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van Bremen K, Parczewski M, Monin M, Leszczyszyn-Pynka M, Schlabe S, Lenkiewicz F, Karasińska-Cieślak M, Wasmuth JC, Witak-Jędra M, Breitschwerdt S, Rockstroh JK, Zhyvytsia D, Boesecke C, Chober D, Aksak-Wąs B. HIV Care in Ukrainian Migrants in Two European Countries: All the Same? Pathogens 2024; 13:621. [PMID: 39204222 PMCID: PMC11356781 DOI: 10.3390/pathogens13080621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 09/03/2024] Open
Abstract
Introduction: War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. Methods: This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. Results: The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; p = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Conclusions: Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.
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Affiliation(s)
- Kathrin van Bremen
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland; (M.P.); (M.K.-C.); (D.C.)
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Malte Monin
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Magdalena Leszczyszyn-Pynka
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Stefan Schlabe
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Franciszek Lenkiewicz
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland; (M.P.); (M.K.-C.); (D.C.)
| | - Malwina Karasińska-Cieślak
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland; (M.P.); (M.K.-C.); (D.C.)
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Jan-Christian Wasmuth
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Magdalena Witak-Jędra
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Sven Breitschwerdt
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Jürgen K. Rockstroh
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Dmytro Zhyvytsia
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Christoph Boesecke
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- German Centre for Infection Research (DZIF), 53127 Bonn, Germany
| | - Daniel Chober
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland; (M.P.); (M.K.-C.); (D.C.)
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
| | - Bogusz Aksak-Wąs
- Bonn University Hospital, 53127 Bonn, Germany; (K.v.B.); (M.M.); (S.S.); (J.-C.W.); (S.B.); (J.K.R.); (C.B.)
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland; (M.P.); (M.K.-C.); (D.C.)
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, 71-455 Szczecin, Poland; (M.L.-P.); (M.W.-J.); (D.Z.)
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Dickey BL, Yanik EL, Thompson Z, Burkholder G, Kitahata MM, Moore RD, Jacobson J, Mathews WC, Christopoulos KA, Fleming J, Napravnik S, Achenbach C, Coghill AE. The Association of HIV Control and Immunosuppression With Risk of Non-AIDS-Defining Cancer Risk Among Patients on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2024; 95:275-282. [PMID: 37977197 PMCID: PMC11146681 DOI: 10.1097/qai.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People living with HIV (PWH) are experiencing an increased prevalence of non-AIDS-defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the United States. METHODS Among patients across 8 clinical cohorts on ART between 1996 and 2016, we assessed immune function and HIV control using 3 parameterizations of CD4 count and HIV-RNA viral load (VL): (1) CD4 or VL at ART initiation; (2) change in CD4 or VL after ART initiation; and (3) proportion of follow-up time at CD4 >500 cells/µL or VL <50 copies/mL. Cox models were used to ascertain the association of these measures with risk of a viral NADC or nonviral NADC. RESULTS Among 29,568 patients on ART, there were 410 nonviral NADCs and 213 viral NADCs. PWH with a CD4 <200 cells/µL at ART initiation had an 80% elevated risk for developing a viral NADC. Each increase of 100 cells/µL in CD4 after ART initiation decreased risk by 14%. For viral and nonviral NADCs, 10% more follow-up time spent with a CD4 >500 cells/µL was associated with decreased risk [viral, adjusted hazard ratio (aHR): 0.82; 95% confidence intervals (CI): 0.78 to 0.86; nonviral, aHR: 0.88; 95% CI: 0.86 to 91], even after accounting for CD4 at ART initiation. When examining HIV control only, 10% more time with VL <50 copies/mL was significantly associated with decreased viral (aHR: 0.85; 95% CI: 0.82 to 0.89) and nonviral NADC risk (aHR: 0.88; 95% CI: 0.85 to 0.90). CONCLUSIONS This study demonstrates that even for PWH on ART therapy, maintaining HIV control is associated with lower risk of both viral and nonviral NADCs.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | - Zachary Thompson
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | | | | | | | | | | | | | | | | | - Anna E. Coghill
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
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The role of HIV/hepatitis B virus/hepatitis C virus RNA+ triple infection in end-stage liver disease and all-cause mortality in Europe. AIDS 2023; 37:91-103. [PMID: 36476454 DOI: 10.1097/qad.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). METHODS All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNA+, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA- was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV. RESULTS Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26). Those under follow-up in 2014 or later had significantly lower rates of ESLD compared with 2007-2013 (aIRR 0.65; 95% CI 0.47-0.89). Differences in ESLD between the three groups were most pronounced in those aged at least 40. After adjustment, there were no significant differences in all-cause mortality across the three groups. CONCLUSION HIV/HBV-coinfected individuals had lower rates of ESLD and HIV/HBV/HCV had higher rates of ESLD compared with those with HIV/HCV, especially in those aged more than 40. ESLD decreased over time across all groups. CLINICALTRIALSGOV IDENTIFIER NCT02699736.
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