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Carlucci JG, De Schacht C, Graves E, González P, Bravo M, Yu Z, Amorim G, Arinze F, Silva W, Tique JA, Alvim MFS, Simione B, Fernando AN, Wester CW. CD4 Trends With Evolving Treatment Initiation Policies Among Children Living With HIV in Zambézia Province, Mozambique, 2012-2018. J Acquir Immune Defic Syndr 2022; 89:288-296. [PMID: 34840319 PMCID: PMC8826612 DOI: 10.1097/qai.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test and Start" wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique. METHODS This retrospective evaluation was performed using routinely collected data. Children living with HIV (CL aged 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation "policy periods" corresponded to implementation of evolving guidelines: in period 1 (2012-2016), ART was recommended for CD4 <350 cells/mm3; during period 2 (2016-2017), the CD4 threshold increased to <500 cells/mm3; Test and Start was implemented in period 3 (2017-2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4 <200 cells/mm3) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency. RESULTS The cohort included 1815 children with CD4 data at enrollment and 1922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in period 1 vs. 16% in period 3 (P = 0.113) and 21% at ART initiation in period 1 vs. 15% in period 3 (P = 0.004). Children initiating ART in period 3 had lower odds of severe immunodeficiency at ART initiation compared with those in period 1 [adjusted odds ratio (aOR) = 0.67; 95% CI: 0.51 to 0.88]. Older age was associated with severe immunodeficiency at enrollment (aOR = 1.13; 95% CI: 1.06 to 1.20) and at ART initiation (aOR = 1.14; 95% CI: 1.08 to 1.21). CONCLUSIONS The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of children living with HIV is imperative.
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Affiliation(s)
- James G. Carlucci
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Infectious Diseases, Nashville, TN
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
| | | | - Erin Graves
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
| | | | | | - Zhihong Yu
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN;
| | - Gustavo Amorim
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN;
| | | | | | | | | | - Beatriz Simione
- Ministry of Health, National Directorate of Public Health, Maputo, Mozambique;
| | | | - C. William Wester
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
- Vanderbilt University Medical Center, Department of Medicine, Division of Infectious Diseases, Nashville, TN
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Minkove SJ, Geiger G, Llibre JM, Montgomery MW, West NE, Chida NM, Antar AAR, Dandachi D, Weld ED, Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM, Rahimian J, Zervou FN, Rebick G, Stachel A, Tang S, Ding D, Jones JL, Farley JE, Dooley KE, Wilgus BE, Sanchez M, Chow J, Kitchell E, Koh S, Maxwell D, Lau A, Brooks S, Chu J, Estrada J, Lazarte SM, Arinze F, Francis A, Paranjape N, Sax PE, Wanjalla CN, Kheshti AN, Bailin S, Koethe J, Kelly SG, Raffanti SP, Patel SM, Xu TH, Goebel M, Santiago ADD, Ray M, Slim J, Kratz AMP, Koren DE, Hiryak K, Hill B, Dare RK, Bordelon S, Bailey B, Baddley JW, Matthew Shoemaker D, Rodriguez-Nava G, Shweta FNU, Chu C, Pearson C, Treakle A, Furin JJ, Bogorodskaya M, Desai S, Osterholzer D, Arquiette J, Ford ES, Ching PR, Sun L, Buggy BP, Tirmizi A, Argentine S, Desai B, Swartz TH, Latimer D, Camazine M. Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series. AIDS Res Ther 2022; 19:6. [PMID: 35148782 PMCID: PMC8832430 DOI: 10.1186/s12981-022-00430-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. CASE PRESENTATION We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. CONCLUSIONS In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.
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Awoniyi A, Rohm Z, Paranjape N, Arinze F. Prolonged Detection of SARS-CoV-2 in a Patient With the Development of New Clinical Symptoms. Infect Dis Clin Pract (Baltim Md) 2021; 29:e105-e108. [PMID: 34191903 PMCID: PMC7968956 DOI: 10.1097/ipc.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of a 65-year-old woman with a persistently positive nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 PCR who developed new complications of coronavirus disease 2019 (COVID-19) 63 days from illness onset. She presented with intermittent fevers, fluctuating disorientation, gait instability, diffuse corticospinal tract signs, and acute venous thromboembolism. No alternate diagnosis was identified. This case highlights the potential for prolonged SARS-CoV-2 PCR positivity and persistent multisystem complications (particularly neurological), even after several months of initial COVID-19 diagnosis.
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Affiliation(s)
| | | | - Neha Paranjape
- Division of Infectious Diseases, Wellstar Health System, Marietta, GA
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Dandachi D, Geiger G, Montgomery MW, Karmen-Tuohy S, Golzy M, Antar AAR, Llibre JM, Camazine M, Díaz-De Santiago A, Carlucci PM, Zacharioudakis IM, Rahimian J, Wanjalla CN, Slim J, Arinze F, Kratz AMP, Jones JL, Patel SM, Kitchell E, Francis A, Ray M, Koren DE, Baddley JW, Hill B, Sax PE, Chow J. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Infect Dis 2020; 73:e1964-e1972. [PMID: 32905581 PMCID: PMC7499544 DOI: 10.1093/cid/ciaa1339] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. Methods Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. Results 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. Conclusion Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, MO
| | - Grant Geiger
- School of Medicine, University of Missouri-Columbia, MO
| | - Mary W Montgomery
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | | | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri-Columbia, MO
| | - Annukka A R Antar
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josep M Llibre
- Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain
| | | | - Alberto Díaz-De Santiago
- Internal Medicine Department, HIV Infection Unit. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Philip M Carlucci
- School of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Joseph Rahimian
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ
| | - Folasade Arinze
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | | | - Joyce L Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shital M Patel
- Section of Infectious Diseases, Medicine, Baylor College of Medicine, TX
| | - Ellen Kitchell
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
| | - Adero Francis
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Manoj Ray
- Division of Infectious Diseases, Santa Clara Valley Health & Hospital System, CA
| | - David E Koren
- Department of Pharmacy, Temple University Health System, PA
| | - John W Baddley
- Division of Infectious Disease, University of Maryland, Baltimore, MD
| | - Brannon Hill
- Department of Pharmacy, University of Arkansas for Medical Sciences, AR
| | - Paul E Sax
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Jeremy Chow
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
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Arinze F, Gong W, Green AF, De Schacht C, Carlucci JG, Silva W, Claquin G, Tique JA, Stefanutto M, Graves E, Van Rompaey S, Alvim MFS, Tomo S, Moon TD, Wester CW. Immunodeficiency at Antiretroviral Therapy Start: Five-Year Adult Data (2012-2017) Based on Evolving National Policies in Rural Mozambique. AIDS Res Hum Retroviruses 2020; 36:39-47. [PMID: 31359762 PMCID: PMC9836686 DOI: 10.1089/aid.2019.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Before the 2015 implementation of "Test and Start," the initiation of combination antiretroviral therapy (ART) was guided by specific CD4 cell count thresholds. As scale-up efforts progress, the prevalence of advanced HIV disease at ART initiation is expected to decline. We analyzed the temporal trends in the median CD4 cell counts among adults initiating ART and described factors associated with initiating ART with severe immunodeficiency in Zambézia Province, Mozambique. We included all HIV-positive, treatment-naive adults (age ≥ 15 years) who initiated ART at a Friends in Global Health (FGH)-supported health facility between September 2012 and September 2017. Quantile regression and multivariable logistic regression models were applied to ascertain the median change in CD4 cell count and odds of initiating ART with severe immunodeficiency, respectively. A total of 68,332 patients were included in the analyses. The median change in CD4 cell count under "Test and Start" was higher at +68 cells/mm3 (95% CI: 57.5-78.4) compared with older policies. Younger age and female sex (particularly those pregnant/lactating) were associated with higher median CD4 cell counts at ART initiation. Male sex, advanced age, WHO Stage 4 disease, and referrals to the health facility through inpatient provider-initiated testing and counseling (PITC) were associated with higher odds of initiating ART with severe immunodeficiency. Although there were reassuring trends in increasing median CD4 cell counts with ART initiation, ongoing efforts are needed that target universal HIV testing to ensure the early initiation of ART in men and older patients.
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Affiliation(s)
- Folasade Arinze
- Department of Internal Medicine, WellStar Health System, Marietta, Georgia.,Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee
| | - Ann F. Green
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee
| | | | - James G. Carlucci
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee.,Department of Pediatrics, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee
| | - Wilson Silva
- Friends in Global Health (FGH), Maputo, Mozambique.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee
| | - Gael Claquin
- Friends in Global Health (FGH), Maputo, Mozambique
| | | | | | - Erin Graves
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee
| | | | | | - Simão Tomo
- Direcção Provincial de Saúde Zambézia (DPS-Z), Quelimane, Mozambique
| | - Troy D. Moon
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee.,Department of Pediatrics, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee
| | - C. William Wester
- Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee.,Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee.,Address correspondence to: C. William Wester, MD, MPH, Vanderbilt Institute for Global Health (VIGH), 2525 West End Avenue, Suite 750, Nashville, TN 37203
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Arinze F, Shaver A, Raffanti S. Surgical excision for recurrent herpes simplex virus 2 (HSV-2) anogenital infection in a patient with human immunodeficiency virus (HIV). Infection 2017; 45:705-707. [PMID: 28508238 DOI: 10.1007/s15010-017-1027-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/11/2017] [Indexed: 11/28/2022]
Abstract
Recurrent anogenital herpes simplex virus infections are common in patients with human immunodeficiency virus (HIV), of whom approximately 5% develop resistance to acyclovir. We present a case of a 49-year-old man with HIV who had an 8-year history of recurrent left inguinal herpes simplex virus type 2 ulcerations. He initially responded to oral acyclovir, but developed resistance to acyclovir and eventually foscarnet. The lesion progressed to a large hypertrophic mass that required surgical excision, which led to resolution without recurrences. Our case highlights the importance of surgical excision as a treatment option in refractory herpes simplex virus anogenital infections.
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Affiliation(s)
- Folasade Arinze
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200 MCN 1161 21st Avenue South Nashville, Nashville, TN, 37232-2605, USA.
| | - Aaron Shaver
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen Raffanti
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200 MCN 1161 21st Avenue South Nashville, Nashville, TN, 37232-2605, USA
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Aliyu MH, Blevins M, Arinze F, Megazzini KM, Bussell S, Dunlap J, Odoh C, Gebi UI, Muhammad MY, Shepherd BE, Audet CM, Vermund SH, Wester CW. Enrolment trends in a comprehensive HIV programme in rural north-central Nigeria: improved care indices, but declining quality of clinical data over time. Pathog Glob Health 2016; 109:75-83. [PMID: 25822098 DOI: 10.1179/2047773215y.0000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Vanderbilt University affiliate Friends in Global Health was funded in 2008 to support comprehensive HIV/AIDS services in north-central Nigeria. We summarise programme characteristics and trends in enrolment and quality of data collection in this rural, resource-limited environment. METHODS We used routinely collected programme data in supported sites from June 1 2009 to September 30, 2013.Baseline characteristics were defined as those collected closest to a 90-day window period before and after enrolment. Summary characteristics were compared by site and enrolment year. RESULTS We enrolled 3,960 HIV-infected patients into care (68% women), median age of 32 years [interquartile range (IQR): 27-40]. Most clients were married (79%) and unemployed (60%). At enrolment, median CD4+ cell count was 230 cells/μL (IQR: 114-390) and haemoglobin was 10.7 g/dL (IQR: 9.3-11.9). Advanced clinical disease [World Health Organization (WHO) clinical stage III/IV] at enrolment was documented in 29% of clients. Cumulative enrolment increased from 377 patients in 2009 to 3,960 patients by 2013.With each successive year, more clients were enrolled at earlier stages of disease; in 2009, 37% of patients were identified as WHO clinical stage I, while in 2013, 55% of patients were so classified. While documentation of clinical staging remained stable, the completeness of CD4+ cell count and haemoglobin data declined with time. CONCLUSION Expanded testing in a comprehensive HIV programme in rural Nigeria brought persons to care at earlier stages of illness. Yet, as clinical services expanded, data collection quality declined. The paradox of successful scaling up HIV services but deteriorating quality of data underscores the importance of data management training and quality improvement efforts.
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Arinze F. [The doctrine of suffering in various religions]. Servir 1997; 45:327-31. [PMID: 9485895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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