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Kamwiziku GK, Makangara JCC, Orefuwa E, Denning DW. Serious fungal diseases in Democratic Republic of Congo - Incidence and prevalence estimates. Mycoses 2021; 64:1159-1169. [PMID: 34133799 DOI: 10.1111/myc.13339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
A literature review was conducted to assess the burden of serious fungal infections in the Democratic Republic of the Congo (DRC) (population 95,326,000). English and French publications were listed and analysed using PubMed/Medline, Google Scholar and the African Journals database. Publication dates spanning 1943-2020 were included in the scope of the review. From the analysis of published articles, we estimate a total of about 5,177,000 people (5.4%) suffer from serious fungal infections in the DRC annually. The incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia in adults and invasive aspergillosis in AIDS patients was estimated at 6168, 2800 and 380 cases per year. Oral and oesophageal candidiasis represent 50,470 and 28,800 HIV-infected patients respectively. Chronic pulmonary aspergillosis post-tuberculosis incidence and prevalence was estimated to be 54,700. Fungal asthma (allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization) probably has a prevalence of 88,800 and 117,200. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 1,202,640 and 3,551,900 respectively.Further work is required to provide additional studies on opportunistic infections for improving diagnosis and the implementation of a national surveillance programme of fungal disease in the DRC.
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Affiliation(s)
- Guyguy K Kamwiziku
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude C Makangara
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Emma Orefuwa
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland.,Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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52
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Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis. J Clin Med 2021; 10:jcm10112300. [PMID: 34070645 PMCID: PMC8198877 DOI: 10.3390/jcm10112300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56-3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054-2.41)), men who have sex with men (AOR: 1.21 (95% CI: -0.76-1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53-4.38)) and not receiving ART (AOR: 2.89 (95% CI: -0.44-2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.
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Zeng BS, Zeng BY, Hung CM, Chen TY, Wu YC, Tu YK, Lin PY, Su KP, Stubbs B, Sun CK, Cheng YS, Li DJ, Liang CS, Hsu CW, Chen YW, Tseng PT, Chen CH. Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis. Expert Rev Anti Infect Ther 2021; 19:1469-1479. [PMID: 33899657 DOI: 10.1080/14787210.2021.1922078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Oropharyngeal/esophageal candidiasis are the most common opportunistic infections observed in patients with human immunodeficiency virus (HIV). While the commonly recommended treatment is fluconazole, relapse of oropharyngeal or esophageal candidiasis has been gradually increasing in recent decades.Methods: The current network meta-analysis (NMA) included randomized controlled trials (RCTs) investigating the efficacy and acceptability (i.e. drop-out rate) of different anti-fungal interventions against oropharyngeal or esophageal candidiasis in adults with HIV. All NMA procedures were conducted using the frequentist model.Results: Twenty-seven RCTs and 6277 participants were included. For oropharyngeal candidiasis, photosensitizer-based antimicrobial photodynamic therapy (aPDT) with laser irradiation plus methylene blue was associated with the highest cure rate and the lowest relapse rate among the investigated interventions [odds ratio (OR) = 6.82, 95% confidence intervals (95%CIs) = 0.19 to 244.42, p = 0.293, and OR = 0.03, 95%CIs = 0.00 to 0.77, p = 0.034, compared to fluconazole]. None of the investigated anti-fungal interventions were superior to fluconazole for esophageal candidiasis in respect of cure rates/relapse rates. All investigated anti-fungal interventions were well-accepted.Conclusions: aPDT could be the preferred strategy to manage oropharyngeal candidiasis; however the evidence for esophageal candidiasis still remained inconclusive.
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Affiliation(s)
- Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (Mbi-lab), China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chang-Hua Chen
- Program in Translational Medicine, National Chung Hsing University, Taichung City, Taiwan.,Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung City, Taiwan.,Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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54
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Chanie ES, Bayih WA, Birhan BM, Belay DM, Asmare G, Tiruneh T, Aynalem YAA, Abat BB, Asnakew S, Mekie M, Yitbarek GY, GebreEyesus FA. Incidence of advanced opportunistic infection and its predictors among HIV infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized hospitals, Northwest Ethiopia, 2020: A multicenter retrospective follow-up study. Heliyon 2021; 7:e06745. [PMID: 33912717 PMCID: PMC8063747 DOI: 10.1016/j.heliyon.2021.e06745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study is aimed to assess the incidence of advanced opportunistic infections (OIs) and its predictors among Human Immunodeficiency Virus (HIV) infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized Hospitals, Northwest Ethiopia, 2020. Methods A retrospective follow-up study was conducted from June 1, 2010, to May 30, 2020. A total of 349 children under the age of 15 who had received Anti-Retroviral Therapy (ART) were included in the study. Data were entered into Epi info version 7.2 and then exported to Stata 14.0 for analysis. Kaplan Meier curve and Log-rank test were used to determine the median survival time and the discrepancy of different categorical variables. The Cox regression model was used to identify the predictors of advanced opportunistic infections. The Adjusted hazard ratio (AHR) at 95% confidence interval (CI) was used to declare statistical significance. Result The incidence rate of advanced opportunistic infection was 5.53 per 100 (95% CI: 4.7, 6.9) Person per year observation (PYO). The median survival time was 113 months and the total follow-up periods were yielding 18882 months. Children presenting with treatment failure, Cotrimoxazole Preventive Therapy (CPT) non-user, low hemoglobin level (<10 mg/dl), and poor/fair level of adherence to ART were less free survival time as compared to their counterparts for advanced opportunistic infections. Conclusion In this study, the median of advanced OIs free survival time was found to be low and the incidence rate was found to be high. The incidence advanced OIs was associated with anemia, treatment failure, and poor/fair level of adherence, cotrimoxazole preventive therapy non-users. Further research should conduct to evaluate and to improve the quality of care in the study area.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhan
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getnet Asmare
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yared Asmare Aynalem Aynalem
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Biruk Beletew Abat
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sintayehu Asnakew
- Department Psychiatric, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Maru Mekie
- Department Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getache Yideg Yitbarek
- Department of Biomedical, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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55
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A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala. J Fungi (Basel) 2021; 7:jof7040268. [PMID: 33916153 PMCID: PMC8065950 DOI: 10.3390/jof7040268] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023] Open
Abstract
Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.
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56
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Mnyambwa NP, Mahende C, Wilfred A, Sandi E, Mgina N, Lubinza C, Kahwa A, Petrucka P, Mfinanga S, Ngadaya E, Kimaro G. Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study. Infect Drug Resist 2021; 14:869-878. [PMID: 33688222 PMCID: PMC7937390 DOI: 10.2147/idr.s294575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse. Methods A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards. Results We processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12–44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections. Conclusion Antibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.
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Affiliation(s)
- Nicholaus P Mnyambwa
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Coline Mahende
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Amani Wilfred
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Erica Sandi
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Nicodem Mgina
- Central Tuberculosis Reference Laboratory (CTRL), Dar es Salaam, Tanzania
| | - Clara Lubinza
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Amos Kahwa
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Pammla Petrucka
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.,University of Saskatchewan, Saskatoon, Canada
| | - Sayoki Mfinanga
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania.,School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.,Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Godfather Kimaro
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
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Turner CT, Brown J, Shaw E, Uddin I, Tsaliki E, Roe JK, Pollara G, Sun Y, Heather JM, Lipman M, Chain B, Noursadeghi M. Persistent T Cell Repertoire Perturbation and T Cell Activation in HIV After Long Term Treatment. Front Immunol 2021; 12:634489. [PMID: 33732256 PMCID: PMC7959740 DOI: 10.3389/fimmu.2021.634489] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Objective In people living with HIV (PLHIV), we sought to test the hypothesis that long term anti-retroviral therapy restores the normal T cell repertoire, and investigate the functional relationship of residual repertoire abnormalities to persistent immune system dysregulation. Methods We conducted a case-control study in PLHIV and HIV-negative volunteers, of circulating T cell receptor repertoires and whole blood transcriptomes by RNA sequencing, complemented by metadata from routinely collected health care records. Results T cell receptor sequencing revealed persistent abnormalities in the clonal T cell repertoire of PLHIV, characterized by reduced repertoire diversity and oligoclonal T cell expansion correlated with elevated CD8 T cell counts. We found no evidence that these expansions were driven by cytomegalovirus or another common antigen. Increased frequency of long CDR3 sequences and reduced frequency of public sequences among the expanded clones implicated abnormal thymic selection as a contributing factor. These abnormalities in the repertoire correlated with systems level evidence of persistent T cell activation in genome-wide blood transcriptomes. Conclusions The diversity of T cell receptor repertoires in PLHIV on long term anti-retroviral therapy remains significantly depleted, and skewed by idiosyncratic clones, partly attributable to altered thymic output and associated with T cell mediated chronic immune activation. Further investigation of thymic function and the antigenic drivers of T cell clonal selection in PLHIV are critical to efforts to fully re-establish normal immune function.
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Affiliation(s)
- Carolin T. Turner
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - James Brown
- Departments of HIV and Respiratory Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Emily Shaw
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Evdokia Tsaliki
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Jennifer K. Roe
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Yuxin Sun
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - James M. Heather
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Marc Lipman
- Departments of HIV and Respiratory Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
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Baadani AM, Ballool S, Alhemyadi S, Sallam L, ALsufyani E, Alghamdi A, Alfahad W. The clinical outcome of HIV infection at a tertiary care center in Riyadh, Saudi Arabia. Saudi Med J 2021; 41:965-970. [PMID: 32893278 PMCID: PMC7557546 DOI: 10.15537/smj.2020.9.25274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To investigate clinical characteristics and the outcome of people living with HIV (PLWHIV) at tertiary care center in Riyadh, Saudi Arabia. Methods: The present retrospective, observational study was carried between 2000-2019 at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. The demographic and clinical characteristics of 137 PLWHIV patients were collected by reviewing the medical data record. Results: Of the total 137 PLWHIV, 78.8% were male and 21.2% were female. At care entry, the most opportunistic infections found were the cytomegalovirus infections. cytomegalovirus (CMV) infections in 13.8% of patients, tuberculosis (8%), AIDS associated malignancy (10.9%), hepatitis B (5.8%), NTM (3.6%), hepatitis C (2.2%). In the present study, more than half of the patients received integrase based combination therapy. The highest number (n=20) of patients were diagnosed in 2018. Conclusions: Our findings describe the clinical characteristics and outcomes of PLWHIV at a major tertiary referral hospital in Saudi Arabia. The non AIDS related disease is the major cause of death in HIV infected patients. Early diagnosis and initiation of antiretroviral therapy resulted in a significant decrease in morbidity and mortality.
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Affiliation(s)
- Abeer M Baadani
- Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Winchester NE, Maldarelli F, Mejia Y, Dee N, Dewar R, Laidlaw E, Kuriakose SS, Stoll P, Proschan M, Lane HC, Pau AK. Eight-day Inpatient Directly Observed Therapy for Antiretroviral Therapy (ART) Failure: A Tool For Preventing Unnecessary ART Changes and Optimizing Adherence Support. Clin Infect Dis 2021; 70:1222-1225. [PMID: 31298273 DOI: 10.1093/cid/ciz590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
Eight-day inpatient directly observed therapy confirmed nonadherence as the major cause of virologic failure for 9 (45%) of 20 highly treatment-experienced persons with human immunodeficiency virus, extensive antiretroviral drug resistance, and high self-reported adherence rates, preventing unnecessary regimen changes.
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Affiliation(s)
| | | | - Yolanda Mejia
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nicola Dee
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Robin Dewar
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Safia S Kuriakose
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Pamela Stoll
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | - H Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda
| | - Alice K Pau
- National Institute of Allergy and Infectious Diseases, Bethesda
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Agudelo CA, Álvarez MF, Hidrón A, Villa JP, Echeverri-Toro LM, Ocampo A, Porras GP, Trompa IM, Restrepo L, Eusse A, Restrepo CA. Outcomes and complications of hospitalised patients with HIV-TB co-infection. Trop Med Int Health 2020; 26:82-88. [PMID: 33155342 DOI: 10.1111/tmi.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. METHODS Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. RESULTS Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. CONCLUSIONS Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.
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Affiliation(s)
- Carlos Andrés Agudelo
- Universidad Pontificia Bolivariana, Medellín.,Clínica Universitaria Bolivariana, Medellín, Colombia.,Hospital San Vicente de Paúl, Rionegro, Colombia
| | | | - Alicia Hidrón
- Universidad Pontificia Bolivariana, Medellín.,Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Juan Pablo Villa
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
| | - Lina María Echeverri-Toro
- Hospital San Vicente de Paúl, Rionegro, Colombia.,Hospital Universitario, San Vicente Fundación, Medellín, Colombia
| | | | | | - Iván Mauricio Trompa
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
| | | | | | - Carlos Andrés Restrepo
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
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Pujari S, Gugale P, Shah D, Patel D, Gaikwad S, Desouza C, Atre A. Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression. AIDS 2020; 34:2165-2168. [PMID: 32910070 DOI: 10.1097/qad.0000000000002676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Nakalema HS, Rajan SS, Morgan RO, Lee M, Gillespie SL, Kekitiinwa A. The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda. AIDS Care 2020; 33:904-913. [PMID: 33021095 DOI: 10.1080/09540121.2020.1829533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTOpportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15-24 years old, who started ART pre-guideline (January 2012-June 2014) and post-guideline (July 2014-December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
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Affiliation(s)
- Hilda Sekabira Nakalema
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda.,Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA
| | - Minjae Lee
- Department of Epidemiology, Human Genetics & Environmental Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Susan L Gillespie
- Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
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McCarty TR, Sharma P, Lange A, Ngu JN, Davis A, Njei B. Safety of Bariatric Surgery in Morbidly Obese Patients with Human Immunodeficiency Virus: A Nationwide Inpatient Sample Analysis, 2004-2014. Bariatr Surg Pract Patient Care 2020; 15:116-123. [PMID: 32939330 DOI: 10.1089/bari.2019.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Despite rising rates of obesity among human immunodeficiency virus (HIV)-positive individuals, the safety and tolerability of surgery in this population have not been established. The primary aim of this study was to examine the safety of bariatric surgery and rate of in-hospital postoperative complications in morbidly obese patients with HIV. Materials and Methods: The U.S. Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with codiagnoses of morbid obesity and bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospitalization costs, and multiple categories of complications, including systemic complications, surgical complications, and nutritional and behavioral complications. Results: Among 267,082 patients with discharge diagnoses of morbid obesity and bariatric surgery, 346 (0.13%) were diagnosed with HIV. On multivariable analysis, HIV did not influence in-hospital mortality (p = 0.530). HIV was not associated with increased risk of renal failure (p = 0.274), thromboembolism (p = 0.713), myocardial infarction (p = 0.635), sepsis (p = 0.757), hemorrhage (p = 0.303), or wound infection (p = 0.229). Other measured surgical complications were not significantly different (p > 0.05). Notably, HIV-positive patients had an increased risk for postoperative pneumonia (p = 0.002), pancreatitis (p = 0.049), and thiamine deficiency (p = 0.016). Conclusion: Bariatric surgery among HIV-positive patients appears to be acceptably safe with the risk of postoperative complications comparable with non-HIV patients.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Prabin Sharma
- Department of Gastroenterology and Hepatology, Yale New Haven Health-Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Andrew Lange
- Department of Gastroenterology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Julius N Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashley Davis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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64
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Dockrell DH, O’Shea D, Cartledge JD, Freedman AR. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019. HIV Med 2020; 20 Suppl 8:2-24. [PMID: 31670458 DOI: 10.1111/hiv.12806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- D H Dockrell
- University of Edinburgh, Edinburgh, UK and Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | - D O’Shea
- University of Edinburgh, Edinburgh, UK and Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | | | - A R Freedman
- Cardiff University School of Medicine, Cardiff, UK
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65
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Brief Report: Diagnostic Accuracy of Oral Mucosal Transudate Tests Compared with Blood-Based Rapid Tests for HIV Among Children Aged 18 Months to 18 Years in Kenya and Zimbabwe. J Acquir Immune Defic Syndr 2020; 82:368-372. [PMID: 31425318 PMCID: PMC6830960 DOI: 10.1097/qai.0000000000002146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gaps persist in HIV testing for children who were not tested in prevention of mother-to-child HIV transmission programs. Oral mucosal transudate (OMT) rapid HIV tests have been shown to be highly sensitive in adults, but their performance has not been established in children.
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66
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Early scale-up of antiretroviral therapy at diagnosis for reducing economic burden of cardiometabolic disease in HIV-infected population. AIDS 2020; 34:903-911. [PMID: 32028326 DOI: 10.1097/qad.0000000000002490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The current study aims to assess the effect of early scale-up of antiretroviral therapy (ART) at HIV diagnosis on the economic burden of cardiometabolic diseases (CMDs) in HIV-infected population. DESIGN Cohort study. METHODS The study cohort comprised 10 693 newly diagnosed HIV patients without CMDs before HIV diagnosis identified from a nationwide HIV cohort in Taiwan. The patients were stratified by ART use [medication possession ratio ≥0.8: (high) vs. <0.8: (low)] and AIDS-defining illnesses (ADI) status [present: (+) vs. absent: (-)] at the first year of HIV diagnosis into four groups: ART (low) and ADI (-), ART (low) and ADI (+), ART (high) and ADI (-), and ART (high) and ADI (+). The economic analysis of incident CMDs was from the perspective of Taiwan's single-payer healthcare system and estimated using generalized estimating equations. RESULTS CMDs significantly increased annual direct medical costs by 31% (hypertension) to 127% [cardiovascular diseases (CVDs)]. The annual cost burden of diabetes, dyslipidemia, and CVDs in the ART (high) and ADI (-) group significantly decreased by 42, 30, and 31%, respectively, compared with the ART (low) and ADI (+) group. Compared with the ART (low) and ADI (+) group, the annual cost burden of CVDs in the ART (high) and ADI (-) and ART (high) and ADI (+) groups decreased by 31 and 14%, respectively, suggesting increased cost-savings when ART is initiated at diagnosis before ADI occurrence. CONCLUSION The early scale-up of ART at diagnosis before ADI occurrence is important for minimizing the economic burden of incident CMDs among HIV-infected patients.
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Jia S, Li J, Liu Y, Zhu F. Precision immunization: a new trend in human vaccination. Hum Vaccin Immunother 2020; 16:513-522. [PMID: 31545124 DOI: 10.1080/21645515.2019.1670123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination has been one of the major revolutions in the history of human health. Vaccination programs have targeted entire populations such as infants or elderly subjects as a matter of being efficient with time and resources. These general populations are heterogeneous in terms of factors such as ethnicity, health status, and socio-economics. Thus, there have been variations in the safety and effectiveness profiles of certain vaccinations according to current population-wide strategies. As the concept of precision medicine has been raised in recent years, many researchers have suggested that vaccines could be administered more precisely in terms of particular target populations, vaccine formulations, regimens, and dosage levels. This review addresses the concept and framework of precision immunization, summarizes recent and representative clinical trials of among specific populations, mentions important factors to be addressed in customizing vaccinations, and provides suggestions on the establishment of precision immunization with the goal of maximizing the effectiveness of vaccines in general.
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Affiliation(s)
- Siyue Jia
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Jingxin Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Yuanbao Liu
- Expanded Program on Immunization Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.,NHC Key laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Fengcai Zhu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.,NHC Key laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
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Wykowski J, Galagan SR, Govere S, Wallis CL, Moosa MY, Celum C, Drain PK. Cryptococcal antigenemia is associated with meningitis or death in HIV-infected adults with CD4 100-200 cells/mm 3. BMC Infect Dis 2020; 20:61. [PMID: 31959112 PMCID: PMC6971851 DOI: 10.1186/s12879-020-4798-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cryptococcal antigen (CrAg) screening with fluconazole prophylaxis has been shown to prevent cryptococcal meningitis and mortality for people living with HIV (PLWH) with CD4 < 100 cells/mm3. While cryptococcal meningitis occurs in individuals with CD4 100-200 cells/mm3, there is limited evidence that CrAg screening predicts cryptococcal meningitis or mortality among this group with moderate immunosuppression. Current IDSA and WHO clinical guidelines recommend restricting CrAg screening to PLWH with CD4 < 100 cells/mm3. METHODS We conducted a prospective cohort study of PLWH 18+ years who had not initiated ART in South Africa. We followed participants for 14 months to determine onset of cryptococcal meningitis or all-cause mortality. At study completion, we retrospectively tested stored serum samples for CrAg using an enzyme immunoassay (EIA). We calculated CD4-stratified incidence rates of outcomes and used Cox proportional hazards to measure associations between CrAg positivity and outcomes. RESULTS We enrolled 2383 PLWH, and 1309 participants had serum samples tested by CrAg EIA. The median CD4 was 317 cells/mm3 (interquartile range: 173-491 cells/mm3). By CD4 count at baseline, there were 209 individuals with a CD4 count of 100-200 cells/mm3 and available CrAg test results. Of these, four (1.9%) tested positive. Two of four (IR: 58.8 per 100 person-years) CrAg+ participants and 11 of 205 (IR: 5.6 per 100 person-years) CrAg- participants developed cryptococcal meningitis or died for an overall rate of death or cryptococcal meningitis that was 10.0-times higher for those who were CrAg+ (95% confidence interval: 2.2-45.3). Among those with CD4 < 100 cell/mm3 and CrAg EIA test results (N = 179), ten (5.6%) participants tested CrAg+. Among this group, seven of ten (IR: 137.6 per 100 person-years) CrAg+ participants and 26 of 169 (IR: 17.8 per 100 person-years) CrAg- participants developed cryptococcal meningitis or died, for a rate of death or cryptococcal meningitis that was 6.3-times higher for those who were CrAg+ (95% confidence interval: 2.7-14.6). CONCLUSIONS Although few PLWH with moderate immunosuppression screened CrAg positive, a positive CrAg test was predictive of increased risk of cryptococcal meningitis or death. Similar to those with a CD4 < 100 cell/mm3, systematic CrAg screening may reduce morbidity and mortality in PLWH with CD4 100-200 cells/mm3.
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Affiliation(s)
- James Wykowski
- Department of Medicine, University of Washington, Seattle, USA.
| | | | | | | | - Mahomed-Yunus Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Connie Celum
- Department of Medicine, University of Washington, Seattle, USA.,Global Health, University of Washington, Seattle, USA
| | - Paul K Drain
- Department of Medicine, University of Washington, Seattle, USA.,Global Health, University of Washington, Seattle, USA.,Epidemiology, University of Washington, Seattle, USA
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69
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Melkamu MW, Gebeyehu MT, Afenigus AD, Hibstie YT, Temesgen B, Petrucka P, Alebel A. Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study. BMC Infect Dis 2020; 20:50. [PMID: 31948393 PMCID: PMC6966876 DOI: 10.1186/s12879-020-4772-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. Methods A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. Results This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having “fair” or “poor” ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. Conclusions In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, “fair” or “poor” ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.
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Affiliation(s)
| | | | | | | | - Belisty Temesgen
- Debre Markos Referral Hospital, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia. .,Faculty of Health, University of Technology Sydney, Sydney, Australia.
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Anywar G, Kakudidi E, Byamukama R, Mukonzo J, Schubert A, Oryem-Origa H. Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda. JOURNAL OF ETHNOPHARMACOLOGY 2020; 246:112205. [PMID: 31476442 DOI: 10.1016/j.jep.2019.112205] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Currently, more than two thirds of the world's 36.9 million people living with HIV/AIDS reside in Sub-Saharan Africa. Opportunistic infections (OI) associated with HIV are the single most important cause of mortality and morbidity among HIV/AIDS patients in poor countries. There is widespread use of medicinal plant species to manage the HIV infection and it's associated OI in Uganda, even by patients already on antiretroviral drugs (ARV). However, much of this information remains undocumented and unverified. AIM OF STUDY The aim of this study was to systematically and comprehensively document the traditional indigenous knowledge and practices associated with the management of HIV/AIDS infections by herbalists in Uganda. METHODS Ethnobotanical data were collected using semi-structured interviews and questionnaires. Ninety traditional medicine practitioners (TMP) or herbalists were interviewed in Arua, Dokolo, Mbale, Bushenyi, Iganga, Rakai, Luwero and Kaabong districts to gather information on the plant species used. Data were analysed and presented using descriptive statistics and the Informant Consensus Factor. RESULTS We documented 236 medicinal plant species from 70 families and 201 genera. Acacia was the most widely represented genus with five species. The most frequently used medicinal plant species for treating various OI were Erythrina abyssinica (45), Warburgia ugandensis (43), Zanthoxylum chalybeum (38), Acacia hockii (37), Mangifera indica (36), Aloe vera (35), Albizia coriaria (34), Azadirachta indica (32), Psorospermum febrifugum (27) Vernonia amygdalina (22) and Gymnosporia senegalensis (21). Some of the plant species were used for treating all the OI mentioned. There is a high degree of consensus among the TMP on which plant species they use for the different OI, even though they are geographically separated. Herbalists contribute to the widespread practice of simultaneously using herbal medicines and ARV. Some TMP are also engaged in dangerous practices like injecting patients with herbs and encouraging simultaneous use of herbs and ARV. Although the TMP relied on biomedical laboratory diagnoses for confirming the patients' HIV sero status, they were familiar with the signs and symptoms of HIV/AIDS. CONCLUSION There is wide spread use of a rich diversity of medicinal plants species and practices by TMP to manage OI in HIV/AIDS patients in Uganda.
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Affiliation(s)
- G Anywar
- Department of Plant Sciences, Microbiology & Biotechnology, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda; Fraunhofer Institute for Cell Therapy & Immunology (IZI), Perlickstraße, 104103, Leipzig, Germany.
| | - E Kakudidi
- Department of Plant Sciences, Microbiology & Biotechnology, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - R Byamukama
- Department of Chemistry, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - J Mukonzo
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - A Schubert
- Fraunhofer Institute for Cell Therapy & Immunology (IZI), Perlickstraße, 104103, Leipzig, Germany
| | - H Oryem-Origa
- Department of Plant Sciences, Microbiology & Biotechnology, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda
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Lamp K, McGovern S, Fong Y, Atem CD, Nfetam JBE, Nzuobontane D, Bollinger T, Jani I, Sitoe N, Kiyaga C, Senyama G, Mangwendeza PM, Mtapuri-Zinyowera S, Doi N, Peter T, Sacks JA, Vojnov L. Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries. PLoS One 2020; 15:e0226987. [PMID: 31910221 PMCID: PMC6946176 DOI: 10.1371/journal.pone.0226987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Globally, nearly 22 million HIV-infected patients are currently accessing antiretroviral treatment; however, almost one million people living with HIV died of AIDS-related illnesses in 2018. Advanced HIV disease remains a significant issue to curb HIV-related mortality. Methods We analyzed 864,389 CD4 testing records collected by 1,016 Alere Pima Analyzers implemented at a variety of facilities, including peripheral facilities, between January 2012 and December 2016 across four countries in sub-Saharan Africa. Routinely collected data and programmatic records were used to analyze the median CD4 counts and proportions of patients with advanced HIV disease by country, facility type, and year. Results Median CD4 counts were between 409–444 cells/ul each year since 2012 with a median in 2016 of 444 cells/ul (n = 319,829). The proportion of test results returning CD4 counts above 500 cells/ul has increased slowly each year with 41.8% (95% CI: 41.6–41.9%) of tests having a CD4 count above 500 cells/ul in 2016. Median CD4 counts were similar across facility types. The proportion of test results indicating advanced HIV disease has remained fairly consistent: 19.4% (95% CI: 18.8–20.1%) in 2012 compared to 16.1% (95% CI: 16.0–16.3%) in 2016. The proportion of test results indicating advanced HIV disease annually ranged from 14.5% in Uganda to 29.8% in Cameroon. 6.9% (95% CI: 6.8–7.0%) of test results showed very advanced HIV disease (CD4<100 cells/ul) in 2016. Conclusions The proportion of CD4 test results indicating advanced disease was relatively high and consistent across four high HIV burden countries.
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Affiliation(s)
- Katherine Lamp
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Seth McGovern
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | | | | | | | | | - Ilesh Jani
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Nadia Sitoe
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | | | | | | | - Naoko Doi
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Jilian A. Sacks
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Lara Vojnov
- Clinton Health Access Initiative, Boston, MA, United States of America
- * E-mail:
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72
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Bobat R. Opportunistic Infections. HIV INFECTION IN CHILDREN AND ADOLESCENTS 2020. [PMCID: PMC7120925 DOI: 10.1007/978-3-030-35433-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Evolution in paediatric HIV management has changed the incidence and prevalence of opportunistic infections and a major reduction has been shown for most opportunistic infections with antiretroviral therapy use in lower and middle-income countries, especially in the first year of treatment. However, the high prevalence of disease still requires adequate management of opportunistic infections, to improve patient quality of life and the impact on burden of disease. Lower CD4 counts were associated with chronic infection and increased risk of opportunistic infections in patients, but some studies have shown that even children with high CD4 counts may have opportunistic infections. This chapter reviews common opportunistic infections that may infect HIV positive children and adolescents, particularly in sub Saharan Africa.
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Affiliation(s)
- Raziya Bobat
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
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Stacey HJ, Woodhouse L, Welburn SC, Jones JD. Aetiologies and therapies of nodding syndrome: a systematic review and meta-analysis. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Toh HS, Yang CT, Yang KL, Ku HC, Liao CT, Kuo S, Tang HJ, Ko WC, Ou HT, Ko NY. Reduced economic burden of AIDS-defining illnesses associated with adherence to antiretroviral therapy. Int J Infect Dis 2019; 91:44-49. [PMID: 31740407 DOI: 10.1016/j.ijid.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We assessed the economic burden of AIDS-defining illnesses (ADIs), which was further stratified by adherence to antiretroviral therapy (ART). METHODS AND MATERIALS A nationwide longitudinal cohort of 18,234 incident cases with HIV followed for 11years was utilized. Adherence to ART was measured by medication possession ratio (MPR). Generalized estimating equations modeling was used to estimate the cost impact of ADIs. RESULTS Having opportunistic infections increased the annual cost by 9% (varicella-zoster virus infection) to 98% (cytomegalovirus disease), while the annual costs increased by 26% (Kaposi's sarcoma) to 95% (non-Hodgkin's lymphoma) in the year when AIDS-related cancer occurred. ADIs occurred more frequently in the years with low adherence for ART compared to the high-adherence years (e.g., 0.1≤MPR<0.8 vs. MPR≥0.8, event rate of cytomegalovirus disease 4.03% vs. 0.51%). The annual baseline costs in the years with MPR<0.1, 0.1≤MPR<0.8, and MPR≥0.8 were $250, $4,752, and $8,990 (in 2018 USD), respectively. The economic impact of ADIs in the years with low adherence (MPR<0.1) was larger than that in the high-adherence years (MPR≥0.8) (e.g., MPR<0.1 vs. MPR≥0.8, annual cost increased by 244% vs. 9% when candidiasis occurred). CONCLUSIONS Adherence to ART may increase the baseline medical costs but mitigate the incidence and economic burden of ADIs.
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Affiliation(s)
- Han-Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Li Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan; Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Te Liao
- Division of Cardiology, Department of Internal Medicine, Chimei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Hung-Jen Tang
- Division of Infectious Diseases, Department of Internal Medicine, Chimei Medical Center, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Longitudinal evaluation of asymptomatic Leishmania infection in HIV-infected individuals in North-West Ethiopia: A pilot study. PLoS Negl Trop Dis 2019; 13:e0007765. [PMID: 31593563 PMCID: PMC6799935 DOI: 10.1371/journal.pntd.0007765] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 10/18/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background In endemic regions, asymptomatic Leishmania infection is common. In HIV patients, detection of asymptomatic Leishmania infection could potentially identify those at risk of visceral leishmaniasis (VL). However, data on the prevalence, incidence, and determinants of asymptomatic infection, and the risk of VL are lacking. Methods We conducted a cross-sectional survey at a single ART centre, followed by a prospective cohort study amongst HIV-infected adults in HIV care in a district hospital in a VL-endemic area in North-West Ethiopia (9/2015-8/2016). Asymptomatic Leishmania infection was detected using the direct agglutination test (DAT), rK39-rapid diagnostic test (RDT)), PCR on peripheral blood and the KAtex urine antigen test, and defined as positivity on any Leishmania marker. All individuals were followed longitudinally (irrespective of the Leishmania test results). Risk factors for asymptomatic Leishmania infection were determined using logistic regression. Results A total of 534 HIV-infected individuals enrolled in HIV care were included in the study. After excluding 13 patients with a history of VL and an 10 patients with incomplete baseline Leishmania tests, 511 were included in analysis. The median age was 38 years (interquartile range (IQR) 30–45), 62.6% were male. The median follow-up time was 12 months (IQR 9–12). No deaths were reported during the study period. Most (95.5%) were on antiretroviral treatment at enrolment, for a median of 52 months (IQR 27–79). The median CD4 count at enrolment was 377 cells/mm3 (IQR 250–518). The baseline prevalence of Leishmania infection was 12.8% in males and 4.2% in females. Overall, 7.4% tested positive for rK39, 4.3% for DAT, 0.2% for PCR and 0.2% for KAtex. Independent risk factors for a prevalent infection were male sex (odds ratio (OR) 3.2; 95% confidence intervals (CI) 14–7.0) and concurrent malaria infection (OR 6.1; 95% CI 1.9–18.9). Amongst the 49 prevalent (baseline) infections with further follow-up, the cumulative incidence of losing the Leishmania markers by one year was 40.1%. There were 36 incident infections during the course of the study, with a cumulative one-year risk of 9.5%. Only one case of VL was detected during follow-up. Conclusions We found a high prevalence of asymptomatic Leishmania infection, persisting in most cases. The incidence was more modest and overt VL was rare. Larger and longer studies with more complete follow-up may help to decide whether a test and treat strategy would be justified in this context. Trial registration ClinicalTrials.gov NCT02839603 As visceral leishmaniasis (VL) in HIV patients is difficult to treat and associated with high mortality, strategies to detect and treat asymptomatic Leishmania infection in HIV patients should be explored. However, data on the prevalence, incidence, determinants of asymptomatic infection and risk of VL are lacking. We conducted a longitudinal study, including HIV-infected adult patients in HIV care in a district hospital in a VL-endemic area in North-West Ethiopia. Asymptomatic Leishmania infection was evaluated by Leishmania antibody tests (DAT and rK39), urine antigen tests (KAtex) and PCR, and was defined as positivity on any Leishmania marker. We also looked for independent risk factors for asymptomatic Leishmania infection at study recruitment. A total of 511 patients were included in the analysis. The median age was 38 years, 62.6% were male. The median time of residence in a VL-endemic area was 18 years. Most (95.5%) were on antiretroviral treatment at enrolment, for a median of 52 months. The median CD4 count at enrolment was 377 cells/mm3. The baseline prevalence of Leishmania infection was 12.8% in males and 4.2% in females. Overall, 7.4% tested positive for rK39, 4.3% for DAT, 0.2% for PCR and 0.2% for KAtex. Independent risk factors for a prevalent infection were male sex and concurrent malaria infection. Amongst the 49 prevalent infections that were present upon enrolment in the study, the probability of losing the Leishmania markers by one year was 40.1%. There were 36 new infections during the course of the study, with an overall risk of 9.5% by one year of follow-up. One case of VL was detected during follow-up. In conclusion, we found a high prevalence of asymptomatic Leishmania infection, which persisted in most cases. The incidence was more modest. Larger and longer studies would be needed to decide whether a test and treat strategy would be justified in this context.
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76
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Dereje N, Moges K, Nigatu Y, Holland R. Prevalence And Predictors Of Opportunistic Infections Among HIV Positive Adults On Antiretroviral Therapy (On-ART) Versus Pre-ART In Addis Ababa, Ethiopia: A Comparative Cross-Sectional Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:229-237. [PMID: 31632155 PMCID: PMC6789429 DOI: 10.2147/hiv.s218213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022]
Abstract
Purpose Data comparing the burden of the opportunistic infections among the Pre-ART and On-ART HIV-infected patients in Ethiopia are scarce. Therefore, this study aimed to compare the prevalence and predictors of opportunistic infections in Pre-ART and On-ART HIV-infected patients. Methods A comparative cross-sectional study was conducted among adult patients infected with HIV and who were on Pre-ART or On-ART and followed up from 2012 to 2016 in Zewditu Memorial Hospital, Addis Ababa. Those patients who were infected with HIV, but not eligible for ART were categorized under Pre-ART follow-up (n=192) and those patients who started taking ART were categorized under the On-ART follow-up group (n=192). Patients were included in the study by using simple random sampling technique from the list of the patients registered in the ART follow-up database. The presence of opportunistic infections along with clinical findings and baseline laboratory data was extracted from the ART follow-up database and the medical records of the patients using a standardized checklist. Factors associated with the development of opportunistic infections were analyzed using multi-variable binary logistic regression analysis. Results The overall prevalence of opportunistic infections was found to be 33.6% (95% CI; 28.9-38.5). The prevalence of opportunistic infections among the Pre-ART group (38%) was higher than On-ART group (29.2%) (P-value = 0.04). Pulmonary tuberculosis was the most common opportunistic infection observed in both Pre-ART and On-ART groups. Being in the WHO clinical Stage III (AOR = 2.1; 95% CI 1.1-3.9) or Stage IV (AOR = 3.6; 95% CI 1.7-7.7) were independent predictors for the development of opportunistic infections. Conclusion The prevalence of opportunistic infections among the HIV-infected patients who were in Pre-ART was higher than On-ART group. This finding reinforces the need for early initiation of ART for HIV-infected patients irrespective of their CD4 counts.
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Affiliation(s)
- Nebiyu Dereje
- Department of Public Health, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Kalkidan Moges
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Yemisrach Nigatu
- Department of Public Health, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Roger Holland
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
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Garvey EP, Sharp AD, Warn PA, Yates CM, Schotzinger RJ. The novel fungal CYP51 inhibitor VT-1598 is efficacious alone and in combination with liposomal amphotericin B in a murine model of cryptococcal meningitis. J Antimicrob Chemother 2019; 73:2815-2822. [PMID: 29947783 DOI: 10.1093/jac/dky242] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/25/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives Annual global deaths from cryptococcal meningitis (CM) are estimated at 180 000 and mortality is as high as 30%, even with optimal therapy. VT-1598 is a novel fungal CYP51 inhibitor with potent intrinsic antifungal activity against Cryptococcus. We report here VT-1598's in vivo antifungal activity in a murine model of CM. Methods Single-dose plasma and brain pharmacokinetics in mice and MIC for Cryptococcus neoformans H99 were determined prior to efficacy studies. Short-course monotherapy and combination doses were explored with the endpoint of brain fungal burden. A survival study was also conducted using monotherapy treatment with fungal burden measured after a 6 day drug washout. Results Oral doses of VT-1598 had good plasma and brain exposure and resulted in significant (P < 0.0001) and dose-dependent reductions in brain fungal burden, reaching a 6 log10 reduction. Unlike either positive drug control (fluconazole or liposomal amphotericin B), both mid and high doses of VT-1598 reduced fungal burden to below levels measured at the start of treatment. When VT-1598 was dosed in the survival study, no VT-1598-treated animal succumbed to the infection. Whereas fluconazole showed a 2.5 log10 increase in fungal burden after the 6 day washout, the VT-1598 mid- and high-dose animals showed almost no regrowth (<0.5 log10). In a separate fungal burden study using suboptimal doses of VT-1598 and liposomal amphotericin B to probe for combination effects, each combination had a positive effect relative to corresponding monotherapies. Conclusions These pre-clinical in vivo data strongly support clinical investigation of VT-1598 as a novel therapy for this lethal infection.
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Affiliation(s)
- E P Garvey
- Viamet Pharmaceuticals, Inc., Durham, NC, USA
| | | | | | - C M Yates
- Viamet Pharmaceuticals, Inc., Durham, NC, USA
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Ford N, Meintjes G, Calmy A, Bygrave H, Migone C, Vitoria M, Penazzato M, Vojnov L, Doherty M. Managing Advanced HIV Disease in a Public Health Approach. Clin Infect Dis 2019. [PMID: 29514232 PMCID: PMC5850613 DOI: 10.1093/cid/cix1139] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplified intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.
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Affiliation(s)
- Nathan Ford
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Graeme Meintjes
- Wellcome Trust Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV Unit, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Helen Bygrave
- Médecins Sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa
| | - Chantal Migone
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | | | - Lara Vojnov
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
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North CM, MacNaughton P, Lai PS, Vallarino J, Okello S, Kakuhikire B, Tsai AC, Castro MC, Siedner MJ, Allen JG, Christiani DC. Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study. Environ Health 2019; 18:73. [PMID: 31429759 PMCID: PMC6701123 DOI: 10.1186/s12940-019-0517-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/12/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. METHODS From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. RESULTS Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7-27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1-10.0) but not men (AOR 1.3, 95%CI 0.4-4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01-6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1-14.4) participants. CONCLUSIONS In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.
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Affiliation(s)
- Crystal M. North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Peggy S. Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jose Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Samson Okello
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of Virginia Health System, Charlottesville, USA
| | | | - Alexander C. Tsai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Mark J. Siedner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph G. Allen
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - David C. Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Peer N, Bogoch II, Bassat Q, Newcombe L, Watson LK, Nagelkerke N, Jha P. AIDS-defining causes of death from autopsy findings for HIV-positive individuals in sub-Saharan Africa in the pre- and post-ART era: A systematic review and meta-analyses. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13041.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The lack of representative data on causes of death in sub-Saharan Africa (SSA) hampers our understanding of the regional burden of HIV and impact of interventions. In spite of the roll-out of antiretroviral therapy (ART) programs, HIV-infected individuals are still dying from complications of AIDS in SSA. We reviewed autopsy findings in SSA to observe whether the prevalence of 14 AIDS-defining illnesses changed from the pre-ART era to the post-ART era. Methods: We conducted a systematic review of autopsy findings in SSA using Medline, CINAHL, Evidence Based Medicine, EMBASE, Scopus, Web of Science, and abstracts from the Conference on Retroviruses and Opportunistic Infections, for literature published between January 1, 1990 and September 30, 2018. We focused on 14 AIDS-defining illnesses as causes of death. Results: In total, 33 studies were identified, including 9 from South Africa, 4 from the Ivory Coast, and the rest from eastern regions of sub-Saharan Africa. Of these, 18 studies were included in the meta-analyses for each of the AIDS-defining illnesses for adults. A ‘mixed group’ of studies that included adults and children was used for separate meta-analyses. Most opportunistic infections (OIs) showed a decrease in prevalence, with the notable exception of tuberculosis (TB), which showed a 13% increase in adult deaths and a 5% increase in mixed population group deaths. Kaposi’s sarcoma and non-Hodgkin’s lymphoma both showed a notable increase in prevalence, and liver disease showed a 10% increase in prevalence in the adult group. Conclusions: Even though ART has reduced the contribution of OIs to causes of death for people infected with HIV in SSA, targeted and strategic efforts are needed in order to strengthen existing prevention, diagnosis, and treatment of TB. More research is required to understand the complex role ARTs have on liver and kidney diseases.
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81
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Singh P, Rajput R, Mehra NK, Vajpayee M, Sarin R. Cytokine gene polymorphisms among North Indians: Implications for genetic predisposition? INFECTION GENETICS AND EVOLUTION 2019; 73:450-459. [PMID: 31173933 DOI: 10.1016/j.meegid.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022]
Abstract
Variations in the production and activity of cytokines influence the susceptibility and/or resistance to various infectious agents, autoimmune diseases, as well as the post-transplant engraftment/ rejection. Differences in the production of cytokines between individuals have been correlated to single nucleotide polymorphisms (SNPs) in the promoter, coding or non-coding regions of cytokine genes. The present study aimed at understanding distribution of cytokine gene variants among HIV seropositive subjects including HIV + TB+ subjects of Indian origin. Our findings indicate significant association of pro-inflammatory (IL2, IFN-γ, TNF-α) and anti-inflammatory cytokine gene variants (IL4, IL10) with the risk to acquire the HIV infection and development of AIDS related illness in Indian population. Since distribution of genetic polymorphisms varies significantly across different populations, different genotypes might exhibit different disease-modifying effects. An understanding of the immunogenetic factors or AIDS restriction genes is important not only for elucidating the mechanisms of disease pathogenesis but also for vaccine design and its application.
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Affiliation(s)
- Paras Singh
- Department of Molecular Medicine, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India.
| | - Roopali Rajput
- Department of Molecular Medicine, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Narinder K Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Madhu Vajpayee
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rohit Sarin
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
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Collin SM, Wurie F, Muzyamba MC, de Vries G, Lönnroth K, Migliori GB, Abubakar I, Anderson SR, Zenner D. Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews. Eur Respir Rev 2019; 28:28/152/180107. [PMID: 31142548 DOI: 10.1183/16000617.0107-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/22/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence? METHODS We conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to "direct" or "indirect" effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as "sufficient", "tentative", "insufficient" or "no" using a framework based on the consistency of evidence within and between reviews. RESULTS We found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection. DISCUSSION Our review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.
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Affiliation(s)
- Simon M Collin
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Fatima Wurie
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Morris C Muzyamba
- TB Unit, National Infection Service, Public Health England, London, UK
| | | | | | | | | | - Sarah R Anderson
- TB Unit, National Infection Service, Public Health England, London, UK
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Hagiwara S, Nagai H, Tanaka J, Okada S. The current state of human immunodeficiency virus-associated lymphoma in Japan: a nationwide retrospective study of the Japanese Society of Hematology Blood Disease Registry. Int J Hematol 2019; 110:244-249. [PMID: 31111394 DOI: 10.1007/s12185-019-02668-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
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Álvarez-Moreno CA, González-Vélez AE, Colmenares-Mejía CC, Rincón-Ramírez KL, García-Buitrago JA, Rengifo-Bobadilla PA, Isaza-Ruget MA. The cost of hospital care for HIV patients in Colombia: an insurer's perspective. Int J STD AIDS 2019; 30:696-702. [PMID: 31046613 DOI: 10.1177/0956462419835636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.
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Salzer HJF, Heyckendorf J, Kalsdorf B, Herzmann C, Hoffmann C, Lange C. Chronic Cough and Severe Weight Loss in a 55-Year-Old Previously Healthy Man. Clin Infect Dis 2019; 65:349-351. [PMID: 28931270 DOI: 10.1093/cid/cix268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit
| | - Christian Herzmann
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit.,Center for Clinical Studies, Research Center Borstel
| | - Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg Study Center.,Department of Medicine II, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit.,Department of Internal Medicine, University of Namibia School of Medicine, Windhoek.,International Health/Infectious Diseases, University of Lübeck, Germany.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
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Kendall EA, Azman AS, Maartens G, Boulle A, Wilkinson RJ, Dowdy DW, Rangaka MX. Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting. AIDS 2019; 33:525-536. [PMID: 30325773 PMCID: PMC6355370 DOI: 10.1097/qad.0000000000002053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) reduce tuberculosis risk in individuals living with HIV. We sought to estimate the broader, population-wide impact of providing a pragmatically implemented 12-month IPT regimen to ART recipients in a high-burden community. DESIGN Dynamic transmission model of a tuberculosis (TB)-HIV epidemic, calibrated to site-specific, historical epidemiologic and clinical trial data from Khayelitsha, South Africa. METHODS We projected the 5-year impact of delivering a 12-month IPT regimen community-wide to 85% of new ART initiators and 15%/year of those already on ART, accounting for IPT-attributable reductions in TB infection, progression, and transmission. We also evaluated scenarios of continuously-delivered IPT, ongoing ART scale-up, and lower tuberculosis incidence. RESULTS Under historical (early 2010) ART coverage, this ART-linked IPT intervention prevented one tuberculosis case per 18 [95% credible interval (CrI) 11-29] people treated. It lowered TB incidence by a projected 23% (95% CrI 14-30%) among people receiving ART, and by 5.2% (95% CrI 2.9-8.7%) in the total population. Continuous IPT reduced the number needed to treat to prevent one case of TB to 10 (95% CrI 7-16), though it required 74% more person-years of therapy (95% CrI 64-94%) to prevent one TB case, relative to 12-month therapy. Under expanding ART coverage, the tuberculosis incidence reduction achieved by 12-month IPT grew to 7.6% (95% CrI 4.3-12.6%). Effect sizes were similar in a simulated setting of lower TB incidence. CONCLUSIONS IPT in conjunction with ART reduces tuberculosis incidence among those who receive therapy and has additional impact on tuberculosis transmission in the population.
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Affiliation(s)
- Emily A Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine
| | - Andrew S Azman
- Division of Infectious Disease Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, Department of Public Health and Family Medicine, University of Cape Town
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Imperial College
- Francis Crick Institute
| | - David W Dowdy
- Division of Infectious Disease Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Molebogeng X Rangaka
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Institute for Global Health, University College London, London, UK
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87
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Yang S, Li M, Cheng J, Wan G, Zhou Y, Jia H, Wei H, Song R, Sheng L, Wang H, Wang L, Hua W. Diagnostic determination of Norovirus infection as one of the major causes of infectious diarrhea in HIV patients using a multiplex polymerase chain reaction assay. Int J STD AIDS 2019; 30:550-556. [PMID: 30722749 DOI: 10.1177/0956462418824912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although infectious diarrhea is one of the most common complications in human immunodeficiency virus (HIV)-infected patients, robust diagnostic methods for determining potential pathogens are still limited in the clinic. Norovirus, a type of calicivirus, has been shown to be the most common cause of gastroenteritis. Here, we used multiplex polymerase chain reaction as a diagnostic tool to verify Norovirus as the diarrhea-related pathogen in HIV-infected patients with unknown etiological information. Stool specimens obtained from 81 HIV-infected patients with diarrhea were analyzed by BioFire FilmArray Gastrointestinal (GI) panel. Among 26 HIV-infected patients with unknown etiological information, we detected Norovirus in 14 stool specimens of these patients with 100% sensitivity and specificity as confirmed by reverse transcription polymerase chain reaction (RT-PCR), and one specimen showed both Norovirus and enterotoxigenic Escherichia coli infection. Among the remaining 55 patients with verified Clostridium difficile infection, nine patients also detected positive for Norovirus infection. In conclusion, using FilmArray GI panel and RT-PCR, we determined that Norovirus infection as one of the main pathogens responsible for diarrhea in HIV patients.
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Affiliation(s)
- Siyuan Yang
- 1 The Laboratory of Infectious Diseases Centre, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Li
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jingwei Cheng
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- 3 Medical Information Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunao Zhou
- 4 Department of Research and Education, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongyu Jia
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongshan Wei
- 5 Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rui Song
- 6 Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Linjun Sheng
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huizhu Wang
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Linghang Wang
- 7 Department of Emergency, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Hua
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
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88
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Lam-Ubol A, Rungsiyanont S, Vacharotayangul P, Sappayatosok K, Chankanka O. Oral manifestations, salivary flow rates and Candida species in Thai HIV-infected patients. J Clin Exp Dent 2019; 11:e138-e145. [PMID: 30805118 PMCID: PMC6383906 DOI: 10.4317/jced.55384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Effects of various Highly Active Antiretroviral Therapy (HAART) regimens on oral heath are unclear. Objectives: We aimed to evaluate effects of HAART on oral manifestations, salivary flow rates (SFR) and Candida species in HIV-infected patients who took mostly non-protease inhibitor-based HAART regimens. Material and Methods A cross-sectional study was performed on HIV-infected patients taking and never taken HAART who attended Thai Red Cross AIDS Research Centre (n = 48). Non-HIV subjects were recruited as control (n = 20). Oral conditions and salivary flow rates were evaluated using oral examination and measurement of unstimulated and stimulated saliva. In addition, Candida colonization counts (colony forming units; CFUs) and Candida species from the collected saliva were evaluated using CHROMagar. Results The most common oral manifestation in HIV-infected subjects taking HAART was hyperpigmentation. Unstimulated and stimulated SFR among the three groups were not statistically significant. Candida colonization was detected in 64%, 65% and 35% of HIV-infected subjects taking HAART, HAART-naïve, and non-HIV subjects, respectively. While 20% and 35% of HIV-infected subjects with and without HAART, respectively, had Candida CFUs higher than 500/ml, all non-HIV carriers had Candida CFUs lower than 500/ml. The most common Candida colonization species was C. albicans in HAART and non-HIV groups. Interestingly, HAART-naïve group was colonized more by non-albicans species. Conclusions HAART has minimal effects on oral health. While HAART may not prevent Candida colonization, it might lead to reduction of non-albicans species. Because maintaining low Candida counts is important, HAART administration and antifungal sensitivity test should be considered in HIV-infected patients. Key words:HIV, Candida, HAART, Oral manifestation, Salivary flow rates.
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Affiliation(s)
- Aroonwan Lam-Ubol
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Sorasun Rungsiyanont
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Piamkamon Vacharotayangul
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Kraisorn Sappayatosok
- Faculty of Dentistry, Rangsit University, 52/347 Phaholyothin Road, Mueang Pathum Thani District, Pathum Thani 12000, Thailand
| | - Oitip Chankanka
- Faculty of Dentistry, Prince of Songkla University, 15 Karnjanavanich Raod, Hat Yai, Songkhla 90110, Thailand
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89
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Konečný P, Ehrlich R, Gulumian M, Jacobs M. Immunity to the Dual Threat of Silica Exposure and Mycobacterium tuberculosis. Front Immunol 2019; 9:3069. [PMID: 30687311 PMCID: PMC6334662 DOI: 10.3389/fimmu.2018.03069] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/11/2018] [Indexed: 01/28/2023] Open
Abstract
Exposure to silica and the consequent development of silicosis are well-known health problems in countries with mining and other dust producing industries. Apart from its direct fibrotic effect on lung tissue, chronic and immunomodulatory character of silica causes susceptibility to tuberculosis (TB) leading to a significantly higher TB incidence in silica-exposed populations. The presence of silica particles in the lung and silicosis may facilitate initiation of tuberculous infection and progression to active TB, and exacerbate the course and outcome of TB, including prognosis and survival. However, the exact mechanisms of the involvement of silica in the pathological processes during mycobacterial infection are not yet fully understood. In this review, we focus on the host's immunological response to both silica and Mycobacterium tuberculosis, on agents of innate and adaptive immunity, and particularly on silica-induced immunological modifications in co-exposure that influence disease pathogenesis. We review what is known about the impact of silica and Mycobacterium tuberculosis or their co-exposure on the host's immune system, especially an impact that goes beyond an exclusive focus on macrophages as the first line of the defense. In both silicosis and TB, acquired immunity plays a major role in the restriction and/or elimination of pathogenic agents. Further research is needed to determine the effects of silica in adaptive immunity and in the pathogenesis of TB.
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Affiliation(s)
- Petr Konečný
- Centre for Environmental and Occupational Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Immunology, Department of Pathology and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rodney Ehrlich
- Centre for Environmental and Occupational Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary Gulumian
- National Health Laboratory Service, Department of Toxicology and Biochemistry, National Institute for Occupational Health, Johannesburg, South Africa.,Division of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Service, Johannesburg, South Africa
| | - Muazzam Jacobs
- Division of Immunology, Department of Pathology and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Johannesburg, South Africa.,Immunology of Infectious Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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90
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Heidary M, Nasiri MJ, Mirsaeidi M, Jazi FM, Khoshnood S, Drancourt M, Darban-Sarokhalil D. Mycobacterium avium complex infection in patients with human immunodeficiency virus: A systematic review and meta-analysis. J Cell Physiol 2018; 234:9994-10001. [PMID: 30548598 DOI: 10.1002/jcp.27859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/13/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Mycobacterium avium-intracellulare complex (MAC) is one of the leading causes of death among people living with human immunodeficiency virus (HIV). The current study was aimed to determine the frequency of MAC infection in patients infected with HIV. METHODS Embase, PubMed, and Web of Science were searched for relevant studies. All statistical analyses were performed by STATA version 14. RESULTS From 6,627 retrieved articles, 23 were included in the final analysis. A total of 18,463 patients with HIV were included in the analysis. The frequency of MAC infection in patients with HIV was found to be 10.6% (95% confidence interval, 6.9-14.2). CONCLUSION The relatively large fractions of HIV-infected patients were coinfected with MAC, which may poses significant public health problems. Continued progress in the development of rapid diagnostic methods and preventive therapy for MAC should lead to further improvements in survival and quality of life in patients with HIV.
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Affiliation(s)
- Mohsen Heidary
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirsaeidi
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Miami, Coral Gables, Florida
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Khoshnood
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Michel Drancourt
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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91
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Ten years of antiretroviral therapy: Incidences, patterns and risk factors of opportunistic infections in an urban Ugandan cohort. PLoS One 2018; 13:e0206796. [PMID: 30383836 PMCID: PMC6211746 DOI: 10.1371/journal.pone.0206796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite increased antiretroviral therapy (ART) coverage and the raised CD4 threshold for starting ART, opportunistic infections (OIs) are still one of the leading causes of death in sub-Saharan Africa. There are few studies from resource-limited settings on long-term reporting of OIs other than tuberculosis. METHODS Patients starting ART between April 2004 and April 2005 were enrolled and followed-up for 10 years in Kampala, Uganda. We report incidences, patterns and risk factors using Cox proportional hazards models of OIs among all patients and among patients with CD4 cell counts >200 cells/μL. RESULTS Of the 559 patients starting ART, 164 patients developed a total of 241 OIs during 10 years of follow-up. The overall incidence was highest for oral candidiasis (25.4, 95% confidence interval (CI): 20.5-31.6 per 1000 person-years of follow-up), followed by tuberculosis (15.3, 95% CI: 11.7-20.1), herpes zoster (12.3, 95% CI: 9.1-16.6) and cryptococcal meningitis (3.0, 95% CI: 1.7-5.5). Incidence rates for all OIs were highest in the first year after ART initiation and decreased with the increase of the current CD4 cell count. Factors independently associated with development of OIs were baseline nevirapine-based regimens, time-varying higher viral load, time-varying lower CD4 cell count and time-varying lower hemoglobin. In patients developing OIs at a current CD4 cell count >200 cells/μL, factors independently associated with OI development were time-varying increase in viral load and time-varying decrease in hemoglobin, whereas a baseline CD4 cell count <50 cells/μL was protective. CONCLUSION We report high early incidences of OIs, decreasing with increasing CD4 cell count and time spent on ART. Ongoing HIV replication and anemia were strong predictors for OI development independent of the CD4 cell count. Our findings support the recommendation for early initiation of ART and suggest close monitoring for OIs among patients recently started on ART, with low CD4 cell count, high viral load and anemia.
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92
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Han WM, Apornpong T, Kerr SJ, Hiransuthikul A, Gatechompol S, Do T, Ruxrungtham K, Avihingsanon A. CD4/CD8 ratio normalization rates and low ratio as prognostic marker for non-AIDS defining events among long-term virologically suppressed people living with HIV. AIDS Res Ther 2018; 15:13. [PMID: 30261902 PMCID: PMC6158807 DOI: 10.1186/s12981-018-0200-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Immune restoration is often incomplete after ART in HIV patients, both quantitatively and qualitatively. We studied the incidence and probability of CD4/CD8 normalization in an adult Thai HIV cohort and explored the predictive value of the ratio for developing of non-AIDS defining events (NAEs). Methods We analyzed data from HIV-infected Thai adults between 1996 and 2017 in the HIV-NAT 006 prospective long-term cohort in Bangkok, Thailand. Normalization was defined as CD4/CD8 ratio ≥ 1 on two consecutive visits, and normalization probability was calculated using the Kaplan–Meier method. NAEs were a composite endpoint including cardiovascular or cerebrovascular diseases, chronic kidney diseases, non-AIDS defining malignancies and death. Multivariate Cox regression was used to evaluate demographic, disease and treatment characteristics associated with CD4/CD8 ratio normalization and NAEs. Results A total of 800 ART-naïve patients with baseline CD4/CD8 ratio of < 0.8 who started combination ART, and had sustained virological suppression were enrolled. Participants were on ART for a median of 8.9 years and virologically suppressed for 6.1 years. The probabilities of CD4/CD8 normalization at 2, 5 and 10 years after virological suppression were 5.1%, 18.6% and 39.1%, respectively. Factors associated with normalization in multivariate analysis were female sex (hazard ratio [HR]: 2.47, 95% CI 1.71–3.56, p < 0.001) and baseline CD4 counts ≥ 350 cells/mm3 (HR: 3.62, 95% CI 2.36–5.55), p < 0.001) vs. < 200 cells/mm3 as reference. The second analysis explored the predictive value of CD4/CD8 ratio for NAEs. Older age (HR: 1.09, 95% CI 1.05–1.13, p < 0.01) and current CD4/CD8 ratio < 0.3 (HR: 3.02, 95% CI 1.27–7.21, p = 0.01) or between 0.3 and 0.45 (HR: 2.03, 95% CI 1.03–3.98, p = 0.04) vs. > 0.45 were independently associated with higher risk of progression to NAEs in the multivariate analysis. Conclusions Our findings showed that complete immune recovery is uncommon in an Asian setting and earlier ART initiation at higher CD4 counts may have increased the ratio sooner. The findings demonstrate the use of CD4/CD8 ratio as a prognostic marker for clinical progression of NAEs. Trial registration HIV-NAT 006 cohort, clinical trial number: NCT00411983
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93
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Weldegebreal T, Ahmed I, Muhiye A, Belete S, Bekele A, Kaba M. Magnitude of opportunistic diseases and their predictors among adult people living with HIV enrolled in care: national level cross sectional study, Ethiopia. BMC Public Health 2018; 18:820. [PMID: 29970047 PMCID: PMC6029130 DOI: 10.1186/s12889-018-5733-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Opportunistic diseases cause morbidity and mortality among human immunodeficiency virus (HIV) infected persons. There is dearth of evidence on the magnitude and predictors of opportunistic diseases among PLHIV in Ethiopia. This study was conducted to determine the magnitude and predictors of opportunistic diseases among adults enrolled in the national HIV/AIDS care and treatment services and generate information for program planning and medicine quantification in the country. Methods A health facility-based cross-sectional study was conducted. Probability proportional to size and random sampling methods were employed to select health facilities and medical records of adult HIV-infected patients respectively. A total of 7826 medical records were reviewed from 60 health facilities nationwide. Socio-demographic and clinical data including diagnosis of opportunistic diseases were collected from the medical records. Period prevalence of opportunistic diseases over one year period was determined. Bivariate and multivariate logistic regression was used to measure associations between independent variables and the dependent variable, occurrence of opportunistic diseases. Results Of the total of 7826 study participants, 3748 (47.9%) were from hospitals and 4078 were from health centers. The majority (61.8%) were female. The median age was 32 years with interquartile range (IQR) of 27–40. The median duration of stay in HIV care was 56 (IQR = 28–80) months; 7429 (94.9%) were on antiretroviral treatment. A total of 1665 cases of opportunistic diseases were recorded with an overall prevalence estimated at 21.3% (95% confidence interval (CI): 20.36, 22.18%). Skin diseases (4.1%), diarrhea (4.1%), bacterial pneumonia (3.6%), recurrent upper respiratory tract infections (3.1%) and tuberculosis (2.7%) were the leading opportunistic diseases. Isoniazid preventive therapy coverage among eligible patients was 24.8%. Persons with a CD4 count < 200 cells/mm3 [adjusted odds ratio (AOR) 1.80, 95% CI: 1.45, 2.23]; and who were bed ridden or ambulatory functional status [AOR (95% CI) = 3.19 (2.32, 4.39)] were independent predictors of diagnosis of opportunistic diseases. Conclusion Opportunistic diseases were found to be pervasive among HIV infected adults in Ethiopia. Proactive identification and management, and prevention of opportunistic diseases should be strengthened especially among females, ambulatory or bed-ridden, and patients with low CD4 cell count.
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Affiliation(s)
- Teklu Weldegebreal
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia
| | - Ismael Ahmed
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia.
| | - Abiyou Muhiye
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | | | | | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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94
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Su S, Mao L, Zhao J, Chen L, Jing J, Cheng F, Zhang L. Epidemics of HIV, HCV and syphilis infection among synthetic drugs only users, heroin-only users and poly-drug users in Southwest China. Sci Rep 2018; 8:6615. [PMID: 29700352 PMCID: PMC5919913 DOI: 10.1038/s41598-018-25038-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4]; 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9]; 3.9, [1.8–5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Limin Mao
- Center for Social Research in Health, Arts and Social Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Jinxian Zhao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
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95
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Cristelli M, Mazolin M, Manzardo C, Ribeiro M, Cofán F, Santos D, Castel M, Tedesco-Silva H, Moreno A, Diekman F, Miro J, Medina-Pestana J. Sexual acquisition of HIV infection after solid organ transplantation: Late presentation and potentially fatal complications. Transpl Infect Dis 2018; 20:e12894. [DOI: 10.1111/tid.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- M.P. Cristelli
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - M.A. Mazolin
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - C. Manzardo
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - M.S.J. Ribeiro
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - F. Cofán
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - D.W.C. Santos
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - M.A. Castel
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - H. Tedesco-Silva
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - A. Moreno
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - F. Diekman
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - J.M. Miro
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
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96
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Dawood H, Hassan-Moosa R, Zuma NY, Naidoo K. Mortality and treatment response amongst HIV-infected patients 50 years and older accessing antiretroviral services in South Africa. BMC Infect Dis 2018; 18:168. [PMID: 29636023 PMCID: PMC5894176 DOI: 10.1186/s12879-018-3083-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the clinical presentation and outcomes amongst older HIV infected populations accessing ART in sub-Saharan Africa. We compared mortality amongst HIV infected patients accessing ART that were < 50 years to those ≥50 years in Kwa-Zulu Natal, South Africa. METHODS We undertook a retrospective review of medical records of patients that accessed HIV services at the CAPRISA AIDS Treatment program (CAT) between June 2004 to December 2012 (N = 4003). HIV infected patients, 14 years or older were enrolled. All-cause mortality and treatment response to ART in those < 50 years to those ≥50 years were compared. A Kaplan-Meier curve and log-rank test were used to compare the cumulative probability of death between the two age groups with the primary endpoint being mortality. Statistical analysis was done using SAS (version 9.4.; SAS Institute Inc., Cary, NC, USA). RESULTS Of 4003 individuals, 262 (6.5%) were ≥ 50 years (older group). The median age in those ≥50 years and < 50 year was 54.5 and 32.0 years, respectively. The younger group was mainly female (64.7%). There was no difference in mortality rate, between the older (6.9/100 person-years (py), 95% confidence interval (CI): 4.7-9.6) and younger group (5.3/100 py, 95% CI: 4.7-5.8) at 60 months (p = 0.137). In the multivariable model older patients had a significantly higher risk of death compared to younger patients. (hazard ratio (HR) 1.60, 95% CI: 1.08-2.39, p = 0.019).The rate of CD4+ cell count increase was higher in those < 50 years (β = 0.34, 95% CI: 0.19-0.50, p < 0.001) with no difference in viral suppression. The older group showed significantly higher prevalence of diabetes (6.3%) and hypertension (21.5%), p < 0.001. CONCLUSION ART initiation in older HIV infected patients was associated with a higher mortality compared to those younger than 50 years. ART immunological response was less robust in older individuals. The increase in hypertension and diabetes among older patients suggests the need to restructure and integrate primary and specialized health care services into ART services.
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Affiliation(s)
- Halima Dawood
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Infectious Diseases, Department of Internal Medicine, Greys Hospital, Pietermaritzburg, South Africa
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nonhlanhla-Yende Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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97
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Baghban A, Malinis M. Ganciclovir and foscarnet dual-therapy for cytomegalovirus encephalitis: A case report and review of the literature. J Neurol Sci 2018; 388:28-36. [PMID: 29627026 DOI: 10.1016/j.jns.2018.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/15/2018] [Accepted: 02/18/2018] [Indexed: 11/26/2022]
Abstract
Cytomegalovirus (CMV) is a ubiquitous herpesvirus which establishes lifelong latency following primary infection. It is then capable of reactivating in the face of immunosuppression. Encephalitis is a less common, but particularly devastating syndrome associated with CMV. Here, we describe a case of CMV encephalitis in an allogeneic hematopoietic stem cell transplant recipient who received dual antiviral therapy with ganciclovir and foscarnet. The case presentation is followed by a summary of cases reported in the last ten years, with the goal of describing vulnerable patient populations, treatment courses, and outcomes. Finally, the discussion includes a review of the literature, with a focus on diagnostic criteria and the role for dual antiviral therapy in CMV encephalitis.
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Affiliation(s)
- Adam Baghban
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States.
| | - Maricar Malinis
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
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98
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Kawai K, Hawkins CA, Hertzmark E, Francis JM, Sando D, Muya AN, Ulenga N, Fawzi WW. Impact of Antiretroviral Therapy on the Risk of Herpes Zoster among Human Immunodeficiency Virus-Infected Individuals in Tanzania. Am J Trop Med Hyg 2018; 98:396-401. [PMID: 29313475 DOI: 10.4269/ajtmh.17-0568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors for HZ among human immunodeficiency virus (HIV)-infected individuals in Tanzania. A cohort study was conducted among HIV-positive individuals enrolled in HIV care and treatment clinics in Dar es Salaam, Tanzania. A Cox proportional hazard model was used to examine the effect of ART on the risk of HZ after adjusting for sociodemographics and time-varying clinical and nutritional factors. Among 72,670 HIV-positive individuals, 2,312 incident cases of HZ (3.2%) occurred during the median follow-up of 15 months (interquartile range: 3-35). The incidence rate of HZ significantly declined from 48.9 (95% confidence interval [CI] = 46.7-51.0) per 1,000 person-years before ART to 3.7 (95% CI = 3.3-4.1) per 1,000 person-years after the initiation of ART (P < 0.001). The risk of HZ declined with longer duration on ART. Low CD4 cell count, older age, female sex, district of Dar es Salaam, and year of enrollment were independently associated with the risk of HZ in the multivariate analysis. Low body mass index and anemia were not associated with the risk of HZ. The risk of HZ substantially declined after ART initiation in this large cohort of HIV-infected individuals. Earlier initiation of ART could reduce the risk of HZ and other opportunistic infections among HIV-infected individuals in sub-Saharan Africa.
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Affiliation(s)
- Kosuke Kawai
- Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Claudia A Hawkins
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ellen Hertzmark
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joel M Francis
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aisa N Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Management and Development for Health, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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99
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Milev MP, Yao X, Berthoux L, Mouland AJ. Impacts of virus-mediated manipulation of host Dynein. DYNEINS 2018. [PMCID: PMC7150161 DOI: 10.1016/b978-0-12-809470-9.00010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In general viruses' modus operandi to propagate is achieved by the co-opting host cell components, membranes, proteins, and machineries to their advantage. This is true for virtually every aspect of a virus' replication cycle from virus entry to the budding or release of progeny virus particles. In this chapter, we will discuss new information on the impacts of virus-mediated manipulation of Dynein motor complexes and associated machineries and factors. We will highlight how these host cell components impact on pathogenicity and immune responses, as many of the virus-mediated hijacked components also play pivotal roles in immune responses to pathogen insult. There are several comprehensive reviews that define virus–Dynein interactions including the first edition of this book that describes how viruses manipulate the host cell machineries their advantage. An updated table is included to summarize these virus–host interactions. Notably, barriers to intracellular translocation represent major hurdles to viral components during de novo infection and during active replication and the generation of progeny virus particles. Clearly, the subversion of host cell molecular motor protein activities takes advantage of constitutive and regulated membrane trafficking events and will target virus components to intracytoplasmic locales and membrane assembly. Broadening our understanding of the interplay between viruses, Dynein and the cytoskeleton will likely inform on new types of therapies. Continual enhancement of the breadth of new information on how viruses manipulate host cell biology will inevitably aid in the identification of new targets that can be poisoned to block old, new, and emerging viruses alike in their tracks.
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100
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Sinha S, Gupta K, Tripathy S, Dhooria S, Ranjan S, Pandey RM. Nevirapine- versus Efavirenz-based antiretroviral therapy regimens in antiretroviral-naive patients with HIV and Tuberculosis infections in India: a multi-centre study. BMC Infect Dis 2017; 17:761. [PMID: 29228918 PMCID: PMC5725946 DOI: 10.1186/s12879-017-2864-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background According to World Health Organization (WHO) guidelines, which have also been adopted by the National AIDS Control Organization (NACO), India, Efavirenz-based Anti-Retroviral Therapy (ART) is better in Human-Immunodeficiency-Virus (HIV)-infected patients who are also being treated with Rifampicin-based Anti-Tuberculous Therapy (ATT). However, Efavirenz is much more expensive. We hypothesize that Nevirapine is a cheaper alternative that possesses equal efficacy as Efavirenz in HIV-Tuberculosis (TB) co-infected patients. Methods A parallel open-label randomized clinical trial was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi and National AIDS Research Institute (NARI), Pune. Those who were ART-naïve and co-infected with TB were randomized to receive either Nevirapine (Group 1)- or Efavirenz (Group 2)-based ART along with Rifampicin-based ATT. ATT was begun first in ART-naïve patients according to the NACO guidelines, with a median of 27 days between ATT and ART in both groups. The primary endpoint was a composite unfavourable outcome (death and/or ART failure) at 96 weeks, and the secondary outcome was successful TB treatment at 48 weeks. Results A total of 284 patients (mean age 36.7 ± 8.1 years) were randomized in a 1:1 ratio to receive either Nevirapine (n = 144)- or Efavirenz (n = 140)-based ART after a median ATT-ART gap of 27 days. The median CD4 count was 105 cells/μl, with a median viral load of 820,200 copies/μl and no significant difference between the groups. Composite unfavourable outcomes were reported in 49 patients in the Nevirapine group and 51 patients in the Efavirenz group (35.3% vs. 36.9%; hazard ratio, 0.95, 95% confidence interval (CI), 0.63,1.43, adjusted). There was no difference in successful TB treatment outcome between the groups (71.5% vs. 65.6%, 95% CI -3.8,17.9, adjusted). The results were similar, showing no difference between the groups in the two centres of the study after adjusting for disease stage. Conclusions Composite unfavourable outcome in HIV-TB co-infected patients who were ART-naïve showed no statistically significant difference in the Nevirapine or Efavirenz groups.. Therefore, Nevirapine-based ART is a reasonable alternative to Efavirenz in resource-limited settings. However, multi-centric studies with larger sample sizes are required to confirm these findings. Trial registration NCT01805258 (Retrospectively registered on March 6, 2013) Date of registration: March 2013. Electronic supplementary material The online version of this article (10.1186/s12879-017-2864-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanjeev Sinha
- Departments of Medicine, All-India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
| | - Kartik Gupta
- Departments of Medicine, All-India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | | | - Sahajal Dhooria
- Departments of Medicine, All-India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Sanjay Ranjan
- Departments of Medicine, All-India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - R M Pandey
- Biostatistics, All-India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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