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Fekadu G, Bati L, Gebeyehu H. Reasons for Antiretroviral Treatment Change Among Adult HIVAIDS Patients at Nedjo General Hospital, Western Ethiopia. Open AIDS J 2019. [DOI: 10.2174/1874613601913010065] [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
Background:
Frequent change of Antiretroviral Treatment (ART) regimen is a challenging problem especially in a resource-limited setting like Ethiopia where treatment options are limited. This study was aimed to identify reasons for ART regimen change among adult HIV patients at Nedjo General Hospital (NGH).
Methods:
An institutional-based retrospective cross-sectional study was conducted at NGH by reviewing patient information cards from 2006 to 2016.
Results:
From a total of 117 included patients, 50.4% were females and the median (IQR) age of the patients was 28 (24-47) years. Majority of patients, 63 (53.9%) started their treatment at world health organization (WHO) clinical stage III (53.9%) and CD4 count of between 200-350 cells/mm3 (44.54%). At the beginning of ART, 56 (47.9%) patients were on a fixed-dose combination of stavudine-lamivudine-nevirapine (D4T/3TC/NVP). The single-drug substitutions were D4T (n = 63), NVP (n = 34), AZT (n =5), EFV (n = 2), and TDF (n = 1). Majority of the patients, 35(29.9%) switched their initial ART regimen after 3 years of regimen commencement. The common reasons reported for initial regimen change was availability of new drug 46 (39.3%) followed by toxicity/side effects 34 (29.2%). From all toxicities, peripheral neuropathy (47.1%) was the most common toxicity followed by rash (20.6%). After regimen change, 47 (40.2%) were received AZT+3TC+NVP.
Conclusion:
Availability of new drug and toxicity were the common reasons for regimen modifications. There should be updated guidelines, sustainable supply of affordable ART drugs, and effective laboratory materials to increase treatment success and minimize the toxicity of the drugs.
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[Survival in HIV-1 patients receiving antiretroviral therapy in Morocco]. Rev Epidemiol Sante Publique 2018; 66:311-316. [PMID: 30177238 DOI: 10.1016/j.respe.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose was to study factors associated with the survival of HIV-1 patients receiving antiretroviral therapy in Morocco. MATERIAL AND METHOD This was a retrospective study of a cohort of 182 HIV-1 patients receiving antiretroviral therapy in the department of dermatology venereology at the Military Instruction Hospital Mohamed V in Rabat during the period from 1 January 2006 to 1 January 2017. Death of any cause during the study period was considered to be the result of HIV infection. The log-rank test was used to compare the survival curves based on determinants. The Cox regression model analyzed the determinants of survival since induction of antiretroviral therapy. RESULTS The median follow-up time was 4.7 years (IQR: 1.97-8.18). The mortality rate was 75 deaths per 1000 person-years. Advanced clinical stage CDC C (RR: 2.72; CI 95%: 1.33-5.56) and treatment with indinavir (RR: 1.41; CI 95%: 0.77-2.59) were significantly associated with death. CONCLUSION Initiation of antiretroviral therapy in the early stage of the disease and use of less toxic molecules are recommended to reduce mortality.
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Tchounga B, Ekouevi DK, Balestre E, Dabis F. Mortality and survival patterns of people living with HIV-2. Curr Opin HIV AIDS 2016; 11:537-544. [PMID: 27254747 PMCID: PMC5055442 DOI: 10.1097/coh.0000000000000299] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW People living with HIV-2 infected usually initiate antiretroviral therapy (ART) at an advanced period in the course of their infection after a long asymptomatic period characterized by high CD4 cell count and thus at a relatively advanced age. In the new international context of early and universal ART initiation, the aim was to review survival patterns among HIV-2 infected patients, either on ART or not. RECENT FINDINGS Very few reports were published on mortality in people living with HIV-2 during the last 5 years. People living with HIV-2 experience high mortality rates although lower than people living with HIV-1 before ART initiation. They seem to survive longer regardless of the conditions of ART use. Mortality is associated with late presentation, male sex, CD4 cell count less than 500 cell/μl, high plasma viral load, hemoglobin rate less than 8 g/dl and body mass index less than 18 kg/m. SUMMARY People living with HIV-2 initiate ART later than HIV-1 and HIV duals, resulting in higher disease progression and mortality rate. The clinical management of HIV-2 infected patients should now include early diagnosis and treatment initiation as per international guidelines. Further research needs to explore the 'what to start' question and document specific causes of death in people living with HIV-2 and enrolled in care in Africa.
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Affiliation(s)
- Boris Tchounga
- aUniversité de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population HealthbProgramme PACCI, site de recherche ANRS, Abidjan, Côte d'IvoirecDépartement de Santé Publique, Université de Lomé, Lomé-Togo
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Galy A, Ciaffi L, Le Moing V, Eymard-Duvernay S, Abessolo H, Toby R, Ayangma L, Le Gac S, Mpoudi-Etame M, Koulla-Shiro S, Delaporte E, Cournil A. Incidence of infectious morbidity events after second-line antiretroviral therapy initiation in HIV-infected adults in Yaoundé, Cameroon. Antivir Ther 2016; 21:547-552. [PMID: 26882335 DOI: 10.3851/imp3030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since antiretroviral therapy (ART), HIV-infected individuals experience mainly non-AIDS-related conditions, among which infectious events are prominent. We aimed to estimate incidence and describe overall spectrum of infectious events, including all grade events, among HIV-1-infected adults failing first-line ART in Yaoundé, Cameroon. METHODS All patients from Cameroon enrolled in the second-line ART 2LADY trial (ANRS12169) were included in this secondary analysis. Medical files were reviewed with predefined criteria for diagnosis assessment. Incidence rates (IR) were estimated per 100 person-years (% PY). RESULTS A total of 302 adult patients contributing 840 PY experienced 596 infectious events (IR 71% PY). Only 29 (5%) events were graded as severe. Most frequent infections were upper respiratory tract infections (15% PY), diarrhoea (9% PY) and malaria (9% PY). A total of 369 (62%) infections occurred during the first year (IR 130% PY) followed by a persistent lower incidence during the following 3 years. Higher IR were observed in patients with CD4+ T-cell count <200 cells/mm3 for all infectious events except for mycobacterial and parasitic infections. IR of viral, bacterial and parasitic infectious events were lower in case of co-trimoxazole use in patients with CD4+ T-cell count <200 cells/mm3. CONCLUSIONS Infectious events are common and mainly occur during the first year after treatment initiation. Second-line ART initiation had a positive impact on the entire spectrum of infectious morbidity.
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Affiliation(s)
- Adrien Galy
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
| | - Laura Ciaffi
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | - Vincent Le Moing
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,Department of Infectious Diseases, University Hospital, Montpellier, France
| | - Sabrina Eymard-Duvernay
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
| | - Hermine Abessolo
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | - Roselyne Toby
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | | | - Sylvie Le Gac
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | | | - Sinata Koulla-Shiro
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon.,Faculté de Médecine et des Sciences Biomédicales (FMSB), University of Yaoundé 1, Yaoundé, Cameroon
| | - Eric Delaporte
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,Department of Infectious Diseases, University Hospital, Montpellier, France
| | - Amandine Cournil
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
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Gender Differences in Adherence and Response to Antiretroviral Treatment in the Stratall Trial in Rural District Hospitals in Cameroon. J Acquir Immune Defic Syndr 2015; 69:355-64. [PMID: 26181708 DOI: 10.1097/qai.0000000000000604] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence of gender differences in antiretroviral treatment (ART) outcomes in sub-Saharan Africa is conflicting. Our objective was to assess gender differences in (1) adherence to ART and (2) virologic failure, immune reconstitution, mortality, and disease progression adjusting for adherence. METHODS Cohort study among 459 ART-naive patients followed up 24 months after initiation in 2006-2010 in 9 rural district hospitals. Adherence to ART was assessed using (1) a validated tool based on multiple patient self-reports and (2) antiretroviral plasma concentrations. The associations between gender and the outcomes were assessed using multivariate mixed models or accelerated time failure models. RESULTS One hundred thirty-five patients (29.4%) were men. At baseline, men were older, had higher body mass index and hemoglobin level, and received more frequently efavirenz than women. Gender was not associated with self-reported adherence (P = 0.872, 0.169, and 0.867 for moderate adherence, low adherence, and treatment interruption, respectively) or with antiretroviral plasma concentrations (P = 0.549 for nevirapine/efavirenz). In contrast, male gender was associated with virologic failure [odds ratio: 2.18, 95% confidence interval (CI): 1.31 to 3.62, P = 0.003], lower immunologic reconstitution (coefficient: -58.7 at month 24, 95% CI: -100.8 to -16.6, P = 0.006), and faster progression to death (time ratio: 0.30, 95% CI: 0.12 to 0.78, P = 0.014) and/or to World Health Organization stage 4 event (time ratio: 0.27, 95% CI: 0.09 to 0.79, P = 0.017). CONCLUSIONS Our study provides important evidence that African men are more vulnerable to ART failure than women and that the male vulnerability extends beyond adherence issues. Additional studies are needed to determine the causes for this vulnerability to optimize HIV care. However, personalized adherence support remains crucial.
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Avi R, Pauskar M, Karki T, Kallas E, Jõgeda EL, Margus T, Huik K, Lutsar I. Prevalence of drug resistance mutations in HAART patients infected with HIV-1 CRF06_cpx in Estonia. J Med Virol 2015; 88:448-54. [PMID: 26291050 DOI: 10.1002/jmv.24361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/08/2022]
Abstract
HIV-1 drug resistance mutations (DRMs) and substitutions were assessed after the failure of the first line non-nucleoside reverse transcriptase inhibitors (NNRTIs) + 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) treatment regimens (efavirenz [EFV] + lamivudine[3TC] + zidovudine [ZDV] vs. EFV + 3TC + ddI) among the HIV-1 CRF06_cpx infected subjects in Estonia. HIV-1 genomic RNA was sequenced; DRMs and amino acid substitutions were compared in 44 treatment naïve and 45 first-line NNRTI + 2 NRTI treatment failed patients consisting of EFV + 3TC + ZDV (n = 17) and EFV + 3TC + didanosine[ddI] (n = 21) therapy failed sub-populations. At least one DRM was found in 78% of treatment experienced patients. The most common NRTI mutations were M184V (80%), L74V (31%), L74I (17%), K219E (9%), and M184I (9%), NNRTI mutations were K103N (83%), P225H (14%), L100I (11%), and Y188L (11%), reflecting generally the similar pattern of DRMs to that seen in treatment failed subtype B viruses. Sub-population analysis revealed that EFV + 3TC + ddI failed patients had more DRMs compared to EFV + 3TC + ZDV failed patients, especially the ddI DRM L74IV and several additional NNRTI DRMs. Additionally, CRF06_cpx specific mutation E179V and substitutions R32K, K122E, and V200AE were also detected in treatment experienced population. After the failure of the first-line EFV + 3TC + ddI therapy HIV-1 CRF06_cpx viruses develop additional NRTI and NNRTI mutations compared to EFV + 3TC + ZDV regimen. Therefore the usage of EFV + 3TC + ddI in this subtype decreases the options for next regimens containing abacavir, and NNRTI class agents.
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Affiliation(s)
- Radko Avi
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Merit Pauskar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tõnis Karki
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Eveli Kallas
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Ene-Ly Jõgeda
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tõnu Margus
- Department of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Kristi Huik
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Irja Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Rutto EK, Nyagol J, Oyugi J, Ndege S, Onyango N, Obala A, Simiyu CJ, Boor G, Cheriro WC, Otsyula B, Estambale B. Effects of HIV-1 infection on malaria parasitemia in milo sub-location, western Kenya. BMC Res Notes 2015; 8:303. [PMID: 26173396 PMCID: PMC4501056 DOI: 10.1186/s13104-015-1270-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 07/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Malaria and HIV infections are both highly prevalent in sub-Saharan Africa, with HIV-infected patients being at higher risk of acquiring malaria. HIV-1 infection is known to impair the immune response and may increase the incidence of clinical malaria. However, a positive association between HIV-1 and malaria parasitaemia is still evolving. Equally, the effect of malaria on HIV-1 disease stage has not been well established, but when fever and parasitemia are high, malaria may be associated with transient increases in HIV-1 viral load, and progression of HIV-1 asymptomatic disease phase to AIDS. Objective To determine the effects of HIV-1 infection on malaria parasitaemia among consented residents of Milo sub-location, Bungoma County in western Kenya. Study design Census study evaluating malaria parasitaemia in asymptomatic individuals with unknown HIV-1 status. Methods After ethical approvals from both Moi University and MTRH research ethics committees, data of 3,258 participants were retrieved from both Webuye health demographic surveillance system (WHDSS), and Academic Model Providing Access to Healthcare (AMPATH) in the year 2010. The current study was identifying only un-diagnosed HIV-1 individuals at the time the primary data was collected. The data was then analysed for significant statistical association for malaria parasitemia and HIV-1 infection, using SPSS version 19. Demographic characteristics such as age and sex were summarized as means and percentages, while relationship between malaria parasitaemia and HIV-1 (serostatus) was analyzed using Chi square. Results Age distribution for the 3,258 individuals ranged between 2 and 94 years, with a mean age of 26 years old. Females constituted 54.3%, while males were 45.8%. In terms of age distribution, 2–4 years old formed 15.1% of the study population, 5–9 years old were 8.8%, 10–14 years old were 8.6% while 15 years old and above were 67.5%. Of the 3,258 individuals whose data was eligible for analysis, 1.4% was newly diagnosed HIV-1 positive. Our findings showed a higher prevalence of malaria in children aged 2–10 years (73.4%), against the one reported in children in lake Victoria endemic region by the Kenya malaria indicator survey in the year 2010 (38.1%). There was no significant associations between the prevalence of asymptomatic malaria and HIV-1 status (p = 0.327). However, HIV-1/malaria co-infected individuals showed elevated mean malaria parasite density, compared to HIV-1 negative individuals, p = 0.002. Conclusion HIV-1 status was not found to have effect on malaria infection, but the mean malaria parsite density was significantly higher in HIV-1 positive than the HIV-1 negative population. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1270-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erick Kipkoech Rutto
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya. .,Department of Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya.
| | - Joshua Nyagol
- Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya. .,Department of Medical Microbiology College of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Samson Ndege
- Department of Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya.
| | - Noel Onyango
- Department of of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Andrew Obala
- Department of Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya.
| | - Chrispinus J Simiyu
- Department of Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya.
| | - Gye Boor
- Department of Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya.
| | | | - Barasa Otsyula
- Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.
| | - Ben Estambale
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya. .,Department of Medical Microbiology College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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Ezeamama AE, Mupere E, Oloya J, Martinez L, Kakaire R, Yin X, Sekandi JN, Whalen CC. Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV-tuberculosis co-infected patients on combination antiretroviral therapy. Int J Infect Dis 2015; 35:73-9. [PMID: 25910854 DOI: 10.1016/j.ijid.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/09/2015] [Accepted: 04/15/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Baseline age and combination antiretroviral therapy (cART) were examined as determinants of CD4+ T-cell recovery during 6 months of tuberculosis (TB) therapy with/without cART. It was determined whether this association was modified by patient sex and nutritional status. METHODS This longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+ T-cell counts were measured using flow cytometry. Age was defined as ≤24, 25-29, 30-34, and 35-39 vs. ≥40 years. Nutritional status was defined as normal (>18.5kg/m(2)) vs. underweight (≤18.5kg/m(2)) using the body mass index (BMI). Multivariate random effects linear mixed models were fitted to estimate differences in CD4+ T-cell recovery in relation to specified determinants. RESULTS cART was associated with a monthly rise of 15.7 cells/μl (p<0.001). Overall, age was not associated with CD4+ T-cell recovery during TB therapy (p = 0.655). However, among patients on cART, the age-associated CD4+ T-cell recovery rate varied by sex and nutritional status, such that age <40 vs. ≥40 years predicted superior absolute CD4+ T-cell recovery among females (p=0.006) and among patients with a BMI ≥18.5kg/m(2) (p<0.001). CONCLUSIONS TB-infected HIV-positive patients aged ≥40 years have a slower rate of immune restoration given cART, particularly if BMI is >18.5kg/m(2) or they are female. These patients may benefit from increased monitoring and nutritional support during cART.
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Affiliation(s)
- Amara E Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda; Uganda-Case Western Reserve Research Collaboration, Kampala, Uganda
| | - James Oloya
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA
| | - Leonardo Martinez
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA
| | - Robert Kakaire
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA
| | - Xiaoping Yin
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA
| | - Juliet N Sekandi
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA
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Incidence of HIV-associated tuberculosis among individuals taking combination antiretroviral therapy: a systematic review and meta-analysis. PLoS One 2014; 9:e111209. [PMID: 25393281 PMCID: PMC4230893 DOI: 10.1371/journal.pone.0111209] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/26/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis. METHODS Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy. RESULTS From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings) were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI) 3.39-5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23-0.69 per 100 person-years]) with significant heterogeneity observed between the studies. CONCLUSIONS Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.
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Andia I, Kaida A, Maier M, Guzman D, Emenyonu N, Pepper L, Bangsberg DR, Hogg RS. Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Am J Public Health 2008; 99:340-7. [PMID: 19059862 DOI: 10.2105/ajph.2007.129528] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether the prevalence of contraceptive use among women who are HIV positive varied according to use of highly active antiretroviral therapy (HAART) in Mbarara, Uganda. METHODS We used data from a cross-sectional survey of 484 women who were HIV positive (18-50 years) and were attending Mbarara University's HIV clinic, 45% of whom were receiving HAART. Multivariate logistic regression was used to investigate the association between HAART use and contraceptive use. Data were collected between November 2005 and June 2006. RESULTS Overall, 45% of the women were sexually active in the previous 3 months. Of these, 85% reported using contraceptive methods, with 84% reporting use of barrier contraceptive methods. Women receiving HAART were more than twice as likely to use contraceptive methods (adjusted odds ratio [AOR] = 2.64; 95% confidence interval [CI] = 1.07, 6.49) and more than 3 times as likely to use barrier contraceptive methods (AOR = 3.62; 95% CI = 1.54, 8.55) than were women not receiving HAART. CONCLUSIONS Our findings support the need for increased attention to better integration of reproductive health and HIV and AIDS services for women who are HIV positive.
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Affiliation(s)
- Irene Andia
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
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Losina E, Yazdanpanah Y, Deuffic-Burban S, Wang B, Wolf LL, Messou E, Gabillard D, Seyler C, Freedberg KA, Anglaret X. The Independent Effect of Highly Active Antiretroviral Therapy on Severe Opportunistic Disease Incidence and Mortality in HIV-Infected Adults in Côte D'Ivoire. Antivir Ther 2007. [DOI: 10.1177/135965350701200416] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Studies in developed countries have shown highly active antiretroviral therapy (HAART) decreases incidence of severe opportunistic diseases (ODs) in HIV-infected patients beyond that which is expected from changes in CD4+T-cell count. Objective To estimate the independent impact of HAART on reducing ODs and mortality in Côte d'Ivoire. Methods Within two longitudinal studies of HIV-infected adults (1996–2003), we identified time on ‘cotrimoxazole alone’ and ‘HAART plus cotrimoxazole’. WHO stage 3–4 defining events and severe malaria were divided into those preventable and not preventable with cotrimoxazole. Incidence of ODs by CD4 count stratum was estimated using incidence density analysis. CD4+ T-cell count at time of OD was estimated using linear interpolation. Using Poisson regression, we estimated the effect of HAART on OD incidence and mortality by CD4 count stratum. Results Totals of 446 and 135 adults were followed during 6,216 and 3,412 person-months in the cotrimoxazole alone and HAART plus cotrimoxazole periods, respectively. There was a CD4+ T-cell-independent risk reduction for ODs and mortality during the HAART plus cotrimoxazole period compared with cotrimoxazole alone, which varied by time on HAART, CD4 count stratum and OD type. It was mainly seen after 6 months on HAART and for ODs not preventable by cotrimoxazole. The HAART effect differed significantly by CD4 count stratum ( P=0.02), but was significant in all strata after 6 months on HAART. Conclusions In these sub-Saharan African adults, HAART initiation reduced ODs and mortality beyond that which was expected through the HAART-induced CD4+ T-cell increase. Further studies should examine practical implications of this independent ‘HAART effect’ on clinical outcomes in patients on HAART.
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Affiliation(s)
- Elena Losina
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Divisions of General Medicine and Infectious Disease and the Harvard Center for AIDS Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yazdan Yazdanpanah
- CNRS UMR 8179, Institut Catholique de Lille, Lille, France
- EA 2694, Faculté de Médecine de Lille, Lille, France; and Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | - Bingxia Wang
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Divisions of General Medicine and Infectious Disease and the Harvard Center for AIDS Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lindsey L Wolf
- Divisions of General Medicine and Infectious Disease and the Harvard Center for AIDS Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Delphine Gabillard
- Unité INSERM 593, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Catherine Seyler
- Programme PACCI, Abidjan, Côte d'Ivoire
- Unité INSERM 593, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Kenneth A Freedberg
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Divisions of General Medicine and Infectious Disease and the Harvard Center for AIDS Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xavier Anglaret
- Programme PACCI, Abidjan, Côte d'Ivoire
- Unité INSERM 593, Université Victor Segalen Bordeaux 2, Bordeaux, France
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Moh R, Danel C, Sorho S, Sauvageot D, Anzian A, Minga A, Gomis OB, Konga C, Inwoley A, Gabillard D, Bissagnene E, Salamon R, Anglaret X. Haematological changes in adults receiving a zidovudine-containing HAART regimen in combination with cotrimoxazole in Côte d'Ivoire. Antivir Ther 2005; 10:615-24. [PMID: 16152755 DOI: 10.1177/135965350501000510] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. We estimated the incidence of haematological disorders during the first 6 months of a zidovudine-containing highly active antiretroviral therapy (HAART) regimen in sub-Saharan African adults receiving cotrimoxazole. METHODS Prospective cohort study in Abidjan, with blood cell count measurement at baseline (HAART initiation), month 1, month 3 and month 6. RESULTS A total of 498 adults [baseline: 80% currently on cotrimoxazole prophylaxis; median CD4 count 237/mm3 [interquartile range (IQR) 181;316]; median neutrophil count 1647/mm3 (IQR 1221;2256); median haemoglobin 113 g/l (IQR 102;122)] started zidovudine (AZT)/lamivudine/efavirenz. During follow-up, 118 patients had a grade 3-4 neutropenia [(56.3/100 person-years (PY)], 23 had a grade 3-4 anaemia (9.6/100 PY) and no cases of grade 3-4 thrombocytopenia. Of the 118 patients with grade 3-4 neutropenia, 86 (73%) had to stop cotrimoxazole because neutropenia persisted, and one (<1%) had to stop AZT because of persistent neutropenia after cotrimoxazole was stopped (neutropenia-related HAART modification: 0.4/100 PY). Of the 23 patients with grade 3-4 anaemia, 11 had to stop AZT (anaemia-related HAART modification: 4.4/100 PY). In patients who stopped cotrimoxazole but not AZT, the median gain in neutrophils at 1 month was +540/mm3 (IQR +150;+896). CONCLUSIONS At baseline, most patients had a normal neutrophil count and 80% of them were already receiving cotrimoxazole. An unexpectedly high rate of grade 3-4 neutropenia occurred shortly after introduction of AZT. Almost all of the persistent severe neutropenia disappeared after cotrimoxazole was stopped. This suggests an accentuated drug interaction between the two drugs in these sub-Saharan African individuals. Grade 3-4 anaemia was much less frequent, but remained the first cause of AZT discontinuation.
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Affiliation(s)
- Raoul Moh
- Programme PAC-CI, Abidjan, Côte d'Ivoire
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Seyler C, Toure S, Messou E, Bonard D, Gabillard D, Anglaret X. Risk factors for active tuberculosis after antiretroviral treatment initiation in Abidjan. Am J Respir Crit Care Med 2005; 172:123-7. [PMID: 15805184 DOI: 10.1164/rccm.200410-1342oc] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE In sub-Saharan Africa: (1) tuberculosis is the first cause of HIV-related mortality; (2) the incidence of tuberculosis in adults receiving highly active antiretroviral therapy (HAART) is lower than in untreated HIV-infected adults but higher than in HIV-negative adults; and (3) factors associated with the occurrence of tuberculosis in patients receiving HAART have never been described. OBJECTIVE To look for the risk factors for active tuberculosis in HIV-infected adults receiving HAART in Abidjan. METHODS Seven-year prospective cohort of HIV-infected adults, with standardized procedures for documenting morbidity. We analyzed the incidence of active tuberculosis in patients who started HAART and the association between the occurrence of tuberculosis and the characteristics of these patients at HAART initiation. MAIN RESULTS A total of 129 adults (median baseline CD4 count 125/mm(3)) started HAART and were then followed for 270 person-years (P-Y). At HAART initiation, 31 had a history of tuberculosis and none had current active tuberculosis. During follow-up, the incidence of active tuberculosis was 4.8/100 P-Y (95% confidence interval [CI], 2.5-8.3) overall, 3.0/100 P-Y (95% CI, 1.1-6.6) in patients with no tuberculosis history, and 11.3/100 P-Y (95% CI, 4.1-24.5) in patients with a history of tuberculosis (adjusted hazard ratio, 4.64; 95% CI, 1.29-16.62, p = 0.02). CONCLUSION The risk of tuberculosis after HAART initiation was significantly higher in patients with a history of tuberculosis than in those with no tuberculosis history. If confirmed by others, this finding could lead to assessment of new patterns of time-limited tuberculosis secondary chemoprophylaxis during the period of initiation of HAART in sub-Saharan African adults.
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Affiliation(s)
- Catherine Seyler
- INSERM U593, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, France
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Bourgeois A, Laurent C, Mougnutou R, Nkoué N, Lactuock B, Ciaffi L, Liégeois F, Andrieux-Meyer I, Zekeng L, Calmy A, Mpoudi-Ngolé E, Delaporte E. Field Assessment of Generic Antiretroviral Drugs: A Prospective Cohort Study in Cameroon. Antivir Ther 2005. [DOI: 10.1177/135965350501000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess the effectiveness of generic anti-retroviral drugs in terms of survival and virological and immunological responses, as well as their tolerability and the emergence of viral resistance. Methods A total of 109 HIV-1-infected patients were enrolled in a prospective cohort study in Yaoundé, Cameroon. Available generic drugs were a fixed-dose combination (FDC) of zidovudine (ZDV) and lamivudine (3TC), an FDC of 3TC, stavudine (d4T) and nevirapine (NVP), and individual formulations of ZDV, 3TC and NVP. Results At baseline, the median CD4 cell count was 150/mm3 [interquartile range (IQR) 61–223] and median viral load was 5.4 log10 copies/ml (IQR 4.8–5.6); 78% of patients received ZDV/3TC/NVP and 22% received 3TC/d4T/NVP. Median follow-up was 16 months (IQR 11–23). The survival probability was high (0.92 at 12 months); plasma viral load declined by a median of 3.3 log10 copies/ml and 86.9% of the intention-to-treat population had viral load <400 copies/ml at 12 months; CD4 count had increased by a median of 106 cells/mm3 at 12 months; drug resistance rarely emerged (incidence rate 3.2 per 100 person-years); and the treatments were reasonably well-tolerated (incidence rate of severe adverse effects 7.8 per 100 person-years). Conclusion Together with previous pharmacological and clinical studies, this prospective study suggests that these generic antiretroviral drugs can be used in developing countries.
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Affiliation(s)
- Anke Bourgeois
- Institut de Recherche pour le Développement and Department of International Health, University of Montpellier (UMR 145), Montpellier, France
| | - Christian Laurent
- Institut de Recherche pour le Développement and Department of International Health, University of Montpellier (UMR 145), Montpellier, France
| | - Rose Mougnutou
- Projet PARVY, Military Hospital, Yaoundé, Cameroon
- Médecins Sans Frontières, Geneva, Switzerland
| | | | - Bernadette Lactuock
- Projet PARVY, Military Hospital, Yaoundé, Cameroon
- Médecins Sans Frontières, Geneva, Switzerland
| | | | - Florian Liégeois
- Institut de Recherche pour le Développement and Department of International Health, University of Montpellier (UMR 145), Montpellier, France
| | | | - Léopold Zekeng
- Laboratoire de Santé et d'Hygiène Mobile, Yaoundé, Cameroon
- National AIDS Program, Yaoundé, Cameroon
| | | | | | - Eric Delaporte
- Institut de Recherche pour le Développement and Department of International Health, University of Montpellier (UMR 145), Montpellier, France
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