Determinants of viral load rebound on HIV/AIDS patients receiving antiretroviral therapy: results from South Africa

Factors associated with an unsuppressed viral load among HIV-positive individuals attending STI services in South Africa, 2019

BACKGROUND

Sexually transmitted infections (STIs), particularly in the absence of viral suppression, increase the risk of HIV transmission to uninfected partners. We determined factors associated with having an unsuppressed VL among HIV-positive individuals attending STI services in South Africa (SA).

METHODS

We analysed secondary cross-sectional data collected on HIV-positive individuals presenting with STI symptoms s at sentinel sites in Western Cape and Gauteng provinces between January-December 2019 in SA. We compared demographic characteristics of individuals on ART or not on ART, and a Poisson regression model to identify factors associated with having an unsuppressed VL (≥ 50 copies/ml) was used.

RESULTS

Among 93 HIV-positive individuals attending STI services with VL data, the median age was 32 years (IQR 27-37). Thirty-two (34.41%) individuals were on ART compared to 61 (65.59%) not on ART. Most of those on ART (56.25%) had an unsuppressed VL, while 86.89% of those not on ART had an unsuppressed VL. ART use was associated with a 33% lower prevalence of having unsuppressed VL. In a model adjusting for age, age at first sex and oral sex, none of the factors were significant. Among those on ART, individuals < 25 years were more likely to have an unsuppressed VL (aPRR = 1.94: 95% CI = 1.27-2.97) compared to those ≥ 25 years.

CONCLUSION

ART use among HIV-positive individuals was low and VL suppression among those on ART was sub-optimal. Intensified ART initiation and adherence support to HIV-positive individuals seeking STI services could improve VL suppression.

Factors associated with ART adherence among HIV-positive adherence club members in Ekurhuleni Metropolitan Municipality, South Africa: A cross-sectional study

BACKGROUND

HIV is a leading cause of morbidity and mortality in South Africa that can be managed using antiretroviral therapy (ART). Adherence clubs are interventions that have been introduced to decentralize ART to improve ART adherence and provide social support for club members. However, ART adherence can be suboptimal even among adherence club members.

AIM

This study aimed to determine the factors affecting ART adherence among people living with HIV/AIDS (PLWHA) attending adherence clubs in Ekurhuleni Metropolitan Municipality.

METHODS

A cross-sectional study was conducted. Ordinal logistic regression was used in univariable and multivariable analyses to determine factors significantly associated with adherence scores. Factors included in the final model were age, comorbidity, ART regimen and club membership duration.

RESULTS

The records of 730 participants were analysed. After adjusting for age, participants with comorbidities were half as likely to report high ART adherence scores compared to participants without comorbidities (AOR = 0.5, 95% CI: 0.3-0.8, p = 0.005). The adjusted odds of reporting high levels of adherence among participants on cART were 1.8 times those on a single tablet regimen (AOR = 1.8, 95% CI: 1.0-3.2; p = 0.033). There was a 20% reduction in the adjusted odds of reporting high ART adherence for each additional year of adherence club membership (AOR = 0.8, 95% CI: 0.8-0.9, p<0.001).

CONCLUSION

Increasing years spent as adherence club members, single tablet ART regimens and the presence of comorbidities were all significantly associated with low ART adherence among study participants. Regular assessment of the quality of counselling sessions for ART adherence club members and questionnaires for early screening of treatment fatigue have been suggested as tools for improved adherence in ART adherence club settings.

Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach

INTRODUCTION

Combination antiretroviral therapy has become the standard care of human immunodeficiency virus (HIV)-infected patients and has further led to a dramatically decreased progression probability to acquired immune deficiency syndrome (AIDS) for patients under such a therapy. However, responses of the patients to this therapy have recorded heterogeneous complexity and high dynamism. In this paper, we simultaneously model long-term viral suppression, viral rebound, and state-specific duration of HIV-infected patients.

METHODS

Full-parametric and semi-parametric Markov multistate models were applied to assess the effects of covariates namely TB co-infection, educational status, marital status, age, quality of life (QoL) scores, white and red blood cell parameters, and liver enzyme abnormality on long-term viral suppression, viral rebound and state-specific duration for HIV-infected individuals before and after treatment. Furthermore, two models, one including and another excluding the effect of the frailty, were presented and compared in this study.

RESULTS

Results from the diagnostic plots, Akaike information criterion (AIC) and likelihood ratio test showed that the Weibull multistate frailty model fitted significantly better than the exponential and semi-parametric multistate models. Viral rebound was found to be significantly associated with many sex partners, higher eosinophils count, younger age, lower educational level, higher monocyte counts, having abnormal neutrophils count, and higher liver enzyme abnormality. Furthermore, viral suppression was also found to be significantly associated with higher QoL scores, and having a stable sex partner. The analysis result also showed that patients with a stable sex partner, higher educational levels, higher QoL scores, lower eosinophils count, lower monocyte counts, and higher RBC indices were more likely to spend more time in undetectable viral load state.

CONCLUSIONS

To achieve and maintain the UNAIDS 90% suppression targets, additional interventions are required to optimize antiretroviral therapy outcomes, specifically targeting those with poor clinical characteristics, lower education, younger age, and those with many sex partners. From a methodological perspective, the parametric multistate approach with frailty is a flexible approach for modeling time-varying variables, allowing for dealing with heterogeneity between the sequence of transitions, as well as allowing for a reasonable degree of flexibility with a few additional parameters, which then aids in gaining a better insight into how factors change over time.

The effects of MAPK p38α on AZT resistance against reactivating HIV-1 replication in ACH2 cells

Antiretroviral therapy (ART) has remarkably decreased HIV-related mortality. However, drug-resistant HIV variants pose a potential threat to the long-term success of ART. Both HIV mutants and host factors can cause HIV drug resistance. Using susceptible ACH2 cells chronically infected with HIV-1, we examined the effects of MAPK p38α on AZT resistance against reactivating HIV-1 replication that can be activated by HIV-1 superinfection. We found that HIV-1 superinfection induced more viral production, which was diminished by p38 inhibitor, SB203580, and by AZT in cells infected with non-AZT-resistant HIV-1 strain MN. p38α expression can resist action of AZT in inhibition of HIV-1 replication with increased expression of transcription factor, NF-ĸBp65, SP1, and c-Fos through activation of TCR-related pathways with upregulation of CD3, TCRα, TCRβ, Zap-70, PKC, PLCγ1, GRB2, and PI3K/Akt expression. In HIV-1 MN superinfection under AZT treatment, expression of p38α led to HIV vif expression and inhibited APOBEC3G expression. We also investigated effects of p38α on gp130/JAK-STAT pathways, in which p38α increased expression of protein, gp130, EGFR, Jak2, STAT1, STAT3, STAT5, ras, and TF. p38α could induce apoptotic pathways with upregulation of Fas, FADD, Caspase-8, p53, and Bax, and downregulation of Bcl2 expression. These results indicate that p38α plays a positive role in reactivation of viral replication from HIV-1 latent infection and leads to HIV-1 AZT resistance. In conclusion, MAPKp38α can activate HIV-1 replication inhibited by AZT from HIV-1 latent infection and may be used as a latency reversal agent. The activation involves induction of several cell signaling pathways that are required for HIV-1 replication, which may be integrated into future viral remission strategies.