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Reinaldo LGC, Araújo Júnior RJC, Diniz TM, Moura RDD, Meneses Filho AJ, Furtado CVVDM, Dos Santos WLC, Costa DL, Eulálio KD, Ferreira GR, Costa CHN. The spleen is the graveyard of CD4+ cells in patients with immunological failure of visceral leishmaniasis and AIDS. Parasit Vectors 2024; 17:132. [PMID: 38491526 PMCID: PMC10941596 DOI: 10.1186/s13071-024-06151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure. METHODS From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight. RESULTS CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015). CONCLUSIONS This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.
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Affiliation(s)
| | | | - Thiago Melo Diniz
- University Hospital of the Federal University of Piauí, Teresina, Brazil
| | - Rafael de Deus Moura
- University Hospital of the Federal University of Piauí, Teresina, Brazil
- Department of Community Medicine, Federal University of Piauí, Teresina, Brazil
| | | | | | | | - Dorcas Lamounier Costa
- Maternal and Child Department, Federal University of Piauí, Teresina, Brazil
- Intelligence Center for Emerging and Neglected Tropical Diseases, Teresina, Brazil
| | | | - Gabriel R Ferreira
- Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Laval, QC, Canada
| | - Carlos Henrique Nery Costa
- Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
- Instituto de Doenças Tropicais Natan Portella, Teresina, Brazil.
- Intelligence Center for Emerging and Neglected Tropical Diseases, Teresina, Brazil.
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Siraj J, Feyissa D, Mamo Y, Zewudie A, Regesa T, Ejeta F, Feyisa D, Hasen G, Mohammed T, Aferu T. Antiretroviral treatment failure and associated factors among HIV patients on the first-line antiretroviral therapy at Mizan-Tepi University teaching hospital, Southwest Ethiopia: A cross-sectional study. Medicine (Baltimore) 2021; 100:e28357. [PMID: 34941151 PMCID: PMC8702282 DOI: 10.1097/md.0000000000028357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/08/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The use of Antiretroviral therapy (ART) has become a standard of care for the treatment of HIV infection. The therapy restores immune function and reduces HIV-related adverse outcomes. However, treatment failure erodes this advantage and leads to an increased morbidity and compromised quality of life in HIV patients. Thus, this study aimed to assess anti-retroviral treatment failure and associated factors among HIV patients on the first line ART at Mizan-Tepi University Teaching Hospital. A cross-sectional study was undertaken among adult patient who have been on ART and attending ART Clinic of Mizan-Tepi University Teaching Hospital from September 2014 to September 2018. Data were collected retrospectively by reviewing patients' medical charts using a standard structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of anti-retroviral treatment failure, multiple stepwise backward logistic regression analysis were done. P value < .05 was considered as statistically significant. Among 221 patients included in the study, 118 (53.39%) were females. The mean weight of study participants at ART initiation was 57.04 kg. Of the 221 patients on the first line ART, 10 (4.5%) experienced treatment failure. Of these patients, 5 (50%) and 3 (30%) experienced virological failure and clinical failure, respectively. Functional status (AOR: 3, CI: [1.13-6.5], P < .001) and low baseline CD4 cell count (AOR: 4.3, CI: [3.4-10.6], P < .0001) were found to be an independent predictors of treatment failure. The rate of first-line ART treatment failure in the study setting was substantial. Functional status and low baseline CD4 cell count were found to be an independent predictors of virological, clinical and immunological failure. Therefore, more attention should be given for the lifestyle of pateints' on ART and maximize virological tests for monitoring treatment failures.
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Affiliation(s)
- Jafer Siraj
- Department of Pharmacology and Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Desalegn Feyissa
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yitagesu Mamo
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Ameha Zewudie
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Tolcha Regesa
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Fikadu Ejeta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Diriba Feyisa
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Gemmechu Hasen
- School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
- Laboratory of Drug Quality (JuLaDQ), Jimma University, Jimma, Ethiopia
| | - Tesfaye Mohammed
- School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
- Laboratory of Drug Quality (JuLaDQ), Jimma University, Jimma, Ethiopia
| | - Temesgen Aferu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Demeke Bayou F, Nigussie Amare S. Time to Immunologic Recovery and Its Determinant Factors Among Adult HIV Patients Who Initiated Antiretroviral Treatment at Hiwot Fana Specialized University Hospital, Harar, Ethiopia. HIV AIDS (Auckl) 2021; 13:1009-1014. [PMID: 34880680 PMCID: PMC8647166 DOI: 10.2147/hiv.s336167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Fekade Demeke Bayou
- Department of Epidemiology, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
- Correspondence: Fekade Demeke Bayou Email
| | - Shambel Nigussie Amare
- Department of Clinical Pharmacy, School of pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Getawa S, Fentahun A, Adane T, Melku M. Antiretroviral Treatment Failure and Associated Factors Among HIV-Infected Children on Antiretroviral Therapy: A Retrospective Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:229-237. [PMID: 33664596 PMCID: PMC7921627 DOI: 10.2147/hiv.s294046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Background HIV/AIDS-associated morbidity and mortality have reduced since the introduction of antiretroviral therapy (ART). Treatment failure is one of the causes of mortality, morbidity, and the development of drug-resistant viral strains. Therefore, this research aims to assess the prevalence and associated factors of treatment failure among children with HIV/AIDS on antiretroviral therapy attending the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Methods A retrospective study was conducted on 200 children registered for ART from 2005 to 2017. Data regarding patients’ socio-demographic, baseline clinical characteristics, and treatment-related information were collected through a review of their medical records. Data were entered into Epi-info version 3.5.3 and analyzed using statistical package for social sciences (SPSS) version 21 software. To summarize characteristics of the study participant’s descriptive statistics were done. Bivariable and multivariable binary logistic regression were fitted to identify factors associated with treatment failure. The odds ratio and 95% confidence interval (CI) were calculated to assess the strength of the association and P-value<0.05 in the multivariable regression was considered as statistically significant. Results The prevalence of ART failure was 12.5% (95% CI: 7.88, 17.12), clinical failure was the most common followed by immunologic failure with only a small proportion having both clinical and immunologic failure. The mean time to develop treatment failure after initiation of the first-line regimen was 22.28 ± 24.00 months. Being male (AOR= 3.15; 95% CI: 1.18–8.39), co-infected with tuberculosis (TB) at baseline (AOR= 2.37; 95% CI: 1.23–8.84), being on ART for a long period (>36 months) (AOR= 1.01; 95% CI: 1.34–2.89), and regimen change (AOR=9.22; 95% CI: 3.36–25.03) were factors of ART failure. Conclusion In this study, there is significant treatment failure among HIV-infected children. Having co-infection, being on ART for a long period, regimen change, and being male were found to be independent factors of treatment failure in children. Therefore, timely identification and monitoring of ART failure should be necessary to enhance the benefit and to prevent further complications. Prophylaxis for opportunistic infections such as co-trimoxazole preventive therapy should continue to recover the immunological status of the child.
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Affiliation(s)
- Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abaynesh Fentahun
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Alkhatib NS, McBride A, Bhattacharjee S, Ramos K, Erstad B, Slack M, Billheimer D, Abraham I. Pricing methods in outcome-based contracting: δ5: risk of efficacy failure-based pricing. J Med Econ 2020; 23:1246-1255. [PMID: 32845204 DOI: 10.1080/13696998.2020.1815029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The fifth dimension (δ5) estimates prices on the basis of the risk of efficacy failure of a drug. We describe this dimension's methodology and present a proof-of-concept application to the treatment of non-small cell lung cancer (NSCLC) with EGFR mutation with osimertinib. MATERIALS AND METHODS The risk of efficacy failure pricing dimension utilizes a seven-step method: (1) defining risk; (2) extracting data; (3) predicting models; (4) performing Monte Carlo Simulation (MCS) to estimate risk of efficacy failure; 5) estimating ranges for a payback; (6) adjusting for medical inflation; and (7) performing Monte Carlo Simulation (MCS) to estimate the DSPRisk of efficacy failure. A proof-of-concept exercise with osimertinib in NSCLC was performed for two hypothetical outcome-based contracts: 1-year (2019-2020) and 2-year (2019-2021). We estimated the risk of efficacy failure for osimertinib in terms of overall and progression-free survival versus standard of care. We used the estimated risk to estimate the price reduction on the wholesale acquisition cost (WAC) for the two hypothetical contracts: a 1-year (2019-2020) and 2-year contract (2019-2021). From this we estimated the DSPRisk of efficacy failure. RESULTS Based on the risk of OS and PFS efficacy failure for osimertinib in OS and PFS, in the 1-year contract, the DSPRisk of efficacy failure was estimated at $12,652 (or -13.44% the 2018 WAC) for a 30-day prescription. For the 2-year contract (2019-2021), the DSPRisk of efficacy failure was estimated at $13,019 (or -10.93% the 2018 WAC). CONCLUSIONS We demonstrated that pricing methods based on risk of efficacy failure methods can be integrated into our proposed Six Delta platform for outcome-based pricing/contracting.
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Affiliation(s)
- Nimer S Alkhatib
- Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Ali McBride
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Sandipan Bhattacharjee
- Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Kenneth Ramos
- Institute of Bio Sciences and Technology, Texas A&M University, Houston, TX, USA
| | - Brian Erstad
- Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Marion Slack
- Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Dean Billheimer
- Center for Biomedical Informatics & Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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6
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Sher R, Dlamini S, Muloiwa R. Patterns of detectable viral load in a cohort of HIV-positive adolescents on antiretroviral therapy in South Africa. J Int AIDS Soc 2020; 23:e25474. [PMID: 32180367 PMCID: PMC7076279 DOI: 10.1002/jia2.25474] [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: 09/06/2019] [Accepted: 02/20/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load (VL) in a cohort of adolescents attending an ARV clinic in Cape Town, South Africa. METHODS We conducted a retrospective cohort study of all patients on antiretroviral therapy aged 10 to 19 years. Participants were included if they underwent at least two VL measurements and remained in care at the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive HIV VL >100 copies/mL, in line with the lower limit of detection of assays in use over the follow-up period. RESULTS AND DISCUSSION Of the 482 screened participants, 327 met inclusion criteria. Most participants had perinatally acquired HIV (n = 314; 96%), and 170 (52%) were males. Overall, there were 203 episodes of confirmed detectable VL involving 159 (49% (95% CI 43% to 54%)) participants during the follow-up period. Six participants had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 participants who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, and 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3 to 13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (Relative Risk 1.24 (95% CI 1.17 to 1.31); p < 0.0001). There was no sex difference with respect to duration (p = 0.4), prevalence (p = 0.46) and rate (p = 0.608) of detectable VL. CONCLUSIONS Clinicians need to be alert to the high prevalence of detectable VL during adolescence so as to pre-empt it and act swiftly once it is diagnosed. This study helps to highlight the risk of detectable VL that is associated with increase in age as well the high proportion of time that poorly adherent adolescents spend in this state.
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Affiliation(s)
- Rebecca Sher
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Sipho Dlamini
- Groote Schuur Hospital, Cape Town, South Africa.,Division of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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Dandachi D, Geiger G, Montgomery MW, Karmen-Tuohy S, Golzy M, Antar AAR, Llibre JM, Camazine M, Díaz-De Santiago A, Carlucci PM, Zacharioudakis IM, Rahimian J, Wanjalla CN, Slim J, Arinze F, Kratz AMP, Jones JL, Patel SM, Kitchell E, Francis A, Ray M, Koren DE, Baddley JW, Hill B, Sax PE, Chow J. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Infect Dis 2020; 73:e1964-e1972. [PMID: 32905581 PMCID: PMC7499544 DOI: 10.1093/cid/ciaa1339] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. Methods Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. Results 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. Conclusion Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, MO
| | - Grant Geiger
- School of Medicine, University of Missouri-Columbia, MO
| | - Mary W Montgomery
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | | | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri-Columbia, MO
| | - Annukka A R Antar
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josep M Llibre
- Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain
| | | | - Alberto Díaz-De Santiago
- Internal Medicine Department, HIV Infection Unit. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Philip M Carlucci
- School of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Joseph Rahimian
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ
| | - Folasade Arinze
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | | | - Joyce L Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shital M Patel
- Section of Infectious Diseases, Medicine, Baylor College of Medicine, TX
| | - Ellen Kitchell
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
| | - Adero Francis
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Manoj Ray
- Division of Infectious Diseases, Santa Clara Valley Health & Hospital System, CA
| | - David E Koren
- Department of Pharmacy, Temple University Health System, PA
| | - John W Baddley
- Division of Infectious Disease, University of Maryland, Baltimore, MD
| | - Brannon Hill
- Department of Pharmacy, University of Arkansas for Medical Sciences, AR
| | - Paul E Sax
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Jeremy Chow
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
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Pollock S, Toegel F, Holtyn AF, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Effects of incentives on viral suppression in people living with HIV who use cocaine or opiates. Drug Alcohol Depend 2020; 212:108000. [PMID: 32362436 PMCID: PMC7293918 DOI: 10.1016/j.drugalcdep.2020.108000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence is essential to maintenance of undetectable viral loads among people living with HIV, which improves health and reduces HIV transmission. Despite these benefits, some people living with HIV do not maintain the level of adherence required to sustain an undetectable viral load. This problem is particularly common among people who use drugs. OBJECTIVE To determine effects of incentivizing viral suppression in people living with HIV who used cocaine or opiates. METHODS In this secondary analysis of data collected during a randomized controlled trial, participants (N=102) with detectable HIV viral loads (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with reduced or undetectable (<200 copies/mL) viral loads. All participants completed assessments every three months. Results collected during the first year were compared based on group assignment and drug use. RESULTS Among participants who used cocaine or opiates, Incentive participants (n = 27) provided more (OR:4.0, CI:1.6-10.3, p = .004) blood samples with an undetectable viral load (69 %) than Usual Care participants (n = 25; 41 %). Among participants who did not use cocaine or opiates, Incentive participants (n = 25) provided more (OR:4.1, CI:1.5-10.7, p = .005) blood samples with an undetectable viral load (78 %) than Usual Care participants (n = 25; 36 %). Effects of incentives did not differ by drug use (OR:1.0, CI:0.3-4.0, p = .992). CONCLUSIONS Incentivizing viral suppression can promote undetectable viral loads in people living with HIV who use cocaine or opiates.
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Affiliation(s)
- Sarah Pollock
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Michael Fingerhood
- Department of Medicine, Comprehensive Care Practice, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave # W2, Baltimore, MD 21224, USA.
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
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9
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Ataro Z, Motbaynor B, Weldegebreal F, Sisay M, Tesfa T, Mitiku H, Marami D, Teklemariam Z, Shewamene Z. Magnitude and causes of first-line antiretroviral therapy regimen changes among HIV patients in Ethiopia: a systematic review and meta-analysis. BMC Pharmacol Toxicol 2019; 20:63. [PMID: 31675986 PMCID: PMC6824137 DOI: 10.1186/s40360-019-0361-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/02/2019] [Indexed: 12/22/2022] Open
Abstract
Background Antiretroviral therapy (ART) has markedly decreased the morbidity and mortality due to HIV/AIDS. ART regimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. This is found to be a major concern among HIV/AIDS patients in a resource-limited setting, where treatment options are limited. Objectives The aim of this review is to generate the best available evidence regarding the magnitude of first-line antiretroviral therapy regimen change and the causes for regimen change among HIV patients on ART in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed Medline, EMBASE, Hinari, Springer link and Google Scholar. Data were extracted using Microsoft Excel and exported to Stata software version 13 for analyses. The overall pooled estimation of outcomes was calculated using a random-effect model of DerSimonian–Laird method at 95% confidence level. Heterogeneity of studies was determined using I2 statistics. For the magnitude of regimen change, the presence of publication bias was evaluated using the Begg’s and Egger’s tests. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42018099742. The published methodology is available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=99742. Results A total of 22 studies published between the years 2012 and 2018 were included. Out of 22 articles, 14 articles reported the magnitude of regimen change and consisted of 13,668 HIV patients. The estimated national pooled magnitude of regimen change was 37% (95% CI: 34, 44%; Range: 15.1–63.8%) with degree of heterogeneity (I2), 98.7%; p-value < 0.001. Seventeen articles were used to identify the causes for first-line antiretroviral therapy regimen change. The major causes identified were toxicity, 58% (95% CI: 46, 69%; Range: 14.4–88.5%); TB co-morbidity, 12% (95% CI: 8, 16%; Range: 0.8–31.7%); treatment failure, 7% (95% CI: 5, 9%; Range: 0.4–24.4%); and pregnancy, 5% (95% CI: 4, 7%; Range: 0.6–11.9%). Conclusions The original first-line regimen was changed in one-third of HIV patients on ART in Ethiopia. Toxicity of the drugs, TB co-morbidity, treatment failure, and pregnancy were the main causes for the change of the first-line regimen among HIV patients on antiretroviral therapy.
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Affiliation(s)
- Zerihun Ataro
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia.
| | - Birhanu Motbaynor
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Ethiopia
| | - Fitsum Weldegebreal
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Tewodros Tesfa
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Habtamu Mitiku
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Dadi Marami
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Zelalem Teklemariam
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
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Perdomo-Celis F, Taborda NA, Rugeles MT. CD8 + T-Cell Response to HIV Infection in the Era of Antiretroviral Therapy. Front Immunol 2019; 10:1896. [PMID: 31447862 PMCID: PMC6697065 DOI: 10.3389/fimmu.2019.01896] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Although the combined antiretroviral therapy (cART) has decreased the deaths associated with the immune deficiency acquired syndrome (AIDS), non-AIDS conditions have emerged as an important cause of morbidity and mortality in HIV-infected patients under suppressive cART. Since these conditions are associated with a persistent inflammatory and immune activation state, major efforts are currently made to improve the immune reconstitution. CD8+ T-cells are critical in the natural and cART-induced control of viral replication; however, CD8+ T-cells are highly affected by the persistent immune activation and exhaustion state driven by the increased antigenic and inflammatory burden during HIV infection, inducing phenotypic and functional alterations, and hampering their antiviral response. Several CD8+ T-cell subsets, such as interleukin-17-producing and follicular CXCR5+ CD8+ T-cells, could play a particular role during HIV infection by promoting the gut barrier integrity, and exerting viral control in lymphoid follicles, respectively. Here, we discuss the role of CD8+ T-cells and some of their subpopulations during HIV infection in the context of cART-induced viral suppression, focusing on current challenges and alternatives for reaching complete reconstitution of CD8+ T-cells antiviral function. We also address the potential usefulness of CD8+ T-cell features to identify patients who will reach immune reconstitution or have a higher risk for developing non-AIDS conditions. Finally, we examine the therapeutic potential of CD8+ T-cells for HIV cure strategies.
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Affiliation(s)
- Federico Perdomo-Celis
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Natalia A Taborda
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia.,Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellin, Colombia
| | - Maria T Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
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Alene M, Awoke T, Yenit MK, Tsegaye AT. Incidence and predictors of second-line antiretroviral treatment failure among adults living with HIV in Amhara region: a multi-centered retrospective follow-up study. BMC Infect Dis 2019; 19:599. [PMID: 31288748 PMCID: PMC6617674 DOI: 10.1186/s12879-019-4243-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/30/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Second-line Antiretroviral Therapy (ART) regimens are used when patients develop treatment failure for first-line drug regimens. It is costly unaffordable and it is not widely available for patients in resource limiting setting, there is a need to maximizing the duration of stay on second-line regimen. This study was conducted to estimate the incidence rate of second-line treatment failure and to identify its predictors among adults living with HIV in the Amhara region. METHODS An institution based retrospective follow-up study was conducted from May to June 2017. A total of 1,011 adults on second-line ART who were enrolled between February 2008 and April 2016 were included for final analysis. Kaplan-Meier estimator curves were used to describe the survival function. Semi-parametric proportional hazard model was fitted to identify the predictors of treatment failure. RESULTS The overall incidence of second-line treatment failure was 9.86 per 100 person-years. It was high during the first and the last year of follow-up. The rate of second-line treatment failure was higher for patients who didn't change second-line regimens (HR: 1.55, 95%CI: 1.18-2.04), who had poor ART adherence (HR: 1.40, 95%CI: 1.06-1.85), and not taking INH (HR: 1.68, 95%CI: 1.23-2.30) as compared to their counter group. The rate of treatment failure for patients who were under WHO clinical stage III at switch (HR: 0.68, 95%CI: 0.50-0.91) was also lower as compared to clients who were under WHO clinical stage I. Furthermore, the rate of treatment failure was higher for clients who were under second-line regimen "TDF-3TC-LPV/r" (HR: 1.55, 95%CI: 1.03-2.32) and "AZT-3TC-LPV/r" (HR: 3.00, 95%CI: 1.86-4.85) as compared to patients under "ABC-ddI-LPV/r" regimens. CONCLUSIONS A high incidence rate of second-line treatment failure was noticed in the study setting. The rate of second-line treatment failure was higher for patients who didn't change drug regimens, who had poor ART adherence, and who were not taking INH. Therefore, addressing significant predictors to prevent treatment failure among ART patients is essential and sustainable monitoring to reduce the risk of treatment failure is also desirable.
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Affiliation(s)
- Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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12
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Amico KR, Dunlap A, Dallas R, Lindsey J, Heckman B, Flynn P, Lee S, Horvath K, West Goolsby R, Hudgens M, Filipowicz T, Polier M, Hill E, Mueller Johnson M, Miller J, Neilan A, Ciaranello A, Gaur A. Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention. JMIR Res Protoc 2019; 8:e11416. [PMID: 30882360 PMCID: PMC6441855 DOI: 10.2196/11416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/05/2018] [Accepted: 01/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Youth living with HIV (YLWH) are confronted with many self-care challenges that can be experienced as overwhelming in the context of normal developmental processes that characterize adolescence and young adulthood. A sizable minority of YLWH have unsuppressed viral loads in the United States attributable to antiretroviral therapy (ART) nonadherence. Interventions to promote sustained viral suppression in YLWH are needed. Objective The aim of this study is to evaluate the efficacy of the Triggered Escalating Real-Time Adherence (TERA) intervention in comparison with standard of care (SOC) in YLWH (aged 13-24 years) failing ART on (1) primary outcome measures—HIV viral suppression (VLS), defined as both <200 copies/ml and <50 copies/ml at 12 weeks, and (2) secondary outcome measures—VLS rates and rates of ART adherence at 24, 36, and 48 weeks as well as patterns of adherence over time as measured by an electronic dose monitoring (EDM) device. Methods The TERA study is a phase 2, multisite clinical trial conducted with 120 YLWH failing ART (randomized 1:1 to TERA or SOC) at participating clinical sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants are followed for a total of 48 weeks. For TERA arm participants, the first 12 weeks involve delivery of the intervention. For all participants, clinical outcomes are collected throughout follow-up, and adherence is assessed using EDM over the full 48 weeks. During the 12-week intervention period, TERA arm participants receive 3 remote coaching sessions delivered in clinic via videoconferencing timed to coincide with baseline and follow-up clinical visits, text message reminders when the EDM has not been opened at dose time (which escalate to 2-way theory-informed short message service coaching interactions in response to real-time nonadherence), and review of dosing graphs produced by EDM at follow-up visits. Results Launch dates for enrollment varied by site. Enrollment began in April 2018 and is expected to be completed by August 2019, with results presented by the second quarter of 2021. Conclusions Effective, generalizable, and scalable approaches to rapidly assist YLWH failing to achieve and sustain VLS may have a substantial impact on individual health and efforts to curb transmission. Coaching for a brief but intensive period from remote coaches and using communication channels common to youth may offer multiple unique advantages in promoting self-care. Trial Registration ClinicalTrials.gov NCT03292432; https://clinicaltrials.gov/ct2/show/NCT03292432 (Archived by WebCite at http://www.webcitation.org/768J8ijjp). International Registered Report Identifier (IRRID) DERR1-10.2196/11416
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Affiliation(s)
- K Rivet Amico
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Dunlap
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Ronald Dallas
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Jane Lindsey
- Chan School of Public Health, Department of Biostatistics, Harvard University, Boston, MA, United States
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY, United States
| | - Patricia Flynn
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Sonia Lee
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Keith Horvath
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Rachel West Goolsby
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Hudgens
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Teresa Filipowicz
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Melissa Polier
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Hill
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Megan Mueller Johnson
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Miller
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Anne Neilan
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Andrea Ciaranello
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Aditya Gaur
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
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Ayele G, Tessema B, Amsalu A, Ferede G, Yismaw G. Prevalence and associated factors of treatment failure among HIV/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia. BMC Immunol 2018; 19:37. [PMID: 30558580 PMCID: PMC6296084 DOI: 10.1186/s12865-018-0278-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background The initiation of highly active antiretroviral therapy (HAART) plays a significant role in the clinical management of HIV infected people by preventing morbidity and mortality. This benefit becomes, the most terrible when treatment failure develops. Thus, this research aims to assess the prevalence and associated factors of treatment failure among HIV/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia. Results Patients on ART with a minimum of 6 months and up to 12 years of treatment were being enrolled. The prevalence of treatment failure, immunological failure and virological failure among people living with HIV/AIDS attending University of Gondar referral hospital were 20.3, 13.2, and 14.7%, respectively. Patients who had no formal education (Adjusted odds ratio (AOR): 3.8; 95% CI, 1.05–13.77), primary level education (AOR: 4.2; 95% CI, 1.16–15.01) and duration on ART < 6 years (AOR: 2.1; 95%CI, 1.12–3.81) were a significant risk factor. However, initial adult regimen D4T + 3TC+ EFV (AOR: 0.025; 95% CI, 0.002–0.36), AZT +3TC + NVP (AOR: 0.07; 95% CI, 0.01–0.71), AZT + 3TC + EFV (AOR: 0.046; 95% CI, 0.004–0.57) andTDF+3TC + EFV (AOR: 0.04; 95% CI, 0.004–0.46) were significantly protective for treatment failure. Conclusions Timely and early identification of associated factors and monitoring antiretroviral therapy treatment failure should be done to enhance the benefit and to prevent further complication of the patients. It is preferable to initiate ART using any one of the following ART regimens: AZT +3TC + NVP, AZT + 3TC + EFV and TDF + 3TC + EFV to prevent treatment failure. Since the prevalence of this treatment failure and its associated factor may be different from other ART centers and community in Ethiopia, further national representative institutional based cross-sectional researches are needed across all ART centers of Ethiopia in order to determine the prevalence of treatment failure and its associated factors.
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Affiliation(s)
- Gizachew Ayele
- College of Health Sciences, Mizan-Tepi University, P.O. BoX 206, Mizan Teferi, Ethiopia.
| | - Belay Tessema
- Departhement of Medical Microbiology college of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Anteneh Amsalu
- Departhement of Medical Microbiology college of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Ferede
- Departhement of Medical Microbiology college of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Yismaw
- Departhement of Medical Microbiology college of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Longo S, Bon I, Musumeci G, Bertoldi A, D'Urbano V, Calza L, Re MC. Comparison of the Aptima HIV-1 Quant Dx assay with the COBAS AmpliPrep/COBAS TaqMan HIV-1 v2.0 Test for HIV-1 viral load quantification in plasma samples from HIV-1-infected patients. Health Sci Rep 2018; 1:e31. [PMID: 30623066 PMCID: PMC6266574 DOI: 10.1002/hsr2.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS HIV-1 RNA viral load (VL) in plasma samples of HIV-1-positive patients is used to assess the level of viral replication, the risk of disease progression, and the response and efficacy to antiretroviral treatment. Knowing the performance of different tests for HIV-1 RNA detection is, therefore, important for clinical care. This study compared the performance of the recently introduced Aptima HIV-1 Quant Dx assay (Hologic, Inc) and the standard COBAS AmpliPrep/COBAS TaqMan HIV-1 v2.0 Test (CAP/CTM2) (Roche Molecular System, Inc) for HIV-1 RNA quantitation. METHODS Assay performance was assessed using 335 clinical samples, a standard HIV-1 low VL panel, and 2 diluted samples from well-characterized patients infected with different HIV-1 subtypes tested in 5 replicates over 3 days. All samples were tested on both assays to evaluate inter-assay agreement, both qualitatively and quantitively. Altogether, we evaluated assay sensitivity, linearity, accuracy, precision, repeatability, and reproducibility. RESULTS Assay agreement for qualitative results in 335 clinical samples was fair (80.6%). Correlation of quantitative assay results (n = 164) was excellent (R 2 = 0.97), with 96.3% of the results within the 95% limit of assay agreement (-0.42 to +0.86 log), and 98.8% within 1 log of each other. Aptima-HIV-1 yielded results, on average, 0.22 log higher than CAP/CTM2. Both assays accurately quantitated the HIV-1 standard at low VL (R 2 ≥ 0.94), with all samples within 0.5 log of the target. CONCLUSION Aptima-HIV-1 assay demonstrated sensitivity, accuracy, reproducibility, and precision for the detection and quantitation of HIV-1 RNA across a wide dynamic range of VLs. Its performance, together with full automation and high throughput, suggests that Aptima-HIV-1 could be a suitable assay for reliable monitoring of HIV-1 VL in patients undergoing treatment.
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Affiliation(s)
- Serena Longo
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
| | - Isabella Bon
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
| | - Giuseppina Musumeci
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
| | - Alessia Bertoldi
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
| | - Vanessa D'Urbano
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
| | - Leonardo Calza
- Clinics of Infectious Diseases, Department of Medical and Surgical SciencesSt. Orsola‐Malpighi Hospital, University of BolognaItaly
| | - Maria Carla Re
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of MedicineUniversity of BolognaItaly
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15
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Joseph Davey D, Abrahams Z, Feinberg M, Prins M, Serrao C, Medeossi B, Darkoh E. Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa. Int J STD AIDS 2018; 29:603-610. [PMID: 29334886 PMCID: PMC7053422 DOI: 10.1177/0956462417748859] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unsuppressed viral load (VL) in patients on antiretroviral therapy (ART) occurs when treatment fails to suppress a person's VL and is associated with decreased survival and increased HIV transmission. The objective of this study was to evaluate factors associated with unsuppressed VL (VL > 400 copies/ml) in patients currently in care on first-line ART for ≥ 6 months attending South African public healthcare facilities. We analysed electronic medical records of ART patients with a VL result on record who started ART between January 2004 and April 2016 from 271 public health facilities. We present descriptive and multivariable logistic regression for unsuppressed VL at last visit using a priori variables. We included 244,370 patients (69% female) on first-line ART in April 2016 for ≥ 6 months. Median age at ART start was 33 years (7% were < 15 years old). Median duration on ART was 3.7 years. Adjusting for other variables, factors associated with having an unsuppressed VL at the most recent visit among patients in care included: (1) < 15 years old at ART start (adjusted odds ratio [aOR]=2.58; 95% CI = 2.37, 2.81) versus 15-49 years at ART start, (2) male gender (aOR = 1.29; 95% CI = 1.25, 1.35), (3) 6-12 months on ART versus longer (aOR = 1.34; 95% CI = 1.29, 1.40), (4) on tuberculosis (TB) treatment (aOR = 1.78; 95% CI = 1.48, 2.13), and (5) prior ART exposure versus none (aOR = 1.20; 95% CI = 1.08, 1.32). Approximately 85% of the ART cohort who were in care had achieved viral suppression, though men, youth/adolescents, patients with prior ART exposure, those with short duration of ART, and patients on TB treatment had increased odds of not achieving viral suppression. There is a need to develop and evaluate targeted interventions for ART patients in care who are at high risk of unsuppressed VL.
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Affiliation(s)
- D Joseph Davey
- 1 BroadReach, Cape Town, South Africa.,2 University of Cape Town, Cape Town, South Africa.,3 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Z Abrahams
- 2 University of Cape Town, Cape Town, South Africa
| | | | - M Prins
- 1 BroadReach, Cape Town, South Africa
| | - C Serrao
- 1 BroadReach, Cape Town, South Africa
| | | | - E Darkoh
- 1 BroadReach, Cape Town, South Africa
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Ouyang Y, Yin Q, Li W, Li Z, Kong D, Wu Y, Hong K, Xing H, Shao Y, Jiang S, Ying T, Ma L. Escape from humoral immunity is associated with treatment failure in HIV-1-infected patients receiving long-term antiretroviral therapy. Sci Rep 2017; 7:6222. [PMID: 28740221 PMCID: PMC5524822 DOI: 10.1038/s41598-017-05594-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/31/2017] [Indexed: 01/22/2023] Open
Abstract
Interindividual heterogeneity in the disease progression of HIV-1-infected patients receiving long-term antiretroviral therapy suggests that some host-related factors may have limited treatment efficacy. To understand the nature of factors contributing to treatment failure, we performed a retrospective cohort study of 45 chronically HIV-1-infected individuals sharing a similar demographics and route of infection, compared the differences between virologically suppressed (VS) and treatment failure (TF) patients with respect to clinical, immunological and virological characteristics. We found that the baseline diversity of HIV-1 env quasispecies was the major difference between VS and TF group, and higher baseline diversity in TF patients. We further predicted TF-related env mutations using a selection pressure-based approach, followed by an analysis of these mutations based on the available three-dimensional structures of gp120/gp41 or their complexes with neutralizing antibodies. Notably, almost all of the identified residues could be mapped to the epitopes of known HIV-1 neutralizing antibodies, especially the epitopes of broadly neutralizing antibodies, and these mutations tended to compromise antibody-antigen interactions. These results indicate that the escape of HIV-1 from host humoral immunity may play a direct role in TF in long-term antiretroviral-experienced patients and that based on env gene sequence of the viruses in the patients.
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Affiliation(s)
- Yabo Ouyang
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.,Beijing You'an Hospital, Capital Medical University, Beijing, China and Beijing Institute of Hepatology, Beijing, China
| | - Qianqian Yin
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wei Li
- Key Laboratory of Medical Molecular Virology of MOE/MOH, School of Basic Medical Sciences, Fudan University, Shanghai, China.,Protein Interactions Section, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland, USA
| | - Zhenpeng Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Desheng Kong
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yanling Wu
- Key Laboratory of Medical Molecular Virology of MOE/MOH, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Kunxue Hong
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology of MOE/MOH, School of Basic Medical Sciences, Fudan University, Shanghai, China. .,Lindsley F. Kimball Research Institute, New York Blood Center, New York, USA.
| | - Tianlei Ying
- Key Laboratory of Medical Molecular Virology of MOE/MOH, School of Basic Medical Sciences, Fudan University, Shanghai, China.
| | - Liying Ma
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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Predictors of Treatment Failure among Adult Antiretroviral Treatment (ART) Clients in Bale Zone Hospitals, South Eastern Ethiopia. PLoS One 2016; 11:e0164299. [PMID: 27716827 PMCID: PMC5055376 DOI: 10.1371/journal.pone.0164299] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
Background Treatment failure defined as progression of disease after initiation of ART or when the anti-HIV medications can’t control the infection. One of the major concerns over the rapid scaling up of ART is the emergence and transmission of HIV drug resistant strains at the population level due to treatment failure. This could lead to the failure of basic ART programs. Thus this study aimed to investigate the predictors of treatment failure among adult ART clients in Bale Zone Hospitals, South east Ethiopia. Methods Retrospective cohort study was employed in four hospitals of Bale zone named Goba, Robe, Ginir and Delomena. A total of 4,809 adult ART clients were included in the analysis from these four hospitals. Adherence was measured by pill count method. The Kaplan Meier (KM) curve was used to describe the survival time of ART patients without treatment failure. Bivariate and multivariable Cox proportional hazards regression models were used for identifying associated factors of treatment failure. Result The incidence rate of treatment failure was found 9.38 (95% CI 7.79–11.30) per 1000 person years. Male ART clients were more likely to experience treatment failure as compared to females [AHR = 4.49; 95% CI: (2.61–7.73)].Similarly, lower CD4 count (<100 m3/dl) at initiation of ART was found significantly associated with higher odds of treatment failure [AHR = 3.79; 95% CI: (2.46–5.84).Bedridden [AHR = 5.02; 95% CI: (1.98–12.73)] and ambulatory [AHR = 2.12; 95% CI: (1.08–4.07)] patients were more likely to experience treatment failure as compared to patients with working functional status. TB co-infected clients had also higher odds to experience treatment failure [AHR = 3.06; 95% CI: (1.72–5.44)]. Those patients who had developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR = 4.35; 95% CI: (1.99–9.54]. Having other opportunistic infection during ART initiation was also associated with higher odds of experiencing treatment failure [AHR = 7.0, 95% CI: (3.19–15.37)]. Similarly having fair [AHR = 4.99 95% CI: (1.90–13.13)] and poor drug adherence [AHR = 2.56; 95% CI: (1.12–5.86)]were significantly associated with higher odds of treatment failure as compared to clients with good adherence. Conclusion The rate of treatment failure in Bale zone hospitals needs attention. Prevention and control of TB and other opportunistic infections, promotion of ART initiation at higher CD4 level, and better functional status, improving drug adherence are important interventions to reduce treatment failure among ART clients in Southeastern Ethiopia.
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Gowda C, Coppock D, Brickman C, Shaw PA, Gross R. Determinants of HIV Transmission Risk Among HIV-Infected Persons Engaged in Care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:440-452. [PMID: 27710086 DOI: 10.1521/aeap.2016.28.5.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.
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Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases, Nationwide Children's Hospital and the Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio
| | - Dagan Coppock
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cristina Brickman
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco School of Medicine, San Francisco
| | - Pamela A Shaw
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Ayalew MB, Kumilachew D, Belay A, Getu S, Teju D, Endale D, Tsegaye Y, Wale Z. First-line antiretroviral treatment failure and associated factors in HIV patients at the University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:141-6. [PMID: 27621669 PMCID: PMC5015875 DOI: 10.2147/hiv.s112048] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) restores immune function and reduces HIV-related adverse outcomes. But treatment failure erodes this advantage and leads to an increased morbidity and compromised quality of life in HIV patients. The aim of this study was to determine the prevalence and factors associated with first-line ART failure in HIV patients at the University of Gondar Teaching Hospital. PATIENTS AND METHODS A retrospective study was conducted on 340 adults who had started ART during the period of September 2011 to May 2015. Data regarding patients' sociodemographics, baseline characteristics, and treatment-related information were collected through review of their medical charts. Data were analyzed using SPSS version 21. Descriptive statistics, cross-tabs, and binary and multiple logistic regressions were utilized. P<0.05 was used to declare association. RESULTS Among the 340 patients enrolled, 205 were females (60.3%). The mean age at ART initiation was 34.4 years. A total of 14 (4.1%) patients were found to have treatment failure. The median duration of treatment failure from initiation of treatment was 17.5 months (8-36 months). Poor adherence to treatment and low baseline CD4 cell count were found to be significant predictors of treatment failure. CONCLUSION The prevalence of first-line ART failure was 4.1%. Treatment failure was most likely to occur for the patients who had poor drug adherence and those who were delayed to start ART till their CD4 cell count became very low (<100 cells/mm(3)).
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Affiliation(s)
| | | | | | - Samson Getu
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Derso Teju
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Endale
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yemisirach Tsegaye
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zebiba Wale
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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A mechanistic theory to explain the efficacy of antiretroviral therapy. Nat Rev Microbiol 2014; 12:772-80. [PMID: 25263222 DOI: 10.1038/nrmicro3351] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the early years of the AIDS epidemic, a diagnosis of HIV-1 infection was equivalent to a death sentence. The development of combination antiretroviral therapy (cART) in the 1990s to combat HIV-1 infection was one of the most impressive achievements of medical science. Today, patients who are treated early with cART can expect a near-normal lifespan. In this Opinion article, we propose a fundamental theory to explain the mechanistic basis of cART and why it works so well, including a model to assess and predict the efficacy of antiretroviral drugs alone or in combination.
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Mhlanga JC, Durand D, Tsai HL, Durand CM, Leal JP, Wang H, Moore R, Wahl RL. Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry. Eur J Nucl Med Mol Imaging 2014; 41:596-604. [PMID: 24469258 DOI: 10.1007/s00259-013-2671-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of a semiautomated (18)F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. METHODS We retrospectively analyzed 41 whole-body (18)F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. RESULTS All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG = 0.96, single SUL-Peak = 0.96, single SUL-Max = 0.97, and MTV = 0.96, compared to 0.67 for CT nodal size (p < 0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. CONCLUSION Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.
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Affiliation(s)
- Joyce C Mhlanga
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Evaluation of WHO immunologic criteria for treatment failure: implications for detection of virologic failure, evolution of drug resistance and choice of second-line therapy in India. J Int AIDS Soc 2013; 16:18449. [PMID: 23735817 PMCID: PMC3672445 DOI: 10.7448/ias.16.1.18449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction Routine HIV viral load (VL) testing is not available in India. We compared test performance characteristics of immunologic failure (IF) against the gold standard of virologic failure (VF), examined evolution of drug resistance among those who stayed on a failing regimen because they did not meet criteria for IF and assessed implications for second-line therapy. Methods Participants on first-line highly active antiretroviral therapy (HAART) in Bangalore, India, were monitored for 24 months at six-month intervals, with CD4 count, VL and genotype, if VL>1000 copies/ml. Standard WHO criteria were used to define IF; VF was defined as having two consecutive VL>1000 copies/ml or one VL>10,000 copies/ml. Resistance was assessed using standard International AIDS Society-USA (IAS-USA) recommendations. Results Of 522 participants (67.6% male, mean age of 37.5; 85.1% on nevirapine-based and 40.4% on d4T-containing regimens), 57 (10.9%) had VF, 38 (7.3%) had IF and 13 (2.5%) had both VF and IF. The sensitivity of immunologic criteria to detect VF was 22.8%, specificity was 94.6% and positive predictive value was 34.2%. Forty-four participants with VF only continued on their failing first-line regimen; by the end of the study period, 90.9% had M184V, 63.6% had thymidine analogue mutations (TAMs), 34.1% had resistance to tenofovir, and 63.6% had resistance to etravirine. Conclusions WHO IF criteria have low sensitivity for detecting VF, and the presence of IF poorly predicts VF. Relying on CD4 counts leads to unnecessary switches to second-line HAART and continuation of failing regimens, jeopardizing future therapeutic options. Universal access to VL monitoring would avoid costly switches to second-line HAART and preserve future treatment options.
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Neogi U, Heylen E, Shet A, Chandy S, Shamsunder R, Sönnerborg A, Ekstrand ML. Long-term efficacy of first line antiretroviral therapy in Indian HIV-1 infected patients: a longitudinal cohort study. PLoS One 2013; 8:e55421. [PMID: 23383185 PMCID: PMC3559582 DOI: 10.1371/journal.pone.0055421] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/22/2012] [Indexed: 11/18/2022] Open
Abstract
Background Short term efficacy of combination antiretroviral therapy (cART) in resource-constrained settings is comparable to that found in western studies. However, long term data are limited. India has the third largest HIV infected population in the world but the long-term outcome of first line therapy according to the national guidelines has not been evaluated yet. Therefore, we conducted a long-term longitudinal analysis of the efficacy of the national first-line therapy in India from an observational cohort of Indian patients in two different clinical settings. Methodology/Principal Findings A total 323 patients who had been on ART for a median of 23 months and achieved virological suppression <100 copies/ml by their study baseline visit, were included and followed for two years. Blood samples were collected every six months for viral load and CD4 count. Drug resistance genotyping was performed when the viral load was >2000 copies/mL. Adherence and treatment interruptions (>48 h) were assessed via self-report. In the studied patients, the median duration of viral suppression was 44 months; 15.8% of patients showed viral rebound, and 2.8% viral failure. Viral rebound or failure was significantly negatively related to perfect adherence (100% adherence and no treatment interruption >48 hrs). Virological re-suppression in the subsequent visit was observed in three patients without any change in therapy despite the presence of key mutations. Conclusion/Significance Our study reports for the first time, a good long-term response to the first line therapy for a median of nearly four years although a less than perfect adherence increases the risk for treatment failure and subsequent drug resistance development. The empirical findings in this study also indicate the overall success of the Indian ART program in two different settings which likely are representative of other clinics that operate under the national guidelines.
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Affiliation(s)
- Ujjwal Neogi
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Castro P, Plana M, González R, López A, Vilella A, Nicolas JM, Gallart T, Pumarola T, Bayas JM, Gatell JM, García F. Influence of episodes of intermittent viremia ("blips") on immune responses and viral load rebound in successfully treated HIV-infected patients. AIDS Res Hum Retroviruses 2013; 29:68-76. [PMID: 23121249 DOI: 10.1089/aid.2012.0145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Presenting episodes of intermittent viremia (EIV) under combination antiretroviral therapy (cART) is frequent, but there exists some controversy about their consequences. They have been described as inducing changes in immune responses potentially associated with a better control of HIV infection. Conversely, it has been suggested that EIV increases the risk of virological failure. A retrospective analysis of a prospective, randomized double-blinded placebo-controlled study was performed. Twenty-six successfully treated HIV-infected adults were randomized to receive an immunization schedule or placebo, and after 1 year of follow-up cART was discontinued. The influence of EIV on T cell subsets, HIV-1-specific T cell immune responses, and viral load rebound, and the risk of developing genotypic mutations were evaluated, taking into account the immunization received. Patients with EIV above 200 copies/ml under cART had a lower proportion of CD4(+) and CD4(+)CD45RA(+)RO(-) T cells, a higher proportion of CD8(+) and CD4(+)CD38(+)HLADR(+) T cells, and higher HIV-specific CD8(+) T cell responses compared to persistently undetectable patients. After cART interruption, patients with EIV presented a significantly higher viral rebound (p=0.007), associated with greater increases in HIV-specific lymphoproliferative responses and T cell populations with activation markers. When patients with EIV between 20 and 200 copies/ml were included, most of the differences disappeared. Patients who present EIV above 200 copies/ml showed a lower CD4(+) T cell count and higher activation markers under cART. After treatment interruption, they showed greater specific immune responses against HIV, which did not prevent a higher virological rebound. EIV between 20 and 200 copies/ml did not have this deleterious effect.
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Affiliation(s)
- Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratories, HIVACAT (HIV Vaccine Development in Catalonia), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Raquel González
- Preventive Medicine Department Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna López
- Retrovirology and Viral Immunopathology Laboratories, HIVACAT (HIV Vaccine Development in Catalonia), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Vilella
- Preventive Medicine Department Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M. Nicolas
- Medical Intensive Care Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Teresa Gallart
- Retrovirology and Viral Immunopathology Laboratories, HIVACAT (HIV Vaccine Development in Catalonia), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Immunology Laboratory, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Microbiology Laboratory, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M. Bayas
- Preventive Medicine Department Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M. Gatell
- Infectious Diseases Unit, HIVACAT (HIV Vaccine Development in Catalonia), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Felipe García
- Infectious Diseases Unit, HIVACAT (HIV Vaccine Development in Catalonia), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Hocqueloux L, Choisy P, Le Moal G, Borsa-Lebas F, Plainchamp D, Legac E, Prazuck T, de la Tribonnière X, Yazdanpanah Y, Parienti JJ. Pharmacologic boosting of atazanavir in maintenance HIV-1 therapy: the COREYA propensity-score adjusted study. PLoS One 2012; 7:e49289. [PMID: 23152890 PMCID: PMC3494679 DOI: 10.1371/journal.pone.0049289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/08/2012] [Indexed: 11/24/2022] Open
Abstract
Background Among HIV-1 infected patients who achieved virologic suppression, the use of atazanavir without pharmacologic boosting is debated. We evaluated the efficacy and tolerance of maintenance therapy with unboosted atazanavir in clinical practice. Methods and Results This multicenter retrospective cohort study evaluated the efficacy of switching HIV-1-infected patients controlled on triple therapy to unboosted (ATV0, n = 98) versus ritonavir-boosted atazanavir (ATV/r, n = 254) +2 nucleos(t)ide reverse transcriptase inhibitors. The primary endpoint was time to virologic failure (VF, >200 copies/mL). ATV groups were compared controlling for potential confounding bias by inverse probability weighted Cox analysis and propensity-score matching. Overall and adjusted VF rates were similar for both strategies. Both strategies improved dyslipidemia and creatininemia, with less jaundice in the ATV0 group. Conclusion In previously well-suppressed patients, within an observational cohort setting, ATV0–based triple-therapy appeared as effective as ATV/r- based triple-therapy to maintain virologic suppression, even if co-administered with TDF, but was better tolerated.
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Affiliation(s)
- Laurent Hocqueloux
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France
| | - Philippe Choisy
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Gustave-Dron, Tourcoing, France
| | - Gwenaël Le Moal
- Service des Maladies Infectieuses, Hôpital de la Milétrie, Poitiers, France
| | | | - David Plainchamp
- Service des Maladies Infectieuses, Hôpital de la Milétrie, Poitiers, France
| | - Eric Legac
- Laboratoire de Biologie, Centre Hospitalier Régional, Orléans, France
| | - Thierry Prazuck
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France
| | - Xavier de la Tribonnière
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Gustave-Dron, Tourcoing, France
| | - Yazdan Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Gustave-Dron, Tourcoing, France
| | - Jean-Jacques Parienti
- Unité Biostatistique et Recherche Clinique, CHU Côte de Nacre, Caen, France
- * E-mail:
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Stephan C, Bartha V, Herrmann E, von Hentig N, Khaykin P, Knecht G, Gute P, Brodt HR, Stürmer M, Berger A, Bickel M. Impact of HIV-1 replication on immunological evolution during long-term dual-boosted protease inhibitor therapy. Med Microbiol Immunol 2012; 202:117-24. [PMID: 22983722 DOI: 10.1007/s00430-012-0276-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
To explore CD4-cell and viral evolution in relation to different levels of HIV-1 replication, as observed during protease inhibitor (PI)-based antiretroviral therapy. Adult HIV-1 infected cohort patients, receiving historical salvage therapy with daily doses of saquinavir (2,000 mg), ritonavir (200 mg) and either lopinavir (800 mg) or atazanavir (300 mg) for >36 weeks were retrospectively analysed for highest detectable viral load up to week 96 and assigned to groups according to the viral load level: always <50 copies/ml (1), 50-199 copies/ml (2), 200-499 copies/ml (3) and ≥500 copies/ml (4). A total of 126 patients were evaluated; at baseline, median CD4-cell count was 204/mm(3), HIV-1 RNA was 5.13 Log10-copies/ml and duration of prior HIV-1 infection was 11.7 years. Patients were assigned by 43, 30, 7 and 20 % to groups 1-4. Median observation time was 136 weeks (range: 38-304); at weeks 48/96, the CD4-cell gains for groups 1-4 were +88/+209, +209/+349, +67/+300 and +114.5/+ 128, respectively. After fitting data in a linear fixed effect model, ascending CD4 slopes were continuously increasing for group 1, similarly for 2 and clearly decreasing for 3-4 (p = 0.0006). Of 25 individuals from group 4, patient number with major IAS-USA protease mutations increased from 5 to 10 before and after failing PI therapy, whereas minor mutations remained stable (n = 18). On double-boosted PI therapy, CD4-cell increases through week 96 were similar for patients at always undetectable or with detection of low viral load. Viral detection >200 copies/ml was associated with decreasing CD4-cell slopes and emergence of major mutations, supporting this as benchmark for virological failure definition on PI therapy.
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Affiliation(s)
- Christoph Stephan
- Infectious Diseases Unit at Medical Department No. 2, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
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Ladefoged K, Andersson M, Koch A, Rendal T, Rydbacken M. Living conditions, quality of life, adherence and treatment outcome in Greenlandic HIV patients. Int J Circumpolar Health 2012; 71:18639. [PMID: 22663939 PMCID: PMC3417688 DOI: 10.3402/ijch.v71i0.18639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 04/18/2012] [Accepted: 04/24/2012] [Indexed: 12/25/2022] Open
Abstract
Objectives Despite a high level of sexually transmitted infections, HIV incidence has remained quite stable in Greenland with 5–6 new cases per year (approximately 10 per 100,000). However, disease control is suboptimal and mortality is relatively high. The aim of the present study was to determine associations between adherence to treatment and treatment outcome, living conditions and quality of life among HIV patients in Greenland. Material and methods Cross-sectional questionnaire-based cohort study of HIV patients in Greenland during 2008–2009. Data regarding treatment, viral load, CD4 count, etc. were obtained from a central HIV-database. Results Forty-six persons, 17 women and 29 men, of the 60 registered HIV-positive patients (77%) were included. Eighty percent were heterosexually infected and 17% by men having sex with men (MSM) activity. Median age at the time of diagnosis was 48 years (range 20–63). Eighty-nine percent received highly active antiretroviral therapy (HAART). Sixty-seven percent were adherent as defined by a combination of adherence to appointments and to treatment. Ninety-seven percent of adherent and 17% non-adherent patients on HAART had HIV-RNA less than 200 copies per ml (RR=24.2, p<0.0001). Poor adherence was associated with younger age (<50 years) (adjusted RR=7.95, p=0.005) and living in remote areas with no direct contact with skilled personnel (adjusted RR=6.75, p=0.01). Unsafe sex was also more frequent among non-adherent patients (RR=4.12, p=0.026), but due to few answers this topic was not included in the multivariate model. Conclusion The HIV population in Greenland is peculiar since most patients are heterosexually infected and middle-aged at diagnosis. A relatively poor adherence and consequently inferior treatment outcome is related to young age and living in remote areas.
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Affiliation(s)
- Karin Ladefoged
- Medical Department, Queen Ingrid's Hospital, Nuuk, Greenland.
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Bélec L, Bonn JP. Challenges in implementing HIV laboratory monitoring in resource-constrained settings: how to do more with less. Future Microbiol 2012; 6:1251-60. [PMID: 22082287 DOI: 10.2217/fmb.11.121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Laboratory monitoring for HIV disease in resource-limited settings has now become one of the key challenges for antiretroviral treatment (ART) access and success, as emphasized by the 2010 revised WHO guidelines for ART in resource-limited settings. Thus, the most common method for initiating ART, and monitoring treatment response in resource-constrained environments is the measurement of CD4 T-cell count. Affordable CD4 T-cell counting has gradually been made possible by using simple, compact and robust, low-cost, new-generation cytometers, operating as single-platform volumetric instruments. Several cost-effective point-of-care CD4 T-cell testing options are also already on the market, in order to improve access to CD4 T-cell monitoring, especially for rural patients, and to reduce loss-to-follow-up of patients. In addition, HIV RNA viral load measurement is becoming increasingly important, mainly for a systematic confirmation of first-line ART failure before switching to second-line treatment to avoid belated as well as premature therapeutic decisions and their potentially negative consequences. Viral load testing should now be considered as the standard of care for therapeutic failure in all resource-limited settings. However, the measurement of HIV viral load remains a centralized marker, carried out in a limited number of reference laboratories. Finally, the costs of second-line ART regimens, rather than the laboratory test costs themselves, currently constitute the primary determinant of the total cost in ART switching. Laboratory monitoring strategies may become more attractive as price negotiations render second-line ART regimens less expensive worldwide.
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Affiliation(s)
- Laurent Bélec
- Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratoire de Virologie, Paris, France.
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Elevated CD8 counts during HAART are associated with HIV virologic treatment failure. J Acquir Immune Defic Syndr 2011; 57:396-403. [PMID: 21602694 DOI: 10.1097/qai.0b013e318221c62a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether elevated CD8 counts are associated with increased risk of virologic treatment failure in HIV-infected individuals. DESIGN Retrospective cohort study. METHODS US Military HIV Natural History Study participants who initiated highly active antiretroviral therapy (HAART) in 1996-2008 had 6- and 12-month post-HAART HIV RNA <400 copies per milliliter, ≥ 2 subsequent HIV viral loads and a baseline CD8 count were eligible (n = 817). Baseline was 12 months after the start of HAART, virologic failure (VF) was defined as confirmed HIV RNA ≥ 400 copies per milliliter, and CD8 counts ≥ 1200 cells per cubic millimeter were considered elevated. Cox models were used to examine the effect of baseline and time-updated CD8 counts on VF. RESULTS There were 216 failures for a rate of 5.6 per 100 person-years [95% confidence interval (CI): 4.9 to 6.4]. Among those initiating HAART in 2000-2008, the participants with elevated baseline CD8 counts had significantly greater risk of VF compared with those with baseline CD8 counts ≤ 600 cells per cubic millimeter [hazard ratio (HR) = 2.68, 95% CI: 1.13 to 6.35]. The participants with elevated CD8 counts at >20% of previous 6-month follow-up visits had a greater risk of failure at the current visit than those who did not (HR = 1.53, 95% CI: 1.14 to 2.06). Those with CD8 counts that increased after the start of HAART had a greater risk of failure than those with CD8 counts that decreased or remained the same (HR = 1.59, 95% CI: 1.19 to 2.13). CONCLUSIONS Initial or serial elevated CD8 counts while on HAART or an increase in CD8 counts from HAART initiation may be early warnings for future treatment failure.
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Chung MH, Richardson BA, Tapia K, Benki-Nugent S, Kiarie JN, Simoni JM, Overbaugh J, Attwa M, John-Stewart GC. A randomized controlled trial comparing the effects of counseling and alarm device on HAART adherence and virologic outcomes. PLoS Med 2011; 8:e1000422. [PMID: 21390262 PMCID: PMC3046986 DOI: 10.1371/journal.pmed.1000422] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioral interventions that promote adherence to antiretroviral medications may decrease HIV treatment failure. Antiretroviral treatment programs in sub-Saharan Africa confront increasing financial constraints to provide comprehensive HIV care, which include adherence interventions. This study compared the impact of counseling and use of an alarm device on adherence and biological outcomes in a resource-limited setting. METHODS AND FINDINGS A randomized controlled, factorial designed trial was conducted in Nairobi, Kenya. Antiretroviral-naïve individuals initiating free highly active antiretroviral therapy (HAART) in the form of fixed-dose combination pills (d4T, 3TC, and nevirapine) were randomized to one of four arms: counseling (three counseling sessions around HAART initiation), alarm (pocket electronic pill reminder carried for 6 months), counseling plus alarm, and neither counseling nor alarm. Participants were followed for 18 months after HAART initiation. Primary study endpoints included plasma HIV-1 RNA and CD4 count every 6 months, mortality, and adherence measured by monthly pill count. Between May 2006 and September 2008, 400 individuals were enrolled, 362 initiated HAART, and 310 completed follow-up. Participants who received counseling were 29% less likely to have monthly adherence <80% (hazard ratio [HR] = 0.71; 95% confidence interval [CI] 0.49-1.01; p = 0.055) and 59% less likely to experience viral failure (HIV-1 RNA ≥5,000 copies/ml) (HR 0.41; 95% CI 0.21-0.81; p = 0.01) compared to those who received no counseling. There was no significant impact of using an alarm on poor adherence (HR 0.93; 95% CI 0.65-1.32; p = 0.7) or viral failure (HR 0.99; 95% CI 0.53-1.84; p = 1.0) compared to those who did not use an alarm. Neither counseling nor alarm was significantly associated with mortality or rate of immune reconstitution. CONCLUSIONS Intensive early adherence counseling at HAART initiation resulted in sustained, significant impact on adherence and virologic treatment failure during 18-month follow-up, while use of an alarm device had no effect. As antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counseling should be implemented to decrease the development of treatment failure and spread of resistant HIV.
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Affiliation(s)
- Michael H Chung
- Department of Global Health, University of Washington, Seattle, Washington, USA.
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Vogel M, Schwarze-Zander C, Wasmuth JC, Spengler U, Sauerbruch T, Rockstroh JK. The treatment of patients with HIV. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:507-15; quiz 516. [PMID: 20703338 DOI: 10.3238/arztebl.2010.0507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/15/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Infection with the human immunodeficiency virus (HIV) remains a major medical challenge. METHODS Selective literature review, including the current German/Austrian, European, and American guidelines on the treatment of HIV infection in adults. RESULTS In Germany, 3000 persons become infected with HIV each year; in 2009, 67,000 persons in Germany were living with HIV. When highly active antiretroviral therapy (HAART) is initiated in time, patients can achieve a nearly normal life expectancy. Nonetheless, in Germany as elsewhere, 30% of patients receive the diagnosis of HIV infection only when they have reached the AIDS stage of the disease or are suffering from advanced immunodeficiency. HAART should be started, at the latest, when the CD4-positive helper cell count drops below 350/microL. Primary drug resistances, accompanying illnesses, and the patient's living circumstances must all be taken into account in the selection of antiretroviral drugs. The goal of treatment is lasting suppression of HIV-RNA to below 50 copies per milliliter of plasma. CONCLUSIONS HIV testing should be offered to all patients at high risk for HIV infection and all persons newly diagnosed with a sexually transmitted disease. As persons with HIV grow older, their treatment is complicated by increasing comorbidity and requires increased vigilance for possible drug interactions.
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Affiliation(s)
- Martin Vogel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn
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