The effect of tuberculosis on immune reconstitution among HIV patients on highly active antiretroviral therapy in Adigrat general hospital, eastern Tigrai, Ethiopia; 2019: a retrospective follow up study

Mechanisms of HIV-immunologic non-responses and research trends based on gut microbiota

With the increasing number of people with HIV (PWH) and the use of antiretroviral treatment (ART) for PWH, HIV has gradually become a chronic infectious disease. However, some infected individuals develop issues with immunologic non-responses (INRs) after receiving ART, which can lead to secondary infections and seriously affect the life expectancy and quality of life of PWH. Disruption of the gut microbiota is an important factor in immune activation and inflammation in HIV/AIDS, thus stabilizing the gut microbiota to reduce immune activation and inflammation and promoting immune reconstitution may become a direction for the treatment of HIV/AIDS. This paper, based on extensive literature review, summarizes the definition, mechanisms, and solutions for INRs, starting from the perspective of gut microbiota.

Optimizing HIV care: Insights from CD4 count, viral load, and demographic factors in a tertiary care centre of South Gujarat

PURPOSE

Despite advancements in prevention, diagnosis, and treatment, HIV/AIDS remains a critical health concern, particularly in India. This study contributes valuable insights into HIV management strategies. This prospective and retrospective longitudinal observational study aimed to analyze the trends in CD4 cell count and viral load suppression among adult People Living with HIV (PLHIV) undergoing antiretroviral therapy (ART) and evaluate the influence of demographic factors and ART adherence on these parameters at the ART Centre of New Civil Hospital, Surat, India.

MATERIALS & METHODS

Adult PLHIV registered and initiated on ART between June 2017 and May 2018 at ART-NCH, Surat with Continuous follow-up until 2023 were included in the study. Data was collected and Statistical analysis was performed using Microsoft Excel and SPSS software. Other factors were evaluated for their influence on treatment outcomes.

RESULTS

A longitudinally analyzed data from 365 adult PLHIV receiving ART with continuous follow-up until 2023 revealed significant trends, with CD4 counts increasing from 425 (1st month) to 612.67 (24th month), indicating improving immune function. Individuals on first-line ART regimens had significantly higher odds (OR: 3.5, 95 % CI: 1.1-11.3) of achieving CD4 counts ≥350 compared to those on second-line regimens. Adherence to treatment (OR: 1.98, 95 % CI: 1.1-3.4) also increased the odds of attaining CD4 counts ≥350. Viral load suppression was achieved in 353 out of 365 participants.

CONCLUSION

This study highlights the need for tailored interventions to optimize immune recovery and viral load suppression among PLHIV. Recommendations include targeted intervention to improve long-term health outcomes.

Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis

Background

Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia.

Methods

Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis.

Results

Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals.

Conclusions

The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.

Mortality predictors among patients with HIV-associated pulmonary tuberculosis in Northeast China: A retrospective cohort analysis

The coexistence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV) infection leads to high morbidity and mortality in these populations. Although antiretroviral therapy (ART) has decreased TB incidence in HIV-infected patients, this coexistence still prevails in China. Patients with HIV-PTB admitted to Beijing You An Hospital from 2014 to 2018 were retrospectively enrolled, and information on demographics, clinical characteristics, and laboratory findings were extracted from medical records. Predictors of death, including age (adjusted hazard ratio [AHR]: 1.03; 95% confidence interval [CI]: 1.00-1.05), tobacco use (AHR: 2.76; 95% CI: 1.54-4.94), history of tuberculosis (AHR: 3.53; 95% CI: 1.82-6.85), not being on ART (AHR: 2.94; 95% CI: 1.31-6.63), extrapulmonary tuberculosis (AHR: 2.391; 95% CI: 1.37-4.18), sputum smear positivity (AHR: 2.84; 95% CI: 1.61-4.99), CD4⁺ T cell count ≤ 50 cells/µl (AHR: 3.45; 95% CI: 1.95-6.10), and initiating ART ≥ 8 weeks after the initiation of antituberculous therapy (odds ratio: 3.30; 95% CI: 1.09-10.04). By contrast, there were no deaths among the six patients who began ART within 8 weeks after the initiation of antituberculous therapy. Age, tobacco use, not being on ART, extrapulmonary tuberculosis, sputum smear positivity, and CD4⁺ T cell count ≤50 cells/µl predict those patients at high risk of death among HIV-infected patients with PTB, and the time of initiating ART after the initiation of antituberculous therapy is also important for prognosis.

Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana

People with concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) have an increased risk of hepatotoxic reactions due to antiretroviral therapy (ART) and anti-TB therapy (ATT). Concomitant hepatitis B virus (HBV) in these patients may lead to poorer health outcomes. To assess liver enzyme levels and immune response in adults with HIV, HBV, and TB, data from 300 antiretroviral-naïve people living with HIV (PLWHIV) were analyzed. The prevalence of HIV/HBV (cHIV/HBV) and HIV/TB (cHIV/TB) was 28% (95% CI: 23.0-33.4) and 10% (95% CI: 6.8-14.0), respectively. HIV/HBV/TB (cHIV/HBV/TB) prevalence was 5.3% (95% CI: 3.1-8.5). There was a statistically significant difference between the groups of participants in HIV viral load (p = 0.004), hemoglobin levels (p = 0.025), and body mass index (p = 0.011). A larger proportion of cHIV/HBV/TB participants (37.5%) had an aspartate aminotransferase to platelet ratio index (APRI) score ≥0.5 (p = 0.013), a lower cutoff for significant liver fibrosis. Immunological non-responders (CD4+ T-cell count <20% gain and HIV viral load <400 copies/mL at 6 months) were observed in all groups except those with cHIV/TB. Our findings support the need to screen for infections that could cause excessive liver damage prior to ATT or ART initiation, such as HBV.

Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study

BACKGROUND

In Ethiopia, despite the integrated implementation of antiretroviral therapy since 2005, the human immunodeficiency virus remains a public health concern. Managing and detecting antiretroviral treatment response is important to monitor the effectiveness of the therapy for individuals who experience failed virological response. An increased viral load indicating drug resistance or rapid progression of viral replication needs early detection. Hence, we aimed to assess the prevalence and determinants of virological response among human immunodeficiency virus-infected patients on highly active antiretroviral therapy.

METHODS

A hospital-based cross-sectional study was conducted in Adigrat General Hospital from September to December, 2019, on a total of 422 participants. An interviewer-based questionnaire was used for data collection. About 4 mL of venous blood was collected for viral load determination. Patient records were reviewed for the previous results of CD4+ T cell counts. STATA 14 software was used to analyze the data. Descriptive data were presented using tables and figures. Bivariate and multivariate analyses were performed. A p-value < 0.05 was considered a statistically significant association.

RESULTS

The mean age of study participants was 39 years (SD ±12.2 years), of which 66.7% of them were females. The overall prevalence of virological failure was 12.47% (49/393). Moreover, the prevalence of virological failure was observed to be higher among tuberculosis co-infected individuals (26%) compared with the mono-infected HIV patients (6.3%). The odds of virological failure were higher among obese and undernourished individuals, tuberculosis co-infected, and individuals with the failure of immune reconstitution.

CONCLUSION

There was a high rate of virological failure among the study participants. Tuberculosis infection increased the rate of failure. There should be consistent assessment of viral load testing to determine the status of virological response for appropriate drug switching to clients. HIV patients with virological failure are recommended for switching of the antiretroviral therapy.