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Zhu M, Jia L, Wang Y, Zhang Y, Lv S. Comparative evaluation of adverse drug reactions for tenofovir alafenamide and tenofovir disoproxil fumarate using the FAERS Database: a disproportionality analysis. Expert Opin Drug Saf 2024:1-10. [PMID: 39129454 DOI: 10.1080/14740338.2024.2391496] [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: 04/02/2024] [Revised: 06/05/2024] [Accepted: 06/27/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are widely used nucleoside reverse transcriptase inhibitors (NRTIs), necessitating a thorough understanding of their safety profiles to ensure optimal patient care and treatment adherence. METHODS We employed statistical methods including the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-Item Gamma Poisson Shrinker (MGPS) to compare and evaluate the safety profiles of these NRTIs. RESULTS TAF was significantly associated with weight increase (ROR: 6.43; 95% CI: 5.93-6.96) and specific psychiatric disorders. TDF showed a notable signal for renal disorders and product-related issues, including product dose omission (ROR: 3.53; 95% CI: 3.22-3.87). Additionally, the study highlighted differences in safety signals related to pregnancy outcomes, with TAF having a higher ROR for maternal exposure (ROR: 7.83; 95% CI: 7.06-8.69) and TDF for fetal exposure (ROR: 4.51; 95% CI: 3.93-5.18), underscoring the need for cautious use in pregnant women. The comparative analysis also identified signals for osteonecrosis (ROR: 108.81; 95% CI: 106.25-111.43) and bone loss (ROR: 714; 95% CI: 685.49-743.68) for TAF and TDF, respectively, highlighting the importance of bone health considerations in treatment plans. CONCLUSION These findings underscore the importance of personalized antiviral therapy and patient safety.
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Affiliation(s)
- Meng Zhu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lingjuan Jia
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yike Wang
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yongsheng Zhang
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shengxia Lv
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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2
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Chandiwana NC, Siedner MJ, Marconi VC, Hill A, Ali MK, Batterham RL, Venter WDF. Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications. J Clin Endocrinol Metab 2024; 109:e478-e487. [PMID: 37437159 PMCID: PMC10795932 DOI: 10.1210/clinem/dgad411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
Rapid advances in the potency, safety, and availability of modern HIV antiretroviral therapy (ART) have yielded a near-normal life expectancy for most people living with HIV (PLWH). Ironically, considering the history of HIV/AIDS (initially called "slim disease" because of associated weight loss), the latest dilemma faced by many people starting HIV therapy is weight gain and obesity, particularly Black people, women, and those who commenced treatment with advanced immunodeficiency. We review the pathophysiology and implications of weight gain among PLWH on ART and discuss why this phenomenon was recognized only recently, despite the availability of effective therapy for nearly 30 years. We comprehensively explore the theories of the causes, from initial speculation that weight gain was simply a return to health for people recovering from wasting to comparative effects of newer regimens vs prior toxic agents, to direct effects of agents on mitochondrial function. We then discuss the implications of weight gain on modern ART, particularly concomitant effects on lipids, glucose metabolism, and inflammatory markers. Finally, we discuss intervention options for PLWH and obesity, from the limitations of switching ART regimens or specific agents within regimens, weight-gain mitigation strategies, and potential hope in access to emerging antiobesity agents, which are yet to be evaluated in this population.
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Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Vincent C Marconi
- Division of Infectious Diseases and Department of Global Health, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 4223, USA
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 7BE, UK
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 4223, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | | | - Willem Daniel Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Department of Public Health Medicine, Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa
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3
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Mengistu ST, Yohannes A, Issaias H, Mesfn M, Zerufael S, Dirar A, Teklemariam HM, Ghebremeskel GG, Achila OO, Basha S. Antiretroviral therapy regimen modification rates and associated factors in a cohort of HIV/AIDS patients in Asmara, Eritrea: a 16-year retrospective analysis. Sci Rep 2023; 13:4183. [PMID: 36918596 PMCID: PMC10015006 DOI: 10.1038/s41598-023-30804-8] [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: 10/09/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
Combined antiretroviral therapy (cART) durability and time to modification are important quality indicators in HIV/AIDs treatment programs. This analysis describes the incidence, patterns, and factors associated with cART modifications in HIV patients enrolled in four treatment centers in Asmara, Eritrea from 2005 to 2021. Retrospective cohort study combining data from 5020 [males, 1943 (38.7%) vs. females, 3077 (61.3%)] patients were utilized. Data on multiple demographic and clinical variables were abstracted from patient's charts and cART program registry. Independent predictors of modification and time to specified events were evaluated using a multi-variable Cox-proportional hazards model and Kaplan-Meier analysis. The median (±IQR) age, CD4+ T-cell count, and proportion of patients with WHO Clinical stage III/IV were 48 (IQR 41-55) years; 160 (IQR 80-271) cells/µL; and 2667 (53.25%), respectively. The cumulative frequency of all cause cART modification was 3223 (64%): 2956 (58.8%) substitutions; 37 (0.7%) switches; and both, 230 (4.5%). Following 241,194 person-months (PMFU) of follow-up, incidence rate of cART substitution and switch were 12.3 (95% CI 11.9-12.8) per 1000 PMFU and 3.9 (95% CI 3.2-4.8) per 10,000 PMFU, respectively. Prominent reasons for cART substitution included toxicity/intolerance, drug-shortage, new drug availability, treatment failure, tuberculosis and pregnancy. The most common adverse event (AEs) associated with cART modification included lipodystrophy, anemia and peripheral neuropathy, among others. In the adjusted multivariate Cox regression model, Organisation (Hospital B: aHR = 1.293, 95% CI 1.162-1.439, p value < 0.001) (Hospital D: aHR = 1.799, 95% CI 1.571-2.060, p value < 0.001); Initial WHO clinical stage (Stage III: aHR = 1.116, 95% CI 1.116-1.220, p value < 0.001); NRTI backbone (D4T-based: aHR = 1.849, 95% CI 1.449-2.360, p value < 0.001) were associated with increased cumulative hazard of treatment modification. Baseline weight (aHR = 0.996, 95% CI 0.993-0.999, p value = 0.013); address within Maekel (aHR = 0.854, 95% CI 0.774-0.942, p value = 0.002); AZT-based backbones (aHR = 0.654, 95% CI 0.515-0.830, p value < 0.001); TDF-based backbones: aHR = 0.068, 95% CI 0.051-0.091, p value < 0.001), NVP-based anchors (aHR = 0.889, 95% CI 0.806-0.980, p value = 0.018) were associated with lower cumulative hazards of attrition. The minimal number of switching suggests inadequate VL testing. However, the large number of toxicity/intolerance and drug-shortage driven substitutions highlight important problems in this setting. Consequently, the need to advocate for both sustainable access to safer ARVs in SSA and improvements in local supply chains is warranted.
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Affiliation(s)
| | - Arsema Yohannes
- Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Hermon Issaias
- Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Mical Mesfn
- Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Simon Zerufael
- Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Aman Dirar
- Eritrean National Institute of Higher Education and Research, Mai-Nefhi College of Sciences, Mai-Nefhi, Eritrea
| | | | | | - Oliver Okoth Achila
- Unit of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Saleem Basha
- Unit of Allied Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
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4
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Munsami L, Schutte CM, de Villiers M, Hiesgen J. Late-onset efavirenz toxicity: A descriptive study from Pretoria, South Africa. South Afr J HIV Med 2023; 24:1439. [PMID: 36751478 PMCID: PMC9900310 DOI: 10.4102/sajhivmed.v24i1.1439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023] Open
Abstract
Background The neuropsychiatric side effects of efavirenz occur mainly early during treatment and are usually mild. A lesser-known and serious complication is late-onset efavirenz toxicity causing ataxia and encephalopathy. Data regarding this condition are limited. Objectives We describe the clinical picture of late-onset efavirenz toxicity, investigate co-morbidities and report outcomes. Method This descriptive study of all patients with late-onset efavirenz toxicity was conducted over three years at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa. Results Forty consecutive patients were identified. Mean age was 42.1 years, three patients (7.5%) were male and the mean efavirenz level was 49.0 μg/mL (standard deviation [s.d.]: 24.8). Cerebellar ataxia (82.5%) and encephalopathy (47.5%) were the most common presenting features (40.0% had both); four patients presented with psychosis. Presence of encephalopathy and/or cerebellar ataxia was associated with higher efavirenz levels compared with psychosis (52.1 μg/mL, s.d.: 24.1 vs 25.0 μg/mL, s.d.: 17.1). In most patients, symptoms resolved, but four patients (10.0%) died, and one patient remained ataxic. Conclusion Late-onset efavirenz toxicity typically presented with ataxia and encephalopathy, but psychosis can be the presenting feature. The outcome after withdrawal was good, but the mortality of 10.0% is concerning. Recent changes in guidelines favour dolutegravir, but many patients remain on efavirenz, and awareness of the condition is vital. What this study adds This large, single-centre study contributes to the limited data of HIV-positive patients with late-onset efavirenz toxicity and emphasises its ongoing relevance in clinical practice.
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Affiliation(s)
- Lyneshree Munsami
- Department of Neurology, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Clara M. Schutte
- Department of Neurology, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Maryke de Villiers
- Department of Internal Medicine, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Juliane Hiesgen
- Department of Neurology, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
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5
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Munsami L, Schutte CM, de Villiers M, Hiesgen J. Late-onset efavirenz toxicity: A descriptive study from Pretoria, South Africa. South Afr J HIV Med 2022. [DOI: 10.4102/sajhivmed.v23i1.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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6
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Chaparala S, Da Silva RC, Papadopoulos JP. Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide. Cureus 2021; 13:e19008. [PMID: 34824925 PMCID: PMC8610206 DOI: 10.7759/cureus.19008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/28/2022] Open
Abstract
A 46-year-old female with a history of generalized anxiety disorder was admitted after intentional ingestion of an unknown amount of emtricitabine/tenofovir alafenamide (Descovy®) in a suicidal attempt. Patient was emergently intubated secondary to severe agitation and inability to protect airways. Patient developed severe lactic acidosis early in the admission, secondary as to a possible mitochondrial toxicity. Failed attempts to fluid resuscitation with Lactate Ringer®, eventually warranted to start the patient on norepinephrine infusion. Metabolic acidosis remained refractory to bicarbonate bolus and infusion. Hypothermia and hypoglycemia were corrected. Despite the initial approach, the patient remained acidotic, and the nephrology was consulted for emergent continuous renal replacement therapy (CRRT). After three days of intensive care unit stay and CRRT, the patient improved and was successfully decannulated. Her metabolic profile also showed remarkable improvement and the metabolic lactic acidosis resolved. The previous formulation of tenofovir with disoproxil fumarate is associated with severe lactic acidosis due to inhibition of mammalian mitochondrial DNA polymerase. Risk factors include liver cirrhosis, chronic kidney disease, hepatitis B and C coinfection, and metformin use. The new pharmaceutical formulation of tenofovir with alafenamide (TAF) has caused a significant decrease in the incidence of lactic acidosis. However, its real incidence and the usual plasma level to induce toxicity and mitochondrial dysfunction are unknown. The aim of this report is to highlight the risk of severe lactic acidosis with the use of TAF.
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Affiliation(s)
| | - Rafael C Da Silva
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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7
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Airewele EA, Sunpath H, Moosa MYS, Gandhi RT. Importance of global communication to combat global pandemics: Lessons from the HIV Online Provider Education programme. South Afr J HIV Med 2021; 22:1281. [PMID: 34522431 PMCID: PMC8424751 DOI: 10.4102/sajhivmed.v22i1.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 11/02/2022] Open
Abstract
In many ways, the coronavirus disease 2019 (COVID-19) pandemic mirrors the challenges, lessons and opportunities of the HIV pandemic. In this article, we argue that global pandemics such as COVID-19 and HIV require a global response. We highlight the HIV Online Provider Education (HOPE) programme as an example of the importance of global communication when combating a pandemic. From both the COVID-19 and HIV pandemics, we have learned that to optimise health worldwide, it is necessary to have effective and efficient means of swiftly sharing experiences, expertise, best practices and guidelines. To prepare for the next public health emergency, clinicians and researchers must put in place and promote effective programmes for global communication.
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Affiliation(s)
- Efeose A Airewele
- Infectious Disease Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.,Harvard University Center for AIDS Research, Boston, Massachusetts, United States of America
| | - Henry Sunpath
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rajesh T Gandhi
- Infectious Disease Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.,Harvard University Center for AIDS Research, Boston, Massachusetts, United States of America
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8
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Negash H, Welay M, Legese H, Adhanom G, Mardu F, Tesfay K, Gebrewahd A, Berhe B. Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study. Infect Drug Resist 2020; 13:1863-1872. [PMID: 32606835 PMCID: PMC7308120 DOI: 10.2147/idr.s251619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In Ethiopia, despite the integrated implementation of antiretroviral therapy since 2005, the human immunodeficiency virus remains a public health concern. Managing and detecting antiretroviral treatment response is important to monitor the effectiveness of the therapy for individuals who experience failed virological response. An increased viral load indicating drug resistance or rapid progression of viral replication needs early detection. Hence, we aimed to assess the prevalence and determinants of virological response among human immunodeficiency virus-infected patients on highly active antiretroviral therapy. METHODS A hospital-based cross-sectional study was conducted in Adigrat General Hospital from September to December, 2019, on a total of 422 participants. An interviewer-based questionnaire was used for data collection. About 4 mL of venous blood was collected for viral load determination. Patient records were reviewed for the previous results of CD4+ T cell counts. STATA 14 software was used to analyze the data. Descriptive data were presented using tables and figures. Bivariate and multivariate analyses were performed. A p-value < 0.05 was considered a statistically significant association. RESULTS The mean age of study participants was 39 years (SD ±12.2 years), of which 66.7% of them were females. The overall prevalence of virological failure was 12.47% (49/393). Moreover, the prevalence of virological failure was observed to be higher among tuberculosis co-infected individuals (26%) compared with the mono-infected HIV patients (6.3%). The odds of virological failure were higher among obese and undernourished individuals, tuberculosis co-infected, and individuals with the failure of immune reconstitution. CONCLUSION There was a high rate of virological failure among the study participants. Tuberculosis infection increased the rate of failure. There should be consistent assessment of viral load testing to determine the status of virological response for appropriate drug switching to clients. HIV patients with virological failure are recommended for switching of the antiretroviral therapy.
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Affiliation(s)
- Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Miglas Welay
- Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Haftom Legese
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Gebre Adhanom
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Aderajew Gebrewahd
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
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9
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Abah IO, Ncube NBQ, Bradley HA, AgbaJi OO, Kanki P. Antiretroviral Therapy-associated Adverse Drug Reactions and their Effects on Virologic Failure- A Retrospective Cohort Study in Nigeria. Curr HIV Res 2019; 16:436-446. [PMID: 30767743 PMCID: PMC6446442 DOI: 10.2174/1389450120666190214144609] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/30/2023]
Abstract
Background: Adverse drug reactions (ADRs) associated with antiretroviral therapy (ART) can rapidly reverse the gains of ART resulting in poor health outcomes. We need an improved under-standing of specific ART-related ADRs that influence virologic outcomes. Objective: To investigate the frequency of clinical ADRs and assess their effect on virologic failure in patients on ART. Method: We described the prevalence of major clinical ADRs, and the association between specific ADRs and virologic failure in a clinic cohort of HIV-1 infected Nigerians aged ≥18 years, on first-line ART between June 2004 and February 2012. Multivariable logistic regression was run to identify predictors of virologic failure at 24 and 72 weeks of ART. Results: Data of 12,115 patients with a median age of 34 (interquartile range: 29-41) years, and pre-dominantly females (67%) were evaluated. Overall, 957 (7.9%) patients experienced at least one ADR during a median follow-up period of 4 years (interquartile range: 1-7). The three most prevalent ADRs were lipodystrophy (2.6%), anemia (1.9%), and skin rash (0.7%). Virologic failure rate was 36% and 34% at 24 and 72 weeks of ART, respectively. Anemia independently predicted the odds of virologic failure at 72 weeks of ART (adjusted odds ratio, 1.74; 95% CI: 1.2-2.51); adjusted for sex, age, pre-treatment CD4+ cell count, antiretroviral regimen, and medication refill adherence. Conclusion: Antiretroviral therapy-associated anemia increases the likelihood of late virologic failure. We recommend routine monitoring of hemoglobin levels and prompt management of anemia in all pa-tients on ART as a strategy to improve virologic success rates.
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Affiliation(s)
- Isaac O Abah
- School of Public Health, University of the Western Cape, Bellville, South Africa.,Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Hazel A Bradley
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Oche O AgbaJi
- Department of Medicine Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Phyllis Kanki
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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10
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Abstract
PURPOSE OF REVIEW Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. RECENT FINDINGS Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight. SUMMARY IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches.
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Affiliation(s)
- Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Phuti Choshi
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Rannakoe J. Lehloenya
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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11
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Indriati DW, Kotaki T, Khairunisa SQ, Witaningrum AM, Matondang MQY, Ueda S, Nasronudin, Purnama A, Kurniawan D, Kameoka M. Appearance of Drug Resistance Mutations Among the Dominant HIV-1 Subtype, CRF01_AE in Maumere, Indonesia. Curr HIV Res 2019; 16:158-166. [PMID: 29732988 DOI: 10.2174/1570162x16666180502114344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Human Immunodeficiency Virus (HIV) is still a major health issue in Indonesia. In recent years, the appearance of drug resistance-associated mutations has reduced the effectiveness of Antiretroviral Therapy (ART). We conducted genotypic studies, including the detection of drug resistance-associated mutations (from first-line regimen drugs), on HIV-1 genes derived from infected individuals in Maumere, West Nusa Tenggara. Maumere, a transit city in West Nusa Tenggara, which has a high HIV-1 transmission rate. METHOD We collected 60 peripheral blood samples from 53 ART-experienced and 7 ART-naive individuals at TC Hillers Hospital, Maumere between 2014 and 2015. The amplification and a sequencing analysis of pol genes encoding protease (the PR gene) and reverse transcriptase (the RT gene) as well as the viral env and gag genes were performed. HIV-1 subtyping and the detection of drug resistance-associated mutations were then conducted. RESULTS Among 60 samples, 46 PR, 31 RT, 30 env, and 20 gag genes were successfully sequenced. The dominant HIV-1 subtype circulating in Maumere was CRF01_AE. Subtype B and recombinant viruses containing gene fragments of CRF01_AE, subtypes A, B, C, and/or G were also identified as minor populations. The major drug resistance-associated mutations, M184V, K103N, Y188L, and M230I, were found in the RT genes. However, no major drug resistance-associated mutations were detected in the PR genes. CONCLUSION CRF01_AE was the major HIV-1 subtype prevalent in Maumere. The appearance of drug resistance-associated mutations found in the present study supports the necessity of monitoring the effectiveness of ART in Maumere.
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Affiliation(s)
- Dwi Wahyu Indriati
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Tomohiro Kotaki
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Siti Qamariyah Khairunisa
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Adiana Mutamsari Witaningrum
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Qushai Yunifiar Matondang
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Shuhei Ueda
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Nasronudin
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Masanori Kameoka
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan.,Center for Infectious Diseases, Kobe University, Graduate School of Medicine, Hyogo, Japan
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Brennan AT, Bor J, Davies MA, Wandeler G, Prozesky H, Fatti G, Wood R, Stinson K, Tanser F, Bärnighausen T, Boulle A, Sikazwe I, Zanolini A, Fox MP. Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia. Am J Epidemiol 2018; 187:1990-2001. [PMID: 29767681 DOI: 10.1093/aje/kwy093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/18/2018] [Indexed: 01/05/2023] Open
Abstract
Tenofovir is less toxic than other nucleoside reverse-transcriptase inhibitors used in antiretroviral therapy (ART) and may improve retention of human immunodeficiency virus (HIV)-infected patients on ART. We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir for first-line ART. We applied regression discontinuity in a prospective cohort study of 52,294 HIV-infected adults initiating first-line ART within 12 months (±12 months) of each guideline change. We compared outcomes in patients presenting just before and after the guideline changes using local linear regression and estimated intention-to-treat effects on initiation of tenofovir, retention in care, and other treatment outcomes at 24 months. We assessed complier causal effects among patients starting tenofovir. The new guidelines increased the percentages of patients initiating tenofovir in South Africa (risk difference (RD) = 81 percentage points, 95% confidence interval (CI): 73, 89) and Zambia (RD = 42 percentage points, 95% CI: 38, 45). With the guideline change, the percentage of single-drug substitutions decreased substantially in South Africa (RD = -15 percentage points, 95% CI: -18, -12). Starting tenofovir also reduced attrition in Zambia (intent-to-treat RD = -1.8% (95% CI: -3.5, -0.1); complier relative risk = 0.74) but not in South Africa (RD = -0.9% (95% CI: -5.9, 4.1); complier relative risk = 0.94). These results highlight the importance of reducing side effects for increasing retention in care, as well as the differences in population impact of policies with heterogeneous treatment effects implemented in different contexts.
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Affiliation(s)
- Alana T Brennan
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Jacob Bor
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hans Prozesky
- Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | | | - Robin Wood
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kathryn Stinson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Frank Tanser
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa
- Institute of Public Health, School of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Izukanji Sikazwe
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Arianna Zanolini
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Matthew P Fox
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
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Mekonnen E, Workicho A, Hussein N, Feyera T. Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia. BMC Res Notes 2018; 11:351. [PMID: 29871671 PMCID: PMC5989425 DOI: 10.1186/s13104-018-3470-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/01/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This retrospective cohort study is aimed to assess reasons and predictors of regimen change from initial highly active antiretroviral therapy among 1533 Human Immunodeficiency virus-infected adult patients at the Jimma University Tertiary Hospital. RESULTS One in two (47.7%) adults changed their antiretroviral therapy regimen. Patients who were above the primary level of education [Hazard ratio (HR) 1.241 (95% CI 1.070-1.440)] and with human immunodeficiency virus/tuberculosis co-infection [HR 1.405 (95% CI 1.156-1.708)] had the higher risk of regimen change than their comparator. Individuals on Efavirenz [HR 0.675 (95% CI 0.553-0.825)] and non-stavudine [HR 0.494 (95% CI 0.406-0.601)] based regimens had lower risk of regimen change.
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Affiliation(s)
- Endalkachew Mekonnen
- Department of Medicine, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia.
| | - Abdulhalik Workicho
- Department of Epidemiology, College of Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Nezif Hussein
- School of Pharmacy, College of Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Teka Feyera
- Department of Veterinary Clinical Studies, College of Veterinary Medicine, Jigjiga University, Jigjiga, Ethiopia
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Gudina EK, Teklu AM, Berhan A, Gebreegziabhier A, Seyoum T, Nega A, Medhin G, Kebede A, Assefa Y. Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals. Ethiop J Health Sci 2018; 27:39-52. [PMID: 28465652 PMCID: PMC5402801 DOI: 10.4314/ejhs.v27i1.5s] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia. METHODS This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity. RESULT ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems - the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity. CONCLUSION ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available.
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Affiliation(s)
| | | | - Asres Berhan
- Department of Pharmacology, Hawassa University, Hawassa
| | | | - Teshome Seyoum
- Department of Internal Medicine, Hiwot Fana Hospital, Harar
| | - Abiy Nega
- MERQ Consultancy Services, Addis Ababa, Ethiopa
| | | | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa
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Management of HIV Infection during Pregnancy in the United States: Updated Evidence-Based Recommendations and Future Potential Practices. Infect Dis Obstet Gynecol 2016; 2016:7594306. [PMID: 27504071 PMCID: PMC4967680 DOI: 10.1155/2016/7594306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 12/02/2022] Open
Abstract
All HIV-infected women contemplating pregnancy should initiate combination antiretroviral therapy (cART), with a goal to achieve a maternal serum HIV RNA viral load beneath the laboratory level of detection prior to conceiving, as well as throughout their pregnancy. Successfully identifying HIV infection during pregnancy through screening tests is essential in order to prevent in utero and intrapartum transmission of HIV. Perinatal HIV transmission can be less than 1% when effective cART, associated with virologic suppression of HIV, is given during the ante-, intra-, and postpartum periods. Perinatal HIV guidelines, developed by organizations such as the World Health Organization, American College of Obstetricians and Gynecologists, and the US Department of Health and Human Services, are constantly evolving, and hence the aim of our review is to provide a useful concise review for medical providers caring for HIV-infected pregnant women, summarizing the latest and current recommendations in the United States.
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16
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Shiferaw MB, Tulu KT, Zegeye AM, Wubante AA. Liver Enzymes Abnormalities among Highly Active Antiretroviral Therapy Experienced and HAART Naïve HIV-1 Infected Patients at Debre Tabor Hospital, North West Ethiopia: A Comparative Cross-Sectional Study. AIDS Res Treat 2016; 2016:1985452. [PMID: 27493798 PMCID: PMC4963552 DOI: 10.1155/2016/1985452] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/26/2016] [Accepted: 06/16/2016] [Indexed: 01/26/2023] Open
Abstract
Liver disease has emerged as the most common non-AIDS-related cause of death in HIV patients. However, there is limited data regarding this condition including our setting in Ethiopia. Hence, liver enzyme abnormalities among highly active antiretroviral therapy (HAART) experienced and HAART naïve patients were assessed in this study. A total of 164 HAART experienced and 164 HAART naïve patients were studied. Blood specimen was collected to determine alanine aminotransferase (ALT) and aspartate aminotransferase (AST), CD4 count, and viral hepatitis. The prevalence of liver enzyme abnormality was 20.1% and 22.0% among HAART experienced and HAART naïve patients, respectively. The HAART experienced patients had higher mean ALT than HAART naïve patients (P = 0.002). Viral hepatitis (AOR = 6.02; 95% CI = 1.87-19.39), opportunistic infections (AOR = 2.91; 95% CI = 1.04-8.19), current CD4 count <200 cells/mm(3) (AOR = 2.16; 95% CI = 1.06-4.39), and male sex (AOR = 1.83; 95% CI = 1.001-3.33) were associated with elevated ALT and/or AST. In conclusion, liver enzyme abnormalities were high in both HAART experienced and HAART naïve HIV-1 infected patients. Hence, monitoring and management of liver enzyme abnormalities in HIV-1 infected patients are important in our setting.
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Affiliation(s)
| | - Ketema Tafess Tulu
- Department of Biomedical Science, School of Health and Hospital, Adama Science and Technology University, Asella, Ethiopia
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Brentlinger PE, Silva WP, Vermund SH, Valverde E, Buene M, Moon TD. Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline. AIDS Res Hum Retroviruses 2016; 32:12-25. [PMID: 26178574 DOI: 10.1089/aid.2015.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were "etiologic" if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or "syndromic" if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin <10 g/dl) HIV-infected adults. Study clinicians treated nearly all [315 (97.2%)] for suspected iron deficiency and/or helminthes; 56 (17.3%) had laboratory-confirmed malaria. Other assigned diagnoses included tuberculosis [30 (9.3%)], adverse drug reactions [26 (8.0%)], and bacteremia [13 (4.1%)]. Etiologic diagnosis was achieved in 79 (24.4%). Of 169 (52.2%) subjects who improved (hemoglobin increase of ≥1 g/dl without indications for hospitalization), only 65 (38.5%) received conventional management (iron supplementation, deworming, and/or antimalarials) alone. Thirty (9.3%) died and/or were hospitalized, and 125 (38.6%) were lost to follow-up. Multivariable linear and logistic regression models described better hemoglobin responses and/or outcomes in subjects with higher CD4(+) T-lymphocyte counts, pre-enrollment antiretroviral therapy and/or co-trimoxazole prophylaxis, discontinuation of zidovudine for suspected adverse reaction, and smear-positive tuberculosis. Adverse outcomes were associated with fever, low body mass index, bacteremia, esophageal candidiasis, and low or missing CD4(+) T cell counts. In this severely resource-limited setting, successful anemia management often required interventions other than conventional presumptive treatment, thus supporting Mozambique's guideline revision.
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Affiliation(s)
| | - Wilson P. Silva
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Emilio Valverde
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Manuel Buene
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
| | - Troy D. Moon
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
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Sun J, Liu L, Shen J, Qi T, Wang Z, Song W, Zhang R, Lu H. Reasons and Risk Factors for the Initial Regimen Modification in Chinese Treatment-Naïve Patients with HIV Infection: A Retrospective Cohort Analysis. PLoS One 2015. [PMID: 26207639 PMCID: PMC4514877 DOI: 10.1371/journal.pone.0133242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the reasons and risk factors for modification of the first combined antiretroviral therapy (cART) currently used for HIV infected patients who were treatment naïve in Shanghai China. Methods Making a retrospective observational research on treatment naïve patients with HIV infection who initiated cART during the period of September 1st 2005---December 1st 2013. The demographic and clinical data were collected from the first visit to the time of the first regimen modification or the last visit in December 1st, 2014. The reasons of treatment modification were recorded. Survival analysis of modification was made by Kaplan-Meier curves analysis and log rank test, and a Cox multiple regression model was constructed to identify related factors of modification. Results A total number of the eligible participants were 3372 and 871(25.8%) patients changed their first cART regimen. The median follow up was 22 months [interquartile range (IQR) 14–39]. Among patients who modified the original regimen, drug toxicity occurred in 805(92.4%) participants and 44(5.1%) experienced treatment failure. In multiple regression analysis regimen modification was associated with patients’ age more than 40 years old (aHR 1.224, 95%CI 1.051–1.426, P = 0.010), CD4 less than 200(aHR 1.218, 95%CI 1.044–1.421, P = 0.012) and the initial regimen they received. Compared with the regimen of TDF+3TC+EFV, patients with regimen of d4T+3TC+NVP, d4T+3TC+EFV, AZT+3TC+NVP or AZT+3TC+EFV were 10.4, 8.2, 6.4, 2.5 times more likely to modify their initial regimen, respectively. Conclusions The main reason for the regimen switch was drug toxicity and main risk factors for regimen modification were age older than 40 years, CD4 cell counts less than 200 at baseline and regimen they received. Among the 2NRTI plus 1NNRTI regimens, the co-formulation of d4T+3TC+NVP had the highest risk for modification while the regimen of TDF+3TC+EFV was the most tolerable treatment regimen in first years’ follow up.
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Affiliation(s)
- Jianjun Sun
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Li Liu
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jiayin Shen
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Tangkai Qi
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhenyan Wang
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Song
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Renfang Zhang
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Brescini L, Orsetti E, Gesuita R, Piraccini F, Marchionni E, Staffolani S, Castelli P, Drenaggi D, Barchiesi F. Evaluating Liver Fibrosis by Transient Elastometry in Patients With HIV-HCV Coinfection and Monoinfection. HEPATITIS MONTHLY 2014; 14:e15426. [PMID: 25337140 PMCID: PMC4199183 DOI: 10.5812/hepatmon.15426] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/23/2013] [Accepted: 02/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Due to the high efficacy of combination antiretroviral therapy (cART), the number of patients living with HIV is increasing. Chronic HCV infection has become a leading cause of non-AIDS related morbidity and mortality in patients with HIV infection. OBJECTIVES The aim of this cross-sectional study was to identify factors associated with liver fibrosis (LF) in patients with HIV monoinfection and HIV-HCV coinfection. PATIENTS AND METHODS We analyzed LF by transient elastometry ([TE], Fibroscan) in three groups of patients (HIV, HIV-HCV and HCV) followed at the Infectious Diseases Department of University of Ancona, Italy, between October 2009 and November 2012. RESULTS In total, 354 adults including 98 HIV, 70 HIV-HCV and 186 HCV patients were studied. HIV-HCV patients had a longer duration of HIV (P < 0.006) and HCV (P < 0.001) infections. Additionally, they were receiving cART therapy for a longer period (P < 0.001); they had higher prevalence of lipodystrophy (P < 0.001) and higher HCV load (P = 0.004). LF was significantly more pronounced in HCV and HIV-HCV compared to HIV patients (P < 0.001). A total of 13.3%, 39.2% and 51.4% of HIV, HCV and HIV-HCV, respectively, showed a LF ≥ F2. Additionally, a severe LF (F = 4) was significantly more frequent among HIV-HCV compared to other groups. A longer exposure to didanosine, stavudine, lopinavir/ritonavir and fosamprenavir resulted in increased LF by univariate analysis (P ranging from < 0.001 to 0.007). By logistic regression analysis, the only variables significantly associated with increased LF were HCV coinfection, older age, and high AST values (P ranging from < 0.001 to 0.036). CONCLUSIONS HCV coinfection, older age and AST were associated with LF in patients with HIV infection.
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Affiliation(s)
- Lucia Brescini
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Elena Orsetti
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Rosaria Gesuita
- Centre for Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Piraccini
- Centre for Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Marchionni
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Staffolani
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Pamela Castelli
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Davide Drenaggi
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
- Corresponding Author: Francesco Barchiesi, Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy. Tel: +39-715963466, Fax: +39-715963468, E-mail:
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Nglazi MD, West SJ, Dave JA, Levitt NS, Lambert EV. Quality of life in individuals living with HIV/AIDS attending a public sector antiretroviral service in Cape Town, South Africa. BMC Public Health 2014; 14:676. [PMID: 24990360 PMCID: PMC4227123 DOI: 10.1186/1471-2458-14-676] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/19/2014] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQoL) is an important outcome helping to understand the impact of antiretroviral therapy (ART). We examined and compared the HRQoL in relation to ART status among HIV-infected patients in a public sector service in Cape Town, South Africa. In addition, we aimed to examine the relationship between ART status and HRQoL according to CD4 count strata. METHODS A cross sectional study sample of 903 HIV-infected patients who were categorized as not receiving ART (ART-naïve) or receiving first-line ART for > 6 months (ART). HRQoL outcomes were compared in the two groups. HRQoL was assessed using the EQ-5D (five domains) and Visual Analogue Scale (EQ-5D VAS). RESULTS Of the total sample, 435 were categorised as ART naïve (76% women) and 468 were on ART (78% women). There were no significant associations between groups for most of the EQ-5D domains, however ART-naïve experienced a significantly greater problem with mobility than the ART group. Being ART-naïve (adjusted odds ratio (aOR) 3.08 95% confidence interval (CI) 1.63- 7.89) and obese 2.78 (95% CI 1.24- 6.22) were identified as predictors for increased mobility problems in multivariate analysis. In addition, receiving ART (5.61 difference; 95% CI 2.50 - 8.72) and having some source of income (4.76; 95% CI 1.63 -7.89) were identified as predictors for a higher EQ-5D VAS score. When grouped according to CD4 count strata, there were no significant difference between groups for most of the EQ-5D domains, however the ART-naïve group indicated having significantly greater problems under the CD4 count of >500 cells/μL in the anxiety/depression domain (22.4% vs 8.8%, p = 0.018) and significantly lower EQ-5D VAS scores under the CD4 counts of ≤ 200 cells/μL (median 80 (IQR 60-90) vs 90 (IQR 80-100), p = 0.0003) and 201-350 cells/μL (median 80 (IQR 70-90) vs 90 (80-100), p = 0.0004) compared to ART group. CONCLUSIONS HRQoL (self-rated health state) was improved with ART use, including those with immunocompromised status, which may be relevant to the public sector ART program in South Africa.
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Affiliation(s)
- Mweete D Nglazi
- MRC/UCT Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
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Brennan AT, Shearer K, Maskew M, Long L, Sanne I, Fox MP. Impact of choice of NRTI in first-line antiretroviral therapy: a cohort analysis of stavudine vs. tenofovir. Trop Med Int Health 2014; 19:490-8. [PMID: 24589363 PMCID: PMC8224497 DOI: 10.1111/tmi.12285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In April 2010, South Africa replaced stavudine with tenofovir in first-line antiretroviral therapy (ART) despite tenofovir's higher cost. We examined treatment outcomes over 24 months amongst patients initiated on tenofovir-based vs. stavudine-based first-line regimens. METHODS Prospective cohort analysis of 3940 patients newly initiating either stavudine-based (April 2009 to March 2010) or tenofovir-based (April 2010 to March 2011) ART in Johannesburg, South Africa. Cox proportional hazards models and Fine and Gray's competing risk regression accounting for death were used to model mortality and loss to follow-up, respectively. Linear and log-binomial regression were used to evaluate associations with immunologic response and unsuppressed virus (≥ 400 copies/ml), respectively. RESULTS About 1878 patients prescribed tenofovir and 2062 patients prescribed stavudine were included. One hundred and sixty-six (8.8%) tenofovir and 244 (11.8%) stavudine patients died. Three hundred and fifty (18.6%) tenofovir and 379 (18.4%) stavudine patients were lost to follow-up over 24 months on ART. Adjusted regression models showed tenofovir and stavudine were comparable regarding death, loss to follow-up, immunologic response and virologic status. CONCLUSIONS We found no difference in mortality, loss to follow-up, immunological and virologic outcomes over the first 24-months on ART associated with tenofovir compared with stavudine.
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Affiliation(s)
- Alana T. Brennan
- Center for Global Health & Development, Boston University, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Shearer
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Center for Global Health & Development, Boston University, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, Johannesburg, South Africa
| | - Matthew P. Fox
- Center for Global Health & Development, Boston University, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Shet A, Antony J, Arumugam K, Kumar Dodderi S, Rodrigues R, DeCosta A. Influence of adverse drug reactions on treatment success: prospective cohort analysis of HIV-infected individuals initiating first-line antiretroviral therapy in India. PLoS One 2014; 9:e91028. [PMID: 24614165 PMCID: PMC3948746 DOI: 10.1371/journal.pone.0091028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Adverse drug reactions related to antiretroviral therapy (ART) remain a challenge in resource-limited settings, often causing significant morbidity and impaired adherence leading to treatment failure. This 2-year prospective study aimed to describe patterns and predictors of adverse reactions to first-line ART and assess the impact of these events on treatment success. METHODS Between 2010-2013, 321 ART-naïve eligible adults were enrolled at two clinics in southern India. ART regimens included zidovudine or stavudine plus lamivudine, plus nevirapine or efavirenz. Pill count adherence, immunological and virological monitoring, and laboratory-based adverse drug reactions were measured prospectively and analyzed. RESULTS Among 321 patients in the study, 289 (90.0%) patients experienced at least 1 adverse reaction, and 85 (26.5%) experienced at least 1 severe reaction. The incidence rate was 52 and 15 per 100 person-years for all reactions and severe reactions respectively. The cumulative incidence of zidovudine-induced anemia was 37.1% over 2 years. At 12 and 24 months, the proportion of patients with optimal adherence, undetectable viral load and CD4 counts >350 cells/mm3 were similar between patients who experienced or did not experience severe adverse drug reactions. CONCLUSIONS Our results highlight the high frequency of ART-related adverse drug reactions among individuals initiating first-line ART in India, underscoring the importance of detailed counseling and monitoring for maintaining ART durability. Severe drug-induced anemia needs to be addressed urgently with alternative first-line agents, and close laboratory surveillance. High treatment efficacy despite decreased drug safety seen here may be because patients have limited treatment options. Our results support the use of currently recommended safer first-line ART regimens that minimize the risk of severe life-threatening toxicities and provide for a better quality of life. TRIAL REGISTRATION ISRTCN Registry: ISRCTN79261738.
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Affiliation(s)
- Anita Shet
- Department of Pediatrics, St. John’s Medical College Hospital, Bangalore, India
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jimmy Antony
- Division of Public Health and Infection, St. John’s Research Institute, Bangalore, India
| | - Karthika Arumugam
- Division of Biostatistics, St. John’s Research Institute, Bangalore, India
| | - Sunil Kumar Dodderi
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Rashmi Rodrigues
- Department of Community Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Ayesha DeCosta
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
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Mamiafo CT, Moor VJA, Nansseu JRN, Pieme CA, Tayou C, Yonkeu JN. Hyperlactatemia in a group of HIV patients living in Yaounde-Cameroon. AIDS Res Ther 2014; 11:2. [PMID: 24428886 PMCID: PMC3899605 DOI: 10.1186/1742-6405-11-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 01/10/2014] [Indexed: 01/09/2023] Open
Abstract
Background and aim Prolonged exposure to highly active antiretroviral therapy (HAART) is associated with adverse effects such as hyperlactatemia. We determined the prevalence and risk factors for developing hyperlactatemia among human immunodeficiency virus (HIV)-infected cameroonians on antiretroviral therapy (ART). Methods We conducted a cross-sectional study from January to April 2012 involving 91 HIV-infected patients receiving ART for at least 12 months and 30 HIV-infected patients who have never received ART (ART-naïve patients). Plasma lactate levels were determined after at least 12 hours of overnight fasting and hyperlactatemia defined as lactate concentrations ≥ 3 mmol/L. The prevalence of hyperlactatemia was determined and the risk factors were analyzed by a multivariate logistic regression model. Results The mean lactataemia was significantly higher in the group of HIV patients currently taking ART than in the ART-naïve one (2.3 ± 1.3 and 1.7 ± 0.7 mmol/L respectively, p = 0.002). Patients on first line ART regimens had significantly higher lactatemia than those on second line regimens (2.5 ± 1.5 and 1.9 ± 0.7 mmol/L respectively, p = 0.014). The prevalence of hyperlactatemia in HIV patients receiving ART and in ART-naïve HIV patients was respectively 18.7 and 6.7% (p = 0.095). ART-exposure (adjusted odds ratio (aOR) 5.44, 95% confidence interval (CI) 1.06 – 27.84; p = 0.042) and being on a first line regimen (aOR 16.22, 95% CI 1.57 – 167.91; p = 0.019) were independent strong predictors of hyperlactatemia. Conclusion Hyperlactatemia was not rare in our study population. Being on a first line regimen constitutes an important risk factor for developing hyperlactatemia. Measurement of plasma lactate may be useful in optimizing the management of HIV-positive persons on ART.
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Lessells RJ, Mutevedzi PC, Iwuji CC, Newell ML. Reduction in early mortality on antiretroviral therapy for adults in rural South Africa since change in CD4+ cell count eligibility criteria. J Acquir Immune Defic Syndr 2014; 65:e17-24. [PMID: 23756374 PMCID: PMC3867341 DOI: 10.1097/qai.0b013e31829ceb14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the impact of expanded eligibility criteria for antiretroviral therapy (ART) on median CD4⁺ cell count at ART initiation and early mortality on ART. METHODS Analyses included all adults (≥16 years) initiated on first-line ART between August 2004 and July 2012. CD4⁺ cell count threshold 350 cells per microliter for all adults was implemented in August 2011. Early mortality was defined as any death within 91 days of ART initiation. Trends in baseline CD4⁺ cell count and early mortality were examined by year (August to July) of ART initiation. Competing risks analysis was used to examine early mortality. RESULTS A total of 19,080 adults (67.6% female) initiated ART. Median CD4⁺ cell count at ART initiation was 110-120 cells per microliter over the first 6 years, increasing marginally to 145 cells per microliter in 2010-2011 and more significantly to 199 cells per microliter in 2011-2012. Overall, there were 875 deaths within 91 days of ART initiation; early mortality rate was 19.4 per 100 person-years [95% confidence interval (CI) 18.2 to 20.7]. After adjustment for sex, age, baseline CD4⁺ cell count, and concurrent tuberculosis (TB), there was a 46% decrease in early mortality for those who initiated ART in 2011-2012 compared with the reference period 2008-2009 (subhazard ratio, 0.54; 95% CI: 0.41 to 0.71). CONCLUSIONS Since the expansion of eligibility criteria, there is evidence of earlier access to ART and a significant reduction in early mortality rate in this primary health care programme. These findings provide strong support for national ART policies and highlight the importance of earlier ART initiation for achieving reductions in HIV-related mortality.
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Affiliation(s)
- Richard J. Lessells
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Portia C. Mutevedzi
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Collins C. Iwuji
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
- The Brighton Doctoral College, Brighton and Sussex Medical School, United Kingdom; and
| | - Marie-Louise Newell
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
- University College London Institute of Child Health, London, United Kingdom
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Chandra A, Firth J, Sheikh A, Patel P. Emergencies related to HIV infection and treatment (part 2). Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Brennan AT, Maskew M, Ive P, Shearer K, Long L, Sanne I, Fox MP. Increases in regimen durability associated with the introduction of tenofovir at a large public-sector clinic in Johannesburg, South Africa. J Int AIDS Soc 2013; 16:18794. [PMID: 24256692 PMCID: PMC3835788 DOI: 10.7448/ias.16.1.18794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/19/2013] [Accepted: 10/17/2013] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In April 2010, tenofovir replaced stavudine in public-sector first-line antiretroviral therapy (ART) in South Africa. The association of tenofovir with fewer side effects and toxicities compared to stavudine could translate to increased durability of tenofovir-based regimens. We evaluated changes over time in regimen durability at the Themba Lethu Clinic, Johannesburg, South Africa. METHODS This was a cohort analysis of treatment-naïve, non-pregnant adult patients initiated on ART between April 2004 and December 2011. First-line ART regimens before April 2010 consisted of stavudine or zidovudine with lamivudine and either efavirenz or nevirapine. Tenofovir was substituted for stavudine after April 2010. We evaluated the frequency and type of single-drug substitutions (excluding switches to second-line therapy). Cox models were used to evaluate the association of ART initiation year and antiretroviral drug type with single-drug substitutions in the first 12 months on treatment. RESULTS One thousand nine hundred and sixty-four (10%) substitutions occurred amongst 19,699 patients. Excluding 2004 (year of treatment roll-out), before 2010 one-year single-drug substitutions ranged from 10.0 to 13.1%. In 2011, well after integration of tenofovir, substitutions decreased to 5.6%. Single-drug substitution was lowest amongst patients on tenofovir (5.1%) versus zidovudine (11.3%), 30 mg stavudine (10.5%) or 40 mg stavudine (14.4%). Adjusted Cox models showed that patients initiating treatment between 2005 and 2010 (vs. 2011) had a twofold increased hazard of single-drug substitution, while those on zidovudine or stavudine had a two to threefold increase in single-drug substitution versus tenofovir patients in the first 12 months on ART. CONCLUSIONS The decline in single-drug substitutions is associated with the introduction of tenofovir. Tenofovir use could improve regimen durability and treatment outcomes in resource-limited settings.
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Affiliation(s)
- Alana T Brennan
- Center for Global Health & Development, Boston University, Boston, MA, USA; Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa;
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Syndrome d’hypersensibilité médicamenteuse au ténofovir ou DRESS chez une patiente infectée par le VIH. Med Mal Infect 2013; 43:134-5. [DOI: 10.1016/j.medmal.2013.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/04/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022]
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Bennett DE, Jordan MR, Bertagnolio S, Hong SY, Ravasi G, McMahon JH, Saadani A, Kelley KF. HIV drug resistance early warning indicators in cohorts of individuals starting antiretroviral therapy between 2004 and 2009: World Health Organization global report from 50 countries. Clin Infect Dis 2012; 54 Suppl 4:S280-9. [PMID: 22544188 DOI: 10.1093/cid/cis207] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The World Health Organization developed a set of human immunodeficiency virus drug resistance (HIVDR) early warning indicators (EWIs) to assess antiretroviral therapy clinic and program factors associated with HIVDR. EWIs are monitored by abstracting data routinely recorded in clinical records, and the results enable clinics and program managers to identify problems that should be addressed to minimize preventable emergence of HIVDR in clinic populations. As of June 2011, 50 countries monitored EWIs, covering 131 686 patients initiating antiretroviral treatment between 2004 and 2009 at 2107 clinics. HIVDR prevention is associated with patient care (appropriate prescribing and patient monitoring), patient behavior (adherence), and clinic/program management efforts to reduce treatment interruptions (follow up, retention on first-line ART, procurement and supply management of antiretroviral drugs). EWIs measure these factors and the results have been used to optimize patient and population treatment outcomes.
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Affiliation(s)
- Diane E Bennett
- US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Chronic myeloid leukaemia and human immunodeficiency virus (HIV) infection. Int J Hematol 2012; 95:556-63. [PMID: 22527850 DOI: 10.1007/s12185-012-1073-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
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Crane M, Iser D, Lewin SR. Human immunodeficiency virus infection and the liver. World J Hepatol 2012; 4:91-8. [PMID: 22489261 PMCID: PMC3321495 DOI: 10.4254/wjh.v4.i3.91] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 11/04/2011] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Liver disease in human immunodeficiency virus (HIV)-infected individuals encompasses the spectrum from abnormal liver function tests, liver decompensation, with and without evidence of cirrhosis on biopsy, to non-alcoholic liver disease and its more severe form, non-alcoholic steatohepatitis and hepatocellular cancer. HIV can infect multiple cells in the liver, leading to enhanced intrahepatic apoptosis, activation and fibrosis. HIV can also alter gastro-intestinal tract permeability, leading to increased levels of circulating lipopolysaccharide that may have an impact on liver function. This review focuses on recent changes in the epidemiology, pathogenesis and clinical presentation of liver disease in HIV-infected patients, in the absence of co-infection with hepatitis B virus or hepatitis C virus, with a specific focus on issues relevant to low and middle income countries.
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Affiliation(s)
- Megan Crane
- Megan Crane, Sharon R Lewin, Department of Medicine, Monash University, Melbourne 3004, Australia
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Maskew M, Westreich D, Fox MP, Maotoe T, Sanne IM. Effectiveness and safety of 30 mg versus 40 mg stavudine regimens: a cohort study among HIV-infected adults initiating HAART in South Africa. J Int AIDS Soc 2012; 15:13. [PMID: 22410312 PMCID: PMC3313885 DOI: 10.1186/1758-2652-15-13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As stavudine remains an important and widely prescribed drug in resource-limited settings, the effect of a reduced dose of stavudine (from 40 mg to 30 mg) on outcomes of highly active antiretroviral therapy (HAART) remains an important public health question. METHODS We analyzed prospectively collected data from the Themba Lethu Clinic in Johannesburg, South Africa. We assessed the relationship between stavudine dose and six- and/or 12-month outcomes of stavudine substitution, failure to suppress viral load to below 400 copies/ml, development of peripheral neuropathy, lipoatrophy and hyperlactatemia/lactic acidosis. Since individuals with a baseline weight of less than 60 kg were expected to have received the same dose of stavudine throughout the study period, analysis was restricted to individuals who weighed 60 kg or more at baseline. Data were analyzed using logistic regression. RESULTS Between 1 April 2004 and 30 September 2009, 3910 patients were initiated on antiretroviral therapy (ART) with a recorded stavudine dose and were included in the analysis. Of these, 2445 (62.5%) received a 40 mg stavudine dose while 1565 (37.5%) received 30 mg. In multivariate analysis, patients receiving a 40 mg dose were more likely to discontinue stavudine use (adjusted odds ratio, OR 1.71; 95% confidence limits, CI 1.13-2.57) than those receiving 30 mg by 12 months on ART. Additionally, patients receiving 40 mg doses of stavudine were more likely to report peripheral neuropathy (OR 3.12; 95% CI 1.86-5.25), lipoatrophy (OR 11.8; 95% CI 3.2-43.8) and hyperlactatemia/lactic acidosis (OR 8.37; 95% CI 3.83-18.29) in the same time period. Failure to suppress HIV viral load within 12 months of HAART initiation was somewhat more common among those given 40 mg doses (OR 1.62; 95% CI 0.88, 2.97) although this result lacked precision. Sensitivity analyses accounting for death and loss to follow up generally supported these estimates. CONCLUSIONS Lower stavudine dosage is associated with fewer reports of several stavudine-associated adverse events and also a lower risk of stavudine discontinuation within the first year on ART.
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Affiliation(s)
- Mhairi Maskew
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Bertagnolio S, De Luca A, Vitoria M, Essajee S, Penazzato M, Hong SY, McClure C, Duncombe C, Jordan MR. Determinants of HIV drug resistance and public health implications in low- and middle-income countries. Antivir Ther 2012; 17:941-53. [DOI: 10.3851/imp2320] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Kasprowicz VO, Churchyard G, Lawn SD, Squire SB, Lalvani A. Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas. J Infect Dis 2011; 204 Suppl 4:S1168-78. [PMID: 21996699 DOI: 10.1093/infdis/jir449] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A key challenge to greater progress in tuberculosis (TB) control is the reservoir of latent TB infection (LTBI), which represents a huge long-lived reservoir of potential TB disease. In parts of Africa, as many as 50% of 15-year-olds and 77%-89% of adults have evidence of LTBI. A second key challenge to TB control is the human immunodeficiency virus (HIV)-associated TB epidemic, and Africa alone accounts for one-quarter of the global burden of HIV-associated TB. HIV co-infection promotes both reactivation TB from LTBI and rapidly progressive primary TB following recent exposure to Mycobacterium tuberculosis. Preventing active TB and tackling latent infection in addition to the Directly Observed Treatment, Short-Course (DOTS) strategy could improve TB control in high-burden settings, especially where there is a high prevalence of HIV co-infection. Current strategies include intensified case finding (ICF), TB infection control, antiretroviral therapy (ART), and isoniazid preventive therapy (IPT). Although ART has been widely rolled out, ICF and IPT have not. A key factor limiting the rollout and effectiveness of IPT and ICF is the limitations of existing tools to both diagnose LTBI and identify those persons most at risk of progressing to active TB. In this review, we examine the obstacles and consider current progress toward the development of new tools to address this pressing global problem.
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Affiliation(s)
- Victoria O Kasprowicz
- Ragon Institute of MGH, MIT, and Harvard, Harvard Medical School, Boston, Massachusetts, USA
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Matthews LT, Giddy J, Ghebremichael M, Hampton J, Guarino AJ, Ewusi A, Carver E, Axten K, Geary MC, Gandhi RT, Bangsberg DR. A risk-factor guided approach to reducing lactic acidosis and hyperlactatemia in patients on antiretroviral therapy. PLoS One 2011; 6:e18736. [PMID: 21494566 PMCID: PMC3073990 DOI: 10.1371/journal.pone.0018736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/12/2011] [Indexed: 11/18/2022] Open
Abstract
Background Stavudine continues to be used in antiretroviral treatment (ART) regimens in
many resource-limited settings. The use of zidovudine instead of stavudine
in higher-risk patients to reduce the likelihood of lactic acidosis and
hyperlactatemia (LAHL) has not been examined. Methods Antiretroviral-naïve, HIV-infected adults initiating ART between 2004
and 2007 were divided into cohorts of those initiated on stavudine- or
zidovudine-containing therapy. We evaluated stavudine or zidovudine use,
age, sex, body mass index (BMI), baseline CD4 cell count, creatinine,
hemoglobin, alanine aminotransferase, and albumin as predictors of time to
LAHL with Cox Proportional Hazards (PH) regression models. Results Among 2062 patients contributing 2747 patient years (PY), the combined
incidence of LAHL was 3.2/100 PY in those initiating stavudine- and 0.34/100
PY in those initiating zidovudine-containing ART (RR 9.26, 95% CI:
1.28–66.93). In multivariable Cox PH analysis, stavudine exposure (HR
14.31, 95% CI: 5.79–35.30), female sex (HR 3.41, 95% CI:
1.89–6.19), higher BMI (HR 3.21, 95% CI: 2.16–4.77),
higher creatinine (1.63, 95% CI: 1.12–2.36), higher albumin (HR
1.04, 95% CI: 1.01–1.07), and lower CD4 cell count (HR 0.96,
95% CI: 0.92–1.0) at baseline were associated with higher LAHL
rates. Among participants who started on stavudine, switching to zidovudine
was associated with lower LAHL rates (HR 0.15, 95% CI:
0.06–0.35). Subgroup analysis limited to women with higher BMI≥25
kg/m2 initiated on stavudine also showed that switch to zidovudine was
protective when controlling for other risk factors (HR 0.21, 95% CI
.07–0.64). Conclusions Stavudine exposure, female sex, and higher BMI are strong, independent
predictors for developing LAHL. Patients with risk factors for lactic
acidosis have less LAHL while on zidovudine- rather than
stavudine-containing ART. Switching patients from stavudine to zidovudine is
protective. Countries continuing to use stavudine should avoid this drug in
women and patients with higher BMI.
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Affiliation(s)
- Lynn T Matthews
- Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
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Abstract
The immune system requires several essential micronutrients to maintain an effective immune response. HIV infection destroys the immune system and promotes nutritional deficiencies, which further impair immunity. This article reviews the role of several micronutrients (vitamins A, C, E and D, the B vitamins, and minerals, selenium, iron and zinc) that are relevant for maintaining immune function. In addition, the deficiencies of these micronutrients have been associated with faster progression of HIV-1 disease. This review examines the evidence from observational studies of an association between micronutrient status and HIV disease, as well as the effectiveness of micronutrient supplementation on HIV-disease progression, pregnancy outcomes and nutritional status, among others, utilizing randomized clinical trials. Each micronutrient is introduced with a summary of its functions in human physiology, followed by the presentation of studies conducted in HIV-infected patients in relation to this specific micronutrient. Overall findings and recommendations are then summarized.
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Affiliation(s)
- Adriana Campa
- Florida International University, Stempel College of Public Health & Social Work, University Park, HLS-1–337, Miami, FL 33199, USA
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Cohn J, Baker B. Obstacles and opportunities to improve antiretroviral regimen access in low-income countries. Curr HIV/AIDS Rep 2010; 7:161-7. [PMID: 20532837 DOI: 10.1007/s11904-010-0053-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Increasing evidence suggests that dramatically increasing access to effective and well-tolerated antiretroviral medications is key to reversing the HIV pandemic. Currently used first-line therapies in developing countries have multiple toxicities that cause significant morbidity and mortality. New World Health Organization HIV treatment guidelines support earlier treatment initiation and the use of less toxic first-line therapies. Adoption of these guidelines requires political and financial commitment from multiple stakeholders including country governments and donors. This review summarizes the major adverse effects associated with commonly used ARV regimens in low-income countries and also analyzes some of the barriers and potential solutions that affect the ability of low-income countries to implement the new World Health Organization guidelines.
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Affiliation(s)
- Jennifer Cohn
- Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Building, Suite D, Philadelphia, PA 19104, USA.
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Tedla Z, Nyirenda S, Peeler C, Agizew T, Sibanda T, Motsamai O, Vernon A, Wells CD, Samandari T. Isoniazid-associated hepatitis and antiretroviral drugs during tuberculosis prophylaxis in hiv-infected adults in Botswana. Am J Respir Crit Care Med 2010; 182:278-85. [PMID: 20378730 DOI: 10.1164/rccm.200911-1783oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Little is known about the incidence of isoniazid-associated hepatitis in HIV-infected Africans who receive both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART). OBJECTIVES To assess the rate of and risk factors for isoniazid (INH)-associated hepatitis in persons living with HIV (PLWH) during IPT. METHODS PLWH recruited for a clinical trial received 6 months of open-label, daily, self-administered INH at public health clinics. At screening PLWH were excluded if they had any cough, weight loss, night sweats, or other illness. Alcohol abuse was defined as meeting any CAGE criterion. INH-associated hepatitis (INH-hepatitis) was defined as having either alanine or aspartate aminotransferase greater than 5.0 times the upper limit of normal regardless of symptoms when INH was not excluded as the cause. MEASUREMENTS AND MAIN RESULTS Of 1,995 PLWH enrolled between 2004 and 2006, 1,762 adhered to at least 4 months of IPT and were analyzed. Nineteen (1.1%) developed hepatitis probably or possibly associated with INH including one death at month 6; 14 of 19 (74%) occurred in months 1-3. Antiretroviral therapy (ART) was received by 480 participants but was not statistically associated with INH-hepatitis (relative risk [RR], 1.56; 95% confidence intervals [CI], 0.62-3.9); those receiving nevirapine had a higher rate (2.0%) than those receiving efavirenz (0.9%; P = 0.34). Although alcohol use did not reach significance (RR, 1.42; 95% CI, 0.57-3.51), meeting at least one CAGE criterion approached statistical significance (RR, 2.37; 95% CI, 0.96-5.84). Neither age greater than 35 years nor the presence of hepatitis B virus core antibody was associated with INH-hepatitis. CONCLUSIONS The observed rates of INH-hepatitis were similar to published data. Six months of IPT, which is recommended by the World Health Organization, was relatively safe in this, the largest cohort of African PLWH. Clinical trial registered with www.clinicaltrials.gov (NCT 00164281).
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Affiliation(s)
- Zegabriel Tedla
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, 1600 Clifton Road NE, Mailstop E-10, Atlanta, GA 30333, USA
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Innes S, Levin L, Cotton M. LIPODYSTROPHY SYNDROME IN HIV-INFECTED CHILDREN ON HAART. South Afr J HIV Med 2009; 10:76-80. [PMID: 20706598 DOI: 10.4102/sajhivmed.v10i4.264] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lipodystrophy syndrome (LD) is common in HIV-infected children, particularly those taking didanosine, stavudine or zidovudine. Lipo-atrophy in particular causes major stigmatisation and interferes with adherence. In addition, LD may have significant long-term health consequences, particularly cardiovascular. Since the stigmatising fat distribution changes of LD are largely permanent, the focus of management remains on early detection and arresting progression. Practical guidelines for surveillance and avoidance of LD in routine clinical practice are presented. The diagnosis of LD is described and therapeutic options are reviewed. The most important therapeutic intervention is to switch the most likely offending antiretroviral to a non-LD-inducing agent as soon as LD is recognised. Typically, when lipoatrophy or lipohypertrophy is diagnosed the thymidine nucleoside reverse transcriptase inhibitor (NRTI) is switched to a non-thymidine agent such as abacavir (or tenofovir in adults). Where dyslipidaemia is predominant, a dietician review is helpful, and the clinician may consider switching to a protease inhibitor-sparing regimen or to atazanavir.
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Affiliation(s)
- Steve Innes
- KID-CRU (Children's Infectious Diseases Clinical Research Unit), Tygerberg Children's Hospital and Stellenbosch University, Tygerberg, W Cape
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Haanpää ML, Backonja MM, Bennett MI, Bouhassira D, Cruccu G, Hansson PT, Jensen TS, Kauppila T, Rice ASC, Smith BH, Treede RD, Baron R. Assessment of neuropathic pain in primary care. Am J Med 2009; 122:S13-21. [PMID: 19801048 DOI: 10.1016/j.amjmed.2009.04.006] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan.
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Affiliation(s)
- Maija L Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Stavudine- and nevirapine-related drug toxicity while on generic fixed-dose antiretroviral treatment: incidence, timing and risk factors in a three-year cohort in Kigali, Rwanda. Trans R Soc Trop Med Hyg 2009; 104:148-53. [PMID: 19732926 DOI: 10.1016/j.trstmh.2009.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 11/21/2022] Open
Abstract
This cohort study was conducted to report on the incidence, timing and risk factors for stavudine (d4T)- and nevirapine (NVP)-related severe drug toxicity (requiring substitution) with a generic fixed-dose combination under program conditions in Kigali, Rwanda. Probability of 'time to first toxicity-related drug substitution' was estimated using the Kaplan-Meier method and Cox-proportional hazards modeling was used to identify risk factors. Out of 2190 adults (median follow-up: 1.5 years), d4T was replaced in 175 patients (8.0%) for neuropathy, 69 (3.1%) for lactic acidosis and 157 (7.2%) for lipoatrophy, which was the most frequent toxicity by 3 years of antiretroviral treatment (ART). NVP was substituted in 4.9 and 1.3% of patients for skin rash and hepatotoxicity, respectively. Use of d4T 40 mg was associated with increased risk of lipoatrophy and early (<6 months) neuropathy. Significant risk factors associated with lactic acidosis and late neuropathy included higher baseline body weight. Older age and advanced HIV disease increased the risk of neuropathy. Elevated baseline liver tests and older age were identified as risk factors for NVP-related hepatotoxicity. d4T is associated with significant long-term toxicity. d4T-dose reduction, increased access to safer ART in low-income countries and close monitoring for those at risk are all relevant strategies.
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Kallianpur AR, Hulgan T. Pharmacogenetics of nucleoside reverse-transcriptase inhibitor-associated peripheral neuropathy. Pharmacogenomics 2009; 10:623-37. [PMID: 19374518 DOI: 10.2217/pgs.09.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Peripheral neuropathy is an important complication of antiretroviral therapy. Nucleoside reverse-transcriptase inhibitor (NRTI)-associated mitochondrial dysfunction, inflammation and nutritional factors are implicated in its pathogenesis. Pharmacogenetic and genomic studies investigating NRTI neurotoxicity have only recently become possible via the linkage of HIV clinical studies to large DNA repositories. Preliminary case-control studies using these resources suggest that host mitochondrial DNA haplogroup polymorphisms in the hemochromatosis gene and proinflammatory cytokine genes may influence the risk of peripheral neuropathy during antiretroviral therapy. These putative risk factors await confirmation in other HIV-infected populations but they have strong biological plausibility. Work to identify underlying mechanisms for these associations is ongoing. Large-scale studies incorporating clearly defined and validated methods of neuropathy assessment and the use of novel laboratory models of NRTI-associated neuropathy to clarify its pathophysiology are now needed. Such investigations may facilitate the development of more effective strategies to predict, prevent and ameliorate this debilitating treatment toxicity in diverse clinical settings.
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Affiliation(s)
- Asha R Kallianpur
- Department of Medicine, Vanderbilt University, 2525 West End Avenue, Suite 600, Nashville, TN 37203-31738, USA.
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Weight evolution in HIV-1 infected women in Rwanda after stavudine substitution due to lipoatrophy: comparison of zidovudine with tenofovir/abacavir. Trans R Soc Trop Med Hyg 2009; 103:613-9. [DOI: 10.1016/j.trstmh.2008.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 08/18/2008] [Accepted: 08/18/2008] [Indexed: 11/24/2022] Open
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Abstract
PURPOSE OF REVIEW This article reviews recent studies in the field of clinical pharmacology of antiretroviral drugs and highlights the relevance of the findings to clinical practice in developing countries. RECENT FINDINGS Differences in antiretroviral pharmacokinetics are associated with polymorphisms of genes encoding drug metabolizing enzymes. Inadequate concentrations of antiretrovirals in children are common. A study in African children found subtherapeutic concentrations in 40% of patients receiving efavirenz at recommended doses. SUMMARY Recent findings on the pharmacokinetics of antiretroviral agents relevant to clinical practice in developing countries are reviewed. Widespread poverty impacts negatively on HIV/AIDS treatment and prevention efforts. Improved access to treatment, social and economic support and pharmacology research in target populations are needed.
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Banieghbal B. Minimally invasive surgery for children with HIV/AIDS. J Laparoendosc Adv Surg Tech A 2009; 19:97-101. [PMID: 18976127 DOI: 10.1089/lap.2008.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children.
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Affiliation(s)
- Behrouz Banieghbal
- Division of Pediatric Surgery, University of the Witwaterand, CH Baragwanath Hospital, Johannesburg, South Africa.
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Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq'oba study. J Acquir Immune Defic Syndr 2009; 50:37-43. [PMID: 19295333 DOI: 10.1097/qai.0b013e31818ce6c4] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases. METHODS Prospective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation. RESULTS Of 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken. CONCLUSIONS Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.
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Ojikutu B. Introduction: the realities of antiretroviral therapy rollout: overcoming challenges to successful programmatic implementation. J Infect Dis 2008; 196 Suppl 3:S445-8. [PMID: 18181692 DOI: 10.1086/521123] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In 2006, 2 million human immunodeficiency virus (HIV)-infected people living in low- to middle-income countries were receiving antiretroviral therapy (ART). Although this is an improvement over previous years, significant operational challenges have inhibited progress toward universal access to HIV care and treatment. Despite these challenges, the intense efforts focused on addressing the HIV epidemic present an opportunity for overall health systems improvement in developing nations. In October 2006, Harvard University's Centers for AIDS Research, the Nelson Mandela School of Medicine, the Department of Health of KwaZulu-Natal, and the Medical Research Council of South Africa held a conference entitled "The Realities of Antiretroviral Therapy Rollout: Challenges to Successful Programmatic Implementation" in Durban, South Africa. The goal of the meeting was to bring together international and local leadership, including policy makers, health care workers, and funders, to propose an agenda that would address the challenges to more expeditious provision of HIV care and treatment in resource-limited settings.
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Affiliation(s)
- Bisola Ojikutu
- Division of AIDS, Harvard Medical School, Boston, Massachusetts 02215, USA.
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