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Goh HQ, Nelson LE, Teo WZ, Aidoo-Frimpong G, Ramos SR, Shorey S. Perspectives and thoughts of pregnant women and new mothers living with HIV receiving peer support: A mixed studies systematic review. J Adv Nurs 2024; 80:2715-2727. [PMID: 38093472 DOI: 10.1111/jan.16014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 06/13/2024]
Abstract
AIM The aim of this study was to systematically consolidate evidence on perspectives and thoughts of women living with HIV regarding the peer support they have encountered during pregnancy and after childbirth. DESIGN Mixed studies systematic review. DATA SOURCES PubMed, EMBASE, Cochrane, PsycINFO, CINAHL, Scopus and ProQuest were sourced from 1981 to January 2022. METHODS A convergent qualitative synthesis approach was used to analyse the data. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 12 studies were included, involving 1596 pregnant women and 1856 new mothers living with HIV. An overarching theme, 'From One Mother to Another: The Supportive Journey of Pregnant Women and New Mothers Living with HIV', and two themes were identified: (1) Emotional support buddies and extended networks and (2) Link bridge to healthcare support and self-empowerment. CONCLUSION Peer support played an indispensable role in the lives of women living with HIV and served as a complementary support system to professional and family support. IMPACT What problem did the study address? Pregnant women and new mothers living with HIV face preconceived stigma and discrimination. What were the main findings? Peer support was perceived to be beneficial in enhancing emotional support among women living with HIV and was well-accepted by them. Where and on whom will the research have an impact? Healthcare providers and community social workers could develop or enhance peer support educational programmes tailored to pregnant women and new mothers living with HIV. Policymakers and administrators can leverage public awareness, advocacy and political will to formulate and implement policies and campaigns aimed at fostering awareness and receptivity towards peer support interventions. REPORTING METHOD Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Huang Qi Goh
- National Kidney Foundation, Singapore, Singapore
| | - LaRon E Nelson
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Wei Zhou Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gloria Aidoo-Frimpong
- Yale AIDS Prevention Training Program, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - S Raquel Ramos
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Deshpande RP, CS C, Bhadoria RS. Outcomes of HIV-infected Patients on Dialysis: Experience at a Tertiary Care Center. Indian J Nephrol 2024; 34:139-143. [PMID: 38681011 PMCID: PMC11044686 DOI: 10.4103/ijn.ijn_523_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/21/2022] [Indexed: 05/01/2024] Open
Abstract
Background Human immunodeficiency virus (HIV) infection is a major public health problem. These patients are at an increased risk for end-stage kidney disease. Both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are the accepted modalities of treatment. Materials and Methods In this retrospective study, we included all HIV-positive end-stage kidney disease (ESKD) patients who were on dialysis - HD or CAPD - for at least 1 month. Data were collected from the dialysis charts and analyzed. Results There were 20 patients in the CAPD group and 76 patients in the HD group. Mean age was 49.6 ± 8.73 years in the CAPD group and 46.28 ± 9.02 years in the HD group. Hypertension and diabetes were the common causes for ESKD. Mean survival was slightly better in CAPD group (20.94 vs. 15.46 months). The HD group had higher mortality within 12 months of dialysis initiation, and infection was the cause for early deaths. Mean infection episodes was 2.1 in HD group and 3.1 in CAPD group. CAPD patients with low albumin (<2.5 g/dl) had higher peritonitis rates. Conclusion Managing HIV-positive dialysis patients remains challenging. In our study, survival was marginally better in the CAPD group. In both groups, low CD4 count was associated with more infections and low albumin with more peritonitis episodes. A study incorporating more peritoneal dialysis (PD) patients, longer follow-ups, and a matched non-HIV control will throw more light on patient outcomes.
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Affiliation(s)
- Ravi Prakash Deshpande
- Department of Nephrology, ST. Johns National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Chetan CS
- Department of Nephrology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Vallée A, Majerholc C, Zucman D, Livrozet JM, Laurendeau C, Bouée S, Prevoteau du Clary F. Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18. Eur J Public Health 2024:ckae031. [PMID: 38409963 DOI: 10.1093/eurpub/ckae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. METHODS Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. RESULTS During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. CONCLUSION Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Jean-Michel Livrozet
- Department of Infectious and Tropical Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Angel JB, Freilich J, Arthurs E, Ban JK, Lachaine J, Chounta V, Harris M. Adherence to oral antiretroviral therapy in Canada, 2010-2020. AIDS 2023; 37:2031-2040. [PMID: 37418513 PMCID: PMC10552836 DOI: 10.1097/qad.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To assess antiretroviral therapy (ART) adherence among people with HIV (PWH) in Canada and identify baseline characteristics associated with suboptimal adherence (<95%). DESIGN Retrospective observational study using data from the National Prescription Drug Utilization Information System and Régie de l'assurance maladie Quebec (RAMQ) Public Prescription Drug Insurance Plan. METHODS This analysis included PWH aged 18 years or older who initiated an ART regimen and were followed for at least 12 months (2010-2020). Patient characteristics were summarized using medical/pharmacy claims data from seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). ART regimen at index date (first dispensing of a regimen including a core agent) was defined as a single-tablet or multitablet regimen (MTR). Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Multivariate linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics. RESULTS We identified 19 322 eligible PWH, 44.7% of whom had suboptimal adherence (<95%). Among 12 594 PWH with evaluable baseline data, 10 673 (84.8%) were ART-naive, 74.2% were men, mean age was 42.9 years, and 54.1% received a MTR as their ART. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multitablet ART ( P < 0.001) and younger age ( P < 0.001) but not sex. CONCLUSION Almost half of adult PWH in Canada had suboptimal adherence to ART. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact adherence.
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Affiliation(s)
- Jonathan B. Angel
- Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, Ontario, Canada
| | - Jonatan Freilich
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå
- Parexel International, Stockholm, Sweden
| | - Erin Arthurs
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Joann K. Ban
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Jean Lachaine
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Vasiliki Chounta
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, UK
| | - Marianne Harris
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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GAO H, ZHANG J, YANG X, CHEN S, MATHEW R, WEISSMAN S, OLATOSI B, LI X. The incidence and dynamic risk factors of chronic kidney disease among people with HIV. AIDS 2023; 37:1783-1790. [PMID: 37467049 PMCID: PMC10529259 DOI: 10.1097/qad.0000000000003662] [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] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We investigate the incidence of chronic kidney disease (CKD) among people with HIV (PWH) and the dynamic risk factors associated with CKD incidence. DESIGN A population-based cohort study of PWH in South Carolina. METHODS Adults (age ≥18 years) PWH diagnosed between 2006 and 2019 who were CKD-free at baseline were included. The associations of HIV-related risk factors and conventional risk factors with the incidence of CKD were investigated during the overall study period and by different follow-up periods (i.e. 5, 10, and 15 years) by multivariate logistic regression. RESULTS Among 9514 PWH, the incidence of CKD was 12.39 per 1000 person-years. The overall model indicated that conventional risk factors, such as hypertension, dyslipidemia, cardiovascular disease, and diabetes, were significantly associated with a higher risk of developing CKD. HIV-related characteristics, such as high percentage of days with viral suppression, recent CD4 + cell count, and percentage of retention in care, were associated with a lower risk of CKD compared with their counterparts. In the subgroup analysis, the results were similar for the 5-year and 6-10 years follow-up groups. Among patients who did not develop CKD by the 10th year, the risk factors for developing CKD within 11-15 years were dyslipidemia, diabetes, low recent CD4 + cell count, and short duration of retention in care while other predictors vanished. CONCLUSION Diabetes, CD4 + cell count, and retention in care were persistently associated with CKD despite of follow-up duration. Closely monitoring diabetes and improving CD4 + cell count and retention in care are important to lower the risk of CKD in PWH.
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Affiliation(s)
- Haoyuan GAO
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia ZHANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xueying YANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie CHEN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Roy MATHEW
- Division of Nephrology, Department of Medicine Loma Linda VA Health Care System. Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Sharon WEISSMAN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole OLATOSI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming LI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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Moitra E, Stein MD, Busch AM, Pinkston MM, Abrantes AM, Baker JV, Weisberg RB, Anderson BJ, Uebelacker LA. Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress. AIDS Care 2022; 34:1338-1346. [PMID: 34554879 PMCID: PMC8940733 DOI: 10.1080/09540121.2021.1981819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = -.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = -1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Michael D. Stein
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jason V. Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Risa B. Weisberg
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Psychosocial Research, Butler Hospital, Providence RI, USA
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Wei Q, Zhao Y, Lv Y, Kang X, Pan S, Yao S, Wang L. High Rate of HIV-1 Drug Resistance in Antiretroviral Therapy-Failure Patients in Liaoning Province, China. AIDS Res Hum Retroviruses 2022; 38:502-509. [PMID: 35229630 DOI: 10.1089/aid.2021.0079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
This study aimed to monitor the prevalence of HIV-1 drug resistance and risk factors associated with drug resistance in antiretroviral therapy (ART)-failure individuals in Liaoning Province, China. Plasma samples were collected from HIV-1-positive individuals who experienced ART failure in Liaoning Province between April 2018 and September 2019. Genotype resistance test was performed using an in-house assay on these collected samples. Factors associated with drug resistance were identified by logistic regression analysis. We collected a total of 468 ART-failure individuals, of which 256 were successfully included in the final study. Of these, the most predominant genotype was CRF01_AE, accounting for 77.73%. The resistance rate to any of the three classes of antiretroviral drugs (non-nucleoside reverse transcriptase inhibitors [NNRTIs], nucleoside reverse transcriptase inhibitors [NRTIs], and protease inhibitors [PIs]) was 64.84%. Among 256 ART-failure patients, 62.89% showed drug resistance to NNRTIs, 50.39% to NRTIs, and 3.13% to PIs. G190S (31.25%) and Y181C (25.78%) mutations were the most common NNRTIs resistance mutations. K65R (29.69%), M184V (28.52%) were the most common NRTIs resistance mutations. Factors associated with drug resistance included current ART regimen and viral load. The high drug resistance rate among ART-failure individuals in Liaoning Province needs more attention. Corresponding strategies for the risk factors associated with HIV drug resistance can better control and prevent the prevalence of resistance.
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Affiliation(s)
- Qianqian Wei
- Institute for Preventive Medicine of China Medical University, Shenyang, China
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Yan Zhao
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Yani Lv
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Xu Kang
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Shan Pan
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Shujie Yao
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Li Wang
- Institute for Preventive Medicine of China Medical University, Shenyang, China
- Institute for AIDS/STD Control and Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
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Manosuthi W, Charoenpong L, Santiwarangkana C. A retrospective study of survival and risk factors for mortality among people living with HIV who received antiretroviral treatment in a resource-limited setting. AIDS Res Ther 2021; 18:71. [PMID: 34641922 PMCID: PMC8513274 DOI: 10.1186/s12981-021-00397-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The availability and accessibility of effective antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved in the past two decades in resource-limited settings. Therefore, evaluation of survival is needed in the current setting. METHOD We retrospectively analyzed secondary data of the national AIDS program database from national health security region number 4 among PLWH who were ART-naive between January 2014 and December 2018. All PLWH were followed until December 2019 to evaluate their survival status and possible risk factors related to death. RESULTS A total of 42,229 PLWH were identified, of which 14,053 were ART-naive and thus enrolled in the study. Sixty-seven percent were male, the mean ± SD age was 35 ± 12 years, and the median (IQR) baseline CD4 count was 162 (44-353) cells/mm3. Regarding medical care benefits, 46% had a universal health coverage scheme, 34% had a national social security scheme, and 2% had a civil servants medical benefit scheme. A total of 2142 (15%) mortalities occurred during the total follow-up period of 28,254 patient-years. The mortality rate was 7.5 (95% CI 7.2-7.9) per 100 person-years. Survival rates at 1, 2, 3, 4 and 5 years after HIV registration were 88.2% (95% CI 87.6-88.7%), 85.3% (95% CI 84.6-85.9%), 82.9% (95% CI 81.9-83.4%), 81.3% (95% CI 80.5-82.0%) and 75.1% (95% CI 73.5-76.8%), respectively. The Cox proportional hazards model showed that all-cause mortality was associated with a history of ART switching (HR = 7.06, 95% CI 4.53-11.00), major opportunistic infections during ART (HR = 1.93, 95% CI 1.35-2.77), baseline CD4 count ≤ 200 vs. > 500 cells/mm3 (HR = 4.00, 95% CI 1.45-11.11), age ≥ 50 vs. < 30 years (HR = 1.77, 95% CI 1.12-2.78), and receiving nevirapine-based regimens(HR = 1.43, 95% CI 1.04-1.97). CONCLUSIONS This study demonstrated the substantial mortality rate over the consecutive 5 years of the follow-up period among PLWH who received ART in a resource-limited setting. Early case finding and prompt initiation of ART as well as continuous HIV care are a cornerstone to improve survival.
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Affiliation(s)
- Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Department of Diseases Control, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Lantharita Charoenpong
- Bamrasnaradura Infectious Diseases Institute, Department of Diseases Control, Ministry of Public Health, Nonthaburi, 11000, Thailand
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Onwuamah CK, Okwuraiwe AP, Ahmed RA, Sokei JO, Ponmak J, Okoli LC, Kagurusi BA, Anejo-Okopi J. Laboratory Optimization Tweaks for Sanger Sequencing in a Resource-Limited Setting. J Biomol Tech 2021; 31:157-164. [PMID: 33100921 DOI: 10.7171/jbt.20-3104-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite various challenges that hinder the implementation of high-tech molecular methods in resource-limited settings, we have been able to implement and achieve International Organization for Standardization 15189:2012 accreditation for genotypic HIV drug resistance testing in our facility. At the Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Nigeria has recorded a high sequencing success rate and good quality sequence data. This was achieved by optimizing laboratory processes from 2008 to the current date. We have optimized sample preparation, RT-PCR, several post-PCR processes, and the cycle sequencing to improve the sensitivity of amplification even with limited plasma samples and low viral copy numbers. The optimized workflow maximizes output, minimizes reagent wastage, and achieves substantial cost savings without compromising the quality of the sequence data. Our performance at our last external quality assurance program is a testimonial to the efficiency of the workflow. For the 5-sample panel, each with 67-68 mutation points evaluated, we scored 100% for all 5 specimens. Our optimized laboratory workflow is thus documented to support laboratories and to help researchers achieve excellent results the first time and eliminate contamination while minimizing the wastage of costly sequencing reagents.
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Affiliation(s)
- Chika K Onwuamah
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | - Azuka P Okwuraiwe
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | - Rahaman A Ahmed
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | - Judith O Sokei
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | - Jamda Ponmak
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | - Leona C Okoli
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba 101212, Lagos, Nigeria
| | | | - Joseph Anejo-Okopi
- AIDS Prevention Initiative in Nigeria, Jos, University Teaching Hospital, Jos, Nigeria
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Kuber A, Reuter A, Geldsetzer P, Chimbindi N, Moshabela M, Tanser F, Bärnighausen T, Vollmer S. The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa. Sci Rep 2021; 11:14718. [PMID: 34282184 PMCID: PMC8289961 DOI: 10.1038/s41598-021-94057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
We use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.
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Affiliation(s)
- Aditi Kuber
- Department of Economics, University of Goettingen, Göttingen, Germany
| | - Anna Reuter
- Department of Economics, University of Goettingen, Göttingen, Germany.
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mosa Moshabela
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Göttingen, Germany
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Hepatocellular cancer therapy in patients with HIV infection: Disparities in cancer care, trials enrolment, and cancer-related research. Transl Oncol 2021; 14:101153. [PMID: 34144349 PMCID: PMC8220238 DOI: 10.1016/j.tranon.2021.101153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
In the highly active antiretroviral therapy (HAART) era, hepatocellular carcinoma (HCC) is arising as a common late complication of human immunodeficiency virus (HIV) infection, with a great impact on morbidity and mortality. Though HIV infection alone may not be sufficient to promote hepatocarcinogenesis, the complex interaction of HIV with hepatitis is a main aspect influencing HCC morbidity and mortality. Data about sorafenib effectiveness and safety in HIV-infected patients are limited, particularly for patients who are on HAART. However, in properly selected subgroups, outcomes may be comparable to those of HIV-uninfected patients. Scarce data are available for those other systemic treatments, either tyrosine kinase inhibitors, as well as immune checkpoint inhibitors (ICIs), which have been added to our therapeutic armamentarium. This review examines the influence of HIV infection on HCC development and natural history, summarizes main data on systemic therapies, offers some insight into possible mechanisms of T cell exhaustion and reversal of HIV latency with ICIs and issues about clinical trials enrollment. Nowadays, routine exclusion of HIV-infected patients from clinical trial participation is totally inappropriate, since it leaves a number of patients deprived of life-prolonging therapies.
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12
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Iversen J, Qureshi SUH, Zafar M, Busz M, Maher L. Adherence to antiretroviral therapy among HIV positive men who inject drugs in Pakistan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103281. [PMID: 34016509 DOI: 10.1016/j.drugpo.2021.103281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV have poorer adherence to HIV antiretroviral therapy (ART) and elevated mortality compared to other populations. Little is known about factors associated with adherence among PWID in low-and middle-income countries, including in countries where opioid agonist therapy (OAT) is unavailable. We aimed to estimate ART adherence among men who inject drugs (MWID) living with HIV in Pakistan and identify factors independently associated with adherence. METHODS Nai Zindagi Trust (NZT) provides a range of HIV prevention, testing and treatment services to PWID in Pakistan. This study utilized data from HIV positive MWID who received ART refill/s from public sector ART Centres via NZT's Social Mobilizer Adherence Support Unit between September 2016 and December 2018. Multivariable logistic regression modelled factors independently associated with ART adherence. RESULTS Among 5,482 HIV positive MWID registered with NZT who had attended the AAU and were supplied with ART refills between September 2016 and December 2018., 55% were adherent to ART. Independent predictors of adherence were being married (AOR 1.38, 95% CI:1.23-1.55, p<0.001) and >5 years of education compared to those with no education (AOR 1.19, 95% CI:1.05-1.35, p = 0.005). MWID living on the street at night had lower adjusted odds of ART adherence (AOR 0.75, 95% CI:0.62-0.91, p = 0.003). CONCLUSIONS Findings indicate that MWID living with HIV continue to face barriers to ART adherence in Pakistan. Despite considerable evidence supporting the impact of OAT in increasing ART adherence among PWID, OAT remains illegal and inaccessible in Pakistan. Evidence-based interventions, including OAT, are needed to increase adherence and improve clinical outcomes, health equity and survival among PWID living with HIV in Pakistan.
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Affiliation(s)
- Jenny Iversen
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Sydney, Australia.
| | | | | | | | - Lisa Maher
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Sydney, Australia
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13
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Anti-Retroviral Protease Inhibitors Regulate Human Papillomavirus 16 Infection of Primary Oral and Cervical Epithelium. Cancers (Basel) 2020; 12:cancers12092664. [PMID: 32961945 PMCID: PMC7563395 DOI: 10.3390/cancers12092664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In 2016, globally, 36.7 million people were living with Human Immunodeficiency Virus (HIV), of which 53% had access to anti-retroviral therapy (ART) (UNAIDS 2017 Global HIV Statistics). The risk of Human Papillomavirus (HPV) associated oropharyngeal, cervical and anal cancers are higher among patients infected with HIV in the era of ART. Generally, HPV infections are self-limiting, however, persistent HPV infection is a major risk to carcinogenic progression. Long intervals between initial infection and cancer development imply cofactors are involved. Co-factors that increase infectivity, viral load, and persistence increase risk of cancer. We propose that the ART Protease Inhibitors (PI) class of drugs are novel co-factors that regulate HPV infection in HIV-infected patients. We developed a model system of organotypic epithelium to study impact of PI treatment on HPV16 infection. Our model could be used to study mechanisms of HPV infection in context of ART, and for developing drugs that minimize HPV infections. Abstract Epidemiology studies suggest that Human Immunodeficiency Virus (HIV)-infected patients on highly active anti-retroviral therapy (HAART) may be at increased risk of acquiring opportunistic Human Papillomavirus (HPV) infections and developing oral and cervical cancers. Effective HAART usage has improved survival but increased the risk for HPV-associated cancers. In this manuscript, we report that Protease Inhibitors (PI) treatment of three-dimensional tissues derived from primary human gingiva and cervical epithelial cells compromised cell-cell junctions within stratified epithelium and enhanced paracellular permeability of HPV16 to the basal layer for infection, culminating in de novo biosynthesis of progeny HPV16 as determined using 5-Bromo-2′-deoxyuridine (BrdU) labeling of newly synthesized genomes. We propose that HAART/PI represent a novel class of co-factors that modulate HPV infection of the target epithelium. Our in vitro tissue culture model is an important tool to study the mechanistic role of anti-retroviral drugs in promoting HPV infections in HAART-naïve primary epithelium. Changes in subsequent viral load could promote new infections, create HPV reservoirs that increase virus persistence, and increase the risk of oral and cervical cancer development in HIV-positive patients undergoing long-term HAART treatment.
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14
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Asiimwe SB, Montana L, Kahn K, Tollman SM, Kabudula CW, Gómez-Olivé XF, Berkman LF, Glymour MM, Bärnighausen T. HIV Status and Antiretroviral Therapy as Predictors of Disability among Older South Africans: Overall Association and Moderation by Body Mass Index. J Aging Health 2020; 32:1335-1344. [PMID: 32501168 DOI: 10.1177/0898264320925323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Among older people living with HIV (PLWH) and comparable individuals without HIV, we evaluated whether associations of HIV and antiretroviral therapy (ART) with disability depend on body mass index (BMI). Methods: We analyzed 4552 participants in the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa." (HAALSI) We compared prevalence of disability (≥1 impairment in basic activities of daily living) by HIV status, ART use, and BMI category, adjusting for age, sex, education, father's occupation, country of origin, lifetime alcohol use, and primary health-care utilization. Results: Among PLWH, those underweight had 9.8% points (95% confidence interval (CI): 1.2 to 18.4) higher prevalence of disability than those with normal BMI. Among ART users, those underweight had 11.9% points (95% CI: 2.2 to 21.6) higher prevalence of disability than those with normal BMI. Conclusions: We found no evidence that weight improvement associated with ART use is likely to increase disability.
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Affiliation(s)
| | | | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Xavier F Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa F Berkman
- Harvard University, MA, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Till Bärnighausen
- Harvard University, MA, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,University of Heidelberg, Baden-Württemberg, Germany
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15
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Madkour AS, Felker-Kantor E, Wallace M, Ferguson T, Welsh DA, Molina PE, Theall KP. Latent Alcohol Use Typologies and Health Status Among a Cohort of Adults Living with HIV. Alcohol Alcohol 2020; 54:584-592. [PMID: 31580404 DOI: 10.1093/alcalc/agz071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. METHODS Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heavy drinking, intoxication, withdrawal and dependence symptoms, alcohol-related problems and past contact with alcohol use treatment were drawn from validated scales. Physical and mental health measures included SF-36 subscales, medication non-adherence and anxiety, depressive and post-traumatic stress disorder symptoms. Latent class analysis was conducted to characterize alcohol drinking typologies. Logistic and ordinary least-squares regression were employed to test associations between alcohol use and health status. RESULTS Four latent classes were identified: heavy drinkers (36%), former heavy drinkers (14%), heavy drinkers with problems (12%) and low-risk drinkers/abstainers (38%). Controlling for background characteristics, low-risk drinkers/abstainers showed significantly better health compared to heavy drinkers with problems across most domains. Although current and former heavy drinkers without alcohol-related problems were similar to heavy drinkers with problems in most health domains, they presented worse mental health and energy compared to low-risk drinkers/abstainers. CONCLUSIONS Heavy drinkers with alcohol-related problems evidenced the worst health status among PLWH, and should be considered for mental and physical health interventions. However, interventions to improve physical and mental health of PLWH should consider history of heavy alcohol use, as current alcohol use status alone may be insufficient for identifying groups at increased risk.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, 1901 Perdido Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Patricia E Molina
- Department of Physiology Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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16
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Development and Validation of a Risk Prediction Tool to Identify People with HIV Infection Likely Not to Achieve Viral Suppression. AIDS Patient Care STDS 2020; 34:157-165. [PMID: 32324484 DOI: 10.1089/apc.2019.0224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Identifying people with HIV infection (PHIV), who are at risk of not achieving viral suppression, is important for designing targeted intervention. The aim of this study was to develop and test a risk prediction tool for PHIV who are at risk of not achieving viral suppression after a year of being in care. We used retrospective data to develop an integer-based scoring method using backward stepwise logistic regression. We also developed risk score categories based on the quartiles of the total risk score. The risk prediction tool was internally validated by bootstrapping. We found that nonviral suppression after a year of being in care among PHIV can be predicted using seven variables, namely, age group, race, federal poverty level, current AIDS status, current homelessness status, problematic alcohol/drug use, and current viral suppression status. Those in the high-risk category had about a 23 increase in the odds of nonviral suppression compared with the low-risk group. The risk prediction tool has good discriminative performance and calibration. Our findings suggest that nonviral suppression after a year of being in care can be predicted using easily available variables. In settings with similar demographics, the risk prediction tool can assist health care providers in identifying high-risk individuals to target for intervention. Follow-up studies are required to externally validate this risk prediction tool.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Sandra G. Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida, USA
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
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17
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Caetano DG, de Paula HHS, Bello G, Hoagland B, Villela LM, Grinsztejn B, Veloso VG, Morgado MG, Guimarães ML, Côrtes FH. HIV-1 elite controllers present a high frequency of activated regulatory T and Th17 cells. PLoS One 2020; 15:e0228745. [PMID: 32023301 PMCID: PMC7001932 DOI: 10.1371/journal.pone.0228745] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022] Open
Abstract
HIV-1 infection is characterized by generalized deregulation of the immune system, resulting in increased chronic immune activation. However, some individuals called HIV controllers (HICs) present spontaneous control of viral replication and have a more preserved immune system. Among HICs, discordant results have been observed regarding immune activation and the frequency of different T cell subsets, including Treg and Th17 cells. We evaluated T cell immune activation, differentiation and regulatory profiles in two groups of HICs—elite controllers (ECs) and viremic controllers (VCs)—and compared them to those of cART-treated individuals (cART) and HIV-1-negative (HIV-neg) individuals. ECs demonstrated similar levels of activated CD4+ and CD8+ T cells in comparison to HIV-neg, while cART and VCs showed elevated T cell activation. CD4+ T cell subset analyses showed differences only for transitional memory T cell frequency between the EC and HIV-neg groups. However, VC individuals showed higher frequencies of terminally differentiated, naïve, and stem cell memory T cells and lower frequencies of transitional memory and central memory T cells compared to the HIV-neg group. Among CD8+ T cell subsets, ECs presented higher frequencies of stem cell memory T cells, while VCs presented higher frequencies of terminally differentiated T cells compared to the HIV-neg group. HICs showed lower frequencies of total Treg cells compared to the HIV-neg and cART groups. ECs also presented higher frequencies of activated and a lower frequency of resting Treg cells than the HIV-neg and cART groups. Furthermore, we observed a high frequency of Th17 cells in ECs and high Th17/Treg ratios in both HIC groups. Our data showed that ECs had low levels of activated T cells and a high frequency of activated Treg and Th17 cells, which could restrict chronic immune activation and be indicative of a preserved mucosal response in these individuals.
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Affiliation(s)
- Diogo G. Caetano
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Hury H. S. de Paula
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Gonzalo Bello
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Larissa M. Villela
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Mariza G. Morgado
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Monick L. Guimarães
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Fernanda H. Côrtes
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
- * E-mail: ,
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18
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Hessol NA, Eng M, Vu A, Pipkin S, Hsu LC, Scheer S. A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco. BMC Public Health 2019; 19:1440. [PMID: 31675932 PMCID: PMC6825332 DOI: 10.1186/s12889-019-7817-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.
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Affiliation(s)
- Nancy A Hessol
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA.
| | - Monica Eng
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA
| | - Annie Vu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Sharon Pipkin
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Ling C Hsu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Susan Scheer
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
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19
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Gebrezgi MT, Sheehan DM, Mauck DE, Fennie KP, Ibanez GE, Spencer EC, Maddox LM, Trepka MJ. Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13-24) living with HIV in 2015. Int J STD AIDS 2019; 30:1095-1104. [PMID: 31551004 DOI: 10.1177/0956462419857302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).
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Affiliation(s)
- Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA
| | - Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibanez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary J Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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20
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Agu CE, Uchendu IK, Nsonwu AC, Okwuosa CN, Achukwu PU. Prevalence and associated risk factors of peripheral artery disease in virologically suppressed HIV-infected individuals on antiretroviral therapy in Kwara state, Nigeria: a cross sectional study. BMC Public Health 2019; 19:1143. [PMID: 31429736 PMCID: PMC6700806 DOI: 10.1186/s12889-019-7496-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association between HIV and cardiovascular disease (CVD) has been reported in several studies. However, there is paucity of information on the prevalence of subclinical disease as well as its associated risk factors in sub-Saharan African population. The aim of this study was to determine the prevalence and associated risk factors of peripheral artery disease (PAD) among virologically suppressed HIV-infected participants in Kwara State, Nigeria. METHODS This study was conducted between July 2018 and December 2018. A total of 150 HIV-infected participants aged between 20 and 55 years and 50 HIV non-infected age-matched controls were randomly recruited in the study. Sociodemographic, anthropometric and clinical data were collected using a well-structured questionnaire. Ankle brachial index (ABI) was measured, PAD was defined as ABI of < 0.9. Cryopreserved serum was used to evaluate lipid profile parameters. Student's t-test and Chi-square were used to compare continuous and categorical variables. Associations of CVD risk factors and clinical data, and lipid profile with low ABI were assessed using logistic regression analysis. RESULTS The study participants had a mean age of 43.73 ± 8.74, majority were females (72.7%) with a mean duration on ART of 7.73 ± 3.52 years. Hypertension was present in 15.9%, diabetes 4%, family history of CVD 8.6% and metabolic syndrome 17.3% in the study group. The study participants recorded significantly lower mean values for ABI, HDL-C and significantly higher mean values of TG (P < 0.05) compared to the control group. The prevalence of low ABI (14.6%) was higher in the study group compared to the control group (2%). A significantly negative correlation between ABI and duration on ART (r = - 0.163, P = 0.041) and a positive correlation between viral load and TG were observed in the study group. TC (OR 1.784, P = 0.011), LDL-C (OR 1.824, P = 0.010) and CD4 cell count < 200 cells/mm3 (OR 2.635, P = 0.364) were associated with low ABI in the participants. CONCLUSION Viral suppression with combined antiretroviral therapy and long term treatment is associated with dyslipidaemia, with increased risk of PAD. Prevalence of PAD in virologically-suppressed individuals does not differ from the controls in the population studied.
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Affiliation(s)
- Chidozie Elochukwu Agu
- Prime Health Response Initiative (PHRI)-sub-recipients of Global Fund HIV Impact Project, Ilorin, Kwara State Nigeria
| | - Ikenna Kingsley Uchendu
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Augusta Chinyere Nsonwu
- Department of Medical Laboratory Science, Faculty of Allied Medical Science, University of Calabar, Calabar, Cross River State Nigeria
| | - Chukwugozie Nwachukwu Okwuosa
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Peter Uwadiegwu Achukwu
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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21
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Abstract
Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.
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Allan B, Closson K, Collins AB, Kibel M, Pan S, Cui Z, McLinden T, Parashar S, Lima VD, Chia J, Yip B, Barrios R, Montaner JSG, Hogg RS. Physicians' patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting. BMJ Open 2019; 9:e023957. [PMID: 30898806 PMCID: PMC6475242 DOI: 10.1136/bmjopen-2018-023957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the impact of physicians' patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada. DESIGN Observational cohort study from 1 January 2000 to 31 December 2013. SETTING BC Centre for Excellence in HIV/AIDS' (BC-CfE) Drug Treatment Program, where HAART is available at no cost. PARTICIPANTS PLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study. OUTCOME MEASURES All-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency. STATISTICAL ANALYSIS We examined the relationships between patient characteristics, physicians' patient base composition, the location of the practice, and physicians' experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models. RESULTS A total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34-49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23-170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004-2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000-2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians' patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03-1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality. CONCLUSIONS Our findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians' patient bases and survival.
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Affiliation(s)
- Beverly Allan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Mia Kibel
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shenyi Pan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Taylor McLinden
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Viviane Dias Lima
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Chia
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Benita Yip
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Simoni JM, Beima-Sofie K, Mohamed ZH, Christodoulou J, Tapia K, Graham SM, Ho R, Collier AC. Long-Acting Injectable Antiretroviral Treatment Acceptability and Preferences: A Qualitative Study Among US Providers, Adults Living with HIV, and Parents of Youth Living with HIV. AIDS Patient Care STDS 2019; 33:104-111. [PMID: 30844308 DOI: 10.1089/apc.2018.0198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To better understand acceptability of long-acting injectable antiretroviral treatment (LAI-ART) regimens for HIV management, we conducted seven semi-structured focus group discussions with experienced HIV care providers and persons living with HIV (PLWH) and five individual interviews with parents of children living with HIV in the western United States. Although providers were wary about a potential negative impact on consistent engagement in care, they predicted that patients, especially those with adherence challenges, would be enthusiastic about LAI options. Many PLWH, especially young adults, welcomed the option of an LAI-ART regimen; however, others feared injections and expressed concerns about possible side effects, dosing more frequent than every 2 weeks, additional costs, and lower efficacy. Parents' interest varied according to their child's age and sensitivity to injections. In summary, potential users considered LAI-ART generally acceptable yet voiced possible concerns as well, especially if their current pill-based regimen was effective in achieving viral suppression.
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Affiliation(s)
- Jane M. Simoni
- Department of Psychology, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Gender, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Kristin Beima-Sofie
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Zahra H. Mohamed
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Joan Christodoulou
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Kenneth Tapia
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Susan M. Graham
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Rodney Ho
- Department of Pharmaceutics, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington
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Influence of Injection Drug Use-Related HIV Acquisition on CD4 Response to First Antiretroviral Therapy Regimen Among Virally Suppressed Individuals. J Acquir Immune Defic Syndr 2019; 77:317-324. [PMID: 29210833 DOI: 10.1097/qai.0000000000001607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The inflammatory effects of injection drug use (IDU) may result in an impaired immune response to antiretroviral therapy (ART). We examined CD4 response to first ART regimen among individuals in routine HIV care, stratified by IDU-related HIV acquisition. SETTING Cohort study including patients who initiated ART between 2000 and 2015 in the Johns Hopkins HIV Clinic. METHODS We followed individuals from ART initiation until death, loss to follow-up, loss of viral load suppression (<500 copies/mL), or administrative censoring. We described CD4 trajectories after ART initiation using inverse probability weighted quantile regression models with restricted cubic splines for time. Weights accounted for differences in baseline characteristics of persons comparing those with IDU-related HIV acquisition to those with other HIV acquisition risks (non-IDU) and possible nondifferential censoring due to death, loss to follow-up, or loss of viral load suppression. We also examined CD4 response by strata of CD4 at ART initiation (≤200, 201-350, >350). RESULTS Of 1244 patients initiating ART, 30.4% were IDU. Absolute CD4 cell difference at the 50th percentile comparing IDU with non-IDU was -25 cells [95% confidence interval (CI): -63 to 35], -66 cells (95% CI: -141 to 16), and -91 cells (95% CI: -190 to -5) at 2, 4, and 6 years after ART initiation, respectively. Results were similar (non-IDU with slightly higher CD4 count, but not statistically significant differences) at other percentiles and stratified by baseline CD4. CONCLUSIONS CD4 recovery after ART initiation was similar for IDU and non-IDU, conditional on consistent viral load suppression.
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Akbari M, Fararouei M, Haghdoost AA, Gouya MM, Kazerooni PA. Survival and associated factors among people living with HIV/AIDS: A 30-year national survey in Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:5. [PMID: 30815018 PMCID: PMC6383342 DOI: 10.4103/jrms.jrms_630_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/08/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
Background: The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran. Materials and Methods: The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis. Results: Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher. Conclusion: The survival in studied patients increased in recent time periods, and ART reduced AIDS-related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.
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Affiliation(s)
- Mojtaba Akbari
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Haghdoost
- Department of Epidemiology and Biostatistics, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Mahdi Gouya
- National Communicable Disease Control Centre, Ministry of Health and Medical Education, Tehran, Iran
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26
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Simultaneous quantitation of zidovudine, efavirenz, lopinavir and ritonavir in human hair by liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1097-1098:54-63. [DOI: 10.1016/j.jchromb.2018.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/27/2022]
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27
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San Miguel GG, Paulus DJ, Brandt CP, Ditre J, Lemaire CM, Mayorga NA, Leonard AD, Zvolensky MJ. Exploring Distress Tolerance as an Underlying Mechanism in the Relation Between Negative Affectivity and Anxiety/Depression Among Persons Living with HIV/AIDS. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:369-383. [PMID: 31531002 PMCID: PMC6748336 DOI: 10.1080/15381501.2018.1502707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 06/10/2023]
Abstract
Persons living with HIV/AIDS (PLHIV) suffer disproportionately from a variety of mood disorders relative to the general population, yet, there is little understanding of the underlying nature behind this. The present study explored the indirect effect of perceived distress tolerance in relation between negative affectivity and anxiety/depressive symptoms and disorders among PLHIV. Participants included 97 PLHIV (60.8% male; 66% Minority; M age = 48.5 years, SE = 7.7). Results revealed indirect effects of negative affectivity via perceived distress tolerance in relation to social anxiety, depression symptoms, as well as the existence of any anxiety disorder; findings were evident after controlling for covariates. Perceived distress tolerance may serve as a construct to aid understanding in the relation between negative affectivity and the expression of anxiety/depressive symptoms and disorders among PLHIV. Future work may consider addressing distress tolerance in efforts to offset the severity of the expression of anxiety/depressive symptoms among PLHIV.
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Affiliation(s)
- Guadalupe G San Miguel
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Daniel J Paulus
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Charles P Brandt
- Houston OCD Program, 708 E. 19 Street, Houston, TX, 77008, United States
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse NY, 13244, United States
| | - Chad M Lemaire
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, United States
- Behavioral Health Department, Legacy Community Health, 1415 California St, Houston, TX, 77006, United States
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Amy D Leonard
- Behavioral Health Department, Legacy Community Health, 1415 California St, Houston, TX, 77006, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
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28
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A Surveillance on Protease Inhibitor Resistance-Associated Mutations Among Iranian HIV-1 Patients. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.69153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mota TS, Donalisio MR, Silveira LVDA. Spatial risk of death in patients with AIDS in Campinas, São Paulo, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180017. [PMID: 30234884 DOI: 10.1590/1980-549720180017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 08/10/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. METHOD We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. RESULTS The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. CONCLUSIONS Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.
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Affiliation(s)
- Thiago Santos Mota
- Departamento de Bioestatística, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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The HIV patient profile in 2013 and 2003: Results from the Greek AMACS cohort. PLoS One 2018; 13:e0203601. [PMID: 30208097 PMCID: PMC6135491 DOI: 10.1371/journal.pone.0203601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023] Open
Abstract
Combined Antiretroviral therapy (cART) has improved life-expectancy of people living with HIV (PLHIV) but as they age, prevalence of chronic non-AIDS related comorbidities may increase. We study the evolution of HIV-disease markers and comorbidities’ prevalence in PLHIV in Greece. Two cross-sectional analyses (2003 and 2013) on data from the AMACS cohort were performed. Comparisons were based on population average models and were repeated for subjects under follow-up at both 2003 and 2013. 2,403 PLHIV were identified in 2003 and 4,910 in 2013 (1,730 contributing for both cross-sections). Individuals in 2013 were on average older, diagnosed/treated for HIV for longer, more likely to be on cART, virologically suppressed, and with higher CD4 counts. Chronic kidney disease, dyslipidemia and hypertension prevalence increased over time. There was an increase in prescription of lipid-lowering treatment (3.5% in 2003 vs. 7.7% 2013, p<0.001). Among 220 and 879 individuals eligible for Framingham 10-year Event Risk calculation, the proportion of patients in the high-risk group (>20%) increased from 18.2% to 22.2% (p = 0.002). Increase in the prevalence of comorbidities was more pronounced in the subset of patients who were followed in both 2003 and 2013. The increased availability and uptake of cART led to significant improvements in the immuno-virological status of PLHIV in Greece, but they aged alongside an increase in prevalence of non-AIDS related comorbidities. These results highlight the need for appropriate monitoring, optimal cART selection and long-term management and prevention strategies for such comorbidities.
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Melo MCD, Donalisio MR, Cordeiro RC. Survival of patients with AIDS and co-infection with the tuberculosis bacillus in the South and Southeast regions of Brazil. CIENCIA & SAUDE COLETIVA 2018; 22:3781-3792. [PMID: 29211183 DOI: 10.1590/1413-812320172211.26352015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/31/2016] [Indexed: 11/22/2022] Open
Abstract
The study investigates the survival of patients with co-infection AIDS-TB through a retrospective study of a cohort of individuals aged 13 or more and the diagnosis of AIDS reported in the years 1998-99 and following 10 years. Of the 2,091 AIDS cases, 517 (24.7%) had positive diagnosis for tuberculosis, and 379 (73.3%) were male. The risk among co-infected patients was 1,65 times the not co-infected. Have been compared the exposed and non-exposed through the Kaplan-Meier and Cox method. The variables associated with longer survival were: female gender (HR = 0.63), educational level ≥ eight years (HR = 0.52), CD4 diagnostic criteria (HR = 0.64); and shorter survival: age ≥ 60 years (HR = 2.33), no use of HAART (HR = 8.62), no investigation to Hepatitis B (HR = 2.44) and opportunistic infections ≥ two (HR = 1.97). The average survival rate, related to TB infection was 69 months for the Southeast region and 73 months for the South. AIDS and tuberculosis require monitoring and treatment adherence and they are markers of the quality of care and survival of patients in Brazil.
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Affiliation(s)
- Márcio Cristiano de Melo
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Ricardo Carlos Cordeiro
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
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Dunn K, Lafeuille MH, Jiao X, Romdhani H, Emond B, Woodruff K, Pesa J, Tandon N, Lefebvre P. Risk Factors, Health Care Resource Utilization, and Costs Associated with Nonadherence to Antiretrovirals in Medicaid-Insured Patients with HIV. J Manag Care Spec Pharm 2018; 24:1040-1051. [PMID: 29877140 PMCID: PMC10397656 DOI: 10.18553/jmcp.2018.17507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to antiretrovirals (ARVs) is critical to achieving durable virologic suppression. OBJECTIVE To investigate risk factors of poor adherence and the effect of suboptimal adherence on health care resource utilization (HCRU) and costs in Medicaid patients. METHODS A retrospective longitudinal study was conducted using Medicaid data. Adults (aged ≥ 18 years) with human immunodeficiency virus (HIV)-1 initiating selected ARVs (index date) were identified. Adherence was measured using medication possession ratio (MPR) and proportion of days covered (PDC) at 6 and 12 months post-index. Risk factors of poor adherence (PDC < 80%) were assessed using a logistic regression. HCRU and costs were compared between suboptimal (80% ≤ PDC < 95%) and optimal (PDC ≥ 95%) adherence groups using Poisson and ordinary least square models, respectively. RESULTS In total, 3,477 patients were identified. Using MPR, 1,282 (39.0%) of the evaluable patients had poor adherence; 667 (20.2%) had suboptimal adherence; and 1,342 (40.8%) had optimal adherence versus 1,342 (51.1%), 509 (19.0%), and 804 (30.0%), respectively, using PDC at 6 months. PDC at 12 months was even lower. Younger age (OR = 1.58; 95% CI = 1.18-2.11; P = 0.002), noncapitated coverage (OR = 1.40; 95% CI = 1.16-1.69; P < 0.001), dual Medicaid/Medicare coverage (OR = 5.98; 95% CI = 4.39-8.16; P < 0.001), no baseline ARV treatment (OR = 1.98; 95% CI = 1.62-2.41; P < 0.001), and baseline asymptomatic HIV (OR = 1.37; 95% CI = 1.13-1.68; P = 0.002) were associated with higher risk of poor adherence. Suboptimal adherence patients had higher total number of days spent in a hospital (incidence rate ratio [IRR] = 1.62; 95% CI = 1.13-2.19; P = 0.008), total number of long-term care admissions (IRR = 3.11; 95% CI = 1.26-7.39; P = 0.008), total medical costs (mean monthly cost difference = $339; 95% CI = $153-$536; P < 0.001), and inpatient costs (mean monthly cost difference = $259; 95% CI = $122-$418; P < 0.001) compared with patients with optimal adherence. CONCLUSIONS Nonadherence to ARVs was observed in 60%-80% of Medicaid patients, depending on the adherence measure used, and was associated with incremental HCRU and costs. Age, insurance type and coverage, previous ARV treatment, and HIV symptoms were predictors of adherence. Treatment options that enhance adherence and prevent developing virologic failure with drug resistance should be considered for HIV patients. DISCLOSURES This study was supported by Janssen Scientific Affairs, which was involved in the study design, data collection, data analysis, manuscript preparation, and publication decisions. Emond, Lafeuille, Romdhani, and Lefebvre are employees of Analysis Group, a consulting company that received research grants from Janssen Scientific Affairs to conduct this study. Dunn, Woodruff, Pesa, and Tandon are current employees and stockholders of Johnson & Johnson, owner of Janssen Scientific Affairs. Jiao was an employee of Janssen at the time of the study. Emond has received grants from Novartis, Regeneron, Aegerion, Lundbeck, Bristol-Myers Squibb, Bayer, Millennium, Allergan, AbbVie, and GlaxoSmithKline unrelated to this study. Part of the material in this study was presented at the Academy of Managed Care Pharmacy 2017 Annual Meeting; March 27-30, 2017; Denver, CO, and at the 9th International AIDS Society Conference; July 23-26, 2017; Paris, France.
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Affiliation(s)
- Keith Dunn
- 1 Health Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, New Jersey
| | | | - Xiaolong Jiao
- 1 Health Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, New Jersey
| | | | - Bruno Emond
- 2 Groupe d'analyse, Ltée, Montréal, Quebec, Canada
| | - Kimberly Woodruff
- 1 Health Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, New Jersey
| | - Jacqueline Pesa
- 1 Health Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, New Jersey
| | - Neeta Tandon
- 1 Health Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, New Jersey
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Palmer A, Gabler K, Rachlis B, Ding E, Chia J, Bacani N, Bayoumi AM, Closson K, Klein M, Cooper C, Burchell A, Walmsley S, Kaida A, Hogg R. Viral suppression and viral rebound among young adults living with HIV in Canada. Medicine (Baltimore) 2018; 97:e10562. [PMID: 29851775 PMCID: PMC6392935 DOI: 10.1097/md.0000000000010562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
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Affiliation(s)
- Alexis Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, QB
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto
- St. Michael's Hospital, Toronto, ON
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON
| | - Angela Kaida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Theall KP, Felker-Kantor E, Wallace M, Zhang X, Morrison CN, Wiebe DJ. Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV. Drug Alcohol Depend 2018; 187:236-241. [PMID: 29684891 PMCID: PMC5959796 DOI: 10.1016/j.drugalcdep.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Abstract
Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation's highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects' behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.
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Affiliation(s)
- Katherine P Theall
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | - Erica Felker-Kantor
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Xiao Zhang
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Christopher N Morrison
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
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35
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Torres TS, Harrison LJ, La Rosa AM, Cardoso SW, Zheng L, Ngongondo M, Some F, Lalloo UG, Mwelase T, Collier AC, Hughes MD. Quality of life improvement in resource-limited settings after one year of second-line antiretroviral therapy use among adult men and women. AIDS 2018; 32:583-593. [PMID: 29334547 PMCID: PMC5832593 DOI: 10.1097/qad.0000000000001738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated improvement of quality of life (QoL) after 1 year of second-line antiretroviral therapy (ART) use in resource-limited settings (RLS) among adult men and women, comparing two randomized treatment arms. DESIGN The AIDS Clinical Trial Group A5273 was a randomized clinical trial of second-line ART comparing lopinavir/ritonavir (LPV/r) + raltegravir with LPV/r + nucleos(t)ide reverse transcriptase inhibitors (NRTIs) in participants failing a non-NRTI-containing regimen at 15 sites in nine RLS. Participants completed the AIDS Clinical Trial Group short-form-21 which has eight QoL domains with a standard score ranging from 0 (worst) to 100 (best). METHODS Differences in QoL by randomized arm, as well as by demographic and clinical variables, were evaluated by regression models for baseline and week 48 QoL scores fitted using the generalized estimating equations method. RESULTS A total of 512 individuals (49% men, median age 39 years) were included. A total of 512 and 492 participants had QoL assessments at baseline and week 48, respectively. QoL improved significantly from baseline to week 48 (P < 0.001 for all domains). There was no significant difference between treatment arms for any domain. Individuals with higher viral load and lower CD4 cell count at baseline had lower mean QoL at baseline but larger improvements such that mean QoL was similar at week 48. CONCLUSION Improvements in QoL were similar after starting second-line ART of LPV/r combined with either raltegravir or NRTIs in RLS. QoL scores at baseline were lower among participants with worse disease status prior to starting second-line, but after 1 year similar QoL scores were achieved.
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Affiliation(s)
- Thiago S Torres
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Linda J Harrison
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Sandra W Cardoso
- LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Lu Zheng
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - McNeil Ngongondo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- UNC Project, Lilongwe, Malawi
| | - Fatma Some
- AMPATH at Moi University Teaching Hospital, Eldoret, Kenya
| | | | - Thando Mwelase
- Wits Health Consortium Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Cournoyer JM, Garms AP, Thiessen KN, Bowers MT, Johnson MD, Relf MV. Cardiovascular Disease and HIV: Pathophysiology, Treatment Considerations, and Nursing Implications. Crit Care Nurse 2018; 36:37-46. [PMID: 27694356 DOI: 10.4037/ccn2016839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
HIV infection has progressed from an acute, terminal disease to a chronic illness with cardiovascular disease as the leading cause of death among persons living with HIV. As persons living with HIV infection continue to become older, traditional risk factors for atherosclerosis compounded by the pathophysiological effects of HIV infection and antiretroviral therapy markedly increase the risk for cardiovascular disease. Further, persons living with HIV are also at high risk for cardiomyopathy. Critical care nurses must recognize the risk factors for cardiovascular disease and the pathophysiology and complex treatment options in order to manage care of these patients and facilitate multidisciplinary collaboration. Two case studies are used to highlight the treatment options and nursing considerations associated with cardiovascular disease among persons living with HIV.
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Affiliation(s)
- Justin M Cournoyer
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Aven P Garms
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Kimberly N Thiessen
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Margaret T Bowers
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Melissa D Johnson
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing
| | - Michael V Relf
- Justin M. Cournoyer is a clinical nurse I in the pediatric cardiac intensive care unit, Duke University Hospital, Durham, North Carolina.Aven P. Garms is a clinical nurse I in the intensive care nursery, Duke University Hospital.Kimberly N. Thiessen is a staff nurse in the pediatric emergency department, WakeMed Health and Hospitals, Raleigh, North Carolina.Margaret T. Bowers is an associate professor and the faculty coordinator of the adult/geriatric nurse practitioner program and the lead faculty member for the adult/geriatric nurse practitioner-cardiovascular specialty at Duke University School of Nursing, Durham, North Carolina.Melissa D. Johnson is an associate professor in medicine, Duke University Medical Center, Durham, North Carolina, and Campbell University, Buies Creek, North Carolina.Michael V. Relf is an associate professor and the associate dean for global and community affairs, Duke University School of Nursing.
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Torres TS, Harrison LJ, La Rosa AM, Lavenberg JA, Zheng L, Safren SA, Ngongondo M, Poongulali S, Matoga M, Samaneka W, Collier AC, Hughes MD. Quality of life among HIV-infected individuals failing first-line antiretroviral therapy in resource-limited settings. AIDS Care 2018; 30:954-962. [PMID: 29343078 DOI: 10.1080/09540121.2018.1427207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated health-related quality of life (QoL) in HIV infection participants with virologic failure (VF) on first-line antiretroviral therapy (ART) in 9 resource-limited settings (RLS). ACTG SF-21 was completed by 512 participants at A5273 study entry; 8 domains assessed: general health perceptions (GHP), physical functioning (PF), role functioning (RF), social functioning (SF), cognitive functioning (CF), pain (P), mental health (MH), and energy/fatigue (E/F); each was scored between 0 (worst) to 100 (best). Mean QoL scores ranged from 67 (GHP) to 91 (PF, SF, CF). QoL varied by country; high VL and low CD4 were associated with worse QoL in most domains, except RF (VL only), SF (CD4 only) and CF (neither). Number of comorbidities, BMI and history of AIDS were associated with some domains. Relationships between QoL and VL varied among countries for all domains. The association of worse disease status with worse QoL may reflect low QoL when ART was initiated and/or deterioration associated with VF.
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Affiliation(s)
- Thiago S Torres
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,b LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI-FIOCRUZ) , Rio de Janeiro , Brazil
| | - Linda J Harrison
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | | | - Jeffrey A Lavenberg
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Lu Zheng
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Steven A Safren
- d Department of Psychology , University of Miami , Miami , FL , USA
| | - McNeil Ngongondo
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,e UNC Project Lilongwe , Lilongwe , Malawi
| | | | | | - Wadzanai Samaneka
- g Department of Medicine , University of Zimbabwe-University of California Collaborative Research Programme , Harare , Zimbabwe
| | - Ann C Collier
- h Department of Medicine , University of Washington , Seattle , WA , USA ; for AIDS Clinical Trials Group (ACTG) A5273 Study Group
| | - Michael D Hughes
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
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Accorinti M, Cecere M, Scala A, Pirraglia MP. Cataract Surgery in HIV Seropositive Patients: Long-Term Follow-Up. Ocul Immunol Inflamm 2018; 27:435-446. [PMID: 29333896 DOI: 10.1080/09273948.2017.1416149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To study epidemiology and clinical findings of cataract in HIV+ patients. Methods: A total of 32 HIV+ patients, 11 with uveitis/retinitis before surgery and 21 without, mean follow-up 44.9 ± 36.6 months, and 114 HIV- patients, 57 with uveitis/retinitis before surgery and 57 without, were retrospectively compared. Results: Visual acuity improved in all HIV+ patients (p < 0.001), who were younger (p = 0.01) and more frequently males (p = 0.027). HIV+ patients with uveitis prior surgery improved less (p = 0.046) than HIV- (p < 0.001); their anterior chamber inflammation was similar to baseline. Male sex (p = 0.005), younger age (p < 0.001), dyslipidaemia (p = 0.058), HBV+ (p = 0.037), and unilateral cataract (p = 0.001) were more frequent in HIV+ patients with senile cataract, but they showed the same postoperative course as HIV- patients. Conclusion: Cataract surgery in HIV+ patients is safe and effective. Uveitis prior to surgery did not significantly affect the postoperative course. Systemic comorbidities are more frequent in HIV+ patients with senile cataract than in HIV- subjects.
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Affiliation(s)
- Massimo Accorinti
- a Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
| | - Michela Cecere
- a Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
| | - Andrea Scala
- a Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
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39
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Yaghoobi H, Ahmadinia H, Shabani Z, Vazirinejad R, Safari R, Shahizadeh R, Zolfizadeh F, Rezaeian M. Life expectancy and years of life lost in HIV patients under the care of BandarAbbas Behavioral Disorders Counseling Center. Nepal J Epidemiol 2017; 7:702-712. [PMID: 30510838 PMCID: PMC6204067 DOI: 10.3126/nje.v7i4.20627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022] Open
Abstract
Background: HIV epidemic is mostly targeted adults and has numerous negative health, social, economic, cultural and political consequences. In this study Life Expectancy (LE) and Average Years of Life Lost (AYLL) in HIV/AIDS patients are estimated. Materials and Methods: In this descriptive study all the patients at the age of 18 and more under the care of BandarAbbas Behavioral Disorders Counseling Center (BBDCC) during 2005-2015 are included. The town of BandarAbbas is center of Hormozgan Province in southern Iran. LE and AYLL have been estimated based on Life Table. Results: One hundred thirty four of the 426 eligible patients died during the study period. Compared to the general population LE for HIV/AIDS patients at age 20 is 46 years less in comparison with the general population of BandarAbbas. Moreover, a total of 8839 years of life lost during 2005-2015. Conclusion: LE in HIV/AIDS patients is less than LE among BandarAbbas general population and AYLL among them is more than general population. Most of the years of life lost are preventable if the health care system seriously will implement programs to control HIV/AIDS.
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Affiliation(s)
- Halimeh Yaghoobi
- MSc Student in Epidemiology, Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, BandarAbbas, Iran
| | - Hassan Ahmadinia
- PhD Student in Biostatistics, Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ziba Shabani
- Associate professor of infectious diseases, Immunology of Infectious Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Reza Vazirinejad
- Professor, PhD of Epidemiology, Social Determinants of Health Research Centre, Rafsanjan University of Medical Science, Rafsanjan, Iran
| | - Reza Safari
- MD, Province Health Center and Research Deputy of Hormozgan University, Hormozgan University of Medical Sciences, BandarAbbas, Iran
| | - Roozbeh Shahizadeh
- Expert Professional Management Services for Disease Prevention. Deputy of Hormozgan University of Medical Sciences, BandarAbbas, Iran
| | - Fatemeh Zolfizadeh
- MSc in Health Care Management, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, BandarAbbas, Iran
| | - Mohsen Rezaeian
- Epidemiology and Biostatistics Department, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
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40
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Pancera M, Lai YT, Bylund T, Druz A, Narpala S, O’Dell S, Schön A, Bailer RT, Chuang GY, Geng H, Louder MK, Rawi R, Soumana DI, Finzi A, Herschhorn A, Madani N, Sodroski J, Freire E, Langley DR, Mascola JR, McDermott AB, Kwong PD. Crystal structures of trimeric HIV envelope with entry inhibitors BMS-378806 and BMS-626529. Nat Chem Biol 2017; 13:1115-1122. [PMID: 28825711 PMCID: PMC5676566 DOI: 10.1038/nchembio.2460] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/19/2017] [Indexed: 01/27/2023]
Abstract
The HIV-1 envelope (Env) spike is a conformational machine that transitions between prefusion (closed, CD4- and CCR5-bound) and postfusion states to facilitate HIV-1 entry into cells. Although the prefusion closed conformation is a potential target for inhibition, development of small-molecule leads has been stymied by difficulties in obtaining structural information. Here, we report crystal structures at 3.8-Å resolution of an HIV-1-Env trimer with BMS-378806 and a derivative BMS-626529 for which a prodrug version is currently in Phase III clinical trials. Both lead candidates recognized an induced binding pocket that was mostly excluded from solvent and comprised of Env elements from a conserved helix and the β20-21 hairpin. In both structures, the β20-21 region assumed a conformation distinct from prefusion-closed and CD4-bound states. Together with biophysical and antigenicity characterizations, the structures illuminate the allosteric and competitive mechanisms by which these small-molecule leads inhibit CD4-induced structural changes in Env.
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Affiliation(s)
- Marie Pancera
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Yen-Ting Lai
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Tatsiana Bylund
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Aliaksandr Druz
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sandeep Narpala
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sijy O’Dell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Arne Schön
- Department of Biology, Johns Hopkins University, Baltimore, Maryland
| | - Robert T. Bailer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gwo-Yu Chuang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Hui Geng
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mark K. Louder
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Reda Rawi
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Djade I. Soumana
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrés Finzi
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Alon Herschhorn
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Navid Madani
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph Sodroski
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ernesto Freire
- Department of Biology, Johns Hopkins University, Baltimore, Maryland
| | - David R. Langley
- Computer Assisted Drug Design, Bristol-Myers Squibb, Research and Development, Wallingford, Connecticut
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Peter D. Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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41
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Di Biagio A, Riccardi N, Signori A, Maserati R, Nozza S, Gori A, Bonora S, Borderi M, Ripamonti D, Rossi MC, Orofino G, Quirino T, Nunnari G, Celesia BM, Martini S, Sagnelli C, Mazzola G, Colletti P, Bartolozzi D, Bini T, Ladisa N, Castelnuovo F, Saracino A, Lo Caputo S. PrEP in Italy: The time may be ripe but who's paying the bill? A nationwide survey on physicians' attitudes towards using antiretrovirals to prevent HIV infection. PLoS One 2017; 12:e0181433. [PMID: 28727818 PMCID: PMC5519091 DOI: 10.1371/journal.pone.0181433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/02/2017] [Indexed: 11/18/2022] Open
Abstract
Several studies have demonstrated the efficacy of the oral pre-exposure prophylaxis (PrEP) with tenofovir (with or without emtricitabine) on preventing HIV-negative partners of HIV infected patients to become infected through sexual contacts. PrEP is already available in the United States and now is approved by European Medicine Agency. In this setting we would like to gauge physicians' knowledge, acquaintance with and attitude to include PrEP in their clinical practice. A cross sectional survey was conducted among Italian physicians expert on antiretroviral therapy. Out of 146 physicians, 35% of participants declared to be familiar with PrEP but only 46% of them believed that, currently, there are not enough reasons to make it available in Italy. 51% of physicians have already been attracted to prescribe it and 63.4% have been openly asked about PrEP. The main concerns noticed were: the risk of acquire other sexual transmitted diseases (STDs) (70% of physicians feared that PrEP could favor STDs spread), the potential harmful of PrEP if not adequately implemented and, especially the risk of possible side effects if not properly used. Nevertheless, 55.9% of participants believed that Health Authorities face an ethical obligation to make PrEP available as part of the strategies to protect from HIV transmission and half of the respondents asked for further researches to better define the role for PrEP. Attitudes regarding PrEP impact on Italian National Health Organization were also very interesting: 57.5% of participants did not believe that investing in PrEP would be an appropriate use of healthcare resources, while 70.6% affirmed that PrEP's financial coverage should not be funded by the Italian National System of Health (SSN). This survey showed a high awareness of PrEP potential among Italian physicians coupled with a great deal of skepticism about how and if implementing it in clinical practice.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
- * E-mail:
| | - Alessio Signori
- Department of Health Science, Biostatistics, University of Genoa, Genoa, Italy
| | - Renato Maserati
- Malattie Infettive, Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Silvia Nozza
- Department of Infectious Diseases, IRCCS San Raffaele, Milan, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Marco Borderi
- Infection Diseases Unit, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, AO Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Ospedale Amedeo di Savoia, Torino, Italy
| | - Tiziana Quirino
- Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Benedetto Maurizio Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - Salvatore Martini
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Caterina Sagnelli
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Giovanni Mazzola
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Pietro Colletti
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Dario Bartolozzi
- Infectious Disease Unit, Careggi University Hospital, Florence, Italy
| | - Teresa Bini
- Clinical of Infectious Disease, San Paolo Hospital, Milan, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Disease, University of Bari, Bari, Italy
| | | | | | - Sergio Lo Caputo
- Institute of Infectious Disease, University of Bari, Bari, Italy
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O'Connor EE, Jaillard A, Renard F, Zeffiro TA. Reliability of White Matter Microstructural Changes in HIV Infection: Meta-Analysis and Confirmation. AJNR Am J Neuroradiol 2017; 38:1510-1519. [PMID: 28596189 DOI: 10.3174/ajnr.a5229] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/18/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diffusion tensor imaging has been widely used to measure HIV effects on white matter microarchitecture. While many authors have reported reduced fractional anisotropy and increased mean diffusivity in HIV, quantitative inconsistencies across studies are numerous. PURPOSE Our aim was to evaluate the consistency across studies of HIV effects on DTI measures and then examine the DTI reliability in a longitudinal seropositive cohort. DATA SOURCES Published studies and investigators. STUDY SELECTION The meta-analysis included 16 cross-sectional studies reporting fractional anisotropy and 12 studies reporting mean diffusivity in the corpus callosum. DATA ANALYSIS Random-effects meta-analysis was used to estimate study standardized mean differences and heterogeneity. DTI longitudinal reliability was estimated in seropositive participants studied before and 3 and 6 months after beginning treatment. DATA SYNTHESIS Meta-analysis revealed lower fractional anisotropy (standardized mean difference, -0.43; P < .001) and higher mean diffusivity (standardized mean difference, 0.44; P < .003) in seropositive participants. Nevertheless, between-study heterogeneity accounted for 58% and 66% of the observed variance (P < .01). In contrast, the longitudinal cohort fractional anisotropy was higher and mean diffusivity was lower in seropositive participants (both, P < .001), and fractional anisotropy and mean diffusivity measures were very stable during 6 months, with intraclass correlation coefficients all >0.96. LIMITATIONS Many studies pooled participants with varying treatments, ages, and disease durations. CONCLUSIONS HIV effects on WM microstructure had substantial variations that could result from acquisition, processing, or cohort-selection differences. When acquisition parameters and processing were carefully controlled, the resulting DTI measures did not show high temporal variation. HIV effects on WM microstructure may be age-dependent. The high longitudinal reliability of DTI WM microstructure measures makes them promising disease-activity markers.
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Affiliation(s)
- E E O'Connor
- From the Department of Radiology and Nuclear Medicine (E.E.O.), University of Maryland Medical System, Baltimore, Maryland
| | - A Jaillard
- Unité IRM 3T-Recherche-IRMaGe-Inserm US 17/CNRS UMS 3552 (A.J., F.R.).,Laboratoire MATICE-Pôle Recherche (A.J., F.R.), Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - F Renard
- Unité IRM 3T-Recherche-IRMaGe-Inserm US 17/CNRS UMS 3552 (A.J., F.R.).,Laboratoire MATICE-Pôle Recherche (A.J., F.R.), Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - T A Zeffiro
- Neurometrika (T.A.Z.), Potomac, Maryland.,Department of Human Development (T.A.Z.), University of Maryland College Park, Maryland
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Collins LF, Clement ME, Stout JE. Incidence, Long-Term Outcomes, and Healthcare Utilization of Patients With Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Disseminated Mycobacterium avium Complex From 1992-2015. Open Forum Infect Dis 2017; 4:ofx120. [PMID: 28748197 PMCID: PMC5522579 DOI: 10.1093/ofid/ofx120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/02/2017] [Indexed: 01/10/2023] Open
Abstract
Background Despite the advent of combination antiretroviral therapy (cART), patients with human immunodeficiency virus (HIV) continue to develop late-stage complications including acquired immune deficiency syndrome (AIDS), disseminated Mycobacterium avium complex (DMAC), and death. Methods We performed an observational retrospective cohort study of HIV-infected adults who developed DMAC in the Duke University Health System from 1992 to 2015 to determine the incidence, long-term outcomes, and healthcare utilization of this population at high risk for poor outcomes. Findings were stratified by the “pre-cART” era (before January 1, 1996) and “post-cART” thereafter. Results We identified 330 adult HIV-infected patients newly diagnosed with DMAC, the majority (75.2%) of whom were male and non-Hispanic black (69.1%), with median age of 37 years. Incidence of DMAC declined significantly from 65.3/1000 in 1992 to 2.0/1000 in 2015, and the proportion of females and non-Hispanic blacks was significantly higher in the post-cART era. The standardized mortality ratios for DMAC patients who received cART were 69, 58, 27, 5.9, and 6.8 at years 1–5, respectively, after DMAC diagnosis. For patients diagnosed with DMAC in 2000 or later (n = 135), 20% were newly diagnosed with HIV in the 3 months preceding presentation with DMAC. Those with established HIV had a median time from HIV diagnosis to DMAC diagnosis of 7 years and were more likely to be black, rehospitalized in the 6 months after DMAC diagnosis, and die in the long term. Conclusions Disseminated Mycobacterium avium complex continues to be a lethal diagnosis in the cART era, disproportionately afflicts minority populations, and reflects both delayed entry into care and failure to consistently engage care.
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Affiliation(s)
- Lauren F Collins
- Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Meredith E Clement
- Division of Infectious Diseases, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jason E Stout
- Division of Infectious Diseases, Duke University, Durham, North Carolina
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Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care. J Acquir Immune Defic Syndr 2017; 73:39-46. [PMID: 27028501 DOI: 10.1097/qai.0000000000001014] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care. METHODS We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20. RESULTS Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors. CONCLUSIONS Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
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Ellis CL. HIV associated kidney diseases: Clarifying concordance between renal failure in HIV infection and histopathologic manifestations at kidney biopsy. Semin Diagn Pathol 2017; 34:377-383. [PMID: 28578979 DOI: 10.1053/j.semdp.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with HIV infection have a wide spectrum of renal diseases. Some are known to be the direct effect of the viral infection while others are renal diseases that also occur in uninfected populations. HIV associated nephropathy (HIVAN) is considered to be a subtype of primary focal and segmental glomerulosclerosis that is distinct in HIV infected patients. It is more frequent in the African-American population and associated with mutations of the apolipoprotein L1 (APOL1) gene. HIV associated immune complex kidney disease (HIVICD) encompasses a spectrum of HIV associated renal diseases characterized by the presence of immune complex deposition within glomeruli. Thrombotic microangiopathy (TMA) is a complication of HIV infection that presents with hemolytic anemia, thrombocytopenia, and renal failure. TMA in HIV patients is associated with very high mortality. Lastly, the multitude of antiretroviral drugs used for treatment of HIV infections can result in nephrotoxicity. Although a kidney biopsy may not be the first line study for renal disease, knowledge of the different histopathologic features of HIV-associated and unassociated diseases is of paramount importance in the treatment and subsequent outcome of renal function in HIV infected patients. In this review we will describe the histopathologic features and discuss the pathophysiology of the entities previously named.
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Affiliation(s)
- Carla L Ellis
- Emory University Hospital and School of Medicine Department of Pathology and Laboratory Medicine, 1364 Clifton Road N.E., H-194, Atlanta, GA 30322, United States.
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46
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Nelson AM, Manabe YC, Lucas SB. Immune Reconstitution Inflammatory Syndrome (IRIS): What pathologists should know. Semin Diagn Pathol 2017; 34:340-351. [PMID: 28552210 DOI: 10.1053/j.semdp.2017.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Antiretroviral therapy has significantly improved the quality and length of life for those patients able to access effective and sustained treatment. The resulting restoration of the immune response is associated with a change in the clinical presentation of opportunistic infections, and the histologic reaction to pathogens. A complex combination of alterations in host response across the stages of HIV infection has been documented over the past 3 decades. The defects are seen in both acute and chronic phases of inflammation and involve innate and adaptive immunity. In advanced stages of HIV infection, the marked disruption of lymphoid tissue and loss of follicular dendritic cells limits the host's ability to process antigen and mount specific responses to pathogens. There are qualitative and quantitative defects in CD4 T cells due to HIV infection. The resulting indirect effects include loss of cytokine production, dysregulation of B-cell function, loss of cellular mediated immunity and "holes" in the immunologic repertoire that may not be restored with the use of antiretroviral therapy. Immune reconstitution allows the host to respond to and control infection, but a significant number of patients will have atypical inflammatory syndromes during the recovery period. We briefly discuss the impact of HIV infection on the immune system and give an overview of the spectrum of conditions attributed to the Immune Reconstitution Inflammatory syndrome (IRIS).
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47
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Iwamoto A, Taira R, Yokomaku Y, Koibuchi T, Rahman M, Izumi Y, Tadokoro K. The HIV care cascade: Japanese perspectives. PLoS One 2017; 12:e0174360. [PMID: 28319197 PMCID: PMC5358866 DOI: 10.1371/journal.pone.0174360] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022] Open
Abstract
Japan has been known as a low HIV-prevalence country with a concentrated epidemic among high-risk groups. However, it has not been determined whether Japan meets the 90-90-90 goals set by the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO). Moreover, to date, the HIV care cascade has not been examined. We estimated the total number of diagnosed people living with HIV/AIDS (PLWHA) (n = 22,840) based on legal reports to the Ministry of Health, Labour and Welfare by subtracting the number of foreigners who left Japan (n = 2,273) and deaths (n = 2,321) from the cumulative diagnosis report (n = 27,434). The number of total undiagnosed PLWHA was estimated by age and sex specific HIV-positive rates observed among first-time blood donors between 2011–2015 in Japan. Our estimates show that 14.4% (n = 3,830) of all PLWHA (n = 26,670) were undiagnosed in Japan at the end of 2015. The number of patients retained in care (n = 20,615: 77.3% of PLWHA), the percentage of those on antiretroviral therapy (n = 18,921: 70.9% of PLWHA) and those with suppressed viral loads (<200 copies/mL; n = 18,756: 70.3% of PLWHA) were obtained through a questionnaire survey conducted in the AIDS Core Hospitals throughout the country. According to these estimates, Japan failed to achieve the first two of the three UNAIDS/WHO targets (22,840/26,670 = 85.6% of HIV-positive cases were diagnosed; 18,921/22,840 = 82.8% of those diagnosed were treated; 18,756/18,921 = 99.1% of those treated experienced viral suppression). Although the antiretroviral treatment uptake and success after retention in medical care appears to be excellent in Japan, there are unmet needs, mainly at the surveillance level before patients are retained in care. The promotion of HIV testing and treatment programs among the key affected populations (especially men who have sex with men) may contribute to further decreasing the HIV epidemic and achieving the UNAIDS/WHO targets in Japan.
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Affiliation(s)
- Aikichi Iwamoto
- Japan Agency for Medical Research and Development, Tokyo, Japan
- * E-mail:
| | - Rikizo Taira
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yoshiyuki Yokomaku
- Clinical Research Center, Nagoya Medical Center, National Hospital Organization. Nagoya, Japan
| | - Tomohiko Koibuchi
- The Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | | | - Yoko Izumi
- Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Kenji Tadokoro
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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48
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Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, Lima VD, Shoveller J, Moore D, Montaner JSG, Hogg RS. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis 2017; 17:174. [PMID: 28241797 PMCID: PMC5329918 DOI: 10.1186/s12879-017-2254-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background Non-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada. Methods We analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC – which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed. Results 3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011–2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals. Conclusions Despite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.
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Affiliation(s)
- Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Conrado Franco-Villalobos
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | | | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Jeannie Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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49
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Mannes ZL, Burrell LE, Dunne EM, Hearn LE, Whitehead NE. Contextualizing Psychosocial Determinants of Alcohol Use by Age Cohorts of Adults Living With HIV, Ages 50 and Older. J Assoc Nurses AIDS Care 2016; 28:279-288. [PMID: 28003102 DOI: 10.1016/j.jana.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022]
Abstract
We examined the influence of age on associations between affective states, social support, and alcohol use by age cohorts. We recruited 96 older Black adults living with HIV from the southeastern United States in 2013 and 2014. Participants completed questionnaires assessing demographics, psychological function, and substance use. Hierarchical regression analyses assessed the relationship between psychosocial factors and alcohol use in a 50- to 59-year-old group, and a 60-years-and-older age group. After controlling for covariates, trait anger, state anger, and life stress were positively associated with alcohol consumption in the younger group, while social support was negatively associated with alcohol consumption in the older group. Interventions should target negative affective states in 50- to 59-year-old adults with HIV, and preserve social support for adults with HIV as they age, as such interventions will likely have an impact on these individuals' alcohol consumption and longstanding quality of life.
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50
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Tanner Z, Lachowsky N, Ding E, Samji H, Hull M, Cescon A, Patterson S, Chia J, Leslie A, Raboud J, Loutfy M, Cooper C, Klein M, Machouf N, Tsoukas C, Montaner J, Hogg RS. Predictors of viral suppression and rebound among HIV-positive men who have sex with men in a large multi-site Canadian cohort. BMC Infect Dis 2016; 16:590. [PMID: 27769246 PMCID: PMC5073906 DOI: 10.1186/s12879-016-1926-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/12/2016] [Indexed: 01/25/2023] Open
Abstract
Background Gay, bisexual and other men who have sex with men (MSM) are disproportionately affected by HIV in Canada. Combination antiretroviral therapy has been shown to dramatically decrease progression to AIDS, premature death and HIV transmission. However, there are no comprehensive data regarding combination antiretroviral therapy outcomes among this population. We sought to identify socio-demographic and clinical correlates of viral suppression and rebound. Methods Our analysis included MSM participants in the Canadian Observational Cohort, a multi-site cohort of HIV-positive adults from Canada’s three most populous provinces, aged ≥18 years who first initiated combination antiretroviral therapy between 2000 and 2011. We used accelerated failure time models to identify factors predicting time to suppression (2 measures <50 copies/mL ≥30 days apart) and subsequent rebound (2 measures >200 copies/mL ≥30 days apart). Results Of 2,858 participants, 2,448 (86 %) achieved viral suppression in a median time of 5 months (Q1–Q3: 3–7 months). Viral suppression was significantly associated with later calendar year of antiretroviral therapy initiation, no history of injection drug use, lower baseline viral load, being on an initial regimen consisting of non-nucleoside reverse-transcriptase inhibitors, and older age. Among those who suppressed, 295 (12 %) experienced viral rebound. This was associated with earlier calendar year of antiretroviral therapy initiation, injection drug use history, younger age, higher baseline CD4 cell count, and living in British Columbia. Conclusions Further strategies are required to optimize combination antiretroviral therapy outcomes in men who have sex with men in Canada, specifically targeting younger MSM and those with a history of injection drug use.
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Affiliation(s)
| | - Nathan Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health & Social Policy, University of Victoria, Victoria, Canada.,Centre for Addiction Research British Columbia, University of Victoria, Victoria, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hasina Samji
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Angela Cescon
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Sophie Patterson
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Jason Chia
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Alia Leslie
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Maple Leaf Medical Clinic, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Marina Klein
- Faculty of Medicine, McGill University, Montreal, Canada.,The Montreal Chest Institute, McGill University Health Centre, Montreal, Canada
| | | | | | - Julio Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, BLU 9512, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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