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d'Arminio Monforte A, Tavelli A, Di Biagio A, Sarmati L, Marchetti GC, Bai F, Cingolani A, Quiros Roldan E, Mussini C, Lichtner M, Vergori A, Piconi S, Orofino G, Fusco FM, Bandera A, Nozza S, Castagna A, Antinori A. Long-term outcomes of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy and as switch strategy in virologically suppressed persons with HIV: data from the ICONA cohort. J Antimicrob Chemother 2024; 79:1279-1288. [PMID: 38581349 DOI: 10.1093/jac/dkae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/06/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVES To assess the effectiveness of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) among people poorly represented in clinical trials and potentially at higher risk of suboptimal response to ART. METHODS Observational cohort study on persons with HIV (PWH) enrolled in ICONA who started BIC/FTC/TAF as initial therapy or as switching regimen while virologically suppressed. Primary endpoint was time to treatment failure (TF): new AIDS/death or virological failure (VF) or discontinuation for toxicity/failure. Secondary endpoints were time to treatment discontinuation for toxicity (TDT) and to VF. Groups of interest were those aged >50 years, female sex, and advanced HIV disease at first ART start. Probability of the events overall and according to groups and adjusted HR for every endpoint were calculated by Kaplan-Meier curves and Cox regression models. RESULTS Nine hundred and thirty-three ART-naive and 1655 ART-experienced PWH initiated BIC/FTC/TAF. Over a median follow-up of 69.8 weeks, 89 (9.6%) PWH at their first regimen experienced TF. PWH aged >50 years had 1.83-fold (95% CI: 1.19-2.83) higher risk of TF; PWH with advanced HIV disease had 2.21-fold (95% CI: 1.53-3.82) higher risk; there were no differences in TF according to sex.Over a median follow-up of 146.3 weeks, 109 (6.6%) out of 1655 switching PWH experienced TF; no differences were found in the risk of TF, TDT and VF according to groups of interest. CONCLUSIONS Overall, BIC/FTC/TAF is well tolerated and virologically effective in the real-world scenario for ART-naive and -experienced PWH. Older ART-naive PWH and those with advanced HIV disease may respond less well as the burden of diseases might compromise treatment efficacy.
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Affiliation(s)
| | | | - Antonio Di Biagio
- Department of Health Sciences IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Loredana Sarmati
- Department of Medicine of Systems, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Giulia C Marchetti
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Quiros Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, Infectious Diseases Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Piconi
- Infectious Diseases Unit, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonella Castagna
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Hadavandsiri F, Shafaati M, Mohammad Nejad S, Ebrahimzadeh Mousavi M, Najafi A, Mirzaei M, Narouee S, Akbarpour S. Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue. Sci Rep 2023; 13:12730. [PMID: 37543699 PMCID: PMC10404291 DOI: 10.1038/s41598-023-39828-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023] Open
Abstract
The present study evaluates the non-communicable disease (NCD) patterns and related risk factors among people living with HIV (PLWH) in Iran. This national cross-sectional survey study was conducted on 1173 confirmed PLWHs with a mean age of 35.35 (56.82 Over 50 years old, 33.90 Under 50 years old) admitted from 15 different provinces in the country. Logistic regression was used to analyze the association of factors with having at least one NCD comorbidity. From 1173 PLWH, 225(19.18%) participants experienced at least one NCD (15.20% and 38.69% among under- and over-50-year-old patients, respectively). The prevalence of heart disease, hypertension, diabetes, and sleep apnea among all patients was 1.59%, 2.05%, 1.55%, and 10.26%, respectively. The similar prevalence for each NCD among those over 50 years was 10.11%, 15.71%, 9.01%, 25.44%, and 1.01%, 1.12%, 1.04%, and 9.23% among those under 50 years, respectively. The odds of being at risk of at least one NCD stood higher in patients over 50 years (ORadj = 2.93, 95% CI 1.96-4.37), married (ORadj = 2.48, 95% CI 1.41-4.35), divorced or widowed (ORadj = 2.78, 95% CI 1.48-5.20), and obese (ORadj = 3.82, 95% CI 2.46-5.91). According to our findings regarding the prevalence of NCDs among patients under 50 years of age, we recommend that policymakers give greater consideration to this group in the screening and care programs for NCDs since adults and the elderly are both vulnerable to the risk factors for developing NCDs.
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Affiliation(s)
- Fatemeh Hadavandsiri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shafaati
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Science, Tehran, Iran.
- Department of Microbiology, Faculty Science, Jahrom Branch, Islamic Azad University, Jahrom, Iran.
| | - Safieh Mohammad Nejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical, Tehran, Iran
| | | | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirzaei
- Hamadan Health Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sakineh Narouee
- Department of Epidemiology, Kerman University Medical of Sciences, Kerman, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.
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Jiamsakul A, Gani Y, Avihingsanon A, Azwa I, Chaiwarith R, Khusuwan S, Ross J, Law M, Kiertiburanakul S. Brief Report: Mortality After Loss to Follow-Up-A Linkage Study of People Living With HIV in Thailand and Malaysia. J Acquir Immune Defic Syndr 2022; 91:290-295. [PMID: 35969472 PMCID: PMC9588686 DOI: 10.1097/qai.0000000000003067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/15/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Linkage studies have reported high rates of previously unascertained mortality among people living with HIV (PLHIV) who have been lost to follow-up (LTFU). We assessed survival outcomes among PLHIV who were LTFU in Thailand and Malaysia, through linkages to a national death registry or HIV database. METHODS Data linkages with the national death registry or national HIV database were conducted in 2020 on all PLHIV who met LTFU criteria while enrolled in care at participating HIV clinical sites. LTFU was defined as having no documented clinical contact in the previous year, excluding transfers and deaths. Survival time was analyzed using the Cox regression, stratified by site. RESULTS Data linkages were performed for 489 PLHIV who had been LTFU at sites in Malaysia (n = 2) and Thailand (n = 4). There were 151 (31%) deaths after being LTFU; the mortality rate was 4.89 per 100 person-years. Risk factors for mortality after being LTFU were older age [41-50 years: hazard ratio (HR) = 1.99, 95% confidence interval (CI): 1.08 to 3.68; and older than 50 years: HR = 4.93, 95% CI: 2.63 to 9.22; vs. age 30 years or younger]; receiving NRTI + PI (HR = 1.87, 95% CI: 1.22 to 2.85 vs. NRTI + NNRTI); positive hepatitis C antibody (HR = 2.25, 95% CI: 1.40 to 3.62); and having previous AIDS illness (HR = 1.45, 95% CI: 1.03 to 2.05). An improved survival was seen with a higher CD4 count (CD4 351-500 cells/µL: HR = 0.40, 95%CI: 0.21-0.76; and CD4 >500 cells/µL: HR = 0.43, 95%CI: 0.25-0.75; vs. CD4 ≤200 cells/µL). CONCLUSIONS Almost one-third of PLHIV who were LTFU in this cohort had died while out of care, emphasizing the importance of efforts to reengage PLHIV after they have been LTFU and ensure they have access to ongoing ART.
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Affiliation(s)
| | - Yasmin Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Iskandar Azwa
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Romanee Chaiwarith
- Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand
| | | | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, NSW, Australia
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Incidence, survival time and associated factors of virological failure among adult HIV/AIDS patients on first line antiretroviral therapy in St. Paul's Hospital Millennium Medical College-A retrospective cohort study. PLoS One 2022; 17:e0275204. [PMID: 36227886 PMCID: PMC9560068 DOI: 10.1371/journal.pone.0275204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/13/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Human Immune deficiency Virus or Acquired Immune deficiency Syndrome (HIV/AIDS) is a pandemic affecting millions around the world. The 2020 the Joint United Nations Programme on HIV/AIDS report stated that the estimated number of people living with HIV (PLHIV) is 38 million globally by 2019. Ethiopia is among HIV high burden countries in Africa. By 2021, PLHIV in Ethiopia is estimated to be 754, 256. Globally out of 25.4 million PLHIV on ART, 41% reported virally non-suppressed. According to UNAIDS, the estimated viral non-suppression in Ethiopia is about 27%. Methodology A hospital based retrospective cohort study was conducted among 323 patients who were enrolled to ART from July 2016 to December 2020. The medical records of study participants were selected using simple random sampling technique & data was collected using data extraction checklist. The collected data was entered and cleaned using SPSS V.25. Kaplan–Meier is used to estimate the cumulative hazard of virological failure at different time points. During bivariate analysis variables with p<0.25 were taken for Multivariate Cox regression analysis to assess predictors of virological failure & statistically significant association was declared at p<0.05 with 95% confidence interval. Result The overall incidence rate of virological failure was 1.75 per 1000 months of observations. The mean survival time of virological failure was 14.80 months. Disclosure of sero-status (AHR = 0.038, 95% CI: 0.008–018), poor adherence (AHR = 4.24, 95% CI: 1.04–16), having OIs (Opportunistic infections) (AHR = 4.59, 95% CI: 1.17–18) and use of cotrimoxazole (CPT) prophylaxis (AHR = 0.13, 95% CI: 0.026–0.68) have shown statistically significant association with virological failure. Conclusion The incidence of virological failure among patients on first line ART in St. Paul’s hospital is low. Disclosure of sero-status, poor adherence, having OIs and use of CPT prophylaxis were associated with virological failure. Therefore, a due attention needs to be given to these factors in order to minimize virological failure in patients on ART.
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Factors Influencing Survival Status of HIV/AIDS after HAART in Huzhou City, Eastern China. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:2787731. [PMID: 36249590 PMCID: PMC9560853 DOI: 10.1155/2022/2787731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
Background Highly active antiretroviral therapy (HAART) can effectively reduce the risk of death and opportunistic infections in patients with HIV/AIDS. The aim of this study was to analyse the survival status and its influencing factors in HIV/AIDS after HAART. Methods The data on patients' sociodemographic characteristics, treatment information, and follow-up results from the Information Management System of the Chinese Center for Disease Control and Prevention were obtained. Bivariate and stepwise multivariate Cox proportional hazards regression model analyses were performed. Results A total of 1812 participants were included in this study, of which 1716 were still alive (survival group) and 96 had died (death group). The results indicated that respondents who were elderly (HR = 1.053, 95% CI: 1.037–1.069, P < 0.01), who had heterosexual transmission (HR = 2.422, 95% CI: 1.314–4.465, P < 0.01) and whose current WHO clinical stage was stage III or IV (HR = 2.399, 95% CI: 1.215–4.735, P < 0.05) were more likely to have died; respondents whose baseline CD4+ T-lymphocyte count was equal to or more than 200 cells/μL (HR = 0.412, 95% CI: 0.275–0.616, P < 0.05) were unlikely to have died. Conclusions It is recommended that HAART be provided to HIV/AIDS patients at an early clinical stage and that the health services for HIV/AIDS patients after taking medicines be strengthened, which will help promote adherence to therapeutic regimens and improve quality of life.
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Azamar-Alonso A, Mbuagbaw L, Smaill F, Bautista-Arredondo SA, Costa AP, Tarride JE. Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study. Int J STD AIDS 2022; 33:363-373. [PMID: 35118929 PMCID: PMC8958557 DOI: 10.1177/09564624211067036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy. Methods A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation. Results We found a lower proportion of people with VF in 2014–2017 compared with 2008–2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48–0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014–2017, but not before. Conclusion This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014–2017, compared to 2008–2013 and the odds of VF were reduced.
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Affiliation(s)
- Amilcar Azamar-Alonso
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Gilead Sciences Inc., Foster City, CA, United States
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, Hamilton, ON, Canada
| | - Fiona Smaill
- ChB Department of Pathology and Molecular Medicine, Faculty of Health Sciences, 3710McMaster University, Hamilton, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada.,McMaster Chair in Health Technology Management Hamilton, Hamilton, ON, Canada
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Ortíz DW, Roberts-Sano O, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala. AIDS Res Ther 2021; 18:79. [PMID: 34706742 PMCID: PMC8554948 DOI: 10.1186/s12981-021-00400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
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Affiliation(s)
- Dean W Ortíz
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala.
| | - Olivia Roberts-Sano
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Hugo E Marroquin
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Katherine B Franco
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Johanna R Melendez
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Rodolfo Pinzón
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Ana J Samayoa
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
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Zhou Y, Yang Z, Liu M, Lu Y, Qin Y, He X, Zeng Y, Harypursat V, Chen Y. Independent Risk Factors for Deaths due to AIDS in Chongqing, China: Does Age Matter? Front Med (Lausanne) 2021; 7:586390. [PMID: 33681235 PMCID: PMC7925819 DOI: 10.3389/fmed.2020.586390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background: People living with HIV (PLWH) are aging worldwide, and different management strategies may be required for older and younger PLWH. However, demographic characteristics, illness distribution, mortality, and independent risk factors in the PLWH population in China are not yet fully understood, especially in patients aged 50 years or older. Methods: We conducted a retrospective analysis of 4445 HIV-positive Chinese inpatients in Chongqing, China. Results: The mortality rate in patients 50 years or older (the older group) was significantly higher than that in those under 50 years (the younger group) (p < 0.001). In the younger group, independent risk factors for death included: nadir CD4+ T-cell counts <200 cells/μL, not owning medical healthcare insurance, not being on cART, injection drug use, and having one of the following comorbidities: Pneumocystis pneumonia, cryptococcal meningitis, AIDS malignancy, non-AIDS malignancy, and kidney disease. In the older group, independent predictors of death included: being urban residents, nadir CD4+ T-cell counts <200 cells/μL, not being on cART, and having comorbidities such as Pneumocystis pneumonia, hepatitis C, talaromycosis, non-AIDS malignancy, and kidney disease. Conclusions: Demographic characteristics, illness distribution, mortality, and independent risk factors for death in HIV-positive patients differ between the older group and the younger group, indicating that a changing suite of medical and allied support services may be required the for management of older PLWH.
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Affiliation(s)
- Yihong Zhou
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Zhongping Yang
- National Key Laboratory for Infectious Diseases Prevention and Treatment With Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing, China
| | - Min Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yanqiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yuanyuan Qin
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiaoqing He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yanming Zeng
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
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Castilho JL, Kim A, Jenkins CA, Grinsztejn B, Gotuzzo E, Fink V, Padgett D, Belaunzaran‐Zamudio PF, Crabtree‐Ramírez B, Escuder MM, Souza RA, Tenore SB, Pimentel SR, Ikeda MLR, de Alencastro PR, Tupinanbas U, Brites C, Luz E, Netto J, Cortes CP, Grangeiro A, Shepherd BE, McGowan CC. Antiretroviral therapy and Kaposi's sarcoma trends and outcomes among adults with HIV in Latin America. J Int AIDS Soc 2021; 24:e25658. [PMID: 33405281 PMCID: PMC7787071 DOI: 10.1002/jia2.25658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). METHODS Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression. RESULTS Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation. CONCLUSIONS KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Ahra Kim
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | | | - Eduardo Gotuzzo
- Universidad Peruana Cayetano HerediaInstituto de Medicina Tropical Alexander von HumboldtLimaPeru
| | - Valeria Fink
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela UniversitarioTegucigalpaHonduras
| | - Pablo F Belaunzaran‐Zamudio
- Deparatmento de InfectologiaInstituto Nacional de Ciencias Médicas y NutriciónSalvador Zubirán. Mexico CityMexico
| | - Brenda Crabtree‐Ramírez
- Deparatmento de InfectologiaInstituto Nacional de Ciencias Médicas y NutriciónSalvador Zubirán. Mexico CityMexico
| | | | - Rosa Alencar Souza
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Simone B Tenore
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Sidnei R Pimentel
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Maria Letícia Rodrigues Ikeda
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
- University of Vale do Rio dos SinosSão LeopoldoBrazil
| | - Paulo R de Alencastro
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
| | - Unai Tupinanbas
- Medical SchoolFederal University of Minas GeraisBelo HorizonteBrazil
| | - Carlos Brites
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Estela Luz
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Juliana Netto
- Instituto Nacional de Infectiologia Evandro ChagasFiocruzBrazil
| | - Claudia P Cortes
- Fundaciòn Arriaran and University of Chile School of MedicineSantiagoChile
| | - Alexandre Grangeiro
- Department of Preventive MedicineUniversity of São Paulo School of MedicineSão PauloBrazil
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Catherine C McGowan
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
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10
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Okhai H, Tariq S, Burns F, Gilleece Y, Dhairyawan R, Hill T, Sabin CA. Associations of menopausal age with virological outcomes and engagement in care among women living with HIV in the UK. HIV Res Clin Pract 2020; 21:174-181. [PMID: 33287689 PMCID: PMC8654140 DOI: 10.1080/25787489.2020.1852817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Women ageing with HIV undergo sex-specific changes. There is limited evidence available with regards to how the menopause impacts HIV outcomes. Objective: To investigate whether menopausal age is associated with engagement-in-care (EIC), viral load (VL) suppression and rebound among women living with HIV. Methods: Women were grouped by age (<40, 40–50, >50 years), corresponding to pre-, peri- and post-menopausal stages. EIC, HIV VL suppression (VL < 50 copies/mL) within 12 months of antiretroviral therapy initiation and VL rebound (two consecutive VL > 50 copies/mL) after VL suppression were compared across age groups using logistic/Cox proportional hazards regression. Associations were compared to those seen in heterosexual men. Results: Six thousand four hundred and fifty-five (6455) eligible women (median age 36 [interquartile range: 29–42], 64.4% black African, 19.1% white) contributed 44,226 person-years (PYRS) of follow-up; 29,846, 10,980 and 3,399 PYRS in those aged <40, 40–50 and >50, respectively. Women were engaged-in-care for 79.5% of follow-up time, 3,344 (78.0%) experienced VL suppression and 739 (22.1%) VL rebound. After adjustment, women aged >50 years had lower EIC than those aged <40. Women aged 40–50 were more likely to have VL suppression and were less likely to experience VL rebound than those aged <40 years. Trends in heterosexual men were similar for EIC but with no evidence of a higher VL suppression rate in those aged 40–50 years (pint. 0< .0001) and a stronger protective association between older age and VL rebound (pint. 0< .0001). Conclusion: Our findings warrant further research into the potential impact of the menopause to support women and clinicians through HIV care.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections, University College London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Yvonne Gilleece
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | | - Teresa Hill
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections, University College London, UK
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11
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Bahemana E, Esber A, Dear N, Ganesan K, Parikh A, Reed D, Maganga L, Khamadi S, Mizinduko M, Lwilla A, Mkondoo D, Mwaisanga G, Somi N, Owouth J, Maswai J, Kiweewa F, Iroezindu M, Ake JA, Crowell TA, Valcour VG, Polyak CS. Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study. AIDS Res Ther 2020; 17:66. [PMID: 33183355 PMCID: PMC7664082 DOI: 10.1186/s12981-020-00323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). METHODS Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. RESULTS Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130-547 vs. 277cells/mm3, IQR: 132-437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). CONCLUSION This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.
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Affiliation(s)
- Emmanuel Bahemana
- HJF Medical Research International, Inc., Mbeya, Tanzania.
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kavitha Ganesan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ajay Parikh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Domonique Reed
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Samoel Khamadi
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Mucho Mizinduko
- Muhimbili University of Health and Allied Science-Dar-Es-Salaam, Dar-Es-Salaam, Tanzania
| | - Anange Lwilla
- HJF Medical Research International, Inc., Mbeya, Tanzania
| | - Dorothy Mkondoo
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Gwamaka Mwaisanga
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nancy Somi
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - John Owouth
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Kisumu, Kenya
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Kericho, Kenya
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Abuja, Nigeria
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
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12
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Immunological and Virological Responses in Older HIV-Infected Adults Receiving Antiretroviral Therapy: An Evidence-Based Meta-Analysis. J Acquir Immune Defic Syndr 2020; 83:323-333. [PMID: 31913990 DOI: 10.1097/qai.0000000000002266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Millions of people living with the HIV have received antiretroviral therapy (ART). Older adults make up a significant portion of these individuals; however, the immunological and virological responses to ART for older patients still need to be clarified. DESIGN Meta-analysis. METHODS In this article, we systematically reviewed research articles published between 2001 and 2018 that reported immunological and virological responses and AIDS-related mortality among HIV- infected adults (including individuals aged 50 years and older) receiving ART, using meta-analysis. ART efficiency was measured using 3 outcomes: (1) immunological response, (2) virological response, and (3) mortality. RESULTS We identified 4937 citations, and 40 studies were eventually selected to investigate ART efficiency in older HIV-infected patients, comprising more than 888,151 patients initiating ART. We report that older patients showed poor immunological responses, with CD4 counts and the restoration of CD4 counts after ART initiation being significantly lower than seen in younger patients. However, older patients exhibited better viral suppression rates (risk ratio: 1.04; 95% confidence intervals: 1.01 to 1.08) after 36 months following ART initiation. In addition, older adults had a higher risk of AIDS-related death (adjusted hazard ratio: 1.44, 95% confidence interval: 1.30 to 1.60). CONCLUSIONS Older age after ART initiation was associated with a poorer immunological response and a higher risk of mortality, suggesting the need to increase early diagnosis and treatment among older HIV patients.
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13
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Meshesha HM, Nigussie ZM, Asrat A, Mulatu K. Determinants of virological failure among adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia: a case-control study. BMJ Open 2020; 10:e036223. [PMID: 32713849 PMCID: PMC7383949 DOI: 10.1136/bmjopen-2019-036223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To identify determinants of virological failure among HIV-infected adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia, in 2019. METHODS An unmatched case-control study was conducted from April to May 2019. About 130 cases and 259 controls were selected by simple random sampling. Data were extracted from charts of patients using a structured checklist. Multiple logistic regression analysis was performed to identify possible factors. Hosmer-Lemeshow goodness of fit test was used to check the model. Finally, independent predictor variables of virological failure were identified based on adjusted OR (AOR) with 95% CI and a p value of 0.05. RESULTS The odds of virological failure were 2.4-fold (AOR=2.44, 95% CI 1.353 to 4.411) higher in clients aged <35 years compared with older clients, fivefold (AOR=5.00, 95% CI 2.60 to 9.63) higher in clients who did not disclose their HIV status, threefold (AOR=2.99, 95% CI 1.33 to 6.73) higher in clients with poor adherence, and 7.5-fold (AOR=7.51, 95% CI 3.98 to 14.14) higher in clients who had recent CD4 count of ≤250 cells/mm3. CONCLUSION AND RECOMMENDATION This study revealed that age, marital status, occupation, disclosure status, baseline functional status, missed clinic visit, current antiretroviral therapy regimen, adherence to treatment and recent CD4 count were significantly associated with virological failure. Therefore, adherence support should be strengthened among clients. Missed clinic visits should also be reduced, as it could help clients better adhere to treatment, and therefore boost their immunity and suppress viral replication.
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Affiliation(s)
- Habtamu Mengist Meshesha
- Ethiopian Field Epidemiology Training Program, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Zelalem Mehari Nigussie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
| | - Anemaw Asrat
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
| | - Kebadnew Mulatu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
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14
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Belaunzaran-Zamudio PF, Caro-Vega Y, Giganti MJ, Castilho JL, Crabtree-Ramirez BE, Shepherd BE, Mejía F, Cesar C, Moreira RC, Wolff M, Pape JW, Padgett D, McGowan CC, Sierra-Madero JG. Frequency of non-communicable diseases in people 50 years of age and older receiving HIV care in Latin America. PLoS One 2020; 15:e0233965. [PMID: 32555607 PMCID: PMC7299309 DOI: 10.1371/journal.pone.0233965] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/15/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A growing population of older adults with HIV will increase demands on HIV-related healthcare. Nearly a quarter of people receiving care for HIV in Latin America are currently 50 years or older, yet little is known about the frequency of comorbidities in this population. We estimated the prevalence and incidence of non-communicable diseases (NCDs) among people 50 years of age or older (≥50yo) receiving HIV care during 2000-2015 in six centers affiliated with the Caribbean, Central and South American network for HIV epidemiology (CCASAnet). METHODS We estimated the annual prevalence, and overall prevalence and incidence of cardiovascular diseases, diabetes, hypertension, dyslipidemia, psychiatric disorders, chronic liver and renal diseases, and non-AIDS-defining cancers, and multimorbidity (more than one NCD) of people ≥50yo receiving care for HIV. Analyses were performed according to age at enrollment into HIV care (<50yo and ≥50yo). RESULTS We included 3,415 patients ≥50yo, of whom 1,487(43%) were enrolled at age ≥50 years. The annual prevalence of NCDs increased from 32% to 68% and multimorbidity from 30% to 40% during 2000-2015. At the last registered visit, 53% of patients enrolled <50yo and 50% of those enrolled ≥50yo had at least one NCD. Most common NCDs at the last visit in each age-group at enrollment were dyslipidemia (36% in <50yo and 28% in ≥50yo), hypertension (17% and 18%), psychiatric disorders (15% and 10%), and diabetes (11% and 12%). CONCLUSIONS The prevalence of NCDs and multimorbidity in people ≥50 years receiving care for HIV in CCASAnet centers in Latin America increased substantially in the last 15 years. Our results make evident the need of planning for provision of complex, primary care for aging adults living with HIV.
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Affiliation(s)
- Pablo F. Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanink Caro-Vega
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mark J. Giganti
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jessica L. Castilho
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Brenda E. Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rodrigo C. Moreira
- Fundacão Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Marcelo Wolff
- Department of Infectious Diseases, Fundación Arriarán, Santiago de Chile, Chile
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | - Catherine C. McGowan
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Juan G. Sierra-Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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15
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Giganti MJ, Shepherd BE, Caro-Vega Y, Luz PM, Rebeiro PF, Maia M, Julmiste G, Cortes C, McGowan CC, Duda SN. The impact of data quality and source data verification on epidemiologic inference: a practical application using HIV observational data. BMC Public Health 2019; 19:1748. [PMID: 31888571 PMCID: PMC6937856 DOI: 10.1186/s12889-019-8105-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/17/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Data audits are often evaluated soon after completion, even though the identification of systematic issues may lead to additional data quality improvements in the future. In this study, we assess the impact of the entire data audit process on subsequent statistical analyses. METHODS We conducted on-site audits of datasets from nine international HIV care sites. Error rates were quantified for key demographic and clinical variables among a subset of records randomly selected for auditing. Based on audit results, some sites were tasked with targeted validation of high-error-rate variables resulting in a post-audit dataset. We estimated the times from antiretroviral therapy initiation until death and first AIDS-defining event using the pre-audit data, the audit data, and the post-audit data. RESULTS The overall discrepancy rate between pre-audit and audit data (n = 250) across all audited variables was 17.1%. The estimated probability of mortality and an AIDS-defining event over time was higher in the audited data relative to the pre-audit data. Among patients represented in both the post-audit and pre-audit cohorts (n = 18,999), AIDS and mortality estimates also were higher in the post-audit data. CONCLUSION Though some changes may have occurred independently, our findings suggest that improved data quality following the audit may impact epidemiological inferences.
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Affiliation(s)
| | | | - Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Marcelle Maia
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Claudia Cortes
- Fundación Arriarán, University of Chile School of Medicine, Santiago, Chile
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16
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Wu G, Zhou C, Zhang X, Zhang W, Lu R, Ouyang L, Xing H, Shao Y, Ruan Y, Qian HZ. Higher Risks of Virologic Failure and All-Cause Deaths Among Older People Living with HIV in Chongqing, China. AIDS Res Hum Retroviruses 2019; 35:1095-1102. [PMID: 31544479 PMCID: PMC6862950 DOI: 10.1089/aid.2019.0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Older people living with HIV (PLWH) may have delayed diagnosis and access to care and therefore have poorer disease outcomes. Little is known about HIV care and disease outcomes among older PLWH in China. This retrospective cohort study used data from all adult HIV/AIDS cases during 1988-2017 in Chongqing, China from two national databases. We compared demographic and behavioral profiles, HIV care, virologic suppression, and mortality between two age groups of 18-49 and ≥50 years. Multivariate logistic and cox regression analyses were used to calculate adjusted odds ratio (AOR) and adjusted hazard ratio (AHR) among older versus younger PLWH. Of 46,580 adult HIV/AIDS cases, 76.1% were men and 38.2% were 50 years of age or older. The proportion of older cases in men increased from 2.4% in 2002 to 51.8% in 2017, and in women from 3.3% to 57.9%. Older PLWH had a lower CD4 count than their younger counterparts at HIV diagnosis (median 323 vs. 391 cells/μL; p < .001). The average time from HIV diagnosis to initiation of antiretroviral therapy (ART) were 6.3 months among older and 12.8 months among younger PLWH (p < .001). Nearly one tenth (9.6%) had virologic failure within 12 months of ART initiation, and the odds of virologic failure among older PLWH was 80% higher [AOR 1.8; 95% confidence interval (CI), 1.1-3.0] than among younger ones after controlling for calendar year of initiating ART and other covariates. The mortality rate within 12 months of initiating ART was 9.8 deaths per 100 person years, and the risk of mortality among older PLWH was three times among younger ones (AHR, 3.1; 95% CI, 2.1-4.6). Older people represented an increasing proportion of new HIV/AIDS cases and were more likely to have virologic failure and mortality within 12 months of ART initiation.
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Affiliation(s)
- Guohui Wu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Chao Zhou
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Xiangjun Zhang
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada
| | - Wei Zhang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Rongrong Lu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Lin Ouyang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Han-Zhu Qian
- Shanghai Jiao Tong University-Yale Joint Center for Biostatistics and Data Science, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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