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Li J, Xie DD, Cui HL, Yue C, Wang QY, Luo C, Tian L, Sheng ZF. Trends in the burden and determinants of HIV in the Asia-Pacific region (1990-2019): An age-period-cohort analysis of the 2019 Global Burden of Disease Study. J Med Virol 2024; 96:e29724. [PMID: 38837426 DOI: 10.1002/jmv.29724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/12/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
Although the burden of the human immunodeficiency virus (HIV) in the Asia-Pacific region is increasingly severe, comprehensive evidence of the burden of HIV is scarce. We aimed to report the burden of HIV in people aged 15-79 years from 1990 to 2019 using data from the Global Burden of Disease Study (GBD) 2019. We analyzed rates of age-standardized disability-adjusted life years (ASDR), age-standardized mortality (ASMR), and age-standardized incidence (ASIR) in our age-period-cohort analysis by sociodemographic index (SDI). According to HIV reports in 2019 from 29 countries in the Asia-Pacific region, the low SDI group in Papua New Guinea had the highest ASDR, ASMR, and ASIR. From 1990 to 2019, the ASDR, ASIR, and ASMR of persons with acquired immune deficiency syndrome (AIDS) increased in 21 (72%) of the 29 countries in the Asia-Pacific region. During the same period, the disability-adjusted life years (DALYs) of AIDS patients in the low SDI group in the region grew the fastest, particularly in Nepal. The incidence of HIV among individuals aged 20-30 years in the low-middle SDI group was higher than that of those in the other age groups. In 2019, unsafe sex was the main cause of HIV-related ASDR in the region's 29 countries, followed by drug use. The severity of the burden of HIV/AIDS in the Asia-Pacific region is increasing, especially among low SDI groups. Specific public health policies should be formulated based on the socioeconomic development level of each country to alleviate the burden of HIV/AIDS.
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Affiliation(s)
- Jing Li
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dan-Dan Xie
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- School of Basic Medical Sciences and Life Sciences, Hainan Medical University, Haikou, Hainan, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Hao-Liang Cui
- School of Public Health, Peking University, Beijing, China
| | - Chun Yue
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin-Yi Wang
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chuo Luo
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lin Tian
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhi-Feng Sheng
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Araujo Chaveron L, Pham TTP, Nguyen BT, Tran TH, Le NTH, Pham TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Nguyen TA, Taieb F, Madec Y. Injecting drug use increases the risk of death in HIV patients on antiretroviral therapy in Vietnam. AIDS Care 2024; 36:631-640. [PMID: 37339000 DOI: 10.1080/09540121.2023.2224549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic remains a major public health issue worldwide. In Vietnam, the HIV epidemic is essentially driven by people who inject drugs (PWID). This study aims to compare mortality and loss to follow-up (LTFU) between PWID and other patients. From June 2017 to April 2018, HIV-infected adults were enrolled in a prospective cohort from time of ART initiation in six provinces of North Vietnam. The end date was July 2020. Mortality and LTFU were described using competing-risk survival models. Factors associated with mortality and with LTFU were identified using Cox models with a competing-risk approach. Of the 578 participants, 261 (45.2%) were PWID and almost exclusively male. 49 patients died, corresponding to a mortality rate (95% confidence interval (CI)) of 3.7 (2.8-4.9) per 100 person-months, and 79 were lost to follow-up, corresponding to a rate (95% CI) of 6.0 (4.8-7.4) per 100 person-months. PWID were at higher risk of death but not of LTFU. Overall, LTFU was high in both groups. Latecomers to clinical visits were more at risk of both death and LTFU. Therefore, this should be a warning to clinical teams and preventive actions taken in these patients.Trial registration: ClinicalTrials.gov identifier: NCT03249493..
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Affiliation(s)
- Lucia Araujo Chaveron
- EHESP French School of Public Health, Paris, France
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
| | - Tram Thi Phuong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thang Hong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Ministry of Health, Vietnam Administration of HIV/AIDS Control (VAAC), Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
| | - Tuan Anh Nguyen
- HIV and AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
- Institut Pasteur, Department of international affairs, Université de Paris, Paris, France
| | - Yoann Madec
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
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Xiong Y, Mo P, Yan Y, Wang S, Zhuang K, Ma Z, Chen X, Deng L, Xiong Y, Deng D, Zhang Y. The safety and efficacy of PD-1 inhibitors in patients with advanced cancers and HIV/AIDS in China. Front Oncol 2023; 13:1248790. [PMID: 37799470 PMCID: PMC10547588 DOI: 10.3389/fonc.2023.1248790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose-Immunotherapy has revolutionized cancer therapy, becoming the standard of care for various malignancy treatments. Human immunodeficiency virus (HIV) patients, however, are an underserved group with limited access to clinical trials and cancer therapy. This study was to evaluate the safety and efficacy of programmed cell death 1 (PD - 1) inhibitors in patients with advanced cancer and HIV/acquired immunodeficiency syndrome (AIDS). Methods and Materials-We performed a prospective, open-label, nonrandomized, phase 1 single center study. Patients with advanced cancer and HIV/AIDS received the treatment of PD - 1 inhibitors (camrelizumab, 200 mg, administered intravenously every 3 weeks), along with combination antiretroviral therapy (cART) for HIV. Results-Sixteen participants (12 men and 4 women; median age, 46.5 (29 - 78) years) were enrolled; 1 had non - Hodgkin lymphoma (NHL), and 15 had non - AIDS - defining cancers. Safety was observed over 130 cycles of treatment with camrelizumab. Most treatment-emergent adverse events at least possibly attributed to camrelizumab were grade 1 or 2, including reactive cutaneous capillary endothelial proliferation (RCCEP) (9 participants), hearing loss (1 participant), hypophysitis (1 participant). 3 participants experienced hemorrhage due to poor performance status. HIV was controlled in all participants. Best tumor responses included 3 complete response, 5 partial response, 2 stable disease, and 6 progressive disease. The 2 years progression-free survival (PFS) was 67.0% (95% CI: -0.05, 0.00) and overall survival (OS) was 55.3% (95% CI: -0.05, 0.01) for the 16 patients who had received camrelizumab. Conclusions-This study demonstrates that camrelizumab treatment in patients with advanced cancers and HIV/AIDS was feasible and the clinical outcomes were acceptable.
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Affiliation(s)
- Yu Xiong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pingzheng Mo
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Centre of AIDS Prevention and Cure, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yajun Yan
- Centre of AIDS Prevention and Cure, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Zhuang
- ABSL-III Laboratory at the Center for Animal Experiment, Wuhan University, Wuhan, Hubei, China
| | - Zhiyong Ma
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoping Chen
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liping Deng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Di Deng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongxi Zhang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Centre of AIDS Prevention and Cure, Zhongnan Hospital of Wuhan University, Wuhan, China
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Önal U, Akalın H. Opportunistic Infections Among Human Immunodeficiency Virus (HIV) Infected Patients in Turkey: A Systematic Review. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:82-93. [PMID: 38633009 PMCID: PMC10986729 DOI: 10.36519/idcm.2023.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/19/2023] [Indexed: 04/19/2024]
Abstract
This study aimed to identify opportunistic infections among human immunodeficiency virus (HIV) infected patients in Turkey. Therefore, we conducted a systematic literature review of the studies published up to October 1, 2022, in the Pubmed, Web of Science (WoS), and ULAKBİM TR Dizin databases. We searched for medical subject headings (MeSH) terms of (HIV) OR (AIDS) OR (human immunodeficiency virus) AND (opportunistic infections) AND (Turkey). Fifty-five studies in Pubmed, 68 in WoS, and 212 in ULAKBİM TR Dizin were listed with these keywords. After removing duplicated studies, we included 22 original articles, two poster presentations, one short communication, one letter to the editor, and 17 case reports/series. Out of 1582 patients, we defined 788 patients (49.8%) as late presenters. In addition, we detected tuberculosis (286, 5.5%), candidal infections (207, 4%), and Pneumocystis jirovecii pneumonia (PCP) (113, 2.1%) as the most frequent opportunistic infections. According to our analysis, late presentation is a major problem in our country, and more screening and sensitization campaigns should be carried out to ensure early diagnosis and earlier care of patients.
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Affiliation(s)
- Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
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Dumchev K, Guo X, Ha TV, Djoerban Z, Zeziulin O, Go VF, Sarasvita R, Metzger DS, Latkin CA, Rose SM, Piwowar-Manning E, Richardson P, Hanscom B, Lancaster KE, Miller WC, Hoffman IF. Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial. BMC Infect Dis 2023; 23:319. [PMID: 37170118 PMCID: PMC10173611 DOI: 10.1186/s12879-023-08201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
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Affiliation(s)
- Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran Viet Ha
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zubairi Djoerban
- Depts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Oleksandr Zeziulin
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine
| | - Vivian F Go
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl A Latkin
- Dept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott M Rose
- Science Facilitation Department, Durham, North Carolina, FHI 360, USA
| | | | - Paul Richardson
- Dept. of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Dept. of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kategeaw W, Nakkam N, Kiertiburanakul S, Sukasem C, Tassaneeyakul W, Chaiyakunapruk N. Cost-effectiveness analysis of HLA-B*13:01 screening for the prevention of co-trimoxazole-induced severe cutaneous adverse reactions among HIV-infected patients in Thailand. J Med Econ 2023; 26:1330-1341. [PMID: 37830976 DOI: 10.1080/13696998.2023.2270868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
Studies found a strong association between HLA-B*13:01 allele and co-trimoxazole-induced severe cutaneous adverse reactions (SCARs). Genetic screening before initiation of co-trimoxazole may decrease the incidence of co-trimoxazole-induced SCARs. This study aims to evaluate the cost-effectiveness of HLA-B*13:01 screening before co-trimoxazole initiation in HIV-infected patients in Thailand. A combination of a decision tree model and a Markov model was used to estimate lifetime costs and outcomes of two strategies including 1) HLA-B*13:01 screening before co-trimoxazole initiation and 2) usual practice from a societal perspective. Alternative drugs are not considered because dapsone (the second-line drug) also presents a genetic risk. Input parameters were obtained from literature, government documents, and part of the TREAT Asia HIV Observational Database (TAHOD). One-way sensitivity analyses and probabilistic analyses were performed to determine robustness of the findings. HLA-B*13:01 screening resulted in 0.0061 quality-adjusted life years (QALYs) loss with an additional cost of 370 THB ($11.84). At the cost-effectiveness threshold of 160,000 THB ($5,112.85), the probability of the genetic screening strategy being cost-effective is 9.54%. This analysis demonstrated that HLA-B*13:01 allele screening before initiation of co-trimoxazole among HIV-infected patients is unlikely to be cost-effective in Thailand. Our findings will help policymakers make an evidence-informed decision making.
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Affiliation(s)
- Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nontaya Nakkam
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sasisopin Kiertiburanakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
- The Thai Severe Cutaneous Adverse Drug Reaction (THAI-SCAR) Research Group, Bangkok, Thailand
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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7
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Rupasinghe D, Choi JY, Yunihastuti E, Kiertiburanakul S, Ross J, Ly PS, Chaiwarith R, Do CD, Chan YJ, Kumarasamy N, Avihingsanon A, Kamarulzaman A, Khusuwan S, Zhang F, Lee MP, Van Nguyen K, Merati TP, Sangle S, Oon Tek NG, Tanuma J, Ditangco R, Sim BLH, Pujari S, Jiamsakul A. Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific. J Med Virol 2022; 94:5451-5464. [PMID: 35869413 PMCID: PMC9534455 DOI: 10.1002/jmv.28019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022]
Abstract
Liver disease is a growing burden among people living with HIV (PLHIV) in resource-limited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82-8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00-5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75-8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23-3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.
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Affiliation(s)
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | | | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | - NG Oon Tek
- Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
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Barré T, Sogni P, Zaegel-Faucher O, Wittkop L, Marcellin F, Carrieri P, Gervais A, Levier A, Rosenthal E, Salmon-Céron D, Protopopescu C. Cannabis Use as a Protective Factor Against Overweight in HIV-Hepatitis C Virus Co-Infected People (ANRS CO13 HEPAVIH Cohort). AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:272-290. [PMID: 35994579 DOI: 10.1521/aeap.2022.34.4.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Overweight is increasingly prevalent in people living with HIV (PLWH), and is a high risk factor for metabolic disorders in this population. PLWH co-infected with hepatitis C virus (HCV) have a higher risk of metabolic disorders than their mono-infected counterparts. The putative relationship between cannabis use and body weight found in the general population has never been documented in HIV-HCV co-infected people. We tested whether cannabis use is associated with body mass index (BMI), overweight, and underweight in HCV co-infected PLWH (N = 992). Mixed-effects linear and logistic regression models were used to study the association between cannabis use and the three outcomes over time. After multivariable adjustment, cannabis use was inversely associated with BMI. Cannabis use was associated with a lower and higher risk of overweight and underweight, respectively. Cannabis use should be assessed and taken into account in the clinical management of the HIV-HCV co-infected population.
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Affiliation(s)
- Tangui Barré
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Philippe Sogni
- Université Paris Descartes, Paris, France, INSERM U1223, Institut Pasteur, Paris, France, and Service d'Hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, France
| | - Olivia Zaegel-Faucher
- Clinical Immuno-Hematology Department, Aix-Marseille University, and Sainte-Marguerite University Hospital, Marseille, France
| | - Linda Wittkop
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Université de Bordeaux, Bordeaux, France, and Service D'information Médicale, CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Fabienne Marcellin
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Patrizia Carrieri
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Axel Levier
- ANRS I Emerging Infectious Diseases, Department of Clinical Research, Paris, France
| | - Eric Rosenthal
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
- ANRS I Emerging Infectious Diseases, Department of Clinical Research, Paris, France
- Université Côte d'Azur, Nice, France
| | - Dominique Salmon-Céron
- Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France, and Université Paris Descartes, Paris, France
| | - Camelia Protopopescu
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
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9
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Kim JH, Jiamsakul A, Kiertiburanakul S, Huy BV, Khusuwan S, Kumarasamy N, Ng OT, Ly PS, Lee MP, Chan YJ, Gani YM, Azwa I, Avihingsanon A, Merati TP, Pujari S, Chaiwarith R, Zhang F, Tanuma J, Do CD, Ditangco R, Yunihastuti E, Ross J, Choi JY. Patterns and prognosis of holding regimens for people living with HIV in Asian countries. PLoS One 2022; 17:e0264157. [PMID: 35353840 PMCID: PMC8967045 DOI: 10.1371/journal.pone.0264157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/04/2022] [Indexed: 01/11/2023] Open
Abstract
The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - Oon Tek Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Man-Po Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tuti Parwati Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Denpasar, Bali, Indonesia
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jeremy Ross
- TREAT Asia, amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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10
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Yamamoto N, Koizumi Y, Tsuzuki S, Ejima K, Takano M, Iwami S, Mizushima D, Oka S. Evaluating the cost-effectiveness of a pre-exposure prophylaxis program for HIV prevention for men who have sex with men in Japan. Sci Rep 2022; 12:3088. [PMID: 35197543 PMCID: PMC8866502 DOI: 10.1038/s41598-022-07116-4] [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: 05/08/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
Men who have sex with men (MSM) have been disproportionally affected by the HIV epidemic in many countries, including Japan. Although pre-exposure prophylaxis (PrEP) is a strong prevention tool, it is not yet approved in Japan. A Markov model was developed to describe HIV infection and disease progression in an MSM cohort (N = 1000) in Japan receiving a PrEP program. The model was used to evaluate the cost-effectiveness of a PrEP program. HIV/AIDS treatment, screening, hospitalization due to AIDS, and PrEP were considered as costs and quality-adjusted life-years (QALYs) gained as utilities. Cost-effectiveness was assessed by comparing the incremental cost-effectiveness ratio (ICER) over a 30-year period against the willingness to pay (WTP) threshold. One-way sensitivity and probabilistic sensitivity analyses were performed. With 50% PrEP coverage, the PrEP program became dominant against the program without PrEP, using a threshold of 5.0 million JPY/QALY (45,455 USD). The probabilistic sensitivity analysis revealed that the PrEP program was dominant or at least cost-effective in most cases of 10,000 simulations. Therefore, preparing cheaper PrEP pills, which results in PrEP being dominant or ICER being lower than the WTP threshold, is important to make the program cost-effective. Introduction of PrEP to an MSM cohort in Japan would be cost-effective over a 30-year time horizon.
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Affiliation(s)
- Nao Yamamoto
- School of Human Evolution and Social Change, Arizona State University, Tempe, USA
| | - Yoshiki Koizumi
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan
| | - Shinya Tsuzuki
- National Center for Global Health and Medicine AMR Clinical Reference Center, Tokyo, Japan.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, USA
| | - Misao Takano
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan
| | - Shingo Iwami
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan. .,MIRAI, JST, Saitama, Japan. .,Nstitute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan. .,NEXT-Ganken Program, Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan. .,Science Groove Inc., Fukuoka, Japan.
| | - Daisuke Mizushima
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan.
| | - Shinichi Oka
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan.
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11
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Choi JY, Lui GCY, Liao CT, Yang CJ. Managing cardiovascular risk in people living with HIV in Asia - where are we now? HIV Med 2021; 23:111-120. [PMID: 34494350 DOI: 10.1111/hiv.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
As the life expectancy of people living with HIV (PLWH) approaches that of the general population, the burden of comorbidities such as cardiovascular disease (CVD) is increasing. Regardless of HIV status, about 50% of CVD deaths worldwide occur in Asia, and Asian PLWH have a high prevalence of conventional CVD risk factors, such as smoking, dyslipidaemia, hypertension and insulin resistance or diabetes. As well as conventional CVD risk factors, PLWH have HIV-specific risk factors such as chronic inflammation, immune activation and endothelial damage, as well as risk factors related to antiretroviral therapy. This review describes the current knowledge on the epidemiology and risk factors of CVD in Asian PLWH and provides an Asian perspective on the recommendations for managing CVD risk in PLWH.
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Affiliation(s)
- Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Grace Chung Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Centre, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chia-Jui Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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12
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Kim JH, Noh J, Kim W, Seong H, Kim JH, Lee WJ, Baek Y, Hyun J, Sohn Y, Cho Y, Kim MH, Ahn S, Lee Y, Ahn JY, Jeong SJ, Ku NS, Yeom JS, Kim C, Choi JY. Trends of age-related non-communicable diseases in people living with HIV and comparison with uninfected controls: A nationwide population-based study in South Korea. HIV Med 2021; 22:824-833. [PMID: 34263511 DOI: 10.1111/hiv.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We aim to compare the trends of non-communicable diseases (NCDs) and death among people living with HIV (PLWH) and uninfected controls in South Korea. METHODS We identified PLWH from a nationwide database of all Korean citizens enrolled from 1 January 2004 to 31 December 2016. A control cohort was randomly selected for PLWH by frequency matching for age and sex in a 20:1 ratio. To compare NCD trends between the groups, adjusted incidence rate ratios for outcomes across ages, calendar years and times after HIV diagnosis were calculated. RESULTS We included 14 134 PLWH and 282 039 controls in this study; 58.5% of PLWH and 36.4% of the controls were diagnosed with at least one NCD. The incidence rates of cancers, chronic kidney disease, depression, osteoporosis, diabetes and dyslipidaemia were higher in PLWH than in the controls, whereas those of cardiovascular disease, heart failure, ischaemic stroke and hypertension were lower in PLWH. Relative risks (RRs) for NCDs in PLWH were higher than controls in younger age groups. Trends in the RRs of NCDs tended to increase with the calendar year for PLWH vs. controls and either stabilized or decreased with time after HIV diagnosis. The RR of death from PLWH has decreased with the calendar year, but showed a tendency to rise again after 2014 and was significant at the early stage of HIV diagnosis. CONCLUSIONS Although the RR of each NCD in PLWH showed variable trends compared with that in controls, NCDs in PLWH have been increasingly prevalent.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Juhwan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Woojin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Seong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Hyoung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Woon Ji Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - YaeJee Baek
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - JongHoon Hyun
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yujin Sohn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yunsuk Cho
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Moo Hyun Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - SangMin Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yongseop Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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13
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Han WM, Jiamsakul A, Salleh NAM, Choi JY, Huy BV, Yunihastuti E, Do CD, Merati TP, Gani YM, Kiertiburanakul S, Zhang F, Chan YJ, Lee MP, Chaiwarith R, Ng OT, Khusuwan S, Ditangco R, Kumarasamy N, Sangle S, Ross J, Avihingsanon A. HIV treatment outcomes among people who acquired HIV via injecting drug use in the Asia-Pacific region: a longitudinal cohort study. J Int AIDS Soc 2021; 24:e25736. [PMID: 34021711 PMCID: PMC8140190 DOI: 10.1002/jia2.25736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Data on HIV treatment outcomes in people who inject drugs (PWID) in the Asia‐Pacific are sparse despite the high burden of drug use. We assessed immunological and virological responses, AIDS‐defining events and mortality among PWID receiving antiretroviral therapy (ART). METHODS We investigated HIV treatment outcomes among people who acquired HIV via injecting drug use in the TREAT Asia HIV Observational Database (TAHOD) between January 2003 and March 2019. Trends in CD4 count and viral suppression (VS, HIV viral load <1000 copies/mL) were assessed. Factors associated with mean CD4 changes were analysed using repeated measures linear regression, and combined AIDS event and mortality were analysed using survival analysis. RESULTS Of 622 PWID from 12 countries in the Asia‐Pacific, 93% were male and the median age at ART initiation was 31 years (IQR, 28 to 34). The median pre‐ART CD4 count was 71 cells/µL. CD4 counts increased over time, with a mean difference of 401 (95% CI, 372 to 457) cells/µL at year‐10 (n = 78). Higher follow‐up HIV viral load and pre‐ART CD4 counts were associated with smaller increases in CD4 counts. Among 361 PWID with ≥1 viral load after six months on ART, proportions with VS were 82%, 88% and 93% at 2‐, 5‐ and 10‐years following ART initiation. There were 52 new AIDS‐defining events and 50 deaths during 3347 person‐years of follow‐up (PYS) (incidence 3.05/100 PYS, 95% CI, 2.51 to 3.70). Previous AIDS or TB diagnosis, lower current CD4 count and adherence <95% were associated with combined new AIDS‐defining event and death. CONCLUSIONS Despite improved outcomes over time, our findings highlight the need for rapid ART initiation and adherence support among PWID within Asian settings.
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Affiliation(s)
- Win Min Han
- Kirby Institute, UNSW, Sydney, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Tuti P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Man-Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | | | - Oon Tek Ng
- Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | | | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - Shashikala Sangle
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Tiarukkitsagul J, Sungkanuparph S. Assessment of atherosclerotic cardiovascular disease risks between people living with HIV receiving first-line and second-line antiretroviral therapy in a resource-limited setting. Int J STD AIDS 2021; 32:421-426. [PMID: 33533302 DOI: 10.1177/0956462420972855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease has become an important health problem in people living with HIV (PLHIV) who receive antiretroviral therapy (ART). Atherosclerotic cardiovascular disease (ASCVD) risk score is a non-invasive tool to estimate the 10-year risk for ASCVD. A cross-sectional study was conducted among PLHIV receiving ART in a resource-limited setting, in order to assess the 10-year ASCVD risk between PLHIV receiving first-line and second-line ART. Of 460 participants with a mean age of 51.2 years, 262 (57.0%) were men. The mean duration of HIV infection was 14.7 years and the mean CD4 cell count was 509 cells/μL. Of all, 345 participants were receiving first-line ART and 115 were receiving second-line ART. The median 10-year ASCVD risk was 3.0% and 5.1% in the first-line and second-line ART groups, respectively (p = 0.029). The prevalence of a high 10-year ASCVD risk (≥20%) was significantly higher in the second-line ART group (3.5% vs 0.9%, p = 0.048). In multivariate analysis, receiving second-line ART was significantly associated with intermediate to high 10-year ASCVD risk (OR = 2.952; 95% CI, 1.656-6.997; p = 0.015). Atherosclerotic cardiovascular disease risk should be assessed in PLHIV, particularly those who receive second-line ART.
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Affiliation(s)
- Jaruwan Tiarukkitsagul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, 549260Mahidol University, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, 549260Mahidol University, Samut Prakan, Thailand
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15
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Murugavel KG, Thakar M, Mehendale S. Recent HIV infection testing algorithms. Indian J Med Res 2020; 152:181-183. [PMID: 33107480 PMCID: PMC7881816 DOI: 10.4103/ijmr.ijmr_2576_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- K G Murugavel
- Division of Immunology, YRG CARE, Chennai 600 113, Tamil Nadu, India
| | - Madhuri Thakar
- Department of Immunology & Serology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Sanjay Mehendale
- Director Research, P.D. Hinduja National Hospital & Medical Research Center, Mumbai, 400 016, Maharashtra, India
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16
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Kim YC, Ahn JY, Kim HY, Song JY, Park DW, Kim MJ, Choi HJ, Kim SW, Kee MK, Han MG, Yoo M, Kim SM, Choi Y, Choi BY, Kim SI, Choi JY. Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015. Yonsei Med J 2020; 61:705-711. [PMID: 32734734 PMCID: PMC7393295 DOI: 10.3349/ymj.2020.61.8.705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. MATERIALS AND METHODS Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation. RESULTS Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5-303] in 2001-2003 to 273 (IQR, 108-399) in 2013-2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per 1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35-5.84] and low CD4 counts (<100 cells/mm³: adjusted hazard ratio, 2.99; 95% CI, 1.44-6.23) were significant risk factors for mortality. CONCLUSION Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.
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Affiliation(s)
- Yong Chan Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mee Kyung Kee
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myung Guk Han
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myeongsu Yoo
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Yunsu Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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17
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Determining standardized causes of death of infants, children, and adolescents living with HIV in Asia. AIDS 2020; 34:1527-1537. [PMID: 32443064 DOI: 10.1097/qad.0000000000002583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To implement a standardized cause of death reporting and review process to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents. DESIGN Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study. METHODS Children under routine HIV care at sites in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam between 2008 and 2017 were followed. Causes of death were reported and then independently and centrally reviewed. Predictors were compared using competing risks survival regression analyses. RESULTS Among 5918 children, 5523 (93%; 52% male) had ever been on combination antiretroviral therapy. Of 371 (6.3%) deaths, 312 (84%) occurred in those with a history of combination antiretroviral therapy (crude all-cause mortality 9.6 per 1000 person-years; total follow-up time 32 361 person-years). In this group, median age at death was 7.0 (2.9-13) years; median CD4 cell count was 73 (16-325) cells/μl. The most common underlying causes of death were pneumonia due to unspecified pathogens (17%), tuberculosis (16%), sepsis (8.0%), and AIDS (6.7%); 12% of causes were unknown. These clinical diagnoses were further grouped into AIDS-related infections (22%) and noninfections (5.8%), and non-AIDS-related infections (47%) and noninfections (11%); with 12% unknown, 2.2% not reviewed. Higher CD4 cell count and better weight-for-age z-score were protective against death. CONCLUSION Our standardized cause of death assessment provides robust data to inform regional resource allocation for pediatric diagnostic evaluations and prioritization of clinical interventions, and highlight the continued importance of opportunistic and nonopportunistic infections as causes of death in our cohort.
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Bijker R, Kiertiburanakul S, Kumarasamy N, Pujari S, Sun LP, Ng OT, Lee MP, Choi JY, Nguyen KV, Chan YJ, Merati TP, Cuong DD, Ross J, Jiamsakul A. Survival after long-term ART exposure: findings from an Asian patient population retained in care beyond 5 years on ART. Antivir Ther 2020; 25:131-142. [PMID: 32369040 DOI: 10.3851/imp3358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study investigated survival in people living with HIV being followed-up from 5 and 10 years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort. METHODS We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond 5 and 10 years on ART were analysed using competing risk regression with time-updated variables. RESULTS Of 13,495 patients retained after 5 years on ART, 279 subsequently died (0.56/100 person-years). Increased mortality was associated with age >50 years (sub-hazard ratio [sHR] 2.24, 95% CI 1.58, 3.15, compared with ≤40 years), HIV exposure through injecting drug use (sHR 2.17, 95% CI 1.32, 3.56), HIV viral load ≥1,000 copies/ml: sHR 1.52, 95% CI 1.05, 2.21, compared with <400), regimen (second-line regimen: sHR 2.11, 95% CI 1.52, 2.94, and third-line regimen: sHR 2.82, 95% CI 2.00, 3.98, compared with first-line regimen), HBV coinfection (sHR 2.23, 95% CI 1.49, 3.33), fasting plasma glucose ≥126 mg/dl (sHR 1.98, 95% CI 1.22, 3.21, compared with <100 mg/dl) and estimated glomerular filtration rate <60 ml/min/1.73 m2 (sHR 2.57, 95% CI 1.56, 4.22). Decreased mortality was associated with transmission through male-to-male sexual contact (sHR 0.44, 95% CI 0.22, 0.88, compared with heterosexual transmission) and higher CD4+ T-cell count (200-349 cells/µl: sHR 0.27, 95% CI 0.20, 0.38, 350-499 cells/µl: sHR 0.10, 95% CI 0.07, 0.16 and ≥500 cells/µl: sHR 0.09, 95% CI 0.06, 0.13, compared with <200 cells/µl). Results after 10 years were similar, but most associations were weaker due to limited power. CONCLUSIONS Next to preventing ART failure, HIV programmes should carefully monitor and treat comorbidities, including hepatitis, kidney disease and diabetes, to optimize survival after long-term ART exposure.
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Affiliation(s)
- Rimke Bijker
- The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | | | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Ly P Sun
- National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia
| | - Oon T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Man P Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Jun Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kinh V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Yu J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tuti P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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Puronen CE, Ford ES, Uldrick TS. Immunotherapy in People With HIV and Cancer. Front Immunol 2019; 10:2060. [PMID: 31555284 PMCID: PMC6722204 DOI: 10.3389/fimmu.2019.02060] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
HIV infection alters the natural history of several cancers, in large part due to its effect on the immune system. Immune function in people living with HIV may vary from normal to highly dysfunctional and is largely dependent on the timing of initiation (and continuation) of effective antiretroviral therapy (ART). An individual's level of immune function in turn affects their cancer risk, management, and outcomes. HIV-associated lymphocytopenia and immune dysregulation permit immune evasion of oncogenic viruses and premalignant lesions and are associated with inferior outcomes in people with established cancers. Various types of immunotherapy, including monoclonal antibodies, interferon, cytokines, immunomodulatory drugs, allogeneic hematopoietic stem cell transplant, and most importantly ART have shown efficacy in HIV-related cancer. Emerging data suggest that checkpoint inhibitors targeting the PD-1/PD-L1 pathway can be safe and effective in people with HIV and cancer. Furthermore, some cancer immunotherapies may also affect HIV persistence by influencing HIV latency and HIV-specific immunity. Studying immunotherapy in people with HIV and cancer will advance clinical care of all people living with HIV and presents a unique opportunity to gain insight into mechanisms for HIV eradication.
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Affiliation(s)
- Camille E Puronen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Emily S Ford
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Thomas S Uldrick
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Global Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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