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Paul RH, Shikuma CM, Chau NVV, Ndhlovu LC, Thanh NT, Belden AC, Chow DC, Chew GM, Premeaux TA, Ly VT, McBride JAD, Bolzenius JD, Le T. Neurocognitive Trajectories After 72 Weeks of First-Line Anti-retroviral Therapy in Vietnamese Adults With HIV-HCV Co-infection. Front Neurol 2021; 12:602263. [PMID: 33776879 PMCID: PMC7996090 DOI: 10.3389/fneur.2021.602263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 weeks of ART using repeated multivariate analyses and latent trajectory models. Methods: One hundred and sixty adults with chronic, untreated HIV infection (n = 80 with HCV co-infection and n = 80 HIV mono-infected) and 80 demographically similar healthy controls were recruited from the Hospital for Tropical Diseases in Ho Chi Minh City and the surrounding community, respectively. Neurocognitive measures (adapted for use in Vietnam) and liver enzyme tests were compared across groups at baseline. Repeated multivariate and group-based trajectory analyses (GBTA) examined neurocognitive subgroup profiles of the co-infected individuals after 72 weeks of de novo efavirenz- (n = 41) or raltegravir-based (n = 39) ART. Results: Baseline analyses revealed worse motor function in HIV-HCV co-infected individuals compared to both comparison groups. Longitudinal analyses revealed improved neurocognitive performance by week 48 for most participants regardless of treatment arm. GBTA identified a subgroup (35% of HIV-HCV sample) with persistent motor impairment despite otherwise successful ART. Higher HIV viral load and lower CD4+ T cell count at baseline predicted persistent motor dysfunction. Liver indices and ART regimen did not predict neurocognitive outcomes in HIV-HCV co-infected individuals. Conclusions: Most HIV-HCV co-infected individuals achieve normative neurocognitive performance after 48 weeks of de novo suppressive ART. However, individuals with more severe HIV disease prior to ART exhibited motor impairment at baseline and 72 weeks after otherwise successful treatment. Interventions aimed at improving motor symptoms at the time of HIV treatment onset may improve long-term clinical outcomes in HIV-HCV co-infected adults.
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Affiliation(s)
- Robert H Paul
- University of Missouri-St. Louis, St. Louis, MO, United States
| | - Cecilia M Shikuma
- Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States
| | | | - Lishomwa C Ndhlovu
- Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States.,Cornell University School of Medicine, New York City, NY, United States
| | - Nguyen Tat Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Andrew C Belden
- University of Missouri-St. Louis, St. Louis, MO, United States
| | - Dominic C Chow
- Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States
| | - Glen M Chew
- Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States
| | - Thomas A Premeaux
- Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States.,Cornell University School of Medicine, New York City, NY, United States
| | - Vo Trieu Ly
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | | | - Thuy Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Duke University School of Medicine, Durham, NC, United States
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Paul RH, Shikuma CM, Chau NVV, Ndhlovu LC, Thanh NT, Belden AC, Chow DC, Chew GM, Premeaux TA, Ly VT, McBride JAD, Bolzenius JD, Le T. Neurocognitive Trajectories After 72 Weeks of First-Line Anti-retroviral Therapy in Vietnamese Adults With HIV-HCV Co-infection. Front Neurol 2021; 12. [DOI: https:/doi.org/10.3389/fneur.2021.602263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background: Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 weeks of ART using repeated multivariate analyses and latent trajectory models.Methods: One hundred and sixty adults with chronic, untreated HIV infection (n = 80 with HCV co-infection and n = 80 HIV mono-infected) and 80 demographically similar healthy controls were recruited from the Hospital for Tropical Diseases in Ho Chi Minh City and the surrounding community, respectively. Neurocognitive measures (adapted for use in Vietnam) and liver enzyme tests were compared across groups at baseline. Repeated multivariate and group-based trajectory analyses (GBTA) examined neurocognitive subgroup profiles of the co-infected individuals after 72 weeks of de novo efavirenz- (n = 41) or raltegravir-based (n = 39) ART.Results: Baseline analyses revealed worse motor function in HIV-HCV co-infected individuals compared to both comparison groups. Longitudinal analyses revealed improved neurocognitive performance by week 48 for most participants regardless of treatment arm. GBTA identified a subgroup (35% of HIV-HCV sample) with persistent motor impairment despite otherwise successful ART. Higher HIV viral load and lower CD4+ T cell count at baseline predicted persistent motor dysfunction. Liver indices and ART regimen did not predict neurocognitive outcomes in HIV-HCV co-infected individuals.Conclusions: Most HIV-HCV co-infected individuals achieve normative neurocognitive performance after 48 weeks of de novo suppressive ART. However, individuals with more severe HIV disease prior to ART exhibited motor impairment at baseline and 72 weeks after otherwise successful treatment. Interventions aimed at improving motor symptoms at the time of HIV treatment onset may improve long-term clinical outcomes in HIV-HCV co-infected adults.
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Jatapai A, Nelson KE, Chuenchitra T, Kana K, Eiumtrakul S, Sunantarod E, Rangsin R. Prevalence and risk factors for hepatitis C virus infection among young Thai men. Am J Trop Med Hyg 2010; 83:433-9. [PMID: 20682895 DOI: 10.4269/ajtmh.2010.09-0749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Epidemiologic studies of hepatitis C virus (HCV) infection are unusual in developing countries, especially Thailand. We evaluated the prevalence and risk factors for HCV among military conscripts, including a sample of 5,246 men (1:30 sample), and human immunodeficiency virus (HIV)-1 positive men (N = 500) between 2005 and 2008. The HCV prevalence was 2.2% in the sampled group and 8.4% in HIV-1 sero-positives. Among the sampled group, HIV-1 infection, injection drug use (IDU) history, and unsafe injections were associated with HCV infection; adjusted prevalence rate ratios [RRs; 95% confidence intervals (CIs)] were 3.7 (1.04-12.77), 1.9 (1.04-3.54), and 1.8 (1.02-3.11), respectively. Among HIV-1 sero-positives, an IDU history and residence in southern Thailand were associated with HCV prevalence; adjusted RRs (95% CIs) were 3.5 (1.71-7.24) and 2.6 (1.18-5.61), respectively. Public health measures to prevent HCV in Thailand should focus on reducing injection drug use and other exposures to unsafe injections among young Thai men.
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Affiliation(s)
- Anchalee Jatapai
- Faculty of Allied Health Sciences, Thammasat University, Khlong Luang, Pathum Thani, Thailand
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Human immunodeficiency virus-hepatitis C virus co-infection in pregnant women and perinatal transmission to infants in Thailand. Int J Infect Dis 2010; 14:e602-7. [PMID: 20047847 DOI: 10.1016/j.ijid.2009.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 08/31/2009] [Accepted: 09/07/2009] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The objectives of this study were to assess the prevalence and factors associated with hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected and -uninfected Thai pregnant women and the rate of HCV transmission to their infants. PATIENTS AND METHODS Study subjects included 1435 HIV-infected pregnant women and their infants, enrolled in a perinatal HIV prevention trial, and a control group of 448 HIV-uninfected pregnant women. Women were screened for HCV antibodies with an enzyme immunoassay. Positive results were confirmed by recombinant immunoblot and HCV RNA quantification. Infants were tested for HCV antibodies at 18 months or for HCV RNA at between 6 weeks and 6 months. RESULTS Of the HIV-infected women, 2.9% were HCV-infected compared to 0.5% of HIV-uninfected women (p=0.001). Only history of intravenous drug use was associated with HCV infection in HIV-infected women. Ten percent of infants born to co-infected mothers acquired HCV. The risk of transmission was associated with a high maternal HCV RNA (p=0.012), but not with HIV-1 load or CD4 count. CONCLUSIONS Acquisition of HCV through intravenous drug use partially explains the higher rate of HCV infection in HIV-infected Thai women than in HIV-uninfected controls. Perinatal transmission occurred in 10% of infants of HIV-HCV-co-infected mothers and was associated with high maternal HCV RNA.
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Abstract
BACKGROUND Successful conduct of HIV vaccine efficacy trials entails identification and enrollment of at-risk populations, assessment of appropriate end points as measures of vaccine efficacy for prevention of HIV acquisition, and amelioration of disease course among infected vaccinees, as well as identification of potential confounders or effect modifiers. Although not invariably useful and bringing their own cost in terms of measurement and validation, a variety of biomarkers may aid at each stage of trial conduct. METHODS A review of selected articles, chosen based on quality, relevance of the biomarker to HIV vaccine trials, and availability of the publication, was conducted. The authors also drew experience from current trials and other planned or ongoing trials. CONCLUSIONS Biomarkers are available to assess HIV incidence in potential study populations, but care is needed in interpreting results of these assays. During trial conduct, sexually transmitted infections such as herpes simplex virus type 2 may act as effect modifiers on primary and secondary end points, including HIV incidence and set point viral load. The utility of sexually transmitted infection biomarkers will likely depend heavily on local epidemiology at clinical trial sites. Analyses from recent large HIV vaccine efficacy trials point to the complexities in interpreting trial results and underscore the potential utility of biomarkers in evaluating confounding and effect modification.
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Watanaveeradej V, Benenson MW, Souza MD, Sirisopana N, Nitayaphan S, Tontichaivanich C, Amphaipit R, Renzullo PO, Brown AE, McNeil JG, Robb ML, Birx DL, Tovanabutra S, Carr JK, McCutchan FE. Molecular epidemiology of HIV Type 1 in preparation for a Phase III prime-boost vaccine trial in Thailand and a new approach to HIV Type 1 genotyping. AIDS Res Hum Retroviruses 2006; 22:801-7. [PMID: 16910837 DOI: 10.1089/aid.2006.22.801] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To characterize HIV-1 genotypes in candidate populations for a prime-boost phase III vaccine trial in Thailand, specimens from prevalent and incident HIV-1 infections from a family planning clinic population in Rayong Province and a community cohort in Chon Buri Province, collected from 1998 to 2001, were genotyped. A new multiregion hybridization assay, MHAbce, capable of distinguishing HIV-1 CRF01_AE, subtype B, and subtype C and their recombinants, was developed and applied to prevalent infections. Most incident and selected prevalent infections were studied by complete genome sequencing. By MHAbce, 168 of 194 prevalent infections were genotyped. Of these, 90.5% were CRF01_AE, 2.4% were subtype B, and 7.2% showed discordant or dual probe reactivity, indicative of recombination or dual infection, respectively. Among 23 incident infections, 20 were sequenced. Eighteen CRF01_AE, one subtype B, and one CRF01/B recombinant strains were seen. Two CRF01/B and one CRF01/C recombinant were identified among selected prevalent infections. These results indicate that incident and prevalent HIV-1 infections in Rayong and Chon Buri during 1998-2001 were 90% CRF01_AE, 3% subtype B, and 7% either recombinant or dual. This study frames the genetic diversity of HIV-1 in these cohorts in their preparatory phase for the ongoing ALVACHIV (vCP1521) prime, AIDSVAX B/E boost, phase III vaccine trial and will provide a benchmark for interpretation and analysis.
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Chanbancherd P, Paris RM, Torugsa K, Myint KS, Sangkharomya S, Brown AE. Changes in HIV prevalence among young Thai men as defined by hepatitis C co-infection as a marker for mode of transmission. AIDS 2004; 18:2339-41. [PMID: 15577552 DOI: 10.1097/00002030-200411190-00020] [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: 11/26/2022]
Abstract
To obtain a better understanding of the evolving HIV-1 epidemic in Thailand, we utilized antibody to hepatitis C virus (HCV) to indicate the mode of HIV-1 transmission. Although the proportion of men with HCV co-infection increased between 1995 and 2000, the prevalence was similar, whereas the prevalence of men not co- infected decreased (1.93-0.46%). This suggests that HIV-1 infection associated with parenteral transmission has been stable despite a dramatic reduction in the sexual transmission of HIV-1.
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Affiliation(s)
- Penprapa Chanbancherd
- Army Institute of Pathology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Ruan YH, Hong KX, Liu SZ, He YX, Zhou F, Qin GM, Chen KL, Xing H, Chen JP, Shao YM. Community-based survey of HCV and HIV coinfection in injection drug abusers in Sichuan Province of China. World J Gastroenterol 2004; 10:1589-93. [PMID: 15162531 PMCID: PMC4572760 DOI: 10.3748/wjg.v10.i11.1589] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate the prevalence and risk factors of HCV/HIV coinfection in injection drug abusers (IDAs) in Lianshan Yi Autonomous Prefecture of Sichuan province, China.
METHODS: From November 8, 2002 to November 29, 2002, a community-based survey was conducted to investigate the demographic characteristics, patterns of shared injectors devices and sexual behaviors in IDAs. Blood samples were also collected to test HCV and HIV infection. A total of 379 subjects were recruited in the study through community outreach and peer recruiting methods.
RESULTS: Of the 379 IDAs, the HCV prevalence and HIV prevalence were 71.0% and 11.3%, respectively, and HCV/HIV coinfection was 11.3%. HCV infection was found in 100% and 67.3% of HIV-positive and HIV-negative IDAs, respectively. HIV prevalence was 16.0% in HCV positive IDAs while none of the HCV negative IDAs was positive for HIV. Ethnicity, shared needles or syringes and cotton in the past 3 mo and syphilis infection were associated with HCV/HIV coinfection shown by univariate analysis using chi-square test. Multivariate logistic regression analysis showed that shared needles or syringes in the past 3 mo (Odds ratio = 3.121, 95% CI: 1.278-7.617, P < 0.05) and syphilis infection (Odds ratio = 2.914, 95% CI: 1.327-6.398, P < 0.01) were significantly associated with HCV infection. No statistically significant association was found in univariate analysis between sexual behaviors and HCV/HIV coinfection.
CONCLUSION: Shared needles and syringes in the past 3 mo and syphilis infection were significantly associated with HCV infection. Further sero-epidemiological prospective cohort studies should be conducted to clarify the impact of syphilis and high risk sexual behaviors on HCV transmission through unprotected sexual intercourse.
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Affiliation(s)
- Yu-Hua Ruan
- Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Abstract
HIV and drugs of abuse have each been implicated as promoters of human organ specific diseases which include the heart, kidney, lung, CNS etc. Whether the drugs of abuse directly and/or indirectly increase the susceptibility of HIV-1-induced pathology and whether the drugs of abuse and HIV effects are cumulative and/or synergistic remain to be established. The scope of the studies that are needed to address this issue and the limitations inherent in such studies are summarized below.
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Affiliation(s)
- Aftab Ahmed Ansari
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Woodruff Memorial Building, Atlanta, GA 30322, USA.
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