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Marston BJ, Macharia DK, Nga'nga L, Wangai M, Ilako F, Muhenje O, Kjaer M, Isavwa A, Kim A, Chebet K, DeCock KM, Weidle PJ. A program to provide antiretroviral therapy to residents of an urban slum in Nairobi, Kenya. ACTA ACUST UNITED AC 2016; 6:106-12. [PMID: 17538002 DOI: 10.1177/1545109707300688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate retention in care and response to therapy for patients enrolled in an antiretroviral treatment program in a severely resource-constrained setting. METHODS We evaluated patients enrolled between February 26, 2003, and February 28, 2005, in a community clinic in Kibera, an informal settlement, in Nairobi, Kenya. Midlevel providers offered simplified, standardized antiretroviral therapy (ART) regimens and monitored patients clinically and with basic laboratory tests. Clinical, immunologic, and virologic indicators were used to assess response to ART; adherence was determined by 3-day recall. A total of 283 patients (70% women; median baseline CD4 count, 157 cells/ mm(3); viral load, 5.16 log copies/mL) initiated ART and were followed for a median of 7.1 months (n = 2384 patient-months). RESULTS At 1 year, the median CD4 count change was +124.5 cells/mm(3) (n = 74; interquartile range, 42 to 180), and 71 (74%) of 96 patients had viral load <400 copies/mL. The proportion of patients reporting 100% adherence over the 3 days before monthly clinic visits was 94% to 100%. As of February 28, 2005, a total of 239 patients (84%) remained in care, 22 (8%) were lost to follow-up, 12 (4%) were known to have died, 5 (2%) had stopped ART, 3 (1%) moved from the area, and 2 (< 1% ) transferred care. CONCLUSIONS Response to ART in this slum population was comparable to that seen in industrialized settings. With government commitment, donor support, and community involvement, it is feasible to implement successful ART programs in extremely challenging social and environmental conditions.
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Affiliation(s)
- Barbara J Marston
- Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya, Atlanta, GA 30333, USA.
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Cihlar T, Fordyce M. Current status and prospects of HIV treatment. Curr Opin Virol 2016; 18:50-6. [PMID: 27023283 DOI: 10.1016/j.coviro.2016.03.004] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/09/2016] [Indexed: 11/24/2022]
Abstract
Current antiviral treatments can reduce HIV-associated morbidity, prolong survival, and prevent HIV transmission. Combination antiretroviral therapy (cART) containing preferably three active drugs from two or more classes is required for durable virologic suppression. Regimen selection is based on virologic efficacy, potential for adverse effects, pill burden and dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, social status, and cost. With prolonged virologic suppression, improved clinical outcomes, and longer survival, patients will be exposed to antiretroviral agents for decades. Therefore, maximizing the safety and tolerability of cART is a high priority. Emergence of resistance and/or lack of tolerability in individual patients require availability of a range of treatment options. Development of new drugs is focused on improving safety (e.g. tenofovir alafenamide) and/or resistance profile (e.g. doravirine) within the existing drug classes, combination therapies with improved adherence (e.g. single-tablet regimens), novel mechanisms of action (e.g. attachment inhibitors, maturation inhibitors, broadly neutralizing antibodies), and treatment simplification with infrequent dosing (e.g. long-acting injectables). In parallel with cART innovations, research and development efforts focused on agents that target persistent HIV reservoirs may lead to prolonged drug-free remission and HIV cure.
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Affiliation(s)
- Tomas Cihlar
- Department of Biology, Gilead Sciences, Inc., Foster City, CA, USA.
| | - Marshall Fordyce
- HIV Clinical Development, Gilead Sciences, Inc., Foster City, CA, USA
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103
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Comparative analysis of drug resistance mutations in the human immunodeficiency virus reverse transcriptase gene in patients who are non-responsive, responsive and naive to antiretroviral therapy. Arch Virol 2016; 161:1101-13. [PMID: 26801790 DOI: 10.1007/s00705-016-2760-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
Drug resistance mutations in the Pol gene of human immunodeficiency virus 1 (HIV-1) are one of the critical factors associated with antiretroviral therapy (ART) failure in HIV-1 patients. The issue of resistance to reverse transcriptase inhibitors (RTIs) in HIV infection has not been adequately addressed in the Indian subcontinent. We compared HIV-1 reverse transcriptase (RT) gene sequences to identify mutations present in HIV-1 patients who were ART non-responders, ART responders and drug naive. Genotypic drug resistance testing was performed by sequencing a 655-bp region of the RT gene from 102 HIV-1 patients, consisting of 30 ART-non-responding, 35 ART-responding and 37 drug-naive patients. The Stanford HIV Resistance Database (HIVDBv 6.2), IAS-USA mutation list, ANRS_09/2012 algorithm, and Rega v8.02 algorithm were used to interpret the pattern of drug resistance. The majority of the sequences (96 %) belonged to subtype C, and a few of them (3.9 %) to subtype A1. The frequency of drug resistance mutations observed in ART-non-responding, ART-responding and drug-naive patients was 40.1 %, 10.7 % and 20.58 %, respectively. It was observed that in non-responders, multiple mutations were present in the same patient, while in responders, a single mutation was found. Some of the drug-naive patients had more than one mutation. Thymidine analogue mutations (TAMs), however, were found in non-responders and naive patients but not in responders. Although drug resistance mutations were widely distributed among ART non-responders, the presence of resistance mutations in the viruses of drug-naive patients poses a big concern in the absence of a genotyping resistance test.
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104
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Calvez V, Marcelin AG, Vingerhoets J, Hill A, Hadacek B, Moecklinghoff C. Systematic review to determine the prevalence of transmitted drug resistance mutations to rilpivirine in HIV-infected treatment-naive persons. Antivir Ther 2016; 21:405-12. [PMID: 26761642 DOI: 10.3851/imp3024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Transmitted drug resistance to antiretrovirals in HIV-1-infected individuals is rising in some regions and could compromise the effectiveness of first-line treatment. It is important to understand the prevalence of resistance to rilpivirine to inform treatment provision. METHODS A PUBMED/EMBASE search identified analyses of transmitted genotypic resistance to specific non-nucleoside reverse transcriptase inhibitor mutations worldwide. Patients were to be HIV-1-infected and antiretroviral-naive. Rilpivirine mutations assessed were: L100I, K101E/P, E138A/G/K/Q/R, V179L, Y181C/I/V, Y188L, H221Y, F227C and M230I/L. Additionally, frequency of resistance mutations were extracted and pooled by HIV subtype from the Stanford HIV drug resistance database. RESULTS 138 eligible articles from 65 countries were identified (n=64,466). Among these 64,466 samples, 7 of the 9 genotypic rilpivirine mutations had a prevalence <0.1%. Two mutations were more prevalent: E138A/G/K/Q/R (0.7%, 95% CI 0.2, 1.3) and Y181C/I/V (0.3%, 95% CI 0.2, 0.4). Prevalence of E138 rilpivirine-related mutations varied between regions: highest in Latin America/Caribbean (3.6%, 95% CI 1.0, 7.6) and in Europe (3.2%, 95% CI 0.7, 6.9). Pooled results from the Stanford database (n=52,680) correlated with these findings indicating a low prevalence of 8/9 rilpivirine mutations (<0.1%), except for E138A/G/K/Q/R (2.9%, 95% CI 1.8, 4.4). Prevalence of the mutations at E138 varied significantly by HIV subtype and was highest for subtype-C (6.1%), subtype-F (5.1%) and subtype-A (3.3%). CONCLUSIONS The prevalence of most transmitted rilpivirine-related HIV mutations is generally low in treatment-naive HIV-1-infected individuals (<0.1%). The prevalence of E138A/G/K/Q/R mutations is higher (0.7%) and varies according to geographical region and HIV subtype.
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Affiliation(s)
- Vincent Calvez
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, F-75013, France
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105
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Xia Q, Braunstein SL, Wiewel EW, Hadler JL, Torian LV. Persistent Racial Disparities in HIV Infection in the USA: HIV Prevalence Matters. J Racial Ethn Health Disparities 2016; 4:87-93. [PMID: 26746424 DOI: 10.1007/s40615-015-0205-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Despite increased funding and efforts to prevent and control HIV infections in the black and Hispanic communities, racial disparities persist in the USA. We used a mathematical model to explain the phenomena. METHODS A mathematical model was constructed to project HIV prevalence ratio (PR), incidence rate ratio (IRR), and HIV-specific mortality rate ratio (MRR) among blacks and Hispanics vs. whites in two scenarios: (1) an annual reduction in HIV incidence rate at the 2007-2010 level and (2) an annual reduction in HIV incidence rate at the 2007-2010 level among whites (4.2 %) and twice that of whites among blacks and Hispanics (8.4 %). RESULTS In scenario no. 1, the PR, IRR, and MRR among blacks would decrease from 7.6 to 5.8, 7.9 to 5.9, and 11.3 to 5.3 and among Hispanics from 2.8 to 1.8, 3.1 to 1.9, and 2.3 to 1.0, respectively. In scenario no. 2, the PR, IRR, and MRR among blacks would decrease from 7.6 to 5.1, 7.9 to 2.5, and 11.3 to 4.7 and among Hispanics from 2.8 to 1.6, 3.1 to 0.8, and 2.3 to 0.9, respectively. CONCLUSIONS Much of the persistent racial disparities in HIV infection in the USA, as measured by PR, IRR, and MRR, can be explained by higher HIV prevalence among blacks and Hispanics. The public health community should continue its efforts to reduce racial disparities, but also need to set realistic goals and measure progress with sensitive indicators.
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Affiliation(s)
- Qiang Xia
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA.
| | - Sarah L Braunstein
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
| | - Ellen W Wiewel
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
| | - James L Hadler
- Yale University School of Public Health, New Haven, CT, USA
| | - Lucia V Torian
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
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Mocroft A, Lundgren JD, Ross M, Fux CA, Reiss P, Moranne O, Morlat P, Monforte AD, Kirk O, Ryom L. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. LANCET HIV 2016; 3:e23-32. [DOI: 10.1016/s2352-3018(15)00211-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/05/2023]
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Ray AS, Fordyce MW, Hitchcock MJ. Tenofovir alafenamide: A novel prodrug of tenofovir for the treatment of Human Immunodeficiency Virus. Antiviral Res 2016; 125:63-70. [DOI: 10.1016/j.antiviral.2015.11.009] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
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108
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Spivak AM, Planelles V. HIV-1 Eradication: Early Trials (and Tribulations). Trends Mol Med 2015; 22:10-27. [PMID: 26691297 DOI: 10.1016/j.molmed.2015.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/27/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022]
Abstract
Antiretroviral therapy (ART) has rendered HIV-1 infection a manageable illness for those with access to treatment. However, ART does not lead to viral eradication owing to the persistence of replication-competent, unexpressed proviruses in long-lived cellular reservoirs. The potential for long-term drug toxicities and the lack of access to ART for most people living with HIV-1 infection have fueled scientific interest in understanding the nature of this latent reservoir. Exploration of HIV-1 persistence at the cellular and molecular level in resting memory CD4(+) T cells, the predominant viral reservoir in patients on ART, has uncovered potential strategies to reverse latency. We review recent advances in pharmacologically based 'shock and kill' HIV-1 eradication strategies, including comparative analysis of early clinical trials.
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Affiliation(s)
- Adam M Spivak
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vicente Planelles
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Djawe K, Buchacz K, Hsu L, Chen MJ, Selik RM, Rose C, Williams T, Brooks JT, Schwarcz S. Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012. J Infect Dis 2015; 212:1366-75. [PMID: 26044289 PMCID: PMC11323282 DOI: 10.1093/infdis/jiv235] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI. DESIGN We used HIV surveillance data to conduct a survival analysis. METHODS We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012. RESULTS Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17). CONCLUSIONS Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.
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Affiliation(s)
- Kpandja Djawe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Ling Hsu
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
| | - Miao-Jung Chen
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
| | - Richard M. Selik
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Charles Rose
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Tiffany Williams
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
- ICF International, Assigned Full-time to Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - John T. Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Sandra Schwarcz
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
- Department of Epidemiology and Biostatistics, University of California San Francisco
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110
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Murray DD, Suzuki K, Law M, Trebicka J, Neuhaus J, Wentworth D, Johnson M, Vjecha MJ, Kelleher AD, Emery S. Circulating microRNAs in Sera Correlate with Soluble Biomarkers of Immune Activation but Do Not Predict Mortality in ART Treated Individuals with HIV-1 Infection: A Case Control Study. PLoS One 2015; 10:e0139981. [PMID: 26465293 PMCID: PMC4605674 DOI: 10.1371/journal.pone.0139981] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/18/2015] [Indexed: 01/10/2023] Open
Abstract
Introduction The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count. Discussion No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.
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Affiliation(s)
- Daniel D. Murray
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Kazuo Suzuki
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Matthew Law
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Jonel Trebicka
- Department of Internal Medicine, University of Bonn, Bonn, Germany
| | - Jacquie Neuhaus
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Deborah Wentworth
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Margaret Johnson
- Ian Charleson Day Centre, Royal Free Hampstead NHS Trust, London, United Kingdom
| | - Michael J. Vjecha
- Institute for Clinical Research, Veterans Affairs Medical Center, Washington D.C., United States of America
| | - Anthony D. Kelleher
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sean Emery
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
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111
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Bowen A, Casadevall A. Increasing disparities between resource inputs and outcomes, as measured by certain health deliverables, in biomedical research. Proc Natl Acad Sci U S A 2015; 112:11335-40. [PMID: 26283360 PMCID: PMC4568675 DOI: 10.1073/pnas.1504955112] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Society makes substantial investments in biomedical research, searching for ways to better human health. The product of this research is principally information published in scientific journals. Continued investment in science relies on society's confidence in the accuracy, honesty, and utility of research results. A recent focus on productivity has dominated the competitive evaluation of scientists, creating incentives to maximize publication numbers, citation counts, and publications in high-impact journals. Some studies have also suggested a decreasing quality in the published literature. The efficiency of society's investments in biomedical research, in terms of improved health outcomes, has not been studied. We show that biomedical research outcomes over the last five decades, as estimated by both life expectancy and New Molecular Entities approved by the Food and Drug Administration, have remained relatively constant despite rising resource inputs and scientific knowledge. Research investments by the National Institutes of Health over this time correlate with publication and author numbers but not with the numerical development of novel therapeutics. We consider several possibilities for the growing input-outcome disparity including the prior elimination of easier research questions, increasing specialization, overreliance on reductionism, a disproportionate emphasis on scientific outputs, and other negative pressures on the scientific enterprise. Monitoring the efficiency of research investments in producing positive societal outcomes may be a useful mechanism for weighing the efficacy of reforms to the scientific enterprise. Understanding the causes of the increasing input-outcome disparity in biomedical research may improve society's confidence in science and provide support for growing future research investments.
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Affiliation(s)
- Anthony Bowen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY 10461
| | - Arturo Casadevall
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY 10461; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
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112
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Kwofie TB, Owusu M, Mutocheluh M, Nguah SB, Obeng-Baah J, Hanson C, Dompreh A. Pattern and predictors of immunologic recovery in HIV infected patients. BMC Res Notes 2015; 8:413. [PMID: 26341633 PMCID: PMC4560874 DOI: 10.1186/s13104-015-1406-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 08/31/2015] [Indexed: 12/22/2022] Open
Abstract
Background Although anti-retroviral therapy has generally improved the survival of HIV infected patients in many developing countries including Ghana, specific socio-demographic factors could still influence outcome of treatment. This study was designed to identify patient-specific factors that could influence the immune recovery of absolute CD4 count in HIV infected patients. Findings Hospital records were extracted from two health facilities in Ghana. The impact of socio-demographic factors type of ART and baseline category of CD4 counts were assessed at six monthly interval using robust linear mixed models. Results A total of 214 follow up records were reviewed at Komfo Anokye Teaching Hospital (KATH) and the Kumasi South Hospital (KSH). One hundred (46.7 %) were from KATH and 114 (53.3 %) were from KSH. There was a general increase in the level of CD4 counts with time, however this increase significantly slowed down with subsequent reviews (p < 0.001). On the average the rate of CD4 count recovery slowed down by 43.6 cells/µl for every 6 months of follow up (SE = 7.69; p < 0.001). Similarly the recovery of CD4 counts in subjects with an initial high baseline CD4 counts decreased by 192.6 cells/µl (SD error = 42.3, p value ≤0.001). All other variables were not significantly associated with recovery of CD4 counts. Conclusion Our study has demonstrated the well-known phenomenon of CD4 counts increasing after administration of ARTs. CD4 counts increased more rapidly in those with relatively lower initial counts, catching up with those with high CD4 count by 2 years post treatment.
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Affiliation(s)
- Theophilus B Kwofie
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Michael Owusu
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Samuel Blay Nguah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Joseph Obeng-Baah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Albert Dompreh
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Newville H, Berg KM, Gonzalez JS. The interaction of active substance use, depression, and antiretroviral adherence in methadone maintenance. Int J Behav Med 2015; 22:214-22. [PMID: 25081100 DOI: 10.1007/s12529-014-9429-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adherence to highly active antiretroviral therapy (HAART) remains crucial in successfully treating HIV. While active substance use and depression are both associated with each other and with HAART nonadherence, little is known about their interaction. An understanding of the interaction of substance use and depressive symptoms on HAART adherence can inform adherence-enhancing interventions as well as interventions that target substance use and depression. PURPOSE We tested an interaction between substance use and depression on HAART adherence among methadone maintenance patients. METHOD We assessed substance use, depressive symptoms, and HAART adherence among 100 HIV-infected individuals receiving methadone maintenance in The Bronx, New York. Regressions were performed on adherence using an interaction term comprised of substance use and depressive symptoms. MODPROBE was used to assess significant interactions. RESULTS Any use of illicit substances was associated with HAART nonadherence (p = 0.043). Cannabis was the single substance of abuse most strongly associated with nonadherence (p = 0.003). Depressive symptoms approached significance in bivariate analysis (p = 0.066). In regression analysis, a significant interaction was found between illicit substance use and depressive symptoms [OR (95% CI) 1.23 (1.06-1.44), p = 0.007], where illicit substance use was associated with nonadherence in individuals with lower depressive symptoms, but not among those with depressive symptoms at higher levels. No individual substances interacted with depressive symptoms on adherence. CONCLUSION Though substance use and depressive symptoms interacted on HAART adherence, they did not have a synergistic effect. Continued substance use (51% of the sample) suggests an unmet need for treatment, even in methadone maintenance. Further examinations of the interplay of substance use and depression on HAART adherence are warranted.
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Affiliation(s)
- Howard Newville
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke's, New York, NY, USA,
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114
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Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2015; 34:361-71. [PMID: 26321131 DOI: 10.1016/j.eimc.2015.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. METHODS Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively. CONCLUSION The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG.
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Velasco C, Pérez I, Podzamczer D, Llibre JM, Domingo P, González-García J, Puig I, Ayala P, Martín M, Trilla A, Lázaro P, Gatell JM. Prediction of higher cost of antiretroviral therapy (ART) according to clinical complexity. A validated clinical index. Enferm Infecc Microbiol Clin 2015; 34:149-58. [PMID: 26298097 DOI: 10.1016/j.eimc.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The financing of antiretroviral therapy (ART) is generally determined by the cost incurred in the previous year, the number of patients on treatment, and the evidence-based recommendations, but not the clinical characteristics of the population. OBJECTIVE To establish a score relating the cost of ART and patient clinical complexity in order to understand the costing differences between hospitals in the region that could be explained by the clinical complexity of their population. METHODS Retrospective analysis of patients receiving ART in a tertiary hospital between 2009 and 2011. Factors potentially associated with a higher cost of ART were assessed by bivariate and multivariate analysis. Two predictive models of "high-cost" were developed. The normalized estimated (adjusted for the complexity scores) costs were calculated and compared with the normalized real costs. RESULTS In the Hospital Index, 631 (16.8%) of the 3758 patients receiving ART were responsible for a "high-cost" subgroup, defined as the highest 25% of spending on ART. Baseline variables that were significant predictors of high cost in the Clinic-B model in the multivariate analysis were: route of transmission of HIV, AIDS criteria, Spanish nationality, year of initiation of ART, CD4+ lymphocyte count nadir, and number of hospital admissions. The Clinic-B score ranged from 0 to 13, and the mean value (5.97) was lower than the overall mean value of the four hospitals (6.16). CONCLUSIONS The clinical complexity of the HIV patient influences the cost of ART. The Clinic-B and Clinic-BF scores predicted patients with high cost of ART and could be used to compare and allocate costs corrected for the patient clinical complexity.
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Affiliation(s)
- Cesar Velasco
- Preventive Medicine and Epidemiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Inaki Pérez
- Infectious Disease and HIV Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Daniel Podzamczer
- HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Josep Maria Llibre
- HIV Unit and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Pere Domingo
- Infectious Disease and HIV Service, Hospital Sant Pau, Spain
| | | | - Inma Puig
- Administration and Economics, Internal Medicine and Dermatology Institute, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pilar Ayala
- Administration and Economics, Internal Medicine and Dermatology Institute, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mayte Martín
- Hospital Pharmacy Service, Hospital Clínic de Barcelona, Spain
| | - Antoni Trilla
- Preventive Medicine and Epidemiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pablo Lázaro
- Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain
| | - Josep Maria Gatell
- Infectious Disease and HIV Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Karetnikov A. Commentary: Questioning the HIV-AIDS Hypothesis: 30 Years of Dissent. Front Public Health 2015; 3:193. [PMID: 26301215 PMCID: PMC4528088 DOI: 10.3389/fpubh.2015.00193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/23/2015] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alexey Karetnikov
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
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Tenofovir Alafenamide Versus Tenofovir Disoproxil Fumarate in the First Protease Inhibitor–Based Single-Tablet Regimen for Initial HIV-1 Therapy. J Acquir Immune Defic Syndr 2015; 69:439-45. [DOI: 10.1097/qai.0000000000000618] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Martins S, Livramento AD, Andrigueti M, Kretzer IF, Machado MJ, Spada C, Treitinger A. The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil. Rev Soc Bras Med Trop 2015; 47:552-8. [PMID: 25467254 DOI: 10.1590/0037-8682-0109-2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/20/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are two of the world's most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers. METHODS This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD4+ T-cell counts using a questionnaire designed to collect sociodemographic data. RESULTS The mean patient age was 44.6 years, the mean CD4 T-cell count was 525/mm3, the mean time since beginning antiretroviral therapy was 7.6 years, and the mean time since HIV diagnosis was 9.6 years. The overall prevalences of HBsAg and total anti-HBc were 2.3% and 29.3%, respectively. Among the individuals analyzed, 0.3% were positive for HBsAg, 27.3% were positive for total anti-HBc, and 2.0% were positive either for HBsAg or total anti-HBc and were classified as chronically HBV-infected. Furthermore, 70.3% of the patients were classified as never having been infected. Male gender, age >40 years and Caucasian ethnicity were associated with an anti-HBc positive test. CONCLUSIONS The results showed an intermediate prevalence of HBsAg among the studied patients. Moreover, the associations between the anti-HBc marker and socio-demographic factors suggest a need for HBV immunization among these HIV-positive individuals, who are likely to have HIV/HBV coinfection.
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Affiliation(s)
- Saulo Martins
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Andréa do Livramento
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Michelle Andrigueti
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Iara Fabricia Kretzer
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Marcos José Machado
- Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Celso Spada
- Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Aricio Treitinger
- Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC
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HIV/AIDS-Associated Cryptococcosis in Portugal Spanning the Pre- to Post-HAART Era: A Retrospective Assessment at the Genotypic Level Based on URA5-RFLP. Curr Microbiol 2015; 71:449-57. [PMID: 26169111 DOI: 10.1007/s00284-015-0873-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 06/03/2015] [Indexed: 01/03/2023]
Abstract
Cryptococcosis caused by the fungus Cryptococcus neoformans is an opportunistic mycosis, infecting mainly immunodepressed individuals. Molecular epidemiology studies of cryptococcosis in Europe are limited. This paper presents a retrospective study of cryptococcosis in 105 cryptococcal isolates from two hospitals in Lisbon, Portugal, among HIV/AIDS patients, from 1991 to 2007. Among these patients, the number of cases of cryptococcosis increased from 5.1 to 6.9 cases per year from the pre- to post-highly active antiretroviral therapy (HAART) era. As expected, the median age of the patients increased, from 32 (mean: 33 ± 8) to 39 (mean: 41 ± 10) years, and the ratio of male to female patients remained high (7.7 and 7.6, respectively). Strain genotyping based on restriction fragment length polymorphism of the orotidine monophosphate pyrophosphorylase (URA5-RFLP) gene showed that, in general, the relative frequencies of the genotypes VNI-IV are similar to those from other European countries. These frequencies were, respectively, for the pre- and post-HAART periods: 41.7 and 43.5 % for VNI; 2.8 and 17.4 % for VNII; 38.9 and 30.4 % for VNIII; 16.7 and 7.2 % for VNIV and 0 and 1.4 % for VGII. Some apparent although statistically insignificant differences among these values were observed between both periods. The genotypic frequencies were not also statistically different according to the patients' gender or age range. Of note are the high proportion of VNIII isolates (common in Europe) and the high increase in the frequency of the VNII genotype in the post-HAART. Ultimately, these results may have implications in disease therapy, management and control.
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Young LC, Roediger MP, Grandits G, Baker J, Somboonwit C, Williams I, Lundgren JD, Neaton JD, Soliman EZ. Relationship between inflammatory and coagulation biomarkers and cardiac autonomic function in HIV-infected individuals. Biomark Med 2015; 8:1073-83. [PMID: 25402578 DOI: 10.2217/bmm.14.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To examine the relationship between inflammatory and coagulation biomarkers and cardiac autonomic function (CAF) as measured by heart rate variability in persons with HIV. MATERIALS & METHODS This analysis included 4073 HIV-infected persons from the Strategies for Management of Antiretroviral Therapy study. We examined the association between IL-6, high-sensitivity C-reactive protein (hsCRP) and D-dimer with heart rate variability measures (SDNN and rMSSD), both cross-sectionally and longitudinally. RESULTS Cross-sectional analysis revealed significant inverse associations between IL-6, hsCRP and d-dimer with SDNN and rMSSD (p < 0.01 for all comparisons). However, longitudinal analysis failed to show a significant association between baseline IL-6, hsCRP and d-dimer with change in CAF over time. CONCLUSION Cross-sectionally, higher levels of inflammatory and coagulation biomarkers were associated with lower levels of CAF in the Strategies for Management of Antiretroviral Therapy trial. Although deterioration in CAF was observed during followup, baseline levels of inflammatory and coagulation markers were not predictive of the decline in CAF over time.
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Affiliation(s)
- Lari C Young
- Center for Integrative Medicine, Wake Forest Baptist Health, Winston Salem, NC, USA
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When is the best time to initiate antiretroviral therapy? Lancet HIV 2015; 2:e312-3. [PMID: 26423369 DOI: 10.1016/s2352-3018(15)00122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022]
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Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem AV, de Wolf F, Hallett TB. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. THE LANCET. INFECTIOUS DISEASES 2015; 15:810-8. [PMID: 26070969 PMCID: PMC4528076 DOI: 10.1016/s1473-3099(15)00056-0] [Citation(s) in RCA: 602] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. METHODS We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs-including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies-and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030. FINDINGS Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug-drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens. INTERPRETATION The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge. FUNDING Medical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.
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Affiliation(s)
- Mikaela Smit
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Suzanne Geerlings
- Division of Infectious Diseases, Amsterdam Medical Centre, Amsterdam, Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, Netherlands
| | | | | | - Frank de Wolf
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
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Future challenges for clinical care of an ageing population infected with HIV: a modelling study. THE LANCET. INFECTIOUS DISEASES 2015. [PMID: 26070969 PMCID: PMC4528076 DOI: 10.1016/s1473-3099%2815%2900056-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. METHODS We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs-including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies-and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030. FINDINGS Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug-drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens. INTERPRETATION The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge. FUNDING Medical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.
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Hleyhel M, Belot A, Bouvier AM, Tattevin P, Pacanowski J, Genet P, De Castro N, Berger JL, Dupont C, Lavolé A, Pradier C, Salmon D, Simon A, Martinez V, Spano JP, Costagliola D, Grabar S. Trends in survival after cancer diagnosis among HIV-infected individuals between 1992 and 2009. Results from the FHDH-ANRSCO4 cohort. Int J Cancer 2015; 137:2443-53. [DOI: 10.1002/ijc.29603] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Mira Hleyhel
- INSERM, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
| | - Aurélien Belot
- Hospices Civils De Lyon, Service De Biostatistique; Lyon F-69003 France
- Département Des Maladies Chroniques Et Traumatismes; Institut De Veille Sanitaire; Saint-Maurice F-94410 France
- CNRS UMR 5558, Laboratoire De Biométrie Et Biologie Évolutive, Equipe Biostatistique-Santé; Villeurbanne France
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine; Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health; London WC1E 7HT United Kingdom
| | - Anne-Marie Bouvier
- INSERM UMR 866, Registre Bourguignon Des Cancers Digestifs, FRANCIM, Centre Hospitalier Universitaire (CHU) De Dijon; Dijon France
| | - Pierre Tattevin
- CHU De Rennes, Hôpital Pontchaillou, Service De Maladies Infectieuses; Rennes France
| | - Jérôme Pacanowski
- Assistance Publique Hôpitaux De Paris (AP-HP), Hôpital Saint Antoine, Service De Maladies Infectieuses Et Tropicales; Paris France
| | - Philippe Genet
- Centre Hospitalier D'argenteuil, Service d'hématologie-SIDA; Argenteuil France
| | - Nathalie De Castro
- AP-HP, Hôpital Saint Louis, Service De Maladies Infectieuses Et Tropicales; Paris France
| | - Jean-Luc Berger
- CHU De Reims, Service De Médecine Interne Et De Pathologie Infectieuse; Reims France
| | - Caroline Dupont
- AP-HP, Hôpital Ambroise-Paré, Service De Médecine Interne; Boulogne France
| | - Armelle Lavolé
- AP-HP, Hôpital Tenon, Service De Pneumologie; Paris France
| | - Christian Pradier
- Département De Santé Publique; CHU De Nice, Hôpital De L'archet; Nice France
| | - Dominique Salmon
- AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Service De Médecine Interne Et Centre De Référence Maladies Rares; Paris France
- Sorbonne Universités, Université Paris Descartes; Paris France
| | - Anne Simon
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Interne; Paris France
| | - Valérie Martinez
- AP-HP, Hôpital Antoine Béclère, Service De Médecine Interne-Immunologie Clinique; Clamart France
| | - Jean-Philippe Spano
- INSERM, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service D'oncologie Médicale, IUC; Paris France
| | - Dominique Costagliola
- INSERM, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
| | - Sophie Grabar
- INSERM, UMR_S 1136, Institut Pierre Louis D'epidémiologie Et De Santé Publique; Paris F-75013 France
- Sorbonne Universités, Université Paris Descartes; Paris France
- AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité De Biostatistique Et D'épidémiologie; Paris France
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Kabbara WK, Ramadan WH. Emtricitabine/rilpivirine/tenofovir disoproxil fumarate for the treatment of HIV-1 infection in adults. J Infect Public Health 2015; 8:409-17. [PMID: 26001757 DOI: 10.1016/j.jiph.2015.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/19/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022] Open
Abstract
This paper reviews the current literature and information on the combination drug Complera(™) (rilpivirine/emtricitabine/tenofovir disoproxil fumarate) that was approved by the Food and Drug Administration (FDA) in August 2011. PubMed, Cochrane and Embase (2001-2014) were searched for primary and review articles on rilpivirine, emtricitabine, and tenofovir disoproxil fumarate, individually or in combination. Data from drug manufacturer and product label was also used. Clinical trial reports were selected, extracted and analyzed to include relevant and recent ones. Selected English-language trials were limited to those with human subjects and included both safety and efficacy outcomes. Results from two phase 3 randomized double blind trials (ECHO and THRIVE) showed that rilpivirine is non-inferior to efavirenz in suppressing viral load below 50 copies/mL in anti-retroviral therapy (ART) naïve human immunodeficiency virus (HIV) infected patients. In addition, psychiatric disturbances, rash and increase in lipid levels occurred less frequently with rilpivirine when compared to efavirenz. However, virological failure and drug resistance were higher with rilpivirine in patients with baseline viral load >100,000 copies/mL. Rilpivirine showed cross resistance to efavirenz and etravirine. Efavirenz, on the other hand, did not demonstrate cross resistance to rilpivirine and etravirine, leaving the latter drugs as options for use in case of virological failure with efavirenz. Complera(™) remains an acceptable alternative treatment to Atripla(™) in ART naïve patients who have a pre-ART plasma HIV RNA <100,000 copies/mL and CD4 count >200 cells/mm(3) with non-inferior efficacy and better safety and tolerability.
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Affiliation(s)
- Wissam K Kabbara
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University (LAU), P.O. Box: 36/F-53, Byblos, Lebanon.
| | - Wijdan H Ramadan
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University (LAU), P.O. Box: 36/F-53, Byblos, Lebanon.
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Bam K, Rajbhandari RM, Karmacharya DB, Dixit SM. Strengthening adherence to Anti Retroviral Therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal. BMC Health Serv Res 2015; 15:188. [PMID: 25939593 PMCID: PMC4428010 DOI: 10.1186/s12913-015-0846-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/24/2015] [Indexed: 01/19/2023] Open
Abstract
Background Anti Retroviral Therapy (ART) is the cornerstone for comprehensive health sector response to Human Immunodeficiency Virus (HIV) treatment, care and support. Adherence of at least 95% is needed to keep HIV under control, as per World Health Organization (WHO) guidelines. This study was aimed at identifying the overall adherence level of, and barriers and facilitators to adherence for patients taking ART in different clinics in all five development regions of Nepal. Methods A descriptive cross-sectional study was conducted among ART clients receiving free ART from Government of Nepal ART clinics. A total of 435 clients taking ART from twelve ART clinics in different regions of Nepal, aged fifteen years and above were interviewed on one-and-one basis using questionnaires developed in reference to Adult AIDS Clinical Trial Group (AACTG) toolkit among them data from 404 were analyzed after cleaning. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. Results The overall adherence in the last month (missed less than three pills total) was 94.8% (383 out of 404). The main barrier to ART adherence was the fear of side effects (among 61.9% of the non adherent population) which included dizziness (18.1%) and headaches (15.4%). The standard wristwatch (39%) was found to be the most useful aid in enabling timely consumption of medication. Educational status (P = 0.018), drug using habits (P = 0.039) and the conducive environment at ART clinics (P = 0.004) were significantly associated with ART adherence. Conclusion Improving better adherence may require a more holistic approach to treatment regimen and adapting it to patient daily routines. This study identifies issues such as pill count for assessing adherence, better access to health care facilities by clients, better access to medication, as well as improved nutritional support issues for better adherence by the population in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0846-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kiran Bam
- Center for Molecular Dynamics Nepal (CMDN), Thapathali, Kathmandu, Nepal.
| | | | | | - Sameer M Dixit
- Center for Molecular Dynamics Nepal (CMDN), Thapathali, Kathmandu, Nepal.
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Kryst J, Kawalec P, Pilc A. Efavirenz-Based Regimens in Antiretroviral-Naive HIV-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0124279. [PMID: 25933004 PMCID: PMC4416921 DOI: 10.1371/journal.pone.0124279] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/12/2015] [Indexed: 01/19/2023] Open
Abstract
Efavirenz, a non-nucleoside reverse-transcriptase inhibitor (NNRTI) is one of the most commonly prescribed antiretroviral drugs. The present article provides a systematic overview and meta-analysis of clinical trials comparing efavirenz and other active drugs currently recommended for treatment of HIV-infected, antiretroviral-naive patients. Electronic databases (Pubmed, Embase, the Cochrane Library, Trip Database) were searched up till 23 December 2013 for randomized controlled clinical trials published as a peer-reviewed papers, and concerning efavirenz-based regimens used as initial treatment for HIV infection. Thirty-four studies were included in the systematic review, while twenty-six trials were suitable for the meta-analysis. Efavirenz was compared with drugs from four different classes: NNRTIs other than efavirenz (nevirapine or rilpivirine), integrase strand transfer inhibitors (InSTIs), ritonavir-boosted protease inhibitors (bPI) and chemokine (C-C motif) receptor 5 (CCR5) antagonists (maraviroc), all of them were added to the background regimen. Results of the current meta-analysis showed that efavirenz-based regimens were equally effective as other recommended regimens based on NNRTI, ritonavir-boosted PI or CCR5 antagonist in terms of efficacy outcomes (disease progression and/or death, plasma viral HIV RNA <50 copies/ml) while statistically significant more patients treated with InSTI achieved plasma viral load <50 copies/ml at week 48. In comparison with both InSTI-based and CCR5-based therapy, efavirenz-based treatment was associated with a higher risk of therapy discontinuation due to adverse events. However, comparisons of efevirenz-based treatment with InSTI-based and CCR5-based therapy were based on a limited number of trials, therefore, conclusions from these two comparisons must be confirmed in further reliable randomized controlled studies. Results of our meta-analysis support the present clinical guidelines for antiretroviral-naive, HIV-infected patients, in which efavirenz is one of the most preferred regimens in the analyzed population. Beneficial safety profile of InSTI-based and CCR5-based therapy over efavirenz-based treatment needs further studies.
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Affiliation(s)
| | - Paweł Kawalec
- Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
- * E-mail:
| | - Andrzej Pilc
- Department of Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
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Projected Lifetime Healthcare Costs Associated with HIV Infection. PLoS One 2015; 10:e0125018. [PMID: 25901355 PMCID: PMC4406522 DOI: 10.1371/journal.pone.0125018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/08/2015] [Indexed: 11/25/2022] Open
Abstract
Objective Estimates of healthcare costs associated with HIV infection would provide valuable insight for evaluating the cost-effectiveness of possible prevention interventions. We evaluate the additional lifetime healthcare cost incurred due to living with HIV. Methods We used a stochastic computer simulation model to project the distribution of lifetime outcomes and costs of men-who-have-sex-with-men (MSM) infected with HIV in 2013 aged 30, over 10,000 simulations. We assumed a resource-rich setting with no loss to follow-up, and that standards and costs of healthcare management remain as now. Results Based on a median (interquartile range) life expectancy of 71.5 (45.0–81.5) years for MSM in such a setting, the estimated mean lifetime cost of treating one person was £360,800 ($567,000 or €480,000). With 3.5% discounting, it was £185,200 ($291,000 or €246,000). The largest proportion (68%) of these costs was attributed to antiretroviral drugs. If patented drugs are replaced by generic versions (at 20% cost of patented prices), estimated mean lifetime costs reduced to £179,000 ($281,000 or €238,000) and £101,200 ($158,900 or €134,600) discounted. Conclusions If 3,000 MSM had been infected in 2013, then future lifetime costs relating to HIV care is likely to be in excess of £1 billion. It is imperative for investment into prevention programmes to be continued or scaled-up in settings with good access to HIV care services. Costs would be reduced considerably with use of generic antiretroviral drugs.
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129
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Tang B, Xiao Y, Cheke RA, Wang N. Piecewise virus-immune dynamic model with HIV-1 RNA-guided therapy. J Theor Biol 2015; 377:36-46. [PMID: 25908208 DOI: 10.1016/j.jtbi.2015.03.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/03/2015] [Accepted: 03/24/2015] [Indexed: 12/22/2022]
Abstract
Clinical studies have used CD4 T cell counts to evaluate the safety or risk of plasma HIV-1 RNA-guided structured treatment interruptions (STIs), aimed at maintaining CD4 T cell counts above a safe level and plasma HIV-1 RNA below a certain level. However, quantifying and evaluating the impact of STIs on the control of HIV replication and on activation of the immune response remains challenging. Here we extend the virus-immune dynamic system by including a piecewise smooth function to describe the elimination of HIV viral loads and the activation of effector cells under plasma HIV-1 RNA-guided therapy, in order to quantitatively explore the STI strategies. We theoretically investigate the global dynamics of the proposed Filippov system. Our main results indicate that HIV viral loads could either go to infinity or be maintained below a certain level or stabilize at a previously given level, depending on the threshold level and initial HIV virus loads and effector cell counts. This suggests that proper combinations of threshold and initial HIV virus loads and effector cell counts, based on threshold policy, can successfully preclude exceptionally high growth of HIV virus and, in particular, maximize the controllable region.
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Affiliation(s)
- Biao Tang
- School of Mathematics and Statistics, Xi׳an Jiaotong University, Xi׳an, 710049, PR China
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi׳an Jiaotong University, Xi׳an, 710049, PR China.
| | - Robert A Cheke
- Natural Resources Institute, University of Greenwich at Medway, Chatham Maritime, Chatham, Kent ME4 4TB, UK
| | - Ning Wang
- National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, PR China
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Catumbela E, Freitas A, Lopes F, Mendoza MDCT, Costa C, Sarmento A, da Costa-Pereira A. HIV disease burden, cost, and length of stay in Portuguese hospitals from 2000 to 2010: a cross-sectional study. BMC Health Serv Res 2015; 15:144. [PMID: 25889920 PMCID: PMC4403787 DOI: 10.1186/s12913-015-0801-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/18/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010. METHODS The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9(th) Revision, Clinical Modification diagnosis codes 042.x-044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann-Whitney U test. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge. RESULTS A total of 57,027 hospital admissions were analyzed; 73% of patients were male, and the mean age was 39 years. The median LOS was 11 days, and the in-hospital mortality was 14%. The mean cost per hospitalization was 5,148.7€. A total of 83% of admissions were through the emergency room. During the period, inpatient HIV admissions decreased by 22%, LOS decreased by 9%, and in-hospital mortality dropped by 12%. Elixhauser comorbidities increased the median LOS in nearly all admissions. CONCLUSIONS Despite small regional variations, a strong, consistent decrease was observed in the hospital admission rate, mean cost, length of stay, and mortality rate for HIV-related admissions in Portugal during 2000-2010.
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Affiliation(s)
- Emanuel Catumbela
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- Department of Pathology, Faculty of Medicine, Universidade Agostinho Neto, Luanda, Angola.
- CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
- Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
| | - Alberto Freitas
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
| | - Fernando Lopes
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
| | | | - Carlos Costa
- National School of Public Health, University Nova de Lisbon, Lisbon, Portugal.
| | - António Sarmento
- Department of Infectious Diseases, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Altamiro da Costa-Pereira
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
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Li M, Zhu Q, Zheng W, Pan P, Liang H, Ye L, Wang X, Zhu J, Li G, Dong B. A retrospective cohort study on the mortality of AIDS patients in Guangxi, China (2001-2011). AIDS Res Hum Retroviruses 2015; 31:439-47. [PMID: 25420616 DOI: 10.1089/aid.2014.0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this article is to describe mortality trends in different highly active antiretroviral therapy (HAART) periods and associated factors among AIDS patients in Guangxi, China. We prospectively analyzed AIDS patients in Guangxi between 2001 and 2011; demographic characteristics were compared among AIDS patients diagnosed in three treatment periods (pre-HAART: 2001-2004, early-HAART: 2005-2008, and late-HAART: 2009-2011). AIDS mortality was calculated by person-years, and treatment coverage was defined as the proportion of time that patients who were eligible for treatment received treatment. Factors of AIDS mortality were determined by a Cox proportional hazard regression. Of 19,020 AIDS patients, overall mortality declined from 41.1 per 100 person-years in 2001 to 13.3 per 100 person-years in 2011 with treatment coverage increasing from zero to 72.1%. The overall median survival figure was 5.6 years (95% CI: 4.4-6.8) with 60.3% for 5-year survival rate. After AIDS diagnosis, the mortality rate peaked in the first year, and 37.4% patients were still active in the ninth year. Protective factors for mortality were AIDS patients diagnosed from 2009 to 2011 (AHR=0.75, 95% CI: 0.58-0.89), having received HAART (AHR=0.71, 95% CI: 0.50-0.87), and having a CD4 count of higher than 350 cells/μl at AIDS diagnosis (AHR=0.79, 95% CI: 0.60-0.92). Risk factors for mortality included being male (AHR=1.28, 95% CI: 1.07-1.43), living in a rural area (AHR=1.40, 95% CI: 1.18-1.94), and being aged ≥60 years at AIDS diagnosis (AHR=1.36, 95% CI: 1.18-1.73). A decline in AIDS mortality was observed in Guangxi with a concomitant increase in treatment coverage. Some subpopulations of AIDS patients, such as males, rural residents, and the old, require more medical care.
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Affiliation(s)
- Mingli Li
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Institute for HIV/AIDS Control and Prevention, Guangxi Zhuang Autonomous Regional Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Qiuying Zhu
- Institute for HIV/AIDS Control and Prevention, Guangxi Zhuang Autonomous Regional Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Wenbin Zheng
- Project Department, Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Peijiang Pan
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaofang Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhu
- Institute for HIV/AIDS Control and Prevention, Guangxi Zhuang Autonomous Regional Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Guojian Li
- Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Baiqing Dong
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Moreira-Silva SF, Zandonade E, Miranda AE. Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria, Brazil. BMC Infect Dis 2015; 15:155. [PMID: 25888439 PMCID: PMC4380259 DOI: 10.1186/s12879-015-0893-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/12/2015] [Indexed: 11/26/2022] Open
Abstract
Background Daily throughout 2011, about 900 new HIV infections occurred in children and 630 children died as a result of AIDS-related complications worldwide. Late diagnosis, mortality trends, causes of and risk factors for death were evaluated in vertically HIV-infected children. Methods A retrospective 11-year study was conducted with Brazilian vertically HIV-infected children and adolescents using patients’ charts. Medical records, death certificates and the Ministry of Health’s mortality database were verified for mortality and cause of death. Diagnoses were made according to the CDC Revised Classification System for HIV infection. Results Of 177 patients included, 97 were female (54.8%). Median age at admission was 30 months (IQR: 5–72 months). Median follow-up was 5 years (IQR: 2–8 years). After 11 years, 132 (74,6%) patients continued in follow-up, 11 (6.2%) had been transferred and 8 (4.5%) were lost to follow-up. Twenty-six deaths occurred (14,7%), the majority (16/26; 61.5%) in children <3 years of age. Death cases decreased over time and the distribution of deaths was homogenous over the years of evaluation. In 17/26 (65.4%) of the children who died, diagnosis had been made as the result of their becoming ill. Beginning antiretroviral therapy before 6 months of age was associated with being alive (OR = 2.86; 95% CI: 1.12–7.25; p = 0.027). The principal causes of death were severe bacterial infections (57%) and opportunistic infections (33.3%). Conclusions In most of the HIV-infected children, diagnosis was late, increasing the risk of progression to AIDS and death due to delayed treatment. The mortality trend was constant, decreasing in the final two years of the study. Bacterial infections remain as the major cause of death. Improvements in prenatal care and pediatric monitoring are mandatory.
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Affiliation(s)
- Sandra Fagundes Moreira-Silva
- Infectious Diseases Department, Nossa Senhora da Glória State Hospital (SI-HEINSG), Vitória, Espírito Santo, Brazil. .,Postgraduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil.
| | - Eliana Zandonade
- Statistics Department, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil.
| | - Angélica Espinosa Miranda
- Postgraduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil. .,Núcleo de Doenças Infecciosas, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Vitória, ES, [29100-240], Brazil.
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133
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Seape T, Gounden V, van Deventer HE, Candy GP, George JA. Cystatin C- and creatinine-based equations in the assessment of renal function in HIV-positive patients prior to commencing Highly Active Antiretroviral Therapy. Ann Clin Biochem 2015; 53:58-66. [PMID: 25766385 DOI: 10.1177/0004563215579695] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the accuracy and precision of creatinine- and cystatin C-based prediction equations for estimating glomerular filtration rate compared to measured glomerular filtration rate in an antiretroviral-naive human immunodeficiency virus population. METHODS The study population consisted of 100 treatment-naive HIV patients. Glomerular filtration rate was estimated using the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, as well as cystatin C-based equations (CKD-EPIcystatin C, cystatin Cvan Deventer and CKD-EPIcombined)) compared to (51)Cr-EDTA plasma clearance-measured glomerular filtration rate. We calculated percentage bias, standard deviation of the differences, accuracy within 15 and 30% of measured glomerular filtration rate and sensitivity and specificity for predicting measured glomerular filtration rate <60 mL/min/1.73 m(2). RESULTS Bias for all estimating glomerular filtration rate equations ranged from -9.4% to 38.4%. The CKD-EPIcombined without ethnicity correction factor equation had the least bias, 2.9% (-2.9 to 8.8). Bias was higher for the Modification of Diet in Renal Disease and CKD-EPI equation with the African-American ethnicity factor (38.4 and 33.7%) than without (14.2 and 15.3%). Standard deviation of the differences ranged from 29.2% (CKD-EPIcombined without ethnicity factor) to 54.0% (Modification of Diet in Renal Disease with ethnicity factor). Accuracy within 30% of measured glomerular filtration rate ranged from 78% for CKD-EPIcombined without ethnicity factor to 56.7% for the Cockcroft-Gault equation. Sensitivity for creatinine-based equations was less than 50% and for the CKD-EPIcystatin C equation was 75%. CONCLUSION Sensitivity of creatinine-based equations for predicting glomerular filtration rate was poor in this group of patients. The CKD-EPIcombined equation performed better than creatinine-based equations.
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Affiliation(s)
- Tebogo Seape
- Department of Chemical Pathology, University of Witwatersrand and National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Verena Gounden
- Department of Chemical Pathology, University of Witwatersrand and National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa Department of Chemical Pathology, University of Kwa Zulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Hendrick E van Deventer
- Department of Chemical Pathology, University of Witwatersrand and National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa Lancet Laboratories, Auckland Park, Johannesburg, South Africa
| | - Geoffrey P Candy
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, University of Witwatersrand and National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Mocroft A, Lundgren JD, Ross M, Law M, Reiss P, Kirk O, Smith C, Wentworth D, Neuhaus J, Fux CA, Moranne O, Morlat P, Johnson MA, Ryom L. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study. PLoS Med 2015; 12:e1001809. [PMID: 25826420 PMCID: PMC4380415 DOI: 10.1371/journal.pmed.1001809] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/20/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. METHODS AND FINDINGS A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. CONCLUSIONS Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.
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Affiliation(s)
- Amanda Mocroft
- Department of Infection and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Jens D. Lundgren
- Copenhagen HIV Programme, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Ross
- Division of Nephrology, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Reiss
- Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ole Kirk
- Copenhagen HIV Programme, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Colette Smith
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Deborah Wentworth
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jacqueline Neuhaus
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Christoph A. Fux
- Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Olivier Moranne
- Nephrology Department, Public Health Department, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Phillipe Morlat
- Université de Bordeaux, INSERM U 897, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Margaret A. Johnson
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Lene Ryom
- Copenhagen HIV Programme, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Yang RR, Gui X, Xiong Y, Gao SC, Yan YJ. Five-year follow-up observation of HIV prevalence in serodiscordant couples. Int J Infect Dis 2015; 33:179-84. [PMID: 25677723 DOI: 10.1016/j.ijid.2015.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the rate of HIV seroconversion and the related risk factors among HIV discordant couples in Hubei Province, China. METHODS HIV seroconversion rates and associated factors in discordant couples were identified during 2010-2012, based on existing data collected in serological and behavioral surveys between 2005 and 2007. RESULTS At baseline, HIV transmission had occurred in 505 out of 1258 couples and the annual rate of HIV transmission was 6.3% in the absence of an intervention (40.14% after HIV exposure for 6.4 years). Five out of 753 discordant couples were found to have seroconverted during the 5-year follow-up observation after the implementation of interventions. Factors independently associated with HIV seroconversion included an HIV viral load >1000 copies/ml (odds ratio (OR) 18.706, 95% confidence interval (CI) 1.577-221.926), the index partner being on antiretroviral therapy (OR 0.019, 95% CI 0.002-0.180), and condom use in the past 6 months (OR 0.194, 95% CI 0.021-0.795). CONCLUSIONS HIV-negative partners in serodiscordant couples were at risk of HIV infection if the index partner did not receive any intervention. It is strongly advised that existing interventions are used, such as couples consultations, condom use, and antiretroviral treatment, to minimize the risk of HIV transmission.
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Affiliation(s)
- Rong-rong Yang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Xien Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China.
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Shi-cheng Gao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Ya-jun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
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Quercia R, Garnier E, Ferré V, Morineau P, Bonnet B, Soulard C, Raffi F. Salvage Therapy with Ritonavir-Boosted Amprenavir/Fosamprenavir: Virological and Immunological Response in Two Years Follow-up. HIV CLINICAL TRIALS 2015; 6:73-80. [PMID: 15983891 DOI: 10.1310/mv8b-2ybd-gam7-ptxx] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy of salvage regimens containing ritonavir-boosted amprenavir (APV/r) or fosamprenavir (FPV/r) in heavily pretreated protease inhibitor (PI)-experienced HIV-1 patients. METHOD Evaluation of APV/r- or FPV/r-containing antiretroviral regimens in PI-experienced HIV-1 patients with 2 or more antiretroviral failures. Follow-up continued to 96 weeks with prospective collection of data. RESULTS 54 episodes (48 on APV/r and 6 on FPV/r) were considered in 45 patients who had received a median of 5 prior antiretroviral regimens (range, 2-13) including a median of 3 PIs (range, 2-4). Median time of treatment at analysis was 72 weeks (range, 12-210). At baseline, plasma viral load (pVL) and CD4 cell count was 67,000 copies/mL and 167 cell/mm(3), respectively. At week 96, the median pVL was < 50 copies/mL and CD4 cell count was 519 cells/mm(3). Proportion of patients with pVL below detection was 62% at week 48 and 61% at week 96. Fifteen patients stopped treatment because of virologic failure; one presented a full resistance profile to APV/r, based on the ANRS 2003 resistance algorithm. Median trough APV plasma concentration 4 weeks after treatment initiation was 1406 ng/mL (range, 452-4321); dose adaptation was required in only 7 patients. CONCLUSION This study provides long-term follow-up of APV/r and FPV/r in the setting of salvage therapy, showing a high and sustained rate of virologic and immunologic response.
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Affiliation(s)
- Romina Quercia
- Service des Maladies Infectieuses et Tropicales, Hotel-Dieu, 44093 Nantes cedex 1, France
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137
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Muhula SO, Peter M, Sibhatu B, Meshack N, Lennie K. Effects of highly active antiretroviral therapy on the survival of HIV-infected adult patients in urban slums of Kenya. Pan Afr Med J 2015; 20:63. [PMID: 26090021 PMCID: PMC4450049 DOI: 10.11604/pamj.2015.20.63.4865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022] Open
Abstract
Recent improvements in access to Anti-Retroviral Therapy (ART) have radically reduced hospitalizations and deaths associated with HIV infection in both developed countries and sub-Saharan Africa. Not much is known about survival of patients on ART in slums. The objective of this study was to identify factors associated with mortality among adult patients on ART in resource poor, urban, sub-Saharan African setting. A prospective open cohort study was conducted with adult patients on ART at a clinic in Kibera slums, Nairobi, Kenya. The patients' enrollment to care was between March 2005 and November 2011. Descriptive statistics were computed and Kaplan-Meier (KM) methods used to estimate survival time while Cox's proportional hazards (CPH) model fitted to determine mortality predictors. A total of 2,011 adult patients were studied, 69% being female. Female gender (p=0.0016), zidovudine-based regimen patients (p<0.0001), CD4 count>351 patients (p<0.0001), WHO stage I patients (p<0.0001) and "Working" functional status patients recorded better survival probability on ART. In CPH analysis, the hazard of dying was higher in patients on Stavudine-based regimen(hazard ratio (HR)=.8; 95% CI, 1.5-2.2; p<0.0001),CD4 count<50 cells/µl (HR=1.6; 95% CI, 1.5-1.7;p<0.0001), WHO Stage IV at ART initiation (HR=1.3; 95% CI, 1.1-1.6; p=0.016) and bedridden patients (HR=2.7; 95% CI, 1.7-4.4;p<0.0001). There was increased mortality among the males, those with advanced Immunosuppression, late WHO stage and bedridden patients. The findings further justify the need to switch patients on Stavudine-based regimen as per the WHO recommendations.
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Affiliation(s)
| | - Memiah Peter
- University of Maryland, School of Medicine-Institute of HumanVirology,Baltimore
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138
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Tenofovir alafenamide vs. tenofovir disoproxil fumarate in single tablet regimens for initial HIV-1 therapy: a randomized phase 2 study. J Acquir Immune Defic Syndr 2015; 67:52-8. [PMID: 24872136 DOI: 10.1097/qai.0000000000000225] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the novel tenofovir prodrug, tenofovir alafenamide (TAF), as part of a single-tablet regimen (STR) for the initial treatment of HIV-1 infection. DESIGN Phase 2, randomized, double-blind, double-dummy, multicenter, active-controlled study. METHODS Antiretroviral naive adults with HIV-1 RNA ≥5000 copies per milliliter and a CD4 count ≥50 cells per microliter were randomized 2:1 to receive an STR of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) or elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF), plus placebo for 48 weeks. RESULTS Patients on both E/C/F/TAF (n = 112) and E/C/F/TDF (n = 58) had high rates of virologic suppression (<50 HIV copies per milliliter) at week 24 (86.6%; 89.7%) and at week 48 (88.4%; 87.9%), and had similar improvements in CD4 at week 48 (177; 204), respectively. Both treatments were well tolerated, and most adverse events were self-limiting and of mild to moderate severity. Compared with patients on E/C/F/TDF, patients on E/C/F/TAF had smaller reductions in estimated creatinine clearance (-5.5 vs. -10.1 mL/min, P = 0.041), significantly less renal tubular proteinuria, and smaller changes in bone mineral density for hip (-0.62% vs. -2.39%, P < 0.001) and spine (-1.00% vs. -3.37%, P < 0.001). Patients on E/C/F/TAF had higher increases in total cholesterol, low-density lipoprotein, and high-density lipoprotein, but the total cholesterol/high-density lipoprotein ratio was unchanged for both. CONCLUSIONS Treatment-naive patients given the STR that contained either TAF or TDF achieved a high rate of virologic success. Compared with those receiving TDF, patients on E/C/F/TAF experienced significantly smaller changes in estimated creatinine clearance, renal tubular proteinuria, and bone mineral density.
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139
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McMahon DK, DiNubile MJ, Meibohm AR, Marino DR, Robertson MN. Efficacy, Safety, and Tolerability of Long-Term Combination Antiretroviral Therapy in Asymptomatic Treatment-Naïve Adults with Early HIV Infection. HIV CLINICAL TRIALS 2015; 8:269-81. [DOI: 10.1310/hct0805-269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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140
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Arrizabalaga J, Arazo P, Aguirrebengoa K, García-Palomo D, Chocarro Á, Labarga P, Muñoz-Sánchez MJ, Echevarría S, Oteo JA, Uriz J, Letona S, Fariñas MC, Peralta G, Pinilla J, Ferrer P, Álvarez ML, Iribarren JA. Effectiveness and Safety of Simplification Therapy with Once-Daily Tenofovir, Lamivudine, and Efavirenz in HIV-1–Infected Patients with Undetectable Plasma Viral Load on HAART. HIV CLINICAL TRIALS 2015; 8:328-36. [DOI: 10.1310/hct0805-328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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141
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Cost-effectiveness of socioeconomic support as part of HIV care for the poor in an urban community-based antiretroviral program in Uganda. J Acquir Immune Defic Syndr 2015; 67:e76-83. [PMID: 25032486 DOI: 10.1097/qai.0000000000000280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Socioeconomic support reduced nonretention in a community-based antiretroviral therapy (ART) program in Uganda. However, resource implications of expanding socioeconomic support are large, and cost-effectiveness analysis can inform budget priorities. We compared the incremental benefits and costs of providing education, food, or both forms of support (dual support) with existing ART services from a health care provider's perspective. METHODS Costs and outcome data were collected from a cohort of 2371 adult patients with HIV receiving education, food, or dual support from Reach Out Mbuya between 2004 and 2010. The primary outcome was averted loss to follow-up. The number of follow-up days was calculated for each patient along with accrued service and fixed program costs for the alternative forms of socioeconomic support in USD by standard costing methods. The socioeconomic support types were compared incrementally over the study period. RESULTS After 7 years, 762 (33%) of the patients were loss to follow-up with 42% of them receiving food. In the presence of providing ART, education support was less costly and more effective than the alternatives. The average unit cost for education, food, and dual support were $237, $538, and $776, respectively. The average total annual costs were $88,643 for education, $538,005 for food, and $103,045 for dual support. CONCLUSIONS Compared with food or dual support, investing in education of the children of ART patients is less costly and more effective in improving patient retention. Reach Out Mbuya should embrace this paradigm shift and channel its resources more efficiently and effectively by focusing on education support.
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142
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Iliyasu G, Habib AG. Comparison of home and hospital deaths among patients on anti-retroviral therapy (ART): A clinical and verbal autopsy study. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
For the first decade and a half after the Human Immunodeficiency Virus (HIV) was first identified, the prognosis for most people infected with HIV was quite poor. Life insurance companies responded accordingly and insurance laboratories developed new means to test for the infection. However, it is now clear that people with HIV infection are living longer and that the majority of deaths occurring among those on treatment are now no longer due to AIDS-defining illnesses. This review examines the results of selected studies which analyzed mortality outcomes in those with HIV infection, the many factors which influence those outcomes, and the limitations in the data and in their applicability to an insurance population.
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144
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Mercadel CJ, Skelley JW, Kyle JA, Elmore LK. Dolutegravir: An Integrase Strand Transfer Inhibitor for the Treatment of Human Immunodeficiency Virus 1 in Adults. J Pharm Technol 2014; 30:216-226. [PMID: 34860879 PMCID: PMC5990157 DOI: 10.1177/8755122514544126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Objective: To review the efficacy, safety, pharmacokinetics, pharmacodynamics, administration, drug interactions, and cost of dolutegravir (Tivicay), a third in class integrase strand transfer inhibitor (INSTI), for the treatment of human immunodeficiency virus (HIV-1) in adults. Data Sources: MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google Scholar searches (January 2000 to May 2014) were conducted for articles published in English and limited to human subjects, using the key words antiretroviral drugs, HIV integrase strand transfer inhibitors, dolutegravir, DTG, and S/GSK1349572. Study Selection and Data Extraction: Following MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google Scholar searches, 6 clinical trials were identified and included in this review. Phase III/IV studies evaluating the safety and efficacy of dolutegravir in humans were selected and evaluated. Data Synthesis: In treatment naïve and experienced patients dolutegravir was noninferior to raltegravir at suppressing viral load when added to background therapy. Abacavir/lamivudine/dolutegravir was noninferior to efavirenz/emtricitabine/tenofovir disoproxil fumarate and darunavir/ritonavir plus background therapy at suppressing viral load. In patients with multiple-class antiretroviral resistance at baseline, dolutegravir decreased HIV RNA by 1.4 log10 copies/mL at day 8, 63% of patients had achieved virologic suppression at week 8, and retained potency in treatment-experienced INSTI-resistant patients up to week 48 or 96 of follow-up. Conclusion: Dolutegravir is a safe, effective, and well-tolerated treatment option for adults with HIV-1, even in the setting of resistance to other antiretrovirals.
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145
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Fennie KP, Lutfi K, Maddox LM, Lieb S, Trepka MJ. Influence of residential segregation on survival after AIDS diagnosis among non-Hispanic blacks. Ann Epidemiol 2014; 25:113-9, 119.e1. [PMID: 25542342 DOI: 10.1016/j.annepidem.2014.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/29/2014] [Accepted: 11/04/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Non-Hispanic blacks (NHBs) are disproportionately affected by the AIDS epidemic. With the advent of highly active antiretroviral therapy (HAART), survival after AIDS diagnosis has increased dramatically, yet survival among NHBs is shorter compared with non-Hispanic whites. Racial residential segregation may be an important factor influencing observed racial disparities in survival. METHODS We linked data on 30,813 NHBs from the Florida Department of Health HIV/AIDS Reporting system (1993-2004) with death records and applied segregation indices and poverty levels to the data. Weighted Cox models were used to examine the association between segregation measured on five dimensions and survival, controlling for demographic factors, clinical factors, and area-level poverty. Analyses were stratified by pre-HAART (1993-1995), early HAART (1996-1998), and late-HAART (1999-2004) eras. RESULTS In the late-HAART era, adjusting for area-level poverty, segregation remained a significant predictor of survival on two dimensions: Concentration (hazard ratio, 1.32; 95% confidence interval, 1.13-1.56) and centralization (hazard ratio, 1.44; 95% confidence interval, 1.12-1.84). Area-level poverty was an independent predictor of survival. CONCLUSIONS These findings suggest that certain dimensions of segregation and poverty are associated with survival after AIDS diagnosis.
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Affiliation(s)
- Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
| | - Khaleeq Lutfi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Lorene M Maddox
- Florida Consortium for HIV/AIDS Research/The AIDS Institute, Tampa
| | - Spencer Lieb
- HIV/AIDS Section, Florida Department of Health, Tallahassee
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
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146
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Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. ACTA ACUST UNITED AC 2014; 72:40. [PMID: 25671112 PMCID: PMC4323115 DOI: 10.1186/2049-3258-72-40] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/13/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND As infection with the Human Immunodeficiency Virus (HIV) has evolved to a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. Literature discusses different factors influencing HRQoL in this population, however, currently no consensus exists about the main determinants. In this review a clear, up-to-date overview of the determinants influencing HRQOL among people living with HIV is provided. METHODS All studies published before July 2013 that identified determinants of HRQoL among people living with HIV in high-income countries, were considered in this narrative review. PubMed, Web of Science and The Cochrane Library were consulted using the keywords 'determinants', 'quality of life', 'HIV' and 'AIDS'. To be included, studies should have reported overall health and/or physical/mental health scores on a validated instrument and performed multivariable regression analyses to identify determinants that independently influence perceived HRQoL. RESULTS In total, 49 studies were included for further analysis and they used a variety of HRQoL instruments: Medical Outcomes Study Short Form-36 or variants, Medical Outcomes Study-HIV, HIV Cost and Services Utilization Study measure, Multidimensional Quality of Life Questionnaire, HIV targeted quality of life instrument, Functional Assessment of Human Immunodeficiency Virus Infection, HIV Overview of Problems Evaluation System, EuroQol, Fanning Quality of Life scale, Health Index and PROQOL-HIV. In this review, the discussed determinants were thematically divided into socio-demographic, clinical, psychological and behavioural factors. Employment, immunological status, presence of symptoms, depression, social support and adherence to antiretroviral therapy were most frequently and consistently reported to be associated with HRQoL among people living with HIV. CONCLUSIONS HRQoL among people living with HIV is influenced by several determinants. These determinants independently, but simultaneously impact perceived HRQoL. Most HRQoL instruments do not capture all key determinants. We recommend that the choice for an instrument should depend on the purpose of the HRQoL assessment.
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Affiliation(s)
- Sophie Degroote
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique M Vandijck
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Economics, Faculty of Business Economics, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium
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147
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An 84-month observational study of the changes in CD4 T-lymphocyte cell count of 110 HIV/AIDS patients treated with traditional Chinese medicine. Front Med 2014; 8:362-7. [PMID: 25190350 DOI: 10.1007/s11684-014-0363-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
This study aimed to evaluate the therapeutic effect of traditional Chinese medicine (TCM) by observing the changes in CD4 T-lymphocyte cell count of 110 cases with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) treated continuously with TCM for 84 months. Information of 110 HIV/AIDS patients from 19 provinces and cities treated with TCM from 2004 to 2013 was collected. Changes in the indexes of CD4 counts ( ≤ 200, 201-350, 351-500 and > 500 cells/mm(3)) at five time points (0, 12, 36, 60 and 84 months) and different treatments [TCM and TCM plus antiretroviral therapy (ART)] were compared. Repeated measures test indicated no interaction between group and time (P > 0.05). Degrees of increasing and decreasing CD4 count of the two groups at four different frames were statistically significant compared with the baseline. The CD4 count between the two groups was not statistically significant. For CD4 count of ≤ 200 cells/mm(3), the mean CD4 count changes were 21 and 28 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of 201-350 cells/mm(3), the mean CD4 count changes were 6 and 25 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of 351-500 cells/mm(3), the mean CD4 count changes were -13 and -7 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of > 500 cells/mm(3), the mean CD4 count changes were -34 and -17 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. Long-term use of TCM could maintain or slow the pace of declining CD4 counts in patients with HIV/AIDS, and may achieve lasting effectiveness.
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148
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Blasco AJ, Llibre JM, Berenguer J, González-García J, Knobel H, Lozano F, Podzamczer D, Pulido F, Rivero A, Tuset M, Lázaro P, Gatell JM. Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2014; 33:156-65. [PMID: 25175171 DOI: 10.1016/j.eimc.2014.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/19/2014] [Accepted: 05/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens. METHODS An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively. CONCLUSION Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings.
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Affiliation(s)
| | - Josep M Llibre
- Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan González-García
- Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain
| | - Fernando Lozano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Daniel Podzamczer
- Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Federico Pulido
- Unidad de VIH, Hospital Universitario 12 de Octubre, i+12, Madrid, Spain
| | - Antonio Rivero
- Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Pablo Lázaro
- Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Madrid, Spain
| | - Josep M Gatell
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
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Zheng H, Wang L, Huang P, Norris J, Wang Q, Guo W, Peng Z, Yu R, Wang N. Incidence and risk factors for AIDS-related mortality in HIV patients in China: a cross-sectional study. BMC Public Health 2014; 14:831. [PMID: 25113245 PMCID: PMC4137099 DOI: 10.1186/1471-2458-14-831] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/03/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To estimate the incidence and risk factors for mortality in HIV-1-infected patients in China. METHODS Information on AIDS-related deaths was collected from the Chinese Center for Disease Control and Prevention's Disease Surveillance Information Reporting System and AIDS Prevention and Control Information System. RESULTS A total of 379,348 HIV cases were recorded in the databases from 2006. Among those, 138,288 patients were reported as having developed AIDS and 72,616 (19%) died of AIDS after data was extracted from the databases in January 2011. Mortality was higher among those patients aged 50 years old or older (AOR: 3.41, CI: 1.47-7.91) who had been infected by intravenous drug use (AOR: 1.65, CI: 1.28-2.14) or blood transfusion/donation (AOR: 2.18: 1.18-3.99). Compared to patients who had not initiated highly active antiretroviral therapy (HAART), those who had initiated HAART were more likely to have a long interval of time between infection confirmation and AIDS-related death. CONCLUSIONS The effective reduction of AIDS mortality could be improved through timely treatment.
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Affiliation(s)
- Hui Zheng
- />Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166 China
| | - Lu Wang
- />National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Huang
- />Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166 China
| | - Jessie Norris
- />National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qing Wang
- />Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166 China
| | - Wei Guo
- />National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhihang Peng
- />Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166 China
| | - Rongbin Yu
- />Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166 China
| | - Ning Wang
- />National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Li L, Tian JH, Yang K, Zhang P, Jia WQ. Humanized PA14 (a monoclonal CCR5 antibody) for treatment of people with HIV infection. Cochrane Database Syst Rev 2014; 2014:CD008439. [PMID: 25063928 PMCID: PMC7173721 DOI: 10.1002/14651858.cd008439.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND PRO 140 (a humanized form of the PA14 antibody, a monoclonal CCR5 antibody) inhibits CCR5-tropic (R5) type 1 human immunodeficiency virus (HIV). This may be an effective new treatment with the potential to address the limitations of currently available therapies for HIV-infected patients. OBJECTIVES We aimed to assess the efficacy, safety, clinical disease progression and immunologic (CD4 count/percentage) and virologic (plasma HIV RNA viral load) markers of PRO 140 for HIV-infected patients in randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs). SEARCH METHODS We searched databases including The Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 4), MEDLINE (PubMed, January 1966 to April 2014), EMBASE (January 1978 to April 2014) and ISI Web of Knowledge (January 1966 to April 2014), online trials registries and other sources. We also screened the reference lists of related literature and eligible studies, and presentations from major HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) conferences. SELECTION CRITERIA We included RCTs and quasi-RCTs comparing PRO 140 with placebo or other antiretroviral drugs, or different doses of PRO 140 for individuals infected with HIV. DATA COLLECTION AND ANALYSIS Two reviewers (L Li and JH Tian) independently screened all retrieved citations and selected eligible studies. Two authors (P Zhang and WQ Jia) independently extracted data. Any disagreements when selecting studies and extracting data were adjudicated by the review mentor (KH Yang). We used Review Manager (RevMan) software for statistical analysis based on an intention-to-treat analysis. We examined heterogeneity using the Chi(2) statistic. We regarded I(2) estimates greater than 50% as moderate or high levels of heterogeneity. According to the level of heterogeneity, we used either a fixed or random-effects model.If significant heterogeneity existed and the reasons could not be found, we reported the results qualitatively. MAIN RESULTS We included three trials comparing PRO 140 with placebo in adult patients with HIV infection. Our review indicates that PRO 140 may offer significant dose-dependent HIV-1 RNA suppression with tolerable side effects. PRO 140 2 mg/kg, 5 mg/kg, 10 mg/kg, 162 mg weekly, 324 mg biweekly, and 324 mg weekly showed statistically significant differences in the changes of HIV-1 RNA levels. HIV-1 RNA levels were reduced by intravenous (IV) infusion of PRO 140 2 mg/kg or 5 mg/kg on day 10, 5 mg/kg or 10 mg/kg on day 12, 162 mg weekly, 324 mg biweekly, or 324 mg weekly on day 22. PRO 140 2 mg/kg, 5 mg/kg, 10 mg/kg, 162 mg weekly, 324 mg biweekly, and 324 mg weekly demonstrated greater antiviral response. PRO 140 324 mg weekly, 5 mg/kg, and 10 mg/kg showed more patients with ≦ 400 copies/mL HIV-1 RNA. Only PRO 140 5 mg/kg showed greater change in CD4(+) cell count on day eight. Headache, lymphadenopathy, diarrhoea, fatigue, hypertension, nasal congestion and pruritus were reported to be the most frequent adverse events. AUTHORS' CONCLUSIONS Limited evidence from three small trials suggests that PRO 140 might demonstrate potent, short-term, dose-dependent, highly significant antiviral activity. However, as the evidence is insufficient, recommendations cannot yet be made. Larger, longer-term, double-blind RCTs are required to provide conclusive evidence.
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Affiliation(s)
- Lun Li
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Jin Hui Tian
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - KeHu Yang
- Lanzhou UniversityKey Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu ProvinceNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Peng Zhang
- Nanyang Central HospitalNanyangHenanChina473000
| | - Wen Qin Jia
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
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