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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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Fennell RD, Sher M, Asghar W. Development of a Microfluidic Device for CD4+ T Cell Isolation and Automated Enumeration from Whole Blood. Biosensors 2021; 12:bios12010012. [PMID: 35049640 PMCID: PMC8773767 DOI: 10.3390/bios12010012] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 12/04/2022]
Abstract
The development of point-of-care, cost-effective, and easy-to-use assays for the accurate counting of CD4+ T cells remains an important focus for HIV-1 disease management. The CD4+ T cell count provides an indication regarding the overall success of HIV-1 treatments. The CD4+ T count information is equally important for both resource-constrained regions and areas with extensive resources. Hospitals and other allied facilities may be overwhelmed by epidemics or other disasters. An assay for a physician’s office or other home-based setting is becoming increasingly popular. We have developed a technology for the rapid quantification of CD4+ T cells. A double antibody selection process, utilizing anti-CD4 and anti-CD3 antibodies, is tested and provides a high specificity. The assay utilizes a microfluidic chip coated with the anti-CD3 antibody, having an improved antibody avidity. As a result of enhanced binding, a higher flow rate can be applied that enables an improved channel washing to reduce non-specific bindings. A wide-field optical imaging system is also developed that provides the rapid quantification of cells. The designed optical setup is portable and low-cost. An ImageJ-based program is developed for the automatic counting of CD4+ T cells. We have successfully isolated and counted CD4+ T cells with high specificity and efficiency greater than 90%.
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Affiliation(s)
- Robert D. Fennell
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA; (R.D.F.); (M.S.)
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Mazhar Sher
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA; (R.D.F.); (M.S.)
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Waseem Asghar
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA; (R.D.F.); (M.S.)
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL 33431, USA
- Correspondence:
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Spitsin S, Pappa V, Kinder A, Evans DL, Rappaport J, Douglas SD. Effect of aprepitant on kynurenine to tryptophan ratio in cART treated and cART naïve adults living with HIV. Medicine (Baltimore) 2021; 100:e25313. [PMID: 34114978 PMCID: PMC8202663 DOI: 10.1097/md.0000000000025313] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/03/2021] [Indexed: 01/04/2023] Open
Abstract
Changes in tryptophan metabolism affect human physiology including the immune system, mood, and sleep and are associated with human immunodeficiency virus (HIV) pathogenesis. This study investigates whether the treatment of HIV-infected individuals with the neurokinin-1 receptor antagonist, aprepitant, alters tryptophan metabolism.This study utilized archival samples from 3 phase 1B clinical trials "Anti-HIV Neuroimmunomodulatory Therapy with Neurokinin-1 Antagonist Aprepitant"-2 double-blinded, placebo-controlled, and 1 open-label study. We tested samples from a total of 57 individuals: 26 combination antiretroviral therapy (cART) naïve individuals receiving aprepitant, 19 cART naïve individuals receiving placebo, and 12 individuals on a ritonavir-containing cART regimen receiving aprepitant. We evaluated the effect of aprepitant on tryptophan metabolism by measuring levels of kynurenine and tryptophan in archival plasma samples and calculating the kynurenine to tryptophan ratio.Aprepitant treatment affected tryptophan metabolism in both cART treated and cART naïve individuals with more profound effects in patients receiving cART. While aprepitant treatment affected tryptophan metabolism in all HIV-infected patients, it only significantly decreased kynurenine to tryptophan ratio in cART treated individuals. Aprepitant treatment offers an opportunity to target inflammation and mood disorders frequently co-existing in chronic HIV infection.
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Affiliation(s)
| | | | | | - Dwight L. Evans
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jay Rappaport
- Tulane National Primate Research Center, Covington, LA, USA
| | - Steven D. Douglas
- Children's Hospital of Philadelphia Research Institute
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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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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Birlutiu V, Birlutiu RM, Zaharie IS, Sandu M. Burkitt lymphoma associated with human immunodeficiency virus infection and pulmonary tuberculosis: A case report. Medicine (Baltimore) 2020; 99:e23853. [PMID: 33350777 PMCID: PMC7769298 DOI: 10.1097/md.0000000000023853] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The association of human immunodeficiency virus (HIV) infection with Burkitt lymphoma is related to the presence of Epstein Barr virus infection and the impact of the HIV antigen on the expansion of B-polyclonal cells. In Southeast Europe, the association is rare, and recognizing this is important in the therapeutic decision to increase patient survival rate. The association of HIV with Burkitt lymphoma and tuberculosis is even more rarely described in the literature. PATIENT CONCERNS We present the case of a 40-year-old patient who presented with a 3-week history of fever (max. 38.7 °C), painful axillary swelling on the right side, lumbar pain, gait disorders, headache, and night sweats. Clinical manifestations included marked weight loss (about 30 kg in the last 2 months before his admission). DIAGNOSIS A LyCD4 count of 38/μL and a HIV1 viral load of 384,000/mm3, classified the patient into a C3 stage. A biopsy of the right axillary lymph node was performed for suspected ganglionic tuberculosis due to immunodeficiency. Histopathological examination confirmed the diagnosis of Burkitt lymphoma. Cultures on Löwenstein-Jensen medium from sputum harvested at first admission were positive for Mycobacterium tuberculosis. INTERVENTIONS Highly active antiretroviral therapy, chemotherapeutic agents for Burkitt lymphoma, anti-tuberculous drug therapy, neurosurgical intervention of spinal cord decompression, and antibiotic therapy of the associated bacterial infection. OUTCOME Burkitt lymphoma disseminated rapidly, with central nervous system, spinal cord, osteomuscular, adrenal, and spleen involvement. The evolution under treatment was unfavorable, with patient death occurring 6 months after diagnosis. CONCLUSIONS The association of HIV infection with Burkitt lymphoma and tuberculosis is rare in the highly active antiretroviral therapy (HAART) era, posing prompt and multidisciplinary therapeutic management issues. Similar cases of HIV-TB and Burkitt lymphoma association have been described, but none of the other cases showed the involvement of the central nervous system or of the bilateral adrenal glands.
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Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu, Romania - Infectious Diseases Clinic
| | - Rares-Mircea Birlutiu
- Faculty of Medicine, “FOISOR” Clinical Hospital of Orthopedics, Traumatology and Osteoarticular TB Bucharest, Lucian Blaga University of Sibiu
| | | | - Mariana Sandu
- Department of Radiology and Medical Imaging, Academic Emergency Hospital Sibiu, Sibiu, Romania
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Yin DE, Ludema C, Cole SR, Golin CE, Miller WC, Warshaw MG, McKinney RE. Time to treatment disruption in children with HIV-1 randomized to initial antiretroviral therapy with protease inhibitors versus non-nucleoside reverse transcriptase inhibitors. PLoS One 2020; 15:e0242405. [PMID: 33226999 PMCID: PMC7682873 DOI: 10.1371/journal.pone.0242405] [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: 02/20/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Choice of initial antiretroviral therapy regimen may help children with HIV maintain optimal, continuous therapy. We assessed treatment-naïve children for differences in time to treatment disruption across randomly-assigned protease inhibitor versus non-nucleoside reverse transcriptase inhibitor-based initial antiretroviral therapy. METHODS We performed a secondary analysis of a multicenter phase 2/3, randomized, open-label trial in Europe, North and South America from 2002 to 2009. Children aged 31 days to <18 years, who were living with HIV-1 and treatment-naive, were randomized to antiretroviral therapy with two nucleoside reverse transcriptase inhibitors plus a protease inhibitor or non-nucleoside reverse transcriptase inhibitor. Time to first documented treatment disruption to any component of antiretroviral therapy, derived from treatment records and adherence questionnaires, was analyzed using Kaplan-Meier estimators and Cox proportional hazards models. RESULTS The modified intention-to-treat analysis included 263 participants. Seventy-two percent (n = 190) of participants experienced at least one treatment disruption during study. At 4 years, treatment disruption probabilities were 70% (protease inhibitor) vs. 63% (non-nucleoside reverse transcriptase inhibitor). The unadjusted hazard ratio (HR) for treatment disruptions comparing protease inhibitor vs. non-nucleoside reverse transcriptase inhibitor-based regimens was 1.19, 95% confidence interval [CI] 0.88-1.61 (adjusted HR 1.24, 95% CI 0.91-1.68). By study end, treatment disruption probabilities converged (protease inhibitor 81%, non-nucleoside reverse transcriptase inhibitor 84%) with unadjusted HR 1.11, 95% CI 0.84-1.48 (adjusted HR 1.13, 95% CI 0.84-1.50). Reported reasons for treatment disruptions suggested that participants on protease inhibitors experienced greater tolerability problems. CONCLUSIONS Children had similar time to treatment disruption for initial protease inhibitor and non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy, despite greater reported tolerability problems with protease inhibitor regimens. Initial pediatric antiretroviral therapy with either a protease inhibitor or non-nucleoside reverse transcriptase inhibitor may be acceptable for maintaining optimal, continuous therapy.
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Affiliation(s)
- Dwight E. Yin
- Division of Infectious Diseases and Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children’s Mercy-Kansas City and University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christina Ludema
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carol E. Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William C. Miller
- Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Meredith G. Warshaw
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ross E. McKinney
- Association of American Medical Colleges, District of Columbia, Washington, United States of America
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Ciccacci F, Lucaroni F, Latagliata R, Morciano L, Mondlane E, Balama M, Tembo D, Gondwe J, Orlando S, Palombi L, Marazzi MC. Hematologic alterations and early mortality in a cohort of HIV positive African patients. PLoS One 2020; 15:e0242068. [PMID: 33170905 PMCID: PMC7654783 DOI: 10.1371/journal.pone.0242068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality. Material and methods We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 –December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model. Results On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn’t be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL. Conclusions Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.
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Affiliation(s)
- Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- * E-mail:
| | - Francesca Lucaroni
- Department of Biomedicine and Prevention, University or Rome Tor Vergata, Rome, Italy
| | - Roberto Latagliata
- Hematology, Department of Translational and Precision Medicine, University ‘Sapienza' and Policlinico Umberto 1, Rome, Italy
| | - Laura Morciano
- Department of Biomedicine and Prevention, University or Rome Tor Vergata, Rome, Italy
| | - Elisa Mondlane
- DREAM program, Community of Sant’Egidio, Maputo, Mozambique
| | - Moises Balama
- DREAM program, Community of Sant’Egidio, Beira, Mozambique
| | - Dyna Tembo
- DREAM program, Community of Sant’Egidio, Blantyre, Malawi
| | - Jane Gondwe
- DREAM program, Community of Sant’Egidio, Blantyre, Malawi
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University or Rome Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Biomedicine and Prevention, University or Rome Tor Vergata, Rome, Italy
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Abstract
It is of great interest for a biomedical analyst or an investigator to correctly model the CD4 cell count or disease biomarkers of a patient in the presence of covariates or factors determining the disease progression over time. The Poisson mixed-effects models (PMM) can be an appropriate choice for repeated count data. However, this model is not realistic because of the restriction that the mean and variance are equal. Therefore, the PMM is replaced by the negative binomial mixed-effects model (NBMM). The later model effectively manages the over-dispersion of the longitudinal data. We evaluate and compare the proposed models and their application to the number of CD4 cells of HIV-Infected patients recruited in the CAPRISA 002 Acute Infection Study. The results display that the NBMM has appropriate properties and outperforms the PMM in terms of handling over-dispersion of the data. Multiple imputation techniques are also used to handle missing values in the dataset to get valid inferences for parameter estimates. In addition, the results imply that the effect of baseline BMI, HAART initiation, baseline viral load, and the number of sexual partners were significantly associated with the patient's CD4 count in both fitted models. Comparison, discussion, and conclusion of the results of the fitted models complete the study.
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Affiliation(s)
- Ashenafi A Yirga
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa.
| | - Sileshi F Melesse
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Henry G Mwambi
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Dawit G Ayele
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, USA
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9
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Boon D, Bruce V, Patel EU, Quinn J, Srikrishnan AK, Shanmugam S, Iqbal S, Balakrishnan P, Sievers M, Kirk GD, Thomas DL, Quinn TC, Cox AL, Page KA, Solomon SS, Mehta SH, Laeyendecker O. Antibody avidity-based approach to estimate population-level incidence of hepatitis C. J Hepatol 2020; 73:294-302. [PMID: 32240715 PMCID: PMC7458132 DOI: 10.1016/j.jhep.2020.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Accurate HCV incidence estimates are critical for monitoring progress towards HCV elimination goals, including an 80% reduction in HCV incidence by 2030. Moreover, incidence estimates can help guide prevention and treatment programming, particularly in the context of the US opioid epidemic. METHODS An inexpensive, Genedia-based HCV IgG antibody avidity assay was evaluated as a platform to estimate cross-sectional, population-level primary HCV incidence using 1,840 HCV antibody and RNA-positive samples from 875 individuals enrolled in 5 cohort studies in the US and India. Using samples collected <2 years following HCV seroconversion, the mean duration of recent infection (MDRI) was calculated by fitting a maximum likelihood binomial regression model to the probability of appearing recent. Among samples collected ≥2 years post-HCV seroconversion, an individual-level false recent ratio (FRR) was calculated by estimating the probability of appearing recent using an exact binomial test. Factors associated with falsely appearing recent among samples collected ≥2 years post seroconversion were determined by Poisson regression with generalized estimating equations and robust variance estimators. RESULTS An avidity index cut-off of <40% resulted in an MDRI of 113 days (95% CI 84-146), and FRRs of 0.4% (95% CI 0.0-1.2), 4.6% (95% CI 2.2-8.3), and 9.5% (95% CI 3.6-19.6) among individuals who were HIV-uninfected, HIV-infected, and HIV-infected with a CD4 count <200/μl, respectively. No variation was seen between HCV genotypes 1 and 3. In hypothetical scenarios of high-risk settings, a sample size of <1,000 individuals could reliably estimate primary HCV incidence. CONCLUSIONS This cross-sectional approach can estimate primary HCV incidence for the most common genotypes. This tool can serve as a valuable resource for program and policy planners seeking to monitor and reduce HCV burden. LAY SUMMARY Determining the rate of new hepatitis C virus (HCV) infections in a population is critical to monitoring progress toward HCV elimination and to appropriately guide control efforts. However, since HCV infections are most often initially asymptomatic, it is difficult to estimate the rate of new HCV infections without following HCV-uninfected people over time and repeatedly testing them for HCV infection. Here, we present a novel, resource-efficient method to estimate the rate of new HCV infections in a population using data from a single timepoint.
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Affiliation(s)
- Denali Boon
- Johns Hopkins University, Baltimore, Maryland, USA.
| | | | | | | | | | | | - Syed Iqbal
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | | | | | - Thomas C Quinn
- Johns Hopkins University, Baltimore, Maryland, USA; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea L Cox
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sunil S Solomon
- Johns Hopkins University, Baltimore, Maryland, USA; YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Oliver Laeyendecker
- Johns Hopkins University, Baltimore, Maryland, USA; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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10
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Ndlovu Z, Massaquoi L, Bangwen NE, Batumba JN, Bora RU, Mbuaya J, Nzadi R, Ntabugi N, Kisaka P, Manciya G, Moudashirou R, Pangani H, Mangochi P, Makoko R, Van Laeken D, Kwitonda C, Ronoh Y, Kuwenyi K, Ortuno R, Mangwanya D, Zvidzai E, Mupepe T, Zinyowera S, Fajardo E, Ellman T. Diagnostic performance and usability of the VISITECT CD4 semi-quantitative test for advanced HIV disease screening. PLoS One 2020; 15:e0230453. [PMID: 32243435 PMCID: PMC7122771 DOI: 10.1371/journal.pone.0230453] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/03/2019] [Accepted: 03/01/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm3. This study evaluated the diagnostic performance of this index test. METHODS Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. RESULTS Among 708 patients, 67.2% were female and median CD4 was 297cells/mm3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.0% [95% CI: 91.3-97.5] and specificity was 81.9% [95% CI: 78.2-85.2%]. Using FP samples, the sensitivity of the Visitect CD4 LFA was 98.3% [95% CI: 95.0-99.6] and specificity was 77.2% [95% CI: 71.6-82.2%]. Usability of the Visitect CD4 LFA was high across the study sites with 97% successfully completed tests. Due to the required specific multiple incubation and procedural steps during the Visitect CD4 LFA testing, few health workers (7/26) were not confident to manage testing whilst multi-tasking in their clinical work. CONCLUSIONS Visitect CD4 LFA is a promising test for decentralized CD4 screening in resource-limited settings, without access to CD4 testing and and it can trigger prompt management of patients with AHD. Lay health cadres should be considered to conduct Visitect CD4 LFA testing in PHCs as well as coordinating all other POC quality assurance.
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Affiliation(s)
- Zibusiso Ndlovu
- Southern Africa Medical Unit, Médecins Sans Frontiéres, Cape Town, South Africa
| | - Lamin Massaquoi
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | | | - John N. Batumba
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Rachelle U. Bora
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Joelle Mbuaya
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Roger Nzadi
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Nadine Ntabugi
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Patrick Kisaka
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | - Gisele Manciya
- Médecins Sans Frontiéres, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sekesai Zinyowera
- National Microbiology Reference Laboratory, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tom Ellman
- Southern Africa Medical Unit, Médecins Sans Frontiéres, Cape Town, South Africa
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11
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Samperiz G, Fanjul F, Valera JL, Lopez M, Rios Á, Peñaranda M, Campins A, Riera M, Agusti A. Increased rate of FEV1 decline in HIV patients despite effective treatment with HAART. PLoS One 2019; 14:e0224510. [PMID: 31661533 PMCID: PMC6818778 DOI: 10.1371/journal.pone.0224510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/03/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous studies have reported that the rate of FEV1 decline over time is increased in HIV patients but the mechanisms underlying this observation are unclear. Since current HIV treatment with Highly Active Antiretroviral Therapy (HAART) results in very good immune-viral control, we hypothesized that HAART should normalize the elevated rate of FEV1 decline previously reported in HIV patients if it was somehow related to the immune alterations caused by HIV, particularly in never smokers or quitters, since smoking is a well established risk factor for accelerated FEV1 decline in the general population. METHODS We explored this hypothesis in a prospectively recruited cohort of 188 HIV (smoker and non-smoker) patients treated with HAART in Palma de Mallorca (Spain) and followed-up for 6 years. The cross-sectional characteristics of this cohort have been published elsewhere. RESULTS We found that: (1) HAART resulted in good immune-viral control; (2) the rate of FEV1 decline remained abnormally elevated, even in non-smokers and quitters; and, (3) alcohol abuse during follow-up was related to FEV1 decline in these patients. DISCUSSION Despite adequate immune-viral control by HAART, lung function decline remains increased in most HIV patients, even in non-smokers and quitters. Alcohol abuse is a preventable risk factor to decrease the accelerated FEV1 decline in this population.
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Affiliation(s)
| | - Francisco Fanjul
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | | | - Meritxell Lopez
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Ángel Rios
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - María Peñaranda
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Antoni Campins
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Melchor Riera
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut d`Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, Univ. Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Palma de Mallorca, Spain
- * E-mail:
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12
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Sher M, Asghar W. Development of a multiplex fully automated assay for rapid quantification of CD4 + T cells from whole blood. Biosens Bioelectron 2019; 142:111490. [PMID: 31302394 PMCID: PMC6718319 DOI: 10.1016/j.bios.2019.111490] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/20/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022]
Abstract
The development of cost-effective and rapid assays for the accurate counting of CD4 cells has remained prime focus for disease management. The lack of such assays has severely affected people living in resource-limited disease prevalent areas. CD4 count information plays a vital role in the effective management of HIV disease. There is an unmet need to develop rapid, cost-effective, portable and user-friendly point-of-care (POC) disease diagnostic platform technology for CD4+ T cell counting. Here, we have developed a flow-free magnetic actuation platform that uses antibody-coated magnetic beads to efficiently capture CD4+ T cells from a 30 μL drop of whole blood. On-chip cell lysate electrical impedance spectroscopy has been utilized to quantify the isolated CD4 cells. The developed assay has a limit of detection of 25 cells per μL and provides accurate CD4 counts in the range of 25-800 cells per μL. The whole immunoassay along with the enumeration process is very rapid and provides CD4 quantification results within 5 min time frame. The assay does not require off-chip sample preparation steps and minimizes human involvement to a greater extent. The developed impedance-based immunoassay has potential to significantly improve the CD4 enumeration process especially for POC settings.
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Affiliation(s)
- Mazhar Sher
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA; Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Waseem Asghar
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA; Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA; Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL, 33431, USA.
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13
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Pierre S, Seo G, Rivera VR, Walsh KF, Victor JJ, Charles B, Julmiste G, Dumont E, Apollon A, Cadet M, Saint‐Vil A, Marcelin A, Severe P, Lee MH, Kingery J, Koenig S, Fitzgerald D, Pape J, McNairy ML. Prevalence of hypertension and cardiovascular risk factors among long-term AIDS survivors: A report from the field. J Clin Hypertens (Greenwich) 2019; 21:1558-1566. [PMID: 31448551 PMCID: PMC6896990 DOI: 10.1111/jch.13663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/02/2019] [Revised: 05/14/2019] [Accepted: 06/18/2019] [Indexed: 12/23/2022]
Abstract
HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long-term AIDS survivors in resource-limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV-infected patients followed for over 10 years in Port-au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33-44), and median CD4 count was 117 cells/mm3 (IQR 34-201). Median follow-up time from ART initiation was 12.1 years (IQR 11.7-12.7). At screening, median CD4 count was 574 cells/mm3 (IQR 378-771), and 84% (282 of 336 screened) had HIV-1 RNA < 1000 copies/mL. Seventy-four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long-term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource-limited settings.
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Affiliation(s)
- Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Grace Seo
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Vanessa R. Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Kathleen F. Walsh
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Jean Joscar Victor
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Benedict Charles
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Gaetane Julmiste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Emelyne Dumont
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Molene Cadet
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alix Saint‐Vil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Myung Hee Lee
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Justin Kingery
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Serena Koenig
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Daniel Fitzgerald
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Jean Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Margaret L. McNairy
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
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Baraki AG, Gezie LD, Zeleke EG, Awoke T, Tsegaye AT. Body mass index variation over time and associated factors among HIV-positive adults on second-line ART in north-west Ethiopia: a retrospective follow-up study. BMJ Open 2019; 9:e033393. [PMID: 31551394 PMCID: PMC6773344 DOI: 10.1136/bmjopen-2019-033393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to assess the evolution of body mass index (BMI) of HIV-positive adults on second-line antiretroviral therapy (ART) over time and factors affecting it in north-west Ethiopia. DESIGN An institution-based retrospective follow-up study was conducted using data extracted from 1016 patient cards from February 2008 to February 2016. SETTING Eight referral hospitals from Amhara region, Ethiopia were included. PARTICIPANTS HIV patients who started second-line ART. OUTCOME MEASURES Change in BMI since starting second-line ART. RESULTS Five hundred and thirty-eight (52.95%) participants were males and the median age of the participants was 33 years (IQR: 28; 39). The median follow-up time was 18 months (IQR: 5.2; 32.2). The average change of BMI showed linear increase over time. The amount of BMI increment or decrement according to each variable was shown as β coefficients. Treatment duration (β=0.013, 95% CI 0.004 to 0.022), isoniazid prophylaxis (β=0.87, 95% CI 0.32 to 1.42), cotrimoxazole prophylaxis (β=0.63, 95% CI 0.08 to 1.19), ambulatory functional status (β=-1.16, 95% CI -1.95 to 1.31), bedridden functional status (β=-1.83, 95% CI -2.47 to 1.21), WHO stage III (β=-0.42, 95% CI -0.65 to 0.20), WHO stage IV (β=-0.62, 95% CI -1.02 to 0.22), CD4 count (β=0.001, 95% CI 0.0008 to 0.0015), and time interaction of variables like tertiary educational status (β=0.02, 95% CI 0.01 to 0.04), ambulatory functional status (β=0.03, 95% CI 0.01 to 0.05) and WHO stages III (β=0.01, 95% CI 0.007 to 0.02) were found to be significant predictors. CONCLUSION The BMI of patients has shown linear increment over the treatment time. Factors affecting it have been identified but its effect on cardiovascular disease needs further study.
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Affiliation(s)
- Adhanom Gebreegziabher Baraki
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Hebeler-Barbosa F, Massolini VM, Watanabe T, Silva GF, Barbosa AN, Simões RP, Ferrasi AC, de Andrade Zanotto PM, de Moura Campos Pardini MI, Grotto RMT. Influence of the HIV GWG variant in the HIV infection progression in mono and HCV coinfected patients. Medicine (Baltimore) 2019; 98:e16376. [PMID: 31335686 PMCID: PMC6708615 DOI: 10.1097/md.0000000000016376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/26/2022] Open
Abstract
The HIV subtype B is the most frequent in Brazil. The HIV subtype B' codes the amino acids glicine-tryptophan-glicine (GWG) instead of glicine-proline-glicine on the tip of gp120 V3 loop. This variant was associated to a slower HIV progression in mono-infected patients; however, there is no information in coinfected patients. This study evaluated the infection progression of HIV variant B' on the hepatitis C virus presence. RNA isolated from plasma of the 601 infected patients were used to human immunodeficiency virus (HIV) subtyping and to classify the virus according their syncytium-inducing ability. The HIV infection progression was evaluated by clinical and laboratorial data. The results showed a significant association between HIV B' variant and CD4 count and time of AIDS in HIV mono-infected patients. Notwithstanding the fact that we did not find a direct association between GWG variant and AIDS and in HIV coinfected patients no mitigating effect due to GWG presence was found. We did observe that the association between GWG variant and CD4 counts is lost in coinfected patients. This is first work showing influence of the HIV GWG variant in coinfected patients. Nevertheless, the presence of the GWG variant can indicate a better prognostic in the mono-infected patients.
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Affiliation(s)
- Flavia Hebeler-Barbosa
- São Paulo State University (Unesp), Medical School
- Molecular Biology Laboratory, Blood Transfusion Center
| | | | - Thais Watanabe
- São Paulo State University (Unesp), School of Agriculture, Botucatu
| | | | | | | | - Adriana Camargo Ferrasi
- São Paulo State University (Unesp), Medical School
- Molecular Biology Laboratory, Blood Transfusion Center
| | - Paolo Marinho de Andrade Zanotto
- Laboratory of Molecular Evolution and Bioinformatics (LEMB), Biomedical Sciences Institute, University of São Paulo (USP), São Paulo, Brazil
| | | | - Rejane Maria Tommasini Grotto
- Molecular Biology Laboratory, Blood Transfusion Center
- São Paulo State University (Unesp), School of Agriculture, Botucatu
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Ndlovu KCZ, Chikobvu P, Mofokeng T, Gounden V, Assounga A. Serum albumin and mortality in patients with HIV and end-stage renal failure on peritoneal dialysis. PLoS One 2019; 14:e0218156. [PMID: 31181128 PMCID: PMC6557525 DOI: 10.1371/journal.pone.0218156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
Background Peritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes. Methods We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy. Results The HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02–6.46, p<0.001) at baseline and 3.99 g/L (95% CI 1.19–6.79, p = 0.006) at 18 months. HIV-positive status (adjusted regression coefficient -2.84, CI -5.00–-0.67, p = 0.011), diabetes (adjusted coefficient -2.85; CI, -5.58–-0.12; p = 0.041), and serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR] 13.06, 95% CI 3.09–55.14, p<0.001) and CD4+ cell count <200 cells/μL (SHR 3.2, CI 1.38–7.45, p = 0.007) were independent predictors of mortality in our competing risk model. Conclusions HIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.
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Affiliation(s)
- Kwazi Celani Zwakele Ndlovu
- Division of Nephrology, University of the Free State, Bloemfontein, South Africa
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
- * E-mail:
| | - Perpetual Chikobvu
- Department of Health of the Free State, Bloemfontein, South Africa
- Department of Community Health, University of the Free State, Bloemfontein, South Africa
| | - Thabiso Mofokeng
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Verena Gounden
- Department of Chemical Pathology, Inkosi Albert Luthuli Hospital, Durban, South Africa
| | - Alain Assounga
- Department of Nephrology, University of KwaZulu-Natal, Durban, South Africa
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Conti S, Karplus M. Estimation of the breadth of CD4bs targeting HIV antibodies by molecular modeling and machine learning. PLoS Comput Biol 2019; 15:e1006954. [PMID: 30970017 PMCID: PMC6457539 DOI: 10.1371/journal.pcbi.1006954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/12/2018] [Accepted: 03/18/2019] [Indexed: 11/21/2022] Open
Abstract
HIV is a highly mutable virus for which all attempts to develop a vaccine have been unsuccessful. Nevertheless, few long-infected patients develop antibodies, called broadly neutralizing antibodies (bnAbs), that have a high breadth and can neutralize multiple variants of the virus. This suggests that a universal HIV vaccine should be possible. A measure of the efficacy of a HIV vaccine is the neutralization breadth of the antibodies it generates. The breadth is defined as the fraction of viruses in the Seaman panel that are neutralized by the antibody. Experimentally the neutralization ability is measured as the half maximal inhibitory concentration of the antibody (IC50). To avoid such time-consuming experimental measurements, we developed a computational approach to estimate the IC50 and use it to determine the antibody breadth. Given that no direct method exists for calculating IC50 values, we resort to a combination of atomistic modeling and machine learning. For each antibody/virus complex, an all-atoms model is built using the amino acid sequence and a known structure of a related complex. Then a series of descriptors are derived from the atomistic models, and these are used to train a Multi-Layer Perceptron (an Artificial Neural Network) to predict the value of the IC50 (by regression), or if the antibody binds or not to the virus (by classification). The neural networks are trained by use of experimental IC50 values collected in the CATNAP database. The computed breadths obtained by regression and classification are reported and the importance of having some related information in the data set for obtaining accurate predictions is analyzed. This approach is expected to prove useful for the design of HIV bnAbs, where the computation of the potency must be accompanied by a computation of the breadth, and for evaluating the efficiency of potential vaccination schemes developed through modeling and simulation.
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Affiliation(s)
- Simone Conti
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Martin Karplus
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts, United States of America
- Laboratoire de Chimie Biophysique, ISIS, Université de Strasbourg, Strasbourg, France
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Joshi S, Muwonge R, Kulkarni V, Deodhar K, Mandolkar M, Lucas E, Sankaranarayanan R. Incidence of cervical intraepithelial neoplasia in women infected with human immunodeficiency virus (HIV) with no evidence of disease at baseline: Results of a prospective cohort study with up to 6.4 years of follow-up from India. Int J Cancer 2019; 144:1082-1091. [PMID: 30132840 DOI: 10.1002/ijc.31826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/01/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 11/12/2022]
Abstract
We report the incidence of cervical intraepithelial neoplasia (CIN) among HIV-infected women who did not have any colposcopic or histopathological evidence of CIN at baseline. Of the 1,023 women without any CIN at baseline, 855 (83.6%) have been followed up to a maximum of 6.4 years contributing 2,875 person years of observation (PYO). Among these 855 women, 54 cases of any CIN were observed resulting in incidence rate of any CIN of 1.9 per 100 PYO. The median time for follow-up for women with any CIN was 3.0 (IQR 1.6-3.7) years. The cumulative incidence rate per 100 PYO of CIN 2 or worse lesion in women with HPV-18 infection at baseline was 13.3% (95% CI 5.1-26.8); in women with HPV-16 infection was 10.8% (95% CI 4.4-20.9); in women with HPV-31 infection was 4.2% (95% CI 0.9-11.7); and in women with other high-risk HPV infections was 5.4% (95% CI 2.6-9.7). HPV-18 infection at baseline contributed highest frequency of incident CIN 2 or worse lesions followed by HPV-16 infection; however, other high-risk HPV types were also responsible for substantial number of incident CIN. The elevated risk of CIN2+ disease in the study cohort was non-significant in women with CD4 count <200, possibly because of the small number of cases. Our results emphasize the need for regular cervical cancer screening of HIV-infected women and urgent implementation of cervical cancer screening services in HIV programs in India and other low and middle-income countries.
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Affiliation(s)
- Smita Joshi
- Department of Preventive Oncology, Prayas and HCJMRI, Pune, India
| | - Richard Muwonge
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | | | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France
- Research Triangle Institute International-India, Commercial Tower, New Delhi, India
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Yirdaw KD, Teklu AM, Mamuye AT, Zewdu S. Breakthrough tuberculosis disease among people with HIV - Should we be worried? A retrospective longitudinal study. PLoS One 2019; 14:e0211688. [PMID: 30716126 PMCID: PMC6361510 DOI: 10.1371/journal.pone.0211688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 01/20/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Isoniazid preventive therapy (IPT) is a proven means to prevent tuberculosis (TB) disease among people living with HIV (PLHIV). However, there is a concern that patients often develop tuberculosis disease while receiving IPT, defined here as breakthrough tuberculosis, which may affect treatment outcome. In this study, we assessed the magnitude and determinants of breakthrough tuberculosis. Methods A multisite retrospective longitudinal study from the year 2005 to 2014 involving 11 randomly selected hospitals from the Addis Ababa, SNNPR (Southern Nations Nationalities and Peoples Region), and Gambela regions of Ethiopia was carried out to assess the occurrence of breakthrough tuberculosis. Cox regression analysis was used to study factors associated with breakthrough TB. Results 4,484 patients in chronic HIV care received IPT. Eighty percent of the same number received antiretroviral therapy (ART). Tuberculosis developed in 88 of 4,484 (2%) patients of which 24 (0.5%) were diagnosed while receiving IPT. Breakthrough TB incidence was 1106 per 100,000 person-years (PY) (95% CI: 742–1651) while TB incidence after completing IPT was 624 per 100,000 PY (95% CI: 488–797). Seven of the 24 (29%) breakthrough TB cases were diagnosed within the first month of IPT initiation. Of 15 patients who developed breakthrough TB while on ART, nine (60%) were diagnosed within the first six months of ART initiation. Having high CD4 cell count and being on ART were associated with having lower risk of developing TB and breakthrough TB. Conclusion Breakthrough TB was uncommon in the study setting. Even then, taking ART reduced the risk of its occurrence. Slightly more than a quarter of the cases of breakthrough TB occurred in the first month of treatment and may be existing undiagnosed TB cases which were missed during diagnostic work-up.
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Affiliation(s)
| | - Alula M. Teklu
- Monitoring Evaluation Research Quality Consultancy, Addis Ababa, Ethiopia
| | - Admasu T. Mamuye
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Solomon Zewdu
- Bill and Melinda Gates Foundation, Addis Ababa, Ethiopia
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Luchters S, Technau K, Mohamed Y, Chersich MF, Agius PA, Pham MD, Garcia ML, Forbes J, Shepherd A, Coovadia A, Crowe SM, Anderson DA. Field Performance and Diagnostic Accuracy of a Low-Cost Instrument-Free Point-of-Care CD4 Test (Visitect CD4) Performed by Different Health Worker Cadres among Pregnant Women. J Clin Microbiol 2019; 57:e01277-18. [PMID: 30463898 PMCID: PMC6355532 DOI: 10.1128/jcm.01277-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3 The field performance and diagnostic accuracy of the test was assessed among HIV-infected pregnant women in South Africa. A nurse performed testing at the point-of-care using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity = 81.7%; 95% confidence interval [CI] = 72.3 to 91.1]; specificity = 82.6%, 95% CI = 77.1 to 88.1) than on finger-prick specimens (sensitivity = 60.7%; 95% CI = 45.0 to 76.3; specificity = 89.5%, 95% CI = 83.2 to 95.8; P = 0.001). No difference in performance was detected by cadre of health worker (P = 0.113) or between point-of-care versus laboratory-based testing (P = 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas.
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Affiliation(s)
- Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karl Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew F Chersich
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul A Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - James Forbes
- Omega Diagnostics, Ltd., Omega House, Alva, Scotland
| | | | - Ashraf Coovadia
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne M Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- The Alfred Hospital and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
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Okunade KS, John-Olabode S, Akinsola OJ, Akinajo O, Akanmu SA, Kanki PJ. Effects of selenium supplementation on pregnancy outcome and disease progression in HIV-infected pregnant women in Lagos, Nigeria: Study protocol for a randomised, double-blind, placebo-controlled trial. Medicine (Baltimore) 2019; 98:e12735. [PMID: 30653086 PMCID: PMC6370178 DOI: 10.1097/md.0000000000012735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Micronutrient deficiencies are common during pregnancy, especially in pregnant women from economically disadvantaged settings where diets with low content of minerals and vitamins are consumed. Selenium is a non-metallic chemical element of great importance to human health. This study will assess the effect of selenium supplementation on major pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos, Nigeria. METHODS A randomized, double-blind, placebo-controlled trial involving confirmed HIV-positive pregnant women at the Lagos University Teaching Hospital (LUTH) between September 2018 and February 2019. Eligible participants are HIV-infected pregnant women aged 15 to 49 years and have a singleton gestation at 14 to 27 weeks' gestation. At enrolment, 90 women will be randomly assigned into each intervention arm to receive either a daily tablet of 200 μg elemental selenium or placebo. Relevant participants' data will be collected at enrolment and at delivery. Statistical analyses will be carried out using SPSS version 23.0 for Windows. The associations between any 2 groups of continuous variables will be tested using the t test or the Mann-Whitney U test and that of 2 groups of categorical variables with chi-square or Fishers exact test where appropriate. A series of multivariable analyses will also be carried out to identify and control for several possible confounders of the major pregnancy outcomes and HIV disease progression. Statistical significance will be defined as P < .05. Ethical approval for the study was obtained from the LUTH's Health Research and Ethics Committee (Approval number: ADM/DCST/HREC/APP/2438; 30th August 2018). DISCUSSION This trial will assess the effect of selenium supplementation on pregnancy outcome and HIV disease progression among HIV-infected pregnant women in Lagos. This will help to determine if routine selenium supplementation in HIV-infected pregnant women will contribute to the improvement in the major adverse pregnancy outcomes such as preterm birth and low birth weight and the HIV disease surrogate markers such as CD4+ cells count and viral load. TRIAL REGISTRATION PACTR, PACTR201809756724274. Registered on 3rd September 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3571.
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Affiliation(s)
- Kehinde S. Okunade
- Department of Obstetrics & Gynaecology
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Nigeria
| | | | - Oluwatosin J. Akinsola
- Epidemiology and Biostatistics unit, Department of Community Health & Primary Health Care, College of Medicine, University of Lagos
| | - Opeyemi Akinajo
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Nigeria
| | | | - Phyllis J. Kanki
- Department of Immunology & Infectious Diseases, Harvard School of Public Health, USA
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Kohatsu L, Bolu O, Schmitz ME, Chang K, Lemwayi R, Arnett N, Mwasekaga M, Nkengasong J, Mosha F, Westerman LE. Evaluation of Specimen Types for Pima CD4 Point-of-Care Testing: Advantages of Fingerstick Blood Collection into an EDTA Microtube. PLoS One 2018; 13:e0202018. [PMID: 30138398 PMCID: PMC6107158 DOI: 10.1371/journal.pone.0202018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/19/2017] [Accepted: 07/26/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Effective point-of-care testing (POCT) is reliant on optimal specimen collection, quality assured testing, and expedited return of results. Many of the POCT are designed to be used with fingerstick capillary blood to simplify the blood collection burden. However, fingerstick blood collection has inherent errors in sampling. An evaluation of the use of capillary and venous blood with CD4 POCT was conducted. METHODS Three different specimen collection methods were evaluated for compatibility using the Alere Pima CD4 assay at 5 HIV/AIDS healthcare sites in Dar es Salaam, Tanzania. At each site, whole blood specimens were collected from enrolled patients by venipuncture and fingerstick. Pima CD4 testing was performed at site of collection on venipuncture specimens (Venous) and fingerstick blood directly applied to a Pima CD4 cartridge (Capillary-Direct) and collected into an EDTA microtube (Capillary-Microtube). Venous blood was also tested at the laboratory by the reference CD4 method and Pima for comparison analysis. RESULTS All three specimen collection methods were successfully collected by healthcare workers for use with the Pima CD4 assay. When compared to the reference CD4 method, Pima CD4 testing with the Capillary-Microtube method performed similarly to Venous, while Pima CD4 counts with the Capillary-Direct method were slightly more biased (-20 cells/μL) and variable (-229 to +189 cells/μL limit of agreement). Even though all three collection methods had similar invalid Pima testing rates (10.5%, 9.8%, and 8.3% for Capillary-Direct, Capillary-Microtube, and Venous respectively), the ability to perform repeat testing with Capillary-Microtube and Venous specimens increased the likelihood of acquiring a valid CD4 result with the Pima assay. CONCLUSIONS Capillary blood, either directly applied to Pima CD4 cartridges or collected in an EDTA microtube, and venous blood are suitable specimens for Pima CD4 testing. The advantages of capillary blood collection in an EDTA microtube are that it uses fingerstick collection which mimics venous blood and allows extra testing without additional blood collection.
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Affiliation(s)
- Luciana Kohatsu
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Omotayo Bolu
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Mary E. Schmitz
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
- Allan Rosenfield Global Health Fellowship, Association of Schools and Programs of Public Health, Washington DC, United States of America
| | - Karen Chang
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
- Allan Rosenfield Global Health Fellowship, Association of Schools and Programs of Public Health, Washington DC, United States of America
| | - Ruth Lemwayi
- African Field Epidemiology Network, Dar es Salaam, Tanzania
| | - Nichole Arnett
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Michael Mwasekaga
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
| | - John Nkengasong
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Fausta Mosha
- African Field Epidemiology Network, Dar es Salaam, Tanzania
- Ministry of Health Community Development Gender Elderly and Children, Government of Tanzania, Dar es Salaam, Tanzania
| | - Larry E. Westerman
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
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Palmer A, Gabler K, Rachlis B, Ding E, Chia J, Bacani N, Bayoumi AM, Closson K, Klein M, Cooper C, Burchell A, Walmsley S, Kaida A, Hogg R. Viral suppression and viral rebound among young adults living with HIV in Canada. Medicine (Baltimore) 2018; 97:e10562. [PMID: 29851775 PMCID: PMC6392935 DOI: 10.1097/md.0000000000010562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
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Affiliation(s)
- Alexis Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, QB
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto
- St. Michael's Hospital, Toronto, ON
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON
| | - Angela Kaida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Rupérez M, Noguera-Julian M, González R, Maculuve S, Bellido R, Vala A, Rodríguez C, Sevene E, Paredes R, Menéndez C. HIV drug resistance patterns in pregnant women using next generation sequence in Mozambique. PLoS One 2018; 13:e0196451. [PMID: 29742132 PMCID: PMC5942837 DOI: 10.1371/journal.pone.0196451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/01/2017] [Accepted: 04/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background Few data on HIV resistance in pregnancy are available from Mozambique, one of the countries with the highest HIV toll worldwide. Understanding the patterns of HIV drug resistance in pregnant women might help in tailoring optimal regimens for prevention of mother to child transmission of HIV (pMTCT) and antenatal care. Objectives To describe the frequency and characteristics of HIV drug resistance mutations (HIVDRM) in pregnant women with virological failure at delivery, despite pMTCT or antiretroviral therapy (ART). Methods Samples from HIV-infected pregnant women from a rural area in southern Mozambique were analysed. Only women with HIV-1 RNA >400c/mL at delivery were included in the analysis. HIVDRM were determined using MiSeq® (detection threshold 1%) at the first antenatal care (ANC) visit and at the time of delivery. Results Ninety and 60 samples were available at the first ANC visit and delivery, respectively. At first ANC, 97% of the women had HIV-1 RNA>400c/mL, 39% had CD4+ counts <350 c/mm3 and 30% were previously not on ART. Thirteen women (14%) had at least one HIVDRM of whom 70% were not on previous ART. Eight women (13%) had at least one HIVDRM at delivery. Out of 37 women with data available from the two time points, 8 (21%) developed at least one new HIVDRM during pMTCT or ART. Twenty seven per cent (53/191), 32% (44/138) and 100% (5/5) of the mutations that were present at enrolment, delivery and that emerged during pregnancy, respectively, were minority mutations (frequency <20%). Conclusions Even with ultrasensitive HIV-1 genotyping, less than 20% of women with detectable viremia at delivery had HIVDRM before initiating pMTCT or ART. This suggests that factors other than pre-existing resistance, such as lack of adherence or interruptions of the ANC chain, are also relevant to explain lack of virological suppression at the time of delivery in women receiving antiretrovirals drugs during pregnancy.
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Affiliation(s)
- María Rupérez
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Raquel González
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Sonia Maculuve
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
| | - Rocío Bellido
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
| | - Anifa Vala
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
| | | | - Esperança Sevene
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain
- Lluita Contra la Sida Foundation, HIV Unit, Hosp Univ Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Clara Menéndez
- Manhiça Health Research Center (CISM), Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Abstract
The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets - access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016.Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4 and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm among ART-naive individuals who performed a first CD4 count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis.Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression.Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.
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Ekrikpo UE, Kengne AP, Akpan EE, Effa EE, Bello AK, Ekott JU, George C, Salako BL, Okpechi IG. Prevalence and correlates of chronic kidney disease (CKD) among ART-naive HIV patients in the Niger-Delta region of Nigeria. Medicine (Baltimore) 2018; 97:e0380. [PMID: 29668591 PMCID: PMC5916672 DOI: 10.1097/md.0000000000010380] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria.This is a single center, 15-year analysis in ART-naïve patients. CKD was defined as the occurrence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m on 2 consecutive occasions 3 to 12 months apart using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The Cochran-Armitage and Cuzick tests were employed to assess for trend across the years for CKD prevalence and CD4 count, respectively. Multivariable logistic regression models were used to identify independent associations with CKD.In all, 1317 patients (62.2% females) with mean age of 34.5 years and median CD4 count of 194 cells/μL were included. CKD prevalence was 13.4% (95%CI 11.6%-15.4%) using the CKD-EPI equation (without the race factor). Multivariable analysis identified increasing age and CD4 count <200 cells/μL as being independently associated with CKD occurrence.This study reports a high prevalence of CKD in ART-naïve HIV-infected patients. Measures to improve diagnosis of kidney disease and ensure early initiation of treatment should be integrated in HIV treatment programmes in this setting.
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Affiliation(s)
- Udeme E. Ekrikpo
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | | | | | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - John U. Ekott
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Fryer HR, Wolinsky SM, McLean AR. Increased T cell trafficking as adjunct therapy for HIV-1. PLoS Comput Biol 2018; 14:e1006028. [PMID: 29499057 PMCID: PMC5864072 DOI: 10.1371/journal.pcbi.1006028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/22/2018] [Accepted: 02/07/2018] [Indexed: 01/15/2023] Open
Abstract
Although antiretroviral drug therapy suppresses human immunodeficiency virus-type 1 (HIV-1) to undetectable levels in the blood of treated individuals, reservoirs of replication competent HIV-1 endure. Upon cessation of antiretroviral therapy, the reservoir usually allows outgrowth of virus and approaches to targeting the reservoir have had limited success. Ongoing cycles of viral replication in regions with low drug penetration contribute to this persistence. Here, we use a mathematical model to illustrate a new approach to eliminating the part of the reservoir attributable to persistent replication in drug sanctuaries. Reducing the residency time of CD4 T cells in drug sanctuaries renders ongoing replication unsustainable in those sanctuaries. We hypothesize that, in combination with antiretroviral drugs, a strategy to orchestrate CD4 T cell trafficking could contribute to a functional cure for HIV-1 infection.
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Affiliation(s)
- Helen R. Fryer
- Institute for Emerging Infections, Department of Zoology, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, United Kingdom
- * E-mail:
| | - Steven M. Wolinsky
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Angela R. McLean
- Institute for Emerging Infections, Department of Zoology, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, United Kingdom
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Kouabosso A, Mossoro-Kpinde CD, Bouassa RSM, Longo JDD, Mbeko Simaleko M, Grésenguet G, Bélec L. Task-shifting of CD4 T cell count monitoring by the touchscreen-based Muse™ Auto CD4/CD4% single-platform system for CD4 T cell numeration: Implication for decentralization in resource-constrained settings. J Immunol Methods 2018; 455:95-98. [PMID: 29402397 DOI: 10.1016/j.jim.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/24/2017] [Revised: 12/27/2017] [Accepted: 01/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The accuracy of CD4 T cell monitoring by the recently developed flow cytometry-based CD4 T cell counting Muse™ Auto CD4/CD4% Assay analyzer (EMD Millipore Corporation, Merck Life Sciences, KGaA, Darmstadt, Germany) was evaluated in trained lay providers against laboratory technicians. METHODS After 2 days of training on the Muse™ Auto CD4/CD4% analyzer, EDTA-blood samples from 6 HIV-positive and 4 HIV-negative individuals were used for CD4 T cell counting in triplicate in parallel by 12 trained lay providers as compared to 10 lab technicians. RESULTS Mean number of CD4 T cells in absolute number was 829 ± 380 cells/μl by lay providers and 794 ± 409 cells/μl by technicians (P > 0.05); and in percentage 36.2 ± 14.8%CD4 by lay providers and 36.1 ± 15.0%CD4 by laboratory technician (P > 0.05). The unweighted linear regression and Passing-Bablok regression analyses on CD4 T cell results expressed in absolute count revealed moderate correlation between CD4 T cell counts obtained by lay providers and lab technicians. The mean absolute bias measured by Bland-Altman analysis between CD4 T cell/μl obtained by lay providers and lab technicians was -3.41 cells/μl. Intra-assay coefficient of variance (CV) of Muse™ Auto CD4/CD4% in absolute number was 10.1% by lay providers and 8.5% by lab technicians (P > 0.05), and in percentage 5.5% by lay providers and 4.4% by lab technicians (P > 0.05). The inter-assay CV of Muse™ Auto CD4/CD4% in absolute number was 13.4% by lay providers and 10.3% by lab technicians (P > 0.05), and in percentage 7.8% by lay providers and 6.9% by lab technicians (P > 0.05). CONCLUSIONS The study demonstrates the feasibility of CD4 T cell counting using the alternative flow cytometer Muse™ Auto CD4/CD4% analyzer by trained lay providers and therefore the practical possibility of decentralization CD4 T cell counting to health community centers.
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Affiliation(s)
- André Kouabosso
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic; Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic.
| | - Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale d'Infectiologie Tropicale de Franceville, Gabon; Université Paris Descartes, and Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France
| | - Jean De Dieu Longo
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic; Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - Marcel Mbeko Simaleko
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Gérard Grésenguet
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic; Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - Laurent Bélec
- Université Paris Descartes, and Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France
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Lewis DJ, Schlichte MJ, Dao H. Atypical disseminated herpes zoster: management guidelines in immunocompromised patients. Cutis 2017; 100:321-330. [PMID: 29232422] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Reactivation of the varicella-zoster virus (VZV) causes dermatomal herpes zoster (HZ) and more rarely severe disseminated HZ including diffuse rash, encephalitis, hepatitis, and pneumonitis. An atypical form of VZV infection, disseminated HZ has been described primarily in immunocompromised hosts. We report 2 cases of atypical disseminated HZ in immunocompromised patients presenting with diffuse, nondermatomal, vesicular eruptions. We also provide a review of the literature and summarize the current guidelines for the treatment and prophylaxis of HZ in patients with human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT), and hematopoietic stem cell transplantation (HSCT). Given the atypical presentation of VZV infection among some immunocompromised patients, this case series emphasizes the need for clinical suspicion for disseminated HZ to facilitate timely diagnosis and initiation of antiviral therapy. Clinician awareness of methods for prevention and treatment of VZV infection in immunocompromised individuals also is critical to minimize the risk for disease and associated morbidity in these patients.
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Affiliation(s)
- Daniel J Lewis
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, and School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Megan J Schlichte
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Harry Dao
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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Gumede-Moyo S, Filteau S, Munthali T, Todd J, Musonda P. Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review. Medicine (Baltimore) 2017; 96:e8055. [PMID: 28984760 PMCID: PMC5737996 DOI: 10.1097/md.0000000000008055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
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Affiliation(s)
- Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Zambia
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tendai Munthali
- School of Public Health, University of Zambia
- Ministry of Health, Lusaka, Zambia
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Kanakasabapathy MK, Pandya HJ, Draz MS, Chug MK, Sadasivam M, Kumar S, Etemad B, Yogesh V, Safavieh M, Asghar W, Li JZ, Tsibris AM, Kuritzkes DR, Shafiee H. Rapid, label-free CD4 testing using a smartphone compatible device. Lab Chip 2017; 17:2910-2919. [PMID: 28702612 PMCID: PMC5576172 DOI: 10.1039/c7lc00273d] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The most recent guidelines have called for a significant shift towards viral load testing for HIV/AIDS management in developing countries; however point-of-care (POC) CD4 testing still remains an important component of disease staging in multiple developing countries. Advancements in micro/nanotechnologies and consumer electronics have paved the way for mobile healthcare technologies and the development of POC smartphone-based diagnostic assays for disease detection and treatment monitoring. Here, we report a simple, rapid (30 minutes) smartphone-based microfluidic chip for automated CD4 testing using a small volume (30 μL) of whole blood. The smartphone-based device includes an inexpensive (<$5) cell phone accessory and a functionalized disposable microfluidic device. We evaluated the performance of the device using spiked PBS samples and HIV-infected and uninfected whole blood, and compared the microfluidic chip results with the manual analysis and flow cytometry results. Through t-tests, Bland-Altman analyses, and regression tests, we have shown a good agreement between the smartphone-based test and the manual and FACS analysis for CD4 count. The presented technology could have a significant impact on HIV management in developing countries through providing a reliable and inexpensive POC CD4 testing.
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Affiliation(s)
- Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA.
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Gebremicael G, Belay Y, Girma F, Abreha Y, Gebreegziabxier A, Tesfaye S, Messele Z, Assefa Y, Bellete B, Kassa D, Vojnov L. The performance of BD FACSPresto™ for CD4 T-cell count, CD4% and hemoglobin concentration test in Ethiopia. PLoS One 2017; 12:e0176323. [PMID: 28448581 PMCID: PMC5407647 DOI: 10.1371/journal.pone.0176323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/23/2016] [Accepted: 04/07/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction In Ethiopia, CD4+ T-cell counting is still required for all patients at baseline before antiretroviral therapy (ART) and to determine eligibility and follow-up of opportunistic infection prophylaxis. However, access to CD4+ T cell count in rural health facilities remains a major challenge in Ethiopia like other resource-limited settings. Methodology Both capillary and venous blood was drawn from each of 325 study participant recruited in Addis Ababa and surroundings. The CD4+ T-cell count, CD4%, and hemoglobin (Hgb) were tested at one of the four study health facilities using capillary blood and BD FACSPresto™ device. These tests were also done at the national HIV reference laboratory, using venous blood with BD FACSCalibur™, Sysmex XT-1800i™, and BD FACSPresto™. Results BD FACSPresto™ had an absolute mean bias of -13.3 cells/ul (-2.99%) and 28.3 cells/μl (6.4%) using venous and capillary blood, respectively, compared with BD FACSCalibur™. The absolute CD4 assay on the BD FACSPresto™ had a regression coefficient (R2) of 0.87 and 0.92 using capillary blood and venous blood samples, respectively, compared with BD FACSCalibur™. The percentage similarity of the BD FACSPresto™ using capillary and venous blood was 105.2% and 99.3%, respectively. The sensitivity of the FACSPresto™ using threshold of 500 cells/μl for ART eligibility using capillary and venous blood was 87.9 and 94.3%, while the specificity was 91.4 and 83.8%, respectively. Furthermore, the BD FACSPresto™ had an absolute mean bias of -0.2 dl/μl (0.0%) (95% LOA: -1.7, 1.3) and -0.59 dl/μl (0.1%) (95% LOA: -1.49, 0.31) for Hgb using capillary and venous blood compared with the Sysmex XT-1800i™, respectively. Conclusion Our results showed acceptable agreement between the BD FACSPresto™ and BD FACSCalibur™ for CD4+ T-cell counting and CD4%; and between the BD FACSPresto™ and Sysmex XT-1800i™for measuring Hgb concentration.
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Affiliation(s)
- Gebremedhin Gebremicael
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
- * E-mail:
| | - Yohanes Belay
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Fitsum Girma
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Yemane Abreha
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Atsbeha Gebreegziabxier
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Simret Tesfaye
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Zelalem Messele
- Clinton Health Access Initiative, Inc. (CHAI), Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Bahrie Bellete
- Clinton Health Access Initiative, Inc. (CHAI), Addis Ababa, Ethiopia
| | - Desta Kassa
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
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Chereau F, Madec Y, Sabin C, Obel N, Ruiz-Mateos E, Chrysos G, Fidler S, Lehmann C, Zangerle R, Wittkop L, Reiss P, Hamouda O, Estrada Perez V, Leal M, Mocroft A, Garcia De Olalla P, Ammassari A, D’Arminio Monforte A, Mussini C, Segura F, Castagna A, Cavassini M, Grabar S, Morlat P, De Wit S, Lambotte O, Meyer L. Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers. PLoS One 2017; 12:e0173893. [PMID: 28380038 PMCID: PMC5381858 DOI: 10.1371/journal.pone.0173893] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022] Open
Abstract
Objective HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control. Methods HICs were identified in COHERE on the basis of ≥5 consecutive viral loads (VL) ≤500 copies/mL over ≥1 year whilst ART-naive, with the last VL ≤500 copies/mL measured ≥5 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models. Results We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds. Discussion Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs.
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Affiliation(s)
- Fanny Chereau
- Université Paris-Saclay, and Université Paris-Sud and Université de Versailles Saint-Quentin-en-Yvelines, and CESP, INSERM U1018, Kremlin-Bicêtre, France
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, United Kingdom
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medecine, Institute of Biomedecine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Georgios Chrysos
- Department of Medicine, Infectious Disease Unit, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | | | - Clara Lehmann
- Department of Internal Medicine I, University of Cologne and German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Robert Zangerle
- Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria
| | - Linda Wittkop
- University Bordeaux, ISPED, INSERM U1219-Bordeaux Population Health, INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, CHU de Bordeaux, Pole de santé publique, Service d’information médicale, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands, and Department of Global Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Osamah Hamouda
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | | | - Manuel Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medecine, Institute of Biomedecine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Amanda Mocroft
- Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, United Kingdom
| | - Patricia Garcia De Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona and CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adriana Ammassari
- Istituto Nazionale Malattie Infettive L. Spallanzani, IRCCS, Roma, Italy
| | - Antonella D’Arminio Monforte
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University Hospital, Milan, Italy
| | - Cristina Mussini
- Clinic of Infectious diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Ferran Segura
- Infectious Diseases Service, Parc Taulí Hospital Universitario and Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sophie Grabar
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and UPMC Université Paris 06, and Université Paris Descartes, Hôpital Cochin Hôtel-Dieu Paris, Paris, France
| | - Philippe Morlat
- Service de médecine interne et maladies infectieuses, CHU de Bordeaux, Université de Bordeaux, Inserm U1219, Bordeaux, France
| | - Stéphane De Wit
- Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Lambotte
- Université Paris Sud, UMR 1184, Le Kremlin-Bicêtre, and CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, and INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France and Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- Université Paris-Saclay, and Université Paris-Sud and Université de Versailles Saint-Quentin-en-Yvelines, and CESP, INSERM U1018, Kremlin-Bicêtre, France
- * E-mail:
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Diedrich CR, O'Hern J, Gutierrez MG, Allie N, Papier P, Meintjes G, Coussens AK, Wainwright H, Wilkinson RJ. Relationship Between HIV Coinfection, Interleukin 10 Production, and Mycobacterium tuberculosis in Human Lymph Node Granulomas. J Infect Dis 2016; 214:1309-1318. [PMID: 27462092 PMCID: PMC5079364 DOI: 10.1093/infdis/jiw313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 01/14/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV)-infected persons are more susceptible to tuberculosis than HIV-uninfected persons. Low peripheral CD4+ T-cell count is not the sole cause of higher susceptibility, because HIV-infected persons with a high peripheral CD4+ T-cell count and those prescribed successful antiretroviral therapy (ART) remain more prone to active tuberculosis than HIV-uninfected persons. We hypothesized that the increase in susceptibility is caused by the ability of HIV to manipulate Mycobacterium tuberculosis-associated granulomas. METHODS We examined 71 excised cervical lymph nodes (LNs) from persons with HIV and M. tuberculosis coinfection, those with HIV monoinfection, and those with M. tuberculosis monoinfection with a spectrum of peripheral CD4+ T-cell counts and ART statuses. We quantified differences in M. tuberculosis levels, HIV p24 levels, cellular response, and cytokine presence within granulomas. RESULTS HIV increased M. tuberculosis numbers and reduced CD4+ T-cell counts within granulomas. Peripheral CD4+ T-cell depletion correlated with granulomas that contained fewer CD4+ and CD8+ T cells, less interferon γ, more neutrophils, more interleukin 10 (IL-10), and increased M. tuberculosis numbers. M. tuberculosis numbers correlated positively with IL-10 and interferon α levels and fewer CD4+ and CD8+ T cells. ART reduced IL-10 production. CONCLUSIONS Peripheral CD4+ T-cell depletion correlated with increased M. tuberculosis presence, increased IL-10 production, and other phenotypic changes within granulomas, demonstrating the HIV infection progressively changes these granulomas.
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Affiliation(s)
- Collin R Diedrich
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Jennifer O'Hern
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | | | | | | | - Graeme Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Helen Wainwright
- Division of Anatomical Pathology
- Department of Medicine, University of Cape Town, South Africa
| | - Robert J Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
- Francis Crick Institute Mill Hill Laboratory
- Department of Medicine, Imperial College London, United Kingdom
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Erlandson KM, Zhang L, Lake JE, Schrack J, Althoff K, Sharma A, Tien PC, Margolick JB, Jacobson LP, Brown TT. Changes in weight and weight distribution across the lifespan among HIV-infected and -uninfected men and women. Medicine (Baltimore) 2016; 95:e5399. [PMID: 27861378 PMCID: PMC5120935 DOI: 10.1097/md.0000000000005399] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Examine body composition changes across the lifespan of HIV-infected compared to uninfected adults. Longitudinal study of antiretroviral therapy (ART)-treated HIV-infected and uninfected participants from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. Body mass index (BMI), waist (WC), hip circumference (HC), and waist-to-height ratio (WHtR) measured at semiannual visits from 1999 to 2014. The age effect on outcomes over time was investigated using multivariate, piecewise, linear mixed-effect regression models adjusted for demographics, substance use, and comorbidities. Person-visits from 2363 men (1059 HIV-infected/1304 HIV-uninfected) and 2200 women (1455 HIV-infected/745 HIV-uninfected), median ages 45 [IQR 39,51] and 40 [32,46], respectively, were included. BMI gains were slower among HIV-infected participants of 40 years or less (P < 0.001), similar between HIV-infected and uninfected persons 40 to 60 years of age, and plateaued after age 60 in both groups. WC and WHtR increased across the age spectrum (P < 0.001) regardless of HIV serostatus, with significantly greater gains in HIV-infected men more than 60. Black race and Hispanic ethnicity were associated with greater BMI and WC. Lower BMI, WC, hip circumference, and WHtR were associated with hepatitis C infection among women only, and with substance use among all participants, and with lower CD4 cell count and shorter ART duration among HIV-infected participants. Slower BMI gain among younger HIV-infected adults may be partly explained by substance use and hepatitis C infection, and suggests that lower BMI does not represent improved health. Further analysis of muscle and fat abundance and quality will advance understanding of metabolic risk over the lifespan, a key to reducing morbidity in an aging population.
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Affiliation(s)
| | - Long Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Keri Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Phyllis C. Tien
- University of California San Francisco, CA and the Department of Veterans Affairs, San Francisco, CA
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Decloedt EH, Freeman C, Howells F, Casson-Crook M, Lesosky M, Koutsilieri E, Lovestone S, Maartens G, Joska JA. Moderate to severe HIV-associated neurocognitive impairment: A randomized placebo-controlled trial of lithium. Medicine (Baltimore) 2016; 95:e5401. [PMID: 27861379 PMCID: PMC5120936 DOI: 10.1097/md.0000000000005401] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorder (HAND) remains highly prevalent despite effective anti-retroviral therapy (ART). A number of adjunctive pharmacotherapies for HAND have been studied with disappointing results, but preliminary data suggest that lithium may provide clinical benefit. In addition, the low cost of lithium would facilitate access in low- and middle-income countries which carry the greatest burden of HIV. METHODS Our objective was to evaluate the 24-week efficacy and safety of lithium in patients with moderate to severe HAND. Our primary efficacy endpoint was the change in Global Deficit Score (GDS) from baseline to 24 weeks, whereas our secondary endpoint was the change in proton magnetic resonance spectroscopy (H-MRS) brain metabolite concentrations. We conducted a 24-week randomized placebo-controlled trial of lithium as adjunctive pharmacotherapy. We enrolled participants with moderate to severe HAND, on ART for at least 6 months, with suppressed viral loads and attending public sector primary care clinics in Cape Town, South Africa. We randomized 66 participants to lithium (n = 32) or placebo (n = 34). Lithium or placebo was dosed 12-hourly and titrated to achieve the maintenance target plasma concentration of 0.6 to 1.0 mmol/L. Sham lithium concentrations were generated for participants receiving placebo. RESULTS Totally 61 participants completed the study (lithium arm = 30; placebo arm = 31). Participants at enrolment had a mean age of 40 years and a median CD4+ T-cell count of 500 cells/μL. The median change in GDS between baseline and week 24 for the lithium and placebo arms were -0.57 (95% confidence interval [CI] -0.77, -0.32) and -0.56 (-0.69, -0.34) respectively, with a mean difference of -0.054 (95% CI -0.26, 0.15); P = 0.716. The improvement remained similar when analyzed according to age, severity of impairment, CD4+ count, time on ART, and ART regimen. Standard H-MRS metabolite concentrations were similar between the treatment arms. The study drug was well tolerated in both study arms. Six serious adverse events occurred, but none were considered related to the study drug. CONCLUSION Adjunctive lithium pharmacotherapy in patients on ART with HAND was well tolerated but had no additional benefit on neurocognitive impairment.
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Affiliation(s)
- Eric H. Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Carla Freeman
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences
| | - Fleur Howells
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences
| | - Martine Casson-Crook
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Eleni Koutsilieri
- Institute of Virology and Immunobiology, University of Würzburg, Germany
| | - Simon Lovestone
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - John A. Joska
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences
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Konheim A, Watts PJ, Tacastacas JD. Fever and Rash in a Patient with HIV Infection. Am Fam Physician 2016; 94:658-660. [PMID: 27929236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ari Konheim
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Paula J Watts
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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Cheng CY, Chang SY, Lin MH, Ku SY, Sun NL, Cheng SH. Tenofovir disoproxil fumarate-associated hypophosphatemia as determined by fractional excretion of filtered phosphate in HIV-infected patients. J Infect Chemother 2016; 22:744-747. [PMID: 27613487 DOI: 10.1016/j.jiac.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tenofovir disoproxil fumarate (TDF) -containing regimens have been associated with nephrotoxicity and hypophosphatemia in HIV-infected patients. The objective of this study was to assess the possible risk factors for hypophosphatemia and evaluate the relationship between fractional excretion of filtered phosphate (FePi) and hypophosphatemia in TDF users. PATIENT AND METHODS Patients were enrolled in a prospective cohort study between January 2011 and December 2014. We classified experienced HIV-infected patients (individuals maintained on antiretroviral therapy (ART) for 6 months or more) and naïve patients into 3 treatment groups: TDF-containing ART (group 1), non-TDF-containing ART (never received TDF or had not received TDF in the past 6 months; group 2) and naive to antiretroviral therapy (group 3). Specimens from each individual were assessed for serum phosphate, serum creatinine, urine phosphate, and urine creatinine. Multivariable logistic regression was performed to control for the following variables measured at baseline: eGFR, age, sex, sexual orientation, injection drug use (IDUs), HIV-RNA viral load, and CD4 cell count. RESULTS The frequency of hypophosphatemia in groups 1, 2, and 3 was 20.2%, 7.2%, and 14.6%, respectively (P = 0.002). FePi above 10% also was significantly associated with hypophosphatemia (P = 0.003; adjusted odds ratio = 2.54). Patients with elevated CD4 cell counts (>500 cells/μL) exhibited a lower risk of hypophosphatemia (P = 0.002; adjusted odds ratio = 0.35). CONCLUSIONS Hypophosphatemia is a multifactorial etiology; FePi was confirmed as a suggested method to predict the risk of hypophosphatemia in TDF users. Clinical Trial Number: TYGH103011.
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Affiliation(s)
- Chien-Yu Cheng
- Department of Internal Medicine, Division of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
| | - Shu-Yin Chang
- AIDS Care Center, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
| | - Mei-Hui Lin
- AIDS Care Center, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
| | - Shin-Yen Ku
- AIDS Care Center, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
| | - Na-Lee Sun
- AIDS Care Center, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Division of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
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Angira F, Akoth B, Omolo P, Opollo V, Bornheimer S, Judge K, Tilahun H, Lu B, Omana-Zapata I, Zeh C. Clinical Evaluation of the BD FACSPresto™ Near-Patient CD4 Counter in Kenya. PLoS One 2016; 11:e0157939. [PMID: 27483008 PMCID: PMC4970792 DOI: 10.1371/journal.pone.0157939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/22/2015] [Accepted: 06/07/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The BD FACSPresto™ Near-Patient CD4 Counter was developed to expand HIV/AIDS management in resource-limited settings. It measures absolute CD4 counts (AbsCD4), percent CD4 (%CD4), and hemoglobin (Hb) from a single drop of capillary or venous blood in approximately 23 minutes, with throughput of 10 samples per hour. We assessed the performance of the BD FACSPresto system, evaluating accuracy, stability, linearity, precision, and reference intervals using capillary and venous blood at KEMRI/CDC HIV-research laboratory, Kisumu, Kenya, and precision and linearity at BD Biosciences, California, USA. METHODS For accuracy, venous samples were tested using the BD FACSCalibur™ instrument with BD Tritest™ CD3/CD4/CD45 reagent, BD Trucount™ tubes, and BD Multiset™ software for AbsCD4 and %CD4, and the Sysmex™ KX-21N for Hb. Stability studies evaluated duration of staining (18-120-minute incubation), and effects of venous blood storage <6-24 hours post-draw. A normal cohort was tested for reference intervals. Precision covered multiple days, operators, and instruments. Linearity required mixing two pools of samples, to obtain evenly spaced concentrations for AbsCD4, total lymphocytes, and Hb. RESULTS AbsCD4 and %CD4 venous/capillary (N = 189/ N = 162) accuracy results gave Deming regression slopes within 0.97-1.03 and R2 ≥0.96. For Hb, Deming regression results were R2 ≥0.94 and slope ≥0.94 for both venous and capillary samples. Stability varied within 10% 2 hours after staining and for venous blood stored less than 24 hours. Reference intervals results showed that gender-but not age-differences were statistically significant (p<0.05). Precision results had <3.5% coefficient of variation for AbsCD4, %CD4, and Hb, except for low AbsCD4 samples (<6.8%). Linearity was 42-4,897 cells/μL for AbsCD4, 182-11,704 cells/μL for total lymphocytes, and 2-24 g/dL for Hb. CONCLUSIONS The BD FACSPresto system provides accurate, precise clinical results for capillary or venous blood samples and is suitable for near-patient CD4 testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02396355.
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Affiliation(s)
- Francis Angira
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Benta Akoth
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Paul Omolo
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Valarie Opollo
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Scott Bornheimer
- BD Biosciences, 2350 Qume Drive, San Jose, California, United States of America
| | - Kevin Judge
- BD Biosciences, 2350 Qume Drive, San Jose, California, United States of America
| | - Henok Tilahun
- BD Biosciences, 2350 Qume Drive, San Jose, California, United States of America
| | - Beverly Lu
- BD Biosciences, 2350 Qume Drive, San Jose, California, United States of America
| | - Imelda Omana-Zapata
- BD Biosciences, 2350 Qume Drive, San Jose, California, United States of America
| | - Clement Zeh
- US Centers for Disease Control and Prevention (CDC-Kenya), Kisumu, Kenya
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Abstract
In a perspective on Habiyambere and colleagues, Peter Kilmarx and Raiva Simbi discuss the disconnect between HIV testing instrument capacity and utilization.
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Affiliation(s)
- Peter H. Kilmarx
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Raiva Simbi
- Ministry of Health and Child Care, Harare, Zimbabwe
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Makadzange AT, Bogezi C, Boyd K, Gumbo A, Mukura D, Matubu A, Ndhlovu CE. Evaluation of the FACSPresto, a New Point of Care Device for the Enumeration of CD4% and Absolute CD4+ T Cell Counts in HIV Infection. PLoS One 2016; 11:e0157546. [PMID: 27388763 PMCID: PMC4936750 DOI: 10.1371/journal.pone.0157546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/15/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Enumeration of CD4+ T lymphocytes is important for pre-ART disease staging and screening for opportunistic infections, however access to CD4 testing in resource limited settings is poor. Point of care (POC) technologies can facilitate improved access to CD4 testing. We evaluated the analytical performance of a novel POC device the FACSPresto compared to the FACSCalibur as a reference standard and to the PIMA, a POC device in widespread use in sub-Saharan Africa. METHOD Specimens were obtained from 253 HIV infected adults. Venous blood samples were analyzed on the FACSPresto and the FACSCalibur, in a subset of 41 samples additional analysis was done on the PIMA. RESULTS The absolute CD4 count results obtained on the FACSPresto were comparable to those on the FACSCalibur with low absolute (9.5cells/μl) and relative bias (3.2%). Bias in CD4% values was also low (1.06%) with a relative bias of 4.9%. The sensitivity was lower at a CD4 count threshold of ≤350cells/μl compared with ≤500cells/μl (84.9% vs. 92.8%) resulting in a high upward misclassification rate at low CD4 counts. Specificity at thresholds of ≤350cells/μl and ≤500cells/μl were 96.6% and 96.8% respectively. The PIMA had a high absolute (-68.6cells/μl) and relative bias (-10.5%) when compared with the FACSCalibur. At thresholds of ≤350cells/μl and ≤500cells/μl the sensitivity was 100% and 95.5% respectively; specificity was 85.7% and 84.2% respectively. The coefficients of repeatability were 4.13%, 5.29% and 9.8% respectively. DISCUSSION The analytic performance of the FACSPresto against the reference standard was very good with better agreement and precision than the PIMA. The FACSPresto had comparable sensitivity at a threshold of 500 cells/μl and better specificity than the PIMA. However the FACSPresto showed reduced sensitivity at low CD4 count thresholds. CONCLUSION The FACSPresto can be reliably used as a POC device for enumerating absolute CD4 count and CD4% values.
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Affiliation(s)
- Azure Tariro Makadzange
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- * E-mail:
| | - Carola Bogezi
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Kathryn Boyd
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Anesu Gumbo
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Dorinda Mukura
- Department of Obstetrics and Gynecology, UZ-UCSF Collaborative Project, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Allen Matubu
- Department of Obstetrics and Gynecology, UZ-UCSF Collaborative Project, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Vojnov L, Markby J, Boeke C, Harris L, Ford N, Peter T. POC CD4 Testing Improves Linkage to HIV Care and Timeliness of ART Initiation in a Public Health Approach: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0155256. [PMID: 27175484 PMCID: PMC4866695 DOI: 10.1371/journal.pone.0155256] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 01/07/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND CD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART) initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional laboratory network. Point of care (POC) CD4 testing has the potential to address some of the challenges of centralized CD4 testing and delays in delivery of timely testing and ART initiation. We conducted a systematic review and meta-analysis to identify the extent to which POC improves linkages to HIV care and timeliness of ART initiation. METHODS We searched two databases and four conference sites between January 2005 and April 2015 for studies reporting test turnaround times, proportion of results returned, and retention associated with the use of point-of-care CD4. Random effects models were used to estimate pooled risk ratios, pooled proportions, and 95% confidence intervals. RESULTS We identified 30 eligible studies, most of which were completed in Africa. Test turnaround times were reduced with the use of POC CD4. The time from HIV diagnosis to CD4 test was reduced from 10.5 days with conventional laboratory-based testing to 0.1 days with POC CD4 testing. Retention along several steps of the treatment initiation cascade was significantly higher with POC CD4 testing, notably from HIV testing to CD4 testing, receipt of results, and pre-CD4 test retention (all p<0.001). Furthermore, retention between CD4 testing and ART initiation increased with POC CD4 testing compared to conventional laboratory-based testing (p = 0.01). We also carried out a non-systematic review of the literature observing that POC CD4 increased the projected life expectancy, was cost-effective, and acceptable. CONCLUSIONS POC CD4 technologies reduce the time and increase patient retention along the testing and treatment cascade compared to conventional laboratory-based testing. POC CD4 is, therefore, a useful tool to perform CD4 testing and expedite result delivery.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, MA, United States of America
| | | | - Caroline Boeke
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Lindsay Harris
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Nathan Ford
- World Health Organization, Geneva, Switzerland
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, MA, United States of America
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Popoola TD, Awodele O. Interplay between antiretroviral therapy and oxidative stress in HIV seropositive patients. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2016; 45:5-21. [PMID: 28686824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND HIV infection results in a decline of CD4+ T-cells count and ultimately results in qualitative impairments of CD4+ T-cell function. Antiretroviral therapy results in an increase in the number of CD4+ cells and the functional reconstitution of the immune system. However, patients on therapy commonly experience adverse effects; management of HIV infection thus becomes a balancing act between the benefits of HIV suppression and the risks of drug toxicity with Highly Active Antiretroviral Therapy (HAART). Purpose and Findings: This review intended to look into the relationship between adverse effects with HAART in relation to its induction of oxidative stress in the host. From literature,. HAART has been shown to induce oxidative stress by several biochemical mechanisms. However, the induction of oxidative stress by HAART is minimal compared to HIV induction of oxidative stress-in the host. The use of HAART in the management of HIV-AIDS thus remains inevitable and the combination with exogenous antioxidants is advocated. Exogenous antioxidants mop up infection induced reactive oxygen species (ROS), and may also be beneficial in ameliorating some of the adverse effects induced by HAART. CONCLUSION Further review on individual adverse effects of ART is recommended and our ongoing research on the teratogenic potentials of HAART will also be very relevant on this subject.
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Koenig SP, Bernard D, Dévieux JG, Atwood S, McNairy ML, Severe P, Marcelin A, Julma P, Apollon A, Pape JW. Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti. PLoS One 2016; 11:e0146903. [PMID: 26901795 PMCID: PMC4763018 DOI: 10.1371/journal.pone.0146903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 08/18/2015] [Accepted: 12/23/2015] [Indexed: 12/26/2022] Open
Abstract
Background High attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions. Methods We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART. Results 24,925 patients (61% female, median age 35 years) were included, and 15,008 (60%) had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding transfers, the proportion of patients who were retained in pre-ART care or initiated ART within the first year after HIV testing was 84%, 82%, 64%, and 64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB) at HIV testing were associated with retention in care. Conclusions The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts.
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Affiliation(s)
- Serena P. Koenig
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Daphne Bernard
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G. Dévieux
- AIDS Prevention Program, Florida International University, Miami, FL, United States of America
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
| | - Patrice Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Adias Marcelin
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Pierrot Julma
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
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Liu Q, Chernish A, DuVall JA, Ouyang Y, Li J, Qian Q, Bazydlo LAL, Haverstick DM, Landers JP. The ARTμS: a novel microfluidic CD4+ T-cell enumeration system for monitoring antiretroviral therapy in HIV patients. Lab Chip 2016; 16:506-514. [PMID: 26687070 DOI: 10.1039/c5lc01153a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report on a novel and cost-effective microfluidic platform that integrates immunomagnetic separation and cell enumeration via DNA-induced bead aggregation. Using a two-stage immunocapture microdevice, 10 μL of whole blood was processed to isolate CD4+ T-cells. The first stage involved the immuno-subtraction of monocytes by anti-CD14 magnetic beads, followed by CD4+ T-cell capture with anti-CD4 magnetic beads. The super hydrophilic surface generated during polydimethylsiloxane (PDMS) plasma treatment allowed for accurate metering of the CD4+ T-cell lysate, which then interacted with silica-coated magnetic beads under chaotropic conditions to form aggregates. Images of the resulting aggregates were captured and processed to reveal the mass of DNA, which was used to back-calculate the CD4+ T-cell number. Studies with clinical samples revealed that the analysis of blood within 24 hours of phlebotomy yielded the best results. Under these conditions, an accurate cell count was achieved (R(2) = 0.98) when compared to cell enumeration via flow cytometry, and over a functional dynamic range from 106-2337 cells per μL.
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Affiliation(s)
- Qian Liu
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Center For Microsystems For The Life Sciences, University of Virginia, Charlottesville, Virginia 22904, USA
| | - Alexis Chernish
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA.
| | - Jacquelyn A DuVall
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Center For Microsystems For The Life Sciences, University of Virginia, Charlottesville, Virginia 22904, USA
| | - Yiwen Ouyang
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Center For Microsystems For The Life Sciences, University of Virginia, Charlottesville, Virginia 22904, USA
| | - Jingyi Li
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Center For Microsystems For The Life Sciences, University of Virginia, Charlottesville, Virginia 22904, USA
| | - Qiang Qian
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA 22904, USA
| | - Lindsay A L Bazydlo
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Department of Pathology, University of Virginia Health Science Center, Charlottesville, Virginia 22908, USA
| | - Doris M Haverstick
- Department of Pathology, University of Virginia Health Science Center, Charlottesville, Virginia 22908, USA
| | - James P Landers
- Department of Chemistry, University of Virginia, McCormick Road, P. O. Box 400319, Charlottesville, Virginia 22904, USA. and Department of Pathology, University of Virginia Health Science Center, Charlottesville, Virginia 22908, USA
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Bwana P, Vojnov L, Adhiambo M, Akinyi C, Mwende J, Prescott M, Mwau M. The BD FACSPresto Point of Care CD4 Test Accurately Enumerates CD4+ T Cell Counts. PLoS One 2015; 10:e0145586. [PMID: 26720601 PMCID: PMC4697849 DOI: 10.1371/journal.pone.0145586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 08/27/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Currently 50% of ART eligible patients are not yet receiving life-saving antiretroviral therapy (ART). Financial constraints do not allow most developing countries to adopt a universal test and offer ART strategy. Decentralizing CD4+ T cell testing may, therefore, provide greater access to testing, ART, and better patient management. We evaluated the technical performance of a new point-of-care CD4+ T cell technology, the BD FACSPresto, in a field methods comparison study. METHODS 264 HIV-positive patients were consecutively enrolled and included in the study. The BD FACSPresto POC CD4+ T cell technology was placed in two rural health care facilities and operated by health care facility staff. We compared paired finger-prick and venous samples using the BD FACSPresto and several existing reference technologies, respectively. RESULTS The BD FACSPresto had a mean bias of 67.29 cells/ul and an r(2) of 0.9203 compared to the BD FACSCalibur. At ART eligibility thresholds of 350 and 500 cells/ul, the sensitivity to define treatment eligibility were 81.5% and 77.2% and the specificities were 98.9% and 100%, respectively. Similar results were observed when the BD FACSPresto was compared to the BD FACSCount and Alere Pima. The coefficient of variation (CV) was less than 7% for both the BD FACSCalibur and BD FACSPresto. CD4+ T cell testing by nurses using the BD FACSPresto at rural health care facilities showed high technical similarity to test results generated by laboratory technicians using the BD FACSPresto in a high functioning laboratory. CONCLUSIONS The BD FACSPresto performed favorably in the laboratory setting compared to the conventional reference standard technologies; however, the lower sensitivities indicated that up to 20% of patients tested in the field in need of treatment would be missed. The BD FACSPresto is a technology that can allow for greater decentralization and wider access to CD4+ T cell testing and ART.
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Affiliation(s)
- Priska Bwana
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | | | | | - Joy Mwende
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Marta Prescott
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
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Castelnuovo B, Kiragga A, Musaazi J, Sempa J, Mubiru F, Wanyama J, Wandera B, Kamya MR, Kambugu A. Outcomes in a Cohort of Patients Started on Antiretroviral Treatment and Followed up for a Decade in an Urban Clinic in Uganda. PLoS One 2015; 10:e0142722. [PMID: 26642214 PMCID: PMC4671641 DOI: 10.1371/journal.pone.0142722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 05/14/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Short-medium term studies from sub-Saharan Africa show that, despite high early mortality, substantial loss to program, and high rates toxicity, patients on antiretroviral treatment have achieved outcomes comparable to those in developed settings. However, these studies were unable to account for long term outcomes of patients as they stayed longer on treatment. OBJECTIVES We aim to describe ten years outcomes of one of the first cohort of HIV positive patients started on antiretroviral treatment (ART) in Sub-Saharan Africa. METHODS We report 10-years outcomes including mortality, retention, CD4-count response, virological outcomes, ART regimens change from a prospective cohort of 559 patients initiating ART and followed up for 10 years Uganda. RESULTS Of 559 patients, 69.1% were female, median age (IQR) was 38 (33-44) years, median CD4-count (IQR) 98 (21-163) cell/μL; 74% were started on stavudine, lamivudine and nevirapine, 26% on zidovudine, lamivudine and efavirenz. After 10 years 361 (65%) patients were still in the study; 127 (22.7%) had died; 30 (5%) were lost to follow-up; 27 (5%) transferred; 18 (3%) withdrew consent. The probability of death was high in the first year (0.15, 95%, CI 0.12-0.18). The median CD4 count increased from 98 to 589 cell/μL (IQR: 450-739 cell/μL) with a median increase of 357 cells/μL (IQR: 128-600 cells/μL); 7.4% never attained initial viral suppression and of those who did 31.7% experienced viral failure. Three hundred and two patients had at least one drug substitution while on first line after a median of 40 months; 66 (11.9%) of the patients were switched to a second line PI-based regimen due to confirmed treatment failure. CONCLUSIONS Despite the high rate of early mortality due to advanced disease at presentation the outcomes from this cohort are encouraging, particularly the remarkable and incremental immune-recovery and a satisfactory rate of virologic suppression.
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Affiliation(s)
- Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- * E-mail:
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Sempa
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Jane Wanyama
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Bonnie Wandera
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Moses Robert Kamya
- School of medicine, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
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Skogmar S, Schön T, Balcha TT, Sturegård E, Jansson M, Björkman P. Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count. PLoS One 2015; 10:e0144292. [PMID: 26630153 PMCID: PMC4668010 DOI: 10.1371/journal.pone.0144292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 12/20/2022] Open
Abstract
Background While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4 cell levels, and determined their predictive capacity as alternative markers of advanced immunosuppression. Methods Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves. Results Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p<0.001) to CD4 cell count, whereas this correlation was weaker for CRP (-0.25, p<0.001). Neither of the markers had adequate predictive value for identification of subjects with CD4 cell count <100 cells/mm3 (area under the curve [AUC] 0.64 for neopterin, AUC 0.59 for CRP). Conclusion Neopterin levels were high in adults with TB, both with and without HIV coinfection, with inverse correlation to CD4 cell count. This suggests that immune activation may be involved in TB-related CD4 lymphocytopenia. However, neither neopterin nor CRP showed promise as alternative tests for immunosuppression in patients coinfected with HIV and TB.
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Affiliation(s)
- Sten Skogmar
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- * E-mail:
| | - Thomas Schön
- Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Microbiology and Infectious diseases, Kalmar County Hospital, Kalmar, Sweden
| | - Taye Tolera Balcha
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Ministry of Health, Addis Ababa, Ethiopia
| | - Erik Sturegård
- Medical Microbiology, Department of Laboratory Medicine Malmö, Lund University, Malmö, Sweden
| | - Marianne Jansson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Microbiology, Tumor and Cell biology, Karolinska Institute, Stockholm, Sweden
| | - Per Björkman
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Hanass-Hancock J, Myezwa H, Carpenter B. Disability and Living with HIV: Baseline from a Cohort of People on Long Term ART in South Africa. PLoS One 2015; 10:e0143936. [PMID: 26625001 PMCID: PMC4666651 DOI: 10.1371/journal.pone.0143936] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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: 06/10/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Through access to life saving antiretroviral treatment (ART) in southern Africa, HIV has been reconceptualised as a chronic disease. This comes with new challenges of HIV-related co-morbidities and disabilities. We still lack an understanding of the types and scope of disabilities experienced by people on long term ART and how this impacts health, adherence, and livelihood. This paper describes the results of a cohort study examining the new health- and disability-related needs of the millions of people on ART in the region. METHODS Data was collected from a cohort of people who had been on ART for six months or longer in a semi-urban public health care setting in South Africa. 1042 adults (18 and older) participated in the cross-sectional study which investigated disabilities/activity limitations, health, ART adherence, depression symptoms, and livelihood. We analysed the associations between these constructs using descriptive statistics, and bivariate and multivariate analyses. RESULTS A large number of participants (35.5%) obtained a weighted score of two or more on the WHODAS 2.0 indicating possible activity limitations. A positive relationship was found between activity limitations and depression symptoms, adherence, and worse health outcomes, while none was found for BMI or CD4 count. These associations varied by type of activity limitations and, in some cases, by gender. CONCLUSION Activity limitations are potentially experienced by a large portion of people on ART in southern Africa which impacts health and ART adherence negatively. These results highlight the importance of better understanding the new health-related needs of people who are on long term ART, as well as the nuances of the disability they experience. This is urgently needed in order to enable HIV-endemic countries to better prepare for the new health-related needs of the millions of people on ART in southern Africa.
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Affiliation(s)
- Jill Hanass-Hancock
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bradley Carpenter
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Gulland A. All patients with HIV should get access to drug treatments regardless of CD4 count, says WHO. BMJ 2015; 351:h5239. [PMID: 26427899 DOI: 10.1136/bmj.h5239] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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