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Turk T, Labarile M, Braun DL, Rauch A, Stöckle M, Cavassini M, Hoffmann M, Calmy A, Bernasconi E, Notter J, Pasin C, Günthard HF, Kouyos RD. Characterization and Determinants of Long-Term Immune Recovery Under Suppressive Antiretroviral Therapy. J Acquir Immune Defic Syndr 2024; 96:68-76. [PMID: 38301637 DOI: 10.1097/qai.0000000000003388] [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: 07/17/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE We developed a robust characterization of immune recovery trajectories in people living with HIV on antiretroviral treatment (ART) and relate our findings to epidemiological risk factors and bacterial pneumonia. METHODS Using data from the Swiss HIV Cohort Study and the Zurich Primary HIV Infection Cohort Study (n = 5907), we analyzed the long-term trajectories of CD4 cell and CD8 cell counts and their ratio in people living with HIV on ART for at least 8 years by fitting nonlinear mixed-effects models. The determinants of long-term immune recovery were investigated using generalized additive models. In addition, prediction accuracy of the modeled trajectories and their impact on the fit of a model for bacterial pneumonia was assessed. RESULTS Overall, our population showed good immune recovery (median plateau [interquartile range]-CD4: 718 [555-900] cells/μL, CD8: 709 [547-893] cells/μL, CD4/CD8: 1.01 [0.76-1.37]). The following factors were predictive of recovery: age, sex, nadir/zenith value, pre-ART HIV-1 viral load, hepatitis C, ethnicity, acquisition risk, and timing of ART initiation. The fitted models proved to be an accurate and efficient way of predicting future CD4 and CD8 cell recovery dynamics: Compared with carrying forward the last observation, mean squared errors of the fitted values were lower by 1.3%-18.3% across outcomes. When modeling future episodes of bacterial pneumonia, using predictors derived from the recovery dynamics improved most model fits. CONCLUSION We described and validated a method to characterize individual immune recovery trajectories of people living with HIV on suppressive ART. These trajectories accurately predict long-term immune recovery and the occurrence of bacterial pneumonia.
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Affiliation(s)
- Teja Turk
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marco Labarile
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Stöckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Hoffmann
- Clinic for Infectious Diseases, Cantonal Hospital Olten, Olten, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano, Switzerland
- University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Julia Notter
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ; and
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Xia H, Li L, Wu Y, Gao L, Zhang D, Ma P. Rapid Initiation of Antiretroviral Therapy Under the Treat-All Policy Reduces Loss to Follow-Up and Virological Failure in Routine Human Immunodeficiency Virus Care Settings in China: A Retrospective Cohort Study (2016-2022). AIDS Patient Care STDS 2024; 38:168-176. [PMID: 38656215 DOI: 10.1089/apc.2024.0045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Following the World Health Organization's guidelines for rapid antiretroviral therapy (ART) initiation [≤7 days after human immunodeficiency virus (HIV) diagnosis], China implemented Treat-All in 2016 and has made significant efforts to provide timely ART since 2017. This study included newly diagnosed HIV adults from Tianjin, China, between 2016 and 2022. Our primary outcome was loss to follow-up (LTFU) at 12 months after enrollment. The secondary outcome was 12-month virological failure. The association between rapid ART and LTFU, as well as virological failure, was assessed via Cox regression and logistic regression. A total of 896 (19.1%) of 4688 participants received ART ≤7 days postdiagnosis. The rate of rapid ART has increased from 7.5% in 2016 to 33.3% by 2022. The rapid ART group had an LTFU rate of 3.3%, as opposed to 5.0% in the delayed group. The rapid ART group had a much reduced virological failure rate (0.6% vs. 1.8%). Rapid ART individuals had a reduced likelihood of LTFU [adjusted hazard ratio: 0.65, 95% confidence intervals (CI): 0.44-0.96] and virological failure (adjusted odds ratio: 0.35, 95% CI: 0.12-0.80). The real-world data indicated that rapid ART is practicable and beneficial for Chinese people with HIV, providing evidence for its widespread implementation and scaling up.
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Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Lei Li
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Yue Wu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Liying Gao
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Defa Zhang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
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Holden CJ, Lampe FC, Burns FM, Chaloner C, Johnson M, Kinloch-De Loes S, Smith CJ. Association of age at antiretroviral therapy initiation with CD4 + : CD8 + ratio recovery among virally suppressed people with HIV. AIDS 2024; 38:703-711. [PMID: 38016172 PMCID: PMC10942155 DOI: 10.1097/qad.0000000000003801] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To investigate the association of age at antiretroviral therapy (ART) initiation with CD4 + : CD8 + T-cell ratio in virally suppressed people with HIV on long-term ART, and to characterize potential CD4 + : CD8 + ratio recovery in this population by age. DESIGN A longitudinal study of people attending an HIV clinic at the Royal Free Hospital NHS Trust, London, who initiated ART between 2001 and 2015, and achieved and maintained HIV-1 viral suppression (viral load <1,000 copies/ml). The association of age group at ART initiation with CD4 + : CD8 + ratio at 5 and 10 years was assessed. METHODS Multivariable linear regression was used to investigate the relationship between age at ART initiation and log CD4 + : CD8 + ratio, adjusting for demographic factors (gender/HIV transmission route, ethnicity), baseline CD4 + count and calendar year. RESULTS The sample included 1859 people aged 20-78 (75% men, 56% white ethnicity). Overall, median CD4 + : CD8 + T-cell ratio increased from 0.24 at baseline to 0.77 at year 5 and 0.88 at year 10. Ratios increased among all age groups in unadjusted and adjusted models but increased less among older ages (baseline ages 60-69 and 70-79). Median ratios at year 5 were 0.85, 0.80, 0.72, 0.76, 0.6, and 0.44, respectively, among people aged 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years at baseline. CONCLUSION In a virally suppressed London population, age had a substantial impact on CD4 + : CD8 + ratio recovery, especially for those starting ART after age 60 years. Results may indicate the level of CD4 + : CD8 + ratio recovery possible in an HIV-positive, virally suppressed, aging population.
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Oyadiran OT, Ogunlade SB, Okusanya TR, Okoka EM, Kuyebi MA, Omotayo MO, Abioye AI. Effect of intake of probiotics and probiotic fermented foods on clinical outcomes among people living with HIV: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:113-127. [PMID: 38112243 DOI: 10.1111/tmi.13955] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The objective of the study was to determine the effect of probiotics and of probiotic-fermented foods on CD4 T-cell count, viral load, anaemia and body mass index (BMI) among people living with HIV (PLHIV). METHODS In this article, we systematically reviewed the evidence on the influence of probiotic supplementation on CD4 lymphocyte count, viral load and anaemia among PLHIV on highly active antiretroviral therapy (HAART) and those who were HAART-naive. Medical literature databases identified randomised trials and pre-post studies of probiotic supplementation and HIV-related outcomes, and random effects meta-analysis was conducted. RESULTS The preponderance of the evidence suggests that probiotic supplementation only improved CD4 lymphocyte count modestly, with quantitatively greater impact among individuals who were HAART-naive compared to HAART-experienced individuals. Probiotic supplementation improved CD4 lymphocyte count by 53 cells/mm3 (95% CI: 22 to 85) from 18 studies. Probiotic supplementation however reduced haemoglobin concentration by -2.1 g/L (95% CI: -4.0 to -0.2). Although viral load remain unchanged in HAART-experienced participants following probiotic supplementation, HAART-naïve participants saw a decrease in viral load. There were too few studies on the impact of probiotic supplementation on viral load (N = 1). CONCLUSION Probiotic supplementation resulted in a modest increase in CD4 lymphocyte count among HAART-naive individuals with no significant change observed among HAART-experienced ones. Viral load and haemoglobin concentration also remained unchanged following probiotic supplementation. Further rigorous and well-powered studies may evaluate the effect of probiotic supplementation on important clinical outcomes among PLHIV on HAART.
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Affiliation(s)
| | | | | | | | | | | | - Ajibola Ibraheem Abioye
- Avicenna Research and Insights Center, Lagos, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Meireles G, Nobre AA, Cardoso SW, Velasque L, Veloso VG, Grinsztejn B, Luz PM. Real-world effectiveness of WHO recommended first-line antiretroviral therapies: a cohort study from a middle-income country. AIDS Care 2023; 35:1891-1903. [PMID: 37001113 DOI: 10.1080/09540121.2023.2190954] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
We estimate the effectiveness of antiretroviral therapy (ART) among individuals receiving HIV care in Rio de Janeiro, Brazil. Adults (18y+) initiating ART between Jan/2008 and Dec/2018 (follow-up through Dec/2020) were included. First-line ART (two nucleoside reverse transcriptase inhibitors plus one antiretroviral from another class) was categorized into four categories: non-nucleoside reverse transcriptase inhibitor/NNRTI-based, protease inhibitor/PI-based, integrase strand transfer inhibitor/INSTI-based, and single-tablet regimen (STR, Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mg). Effectiveness (viral load ≤50 copies/µL) was evaluated at 6(3-9) and 12(9-15) months from ART initiation. Bayesian logistic regression models were used to quantify the association between exposure and outcomes while accounting for missing data. Overall, 1863(57%), 652(19.9%), 412(12.6%), and 342(10.5%) individuals used, respectively, NNRTI-based, PI-based, INSTI-based regimens, and STR. Compared to NNRTIs, the odds of viral suppression with INSTI-based regimens was 76% higher (adjusted OR:1.76, 95%CI:1.23-2.51) at six months but no higher at 12 months. Older age, higher education, CD4 count ≥500 cells/mm3 and viral load <100,000 copies/µL at ART initiation increased the odds of viral suppression. Viral suppression at six months was the strongest predictor of viral suppression at 12 months. These results highlight population groups that could benefit from close monitoring during the first year of ART.
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Affiliation(s)
- Glaucia Meireles
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Aline A Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Centro de Ciências Exatas e Tecnologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Kleinmann WN, Pruszynski JE, Adhikari EH. Use of integrase inhibitors vs protease inhibitors is associated with improved HIV viral suppression. Am J Obstet Gynecol MFM 2023; 5:101151. [PMID: 37689245 DOI: 10.1016/j.ajogmf.2023.101151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Current guidelines for antiretroviral therapy in pregnancy include the use of a dual-nucleoside reverse transcriptase inhibitor with either an integrase strand transfer inhibitor or a ritonavir-boosted protease inhibitor, although there is no designation of which is the preferred option. OBJECTIVE This study aimed to compare viral suppression at delivery among patients on dual-nucleoside reverse transcriptase inhibitors combined with either an integrase strand transfer inhibitor or a protease inhibitor. A hypothesis was made that the incidence of viral suppression is higher with the use of a dual-nucleoside reverse transcriptase inhibitor backbone combined with an integrase strand transfer inhibitor than with the use of a dual-nucleoside reverse transcriptase inhibitor backbone combined with a protease inhibitor. STUDY DESIGN This study was an observational study of pregnant patients living with HIV who received prenatal care and delivered after 20 weeks of gestation at an urban safety net hospital. All pregnant patients with HIV were referred to a centralized clinic for HIV counseling, medication management, and prenatal care. Antiretroviral therapy was continued or initiated according to protocols based on national guidance. Among patients on a dual-nucleoside reverse transcriptase inhibitor backbone combined with integrase strand transfer inhibitor vs protease inhibitor at delivery, we compared the demographics and HIV disease characteristics, including year of diagnosis, viral load, and antiretroviral therapy class. The outcome of interest was viral suppression at delivery, defined as a viral load of <50 copies/mL. RESULTS From January 2011 to December 2021, 604 patients on dual-nucleoside reverse transcriptase inhibitor met the inclusion criteria, including 411 patients (68%) on protease inhibitor and 193 patients (32%) on integrase strand transfer inhibitor at delivery. Demographic distribution was similar, and prenatal care was initiated at 12 weeks of gestation. Among the integrase strand transfer inhibitor group, 101 (17%) were on antiretroviral therapy at initiation of prenatal care compared with 169 (28%) in the protease inhibitor group. At delivery, the frequency of viral load suppression was higher among those on an integrase strand transfer inhibitor (147/193 [76%]) than among those on a protease inhibitor (275/411 [67%]) (odds ratio, 1.59; 95% confidence interval, 1.08-2.33). Among those with a detectable virus, quantitative viral load was not different. During the study period, the use of a protease inhibitor decreased, whereas the use of an integrase strand transfer inhibitor increased. CONCLUSION Among pregnant patients living with HIV, viral suppression was more common among those on a dual-nucleoside reverse transcriptase inhibitor backbone combined with integrase strand transfer inhibitor than among those on a dual-nucleoside reverse transcriptase inhibitor backbone protease inhibitor at delivery. Our results support the use of dual-nucleoside reverse transcriptase inhibitor with integrase strand transfer inhibitor as a first-line antiretroviral therapy regimen in pregnancy.
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Affiliation(s)
- Whitney N Kleinmann
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas and Parkland Health, Dallas, TX.
| | - Jessica E Pruszynski
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas and Parkland Health, Dallas, TX
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas and Parkland Health, Dallas, TX
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Letendre SL, Chen H, McKhann A, Roa J, Vecchio A, Daar ES, Berzins B, Hunt PW, Marra CM, Campbell TB, Coombs RW, Ma Q, Swaminathan S, Macatangay BJC, Morse GD, Miller T, Rusin D, Greninger AL, Ha B, Alston-Smith B, Robertson K, Paul R, Spudich S. Antiretroviral Therapy Intensification for Neurocognitive Impairment in Human Immunodeficiency Virus. Clin Infect Dis 2023; 77:866-874. [PMID: 37183889 PMCID: PMC10506779 DOI: 10.1093/cid/ciad265] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) in people with HIV (PWH) on antiretroviral therapy (ART) is common and may result from persistent HIV replication in the central nervous system. METHODS A5324 was a randomized, double-blind, placebo-controlled, 96-week trial of ART intensification with dolutegravir (DTG) + MVC, DTG + Placebo, or Dual - Placebo in PWH with plasma HIV RNA <50 copies/mL on ART and NCI. The primary outcome was the change on the normalized total z score (ie, the mean of individual NC test z scores) at week 48. RESULTS Of 357 screened, 191 enrolled: 71% male, 51% Black race, 22% Hispanic ethnicity; mean age 52 years; mean CD4+ T-cells 681 cells/µL. Most (65%) had symptomatic HIV-associated NC disorder. Study drug was discontinued due to an adverse event in 15 (8%) and did not differ between arms (P = .17). Total z score, depressive symptoms, and daily functioning improved over time in all arms with no significant differences between them at week 48 or later. Adjusting for age, sex, race, study site, efavirenz use, or baseline z score did not alter the results. Body mass index modestly increased over 96 weeks (mean increase 0.32 kg/m2, P = .006) and did not differ between arms (P > .10). CONCLUSIONS This is the largest, randomized, placebo-controlled trial of ART intensification for NCI in PWH. The findings do not support empiric ART intensification as a treatment for NCI in PWH on suppressive ART. They also do not support that DTG adversely affects cognition, mood, or weight.
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Affiliation(s)
| | - Huichao Chen
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ashley McKhann
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jhoanna Roa
- DLH Corporation, Silver Spring, Maryland, USA
| | - Alyssa Vecchio
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eric S Daar
- Lundquist Institute at Harbor–University of California–Los Angeles Medical Center, Torrance, California, USA
| | | | - Peter W Hunt
- University of California–San Francisco, San Francisco, California, USA
| | - Christina M Marra
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Robert W Coombs
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Qing Ma
- University at Buffalo, Buffalo, New York, USA
| | | | | | | | | | - David Rusin
- DLH Corporation, Silver Spring, Maryland, USA
| | | | - Belinda Ha
- ViiV Healthcare Ltd, Research Triangle Park, North Carolina, USA
| | | | - Kevin Robertson
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert Paul
- University of Missouri, St. Louis, Missouri, USA
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Barthold D, Saldarriaga EM, Brah AT, Hauber B, Banerjee P, Fuller SM, McCaslin D, Moldoveanu AM, Marconi VC, Simoni JM, Graham SM. Preference for daily oral pills over long-acting antiretroviral therapy options among people with HIV. AIDS 2023; 37:1545-1553. [PMID: 37289570 PMCID: PMC10355802 DOI: 10.1097/qad.0000000000003620] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the characteristics of people with HIV (PWH) who prefer remaining on daily oral antiretroviral therapy (ART), rather than switching to long-acting ART (LA-ART). DESIGN Building upon a discrete choice experiment (DCE), we examined characteristics of individuals who always selected their current daily oral tablet regimen over either of two hypothetical LA-ART options presented in a series of 17 choice tasks. METHODS We used LASSO to select sociodemographic, HIV-related, and other health-related predictors of preferring current therapy over LA-ART, and logistic regression to measure the associations with those characteristics. RESULTS Among 700 PWH in Washington State and Atlanta, Georgia, 11% of participants ( n = 74) chose their current daily treatment over LA-ART in all DCE choice tasks. We found that people with lower educational attainment, good adherence, more aversion to injections, and who participated from Atlanta to be more likely to prefer their current daily regimen over LA-ART. CONCLUSIONS Gaps in ART uptake and adherence remain, and emerging LA-ART treatments show promise to address these challenges and help a larger portion of PWH to achieve viral suppression, but preferences for these new treatments are understudied. Our results show that certain drawbacks of LA-ART may help to maintain demand for daily oral tablets, especially for PWH with certain characteristics. Some of these characteristics (lower educational attainment and Atlanta participation) were also associated with a lack of viral suppression. Future research should focus on overcoming barriers that impact preferences for LA-ART among those patients who could benefit most from this innovation.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Enrique M. Saldarriaga
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Aaron T. Brah
- School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Brett Hauber
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
- Pfizer, Inc, New York, New York
| | - Pallavi Banerjee
- Information School, University of Washington, Seattle, Washington
| | | | | | | | - Vincent C. Marconi
- Department of Medicine, Emory University School of Medicine
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Susan M. Graham
- Department of Global Health
- Division of Allergy & Infectious Diseases, Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Yin DE, Cole SR, Ludema C, Brookhart MA, Golin CE, Miller WC, McKinney RE. A Per-Protocol Analysis Using Inverse-Probability-of-Censoring Weights in a Randomized Trial of Initial Protease Inhibitor Versus Nonnucleoside Reverse Transcriptase Inhibitor Regimens in Children. Am J Epidemiol 2023; 192:916-928. [PMID: 36896583 PMCID: PMC10505414 DOI: 10.1093/aje/kwad054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/05/2022] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Protocol adherence may influence measured treatment effectiveness in randomized controlled trials. Using data from a multicenter trial (Europe and the Americas, 2002-2009) of children with human immunodeficiency virus type 1 who had been randomized to receive initial protease inhibitor (PI) versus nonnucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral therapy regimens, we generated time-to-event intention-to-treat (ITT) estimates of treatment effectiveness, applied inverse-probability-of-censoring weights to generate per-protocol efficacy estimates, and compared shifts from ITT to per-protocol estimates across and within treatment arms. In ITT analyses, 263 participants experienced 4-year treatment failure probabilities of 41.3% for PIs and 39.5% for NNRTIs (risk difference = 1.8% (95% confidence interval (CI): -10.1, 13.7); hazard ratio = 1.09 (95% CI: 0.74, 1.60)). In per-protocol analyses, failure probabilities were 35.6% for PIs and 29.2% for NNRTIs (risk difference = 6.4% (95% CI: -6.7, 19.4); hazard ratio = 1.30 (95% CI: 0.80, 2.12)). Within-arm shifts in failure probabilities from ITT to per-protocol analyses were 5.7% for PIs and 10.3% for NNRTIs. Protocol nonadherence was nondifferential across arms, suggesting that possibly better NNRTI efficacy may have been masked by differences in within-arm shifts deriving from differential regimen forgiveness, residual confounding, or chance. A per-protocol approach using inverse-probability-of-censoring weights facilitated evaluation of relationships among adherence, efficacy, and forgiveness applicable to pediatric oral antiretroviral regimens.
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Affiliation(s)
- Dwight E Yin
- Correspondence to Dr. Dwight E. Yin, Divisions of Infectious Diseases and Clinical Pharmacology, Medical Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, 2401 Gillings Road, Kansas City, MO 64108 (e-mail: )
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Van Praet JT, Serrien B, Ausselet N, Darcis G, Demeester R, De Munter P, De Scheerder MA, Goffard JC, Libois A, Messiaen P, Yombi JC, Van Beckhoven D. Dynamics of Weight Change After Initiation of Contemporaneous Antiretroviral Therapy in Treatment-Naive HIV-1 Infected Patients: Results From the Belgian HIV Cohort 2015-2021. J Acquir Immune Defic Syndr 2023; 93:e4-e5. [PMID: 36787727 DOI: 10.1097/qai.0000000000003175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Jens T Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ben Serrien
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Gilles Darcis
- Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Liège, Belgium
| | - Rémy Demeester
- HIV Reference Centre, University Hospital of Charleroi, Lodelinsart, Belgium
| | - Paul De Munter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, UZ Leuven, Leuven, Belgium
| | | | - Jean-Christophe Goffard
- HIV Reference Centre, Internal Medicine, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Department of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Echchakery M, Boumezzough A, Boussaa S. Biological parameters determining the effectiveness of monitoring of HIV / AIDS infected patients in Morocco. Afr Health Sci 2023; 23:109-120. [PMID: 38223572 PMCID: PMC10782351 DOI: 10.4314/ahs.v23i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background & objective Human Immunodeficiency Virus (HIV) remains one of the world's most serious health challenges. The development of therapeutic regimens has significantly increased survival and reduced HIV-associated morbidities in HIV-infected individuals. However, some people living with HIV may not respond as expected, resulting in treatment failure. The objective of this study is to identify and characterize, by immunological (T-cell CD4) and virological (viral load) parameters, HIV infected patients with therapeutic failure in Morocco. Methods Prospective cross-sectional studies were conducted over a 5-years period (between January 2015 and December 2019) at the referral center of Ibn Zohr Hospital, Marrakech, Morocco. A total, of 1088 HIV-infected patients diagnosed by the rapid test (Immunochromatography) in addition to Western Blot analysis, was recruited. All patients were under the antiretroviral therapy (ART) for at least six months and followed every six months. Sociodemographic, clinical, and biological data as well as information on patient adherence were collected. Results Out of 1088 patients, 92.46% were under treatment based on non-nucleoside reverse transcriptase inhibitors (NNRTIs) including 26.20% first line first intention and 66.26% first line second intention, and 7.54% of patients on a protease inhibitor (PI) therapy. Regarding the immunological and virological status, 76% of HIV-infected patients had a CD4 count > 200 cells/µl and 24% had a CD4 count < 200 cells / µl, while 69.5% had an undetectable viral load and 30.05% had a detectable viral load (including 11.86% with viral load < 1000 copies / ml and 18.20% viral load > 1000 copies / ml) (P-values < 0.05). Conclusion In our study, we showed a therapeutic failure rate of 18.2% in HIV-infected patients under treatment in Marrakech region. These failures were mainly related to poor adherence and low CD4+ rates at the initiation of treatment. We concluded that immunological monitoring alone is insufficient to predict virological suppression and therapeutic success. Consequently, we recommend the HIV plasma viral load test be accessible as a routine exam.
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Affiliation(s)
- Mohamed Echchakery
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Epidemiology and biomedical unit, 26000 Settat. University Complex, Casablanca Road km 3.5 B. P 555 Settat, Morocco
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Ali Boumezzough
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Samia Boussaa
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Ministry of Health and social protection, 10000 Rabat, Morocco
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Belaunzarán-Zamudio PF, Naranjo L, Caro-Vega Y, Castillo-Mancilla JR, Camiro-Zuñiga A, Fuentes-García R, Crabtree-Ramírez BE, Sierra-Madero JG. Incomplete Antiretroviral Therapy Adherence Is Associated with Lower CD4-CD8 Ratio in Virally Suppressed Patients with HIV Infection in Mexico. AIDS Res Hum Retroviruses 2023; 39:136-144. [PMID: 36597354 PMCID: PMC9986006 DOI: 10.1089/aid.2021.0179] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Suboptimal adherence to antiretroviral therapy (ART) in people with HIV, even during sustained viral suppression, is associated with persistent inflammation, immune activation, and coagulopathy. Persistently low CD4-CD8 Ratio has been also associated with residual inflammation, is a good predictor of increased risk of death and more widely available than inflammatory biomarkers. We tested the hypothesis that the CD4-CD8 Ratio is associated with ART adherence during periods of complete viral suppression. We used the Medication Possession Ratio based in pharmacy registries as measure of adherence and time-varying, routine care CD4 and CD8 measurements as outcome. We used a linear mixed model for longitudinal data, including fixed effects for sex, age, education, date of ART initiation, AIDS-related conditions, and baseline CD4 to model the outcome. In 988 adults with a median follow-up of 4.13 years, higher ART adherence was independently associated with a modest increase in CD4-CD8. For each increasing percentage point in adherence, the CD4-CD8 Ratio increased 0.000857 (95% confidence interval [CI] -0.000494 to 0.002209, p = .213731) in the first year after achieving viral suppression; 0.001057 (95% CI 0.000262-0.001853, p = .009160) in years 1 to 3; 0.000323 (95% CI -0.000448 to 0.001095, p = .411441) in years 3 to 5; and 0.000850 (95% CI 0.000272-0.001429, p = .003946) 5-10 years after achieving viral suppression. The magnitude of the effect of adherence over CD4-CD8 Ratios varied over time and by baseline CD4 count, with increasing adherence having a larger effect early after ART initiation in people with higher baseline CD4 (>500 cells/μL) and in later years in people with lower baseline CD4 count (≥200 cells/μL). Our findings expand on previous evidence suggesting that the benefits of optimal adherence to modern ART regimens goes beyond maintaining viral suppression. These results highlight the importance of including objective measurements of adherence as part of routine care, even in patients with complete HIV suppression over long-term follow-up.
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Affiliation(s)
- Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Lizbeth Naranjo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Yanink Caro-Vega
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Antonio Camiro-Zuñiga
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Ruth Fuentes-García
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Brenda E. Crabtree-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Juan G. Sierra-Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
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13
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Patten GE, Euvrard J, Anderegg N, Boulle A, Arendse KD, von der Heyden E, Ford N, Davies MA. Advanced HIV disease and engagement in care among patients on antiretroviral therapy in South Africa: results from a multi-state model. AIDS 2023; 37:513-522. [PMID: 36695361 PMCID: PMC9881824 DOI: 10.1097/qad.0000000000003442] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Despite improved access to antiretroviral therapy (ART) for people with HIV (PWH), HIV continues to contribute considerably to morbidity and mortality. Increasingly, advanced HIV disease (AHD) is found among PWH who are ART-experienced. DESIGN Using a multi-state model we examined associations between engagement with care and AHD on ART in South Africa. METHODS Using data from IeDEA Southern Africa, we included PWH from South Africa, initiating ART from 2004 to 2017 aged more than 5 years with a CD4+ cell count at ART start and at least one subsequent measure. We defined a gap as no visit for at least 18 months. Five states were defined: 'AHD on ART' (CD4+ cell count <200 cells/μl), 'Clinically Stable on ART' (CD4+ cell count ≥200 or if no CD4+ cell count, viral load <1000 copies/ml), 'Early Gap' (commencing ≤18 months from ART start), 'Late Gap' (commencing >18 months from ART start) and 'Death'. RESULTS Among 32 452 PWH, men and those aged 15-25 years were more likely to progress to unfavourable states. Later years of ART start were associated with a lower probability of transitioning from AHD to clinically stable, increasing the risk of death following AHD. In stratified analyses, those starting ART with AHD in later years were more likely to re-engage in care with AHD following a gap and to die following AHD on ART. CONCLUSION In more recent years, those with AHD on ART were more likely to die, and AHD at re-engagement in care increased. To further reduce HIV-related mortality, efforts to address the challenges facing these more vulnerable patients are needed.
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Affiliation(s)
- Gabriela E Patten
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | | | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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14
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Mwamuye IC, Karanja S, Msanzu JB, Adem A, Kerich M, Ngari M. Factors associated with poor outcomes among people living with HIV started on anti-retroviral therapy before and after implementation of “test and treat” program in Coastal Kenya. PLoS One 2022; 17:e0270653. [PMID: 36129876 PMCID: PMC9491584 DOI: 10.1371/journal.pone.0270653] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine the factors associated with poor outcomes among people living with HIV (PLHIV) started on anti- retroviral therapy before and after implementation of “Test and treat” program in 18 facilities in Coastal Kenya. Methods A retrospective cohort study design was used to study PLHIV aged > 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcome was retention defined as being alive and on ARVs after 24 months. Death and loss to follow-up were considered as poor outcomes. Kaplan–Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine factors associated with poor outcomes. Results 86 patients (470 before test and treat, and 316 after test and treat cohorts) were enrolled. Overall, the median [IQR] age was 39.3 [32.5–47.5] years and 539 (69%) were female. After 24 months, retention rates for the before (68%) and after (64%) test and start groups were similar (absolute difference: -4.0%, 95%CI: -11-3.1, P = 0.27). There were 240(31%, 95%CI 27 to 34%) PLHIV with poor outcomes, 102 (32%) and 138 (29%) occurred among the test and treat group, and delayed treatment patients respectively. In multivariable regression model, test and treat had no significant effect on risk of poor outcomes (aHR = 1.17, 95%CI 0.89–1.54). Increasing age (aHR = 0.98, 95%CI 0.97–0.99), formal employment (aHR = 0.42, 95%CI 0.23–0.76) and not being employed (aHR = 0.53, 95%CI 0.34–0.81) were negatively associated with poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR = 1.37, 95%CI 1.03–1.82) and among divorced/separated patients compared to the married (aHR = 1.44, 95%CI 1.04–1.99). Conclusion Retention patterns for the “test and treat” cohort were comparable to those who started ART before “test and treat”. Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Interventions targeting PLHIV who are young, male and economically disadvantaged provide an opportunity to improve the long-term outcomes.
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Affiliation(s)
- Isaac Chome Mwamuye
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
- * E-mail:
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | | | - Aggrey Adem
- Technical University of Mombasa, Mombasa, Kenya
| | - Mary Kerich
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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15
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Serrano-Villar S, Wu K, Hunt PW, Lok JJ, Ron R, Sainz T, Moreno S, Deeks SG, Bosch RJ. Predictive value of CD8+ T cell and CD4/CD8 ratio at two years of successful ART in the risk of AIDS and non-AIDS events. EBioMedicine 2022; 80:104072. [PMID: 35644125 PMCID: PMC9156990 DOI: 10.1016/j.ebiom.2022.104072] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While increased CD8 counts and low CD4/CD8 ratio during treated HIV correlate with immunosenescence, their additional predictive values to identify individuals with HIV at higher risk of clinical events remain controversial. METHODS We selected treatment-naive individuals initiating ART from ACTG studies 384, 388, A5095, A5142, A5202, and A5257 who had achieved viral suppression at year 2. We examined the effect of CD8+ T cell counts and CD4/CD8 at year 2 on the probability of AIDS and serious non-AIDS events in years 3-7. We used inverse probability weighting methods to address informative censoring, combined with multivariable logistic regression models. FINDINGS We analyzed 5133 participants with a median age of 38 years; 959 (19%) were female, pre-ART median CD4 counts were 249 (Q1-Q3 91-372) cell/µL. Compared to participants with CD8 counts between 500/µL and 1499/µL, those with >1500/µL had a higher risk of clinical events during years 3-7 (aOR 1.75; 95%CI 1.33-2.32). CD4/CD8 ratio was not predictive of greater risk of events through year 7. Additional analyses revealed consistent CD8 count effect sizes for the risk of AIDS events and noninfectious non-AIDS events, but opposite effects for the risk of severe infections, which were more frequent among individuals with CD8 counts <500/µL (aOR 1.70; 95%CI 1.09-2.65). INTERPRETATION The results of this analysis with pooled data from clinical trials support the value of the CD8 count as a predictor of clinical progression. People with very high CD8 counts during suppressive ART might benefit from closer monitoring and may be a target population for novel interventions. FUNDING This research was supported by NIH/NIAID awards UM1 AI068634, UM1 AI068636, and UM1 AI106701 and Carlos III Health Institute and FEDER funds (BA21/00017 and BA21/00022).
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; San Francisco General Hospital, San Francisco, CA, USA.
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter W Hunt
- San Francisco General Hospital, San Francisco, CA, USA
| | | | - Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | - Talía Sainz
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Yeregui E, Masip J, Viladés C, Domingo P, Pacheco YM, Blanco J, Mallolas J, Alba V, Vargas M, García-Pardo G, Negredo E, Olona M, Vidal-González J, Peraire M, Martí A, Reverté L, Gómez-Bertomeu F, Leal M, Vidal F, Peraire J, Rull A. Adipokines as New Biomarkers of Immune Recovery: Apelin Receptor, RBP4 and ZAG Are Related to CD4+ T-Cell Reconstitution in PLHIV on Suppressive Antiretroviral Therapy. Int J Mol Sci 2022; 23:ijms23042202. [PMID: 35216318 PMCID: PMC8874604 DOI: 10.3390/ijms23042202] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
A significant proportion of people living with HIV (PLHIV) who successfully achieve virological suppression fail to recover CD4+ T-cell counts. Since adipose tissue has been discovered as a key immune organ, this study aimed to assess the role of adipokines in the HIV immunodiscordant response. This is a multicenter prospective study including 221 PLHIV starting the first antiretroviral therapy (ART) and classified according to baseline CD4+ T-cell counts/µL (controls > 200 cells/µL and cases ≤ 200 cells/µL). Immune failure recovery was considered when cases did not reach more than 250 CD4+ T cells/µL at 144 weeks (immunological nonresponders, INR). Circulating adipokine concentrations were longitudinally measured using enzyme-linked immunosorbent assays. At baseline, apelin receptor (APLNR) and zinc-alpha-2-glycoprotein (ZAG) concentrations were significantly lower in INRs than in immunological responders (p = 0.043 and p = 0.034), and they remained lower during all ART follow-up visits (p = 0.044 and p = 0.028 for APLNR, p = 0.038 and p = 0.010 for ZAG, at 48 and 144 weeks, respectively). ZAG levels positively correlated with retinol-binding protein 4 (RBP4) levels (p < 0.01), and low circulating RBP4 concentrations were related to a low CD4+ T-cell gain (p = 0.018 and p = 0.039 at 48 and 144 weeks, respectively). Multiple regression adjusted for clinical variables and adipokine concentrations confirmed both low APLNR and RBP4 as independent predictors for CD4+ T cells at 144 weeks (p < 0.001). In conclusion, low APLNR and RBP4 concentrations were associated with poor immune recovery in treated PLHIV and could be considered predictive biomarkers of a discordant immunological response.
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Affiliation(s)
- Elena Yeregui
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Jenifer Masip
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Consuelo Viladés
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Yolanda M. Pacheco
- Laboratory of Immunology, Institute of Biomedicine of Seville, IBiS, 41013 Seville, Spain;
- UGC Clinical Laboratories, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Julià Blanco
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- IrsiCaixa AIDS Research Institute, 08916 Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Badalona, Spain
- Infectious Diseases and Immunity, Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08500 Vic, Spain
| | - Josep Mallolas
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- HIV Unit and Infectious Diseases Service, Hospital Clinic-IDIBAPS, 08036 Barcelona, Spain
| | - Verónica Alba
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Montserrat Vargas
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Graciano García-Pardo
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Eugènia Negredo
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Infectious Diseases and Immunity, Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08500 Vic, Spain
- Fundació de la Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Montserrat Olona
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | | | - Maria Peraire
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
| | - Anna Martí
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Laia Reverté
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Fréderic Gómez-Bertomeu
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Manuel Leal
- Internal Medicine Service, Hospital Viamed Santa Ángela de la Cruz, 41014 Seville, Spain;
| | - Francesc Vidal
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Correspondence: (F.V.); (A.R.)
| | - Joaquim Peraire
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Anna Rull
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Correspondence: (F.V.); (A.R.)
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Tadesse WT, Adankie BT, Shibeshi W, Amogne W, Aklillu E, Engidawork E. Prevalence and predictors of glucose metabolism disorders among People Living with HIV on combination antiretroviral therapy. PLoS One 2022; 17:e0262604. [PMID: 35045105 PMCID: PMC8769333 DOI: 10.1371/journal.pone.0262604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/04/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Objective We investigated prevalence and predictors of glucose metabolism disorders (GMDs) among People Living with HIV (PLWH) on efavirenz- and atazanavir/ritonavir-based combination antiretroviral therapy (cART). Methods This cross-sectional study involved adult PLWH on efavirenz- (n = 240) and atazanavir/ritonavir-based (n = 111) cART. The prevalence of GMDs was determined by fasting serum glucose, insulin, and homeostasis model assessment. A logistic regression model was used to determine predictors. Results The overall prevalence of GMDs for all regimens was 27.6% (97/351) [95% CI 23.0–32.6%] s, with 31.1% (75/240) [95% CI 25.4–37.5%] for efavirenz-based and 19.8% (22/111) [95% CI 12.9–28.5%)] for atazanavir/ritonavir-based cART group. The prevalence of impaired fasting glycemia was significantly higher (p = 0.026) in the efavirenz- [(15.4%) (37/240); 95%CI (11.1–20.6%)] than atazanavir/ritonavir-based [(7.2%) (8/111), (95%CI (3.2–13.7%)] cART. However, no significant difference was observed in the prevalence of diabetes mellitus and insulin resistance between the two regimens. Age ≥46 years old and specific type of ARV contained in cART, such as TDF, were independent predictors of GMD in both groups. Whereas the male gender and BMI category were predictors of GMDs among EFV-based cART group, AZT- and ABC- containing regimens and triglyceride levels were predictors in the ATV/r-based group. Conclusions GMDs were highly prevalent among adults on EFV- than ATV/r-based cARTs. Age ≥46 years and TDF-containing cARTs are common predictors in both regimens. Close monitoring for impaired fasting glucose during long-term EFV-based cART is recommended for early diagnosis of type-2 diabetes and management.
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Affiliation(s)
- Wondmagegn Tamiru Tadesse
- Department of Pharmacology and Clinical Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanemeskel T. Adankie
- Department of Medical Microbiology, School of Medicine, St. Paul Specialized Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Workineh Shibeshi
- Department of Pharmacology and Clinical Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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18
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Sapuła M, Suchacz M, Załęski A, Wiercińska-Drapało A. Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review. Viruses 2022; 14:122. [PMID: 35062326 PMCID: PMC8780416 DOI: 10.3390/v14010122] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 12/13/2022] Open
Abstract
The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980's. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.
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Affiliation(s)
- Mariusz Sapuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, 01-201 Warsaw, Poland; (M.S.); (A.Z.); (A.W.-D.)
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19
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Nanditha NGA, Dong X, Tafessu HM, Wang L, Lu M, Barrios R, Montaner JSG, Lima VD. A province-wide HIV initiative to accelerate initiation of treatment-as-prevention and virologic suppression in British Columbia, Canada: a population-based cohort study. CMAJ Open 2022; 10:E27-E34. [PMID: 35042692 PMCID: PMC8920539 DOI: 10.9778/cmajo.20210093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2010, HIV treatment as prevention (TasP), encompassing widespread HIV testing and immediate initiation of free antiretroviral treatment (ART), was piloted under the Seek and Treat for Optimal Prevention of HIV/AIDS initiative (STOP) in British Columbia, Canada. We compared the time from HIV diagnosis to treatment initiation, and from treatment initiation to first virologic suppression, before (2005-2009) and after (2010-2016) the implementation of STOP. METHODS In this population-based cohort study, we used longitudinal data of all people living with an HIV diagnosis in BC from 1996 to 2017. We included those aged 18 years or older who had never received ART and had received an HIV diagnosis in the 2005-2016 period. We defined the virologic suppression date as the first date of at least 2 consecutive test results within 4 months with a viral load of less than 200 copies/mL. Negative binomial regression models assessed the effect of STOP on the time to ART initiation and suppression, adjusting for confounders. All p values were 2-sided, and we set the significance level at 0.05. RESULTS Participants who received an HIV diagnosis before STOP (n = 1601) were statistically different from those with a diagnosis after STOP (n = 1700); 81% versus 84% were men (p = 0.0187), 30% versus 15% had ever injected drugs (p < 0.0001), and 27% versus 49% had 350 CD4 cells/μL or more at diagnosis (p < 0.0001). The STOP initiative was associated with a 64% shorter time from diagnosis to treatment (adjusted mean ratio 0.36, 95% confidence interval [CI] 0.34-0.39) and a 21% shorter time from treatment to suppression (adjusted mean ratio 0.79, 95% CI 0.73-0.85). INTERPRETATION In a population with universal health coverage, a TasP intervention was associated with shorter times from HIV diagnosis to treatment initiation, and from treatment initiation to viral suppression. Our results show accelerating progress toward the United Nations' 90-90-90 target of people with HIV who have a diagnosis, those who are on antiretroviral therapy and those who are virologically suppressed, and support the global expansion of TasP to accelerate the control of HIV/AIDS.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Xinzhe Dong
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Hiwot M Tafessu
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Michelle Lu
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS (Nanditha, Dong, Tafessu, Wang, Lu, Barrios, Montaner, Lima); Faculty of Medicine (Nanditha, Montaner, Lima), University of British Columbia, Vancouver, BC
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20
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de Oliveira França P, Ayres LR, Pimassoni LH, Cerutti Junior C. Health-Related Quality of Life and Coping Strategies in a Cohort Study of Highly Active Antiretroviral Therapy Naïve Patients Adherence. Int J Clin Pract 2022; 2022:8341638. [PMID: 35685558 PMCID: PMC9159168 DOI: 10.1155/2022/8341638] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The main objective of this study was to describe the perceived quality of life (QoL) in patients living with AIDS (PLWA) and their chosen coping strategies in a cohort of individuals managed with HAART. METHODS This is a prospective cohort study conducted at the Medication Dispensing Unit of a university hospital (MDU-UH) located in southeastern Brazil. Study population comprised HIV/AIDS patients starting antiretroviral treatment at MDU. The final sample comprised 99 participants. Patients were followed up for 24 months from their recruitment. We used a face-to-face questionnaire to determine sociodemographic and behavioural variables. Quality of life (QoL) and coping strategies (CS) were measured through validated instruments. RESULTS Regarding the QoL dimensions, the general perception of QoL among these participants was considered good. Regarding CS, the adherent patients scored higher than the nonadherents. CONCLUSIONS The present study revealed that the perceived QoL can be maintained in individuals treated for HIV/AIDS. There is an association between high score of coping strategies and adherence to HAART.
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Affiliation(s)
- Patricia de Oliveira França
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Lúcia Helena Pimassoni
- School of Medicine, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitoria, Espirito Santo, Brazil
| | - Crispim Cerutti Junior
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
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21
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Frenkel LM, Morrison RL, Fuller TL, Gouvêa MI, Benamor Teixeira MDL, Coombs RW, Shapiro DE, Mirochnick M, Hennessey R, Whitson K, Chakhtoura N, João EC. Brief Report: Vaginal Viral Shedding With Undetectable Plasma HIV Viral Load in Pregnant Women Receiving 2 Different Antiretroviral Regimens: A Randomized Clinical Trial. J Acquir Immune Defic Syndr 2021; 88:361-365. [PMID: 34369908 PMCID: PMC8547747 DOI: 10.1097/qai.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pregnant women using antiretrovirals (ARVs) may have persistent vaginal viral shedding, which could be associated with sexual and perinatal HIV transmission. However, there are scant data on vaginal viral load (VVL) in pregnant women with undetectable plasma viral load (PVL). METHODS This study was a post hoc analysis of an open-label randomized trial to evaluate the virologic response of 2 ART regimens. The participants were ART-naive women living with HIV initiating ART regimens between 20 and 36 weeks of pregnancy recruited at 19 clinical sites in 6 countries. Participants were randomized to receive 400 mg of raltegravir 2 times a day or 600 mg of efavirenz 4 times a day in addition to 150 mg of lamivudine and 300 mg of zidovudine 2 times a day. VVL and PVL tests were performed at every study visit. The primary outcome measures were HIV-1 PVL and VVL at maternal study week 4 and rates of perinatal HIV transmission. RESULTS A total of 408 were enrolled, of whom 323 had VVL samples 4 weeks after enrollment and were included in this analysis. Among women with undetectable/nonquantifiable PVL during ART, the overall rate of quantifiable VVL at week 4 was 2.54% (7/275). Of the 275 with nonquantifiable PVL, 99.1% (115/116) and 96.2% (153/159) had nonquantifiable VVL in the efavirenz and raltegravir arms, respectively. None of the 7 women with quantifiable VVL at the week 4 study visit transmitted HIV to their infants. CONCLUSIONS Detectable VVL in pregnant women with undetectable/nonquantifiable PVL while receiving ART was rare and not associated with perinatal HIV transmission.
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Affiliation(s)
- Lisa M. Frenkel
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics
- Laboratory Medicine and Pathology; and
- Global Health and Medicine, University of Washington, Seattle, WA
| | - R. Leavitt Morrison
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Trevon L. Fuller
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Maria Isabel Gouvêa
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - David E. Shapiro
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Mark Mirochnick
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | | | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Diseases Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Esaú C. João
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
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22
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Kousari A, Moser C, Olefsky M, Brown TT, Currier JS, McComsey GA, Scherzinger A, Stein JH, Lake JE, Erlandson KM. Poorer Muscle Quality and Quantity With ART Initiation Is Associated With Greater Inflammation and Immune Activation. J Acquir Immune Defic Syndr 2021; 88:399-405. [PMID: 34326283 PMCID: PMC8556226 DOI: 10.1097/qai.0000000000002776] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have previously shown that the initiation of antiretroviral therapy (ART) is associated with a decrease in skeletal muscle density (greater fat accumulation), suggesting that gains in lean body mass seen in many ART studies may reflect gains in low quality, fatty muscle. Here, we explore whether skeletal muscle density and area are associated with markers of inflammation and immune activation. METHODS ART-naïve people with HIV were randomized to raltegravir or ritonavir-boosted atazanavir or darunavir, each with tenofovir disoproxil fumarate/emtricitabine. Abdominal computed tomography scans from baseline and week 96 were reanalyzed for psoas density and area and correlations explored with inflammation [interleukin-6 (IL-6) and high-sensitivity C-reactive protein] and immune activation [soluble CD14 (sCD14), soluble CD163 (sCD163), and %CD38+HLADR+ on CD4+ or CD8+ T cells]. RESULTS Two hundred twenty-two participants had available inflammation/immune activation markers and paired computed tomography scans. At baseline, lower psoas density (greater fat) correlated with higher IL-6 (r = -0.26, P < 0.001) and sCD163 (r -0.15, P = 0.03) and lower lean psoas area correlated with higher IL-6, high-sensitivity C-reactive protein, sCD14, sCD163, and %CD38+HLADR+ on CD4+ T cells (r = -0.30-0.13; all P ≤ 0.05). From baseline to week 96, greater percent decrease in total psoas density (more fat) correlated with greater increase in IL-6 (r = -0.14; P = 0.04); greater % decrease in lean psoas area correlated greater increases in IL-6, sCD14, sCD163, and %CD38+HLADR+ on CD8+ T cells (r = -0.15 to -0.18; all P < 0.04). CONCLUSIONS Greater fat infiltration within the psoas muscle (lower density) and greater loss in lean psoas muscle area were associated with higher inflammation and immune activation, which may portend important effects on muscle function and cardiometabolic risk.
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Affiliation(s)
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health; Boston, MA
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23
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Salama E, Hill L, Patel N, Best BM, Momper JD. Brief Report: Pharmacokinetics of Bictegravir and Tenofovir in Combination With Darunavir/Cobicistat in Treatment-Experienced Persons With HIV. J Acquir Immune Defic Syndr 2021; 88:389-392. [PMID: 34285156 DOI: 10.1097/qai.0000000000002765] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bictegravir coformulated with emtricitabine and tenofovir alafenamide as a fixed-dose combination (BIC/FTC/TAF 50/200/25 mg) is recommended as an initial regimen in patients who are antiretroviral (ARV)-naïve or virologically suppressed on a stable ARV regimen. However, no real-world pharmacokinetic (PK) data are available in treatment-experienced patients with antiretroviral resistance receiving BIC/FTC/TAF plus a boosted protease inhibitor. SETTING/METHODS This prospective, single-center, nonrandomized pharmacokinetic study enrolled adult treatment-experienced persons with HIV and creatinine clearance >30 mL/min receiving BIC/FTC/TAF + DRV/c as part of routine clinical care. Steady-state PK profiles of BIC, TAF, tenofovir (TFV), and DRV after daily dosing of BIC/FTC/TAF + darunavir/cobicistat (DRV/c) were obtained with samples at predose and 0.5, 1, 2, and 4 hours postdose. The AUC0-24 at steady state was extrapolated by imputing C0 for C24 for each participant (AUC0-tau,exp). RESULTS Nine participants were enrolled with a median age of 59 years (range 54-67) and median number of years on ART of 19 (range 5.8-30). The median (interquartile range [IQR]) BIC AUC0-tau,exp and Cmax values were 128.9 µg*h/mL (78.1-159.5) and 6.9 µg/mL (5.1-9.8), respectively. The median (IQR) TAF AUC0-tau,exp and Cmax values were 0.376 µg*h/mL (0.199-0.430) and 0.276 µg/mL (0.149-0.543), respectively. Predose concentrations of TFV and DRV were comparable with historical data. CONCLUSION Treatment-experienced persons with HIV receiving BIC/FTC/TAF + darunavir/cobicistat (DRV/c) had BIC exposures (AUC0-tau) that were increased by approximately 26% compared with historical PK data. Although TAF exposures were substantially increased, plasma TFV was only modestly higher. These results suggest that BIC/TAF/FTC + DRV/c is a viable antiviral regimen option for treatment-experienced persons.
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Affiliation(s)
- Engie Salama
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA; and
| | - Lucas Hill
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA; and
| | - Nimish Patel
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA; and
| | - Brookie M Best
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA; and
- Pediatrics Department, University of California San Diego-Rady Children's Hospital San Diego, San Diego, CA
| | - Jeremiah D Momper
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA; and
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Manaye GA, Abateneh DD, Asmare WN, Abebe M. Factors associated with immunological and virological discordant responses to highly active antiretroviral therapy among adult HIV positive individuals in Ethiopia: A cross-sectional study. Medicine (Baltimore) 2021; 100:e27624. [PMID: 34964727 PMCID: PMC8615327 DOI: 10.1097/md.0000000000027624] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/05/2021] [Indexed: 01/05/2023] Open
Abstract
In clinical practice, not all human immune deficiency virus (HIV) positive individuals who received highly active antiretroviral therapy (HAART) achieve the desired concordant response characterized by a sustained viral suppression or immune recovery. The expected success of HAART doesn't occur in all treated patients and a discordant response between CD4 count and the viral load (VL) has been a major concern in the treatment of HIV patients. Thus, this study is designed to describe the factors associated with immunological and virological discordant responses to HAART among adult HIV positive individuals.A hospital-based cross-sectional study with secondary data review was conducted on 423 HIV positive individuals on HAART from February 1 to April 30, 2017. Socio-demographic characteristics, clinical data and about 10 mL of blood specimen for HIV VL, and CD4 count measurement were collected. The data was entered into SPSS version 20 and descriptive, bivariate, and multivariate logistic regression analysis was employed.The mean age of the patients at study time was 39 (±9.8). The average follow-up duration of patients on antiretroviral therapy (ART) was 7 (±3) years. The prevalence of immunological discordance and virological discordance to HAART were 13.2% and 47%, respectively. With multivariate logistic regression analysis duration of follow-up on ART ≤ 6 years (adjusted odds ratio [AOR] = 3.29 (1.80-6.03), P ≤ .001) and VL ≥20 copies/mm3 (AOR = 3.08 [1.70-5.61], P ≤ .001) were significant factors for immunological discordance conversely the patients who switched drug as a result of TB (AOR = 3.33 [1.10-10.08], P = .03) was significant factors for virological discordance.The prevalence of immunological discordance and virological discordance to HAART among HIV patients is high. Patients with the duration of follow-up on ART ≤ 6 years, VL ≥ 20 copies/mm3 and patients who switched drugs as a result of TB were significant factors for discordance. Hence, intensive adherence support and counseling should be provided to achieve the UNAIDS 90 target. HIV positive individuals co-infected with TB, who have had VL ≥ 20 copies/mm3 and who are ≤6 years duration of follow-up on ART need to be carefully monitored. In addition, national based study of discordant groups is recommended.
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Affiliation(s)
- Gizachew Ayele Manaye
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Dejene Derseh Abateneh
- Department of Medical Laboratory Science, Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Wondwossen Niguse Asmare
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Milkias Abebe
- Department of Medical Laboratory Science, Institute of Health Science, Wollega University, Lekemte, Ethiopia
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Giacomelli A, Cozzi-Lepri A, Cingolani A, Tavelli A, Mazzotta V, Tesoro D, Bassetti M, Castagna A, Di Biagio A, Lichter M, Monforte AD, Rusconi S. Does Syphilis Increase the Risk of HIV-RNA Elevation >200 Copies/mL in HIV-Positive Patients Under Effective Antiretroviral Treatment? Data From the ICONA Cohort. J Acquir Immune Defic Syndr 2021; 88:132-137. [PMID: 34138773 DOI: 10.1097/qai.0000000000002749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess the impact of syphilis infection on the risk of HIV-RNA elevation in people living with HIV (PLWH) with current HIV-RNA ≤50 copies/mL. SETTING The Italian Cohort Naive Antiretrovirals. METHODS All PLWH (2009-2020) under antiretroviral treatment with at least 2 consecutive HIV-RNA values ≤50 copies/mL before the date of syphilis diagnosis and at least 1 HIV-RNA determination after the syphilis event were enrolled. A control group of PLWH without syphilis was matched for mode of HIV transmission. Outcomes were defined using the first HIV-RNA measure in the time window ranging between -2 and +6 months of the diagnosis/index date. The primary outcome used a single value >200 copies/mL to define HIV-RNA elevation associated with risk of transmission. The association between syphilis infection and the protocol defined outcome was evaluated using logistic regression analysis. RESULTS Nine hundred twenty-six PLWH with a syphilis event were enrolled and matched with a random sample of 1370 PLWH without syphilis. Eighteen of the 926 (1.9%) with syphilis had ≥1 HIV-RNA >200 copies/mL in the window vs. 29/1370 (2.1%) of the not exposed (P = 0.77). In the multivariable analysis adjusted for age, year of diagnosis/index date, and clinical site, syphilis infection was not associated with the risk of HIV-RNA >200 copies/mL (adjusted odds ratio 0.81; 95% confidence interval 0.43-1.52, P = 0.508). CONCLUSIONS We did not find any evidence for an association between syphilis infection and viral elevation >200 copies/mL.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Diseases Unit, ASST-FBF-Sacco, Department of Biomedical and Clinical Sciences DIBIC Luigi Sacco, Università di Milano, Milan, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, United Kingdom
| | - Antonella Cingolani
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | | | - Daniele Tesoro
- Clinic of Infectious and Tropical Diseases, ASST Santi Paolo e Carlo, University of Milan Department of Health Sciences, Milan, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Department of Health Sciences, University of Genoa, Genova, Italy
| | - Antonella Castagna
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Department of Health Sciences, University of Genoa, Genova, Italy
| | - Miriam Lichter
- Infectious Diseases Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy; and
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, ASST Santi Paolo e Carlo, University of Milan Department of Health Sciences, Milan, Italy
| | - Stefano Rusconi
- III Infectious Diseases Unit, ASST-FBF-Sacco, Department of Biomedical and Clinical Sciences DIBIC Luigi Sacco, Università di Milano, Milan, Italy
- Currently, UOC Malattie Infettive, ASST Ovest Milanese, Ospedale di Legnano, Italy
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Bayleyegn B, Kifle ZD, Geremew D. Virological failure and associated factors among children receiving anti-retroviral therapy, Northwest Ethiopia. PLoS One 2021; 16:e0257204. [PMID: 34506553 PMCID: PMC8432779 DOI: 10.1371/journal.pone.0257204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Virological failure is under-recognized issue among children living with human immunodeficiency virus in developing countries. This partly may lead to failure to achieve the global goal of 90-90-90 targets in most developing countries including Ethiopia. OBJECTIVES This study aimed to assess the virological failure and its predictors among children receiving antiretroviral therapy at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia. METHODS An institutional based cross-sectional study was conducted among 253 study cohorts from January 2020-April 2021. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview, while detailed clinical data of the children were collected by reviewing the medical record. About 5 ml of blood were collected for the analysis of complete blood count and viral load quantification. Data were analyzed using SPSS version 20 and variables at p-value < 0.05 in the multivariable analysis were considered as statistically significant. RESULTS In this study, the viral load suppression rate among antiretroviral therapy experienced children was 68.8%. Meanwhile, the overall virological failure among study participants was 19.4%. Children living without family (AOR = 3.63; 95%CI: 1.27-10.24), children with unemployed family (AOR = 4.95; 95%CI: 1.74-14.12), being wasted (AOR = 3.02; 95%CI: 1.19-7.67) being stunted (AOR = 2.38;95%CI:1.03-5.46), anemia (AOR = 5.50:95%CI;1.37-22.04) and being lymphopenic (AOR = 2.69:95%CI;1.04-7.75) were significantly associated with virological failure among children under treatment. CONCLUSION Higher virological failure among children was noteworthy in the present study. Caretakers other than immediate family, unemployed family, wasted, stunted, anemia, and lymphopenia were significant independent predictors of virological failure. Hence, standard, and optimal management of children under treatment should be warranted.
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Affiliation(s)
- Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demeke Geremew
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Liu Q, Xu ZY, Wang XL, Huang XM, Zheng WL, Li MJ, Xiao F, Ouyang PW, Yang XH, Cui YH, Pan HW. Changes in Conjunctival Microbiota Associated With HIV Infection and Antiretroviral Therapy. Invest Ophthalmol Vis Sci 2021; 62:1. [PMID: 34473190 PMCID: PMC8419876 DOI: 10.1167/iovs.62.12.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose HIV infection is associated with a variety of ocular surface diseases. Understanding the difference of the ocular microbiota between HIV-infected and healthy individuals as well as the influence of antiretroviral therapy will help to investigate the pathogenesis of these conditions. Methods A cross-sectional study was conducted on subjects including HIV-negative individuals, untreated HIV-infected individuals, and HIV-infected individuals with antiretroviral therapy. Conjunctival microbiota was assessed by bacterial 16S rRNA sequencing of the samples obtained from the conjunctival swab. Results The microbial richness in ocular surface was similar in HIV-negative, untreated HIV-positive, and highly active antiretroviral therapy (HAART) subjects. The bacterial compositions were similar in the two HIV infection groups but were significantly different from the HIV-negative group. HAART changed the beta diversity of bacterial community as determined by Shannon index. CD4+ T cell count had no significant influence on the diversity of ocular microbiota in HIV-infected individuals. Conclusions The data revealed the compositional and structural difference in conjunctival microbial community in subjects with and without HIV infection, indicating that HIV infection or its treatment, may contribute to ocular surface dysbiosis.
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Affiliation(s)
- Qun Liu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Zhi-Yi Xu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, China
| | - Xiao-Li Wang
- Department of Ophthalmology, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Xiao-Mei Huang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wen-Lin Zheng
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Mei-Jun Li
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Fan Xiao
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Pei-Wen Ouyang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiao-Hua Yang
- Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Yu-Hong Cui
- Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
- Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Hong-Wei Pan
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
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Sun Y, Zhan Y, Li H, Yuan T, Gao Y, Liang B, Feng A, Li P, Zheng W, Fitzpatrick T, Wu D, Zhai X, Zou H. Stakeholder efforts to mitigate antiretroviral therapy interruption among people living with HIV during the COVID-19 pandemic in China: a qualitative study. J Int AIDS Soc 2021; 24:e25781. [PMID: 34473409 PMCID: PMC8412021 DOI: 10.1002/jia2.25781/full|10.1002/jia2.25781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/20/2021] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID-19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders. METHODS Between 11 February and 15 February 2020, we interviewed PLHIV, community-based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi-structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID-19 pandemic were discussed. Themes were identified by transcript coding and mindmaps. RESULTS Sixty-four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID-19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out-of-pocket ART. CONCLUSIONS Social and institutional disruption from COVID-19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.
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Affiliation(s)
- Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Li
- Shizhong District Center for Disease Control and Prevention, Jinan, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bowen Liang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Anping Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peiyang Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Dan Wu
- London School of Hygiene & Tropical Medicine, London, UK
| | - Xinyi Zhai
- Danlan Goodness, BlueCity Holdings Ltd., Beijing, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
HIV-1 persists in infected individuals despite years of antiretroviral therapy (ART), due to the formation of a stable and long-lived latent viral reservoir. Early ART can reduce the latent reservoir and is associated with post-treatment control in people living with HIV (PLWH). However, even in post-treatment controllers, ART cessation after a period of time inevitably results in rebound of plasma viraemia, thus lifelong treatment for viral suppression is indicated. Due to the difficulties of sustained life-long treatment in the millions of PLWH worldwide, a cure is undeniably necessary. This requires an in-depth understanding of reservoir formation and dynamics. Differences exist in treatment guidelines and accessibility to treatment as well as social stigma between low- and-middle income countries (LMICs) and high-income countries. In addition, demographic differences exist in PLWH from different geographical regions such as infecting viral subtype and host genetics, which can contribute to differences in the viral reservoir between different populations. Here, we review topics relevant to HIV-1 cure research in LMICs, with a focus on sub-Saharan Africa, the region of the world bearing the greatest burden of HIV-1. We present a summary of ART in LMICs, highlighting challenges that may be experienced in implementing a HIV-1 cure therapeutic. Furthermore, we discuss current research on the HIV-1 latent reservoir in different populations, highlighting research in LMIC and gaps in the research that may facilitate a global cure. Finally, we discuss current experimental cure strategies in the context of their potential application in LMICs.
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Affiliation(s)
- Sherazaan D Ismail
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Joshua Pankrac
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada
| | - Emmanuel Ndashimye
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada
- Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda
| | - Jessica L Prodger
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa-Rose Abrahams
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Jamie F S Mann
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, UK
| | - Andrew D Redd
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Eric J Arts
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada.
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA.
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Dlamini Z, Mbele M, Makhafola TJ, Hull R, Marima R. HIV-Associated Cancer Biomarkers: A Requirement for Early Diagnosis. Int J Mol Sci 2021; 22:ijms22158127. [PMID: 34360891 PMCID: PMC8348540 DOI: 10.3390/ijms22158127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, HIV/AIDS and cancer are increasingly public health problems and continue to exist as comorbidities. The sub-Saharan African region has the largest number of HIV infections. Malignancies previously associated with HIV/AIDS, also known as the AIDS-defining cancers (ADCs) have been documented to decrease, while the non-AIDS defining cancer (NADCs) are on the rise. On the other hand, cancer is a highly heterogeneous disease and precision oncology as the most effective cancer therapy is gaining attraction. Among HIV-infected individuals, the increased risk for developing cancer is due to the immune system of the patient being suppressed, frequent coinfection with oncogenic viruses and an increase in risky behavior such as poor lifestyle. The core of personalised medicine for cancer depends on the discovery and the development of biomarkers. Biomarkers are specific and highly sensitive markers that reveal information that aid in leading to the diagnosis, prognosis and therapy of the disease. This review focuses mainly on the risk assessment, diagnostic, prognostic and therapeutic role of various cancer biomarkers in HIV-positive patients. A careful selection of sensitive and specific HIV-associated cancer biomarkers is required to identify patients at most risk of tumour development, thus improving the diagnosis and prognosis of the disease.
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Campbell GR, Spector SA. Induction of Autophagy to Achieve a Human Immunodeficiency Virus Type 1 Cure. Cells 2021; 10:cells10071798. [PMID: 34359967 PMCID: PMC8307643 DOI: 10.3390/cells10071798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Effective antiretroviral therapy has led to significant human immunodeficiency virus type 1 (HIV-1) suppression and improvement in immune function. However, the persistence of integrated proviral DNA in latently infected reservoir cells, which drive viral rebound post-interruption of antiretroviral therapy, remains the major roadblock to a cure. Therefore, the targeted elimination or permanent silencing of this latently infected reservoir is a major focus of HIV-1 research. The most studied approach in the development of a cure is the activation of HIV-1 expression to expose latently infected cells for immune clearance while inducing HIV-1 cytotoxicity—the “kick and kill” approach. However, the complex and highly heterogeneous nature of the latent reservoir, combined with the failure of clinical trials to reduce the reservoir size casts doubt on the feasibility of this approach. This concern that total elimination of HIV-1 from the body may not be possible has led to increased emphasis on a “functional cure” where the virus remains but is unable to reactivate which presents the challenge of permanently silencing transcription of HIV-1 for prolonged drug-free remission—a “block and lock” approach. In this review, we discuss the interaction of HIV-1 and autophagy, and the exploitation of autophagy to kill selectively HIV-1 latently infected cells as part of a cure strategy. The cure strategy proposed has the advantage of significantly decreasing the size of the HIV-1 reservoir that can contribute to a functional cure and when optimised has the potential to eradicate completely HIV-1.
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Affiliation(s)
- Grant R. Campbell
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA;
- Correspondence: ; Tel.: +1-858-534-7477
| | - Stephen A. Spector
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA;
- Rady Children’s Hospital, San Diego, CA 92123, USA
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Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, Leo YS, Chow A. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore) 2021; 100:e26507. [PMID: 34190180 PMCID: PMC8257899 DOI: 10.1097/md.0000000000026507] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Vernon Jian Ming Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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RICCARDI NICCOLÒ, CENDERELLO GIOVANNI, CROCE DAVIDE, DI PERRI GIOVANNI, RIZZARDINI GIULIANO, MARTINI MARIANO, DI BIAGIO ANTONIO. Nine ideas to improve the clinical management of HIV infected patients during the COVID-19 pandemic. J Prev Med Hyg 2021; 62:E30-E33. [PMID: 34622081 PMCID: PMC8452289 DOI: 10.15167/2421-4248/jpmh2021.62.1s3.1892] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022]
Abstract
Globally, in 2019, HIV infection was still responsible for 1.7 million new infections and for 690,000 deaths in the same year. Tailored and new antiretroviral therapy (ART) regimens, individualised follow-up and new technologies to support data-sharing between health-care professional caring for people living with HIV (PLHIV) and to deliver ART to patients are desperately needed to reach the 90-90-90-90 ambitious goals. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, responsible for the Coronavirus-19 (COVID-19) pandemic that spread globally in 2020, posed a huge challenge for PLHIV and HIV physicians worldwide in terms of continuum of care. In this paper we encourage “up-to-date patient-centred HIV medicine” and we give nine ideas to improve HIV management in clinical practice during the COVID-19 pandemic.
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Affiliation(s)
- NICCOLÒ RICCARDI
- StopTB Italia Onlus, Milan, Italy
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Correspondence: Niccolò Riccardi, Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy - Tel.: +39 045 601 4620 - E-mail:
| | - GIOVANNI CENDERELLO
- Infectious Diseases, Department of Graduated Medical Care, Sanremo Hospital, Sanremo, Italy
| | - DAVIDE CROCE
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - GIOVANNI DI PERRI
- Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - GIULIANO RIZZARDINI
- Fatebenefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - ANTONIO DI BIAGIO
- Infectious Disease, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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van Wyk J, Ait-Khaled M, Santos J, Scholten S, Wohlfeiler M, Ajana F, Jones B, Nascimento MC, Tenorio AR, Smith DE, Wright J, Wynne B. Brief Report: Improvement in Metabolic Health Parameters at Week 48 After Switching From a Tenofovir Alafenamide-Based 3- or 4-Drug Regimen to the 2-Drug Regimen of Dolutegravir/Lamivudine: The TANGO Study. J Acquir Immune Defic Syndr 2021; 87:794-800. [PMID: 33587500 PMCID: PMC8126488 DOI: 10.1097/qai.0000000000002655] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In TANGO, switching to dolutegravir/lamivudine was noninferior at 48 weeks to continuing 3-/4-drug tenofovir alafenamide-based regimens in virologically suppressed individuals with HIV-1. Antiretroviral agents have been associated with weight gain and metabolic complications. SETTING One hundred thirty-four centers; 10 countries. METHODS We assessed weight; fasting lipids, glucose, and insulin; and prevalence of insulin resistance and metabolic syndrome at baseline and week 48 in TANGO participant subgroups by boosting agent use in baseline regimens (boosted and unboosted). RESULTS In each treatment group, 74% of participants used boosted regimens at baseline. In boosted and unboosted subgroups, weight and fasting glucose changes at week 48 were small and similar between treatment groups. Overall and in the boosted subgroup, greater decreases from baseline were observed with dolutegravir/lamivudine in fasting total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), triglycerides (P < 0.001), total cholesterol/high-density lipoprotein cholesterol ratio (overall, P = 0.017; boosted, P = 0.007), and insulin (boosted, P = 0.005). Prevalence of HOMA-IR ≥2 was significantly lower at week 48 with dolutegravir/lamivudine overall [adjusted odds ratio (aOR), 0.59; 95% confidence interval (CI), 0.40 to 0.87; P = 0.008] and in the boosted subgroup [aOR, 0.56; 95% CI, 0.36 to 0.88; P = 0.012] but not in the unboosted subgroup [aOR, 0.70; 95% CI, 0.31 to 1.58; P = 0.396]. Prevalence of metabolic syndrome at week 48 was low and consistent between treatment groups overall, with differences trending to favor dolutegravir/lamivudine in the unboosted subgroup [aOR, 0.41; 95% CI, 0.15 to 1.09; P = 0.075]. CONCLUSION Generally, switching from 3-/4-drug tenofovir alafenamide-based regimens to dolutegravir/lamivudine improved metabolic parameters, particularly when switching from boosted regimens. Because of smaller sample size in the unboosted subgroup, results warrant further investigation.
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Affiliation(s)
| | | | - Jesus Santos
- Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Faïza Ajana
- Infectious Diseases, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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Touizer E, Alrubayyi A, Rees-Spear C, Fisher-Pearson N, Griffith SA, Muir L, Pellegrino P, Waters L, Burns F, Kinloch S, Rowland-Jones S, Gupta RK, Gilson R, Peppa D, McCoy LE. Failure to seroconvert after two doses of BNT162b2 SARS-CoV-2 vaccine in a patient with uncontrolled HIV. Lancet HIV 2021; 8:e317-e318. [PMID: 34087093 PMCID: PMC8169058 DOI: 10.1016/s2352-3018(21)00099-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Emma Touizer
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | | | - Chloe Rees-Spear
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | | | - Sarah A Griffith
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Luke Muir
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Pierre Pellegrino
- The Mortimer Market Centre, Department of HIV, CNWL NHS Foundation Trust, London, UK
| | - Laura Waters
- The Mortimer Market Centre, Department of HIV, CNWL NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London WC1E 6BT, UK; Department of HIV Medicine, Royal Free NHS Foundation Trust, London, UK
| | - Sabine Kinloch
- Department of Immunology, Royal Free Campus, University College London, London WC1E 6BT, UK; Department of Infection and Immunity, Royal Free NHS Foundation Trust, London, UK
| | | | | | - Richard Gilson
- Institute for Global Health, University College London, London WC1E 6BT, UK
| | - Dimitra Peppa
- The Mortimer Market Centre, Department of HIV, CNWL NHS Foundation Trust, London, UK; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Laura E McCoy
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK.
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Wairimu F, Ward NC, Liu Y, Dwivedi G. Cardiac Transplantation in HIV-Positive Patients: A Narrative Review. J Acquir Immune Defic Syndr 2021; 87:763-768. [PMID: 33534274 DOI: 10.1097/qai.0000000000002647] [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: 10/16/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.
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Affiliation(s)
- Faith Wairimu
- Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth Australia
| | - Natalie C Ward
- School of Medicine, University of Western Australia, Perth Australia ; and
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Yingwei Liu
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Girish Dwivedi
- Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth Australia
- School of Medicine, University of Western Australia, Perth Australia ; and
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
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Kumar P, Johnson M, Molina JM, Rizzardini G, Cahn P, Bickel M, Wan H, Xu ZJ, Morais C, Sklar P, Greaves W. Brief Report: Switching to DOR/3TC/TDF Maintains HIV-1 Virologic Suppression Through Week 144 in the DRIVE-SHIFT Trial. J Acquir Immune Defic Syndr 2021; 87:801-805. [PMID: 33633036 PMCID: PMC8126485 DOI: 10.1097/qai.0000000000002642] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the primary analysis of the DRIVE-SHIFT trial, switching to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintained suppression of HIV-1 through week 48. Here, we present long-term efficacy and safety outcomes through week 144 of the DRIVE-SHIFT trial. METHODS This phase 3, randomized, open-label trial evaluated switching from a stable antiretroviral regimen to once-daily DOR/3TC/TDF in adults with HIV-1 suppressed for ≥6 months and no previous virologic failure. Participants switched at day 1 [immediate switch group (ISG); n = 447] or week 24 [delayed switch group (DSG); n = 209]. Nine ISG participants who completed week 48 but did not enter extension-1 were excluded from week 144 efficacy analyses. RESULTS At week 144, HIV-1 RNA <50 copies/mL was maintained in 80.1% of the ISG (351/438) and 83.7% of the DSG (175/209), while 2.7% (12/438) and 4.8% (10/209), respectively, had HIV-1 RNA ≥50 copies/mL (Food and Drug Administration Snapshot approach). Protocol-defined virologic failure after switch occurred in 2.1% of ISG (9/438) and 3.3% of DSG (7/209); no viral resistance to doravirine was detected in 4 participants with samples available. Reductions in fasting lipids were observed at 24 weeks after switch and maintained through week 144. The mean weight change from switch to week 144 was +1.4 kg for ISG and +1.2 kg for DSG. The most common adverse events were nasopharyngitis (16.2%), headache (12.3%), and diarrhea (9.1%). Overall, 4.1% discontinued because of adverse events, and no deaths occurred. CONCLUSIONS These results confirm that switching to once-daily DOR/3TC/TDF is a generally well-tolerated option for maintaining viral suppression in adults considering a change in therapy. REGISTRATION ClinicalTrials.gov NCT02397096.
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Affiliation(s)
- Princy Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC
| | - Margaret Johnson
- Department of HIV Medicine, Royal Free Hospital, London, United Kingdom
| | - Jean-Michel Molina
- Saint-Louis and Lariboisière Hospitals, APHP, University of Paris, INSERM U944, Paris, France
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco Hospital, Milan, Italy
| | - Pedro Cahn
- Fundación Huésped and Buenos Aires University, Buenos Aires, Argentina
| | - Markus Bickel
- Infektiologikum, Centre for Infectious Diseases, Frankfurt, Germany; and
| | - Hong Wan
- Merck & Co., Inc., Kenilworth, NJ
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Gisslen M, Keating SM, Spudich S, Arechiga V, Stephenson S, Zetterberg H, Di Germanio C, Blennow K, Fuchs D, Hagberg L, Norris PJ, Peterson J, Shacklett BL, Yiannoutsos CT, Price RW. Compartmentalization of cerebrospinal fluid inflammation across the spectrum of untreated HIV-1 infection, central nervous system injury and viral suppression. PLoS One 2021; 16:e0250987. [PMID: 33983973 PMCID: PMC8118251 DOI: 10.1371/journal.pone.0250987] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/16/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To characterize the evolution of central nervous system (CNS) inflammation in HIV-1 infection applying a panel of cerebrospinal fluid (CSF) inflammatory biomarkers to grouped subjects representing a broad spectrum of systemic HIV-1 immune suppression, CNS injury and viral control. METHODS This is a cross-sectional analysis of archived CSF and blood samples, assessing concentrations of 10 functionally diverse soluble inflammatory biomarkers by immunoassays in 143 HIV-1-infected subjects divided into 8 groups: untreated primary HIV-1 infection (PHI); four untreated groups defined by their blood CD4+ T lymphocyte counts; untreated patients presenting with subacute HIV-associated dementia (HAD); antiretroviral-treated subjects with ≥1 years of plasma viral suppression; and untreated elite controllers. Twenty HIV-1-uninfected controls were included for comparison. Background biomarkers included blood CD4+ and CD8+ T lymphocytes, CSF and blood HIV-1 RNA, CSF white blood cell (WBC) count, CSF/blood albumin ratio, CSF neurofilament light chain (NfL), and CSF t-tau. FINDINGS HIV-1 infection was associated with a broad compartmentalized CSF inflammatory response that developed early in its course and changed with systemic disease progression, development of neurological injury, and viral suppression. CSF inflammation in untreated individuals without overt HAD exhibited at least two overall patterns of inflammation as blood CD4+ T lymphocytes decreased: one that peaked at 200-350 blood CD4+ T cells/μL and associated with lymphocytic CSF inflammation and HIV-1 RNA concentrations; and a second that steadily increased through the full range of CD4+ T cell decline and associated with macrophage responses and increasing CNS injury. Subacute HAD was distinguished by a third inflammatory profile with increased blood-brain barrier permeability and robust combined lymphocytic and macrophage CSF inflammation. Suppression of CSF and blood HIV-1 infections by antiretroviral treatment and elite viral control were associated with reduced CSF inflammation, though not fully to levels found in HIV-1 seronegative controls.
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Affiliation(s)
- Magnus Gisslen
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sheila M. Keating
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, United States of America
| | - Serena Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Victor Arechiga
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Sophie Stephenson
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Clara Di Germanio
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, United States of America
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Innsbruck Medical University, Innsbruck, Austria
| | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Philip J. Norris
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, United States of America
| | - Julia Peterson
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Barbara L. Shacklett
- Department of Medical Microbiology and Immunology, University of California Davis, Davis CA, United States of America
| | - Constantin T. Yiannoutsos
- Department of Biostatistics, Indiana University R.M. Fairbanks School of Public Health, Indianapolis, IN, United States of America
| | - Richard W. Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
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Busi AN, Nsoh M, Otieno MO, Ndeso SA, Halle-Ekane GE. Evaluation of quality of life and associated factors among HIV patients on antiretroviral therapy in North West region of Cameroon. Afr Health Sci 2021; 21:8-17. [PMID: 34447418 PMCID: PMC8367311 DOI: 10.4314/ahs.v21i1.3s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is evidence that Quality of Life (QoL) of People Living with HIV/AIDS (PLHIV) has a significant role in ART retention, treatment adherence, and survival. As a result, QoL is becoming increasingly important for policymakers, program implementers, and researchers. However, factors associated with QoL, in a culturally diverse country like Cameroon are unknown. OBJECTIVE We aimed to assess the QoL of PLHIV on ART and assess the extent to which physical, psychosocial, environmental, and spiritual factors drive QoL. METHOD A cross-sectional study was conducted among 394 PLHIV aged >21 in North-West Cameroon from April to July 2019. Data were collected using WHO-QOL BREF questionnaire. Descriptive statistics, bivariate, and multivariate linear regression analyses were performed. RESULTS Majority (34.5%) of participants were in the age range of 41-50, with 73% females. The average QoL of the respondents was "good" with mean score of 3.57 on 5 and 71.4% agreed to have satisfactory QoL. Bivariate regression analyses revealed that all six proposed predictors were significantly associated with QoL. Psychological factors made the greatest impact (β = 0.213; p<0.003), followed by physical factors (β = 0.19; p<0.001). CONCLUSION PLHIV fairly agreed to have good QoL. The QoL was driven by mainly psychological and physical factors and not level of independence. However, the mean score perceptions for the investigated domains were low. Mental health services should consider these predictors when designing strategies to improve the QoL of PLHIV. While this study provides useful insights, other possible drivers of QoL among PLHIV should be investigated.
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Affiliation(s)
- Anissette N Busi
- Georgetown University Center for Global Health Practice and Impact; TIDE Project, Cameroon
| | - Marius Nsoh
- Department of Public Health, School of Health Sciences, Catholic University of Central Africa; Cameroon
| | - Moses O Otieno
- National AIDS and Sexually Transmitted Infections Control Program (NASCOP); Kenya
| | - Sylvester A Ndeso
- Department of Public Health, Faculty of Health Sciences, University of Buea; Cameroon
| | - Gregory E Halle-Ekane
- Department of Public Health, Faculty of Health Sciences, University of Buea; Cameroon
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Nsoh M, Tshimwanga KE, Ngum BA, Mgasa A, Otieno MO, Moali B, Sirili N, Atanga NS, Halle-Ekane GE. Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon. Afr Health Sci 2021; 21:29-38. [PMID: 34447421 PMCID: PMC8367305 DOI: 10.4314/ahs.v21i1.6s] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. OBJECTIVE We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influencing return to care. METHOD We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemographic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance approved by CBCHS-IRB. RESULTS A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. CONCLUSION Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered approaches like multiplying proxy ART pick points, devolving stable clients to community ARV model.
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Affiliation(s)
- Marius Nsoh
- Department of Public Health, School of Health Sciences, Catholic University of Central Africa; Cameroon
- HIV Free Project, Cameroon Baptist Convention Health Services, Center region; Cameroon
| | - Katayi E Tshimwanga
- HIV Free Project, Cameroon Baptist Convention Health Services, Center region; Cameroon
| | - Busi A Ngum
- Women Health Program, Mbingo Baptist Hospital, Cameroon Baptist Convention Health Services; Cameroon
| | - Avelina Mgasa
- Ministry of Health Community Development, Gender, Elderly and Children; National Blood Transfusion Service; Tanzania
| | - Moses O Otieno
- National AIDS and Sexually Transmitted Infections Control Program (NASCOP); Kenya
| | - Bokwena Moali
- Ministry of Health and Wellness, Okavango District, Botswana
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences; Tanzania
| | - Ndeso S Atanga
- Department of Public Health, Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea; Cameroon
| | - Gregory E Halle-Ekane
- Department of Public Health, Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea; Cameroon
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Mburugu P, Muiruri P, Opiyo N, Simba J, Adunda J, Kawira R, Gachuno O. Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya. Afr Health Sci 2021; 21:1-7. [PMID: 34447417 PMCID: PMC8367303 DOI: 10.4314/ahs.v21i1.2s] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. OBJECTIVE To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. METHODOLOGY A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. RESULTS A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ml p<0.012. CONCLUSION The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).
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Affiliation(s)
- Patrick Mburugu
- Jomo Kenyatta University of Agriculture and Technology, Child Health and Pediatrics
| | - Peter Muiruri
- Kenyatta National Hospital, Kenya, Comprehensive Care Centre
| | - Nelly Opiyo
- Kenyatta National Hospital, Kenya, Comprehensive Care Centre
| | - Justus Simba
- Jomo Kenyatta University of Agriculture and Technology, Child Health and Pediatrics
| | - Jane Adunda
- Jomo Kenyatta University of Agriculture and Technology, Biostatistics and Actuarial Sciences
| | - Rosemary Kawira
- Jomo Kenyatta University of Agriculture and Technology, School of Nursing Sciences
| | - Onesmus Gachuno
- University of Nairobi, Department of Obstetrics and Gynecology
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Bachanas P, Alwano MG, Lebelonyane R, Block L, Behel S, Raizes E, Ussery G, Wang H, Ussery F, Pretorius Holme M, Sexton C, Pals S, Lasry A, Del Castillo L, Hader S, Lockman S, Bock N, Moore J. Finding, treating and retaining persons with HIV in a high HIV prevalence and high treatment coverage country: Results from the Botswana Combination Prevention Project. PLoS One 2021; 16:e0250211. [PMID: 33882092 PMCID: PMC8059857 DOI: 10.1371/journal.pone.0250211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The scale-up of Universal Test and Treat has resulted in reductions in HIV morbidity, mortality and incidence. However, healthcare system and personal challenges have impacted the levels of treatment coverage achieved. We implemented interventions to improve linkage to care, retention, viral load (VL) coverage and service delivery, and describe the HIV care cascade over the course of the Botswana Combination Prevention Project (BCPP) study. METHODS BCPP was designed to evaluate the impact of prevention interventions on HIV incidence in 30 communities in Botswana. We followed a longitudinal cohort of newly identified and known HIV-positive persons not on antiretroviral therapy (ART) identified through community-based testing activities through BCPP and referred with appointments to local HIV clinics in 15 intervention communities. Those who did not keep the first or follow-up appointments were tracked and traced through phone and home contacts. Improvements to service delivery models in the intervention clinics were also implemented. RESULTS A total of 3,657 newly identified or HIV-positive persons not on ART were identified and referred to their local HIV clinic; 90% (3,282/3,657) linked to care and of those, 93% (3,066/3,282) initiated treatment. Near the end of the study, 221 persons remained >90 days late for appointments or missing. Tracing efforts identified 54/3,066 (2%) persons who initiated treatment but died, and 106/3,066 (3%) persons were located and returned to treatment. At study end, 61/3,066 (2%) persons remained missing and were never reached. Overall, 2,951 (98%) persons living with HIV (PLHIV) who initiated treatment were still alive, retained in care and still receiving ART out of the 3,001 persons alive at the end of the study. Of those on ART, 2,854 (97%) had current VL results and 2,784 (98%) of those were virally suppressed at study end. CONCLUSIONS This study achieved high rates of linkage, treatment initiation, retention and VL coverage and suppression in a cohort of newly identified and known PLHIV not on ART. Tracking and tracing interventions effectively identified those persons who needed more resource intensive follow-up. The interventions implemented to improve service delivery and data quality may have also contributed to high linkage and retention rates. Clinical trial number: NCT01965470.
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Affiliation(s)
- Pamela Bachanas
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary Grace Alwano
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Lisa Block
- Northrup Grumman, Atlanta, Georgia, United States of America
| | - Stephanie Behel
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elliot Raizes
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gene Ussery
- Northrup Grumman, Atlanta, Georgia, United States of America
| | - Huisheng Wang
- Northrup Grumman, Atlanta, Georgia, United States of America
| | - Faith Ussery
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Molly Pretorius Holme
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Connie Sexton
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sherri Pals
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arielle Lasry
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisetta Del Castillo
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Shahin Lockman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Naomi Bock
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janet Moore
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Abe OE, Fagbule OF, Olaniyi OO, Adisa AO, Gbolahan OO. Orofacial lesions associated with long-term highly active antiretroviral therapy among HIV-seropositive adults in Ibadan, Nigeria. Pan Afr Med J 2021; 38:370. [PMID: 34367449 PMCID: PMC8308855 DOI: 10.11604/pamj.2021.38.370.25322] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/07/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION highly active antiretroviral therapy (HAART) has contributed to a reduction in HIV- related oral lesions and improved quality of life among HIV seropositive patients. However, the therapy is not without its side effects. This study was aimed at assessing the self- reported orofacial manifestations due to long term use of HAART, as well as the pattern of oral lesions on examination. METHODS this was a cross-sectional study conducted among HIV seropositive adult patients in Ibadan, who had been on HAART for at least two years. Data were collected using an interviewer-administered questionnaire. Clinical diagnosis of HIV-related oral lesions was made according to the EC-Clearinghouse criteria. Data analysis was done using SPSS version 25. RESULTS the study participants comprised of 227 HIV seropositive patients who were HAART experienced, with 54 (24%) males and 173 (76%) females. Their mean age (±SD) was 44.7 (±9.4) years. The participants CD4 count ranged from 13-1338cells/mm3, with a median count of 341 cells/mm3. About half (45%) of the participants noted one or more orofacial changes since they commenced HAART. These oral changes included dryness of mouth, burning sensation, abnormal taste, melanotic hyperpigmentation, oral thrush, ulcers, and parotid swelling. Most of those who reported oral changes had been on HAART over 10 years (p=0.03), and the changes were more reported among those on the first-line regimen. CONCLUSION melanotic hyperpigmentation was the most common oral lesion found and burning mouth syndrome was the most commonly reported complain among HIV-seropositive adults who are on long-term HAART.
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Affiliation(s)
| | - Omotayo Francis Fagbule
- Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria
| | | | - Akinyele Olumuyiwa Adisa
- Department of Oral Pathology and Oral Medicine, University College Hospital, Ibadan, Nigeria
- Department of Oral Pathology, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olalere Omoyosola Gbolahan
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
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Asrie F, Bazezew A, Motbaynor A, Zeleke B, Dessie K, Bimrew S, Yalew A. Magnitude of Anemia and Associated Factors Among Human Immunodeficiency Virus Infected Children on Highly Active Antiretroviral Therapy at University of Gondar Comprehensive and Specialized Referral Hospital Northwest Ethiopia. Clin Lab 2021; 66. [PMID: 32538059 DOI: 10.7754/clin.lab.2019.190835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anemia is one of the most common hematological problems in HIV infected patients in the world. The main aim of this study was to determine the magnitude of anemia and associated factors among HIV infected children on highly active antiretroviral therapy attending University of Gondar Comprehensive and Specialized Referral Hospital. METHODS A retrospective study was conducted from 2013 to 2018 by reviewing medical records at University of Gondar Comprehensive and Specialized Referral Hospital ART clinic. Records of 238 HIV infected children on HAART were selected using a convenient sampling technique. Socio-demographic characteristics, clinical information, and hematological and immunological profiles of the study participants were collected from the patients record books. WHO cutoff value of hemoglobin was taken and adjusted to define anemia in higher altitude. Data was analyzed by using the SPSS version 20 statistical software, and odds ratios with 95% confidence intervals were used to quantify the strength of association between anemia and its potential predictors. RESULTS The overall prevalence of anemia among HIV infected children in this study was 38.7%. Of anemic children, 48.9% had mild, 39.1% moderate, and 11.9% severe anemia. This study showed that HIV infected children on Highly Active Antiretroviral Therapy who live in rural residence had a two-fold risk of being anemia than urban dwellers (AOR = 2.151, 95% CI, 1.123 - 4.122). There was no significant association with gender, WHO clinical stage, opportunistic infections, cotrimoxazole treatment, and CD4 count percentage. CONCLUSIONS Anemia is a common problem among the children taking highly active antiretroviral therapy. Therefore, health care workers need to routinely investigate and treat anemia, especially in rural dwellers. Furthermore, large scale and longitudinal studies are recommended to strengthen and explore the problem in depth.
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Goldschmidt R, Chu C. HIV Infection in Adults: Initial Management. Am Fam Physician 2021; 103:407-416. [PMID: 33788514] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The HIV epidemic is an important public health priority. Transmissions continue to occur despite effective therapies that make HIV preventable and treatable. Approximately one-half of people with HIV are not receiving suppressive antiretroviral therapy (ART). Starting ART early, followed by continuous lifetime treatment, most effectively achieves durable virologic suppression and restoration of immune function that can improve clinical outcomes and prevent transmission to partners who are seronegative. National treatment guidelines include ART options that can be offered immediately after diagnosis, even before the results of baseline HIV drug-resistance testing are available. Initial ART selection should be guided by co-occurring conditions, including viral hepatitis, medications, and other factors such as pregnancy. Identifying and addressing psychosocial barriers to care is a key element of ensuring long-term adherence to treatment. The initial physical examination typically reveals no clinical manifestations of HIV in the absence of advanced disease. A comprehensive laboratory evaluation, including HIV viral load and CD4 lymphocyte monitoring, is necessary to guide decision-making for treatment, opportunistic infection prophylaxis, and vaccinations. The initial management of people with HIV presents a unique opportunity for family physicians to improve patients' long-term health care and reduce HIV transmissions.
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Affiliation(s)
- Ronald Goldschmidt
- University of California-San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Carolyn Chu
- University of California-San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Wexler C, Maloba M, Goggin K, Kale SB, Maosa N, Muchoki E, Brown M, Gautney B, Finocchario-Kessler S. ART Initiation for Infants Diagnosed With HIV Through Point of Care and Conventional Polymerase Chain Reaction Testing in Kenya: A Case Series. Pediatr Infect Dis J 2021; 40:e151-e153. [PMID: 33464012 PMCID: PMC7954882 DOI: 10.1097/inf.0000000000003032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We sought to understand the sequence of testing and treatment among nine infants offered both conventional and point-of-care testing and diagnosed as HIV-positive by 6 months of age in Kenya. One infant received per protocol testing and treatment. Patient-level (late presentation and disengagement), provider-level (reluctance and error/oversight) and system-level (stock outs, errors) challenges delayed diagnosis and treatment. Early point-of-care testing can streamline testing; however, challenges mitigate benefits.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Kathy Goggin
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO
| | | | | | | | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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Houle B, Kabudula CW, Stein A, Gareta D, Herbst K, Clark SJ. Linking the timing of a mother's and child's death: Comparative evidence from two rural South African population-based surveillance studies, 2000-2015. PLoS One 2021; 16:e0246671. [PMID: 33556118 PMCID: PMC7869981 DOI: 10.1371/journal.pone.0246671] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effect of the period before a mother's death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother's death on child survival up to age five years in rural South Africa. METHODS We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000-2015) to estimate a child's risk of dying before and after their mother's death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother's death on child survival. FINDINGS 3,618 children died from 2000-2015. The probability of a child dying began to increase in the 7-11 months prior to the mother's death and increased markedly in the 3 months before (2000-2003 relative risk = 22.2, 95% CI = 14.2-34.6) and 3 months following her death (2000-2003 RR = 20.1; CI = 10.3-39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children's mortality risk independent of the association between timing of mother and child mortality. CONCLUSIONS The persistence of elevated mortality risk both before and after the mother's death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child's risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Chodziwadziwa W. Kabudula
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Samuel J. Clark
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- Department of Sociology, The Ohio State University, Columbus, Ohio, United States of America
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Berruti M, Riccardi N, Canetti D, Lo Caputo S, Taramasso L, Di Biagio A. Injectable Antiretroviral Drugs: Back to the Future. Viruses 2021; 13:v13020228. [PMID: 33540877 PMCID: PMC7913057 DOI: 10.3390/v13020228] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022] Open
Abstract
Current HIV treatment regimens provide sustained virologic suppression, at least partially restore the immune system and have limited side effects; however, they do not allow viral eradication and they are burdened by daily pill intake with a life-long commitment for the people living with HIV (PHIV). Injectable agents might represent a turning point in the care of PHIV, allowing less frequent administration of antiretroviral treatment (ART), more widespread use of pre-exposure prophylaxis (PrEP) and more stable drug levels in the blood, thus increasing the odds to get closer to end the HIV pandemic. The aim of this manuscript is to give a comprehensive review of injectable antiretrovirals that have been used in the past, which are available now, will be available in the future, and their role in the treatment of HIV infection
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Affiliation(s)
- Marco Berruti
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
| | - Niccolò Riccardi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Diana Canetti
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20097 Milan, Italy;
- School of Medicine, Vita-Salute San Raffaele University, 20097 Milan, Italy
| | - Sergio Lo Caputo
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy;
| | - Antonio Di Biagio
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy;
- Correspondence:
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Luo Y, Jia T, Fang J, Liu D, Saikam V, Sheng X, Iyer SS. Rapid, user-friendly, and inexpensive detection of azidothymidine. Anal Bioanal Chem 2021; 413:1999-2006. [PMID: 33484329 DOI: 10.1007/s00216-021-03168-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 11/25/2022]
Abstract
Strict adherence to highly active antiretroviral therapy (HAART) is very important to improve the quality of life for HIV-positive patients to reduce new infections and determine treatment success. Azidothymidine (AZT) is an antiretroviral drug commonly used in HAART treatment. In this research, an "add, mix, and measure" assay was developed to detect AZT within minutes. Three different probes designed to release fluorophores when samples containing AZT are added were synthesized and characterized. The limit of detection to AZT in simulated urine samples was determined to be 4 μM in 5 min for one of the probes. This simple and rapid point-of-care test could potentially be used by clinicians and health care workers to monitor the presence of AZT in low resource settings.
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Affiliation(s)
- Ying Luo
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Tianwei Jia
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Jieqiong Fang
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Dandan Liu
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Varma Saikam
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Xiaolin Sheng
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA
| | - Suri S Iyer
- 788 Petit Science Center, Department of Chemistry, Center for Diagnostics and Therapeutics, Georgia State University, 161 Jesse Hill Jr. Drive, Atlanta, GA, 30302, USA.
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50
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Philbin MM, Parish C, Bergen S, Kerrigan D, Kinnard EN, Reed SE, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Cocohoba J, Goparaju L, Golub ET, Fischl M, Alcaide ML, Metsch LR. A Qualitative Exploration of Women's Interest in Long-Acting Injectable Antiretroviral Therapy Across Six Cities in the Women's Interagency HIV Study: Intersections with Current and Past Injectable Medication and Substance Use. AIDS Patient Care STDS 2021; 35:23-30. [PMID: 33400587 PMCID: PMC7826427 DOI: 10.1089/apc.2020.0164] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Indexed: 01/21/2023] Open
Abstract
Medications for antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) are currently daily pill regimens, which pose barriers to long-term adherence. Long-acting injectable (LAI) modalities have been developed for ART and PrEP, but minimal LAI-focused research has occurred among women. Thus, little is known about how women's history of injection for medical or nonmedical purposes may influence their interest in LAI. We conducted 89 in-depth interviews at 6 sites (New York, NY; Chicago, IL; San Francisco, CA; Atlanta, GA; Chapel Hill, NC; Washington, DC) of the Women's Interagency HIV study. Interviews occurred with women living with HIV (n = 59) and HIV-negative women (n = 30) from November 2017 to October 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Women's prior experiences with injections occurred primarily through substance use, physical comorbidities, birth control, or flu vaccines. Four primary categories of women emerged; those who (1) received episodic injections and had few LAI-related concerns; (2) required frequent injections and would refuse additional injections; (3) had a history of injection drug use, of whom some feared LAI might trigger a recurrence, while others had few LAI-related concerns; and (4) were currently injecting drugs and had few LAI-related concerns. Most women with a history of injectable medication would prefer LAI, but those with other frequent injections and history of injection drug use might not. Future research needs to address injection-related concerns, and develop patient-centered approaches to help providers best identify which women could benefit from LAI use.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Address correspondence to: Morgan M. Philbin, PhD, MHS, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sadie Bergen
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, District of Columbia, USA
| | - Elizabeth N. Kinnard
- Division of Epidemiology, UC Berkeley School of Public Health, Berkeley, California, USA
| | - Sarah E. Reed
- Teachers College, Columbia University, New York, New York, USA
| | - Mardge H. Cohen
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Anandi N. Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California at San Francisco School of Pharmacy, San Francisco, California, USA
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margaret Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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