1
|
Kim S, Hesseling AC, Wu X, Hughes MD, Shah NS, Gaikwad S, Kumarasamy N, Mitchell E, Leon M, Gonzales P, Badal-Faesen S, Lourens M, Nerette S, Shenje J, de Koker P, Nedsuwan S, Mohapi L, Chakalisa UA, Mngqbisa R, Escada RODS, Ouma S, Heckman B, Naini L, Gupta A, Swindells S, Churchyard G. Factors associated with prevalent Mycobacterium tuberculosis infection and disease among adolescents and adults exposed to rifampin-resistant tuberculosis in the household. PLoS One 2023; 18:e0283290. [PMID: 36930628 PMCID: PMC10022776 DOI: 10.1371/journal.pone.0283290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Understanding factors associated with prevalent Mycobacterium tuberculosis infection and prevalent TB disease in household contacts of patients with drug-resistant tuberculosis (TB) may be useful for TB program staff conducting contact investigations. METHODS Using data from a cross-sectional study that enrolled index participants with rifampin-resistant pulmonary TB and their household contacts (HHCs), we evaluated HHCs age ≥15 years for factors associated with two outcomes: Mycobacterium tuberculosis infection and TB disease. Among HHCs who were not already diagnosed with current active TB disease by the TB program, Mycobacterium tuberculosis infection was determined by interferon-gamma release assay (IGRA). TB disease was adjudicated centrally. We fitted logistic regression models using generalized estimating equations. RESULTS Seven hundred twelve HHCs age ≥15 years enrolled from 279 households in eight high-TB burden countries were a median age of 34 years, 63% female, 22% current smokers and 8% previous smokers, 8% HIV-positive, and 11% previously treated for TB. Of 686 with determinate IGRA results, 471 tested IGRA positive (prevalence 68.8% (95% Confidence Interval: 64.6%, 72.8%)). Multivariable modeling showed IGRA positivity was more common in HHCs aged 25-49 years; reporting prior TB treatment; reporting incarceration, substance use, and/or a period of daily alcohol use in the past 12 months; sharing a sleeping room or more evenings spent with the index participant; living with smokers; or living in a home of materials typical of low socioeconomic status. Forty-six (6.5% (95% Confidence Interval: 4.6%, 9.0%)) HHCs age ≥15 years had prevalent TB disease. Multivariable modeling showed higher prevalence of TB disease among HHCs aged ≥50 years; reporting current or previous smoking; reporting a period of daily alcohol use in the past 12 months; and reporting prior TB treatment. CONCLUSION We identified overlapping and distinct characteristics associated with Mycobacterium tuberculosis infection and TB disease that may be useful for those conducting household TB investigations.
Collapse
Affiliation(s)
- Soyeon Kim
- Department of Biostatistics, Frontier Science Foundation, Brookline, Massachusetts, United States of America
| | - Anneke C. Hesseling
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Xingye Wu
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michael D. Hughes
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - N. Sarita Shah
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College CRS and Sassoon General Hospital, BJMC Clinical Research Site, Pune, Maharashtra, India
| | - Nishi Kumarasamy
- Chennai Antiviral Research and Treatment (CART), Infectious Disease Medical Center, Voluntary Health Services, Chennai, India
| | - Erika Mitchell
- Department of Medicine and University of Cape Town Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa
| | - Mey Leon
- Barranco CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Pedro Gonzales
- San Miguel CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Sharlaa Badal-Faesen
- University of the Witwatersrand CRS, University of the Witwatersrand, Johannesburg, South Africa
| | - Madeleine Lourens
- TASK Applied Science CRS, Brooklyn Chest Hospital, Bellville, South Africa
| | - Sandy Nerette
- Institute of Infectious Diseases and Reproductive Health, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Petra de Koker
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | | | - Lerato Mohapi
- Soweto CRS, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rosie Mngqbisa
- Durban Adult HIV CRS, Enhancing Care Foundation, Durban University of Technology, Durban, South Africa
| | | | - Samuel Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Barbara Heckman
- Frontier Science Foundation, Amherst, New York, United States of America
| | - Linda Naini
- Department of Clinical Research and Bioscience, Social & Scientific Systems, Silver Spring, Maryland, United States of America
| | - Amita Gupta
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Gavin Churchyard
- Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa, Vanderbilt University, Nashville, Tennessee, United States of America
| | | |
Collapse
|
2
|
Brazier E, Ajeh R, Maruri F, Musick B, Freeman A, Wester CW, Lee M, Shamu T, Crabtree Ramírez B, d'Almeida M, Wools‐Kaloustian K, Kumarasamy N, Althoff KN, Twizere C, Grinsztejn B, Tanser F, Messou E, Byakwaga H, Duda SN, Nash D. Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium. J Int AIDS Soc 2022; 25:e26036. [PMID: 36504431 PMCID: PMC9742047 DOI: 10.1002/jia2.26036] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. METHODS From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels. RESULTS Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. CONCLUSIONS While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.
Collapse
Affiliation(s)
- Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | - Rogers Ajeh
- Clinical Research Education Networking and ConsultancyYaoundéCameroon
| | - Fernanda Maruri
- Department of Medicine, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Beverly Musick
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Aimee Freeman
- Department of EpidemiologyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - C. William Wester
- Department of Medicine, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Tinei Shamu
- Newlands ClinicHarareZimbabwe
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Brenda Crabtree Ramírez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y NutriciónMexico CityMexico
| | | | - Kara Wools‐Kaloustian
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - N. Kumarasamy
- VHS Infectious Diseases Medical CentreVoluntary Health ServicesChennaiIndia
| | - Keri N. Althoff
- Department of EpidemiologyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Beatriz Grinsztejn
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN‐AIDS)Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Frank Tanser
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Eugène Messou
- ACONDA ‐ Centre de Prise en Charge, de Recherche et de Formation (CePReF)AbidjanCôte d'Ivoire
| | - Helen Byakwaga
- Mbarara University of Science and TechnologyMbararaUganda
| | - Stephany N. Duda
- Department of Biomedical InformaticsVanderbilt University Medical Center (VUMC)NashvilleTennesseeUSA
- Vanderbilt Institute for Clinical and Translational ResearchVanderbilt University Medical Center (VUMC)NashvilleTennesseeUSA
| | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| |
Collapse
|
3
|
Sudharshan S, Menia NK, Selvamuthu P, Tyagi M, Kumarasamy N, Biswas J. Ocular syphilis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy. Indian J Ophthalmol 2021; 68:1887-1893. [PMID: 32823409 PMCID: PMC7690555 DOI: 10.4103/ijo.ijo_1070_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/24/2022] Open
Abstract
Purpose: Re-emergent ocular syphilis in patients with Human immunodeficiency virus (HIV) co-infection has both diagnostic and management difficulties because of the overlapping risk factors. The clinical manifestations described in non-HIV may not be the same in patients with HIV coinfection. Immune recovery uveitis (IRU) may also alter the course of the disease causing recurrences. We studied the clinical features in correlation with CD4 counts, systemic immune status, sexual preferences and management outcomes in HIV/AIDS patients with ocular syphilis in the highly active antiretroviral treatment (HAART) era from a high endemic HIV population like India. Methods: Retrospective analysis of all patients with ocular syphilis and HIV/AIDS seen between 2016 and 2019 was done. Results: A total of 33 patients (56 eyes) with a CD4 count range of 42–612 cells/cu.mm were included. Ocular syphilis was found to be higher in individuals with high risk behavior such as men who have sex with men (MSMs) (45%). Panuveitis was the commonest manifestation (53.57%) and was even the presenting feature of HIV and syphilis in many patients. Significant vitritis, usually uncommon in HIV/AIDS immunocompromised patients was noted even with low CD4 counts in patients with ocular syphilis. Significant correlation was noted between ocular presentation and CD4 counts (P < 0.05). Conclusion: Ocular syphilis presents differently in patients with HIV/AIDS. Diffuse retinitis is seen commonly in low counts (<100 cells/cu.mm). Classical placoid chorioretinitis lesions usually described in non-HIV individuals is uncommon in HIV patients and is seen in higher CD4 counts ( >400 cells/cu.mm). Ocular manifestations can be an indicator of the immune status of the patient. Not all patients with ocular manifestations have associated features of systemic syphilis. Ocular manifestations can be the first presentation of HIV/AIDS. Although, there is good response to systemic penicillin and HAART, recurrences and immune recovery uveitis (IRU) can also occur.
Collapse
Affiliation(s)
- Sridharan Sudharshan
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Nitin K Menia
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Poongulali Selvamuthu
- VHS Infectious Diseases Medical Center, Chennai Antiviral Research and Treatment (CART) Clinical Research Site (CRS), VHS, Chennai, India
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - N Kumarasamy
- VHS Infectious Diseases Medical Center, Chennai Antiviral Research and Treatment (CART) Clinical Research Site (CRS), VHS, Chennai, India
| | - Jyotirmay Biswas
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| |
Collapse
|
4
|
Han WM, Jiamsakul A, Jantarapakde J, Yunihastuti E, Choi JY, Ditangco R, Chaiwarith R, Sun LP, Khusuwan S, Merati TP, Do CD, Azwa I, Lee MP, Van Nguyen K, Chan YJ, Kiertiburanakul S, Ng OT, Tanuma J, Pujari S, Zhang F, Gani YM, Sangle S, Ross J, Kumarasamy N. Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV. HIV Med 2020; 22:294-306. [PMID: 33200864 DOI: 10.1111/hiv.13017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). METHODS Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. RESULTS Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m2 ), while 26%, 10% and 2% were underweight (< 18.5 kg/m2 ), overweight (25-30 kg/m2) and obese (> 30 kg/m2 ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m2 ). PLHIV with BMIs of 25-30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed. CONCLUSIONS High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.
Collapse
Affiliation(s)
- W M Han
- The Kirby Institute, UNSW, Sydney, NSW, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - A Jiamsakul
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | - J Jantarapakde
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - E Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - R Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - L P Sun
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - S Khusuwan
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - T P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - I Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M-P Lee
- Queen Elizabeth Hospital, Hong Kong SAR, India
| | - K Van Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Y-J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - O T Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Y M Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | |
Collapse
|
5
|
Ross J, Jiamsakul A, Kumarasamy N, Azwa I, Merati TP, Do CD, Lee MP, Ly PS, Yunihastuti E, Nguyen KV, Ditangco R, Ng OT, Choi JY, Oka S, Sohn AH, Law M. Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific. HIV Med 2020; 22:201-211. [PMID: 33151020 DOI: 10.1111/hiv.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. METHODS Adults > 18 years of age on second-line ART for ≥ 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL > 1000 copies/mL with a second VL > 1000 copies/mL within 3-6 months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. RESULTS Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median [interquartile range (IQR)] age was 37 (32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/µL; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3 years. Among 101 patients (7%) with VF, CD4 count > 200 cells/µL at switch [odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 ≤ 50) and HIV exposure through male-male sex (OR = 0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR = 0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. CONCLUSIONS There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens.
Collapse
Affiliation(s)
- J Ross
- TREAT Asia/amfAR -The Foundation for AIDS Research, Bangkok, Thailand
| | - A Jiamsakul
- The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - I Azwa
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong SAR, Hong Kong
| | - P S Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - E Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - R Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - O T Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | - A H Sohn
- TREAT Asia/amfAR -The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| |
Collapse
|
6
|
Boettiger DC, Law MG, Ross J, Huy BV, Heng BSL, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong DD, Kumarasamy N, Kamarulzaman A, Ly PS, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee MP, Sangle S, Choi JY, Ku WW, Tanuma J, Ng OT, Sohn AH, Wester CW, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020; 6:11-18. [PMID: 32175086 PMCID: PMC7043905] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMICs). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia. METHODS Sixteen LMIC sites included in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific network were surveyed. RESULTS Sites were mostly (81%) based in urban public referral hospitals. Half had protocols to assess tobacco and alcohol use. Protocols for assessing physical inactivity and obesity were in place at 31% and 38% of sites, respectively. Most sites provided educational material on ASCVD risk factors (between 56% and 75% depending on risk factors). A total of 94% reported performing routine screening for hypertension, 100% for hyperlipidaemia and 88% for diabetes. Routine ASCVD risk assessment was reported by 94% of sites. Protocols for the management of hypertension, hyperlipidaemia, diabetes, high ASCVD risk and chronic ischaemic stroke were in place at 50%, 69%, 56%, 19% and 38% of sites, respectively. Blood pressure monitoring was free for patients at 69% of sites; however, most required patients to pay some or all the costs for other ASCVD-related procedures. Medications available in the clinic or within the same facility included angiotensin-converting enzyme inhibitors (81%), statins (94%) and sulphonylureas (94%). CONCLUSION The consistent availability of clinical screening, diagnostic testing and procedures and the availability of ASCVD medications in the Asian LMIC clinics surveyed are strengths that should be leveraged to improve the implementation of cardiovascular care protocols.
Collapse
Affiliation(s)
- DC Boettiger
- Kirby Institute,
UNSW Sydney,
Australia,Institute for Health Policy Studies,
University of California, San Francisco,
USA,Corresponding author: David C Boettiger
Institute for Health Policy Studies,
University of California, San Francisco,
3333 California Street,
94118,
USA
| | - MG Law
- Kirby Institute,
UNSW Sydney,
Australia
| | - J Ross
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - BV Huy
- National Hospital for Tropical Disease,
Hanoi,
Vietnam
| | - BSL Heng
- Hospital Sungai Buloh,
Kuala Lumpur,
Malaysia
| | - R Ditangco
- Research Institute for Tropical Medicine,
Manila,
Philippines
| | | | - A Avihingsanon
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - DD Cuong
- Bach Mai Hospital,
Hanoi,
Vietnam
| | - N Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services,
Chennai,
India
| | - A Kamarulzaman
- University Malaya Medical Centre,
Kuala Lumpur,
Malaysia
| | - PS Ly
- Social Health Clinic,
National Center for HIV/AIDS, Dermatology and STDs,
Phnom Penh,
Cambodia
| | - E Yunihastuti
- Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo General Hospital,
Jakarta,
Indonesia
| | | | - F Zhang
- Beijing Ditan Hospital,
Capital Medical University,
Beijing,
China
| | - S Khusuwan
- Chiangrai Prachanukhor Hospital,
Chiangrai,
Thailand
| | - R Chaiwarith
- Research Institute for Health Sciences,
Chiangmai,
Thailand
| | - MP Lee
- Queen Elizabeth Hospital,
Hong Kong
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospitals,
Pune,
India
| | - JY Choi
- Severance Hospital,
Seoul,
South Korea
| | - WW Ku
- Taipei Veterans General Hospital,
Taipei,
Taiwan
| | - J Tanuma
- National Center for Global Health and Medicine,
Tokyo,
Japan
| | - OT Ng
- Tan Tock Seng Hospital,
Singapore
| | - AH Sohn
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - CW Wester
- Vanderbilt University Medical Center,
Institute for Global Health,
Nashville,
USA
| | - D Nash
- Institute for Implementation Science in Population Health,
City University of New York,
New York,
USA,Department of Epidemiology and Biostatistics,
City University of New York,
New York,
USA
| | - C Mugglin
- Institute of Social and Preventative Medicine,
University of Bern,
Switzerland
| | - S Pujari
- Institute for Infectious Diseases,
Pune,
India
| |
Collapse
|
7
|
Boettiger D, Law M, Ross J, Huy B, Heng B, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong D, Kumarasamy N, Kamarulzaman A, Ly P, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee M, Sangle S, Choi J, Ku W, Tanuma J, Ng O, Sohn A, Wester C, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30005-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
8
|
Rupasinghe D, Kiertiburanakul S, Kamarulzaman A, Zhang F, Kumarasamy N, Chaiwarith R, Merati TP, Do CD, Khusuwan S, Avihingsanon A, Lee MP, Ly PS, Yunihastuti E, Nguyen KV, Ditangco R, Chan YJ, Pujari S, Ng OT, Choi JY, Sim B, Tanuma J, Sangle S, Ross J, Law M. Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific. HIV Med 2019; 21:397-402. [PMID: 31852025 DOI: 10.1111/hiv.12836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia-Pacific. METHODS PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow-up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow-up as a competing risk. RESULTS A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first-year mortality rate was 4.27 per 100 person-years (PY). Thirty-eight deaths (52%) were AIDS-related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)-related, 13 (18%) were non-AIDS-related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub-hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60-5.32] compared to BMI 18.5-24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62-23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51-100 cells/μL: SHR 0.28; 95% CI 0.14-0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05-0.26) was associated with reduced hazard for mortality compared to CD4 count ≤ 25 cells/μL. CONCLUSIONS Fifty-two per cent of early deaths were AIDS-related. Efforts to initiate ART at CD4 counts > 50 cell/μL are associated with improved short-term survival rates, even in those with late stages of HIV disease.
Collapse
Affiliation(s)
- D Rupasinghe
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - A Kamarulzaman
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - N Kumarasamy
- CART CRS, Voluntary Health Services, Chennai, India
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - S Khusuwan
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - A Avihingsanon
- HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong SAR, China
| | - P S Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - E Yunihastuti
- Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - R Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Y J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - O T Ng
- Tan Tock Seng Hospital, Singapore City, Singapore
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Blh Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - J Ross
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Opollo VS, Wu X, Hughes MD, Swindells S, Gupta A, Hesseling A, Churchyard G, Kim S, Lando R, Dawson R, Mave V, Mendoza A, Gonzales P, Kumarasamy N, von Groote-Bidlingmaier F, Conradie F, Shenje J, Fontain SN, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi L, Mngqibisa R, Garcia Ferreira AC, Okeyo E, Naini L, Jones L, Smith B, Shah NS. HIV testing uptake among the household contacts of multidrug-resistant tuberculosis index cases in eight countries. Int J Tuberc Lung Dis 2019; 22:1443-1449. [PMID: 30606316 DOI: 10.5588/ijtld.18.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The household contacts (HHCs) of multidrug-resistant tuberculosis (MDR-TB) index cases are at high risk of tuberculous infection and disease progression, particularly if infected with the human immunodeficiency virus (HIV). HIV testing is important for risk assessment and clinical management. METHODS This was a cross-sectional, multi-country study of adult MDR-TB index cases and HHCs. All adult and child HHCs were offered HIV testing if never tested or if HIV-negative >1 year previously when last tested. We measured HIV testing uptake and used logistic regression to evaluate predictors. RESULTS A total of 1007 HHCs of 284 index cases were enrolled in eight countries. HIV status was known at enrolment for 226 (22%) HHCs; 39 (4%) were HIV-positive. HIV testing was offered to 769 (98%) of the 781 remaining HHCs; 544 (71%) agreed to testing. Of 535 who were actually tested, 26 (5%) were HIV-infected. HIV testing uptake varied by site (median 86%, range 0-100%; P < 0.0001), and was lower in children aged <18 years than in adults (59% vs. 78%; adjusted for site P < 0.0001). CONCLUSIONS HIV testing of HHCs of MDR-TB index cases is feasible and high-yield, with 5% testing positive. Reasons for low test uptake among children and at specific sites-including sites with high HIV prevalence-require further study to ensure all persons at risk for HIV are aware of their status.
Collapse
Affiliation(s)
- V S Opollo
- Kenya Medical Research Institute, Kisumu, Kenya
| | - X Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - M D Hughes
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - S Swindells
- University of Nebraska Medical Center, Omaha, Nebraska
| | - A Gupta
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - A Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg
| | | | - S Kim
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, Frontier Science & Technology Research Foundation, Amherst, New York, USA
| | - R Lando
- Kenya Medical Research Institute, Kisumu, Kenya
| | - R Dawson
- University of Cape Town Lung Institute, Mowbray, South Africa
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | - A Mendoza
- Asociacion Civil Impacta Salud y Educacion, Barranco Clinical Research Site, Lima
| | - P Gonzales
- Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site (CRS), Lima, Peru
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment CRS, Chennai, India
| | | | - F Conradie
- University of the Witwatersrand, Helen Joseph Hospital, Johannesburg
| | - J Shenje
- South African Tuberculosis Vaccine Initiative, Cape Town, South Africa
| | - S N Fontain
- GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti
| | - A Garcia-Prats
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg
| | | | - S Nedsuwan
- Prevention and Treatment of HIV infection, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | | | - R Mngqibisa
- Durban International CRS, Durban, South Africa
| | | | - E Okeyo
- Kenya Medical Research Institute, Kisumu, Kenya
| | - L Naini
- Social & Scientific Systems, Inc, Silver Springs, Maryland
| | - L Jones
- Frontier Science & Technology Research Foundation, Amherst, New York, USA
| | - B Smith
- National Institutes of Health, Bethesda, Maryland
| | - N S Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Rose R, Redd AD, Lamers S, Porcella SF, Hudelson SE, Piwowar-Manning E, McCauley M, Gamble T, Wilson EA, Kumwenda J, Hosseinipour MC, Hakim JG, Kumarasamy N, Chariyalertsak S, Pilotto JH, Grinsztejn B, Mills LA, Makhema J, Santos BR, Chen YQ, Quinn TC, Cohen MS, Eshleman SH, Laeyendecker O. A11 Evaluation of phylogenetic inference methods to determine direction of HIV transmission. Virus Evol 2019. [PMCID: PMC6736083 DOI: 10.1093/ve/vez002.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It has been postulated that the direction of HIV transmission between two individuals can be determined by phylogenetic analysis of HIV sequences. This approach may be problematic, since HIV sequences from newly infected individuals are often more similar to index sequences from samples collected years before transmission, compared to those from samples collected at the time of transmission. We evaluated the accuracy of phylogenetic methods for determining the direction of HIV transmission by analyzing next-generation sequencing (NGS) data from index–partner pairs enrolled in the HIV Prevention Trials Network (HPTN) 052 trial. HIV-infected index and HIV-uninfected partner participants were enrolled as serodiscordant couples; samples were analyzed from couples with index-to-partner HIV transmission that was confirmed by genetic linkage studies. NGS for HIV gp41 (HXB2 coordinates: 7691–8374) was performed using plasma samples from thirty-nine index–partner pairs (seventy-eight samples collected within 3 months of partner seroconversion). Maximum likelihood trees were generated using the entire dataset using FastTree v.2. Topological patterns of HIV from each index–partner pair were analyzed. The analysis included 9,368 consensus sequences and 521,145 total sequence reads for the seventy-eight samples analyzed. In 10 per cent (four out of thirty-nine) of couples, the phylogeny was inconsistent with the known direction of transmission. In 26 per cent (ten out of thirty-nine) of couples, the phylogeny results could not discern directionality. In 64 per cent (twenty-five out of thirty-nine) of couples, the results correctly indicated index-to-partner transmission; in two of these twenty-five cases, only one index sequence was closest to the most recent common ancestor. Phylogenetic analysis of NGS data obtained from samples collected within 3 months of transmission correctly determined the direction of transmission in 64 per cent of the cases analyzed. In 36 per cent of the cases, the phylogenetic topology did not support the known direction of infection, and in one-third of these cases the observed topology was opposite to the known direction of transmission. This demonstrates that phylogenetic topology alone may not be sufficient to accurately determine the direction of HIV transmission.
Collapse
Affiliation(s)
- R Rose
- BioInfoExperts, LLC, Thibodaux, LA, USA
| | | | - S Lamers
- BioInfoExperts, LLC, Thibodaux, LA, USA
| | | | - S E Hudelson
- Department of Medicience, Johns Hopkins University, Baltimore, MD, USA
| | - E Piwowar-Manning
- Department of Medicience, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - E A Wilson
- Vaccine and Infectious Disease Science Division, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - J Kumwenda
- College of Medicine-Johns Hopkins Project, Blantyre, Malawi
| | - M C Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J G Hakim
- University of Zimbabwe, Harare, Zimbabwe
| | | | - S Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - J H Pilotto
- Hospital Geral de Nova Iguaçu and Laboratorio de AIDS e Imunologia Molecular, Rio de Janeiro, Brazil
| | - B Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-INI-Fiocruz, Rio de Janeiro, Brazil
| | - L A Mills
- CDC Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya
| | - J Makhema
- Botswana Harvard Aids Institute, Gabarone, Botswana
| | - B R Santos
- Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegro, Brazil
| | - Y Q Chen
- Vaccine and Infectious Disease Science Division, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | | | - M S Cohen
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S H Eshleman
- Department of Medicience, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
11
|
Bijker R, Kumarasamy N, Kiertiburanakul S, Pujari S, Sun LP, Ng OT, Lee MP, Choi JY, Nguyen KV, Chan YJ, Merati TP, Do CD, Ross J, Law M. Diabetes, mortality and glucose monitoring rates in the TREAT Asia HIV Observational Database Low Intensity Transfer (TAHOD-LITE) study. HIV Med 2019; 20:615-623. [PMID: 31338975 DOI: 10.1111/hiv.12779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Diabetes is a growing cause of morbidity and mortality in people living with HIV (PLHIV) receiving antiretroviral therapy (ART). We investigated the association between fasting plasma glucose (FPG) levels and mortality, and factors associated with FPG monitoring rates in Asia. METHODS Patients from the Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) HIV Observational Database Low Intensity Transfer (TAHOD-LITE) cohort were included in the present study if they had initiated ART. Competing risk and Poisson regression were used to analyse the association between FPG and mortality, and assess risk factors for FPG monitoring rates, respectively. FPG was categorized as diabetes (FPG ≥ 7.0 mmol/L), prediabetes (FPG 5.6-6.9 mmol/L) and normal FPG (FPG < 5.6 mmol/L). RESULTS In total, 33 232 patients were included in the analysis. Throughout follow-up, 59% had no FPG test available. The incidence rate for diabetes was 13.7 per 1000 person-years in the 4649 patients with normal FPG at ART initiation. Prediabetes [sub-hazard ratio (sHR) 1.32; 95% confidence interval (CI) 1.07-1.64] and diabetes (sHR 1.90; 95% CI 1.52-2.38) were associated with mortality compared to those with normal FPG. FPG monitoring increased from 0.34 to 0.78 tests per person-year from 2012 to 2016 (P < 0.001). Male sex [incidence rate ratio (IRR) 1.08; 95% CI 1.03-1.12], age > 50 years (IRR 1.14; 95% CI 1.09-1.19) compared to ≤ 40 years, and CD4 count ≥ 500 cells/μL (IRR 1.04; 95% CI 1.00-1.09) compared to < 200 cells/μL were associated with increased FPG monitoring. CONCLUSIONS Diabetes and prediabetes were associated with mortality. FPG monitoring increased over time; however, less than half of our cohort had been tested. Greater resources should be allocated to FPG monitoring for early diabetic treatment and intervention and to optimize survival.
Collapse
Affiliation(s)
- R Bijker
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), Voluntary Health Services-Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, India
| | - S Kiertiburanakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - L Penh Sun
- National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore City, Singapore
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Y J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
12
|
Jiamsakul A, Kiertiburanakul S, Ng OT, Chaiwarith R, Wong W, Ditangco R, Nguyen KV, Avihingsanon A, Pujari S, Do CD, Lee MP, Ly PS, Yunihastuti E, Kumarasamy N, Kamarulzaman A, Tanuma J, Zhang F, Choi JY, Kantipong P, Sim B, Ross J, Law M, Merati TP. Long-term loss to follow-up in the TREAT Asia HIV Observational Database (TAHOD). HIV Med 2019; 20:439-449. [PMID: 30980495 DOI: 10.1111/hiv.12734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES With earlier antiretroviral therapy (ART) initiation, time spent in HIV care is expected to increase. We aimed to investigate loss to follow-up (LTFU) in Asian patients who remained in care 5 years after ART initiation. METHODS Long-term LTFU was defined as LTFU occurring after 5 years on ART. LTFU was defined as (1) patients not seen in the previous 12 months; and (2) patients not seen in the previous 6 months. Factors associated with LTFU were analysed using competing risk regression. RESULTS Under the 12-month definition, the LTFU rate was 2.0 per 100 person-years (PY) [95% confidence interval (CI) 1.8-2.2 among 4889 patients included in the study. LTFU was associated with age > 50 years [sub-hazard ratio (SHR) 1.64; 95% CI 1.17-2.31] compared with 31-40 years, viral load ≥ 1000 copies/mL (SHR 1.86; 95% CI 1.16-2.97) compared with viral load < 1000 copies/mL, and hepatitis C coinfection (SHR 1.48; 95% CI 1.06-2.05). LTFU was less likely to occur in females, in individuals with higher CD4 counts, in those with self-reported adherence ≥ 95%, and in those living in high-income countries. The 6-month LTFU definition produced an incidence rate of 3.2 per 100 PY (95% CI 2.9-3.4 and had similar associations but with greater risks of LTFU for ART initiation in later years (2006-2009: SHR 2.38; 95% CI 1.93-2.94; and 2010-2011: SHR 4.26; 95% CI 3.17-5.73) compared with 2003-2005. CONCLUSIONS The long-term LTFU rate in our cohort was low, with older age being associated with LTFU. The increased risk of LTFU with later years of ART initiation in the 6-month analysis, but not the 12-month analysis, implies that there was a possible move towards longer HIV clinic scheduling in Asia.
Collapse
Affiliation(s)
- A Jiamsakul
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Ditangco
- Research Institute for Tropical Medicine, Manila, Philippines
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - A Avihingsanon
- HIV-NAT, The Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - M-P Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - P S Ly
- National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), The Voluntary Health Services (VHS), Chennai, India
| | - A Kamarulzaman
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Blh Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - T P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | | |
Collapse
|
13
|
Bijker R, Jiamsakul A, Uy E, Kumarasamy N, Ditango R, Chaiwarith R, Wong WW, Avihingsanon A, Sun LP, Yunihastuti E, Pujari S, Do CD, Merati TP, Kantipong P, Nguyen KV, Kamarulzaman A, Zhang F, Lee MP, Choi JY, Tanuma J, Ng OT, Sim B, Ross J, Kiertiburanakul S. Cardiovascular disease-related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD). HIV Med 2019; 20:183-191. [PMID: 30620108 DOI: 10.1111/hiv.12687] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES With aging of the HIV-positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD-related and other causes of death (CODs) and factors associated with CVD in a multi-country Asian HIV-positive cohort. METHODS Patient data from 2003-2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow-up. Cumulative incidences were plotted for CVD-related, AIDS-related, non-AIDS-related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. RESULTS Of 8069 patients with a median follow-up of 7.3 years [interquartile range (IQR) 4.4-10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person-years (PY)], and this total included 22 CVD-related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub-hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36-3.58 for age 41-50 years; sHR 5.52; 95% CI 3.43-8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04-2.52), high total cholesterol (sHR 1.89; 95% CI 1.27-2.82), high triglycerides (sHR 1.55; 95% CI 1.02-2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12-2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle- and upper middle-income countries. CONCLUSIONS The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle-income countries may indicate under-diagnosis of CVD in Asian-Pacific resource-limited settings.
Collapse
Affiliation(s)
- R Bijker
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E Uy
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - R Ditango
- Research Institute for Tropical Medicine, Manila, Philippines
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - A Avihingsanon
- HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - L P Sun
- National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/CiptoMangunkusumo Hospital, Jakarta, Indonesia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine, Sanglah Hospital, Udayana University, Bali, Indonesia
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Bejing, China
| | - M P Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Blh Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|
14
|
Vos AG, Chersich MF, Klipstein-Grobusch K, Zuithoff P, Moorhouse MA, Lalla-Edward ST, Kambugu A, Kumarasamy N, Grobbee DE, Barth RE, Venter WD. Lipid levels, insulin resistance and cardiovascular risk over 96 weeks of antiretroviral therapy: a randomised controlled trial comparing low-dose stavudine and tenofovir. Retrovirology 2018; 15:77. [PMID: 30547820 PMCID: PMC6295103 DOI: 10.1186/s12977-018-0460-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 08/06/2018] [Accepted: 12/07/2018] [Indexed: 01/17/2023] Open
Abstract
Background HIV infection and antiretroviral treatment are associated with changes in lipid levels, insulin resistance and risk of cardiovascular disease (CVD). We investigated these changes in the first 96 weeks of treatment with low-dose stavudine or tenofovir regimens. Methods This is a secondary analysis of a double blind, randomised controlled trial performed in South-Africa, Uganda and India comparing low-dose stavudine (20 mg twice daily) with tenofovir in combination with efavirenz and lamivudine in antiretroviral-naïve adults (n = 1067) (Clinicaltrials.gov, NCT02670772). Over 96 weeks, data were collected on fasting lipids, glucose and insulin. Insulin resistance was assessed with the HOMA-IR index and 10-year CVD risk with the Framingham risk score (FRS). A generalized linear mixed model was used to estimate trends over time. Results Participants were on average 35.3 years old, 57.6% female and 91.8% Black African. All lipid levels increased following treatment initiation, with the sharpest increase in the first 24 weeks of treatment. The increase in all lipid subcomponents over 96 weeks was higher among those in the stavudine than the tenofovir group. Insulin resistance increased steadily with no difference detected between study groups. FRS rose from 1.90% (1.84–1.98%) at baseline to 2.06 (1.98–2.15%) at week 96 for the total group, with no difference between treatment arms (p = 0.144). Lipid changes were more marked in Indian than African participants. Conclusion Lipid levels increased in both groups, with low-dose stavudine resulting in a worse lipid profile compared to tenofovir. Insulin resistance increased, with no difference between regimens. CVD risk increased over time and tended to increase more in the group on stavudine. The low CVD risk across both arms argues against routine lipid and glucose monitoring in the absence of other CVD risk factors. In high risk patients, monitoring may only be appropriate at least a year after treatment initiation. Electronic supplementary material The online version of this article (10.1186/s12977-018-0460-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alinda G Vos
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Zuithoff
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michelle A Moorhouse
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Samanta T Lalla-Edward
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - N Kumarasamy
- YRGCARE Medical Centre, CART Clinical Research Site, Voluntary Health Services, Chennai, India
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos E Barth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willem D Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
15
|
Swindells S, Gupta A, Kim S, Hughes MD, Sanchez J, Mave V, Dawson R, Kumarasamy N, Comins K, Smith B, Rustomjee R, Naini L, Shah NS, Hesseling A, Churchyard G. Resource utilization for multidrug-resistant tuberculosis household contact investigations (A5300/I2003). Int J Tuberc Lung Dis 2018; 22:1016-1022. [PMID: 30092866 DOI: 10.5588/ijtld.18.0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines recommend evaluation of the household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB); however, implementation of this policy is challenging. OBJECTIVE To describe the resource utilization and operational challenges encountered when identifying and characterizing adult MDR-TB index cases and their HHCs. DESIGN Cross-sectional study of adult MDR-TB index cases and HHCs at 16 clinical research sites in eight countries. Site-level resource utilization was assessed with surveys. RESULTS Between October 2015 and April 2016, 308 index cases and 1018 HHCs were enrolled. Of 280 index cases with sputum collected, 94 were smear-positive (34%, 95%CI 28-39), and of 201 with chest X-rays, 87 had cavitary disease (43%, 95%CI 37-50) after a mean duration of treatment of 8 weeks. Staff required 512 attempts to evaluate the 308 households, with a median time per attempt of 4 h; 77% (95%CI 73-80) of HHCs were at increased risk for TB: 13% were aged <5 years, 8% were infected with the human immunodeficiency virus, and 79% were positive on the tuberculin skin test/interferon-gamma release assay. One hundred and twenty-one previously undiagnosed TB cases were identified. Issues identified by site staff included the complexity of personnel and participant transportation, infection control, personnel safety and management of stigma. CONCLUSION HHC investigations can be high yield, but are labor-intensive.
Collapse
Affiliation(s)
- S Swindells
- University of Nebraska Medical Center, Omaha, Nebraska
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - S Kim
- Frontier Science Foundation, Brookline, Massachusetts
| | - M D Hughes
- Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - J Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College Clinical Research Site, Pune, India
| | - R Dawson
- University of Cape Town Lung Institute, Cape Town, South Africa
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment CRS, Chennai, India
| | - K Comins
- Task Applied Science CRS, Bellville, South Africa
| | - B Smith
- National Institutes of Health, Bethesda, MD, USA
| | - R Rustomjee
- National Institutes of Health, Bethesda, MD, USA
| | - L Naini
- Social & Scientific Systems, Inc, Silver Springs, Maryland
| | - N S Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg
| | - G Churchyard
- The Aurum Institute, Johannesburg, School of Public Health, University of Witwatersrand, Johannesburg, Advancing Care and Treatment for TB and HIV, South African Medical Research Council, Johannesburg, South Africa
| |
Collapse
|
16
|
Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
Collapse
|
17
|
Abstract
This paper is based on the last public lecture given by Dr Solomon at the 7th World Workshop on Oral Health & Disease in HIV/AIDS, held in Hyderabad, India, in November 2014. It examines the social impact of HIV in India and the founding of the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE) clinic in Chennai, India, by Dr Suniti Solomon and her colleagues. This is a story of prejudice and ignorance throughout the various social levels in India. Reports of India's first AIDS case surfaced in 1986, when female sex workers were found to be HIV positive. The first voluntary counseling and testing center, part of a sexually transmitted diseases (STD) clinic, was set up to increase awareness about the epidemic. To address the rapid spread of HIV infection in Tamil Nadu and the existing stigma in society and hospitals, Dr Solomon established YRG CARE in 1993. She recognized that fear and panic about HIV led to widespread social prejudice against HIV-positive patients, even within hospitals. By the end of 2014, over 34 000 patients had accessed these services and 20 000 HIV+ patients had been registered, nearly 40% of whom were females. The team embarked on a statewide awareness program on HIV and sexuality, covering over two hundred schools and colleges educating them about prevention strategies and combating the social stigma attached. The grass-root work of YRG CARE in the management of HIV infections revealed a widespread prejudice, due largely to the lack of awareness about the subject. It is estimated that even in 2015, as little as 40% of HIV-infected people are formally diagnosed and have access to care. In a country as socially and culturally diverse as India, there is much more to be carried out to build on the pioneering work of Dr Solomon.
Collapse
Affiliation(s)
- S Solomon
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - N Kumarasamy
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - S J Challacombe
- Centre for Global Health and Dental Institute, Kings College London, London, UK
| |
Collapse
|
18
|
Abstract
Four million people of the global total of 35 million with HIV infection are from South-East Asia. ART is currently utilized by 15 million people and has led to a dramatic decline in the mortality rate, including those in low- and middle-income countries. A reduction in sexually transmitted HIV and in comorbidities including tuberculosis has also followed. Current recommendations for the initiation of antiretroviral therapy in people who are HIV+ are essentially to initiate ART irrespective of CD4 cell count and clinical stage. The frequency of HIV testing should be culturally specific and based on the HIV incidence in different key populations but phasing in viral load technology in LMIC is an urgent priority and this needs resources and capacity. With the availability of simplified potent ART regimens, persons with HIV now live longer. The recent WHO treatment guidelines recommending routine HIV testing and earlier initiation of treatment should be the stepping stone for ending the AIDS epidemic and to meet the UNAIDS mission of 90*90*90.
Collapse
|
19
|
Jung IY, Boettiger D, Wong W, Lee MP, Kiertiburanakul S, Chaiwarith R, Avihingsanon A, Tanuma J, Kumarasamy N, Kamarulzaman A, Zhang F, Kantipong P, Ng OT, Sim BL, Law M, Ross J, Choi JY. The Safety of Substitution of Antiretroviral Regimen in Non-Clinical Trial Settings in Asian Countries. Open Forum Infect Dis 2017. [PMCID: PMC5631403 DOI: 10.1093/ofid/ofx163.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although substitutions of antiretroviral regimen are generally safe, most data on substitutions are based on results from clinical trials. The objective of this study was to evaluate the safety of substituting antiretroviral regimen in virologically suppressed HIV-infected patients in non-clinical trial settings in Asian countries.
Methods
HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD) were included in this analysis if they started combination antiretroviral therapy (cART) after 2002, were being treated at a center that documented a median rate of viral load (VL) monitoring ≥ 1 tests/patient/year, and experienced a minor or major treatment substitution while on virally suppressive cART (VL < 200 copies/mL). Minor regimen substitutions were defined as within-class changes and major regimen substitutions were defined as changes to a drug class. Virologic failure was defined as having had two viral load measurements > 400 copies/mL. The patterns of substitutions and rate of virologic failure after substitutions were analyzed.
Results
Of 3,994 adults who started ART after 2002, 3,119 (78.1%) had at least one period of virological suppression. Among these, 1,170 (37.5%) underwent a minor regimen substitution, and 296 (9.5%) underwent a major regimen substitution during suppression. The rates of virological failure were 1.48/100person years (95% CI 1.14–1.91) in the minor substitution group and 2.85/100person years (95% CI 1.88–4.33) in the major substitution group, and 2.53/100person years (95% CI 2.20–2.92) among patients that did not undergo a treatment substitution.
Conclusion
The rate of virological failure was relatively low in both major and minor substitution groups, showing that regimen substitution is generally safe in non-clinical trial settings in Asian countries.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- In Young Jung
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)
| | | | - Wingwai Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Romanee Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand, Thailand, Thailand
| | | | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan, Tokyo, Japan
| | - N Kumarasamy
- YRG Center for AIDS Research and Education, Chennai, India
| | - Adeeba Kamarulzaman
- University Malaya Medical Centre, Kuala Lumpur, Malaysia, Kuala Lumpur, Malaysia
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Pacharee Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, Chiang Rai, Thailand
| | - Oon Tek Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia, Sydney, Australia
| | - Jeremy Ross
- TREAT Asia, amfAR – The Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)
| |
Collapse
|
20
|
Do TC, Boettiger D, Law M, Pujari S, Zhang F, Chaiwarith R, Kiertiburanakul S, Lee MP, Ditangco R, Wong WW, Nguyen KV, Merati TP, Pham TT, Kamarulzaman A, Oka S, Yunihastuti E, Kumarasamy N, Kantipong P, Choi JY, Ng OT, Durier N, Ruxrungtham K. Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort. HIV Med 2017; 17:542-9. [PMID: 27430354 DOI: 10.1111/hiv.12358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. METHODS Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. RESULTS Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30-39 years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. CONCLUSIONS Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.
Collapse
Affiliation(s)
- T C Do
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - D Boettiger
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - M Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - R Ditangco
- Research Institute for Tropical Medicine, Manila, Philippines
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - T T Pham
- Bach Mai Hospital, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - S Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - E Yunihastuti
- Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - O T Ng
- Tan Tock Seng Hospital, Singapore
| | - N Durier
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - K Ruxrungtham
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
21
|
Celum C, Hong T, Cent A, Donnell D, Morrow R, Baeten JM, Firnhaber C, Grinsztejn B, Hosseinipour MC, Lalloo U, Nyirenda M, Riviere C, Sanchez J, Santos B, Supparatpinyo K, Hakim J, Kumarasamy N, Campbell TB. Herpes Simplex Virus Type 2 Acquisition Among HIV-1-Infected Adults Treated With Tenofovir Disoproxyl Fumarate as Part of Combination Antiretroviral Therapy: Results From the ACTG A5175 PEARLS Study. J Infect Dis 2017; 215:907-910. [PMID: 28453835 DOI: 10.1093/infdis/jix029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 10/28/2016] [Accepted: 01/10/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Tenofovir disoproxyl fumarate (TDF) disoproxyl fumarate (TDF) has in vitro activity against herpes simplex virus type 2 (HSV-2) and reduced HSV-2 acquisition as preexposure prophylaxis. Whether TDF-containing antiretroviral therapy (ART) reduces HSV-2 acquisition is unknown. Design Secondary analysis of AIDS Clinical Trials Group A5175, a randomized, open-label study of 3 ART regimens among 1571 participants. Methods HSV-2 serostatus was assessed at baseline, at study exit, and before a change in ART regimen. Results Of 365 HSV-2-seronegative persons, 68 acquired HSV-2, with 24 receiving TDF-containing ART and 44 receiving ART without TDF (HSV-2 seroconversion incidence, 6.42 and 6.63 cases/100 person-years, respectively; hazard ratio, 0.89; 95% confidence interval, .55-1.44). Conclusions HSV-2 acquisition was not reduced in HIV-infected, HSV-2-uninfected persons during TDF-containing ART.
Collapse
Affiliation(s)
- Connie Celum
- Department of Global Health, University of Washington , Seattle, Washington, USA.,Department of Medicine, University of Washington , Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ting Hong
- Department of Global Health, University of Washington , Seattle, Washington, USA
| | - Anne Cent
- Laboratory Medicine, University of Washington, USA
| | - Deborah Donnell
- Department of Global Health, University of Washington , Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rhoda Morrow
- Laboratory Medicine, University of Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington , Seattle, Washington, USA.,Department of Medicine, University of Washington , Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Umesh Lalloo
- Nelson R. Mandela School of Medicine, Durban, South Africa
| | | | - Cynthia Riviere
- Institut Nacional de laboratoire et de Recherches, Port-au-Prince, Haiti
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Breno Santos
- Servico de Infectology, Hospital Nossa Senhora da Conceicao -GHC, Porto Alegre, Brazil
| | - Khuanchai Supparatpinyo
- Department of Medicine, Research Institute for Health Sciences, Chiang Mai University, Thailand
| | - James Hakim
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - N Kumarasamy
- YRG Centre for AIDS Research and Education, Chennai, India
| | - Thomas B Campbell
- Department of Medicine, University of Colorado School of Medicine, Aurora, USA
| | | |
Collapse
|
22
|
Rezwan K, Khan HS, Azim T, Pendse R, Sarkar S, Kumarasamy N. A success story: identified gaps and the way forward for low HIV prevalence in Bangladesh. J Virus Erad 2016; 2:32-34. [PMID: 28275448 PMCID: PMC5337411] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bangladesh remains a low prevalence country for HIV infection. In this article we attempt to address the reasons for the present success in this country and the challenges lying ahead to minimise the spread of HIV in the future.
Collapse
Affiliation(s)
| | | | | | - Razia Pendse
- WHO – Regional Office for South East Asia,
New Delhi,
India
| | - Swarup Sarkar
- WHO – Regional Office for South East Asia,
New Delhi,
India
| | - N Kumarasamy
- YRGCARE Medical Centre, VHS,
Chennai,
India,Corresponding author: N Kumarasamy,
YRGCARE Medical Centre, VHS,
Rajiv Gandhi Salai Chennai-
600113,
India
| |
Collapse
|
23
|
Rezwan K, Khan HS, Azim T, Pendse R, Sarkar S, Kumarasamy N. A success story: identified gaps and the way forward for low HIV prevalence in Bangladesh. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
24
|
Jenks JD, Kumarasamy N, Ezhilarasi C, Poongulali S, Ambrose P, Yepthomi T, Devaraj C, Benson CA. Improved tuberculosis outcomes with daily vs. intermittent rifabutin in HIV-TB coinfected patients in India. Int J Tuberc Lung Dis 2016; 20:1181-4. [PMID: 27510243 DOI: 10.5588/ijtld.15.0997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Y R Gaitonde Centre for AIDS Research and Education, Chennai, India. OBJECTIVE To compare anti-tuberculosis treatment outcomes in individuals with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection on atazanavir/ritonavir (ATV/r) antiretroviral therapy (ART) plus daily rifabutin (RBT) 150 mg with those on ATV/r plus thrice-weekly RBT 150 mg. DESIGN A retrospective study was conducted of two HIV-TB co-infected cohorts between 2003 and 2014. Basic demographic and TB outcome data were obtained from an electronic database and patient records. The χ(2) and Fisher's exact test were used to compare daily and intermittent RBT treatment groups. RESULTS Of 292 individuals on an ATV/r-based ART regimen plus RBT, 118 (40.4%) received thrice-weekly RBT and 174 (59.6%) daily RBT. Patients in the two RBT treatment groups were similar in sex, age, previous history of TB, site of TB and acid-fast bacilli smear status. More individuals in the daily vs. the intermittent RBT group achieved clinical cure (73.0% vs. 44.1%, P < 0.001), with no significant differences in relapse/recurrence or all-cause mortality between groups. CONCLUSION There were higher rates of clinical TB cure in individuals on a boosted protease inhibitor-based ART regimen with daily RBT compared to intermittently dosed RBT. Optimal RBT dosing in this setting requires further investigation.
Collapse
Affiliation(s)
- J D Jenks
- Division of Infectious Diseases, University of California, San Diego, San Diego, California, USA
| | - N Kumarasamy
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - C Ezhilarasi
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - S Poongulali
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - P Ambrose
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - T Yepthomi
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - C Devaraj
- Y R Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - C A Benson
- Division of Infectious Diseases, University of California, San Diego, San Diego, California, USA
| |
Collapse
|
25
|
Shet A, Kumarasamy N, Poongulali S, Shastri S, Kumar DS, Rewari BB, Arumugam K, Antony J, De Costa A, D'Souza G. Longitudinal Analysis of Adherence to First-Line Antiretroviral Therapy: Evidence of Treatment Sustainability from an Indian HIV Cohort. Curr HIV Res 2016; 14:71-9. [PMID: 26303008 DOI: 10.2174/1570162x13666150825123750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/05/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Given the chronic nature of HIV infection and the need for life-long antiretroviral therapy (ART), maintaining long-term optimal adherence is an important strategy for maximizing treatment success. In order to understand better the dynamic nature of adherence behaviors in India where complex cultural and logistic features prevail, we assessed the patterns, trajectories and time-dependent predictors of adherence levels in relation to virological failure among individuals initiating first-line ART in India. METHODS Between July 2010 and August 2013, eligible ART-naïve HIV-infected individuals newly initiating first-line ART within the national program at three sites in southern India were enrolled and monitored for two years. ART included zidovudine/stavudine/tenofovir plus lamivudine plus nevirapine/efavirenz. Patients were assessed using clinical, laboratory and adherence parameters. Every three months, medication adherence was measured using pill count, and a structured questionnaire on adherence barriers was administered. Optimal adherence was defined as mean adherence ≥95%. Statistical analysis was performed using a bivariate and a multivariate model of all identified covariates. Adherence trends and determinants were modeled as rate ratios using generalized estimating equation analysis in a Poisson distribution. RESULTS A total of 599 eligible ART-naïve patients participated in the study, and contributed a total of 921 person-years of observation time. Women constituted 43% and mean CD4 count prior to initiating ART was 192 cells/mm3. Overall mean adherence among all patients was 95.4%. The proportion of patients optimally adherent was 75.6%. Predictors of optimal adherence included older age (≥40 years), high school-level education and beyond, lower drug toxicity-related ART interruption, full disclosure, sense of satisfaction with one's own health and patient's perception of having good access to health-care services. Adherence was inversely proportional to virological failure (IRR 0.55, 95%CI 0.44-0.69 p<0.001). Drug toxicity and stigma-related barriers were significantly associated with virological failure, while forgetfulness was not associated with virological failure. CONCLUSION Our study highlights the overall high level of medication adherence among individuals initiating ART within the Indian national program. Primary factors contributing towards poor adherence and subsequent virological failure in the proportion of individuals with poor adherence included drug toxicity, perceived stigma and poor access to health care services. Strategies that may contribute towards improved adherence include minimizing drug interruptions for medical reasons, use of newer ART regimens with better safety profiles and increasing access with more link ART centers that decentralize ART dispensing systems to individuals.
Collapse
Affiliation(s)
- Anita Shet
- Department of Pediatrics, Division of Infectious Diseases, St. Johns Research Institute, Sarjapur Road, Bangalore 560034, India.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kumarasamy N. The long-term impact of antiretroviral therapy in resource-limited settings. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
27
|
Boobalan J, Dinesha T, Balakrishnan P, Sivamalar S, Murugavel K, Poongulali S, Kumarasamy N, Solomon S, Solomon S, Saravanan S. Prevalence and risk factors associated with immunological non-response in HIV-1 infected patients treated with NNRTI based first line drugs in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Dinesha T, Sivamalar S, Gomathi S, Boobalan J, Poongulali S, Kumarasamy N, Balakrishnan P, Solomon S, Solomon S, katzenstein D, Kantor R, Saravanan S. Archived drug resistance profile among suppressed HIV patients using conventional and sensitive allele specific PCR in Tenofovir experienced patients in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
29
|
Hosseinipour MC, Bisson GP, Miyahara S, Sun X, Moses A, Riviere C, Kirui F, Badal-Faesen S, Lagat D, Nyirenda M, Naidoo K, Hakim J, Mugyenyi P, Henostroza G, Leger P, Lama J, Mohapi L, Alave J, Mave V, Veloso V, Pillay S, Kumarasamy N, Bao J, Hogg E, Jones L, Zolopa A, Kumwenda J, Gupta A. Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial. Lancet 2016; 387:1198-209. [PMID: 27025337 PMCID: PMC4931281 DOI: 10.1016/s0140-6736(16)00546-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality within the first 6 months after initiating antiretroviral therapy is common in resource-limited settings and is often due to tuberculosis in patients with advanced HIV disease. Isoniazid preventive therapy is recommended in HIV-positive adults, but subclinical tuberculosis can be difficult to diagnose. We aimed to assess whether empirical tuberculosis treatment would reduce early mortality compared with isoniazid preventive therapy in high-burden settings. METHODS We did a multicountry open-label randomised clinical trial comparing empirical tuberculosis therapy with isoniazid preventive therapy in HIV-positive outpatients initiating antiretroviral therapy with CD4 cell counts of less than 50 cells per μL. Participants were recruited from 18 outpatient research clinics in ten countries (Malawi, South Africa, Haiti, Kenya, Zambia, India, Brazil, Zimbabwe, Peru, and Uganda). Individuals were screened for tuberculosis using a symptom screen, locally available diagnostics, and the GeneXpert MTB/RIF assay when available before inclusion. Study candidates with confirmed or suspected tuberculosis were excluded. Inclusion criteria were liver function tests 2·5 times the upper limit of normal or less, a creatinine clearance of at least 30 mL/min, and a Karnofsky score of at least 30. Participants were randomly assigned (1:1) to either the empirical group (antiretroviral therapy and empirical tuberculosis therapy) or the isoniazid preventive therapy group (antiretroviral therapy and isoniazid preventive therapy). The primary endpoint was survival (death or unknown status) at 24 weeks after randomisation assessed in the intention-to-treat population. Kaplan-Meier estimates of the primary endpoint across groups were compared by the z-test. All participants were included in the safety analysis of antiretroviral therapy and tuberculosis treatment. This trial is registered with ClinicalTrials.gov, number NCT01380080. FINDINGS Between Oct 31, 2011, and June 9, 2014, we enrolled 850 participants. Of these, we randomly assigned 424 to receive empirical tuberculosis therapy and 426 to the isoniazid preventive therapy group. The median CD4 cell count at baseline was 18 cells per μL (IQR 9-32). At week 24, 22 (5%) participants from each group died or were of unknown status (95% CI 3·5-7·8) for empirical group and for isoniazid preventive therapy (95% CI 3·4-7·8); absolute risk difference of -0·06% (95% CI -3·05 to 2·94). Grade 3 or 4 signs or symptoms occurred in 50 (12%) participants in the empirical group and 46 (11%) participants in the isoniazid preventive therapy group. Grade 3 or 4 laboratory abnormalities occurred in 99 (23%) participants in the empirical group and 97 (23%) participants in the isoniazid preventive therapy group. INTERPRETATION Empirical tuberculosis therapy did not reduce mortality at 24 weeks compared with isoniazid preventive therapy in outpatient adults with advanced HIV disease initiating antiretroviral therapy. The low mortality rate of the trial supports implementation of systematic tuberculosis screening and isoniazid preventive therapy in outpatients with advanced HIV disease. FUNDING National Institutes of Allergy and Infectious Diseases through the AIDS Clinical Trials Group.
Collapse
Affiliation(s)
- Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi
- University of North Carolina School of Medicine, Chapel Hill, United States
| | - Gregory P. Bisson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | | | - Xin Sun
- Harvard University, Boston, United States
| | | | | | - F.K. Kirui
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Sharla Badal-Faesen
- Clinical HIV Research Unit, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - David Lagat
- Moi University School of Medicine, Eldoret, Kenya
| | | | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | | | | | | | | | - Javier.R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Lerato Mohapi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Jorge Alave
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - V Mave
- B.J. Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Valdilea.G Veloso
- Evandro Chagas National Institute of Infectious Diseases/Fiocruz, Rio de Janeiro, Brazil
| | - Sandy Pillay
- Durban International CRS, Durban University of Technology, Durban, South Africa
| | | | - Jing Bao
- HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, Bethesda, United States
| | - Evelyn Hogg
- Social & Scientific Systems, Silver Spring, United States
| | | | | | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, United States
| | | |
Collapse
|
30
|
Kumarasamy N, Ranganathan K, Tappuni AR, Challacombe SJ. Suniti Solomon, Founder-Director Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE). Oral Dis 2016; 22 Suppl 1:8-9. [PMID: 26881420 DOI: 10.1111/odi.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Shet A, Bhavani PK, Kumarasamy N, Arumugam K, Poongulali S, Elumalai S, Swaminathan S. Anemia, diet and therapeutic iron among children living with HIV: a prospective cohort study. BMC Pediatr 2015; 15:164. [PMID: 26482352 PMCID: PMC4612411 DOI: 10.1186/s12887-015-0484-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children living with HIV have higher-than-normal prevalence of anemia. The beneficial effect of therapeutic iron has been questioned in the setting of high prevalence of infections. This study examines anemia prevalence and effect of standard therapeutic iron on HIV disease progression among children. METHODS Perinatally-infected children aged 2-12 years were enrolled at three sites in southern India, and were followed for 1 year with clinical assessments, dietary recall and anthropometry. Laboratory parameters included iron markers (ferritin, soluble transferrin receptor) and other micronutrient levels (vitamin A, B12, folate). Iron was given to anemic children based on WHO guidelines. Statistical analyses including frequency distributions, chi square tests and multivariate logistic regression were performed using Stata v13.0. RESULTS Among 240 children enrolled (mean age 7.7 years, 54.6% males), median CD4 was 25%, 19.2% had advanced disease, 45.5% had malnutrition, and 43.3% were on antiretroviral treatment (ART) at baseline. Anemia was prevalent in 47.1% (113/240) children. Iron deficiency was present in 65.5%; vitamin A and vitamin B12 deficiency in 26.6% and 8.0% respectively; and anemia of inflammation in 58.4%. Independent risk factors for anemia were stunting, CD4 < 25%, detectable viral load ≥ 400 copies/ml and vitamin A deficiency. Inadequate dietary iron was prominent; 77.9% obtained less than two-thirds of recommended daily iron. Among clinically anemic children who took iron, overall adherence to iron therapy was good, and only minor self-limiting adverse events were reported. Median hemoglobin rose from 10.4 g/dl to 10.9 mg/dl among those who took iron for 3 months, and peaked at 11.3 mg/dl with iron taken for up to 6 months. Iron was also associated with a greater fall in clinical severity of HIV stage; however when adjusted for use of ART, was not associated with improvement in growth, inflammatory and CD4 parameters. CONCLUSIONS Children living with HIV in India have a high prevalence of anemia mediated by iron deficiency, vitamin A deficiency and chronic inflammation. The use of therapeutic iron for durations up to 6 months appears to be safe in this setting, and is associated with beneficial effects on anemia, iron deficiency and HIV disease progression.
Collapse
Affiliation(s)
- Anita Shet
- Department of Pediatrics, St. John's Medical College Hospital, Sarjapur Road, Bangalore, 560034, India. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - P K Bhavani
- Department of Clinical Research, National Institute for Research in Tuberculosis, 1 Sathiyamoorthy Road, Chetput, Chennai, India.
| | - N Kumarasamy
- YRG Center for AIDS Research and Education, Voluntary Health Services Taramani, Chennai, India.
| | - Karthika Arumugam
- Department of Pediatrics, St. John's Medical College Hospital, Sarjapur Road, Bangalore, 560034, India.
| | - S Poongulali
- YRG Center for AIDS Research and Education, Voluntary Health Services Taramani, Chennai, India.
| | - Suresh Elumalai
- Antiretroviral Treatment Center, Institute of Child Health, Egmore, Chennai, India.
| | | |
Collapse
|
32
|
Shet A, Neogi U, Kumarasamy N, DeCosta A, Shastri S, Rewari BB. Virological efficacy with first-line antiretroviral treatment in India: predictors of viral failure and evidence of viral resuppression. Trop Med Int Health 2015; 20:1462-1472. [PMID: 26146863 DOI: 10.1111/tmi.12563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 01/12/2023]
Abstract
OBJECTIVE Combination antiretroviral therapy (ART) has improved in efficacy, durability and tolerability. Virological efficacy studies in India are limited. We determined incidence and predictors of virological failure among patients initiating first-line ART and described virological resuppression after confirmed failure, with the goal of informing national policy. METHODS Therapy-naïve patients initiated on first-line ART as per national guidelines were monitored every 3 months for adherence and virological response over 2 years. Genotyping on baseline samples was performed to assess primary drug resistance. Multivariate Cox regression analysis was used to assess predictors of virological failure. RESULTS Virological failure rate among 599 eligible patients was 10.7 failures per 100 person-years. Cumulative failure incidence was 13.2% in the first year and 16.5% over 2 years. Patients initiated on tenofovir had a significantly lower rate of virological failure than those on stavudine or zidovudine (6.7 vs. 11.9 failures per 100 person-years, P = 0.013). Virological failure was independently associated with age <40 years, mean adherence <95%, non-tenofovir-containing regimens and presence of primary drug resistance. In a subset of 311 patients who were reassessed after treatment failure, 19% (11/58) patients resuppressed their viral load to <400 copies/ml after confirmed virological failure. CONCLUSIONS Our results support the inclusion of tenofovir as first-line ART in resource-limited settings and a role for regular adherence counselling and virological monitoring for enhanced treatment success. Detection of early virological failure should provide an opportunity to augment adherence counselling and repeat viral load testing before therapy switch is considered.
Collapse
Affiliation(s)
- Anita Shet
- Department of Pediatrics, St. John's Medical College Hospital, Bangalore, India.,Division of Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - N Kumarasamy
- YRG Center for AIDS Research and Education, Chennai, India
| | - Ayesha DeCosta
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Suresh Shastri
- National AIDS Control Organization, Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Bharat Bhushan Rewari
- National AIDS Control Organization, Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| |
Collapse
|
33
|
Talaat KR, Babu S, Menon P, Kumarasamy N, Sharma J, Arumugam J, Dhakshinamurthy K, Srinivasan R, Poongulali S, Gu W, Fay MP, Swaminathan S, Nutman TB. Treatment of W. bancrofti (Wb) in HIV/Wb coinfections in South India. PLoS Negl Trop Dis 2015; 9:e0003622. [PMID: 25793933 PMCID: PMC4368731 DOI: 10.1371/journal.pntd.0003622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background The disease course of human immunodeficiency virus (HIV) is often altered by existing or newly acquired coincident infections. Methodology/Principal Findings To assess the influence of pre-existing Wuchereria bancrofti infection on HIV progression, we performed a case-controlled treatment study of HIV positive individuals with (FIL+) or without (FIL-) W. bancrofti infection. Twenty-eight HIV+/FIL+ and 51 matched HIV+/FIL- subjects were treated with a single dose of diethylcarbamazine and albendazole (DEC/Alb) and followed for a year at regular intervals. Sixteen of the HIV+/FIL+ subjects (54%) and 28 of the HIV+/FIL- controls (57%) were on antiretroviral therapy (ART) during the study. Following treatment, no differences were noted in clinical outcomes between the 2 groups. There also was no significant difference between the groups in the HIV viral load at 12 months as a percentage of baseline viral load (HIV+/FIL+ group had on average 0.97 times the response of the HIV+/FIL- group, 95% CI 0.88, 1.07) between the groups. Furthermore, there were no significant differences found in either the change in viral load at 1, 3, or 6 months or in the change in CD4 count at 3, 6, or 12 months between the 2 groups. Conclusions/Significance We were unable to find a significant effect of W. bancrofti infection or its treatment on HIV clinical course or surrogate markers of HIV disease progression though we recognized that our study was limited by the smaller than predicted sample size and by the use of ART in half of the patients. Treatment of W. bancrofti coinfection in HIV positive subjects (as is usual in mass drug administration campaigns) did not represent an increased risk to the subjects, and should therefore be considered for PLWHA living in W. bancrofti endemic areas. Trial Registration ClinicalTrials.gov NCT00344279 In people living with HIV infection, simultaneous infections can adversely affect HIV disease. This has been seen with bacterial (tuberculosis), viral (cytomegalovirus), and parasitic infections (toxoplasmosis). Lymphatic filariasis is caused by a thin thread-like parasite that lives in the lymph vessels of infected people. It can cause significant disability. This infection is found in much of the same areas that high levels of HIV infection. We were interested in knowing if lymphatic filariasis changed the course of HIV infection in people with both diseases. In this study, the authors enrolled people in India who were living with HIV who either had or didn’t have filarial infection. All patients were treated for filariasis with 2 drugs, and then were followed for 1 year to see how their HIV disease progressed. No difference in HIV disease progression was found between the groups that did or did not have filariasis before treatment. The patients with HIV did well with the medicine for filariasis.
Collapse
Affiliation(s)
- Kawsar R. Talaat
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Subash Babu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Pradeep Menon
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, India
| | | | | | | | - Kalaivani Dhakshinamurthy
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, India
| | - Ramalingam Srinivasan
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, India
| | | | - Wenjuan Gu
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Michael P. Fay
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, India
| | - Thomas B. Nutman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
34
|
Touzard Romo F, Smeaton LM, Campbell TB, Riviere C, Mngqibisa R, Nyirenda M, Supparatpinyo K, Kumarasamy N, Hakim JG, Flanigan TP. Renal and metabolic toxicities following initiation of HIV-1 treatment regimen in a diverse, multinational setting: a focused safety analysis of ACTG PEARLS (A5175). HIV Clin Trials 2015; 15:246-60. [PMID: 25433664 DOI: 10.1310/hct1506-246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Convenient dosing, potency, and low toxicity support use of tenofovir disoproxil fumarate (TDF) as preferred nucleotide reverse transcriptase inhibitor (NRTI) for HIV-1 treatment. However, renal and metabolic safety of TDF compared to other NRTIs has not been well described in resource-limited settings. METHODS This was a secondary analysis examining the occurrence of renal abnormalities (RAs) and renal and metabolic serious non-AIDS-defining events (SNADEs) through study follow-up between participants randomized to zidovudine (ZDV)/lamivudine/ efavirenz and TDF/emtricitabine/efavirenz treatment arms within A5175/PEARLS trial. Exact logistic regression explored associations between baseline covariates and RAs. Response profile longitudinal analysis compared creatinine clearance (CrCl) over time between NRTI groups. RESULTS Twenty-one of 1,045 participants developed RAs through 192 weeks follow-up; there were 15 out of 21 in the TDF arm (P = .08). Age 41 years or older (odds ratio [OR], 3.35; 95% CI, 1.1-13.1), his- tory of diabetes (OR, 10.7; 95% CI, 2.1-55), and lower baseline CrCl (OR, 3.1 per 25 mL/min decline; 95% CI, 1.7-5.8) were associated with development of RAs. Renal SNADEs occurred in 42 participants; 33 were urinary tract infections and 4 were renal failure/insufficiency; one event was attributed to TDF. Significantly lower CrCl values were maintained among patients receiving TDF compared to ZDV (repeated measures analysis, P = .05), however worsening CrCl from baseline was not observed with TDF exposure over time. Metabolic SNADEs were rare, but were higher in the ZDV arm (20 vs 3; P < .001). CONCLUSIONS TDF is associated with lower serious metabolic toxicities but not higher risk of RAs, serious renal events, or worsening CrCl over time compared to ZDV in this randomized multinational study.
Collapse
Affiliation(s)
- F Touzard Romo
- The Miriam Hospital, Providence, Rhode Island, USA Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - L M Smeaton
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - T B Campbell
- University of Colorado Denver, Aurora, Colorado, USA
| | - C Riviere
- Institut Nacional de Laboratoire et Recherches, Port-au-Prince, Haiti
| | - R Mngqibisa
- University of KwaZulu-Natal, Durban, South Africa
| | - M Nyirenda
- College of Medicine - Johns Hopkins Research Project, Blantyre, Malawi
| | | | - N Kumarasamy
- YRG Centre for AIDS Research and Education, Chennai, India
| | - J G Hakim
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - T P Flanigan
- The Miriam Hospital, Providence, Rhode Island, USA Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
35
|
Ford N, Meintjes G, Pozniak A, Bygrave H, Hill A, Peter T, Davies MA, Grinsztejn B, Calmy A, Kumarasamy N, Phanuphak P, deBeaudrap P, Vitoria M, Doherty M, Stevens W, Siberry GK. The future role of CD4 cell count for monitoring antiretroviral therapy. Lancet Infect Dis 2014; 15:241-7. [PMID: 25467647 DOI: 10.1016/s1473-3099(14)70896-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and efforts are underway to scale up access in resource-limited settings. Recent studies suggest that in situations where viral load is available and patients are virologically suppressed, long-term CD4 monitoring adds little value and stopping CD4 monitoring will have major cost savings. CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted. However, in settings where both CD4 cell counts and viral load testing are routinely available, countries should consider reducing the frequency of CD4 cell counts or not doing routine CD4 monitoring for patients who are stable on ART.
Collapse
Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
| | - Graeme Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Helen Bygrave
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, UK
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, MA, USA
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland
| | - N Kumarasamy
- YRG Centre for AIDS Research and Education, Chennai, India
| | | | - Pierre deBeaudrap
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand and National health Laboratory Services, Johannesburg, South Africa
| | - George K Siberry
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, Rockville, USA
| |
Collapse
|
36
|
Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978. [PMID: 25742320 PMCID: PMC4459037 DOI: 10.1136/bmj.g5978] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess whether customised mobile phone reminders would improve adherence to therapy and thus decrease virological failure among HIV infected patients starting antiretroviral treatment (ART). DESIGN Randomised controlled trial among HIV infected patients initiating antiretroviral treatment. SETTING Three diverse healthcare delivery settings in south India: two ambulatory clinics within the Indian national programme and one private HIV healthcare clinic. PARTICIPANTS 631 HIV infected, ART naïve, adult patients eligible to initiate first line ART were randomly assigned to mobile phone intervention (n=315) or standard care (n=316) and followed for 96 weeks.. INTERVENTION The intervention consisted of customised, interactive, automated voice reminders, and a pictorial message that were sent weekly to the patients' mobile phones for the duration of the study. MAIN OUTCOME MEASURES The primary outcome was time to virological failure (viral load >400 copies/mL on two consecutive measurements). Secondary outcomes included ART adherence measured by pill count, death rate, and attrition rate. Suboptimal adherence was defined as mean adherence <95%. RESULTS Using an intention-to-treat approach we found no observed difference in time to virological failure between the allocation groups: failures in the intervention and standard care arms were 49/315 (15.6%) and 49/316 (15.5%) respectively (unadjusted hazard ratio 0.98, 95% confidence interval 0.67 to 1.47, P=0.95). The rate of virological failure in the intervention and standard care groups were 10.52 and 10.73 per 100 person years respectively. Comparison of suboptimal adherence was similar between both groups (unadjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.65, P=0.14). Incidence proportion of patients with suboptimal adherence was 81/300 (27.0%) in the intervention arm and 65/299 (21.7%) in the standard care arm. The results of analyses adjusted for potential confounders were similar, indicating no significant difference between the allocation groups. Other secondary outcomes such as death and attrition rates, and subgroup analysis also showed comparable results across allocation groups. CONCLUSIONS In this multicentre randomised controlled trial among ART naïve patients initiating first line ART within the Indian national programme, we found no significant effect of the mobile phone intervention on either time to virological failure or ART adherence at the end of two years of therapy.Trial registration Current Controlled Trials ISRCTN79261738.
Collapse
Affiliation(s)
- Anita Shet
- Department of Pediatrics, St John's Medical College Hospital, Bangalore 560034, India Department of Public Health Sciences, Karolinska Institute, Stockholm 17177, Sweden
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institute, Stockholm 17177, Sweden
| | - N Kumarasamy
- YRG Centre for AIDS Research and Education, Chennai 600113, India
| | - Rashmi Rodrigues
- Department of Public Health Sciences, Karolinska Institute, Stockholm 17177, Sweden Department of Community Medicine, St John's Medical College Hospital, Bangalore 560034, India
| | - Bharat Bhusan Rewari
- National AIDS Control Organization, Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi 110001, India
| | - Per Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | - Bo Eriksson
- Department of Public Health Sciences, Karolinska Institute, Stockholm 17177, Sweden
| | - Vinod Diwan
- Department of Public Health Sciences, Karolinska Institute, Stockholm 17177, Sweden
| |
Collapse
|
37
|
Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
Collapse
Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | | | | | | |
Collapse
|
38
|
Speicher DJ, Saravanan S, Kumarasamy N, Rangananthan K, Johnson NW. Comparison of plasma and salivary HIV loads determined via a coupling of the Abbott HIV detection system with the DNA Genotek OMNIgene™ DISCOVER (OM-505) kits. BMC Infect Dis 2014. [PMCID: PMC4080355 DOI: 10.1186/1471-2334-14-s3-p80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
39
|
Han SH, Zhou J, Lee MP, Zhao H, Chen YMA, Kumarasamy N, Pujari S, Lee C, Omar SFS, Ditangco R, Phanuphak N, Kiertiburanakul S, Chaiwarith R, Merati TP, Yunihastuti E, Tanuma J, Saphonn V, Sohn AH, Choi JY. Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients: results from the TREAT Asia HIV Observational Database. HIV Med 2013; 15:77-85. [PMID: 23980589 DOI: 10.1111/hiv.12073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. METHODS Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment ('early ART'), ART initiated > 90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. RESULTS A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. CONCLUSIONS A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.
Collapse
Affiliation(s)
- S H Han
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Solomon S, Balakrishnan P, Vignesh R, Waldrop G, Solomon SS, Murugavel KG, Kumarasamy N, Yepthomi T, Poongulali S, Swathirajan CR, Sreenivasan V, Chandrasekar C, Suriakumar J, Mahilmaran A, Manoharan G, Moore DAJ. A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India. Indian J Med Microbiol 2013; 31:130-7. [PMID: 23867668 DOI: 10.4103/0255-0857.115225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The converging epidemics of HIV and tuberculosis (TB) pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. OBJECTIVE The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS) assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB) directly from sputum specimens, in the Indian setting. MATERIALS AND METHODS This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. RESULTS Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P<0.001). CONCLUSION Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.
Collapse
Affiliation(s)
- S Solomon
- Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Fiscus SA, Cu-Uvin S, Eshete AT, Hughes MD, Bao Y, Hosseinipour M, Grinsztejn B, Badal-Faesen S, Dragavon J, Coombs RW, Braun K, Moran L, Hakim J, Flanigan T, Kumarasamy N, Campbell TB. Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy. Clin Infect Dis 2013; 57:290-7. [PMID: 23532477 PMCID: PMC3689341 DOI: 10.1093/cid/cit195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/17/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) reduces genital tract human immunodeficiency virus type 1 (HIV-1) load and reduces the risk of sexual transmission, but little is known about the efficacy of cART for decreasing genital tract viral load (GTVL) and differences in sex or HIV-1 subtype. METHODS HIV-1 RNA from blood plasma, seminal plasma, or cervical wicks was quantified at baseline and at weeks 48 and 96 after entry in a randomized clinical trial of 3 cART regimens. RESULTS One hundred fifty-eight men and 170 women from 7 countries were studied (men: 55% subtype B and 45% subtype C; women: 24% subtype B and 76% subtype C). Despite similar baseline CD4(+) cell counts and blood plasma viral loads, women with subtype C had the highest GTVL (median, 5.1 log10 copies/mL) compared to women with subtype B and men with subtype C or B (4.0, 4.0, and 3.8 log10 copies/mL, respectively; P < .001). The proportion of participants with a GTVL below the lower limit of quantification (LLQ) at week 48 (90%) and week 96 (90%) was increased compared to baseline (16%; P < .001 at both times). Women were significantly less likely to have GTVL below the LLQ compared to men (84% vs 94% at week 48, P = .006; 84% vs 97% at week 96, P = .002), despite a more sensitive assay for seminal plasma than for cervical wicks. No difference in GTVL response across the 3 cART regimens was detected. CONCLUSIONS The female genital tract may serve as a reservoir of persistent HIV-1 replication during cART and affect the use of cART to prevent sexual and perinatal transmission of HIV-1.
Collapse
Affiliation(s)
- Susan A Fiscus
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 709 Mary Ellen Jones Bldg, CB7209, Chapel Hill, NC 27599-7209, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Pavithra S, Ranganathan K, Rao UK, Joshua E, Rooban T, Kumarasamy N. Impact of highly active antiretroviral therapy on salivary flow in patients with human-immuno deficiency virus disease in Southern India. J Oral Maxillofac Pathol 2013; 17:17-22. [PMID: 23798824 PMCID: PMC3687181 DOI: 10.4103/0973-029x.110695] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To ascertain and compare between highly active antiretroviral therapy (HAART) and non-HAART patients, the stimulated salivary flow rates and unstimulated salivary flow rates (USFR and SSFR) and to correlate the salivary flow rates with immune suppression. MATERIALS AND METHODS One hundred human-immuno deficiency virus seropositive patients attending RAGAS-YRG CARE were examined and divided into two groups, a HAART group (patients on combination antiretroviral therapy) comprising 50 patients and a non-HAART group comprising 50 patients. The HAART group was followed every 3 months after the baseline visit (0) for a period of 9 months, during which a clinical oral examination and collection of unstimulated and stimulated saliva was done. Their salivary gland function was assessed using a xerostomia inventory during each visit. The study on non-HAART group was cross-sectional. STATISTICAL ANALYSIS Statistical analysis were performed with the aid of the Statistical Package for the Social Sciences (SPSS version 10.05) software. RESULTS There was no significant difference in mean SSFR and USFR between the two groups at baseline. In the HAART group, the mean stimulated salivary flow rate increased from baseline to 3 months (P = 0.02), with the increase being maintained at 6 months and 9 months. When salivary flow rates were correlated with Cluster of Differentiation, CD4 counts, patients in the HAART group with a CD4 ≤ 200 at 6 months visit had a higher mean stimulated salivary flow rate when compared with patients with CD4 ≥ 200 (P = 0.02). The xerostomia inventory did not reveal any significant difference between the two groups and HAART was not significantly associated with xerostomia. CONCLUSION In our study HAART was neither associated with xerostomia nor a reduction in salivary flow rate and immune suppression was not a significant factor for decreasing the salivary flow rate.
Collapse
Affiliation(s)
- S Pavithra
- Department of Oral and Maxillofacial Pathology, Madha Dental College and Hospital, Kundrathur, Tamil Nadu, India
| | | | | | | | | | | |
Collapse
|
43
|
Boyd MA, Kumarasamy N, Moore CL, Nwizu C, Losso MH, Mohapi L, Martin A, Kerr S, Sohn AH, Teppler H, Van de Steen O, Molina JM, Emery S, Cooper DA. Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of HIV-1 infection in adults with virological failure of a standard first-line ART regimen (SECOND-LINE): a randomised, open-label, non-inferiority study. Lancet 2013; 381:2091-9. [PMID: 23769235 DOI: 10.1016/s0140-6736(13)61164-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uncertainty exists about the best treatment for people with HIV-1 who have virological failure with first-line combination antiretroviral therapy of a non-nucleoside analogue (NNRTI) plus two nucleoside or nucleotide analogue reverse transcriptase inhibitors (NtRTI). We compared a second-line regimen combining two new classes of drug with a WHO-recommended regimen. METHODS We did this 96-week, phase 3b/4, randomised, open-label non-inferiority trial at 37 sites worldwide. Adults with HIV-1 who had confirmed virological failure (plasma viral load >500 copies per mL) after 24 weeks or more of first-line treatment were randomly assigned (1:1) to receive ritonavir-boosted lopinavir plus two or three NtRTIs (control group) or ritonavir-boosted lopinavir plus raltegravir (raltegravir group). The randomisation sequence was computer generated with block randomisation (block size four). Neither participants nor investigators were masked to allocation. The primary endpoint was the proportion of participants with plasma viral load less than 200 copies per mL at 48 weeks in the modified intention-to-treat population, with a non-inferiority margin of 12%. This study is registered with ClinicalTrials.gov, number NCT00931463. FINDINGS We enrolled 558 patients, of whom 541 (271 in the control group, 270 in the raltegravir group) were included in the primary analysis. At 48 weeks, 219 (81%) patients in the control group compared with 223 (83%) in the raltegravir group met the primary endpoint (difference 1·8%, 95% CI -4·7 to 8·3), fulfilling the criterion for non-inferiority. 993 adverse events occurred in 271 participants in the control group versus 895 in 270 participants in the raltegravir group, the most common being gastrointestinal. INTERPRETATION The raltegravir regimen was no less efficacious than the standard of care and was safe and well tolerated. This simple NtRTI-free treatment strategy might extend the successful public health approach to management of HIV by providing simple, easy to administer, effective, safe, and tolerable second-line combination antiretroviral therapy. FUNDING University of New South Wales, Merck, AbbVie, the Foundation for AIDS Research.
Collapse
|
44
|
Byakwaga H, Petoumenos K, Ananworanich J, Zhang F, Boyd MA, Sirisanthana T, Li PCK, Lee C, Mean CV, Saphonn V, Omar SFS, Pujari S, Phanuphak P, Lim PL, Kumarasamy N, Chen YMA, Merati TP, Sungkanuparph S, Ditangco R, Oka S, Tau G, Zhou J, Law MG, Emery S. Predictors of clinical progression in HIV-1-infected adults initiating combination antiretroviral therapy with advanced disease in the Asia-Pacific region: results from the TREAT Asia HIV observational database. J Int Assoc Provid AIDS Care 2013; 12:270-7. [PMID: 23422741 DOI: 10.1177/1545109712469684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
The majority of HIV-infected patients in developing countries commences combination antiretroviral therapy (cART) with advanced disease. We examined predictors of disease progression in patients initiating cART with CD4 count ≤200 cells/mm(3) in the TREAT Asia HIV Observational Database. The main outcome measure was progression to either an AIDS-defining illness or death occurring 6 months after initiation of cART. We used survival analysis methods. A total of 1255 patients contributed 2696 person years of follow-up; 73 were diagnosed with AIDS and 9 died. The rate of progression to the combined end point was 3.0 per 100 person years. The factors significantly associated with a higher risk of disease progression were Indian ethnicity, infection through intravenous drug use, lower CD4 count, and hemoglobin ≤130 g/dL at 6 months. In conclusion, measurements of CD4 count and hemoglobin at month 6 may be useful for early identification of disease progression in resource-limited settings.
Collapse
Affiliation(s)
- H Byakwaga
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Venkatesh KK, Saghayam S, Devaleenal B, Poongulali S, Flanigan TP, Mayer KH, Kumarasamy N. Spectrum of malignancies among HIV-infected patients in South India. Indian J Cancer 2012; 49:176-80. [PMID: 22842185 DOI: 10.4103/0019-509x.98947] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The current study examines the spectrum of malignancies among HIV-infected South Indians enrolled in a clinical care program. MATERIALS AND METHODS We conducted a nested matched case-control study among 42 HIV-infected cases who developed cancer and 82 HIV-infected controls between 1998 and 2008 at a tertiary care HIV care program in South India. RESULTS The most common types of cancer included non-Hodgkin's lymphoma (38.1%), Hodgkin's lymphoma (16.7%), squamous cell carcinoma (14.3%), and adenocarcinoma (14.3%). The median duration of time from HIV infection to cancer diagnosis was 549 days [interquartile range (IQR): 58-2013]. The nadir CD4 cell count was significantly lower in cases compared to controls (134 cells/μl vs. 169 cells/μl; P = 0.015). Cancer patients were more likely to have a more advanced HIV disease stage at the time of cancer diagnosis compared to control patients (Stage C: 90.5% vs. 49.4%; P<0.0001). Significantly more cancer patients were receiving antiretroviral treatment relative to control patients at the time of cancer diagnosis (92.9% vs. 66.3%; P=0.001). CONCLUSIONS HIV-infected patients who developed cancer had more advanced immunodeficiency at the time of cancer diagnosis and a lower nadir CD4 cell count. It is possible that with the continued roll-out of highly active antiretroviral therapy in India, the incidence of HIV-associated malignancies will decrease.
Collapse
Affiliation(s)
- K K Venkatesh
- Division of Infectious Diseases, Department of Medicine and Community Health, Alpert Medical School, Brown University/Miriam Hospital, RI, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Kumarasamy N, Venkatesh KK, Vignesh R, Devaleenal B, Poongulali S, Yepthomi T, Flanigan TP, Benson C, Mayer KH. Clinical outcomes among HIV/tuberculosis-coinfected patients developing immune reconstitution inflammatory syndrome after HAART initiation in South India. J Int Assoc Provid AIDS Care 2012; 12:28-31. [PMID: 23011868 DOI: 10.1177/1545109712457711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We determine the frequency and immunological outcome of developing immune reconstitution inflammatory syndrome (IRIS) among HIV/tuberculosis (TB)-coinfected Indians receiving highly active antiretroviral therapy (HAART). METHODS Patients coinfected with TB and HIV who initiated HAART were classified based on treatment outcomes (IRIS and non-IRIS) utilizing an observational HIV/AIDS cohort. RESULTS A total of 1731 HIV/TB-coinfected patients initiated HAART, and 95 of these patients (5.5%) developed TB-IRIS, with an incidence rate of 0.26 per 100 person-years. Patients who developed IRIS had significantly higher CD4 counts than non-IRIS patients at the time of initiating HAART, as well as after 6 months, 18 months, and 24 months following HAART initiation (P < .05). CONCLUSIONS HIV/TB-coinfected patients who developed IRIS following HAART initiation had equivalent clinical outcomes compared with their HIV/TB-coinfected counterparts who did not develop IRIS, suggesting minimal long-term risks associated with IRIS.
Collapse
Affiliation(s)
- N Kumarasamy
- YRG Centre for AIDS Research and Education, Voluntary Health Services (VHS), Chennai, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Robertson K, Jiang H, Kumwenda J, Supparatpinyo K, Evans S, Campbell TB, Price R, Tripathy S, Kumarasamy N, La Rosa A, Santos B, Silva MT, Montano S, Kanyama C, Faesen S, Murphy R, Hall C, Marra CM, Marcus C, Berzins B, Allen R, Housseinipour M, Amod F, Sanne I, Hakim J, Walawander A, Nair A. Improved neuropsychological and neurological functioning across three antiretroviral regimens in diverse resource-limited settings: AIDS Clinical Trials Group study a5199, the International Neurological Study. Clin Infect Dis 2012; 55:868-76. [PMID: 22661489 PMCID: PMC3491853 DOI: 10.1093/cid/cis507] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/11/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. METHODS Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. RESULTS The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P < .05) with the exception of semantic verbal fluency. No differences in neurological and neuropsychological functioning between treatment regimens were detected (P > .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). CONCLUSIONS The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization -recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. CLINICAL TRIALS REGISTRATION NCT00096824.
Collapse
Affiliation(s)
- K Robertson
- University of North Carolina, Chapel Hill, 27599-7025, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Campbell TB, Smeaton LM, Kumarasamy N, Flanigan T, Klingman KL, Firnhaber C, Grinsztejn B, Hosseinipour MC, Kumwenda J, Lalloo U, Riviere C, Sanchez J, Melo M, Supparatpinyo K, Tripathy S, Martinez AI, Nair A, Walawander A, Moran L, Chen Y, Snowden W, Rooney JF, Uy J, Schooley RT, De Gruttola V, Hakim JG. Efficacy and safety of three antiretroviral regimens for initial treatment of HIV-1: a randomized clinical trial in diverse multinational settings. PLoS Med 2012; 9:e1001290. [PMID: 22936892 PMCID: PMC3419182 DOI: 10.1371/journal.pmed.1001290] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 07/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world. METHODS AND FINDINGS 1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure. An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72-1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54-0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39-0.64 for women; HR 0.79, CI 0.62-1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12-2.04; p = 0.007). CONCLUSION EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00084136. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Thomas B Campbell
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
50
|
Abstract
With the rapid scale up of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Several new safe antiretroviral, and newer class of drugs and monitoring assays are developed recently. As a result the treatment guideline for the management of HIV disease continue to change. This review focuses on evolving science on Indian policy - antiretroviral therapy initiation, which drugs to start with, when to change the initial regimen and what to change.
Collapse
Affiliation(s)
- N Kumarasamy
- YRG CARE Medical Centre, Voluntary Health Services, Chennai, India.
| | | | | |
Collapse
|