copies/ml. CONCLUSION In this cohort, both pooling methods improved the efficiency of virologic monitoring over individual testing with a minimal decrease in accuracy. These methods may allow for the induction and sustainability of the virologic monitoring of patients receiving antiretroviral therapy in resource-limited settings.
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Wester CW, Bussmann H, Koethe J, Moffat C, Vermund S, Essex M, Marlink RG. Adult combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges. HIV THERAPY 2009; 3:501-526. [PMID: 20161344 PMCID: PMC2774911 DOI: 10.2217/hiv.09.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.
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Affiliation(s)
- C William Wester
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana
- Harvard School of Public Health, Department of Immunology & Infectious Diseases, Boston, MA, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Institute of Global Health (VIGH), Vanderbilt University, Nashville, TN, USA
| | - Hermann Bussmann
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana
- Harvard School of Public Health, Department of Immunology & Infectious Diseases, Boston, MA, USA
| | - John Koethe
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Claire Moffat
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana
- Harvard School of Public Health, Department of Immunology & Infectious Diseases, Boston, MA, USA
| | - Sten Vermund
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Institute of Global Health (VIGH), Vanderbilt University, Nashville, TN, USA
| | - Max Essex
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana
- Harvard School of Public Health, Department of Immunology & Infectious Diseases, Boston, MA, USA
| | - Richard G Marlink
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana
- Harvard School of Public Health, Department of Immunology & Infectious Diseases, Boston, MA, USA
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Long-term consequences of the delay between virologic failure of highly active antiretroviral therapy and regimen modification. AIDS 2009; 22:2097-106. [PMID: 18832873 DOI: 10.1097/qad.0b013e32830f97e2] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Current treatment guidelines recommend immediate modification of antiretroviral therapy in HIV-infected individuals with incomplete viral suppression. These recommendations have not been tested in observational studies or large randomized trials. We evaluated the consequences of delayed modification following virologic failure. DESIGN/METHODS We used prospective data from two clinical cohorts to estimate the effect of time until regimen modification following first regimen failure on all-cause mortality. The impact of regimen type was also assessed. As the effect of delayed switching can be confounded if patients with a poor prognosis modify therapy earlier than those with a good prognosis, we used a statistical methodology - marginal structural models - to control for time-dependent confounding. RESULTS A total of 982 patients contributed 3414 person-years of follow-up following first regimen failure. Delay until treatment modification was associated with an elevated hazard of all-cause mortality among patients failing a reverse transcriptase inhibitor-based regimen (hazard ratio per additional 3 months delay = 1.23, 95% confidence interval: 1.08, 1.40), but appeared to have a small protective effect among patients failing a protease inhibitor-based regimen (hazard ratio per additional 3 months delay = 0.93, 95% confidence interval: 0.87, 0.99). CONCLUSION Delay in modification after failure of regimens that do not contain a protease inhibitor is associated with increased mortality. Protease inhibitor-based regimens are less dependent on early versus delayed switching strategies. Efforts should be made to minimize delay until treatment modification in resource-poor regions, where the majority of patients are starting reverse transcriptase inhibitor-based regimens and HIV RNA monitoring may not be available.
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Pirkle CM, Boileau C, Nguyen VK, Machouf N, Ag-Aboubacrine S, Niamba PA, Drabo J, Koala S, Tremblay C, Rashed S. Impact of a modified directly administered antiretroviral treatment intervention on virological outcome in HIV-infected patients treated in Burkina Faso and Mali. HIV Med 2009; 10:152-6. [DOI: 10.1111/j.1468-1293.2008.00664.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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HIV Drug Resistance Pattern Among HAART-Exposed Patients With Suboptimal Virological Response in Ouagadougou, Burkina Faso. J Acquir Immune Defic Syndr 2008; 49:17-25. [DOI: 10.1097/qai.0b013e318182d2bc] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barth RE, van der Meer JTM, Hoepelman AIM, Schrooders PA, van de Vijver DA, Geelen SPM, Tempelman HA. Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa. Eur J Clin Microbiol Infect Dis 2008; 27:977-84. [DOI: 10.1007/s10096-008-0534-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
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Hamers RL, Derdelinckx I, van Vugt M, Stevens W, Rinke de Wit TF, Schuurman R. The Status of HIV-1 Resistance to Antiretroviral drugs in Sub-Saharan Africa. Antivir Ther 2008. [DOI: 10.1177/135965350801300502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Access to highly active antiretroviral therapy (HAART) for persons infected with HIV in sub-Saharan Africa has greatly improved over the past few years. However, data on long-term clinical outcomes of Africans receiving HAART, patterns of HIV resistance to antiretroviral drugs and implications of HIV type-1 (HIV-1) subtype diversity in Africa for resistance, are limited. In resource-limited settings, concerns have been raised that deficiencies in health systems could create the conditions for accelerated development of resistance. Coordinated surveillance systems are being established to assess the emergence of resistance and the factors associated with resistance development, and to create the possibility for adjusting treatment guidelines as necessary. The purpose of this report is to review the literature on HIV-1 resistance to antiretroviral drugs in sub-Saharan Africa, in relation to the drug regimens used in Africa, HIV-1 subtype diversity and overall prevalence of resistance. The report focuses on resistance associated with treatment, prevention of mother-to-child transmission and transmitted resistance. It also outlines priorities for public health action and research.
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Affiliation(s)
- Raph L Hamers
- PharmAccess Foundation, Center for Poverty-Related Communicable Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Inge Derdelinckx
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michèle van Vugt
- PharmAccess Foundation, Center for Poverty-Related Communicable Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias F Rinke de Wit
- PharmAccess Foundation, Center for Poverty-Related Communicable Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob Schuurman
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Last year marked the 25th anniversary of the recognition of what we now call AIDS. The AIDS pandemic has claimed more than 25 million lives, the majority of them in the developing world, and has exacerbated poverty and slowed human development. Although much has been accomplished in HIV/AIDS research, much remains to be done, especially regarding delivery of HIV/AIDS therapies and care and prevention interventions to the poorest countries that need them most.
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Affiliation(s)
- Anthony S Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Calmy A, Ford N, Hirschel B, Reynolds SJ, Lynen L, Goemaere E, Garcia de la Vega F, Perrin L, Rodriguez W. HIV viral load monitoring in resource-limited regions: optional or necessary? Clin Infect Dis 2006; 44:128-34. [PMID: 17143828 DOI: 10.1086/510073] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 08/30/2006] [Indexed: 11/04/2022] Open
Abstract
Although it is a standard practice in high-income countries, determination of the human immunodeficiency virus (HIV) load is not recommended in developing countries because of the costs and technical constraints. As more and more countries establish capacity to provide second-line therapy, and as costs and technological constraints associated with viral load testing decrease, the question of whether determination of the viral load is necessary deserves attention. Viral load testing could increase in importance as a guide for clinical decisions on when to switch to second-line treatment and on how to optimize the duration of the first-line treatment regimen. In addition, the viral load is a particularly useful tool for monitoring adherence to treatment, performing sentinel surveillance, and diagnosing HIV infection in children aged <18 months. Rather than considering viral load data to be an unaffordable luxury, efforts should be made to ensure that viral load testing becomes affordable, simple, and easy to use in resource-limited settings.
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Affiliation(s)
- Alexandra Calmy
- Medecins sans Frontieres, Access to Medicines Campaign, Geneva, 1211, Switzerland.
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