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Woldegeorgis BZ, Asgedom YS, Gebrekidan AY, Kassie GA, Borko UD, Obsa MS. Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:471. [PMID: 38702591 PMCID: PMC11069260 DOI: 10.1186/s12879-024-09366-1] [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: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Despite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia. METHODS A comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed. RESULTS Twenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]). CONCLUSIONS This study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Ushula Deboch Borko
- Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Astawesegn FH, Mannan H, Stulz V, Conroy E. Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis. PLoS One 2024; 19:e0300606. [PMID: 38635647 PMCID: PMC11025786 DOI: 10.1371/journal.pone.0300606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. METHODS We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. RESULTS The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. CONCLUSION Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.
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Affiliation(s)
- Feleke Hailemichael Astawesegn
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Haider Mannan
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Virginia Stulz
- School of Nursing and Midwifery Centre for Nursing and Midwifery Research, Western Sydney University, Kingswood, New South Wales, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
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Kassaw A, Chekole B, Agimas MC, Azmeraw M, Beletew B, Zeleke S, Asferi WN, Demis S, Hailemeskel HS, Bayih WA, Chane ES, Kefale D, Aytenew TM. Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Heliyon 2024; 10:e29308. [PMID: 38601598 PMCID: PMC11004412 DOI: 10.1016/j.heliyon.2024.e29308] [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: 01/06/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Background Undernutrition is the leading cause of mortality among children infected with HIV particularly in resource-deprived settings. Despite several studies were disclosed the effect of undernutrition on mortality of children living with HIV in Ethiopia, the findings were fragmented and inconclusive. Therefore, this review aimed to determine the pooled effects of undernutrition on mortality of children infected with HIV in Ethiopia. Methods The search were performed using international online electronic data bases (MEDLINE/though PubMed, Google scholar, Hinari, Scopus and open Google). The review included only retrospective/prospective cohort studies reporting the effects of undernutrition on mortality of children infected with HIV. Heterogeneity between included studies was assessed using Cochrane Q-test and the I2 statistics. Sub-group analysis was done by study regions, sample size and publication year. Results A total of 1345 articles were identified from databases. Among these, 14 studies met the inclusion criteria and included in the study. Meta-analysis of 4 studies revealed that stunting has a significant effect on mortality of children infected with HIV (AHR: 3.36; 95 % CI: 2.95-3.77). Of 14 included studies, 6 articles indicated that wasting has a significant effect on mortality in children infected with HIV (AHR: 3.93; 95 % CI: 2.56-5.30) as compared to their counterparts. Furthermore, the pooled effect of 8 studies showed that underweight has 3.4 times hazard of death among children who lived with HIV as compared to well-nourished children. Conclusion This review revealed that undernutrition has deleterious effect on mortality of children infected with HIV/AIDS by disease progression and prone the children to serious opportunistic infections. From the study, the authors recommended that nutritional status of children on antiretroviral therapy need to be evaluated regularly.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferi
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimeles Hailemeskel
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chane
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Imani PD, Elyanu PJ, Wanless RS, Perry SH, Katembo K, Lukhele B, Steffy T, Seetane T, Thahane L, Haq H, Bell CS, Srivaths P, Braun MC. Chronic kidney disease among children living with the human immunodeficiency virus in sub-Saharan Africa. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ghosh AK, Kovela S, Sharma A, Shahabi D, Ghosh AK, Hopkins DR, Yadav M, Johnson ME, Agniswamy J, Wang YF, Aoki M, Amano M, Weber IT, Mitsuya H. Design, Synthesis and X-ray Structural Studies of Potent HIV-1 Protease Inhibitors Containing C-4 Substituted Tricyclic Hexahydro-furofuran derivatives as P2 ligands. ChemMedChem 2022; 17:e202200058. [PMID: 35170223 PMCID: PMC9081228 DOI: 10.1002/cmdc.202200058] [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] [Received: 01/26/2022] [Indexed: 11/06/2022]
Abstract
The design, synthesis, X-ray structural, and biological evaluation of a series of highly potent HIV-1 protease inhibitors are reported herein. These inhibitors incorporated novel cyclohexane-fused tricyclic bis -tetrahydrofuran as P2 ligands in combination with a variety of P1 and P2'-ligands. Compound 4d with a difluoromethylphenyl P1 ligand and a cyclopropylaminobenzothiazole P2' ligand exhibited the most potent antiviral activity. Also, it maintained highly potent antiviral activity against a panel of highly multidrug-resistant HIV-1 variants. The corresponding inhibitor 5d with an enantiomeric ligand was significantly less potent in these antiviral assays. The new P2 ligands were synthesized in optically active form using enzymatic desymmetrization of meso -diols as the key step. To obtain molecular insight, high resolution X-ray structures of inhibitors 4b and 5d -bound HIV-1 protease were determined and structural analyses are highlighted here.
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Affiliation(s)
- Arun K Ghosh
- Purdue University, Departments of Chemistry and Medicinal Chemistry, 560 Oval Drive, 47907, West Lafayette, UNITED STATES
| | | | | | | | | | | | | | | | - Johnson Agniswamy
- Georgia State University Department of Biology, Biology and Chemistry, UNITED STATES
| | - Yuan-Fang Wang
- Georgia State University Department of Biology, Biology and Chemistry, UNITED STATES
| | - Manabu Aoki
- Kumamoto University: Kumamoto Daigaku, Department of Hematology and Infectious Disease, JAPAN
| | - Masayuki Amano
- Kumamoto University: Kumamoto Daigaku, Department of Hematology and Infectious Disease, JAPAN
| | - Irene T Weber
- Georgia State University Department of Biology, Biology and Chemistry, UNITED STATES
| | - Hiroaki Mitsuya
- National Center for Global Health and Medicine: Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Center for Clinical Sciences, JAPAN
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Amano M, Yedidi RS, Salcedo-Gómez PM, Hayashi H, Hasegawa K, Martyr CD, Ghosh AK, Mitsuya H. Fluorine Modifications Contribute to Potent Antiviral Activity against Highly Drug-Resistant HIV-1 and Favorable Blood-Brain Barrier Penetration Property of Novel Central Nervous System-Targeting HIV-1 Protease Inhibitors In Vitro. Antimicrob Agents Chemother 2022; 66:e0171521. [PMID: 34978889 PMCID: PMC8846478 DOI: 10.1128/aac.01715-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
To date, there are no specific treatment regimens for HIV-1-related central nervous system (CNS) complications, such as HIV-1-associated neurocognitive disorders (HAND). Here, we report that two newly generated CNS-targeting HIV-1 protease (PR) inhibitors (PIs), GRL-08513 and GRL-08613, which have a P1-3,5-bis-fluorophenyl or P1-para-monofluorophenyl ring and P2-tetrahydropyrano-tetrahydrofuran (Tp-THF) with a sulfonamide isostere, are potent against wild-type HIV-1 strains and multiple clinically isolated HIV-1 strains (50% effective concentration [EC50]: 0.0001 to ∼0.0032 μM). As assessed with HIV-1 variants that had been selected in vitro to propagate at a 5 μM concentration of each HIV-1 PI (atazanavir, lopinavir, or amprenavir), GRL-08513 and GRL-08613 efficiently inhibited the replication of these highly PI-resistant variants (EC50: 0.003 to ∼0.006 μM). GRL-08513 and GRL-08613 also maintained their antiviral activities against HIV-2ROD as well as severely multidrug-resistant clinical HIV-1 variants. Additionally, when we assessed with the in vitro blood-brain barrier (BBB) reconstruction system, GRL-08513 and GRL-08613 showed the most promising properties of CNS penetration among the evaluated compounds, including the majority of FDA-approved combination antiretroviral therapy (cART) drugs. In the crystallographic analysis of compound-PR complexes, it was demonstrated that the Tp-THF rings at the P2 moiety of GRL-08513 and GRL-08613 form robust hydrogen bond interactions with the active site of HIV-1 PR. Furthermore, both the P1-3,5-bis-fluorophenyl- and P1-para-monofluorophenyl rings sustain greater contact surfaces and form stronger van der Waals interactions with PR than is the case with darunavir-PR complex. Taken together, these results strongly suggest that GRL-08513 and GRL-08613 have favorable features for patients infected with wild-type/multidrug-resistant HIV-1 strains and might serve as candidates for a preventive and/or therapeutic agent for HAND and other CNS complications.
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Affiliation(s)
- Masayuki Amano
- Department of Hematology, Rheumatology, and Infectious Disease, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Ravikiran S. Yedidi
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- The Center for Advanced-Applied Biological Sciences & Entrepreneurship (TCABS-E), Visakhapatnam, Andhra Pradesh, India
- Department of Zoology, Andhra University, Visakhapatnam, Andhra Pradesh, India
| | - Pedro Miguel Salcedo-Gómez
- Department of Hematology, Rheumatology, and Infectious Disease, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Hironori Hayashi
- Department of Hematology, Rheumatology, and Infectious Disease, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
- Division of Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Hasegawa
- Protein Crystal Analysis Division, Japan Synchrotron Radiation Research Institute, Kouto, Japan
| | - Cuthbert D. Martyr
- Department of Chemistry, Purdue University, West Lafayette, Indiana, USA
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana, USA
| | - Arun K. Ghosh
- Department of Chemistry, Purdue University, West Lafayette, Indiana, USA
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana, USA
| | - Hiroaki Mitsuya
- Department of Hematology, Rheumatology, and Infectious Disease, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- National Center for Global Health and Medicine Research Institute, Tokyo, Japan
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Chanie ES, Tesgera Beshah D, Ayele AD. Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study. SAGE Open Med 2022; 10:20503121221077843. [PMID: 35173969 PMCID: PMC8841924 DOI: 10.1177/20503121221077843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: Retaining on antiretroviral therapy is essential for reducing HIV-related morbidity and mortality. However, attrition in HIV-positive children remains a critical challenge in resource-limited settings, including Ethiopia. This study aims to determine the incidence and predictors of attrition among children on antiretroviral therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: An institution-based retrospective follow-up study was conducted among 357 HIV-positive children at the University of Gondar Comprehensive Specialized Hospital from 1 January 2005 to 30 December 2018 (G.C.). Data were collected by chart review using a structured and pre-tested data abstraction checklist. SPSS 22 and STATA 14.0 were used for data entry and analysis, respectively. In the Cox proportional hazard model, bivariables had a 0.25 computed to multivariable, and variables with a p-value of 0.05 at a 95% confidence interval were considered statistically significant predictors of attrition incidence. Results: A total of 344 child records with a completeness rate of 96.4% were reviewed and included in the analysis. The median follow-up period was 4.3 (interquartile range = 4.3 ± 4.7) years, and the median survival time was 132 months. The incidence rate of attrition was 6.6 per 100 person year observation (PYO) (95% confidence interval = 5.5, 8.0). In all, 105 (30.5%) children were recorded as attrition in the follow-up period. Baseline WHO clinical staging 3 and 4 (adjusted hazard ratio = 2.3 (95% confidence interval = 1.3, 4.0)), baseline weight-for-age −2 Z-score (adjusted hazard ratio = 3.1 (95% confidence interval = 1.7, 5.3)), cotrimoxazole non-users (adjusted hazard ratio = 2.5 (95% confidence interval = 1.4, 4.3)), and baseline hemoglobin levels 10 mg/dL (adjusted hazard ratio = 2.7 (95% confidence interval = 1.5, 47)) were found to be a predictor of attrition. Conclusion: The overall incidence of the rate of attrition was high. Baseline WHO clinical staging 3/4, baseline hemoglobin 10 mg/dL, cotrimoxazole (cotrimoxazole preventive therapy) non-user, and underweight at baseline (weight-for-age 2 Z-score) were found to be the main predictors of attrition.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Debrework Tesgera Beshah
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Northwest Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Northwest Ethiopia
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Kuramoto LK, Sobolev BG, Rosner J, Brasher PMA, Azoulay L, Cragg JJ. A systematic, concept-based method of developing the exposure measure for drug safety and effectiveness studies. Pharmacoepidemiol Drug Saf 2021; 31:13-21. [PMID: 34657356 DOI: 10.1002/pds.5372] [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: 06/18/2021] [Accepted: 10/12/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE In drug safety and effectiveness studies based on secondary data, the choice of an appropriate exposure measure for a given outcome can be challenging. Different measures of exposure can yield different estimates of treatment effect and safety. There is a knowledge gap with respect to developing and refining measures of drug exposure, to ensure that the exposure measure addresses the study question and is suitable for statistical analysis. METHODS We present a transparent, step-by-step approach to the development of drug exposure measures involving secondary data. This approach would be of interest to students and investigators with initial training in pharmacoepidemiology. We illustrate the approach using a study about Parkinson's disease. RESULTS We described the exposure specifications according to the study question. Next, we refined the exposure measure by linking it to knowledge about four major concepts in drug safety and effectiveness studies: drug use patterns, duration, timing, and dose. We then used this knowledge to guide the ultimate choice of exposure measure: time-varying, cumulative 6-month exposure to tamsulosin (a drug used to treat prostate hyperplasia). CONCLUSIONS The proposed approach links exposure specifications to four major concepts in drug safety and effectiveness studies. Formulating subject-matter knowledge about these major concepts provides an avenue to develop the rationale and specifications for the exposure measure.
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Affiliation(s)
- Lisa K Kuramoto
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris G Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan Rosner
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, and Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Jacquelyn J Cragg
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Tiruneh F, Deyas Y. How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis, Southwest Ethiopia. Ethiop J Health Sci 2021; 30:653-660. [PMID: 33911825 PMCID: PMC8047272 DOI: 10.4314/ejhs.v30i5.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Children younger than 15 years, carry almost 80% of the global burden of HIV/AIDS. HIV worsens the progression of latent TB to active TB disease. Although antiretroviral treatment has shown marked reduction in Tuberculosis incidence, TB continues to occur in Sub-Saharan countries including Ethiopia. The aim of this study was to investigate the impact of HAART on the incidence of tuberculosis among children infected with HIV in Southwest Ethiopia. Methods A retrospective cohort study was conducted between 2009 to 2014. We used chi-square test, and Mann-Whitney U test to compare non-HAART and HAART cohort. We estimated the effect of HAART on TB incidence using marginal structural model after adjusting for time-dependent confounders affected by exposure. Result A total of 844 children were followed. We observed them for a median of 51 months (IQR 31) and a total of 2942.99 child-years. The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). TB incidence for specific HAART and non-HAART cohort were 7.67 per 100 child-years (95% CI, 6.318–9.217) and 8.17 per 100 child-years (95% CI, 6.772–9.767) respectively. From marginal structural modeling, children on HAART were 36% (HR=0.642, 95% CI 0.442–0.931, p<0.02) less likely to develop TB compared to those who were not. Conclusion HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than what is expected.
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Affiliation(s)
- Firew Tiruneh
- Department of Midwifery, Collage of Health Science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Yared Deyas
- Department of Midwifery, Collage of Health Science, Mizan Tepi University, Mizan Teferi, Ethiopia
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Astawesegn FH, Stulz V, Agho KE, Mannan H, Conroy E, Ogbo FA. Prenatal HIV Test Uptake and Its Associated Factors for Prevention of Mother to Child Transmission of HIV in East Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105289. [PMID: 34065689 PMCID: PMC8157019 DOI: 10.3390/ijerph18105289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Identifying the socioeconomic and structural issues that act as enablers and/or barriers to HIV testing services is critical in combatting HIV/AIDS amongst mothers and children in Africa. In this study, we used a weighted sample of 46,645 women aged 15–49 who gave birth in the two years preceding the survey from the recent DHS dataset of ten East African countries. Multivariable logistic regression was used to investigate the factors associated with prenatal HIV test uptake in East Africa. The overall prenatal HIV test uptake for the prevention of mother-to-child transmission (PMTCT) of HIV was 80.8% (95% CI: 74.5–78.9%) in East Africa, with highest in Rwanda (97.9%, 95% CI: 97.2–98.3%) and lowest in Comoros (17.0%, 95% CI: 13.9–20.7%). Common factors associated with prenatal HIV test service uptake were higher maternal education level (AOR = 1.29; 95% CI: 1.10–1.50 for primary education and AOR = 1.96; 95% CI: 1.53–2.51 for secondary or higher education), higher partner education level (AOR = 1.24; 95% CI: 1.06–1.45 for primary education and AOR = 1.56; 95% CI: 1.26–1.94 for secondary or higher school), women from higher household wealth index (AOR = 1.29; 95% CI: 1.11–1.50 for middle wealth index; AOR = 1.57; 95% CL: 1.17–2.11 for rich wealth index), improved maternal exposure to the media, and increased awareness about MTCT of HIV. However, residents living in rural communities (AOR = 0.66; 95% CI: 0.51–0.85) and travelling long distances to the health facility (AOR = 0.8; 95% CI: 0.69–0.91) were associated with non-use of prenatal HIV test service in East African countries. In each East African country, factors associated with prenatal HIV test uptake for PMTCT varied. In conclusion, the pooled prenatal HIV test uptake for PMTCT of HIV was low in East Africa compared to the global target. Scaling up interventions to improve enablers whilst addressing barriers to the use of prenatal HIV test services are essential to end the HIV/AIDS epidemic in East African countries.
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Affiliation(s)
- Feleke Hailemichael Astawesegn
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2751, Australia; (H.M.); (E.C.); (F.A.O.)
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia
- Correspondence:
| | - Virginia Stulz
- School of Nursing and Midwifery Centre for Nursing and Midwifery Research, Western Sydney University, Kingswood, NSW 2340, Australia;
| | - Kingsley E. Agho
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia;
- African Vision Research Institute, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa
| | - Haider Mannan
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2751, Australia; (H.M.); (E.C.); (F.A.O.)
| | - Elizabeth Conroy
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2751, Australia; (H.M.); (E.C.); (F.A.O.)
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2751, Australia; (H.M.); (E.C.); (F.A.O.)
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi 972261, Nigeria
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11
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Tiruneh F, Chewaka L, Abdissa D. Statistical Joint Modeling for Predicting the Association of CD4 Measurement and Time to Death of People Living with HIV Who Enrolled in ART, Southwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:73-79. [PMID: 33519244 PMCID: PMC7837561 DOI: 10.2147/hiv.s283059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Abstract
Background In much epidemiological HIV research, patients are often followed over a period of time to predict their survival on the basis of repeatedly measured CD4 status. To predict survival, statistical models of the association between mortality and longitudinal CD4 measurement have been conducted widely using time-varying Cox models. However, in the presence of repeated measure, this approach leads to biased estimates. In view of the limitation of time-varying Cox models, in the present study, we considered joint modeling to predict the association of longitudinal CD4 measurement and time to death among patients initiated on ART. Methods A retrospective cohort study was employed for five years from 2009 to 2014 on a randomly selected 358 samples. Data were collected from patients’ ART and pre-ART follow-up registration book, database and other clinical records. Data were analyzed using joint latent class modeling of repeated CD4 measurement and time-to-event (HIV death). Results We have studied a total of 358 HIV-positive patients. The median and interquartile ranges of the age of patients were 30.31 years and 13.82, respectively. Males constitute the larger proportion, 51.68%. The square root of CD4 count has declined on average over time. This has been indicated with the negative sign of the coefficient for the time effect. The deterioration of health of individuals is severe in class 1, it has been observed with a worse decline in CD4 cell counts over time in this class than other classes (β= −0.488). Women had a larger risk rate than men (β=−2.475, p-value=0.013). Besides, the CD4 counts measurement of patients has been revealed to decrease as age increases (β= −0.016, p=0.008). Conclusion The finding indicated that the square root CD4 cell measurement dropped over time in the three classes. This clearly suggested deterioration in the health of individuals. Women were found to have a higher hazard rate than men.
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Affiliation(s)
- Firew Tiruneh
- Department of Midwifery, College of Health Science, Mizan Tepi University, Mizan Teferi, SNNPR, Ethiopia
| | - Lalisa Chewaka
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan Teferi, SNNPR, Ethiopia
| | - Dinaol Abdissa
- Department of Midwifery, College of Health Science, Mizan Tepi University, Mizan Teferi, SNNPR, Ethiopia.,Department of Nutrition and Reproductive Health, School of Public Health, College of Health Science, Mizan Tepi University, Mizan Teferi, SNNPR, Ethiopia
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12
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Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1. [PMID: 33390160 PMCID: PMC7780691 DOI: 10.1186/s12879-020-05706-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023] Open
Abstract
Background Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. Results Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05706-z.
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13
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Bimer KB, Sebsibe GT, Desta KW, Zewde A, Sibhat MM. Incidence and predictors of attrition among children attending antiretroviral follow-up in public hospitals, Southern Ethiopia, 2020: a retrospective study. BMJ Paediatr Open 2021; 5:e001135. [PMID: 34514177 PMCID: PMC8386224 DOI: 10.1136/bmjpo-2021-001135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It is a global challenge to enrol and retain paediatric patients in HIV/AIDS care. Attrition causes preventable transmission, stoppable morbidity and death, undesirable treatment outcomes, increased cost of care and drug resistance. Thus, this study intended to investigate the incidence and predictors of attrition among children receiving antiretroviral treatment (ART). METHOD A retrospective follow-up study was conducted among children <15 years who had ART follow-up in Gedeo public hospitals. After collection, data were entered into Epi-data V.4.6, then exported to and analysed using STATA V.14. Data were described using the Kaplan-Meier statistics, life table and general descriptive statistics. The analysis was computed using the Cox proportional hazard regression model. Covariates having <0.25 p values in the univariate analysis (such as developmental stage, nutritional status, haemoglobin level, adherence, etc) were fitted to multivariable analysis. Finally, statistical significance was declared at a p value of <0.05. RESULTS An overall 254 child charts were analysed. At the end of follow-up, attrition from ART care was 36.2% (92 of 254), of which 70 (76.1%) were lost to follow-up, and 22 (23.9%) children died. About 8145.33 child-months of observations were recorded with an incidence attrition rate of 11.3 per 1000 child-months (95% CI: 9.2 to 13.9), whereas the median survival time was 68.73 months. Decreased haemoglobin level (<10 g/dl) (adjusted HR (AHR)=3.1; 95% CI: 1.4 to 6.9), delayed developmental milestones (AHR=3.6; 95% CI: 1.2 to 10.7), underweight at baseline (AHR=5.9; 95% CI: 1.6 to 21.7), baseline CD4 count ≤200 (AHR=4.4; 95% CI: 1.6 to 12.2), and poor or fair ART adherence (AHR=3.5; 95% CI: 1.5 to 7.9) were significantly associated with attrition. CONCLUSION AND RECOMMENDATION Retention to ART care is challenging in the paediatrics population, with such a high attrition rate. Immune suppression, anaemia, underweight, delayed developmental milestones and ART non-adherence were independent predictors of attrition to ART care. Hence, it is crucial to detect and control the identified predictors promptly. Serious adherence support and strengthened nutritional provision with monitoring strategies are also essential.
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Affiliation(s)
- Kirubel Biweta Bimer
- Pediatrics and Child Health Nursing, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Girum Teshome Sebsibe
- School of nursing and midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kalkidan Wondwossen Desta
- School of nursing and midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashenafi Zewde
- Pediatrics and Child Health Nursing, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Migbar Mekonnen Sibhat
- Pediatrics and Child Health Nursing, Dilla University College of Health Sciences, Dilla, Ethiopia
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14
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Tiruneh F, Deyas Y. Effect of highly active antiretroviral treatment on TB incidence among HIV infected children and their clinical profile, retrospective cohort study, South West Ethiopia. Sci Rep 2020; 10:21468. [PMID: 33293656 PMCID: PMC7722879 DOI: 10.1038/s41598-020-78466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Globally, 1.8 million HIV infected children live with HIV; nearly 53% of them were receiving HIV treatment. People who are infected with HIV are 18 times more likely to develop active TB. Despite antiretroviral treatment has shown marked reduction in TB incidence, TB continues to occur in Sub-Saharan countries including Ethiopia among HIV infected people. The effect of highly active antiretroviral treatment is quite successful in developed countries. However, in developing country TB/HIV co-infection remains perplexing among children on the treatment. The aim of this study was to investigate the impact of ART on the incidence of TB among Children infected with HIV in Southwest Ethiopia. A retrospective cohort study was conducted on randomly selected 800 samples from ART clinic between 2009 and 2014. We used chi-square test, and Mann–Whitney U test to compare HAART naïve and HAART cohort. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. A total of 800 children were followed for 2942.99 child-years. The children were observed for a median of 51 months with IQR 31 and for a total of 2942.99 child-years. From 506 OIs that occurred, the most common reported OIs were Pneumonia (22%) and TB (23.6%). The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). Whereas among HAART (7.667 per 100-years (95% CI, 6.318–9.217) and 8.1686 per 100 person-years (95% CI 6.772–9.767) for HAART naïve. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.642 (95% CI 0.442–0.931, p < 0.02). HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than expected.
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Affiliation(s)
- Firew Tiruneh
- Department of Midwifery, College of Health Science, Mizan Tepi University, PO box 260, Mizan Teferi, Ethiopia.
| | - Yared Deyas
- Department of Midwifery, College of Health Science, Mizan Tepi University, PO box 260, Mizan Teferi, Ethiopia
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15
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Wubneh CA, Belay GM. Mortality and its association with CD4 cell count and hemoglobin level among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2020; 48:80. [PMID: 32973396 PMCID: PMC7504851 DOI: 10.1186/s41182-020-00267-y] [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: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 08/30/2023] Open
Abstract
Background Even though there are advancements in HIV/AIDS prevention and treatment approach, HIV continues to be a global challenge. Pediatrics HIV is one of the challenges in the reduction of child mortality particularly in less developed countries like Ethiopia. Therefore, this study aims to estimate the pooled proportion of child mortality and the effect of hemoglobin level and CD4 cell count among children on antiretroviral therapy in Ethiopia. Method All published were articles searched using PubMed, EMBASE, Google Scholar, and Web of Science database. Besides, Ethiopian institutional research repositories and reference lists of included studies were used. We limited the searching to studies conducted in Ethiopia and written in the English language. Studies that were done in a cohort, cross-sectional, and case-control study design were considered for the review. The weighted inverse variance random effects model was applied, and the overall variations between studies were checked by using heterogeneity test Higgins’s (I2). Subgroup analysis by region and year of publication was conducted. All of the included articles were assessed using the Joanna Briggs Institute (JBI) quality appraisal criteria. In addition, publication bias was also checked with Egger’s regression test and the funnel plot. Based on the results, trim and fill analysis was performed to manage the publication bias. Result A total of 16 studies with 7047 participants were included in this systematic review and meta-analysis. The overall pooled proportion of mortality among children on antiretroviral therapy (ART) was found to be 11.78% (95% CI 9.34, 14.23). In subgroup analysis, the highest child mortality was observed in the Amhara region 16.76 % (95% CI 9.63, 23.90) and the lowest is in the Tigray region 4.81% (95% CI 2.75, 6.87). Besides, the proportion of mortality among children with low CD4 count and hemoglobin level was 2.42 (AOR = 2.42, 95% CI 1.65, 3.56) and 3.24 (AOR = 3.24, 95% CI 1.51, 6.93) times higher compared to their counterparts, respectively. Conclusion The proportion of mortality among children on ART was high in Ethiopia. Those children who had low CD4 cell count and low hemoglobin levels at baseline need special attention, treatment, and care. Trial registration The protocol of this systematic review and meta-analysis has been registered in PROSPERO with the registration number CRD42018113077.
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Affiliation(s)
- Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Li H, Chi X, Li R, Ouyang J, Chen Y. A Novel lncRNA, AK130181, Contributes to HIV-1 Latency by Regulating Viral Promoter-Driven Gene Expression in Primary CD4 + T Cells. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 20:754-763. [PMID: 32408053 PMCID: PMC7225600 DOI: 10.1016/j.omtn.2020.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 01/31/2023]
Abstract
The functions and mechanisms of long non-coding RNAs (lncRNAs) in latent HIV-1 infection are not yet fully understood and warrant further research. In this study, we identified the newly inhibitory lncRNA AK130181 (also named LOC105747689), which is highly expressed in CD4+ T lymphocytes latently infected with HIV, using bioinformatics. We also found that AK130181 is involved in HIV-1 latency by inhibiting long terminal repeat (LTR)-driven HIV-1 gene transcription in a nuclear factor κB (NF-κB)-dependent manner. Furthermore, silencing AK130181 significantly reactivates viral production from HIV-1 latently infected Jurkat T cells and primary CD4+ T cells. Interestingly, we found that inhibition of AK130181 in resting CD4+ T cells from HIV-1-infected individuals treated with highly active antiretroviral therapy significantly increased viral reactivation upon T cell activation in vivo. We provide new insights and a better understanding of lncRNAs that play a role in HIV-1 latency, and suggest that silencing AK130181 expression to activate HIV-1 latently infected cells may be a potential therapeutic target for HIV-infected individuals.
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Affiliation(s)
- Haiyu Li
- Department of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiangbo Chi
- Department of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
| | - Rong Li
- Department of Department of Gastroenterology, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Ouyang
- Department of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
| | - Yaokai Chen
- Department of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China.
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17
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Bengtson AM, Pence BW, Mimiaga MJ, Gaynes BN, Moore R, Christopoulos K, O'Cleirigh C, Grelotti D, Napravnik S, Crane H, Mugavero M. Depressive Symptoms and Engagement in Human Immunodeficiency Virus Care Following Antiretroviral Therapy Initiation. Clin Infect Dis 2020; 68:475-481. [PMID: 29901695 DOI: 10.1093/cid/ciy496] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
Background The effect of depressive symptoms on progression through the human immunodeficiency virus (HIV) treatment cascade is poorly characterized. Methods We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems cohort who were antiretroviral therapy (ART) naive, had at least 1 viral load and HIV appointment measure after ART initiation, and a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut point (PHQ-9 ≥10). We followed participants from ART initiation through the first of the following events: loss to follow-up (>12 months with no HIV appointment), death, administrative censoring (2011-2014), or 5 years of follow-up. We used log binomial models with generalized estimating equations to estimate associations between recent depressive symptoms and having a detectable viral load (≥75 copies/mL) or missing an HIV visit over time. Results We included 1057 HIV-infected adults who contributed 2424 person-years. At ART initiation, 30% of participants reported depressive symptoms. In multivariable analysis, recent depressive symptoms increased the risk of having a detectable viral load (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.07, 1.53) over time. The association between depressive symptoms and missing an HIV visit (RR, 1.20; 95% CI, 1.05, 1.36) moved to the null after adjustment for preexisting mental health conditions (RR, 1.00; 95% CI, 0.85, 1.18). Conclusions Recent depressive symptoms are a risk factor for unsuppressed viral load, while preexisting mental health conditions may influence HIV appointment adherence.
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health.,Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.,Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Baltimore, Maryland
| | - Richard Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - David Grelotti
- Department of Psychiatry, University of California, San Diego
| | - Sonia Napravnik
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Heidi Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Michael Mugavero
- Department of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham
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18
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Synthesis and evaluation of potent human immunodeficiency virus 1 protease inhibitors with epimeric isopropanol as novel P1' ligands. Future Med Chem 2020; 12:775-794. [PMID: 32125179 DOI: 10.4155/fmc-2019-0331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: HIV-1 protease inhibitors regimens suffered from a number of drawbacks, among which, the most egregious issue was the growing emergence of drug-resistant strains. Materials & methods: The design strategy of maximizing the protease active site interactions with the inhibitor, especially promoting extensive hydrogen bonding with the protein backbone atoms, might be in favor of combating drug resistance. A series of HIV-1 protease inhibitors that incorporated enantiomeric isopropanols as the P1' ligands in combination with phenols as the P2 ligands were reported herein. Results: A number of inhibitors displayed potent protease enzyme inhibition activity. In particular, inhibitor 14c showed comparable potency as darunavir with IC50 value of 1.91 nM and activity against darunavir-resistant HIV-1 variants. Conclusion: The new kind of HIV-1 protease inhibitors deserves further study.
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19
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Ghosh AK, Xia Z, Kovela S, Robinson WL, Johnson ME, Kneller DW, Wang YF, Aoki M, Takamatsu Y, Weber IT, Mitsuya H. Potent HIV-1 Protease Inhibitors Containing Carboxylic and Boronic Acids: Effect on Enzyme Inhibition and Antiviral Activity and Protein-Ligand X-ray Structural Studies. ChemMedChem 2019; 14:1863-1872. [PMID: 31549492 PMCID: PMC6842059 DOI: 10.1002/cmdc.201900508] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/18/2019] [Indexed: 01/07/2023]
Abstract
We report the synthesis and biological evaluation of phenylcarboxylic acid and phenylboronic acid containing HIV-1 protease inhibitors and their functional effect on enzyme inhibition and antiviral activity in MT-2 cell lines. Inhibitors bearing bis-THF ligand as P2 ligand and phenylcarboxylic acids and carboxamide as the P2' ligands, showed very potent HIV-1 protease inhibitory activity. However, carboxylic acid containing inhibitors showed very poor antiviral activity relative to carboxamide-derived inhibitors which showed good antiviral IC50 value. Boronic acid derived inhibitor with bis-THF as the P2 ligand showed very potent enzyme inhibitory activity, but it showed lower antiviral activity than darunavir in the same assay. Boronic acid containing inhibitor with a P2-Crn-THF ligand also showed potent enzyme Ki but significantly decreased antiviral activity. We have evaluated antiviral activity against a panel of highly drug-resistant HIV-1 variants. One of the inhibitors maintained good antiviral activity against HIVDRVRP20 and HIVDRVRP30 viruses. We have determined high resolution X-ray structures of two synthetic inhibitors bound to HIV-1 protease and obtained molecular insight into the ligand-binding site interactions.
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Affiliation(s)
- Arun K. Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907
| | - Zilei Xia
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907
| | - Satish Kovela
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907
| | - William L. Robinson
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907
| | - Megan E. Johnson
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907
| | - Daniel W. Kneller
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303
| | - Yuan-Fang Wang
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303
| | - Manabu Aoki
- Experimental Retrovirology Section, HIV and AIDS Malignancy, Branch, National Cancer Institute, Bethesda, MD 20892,Department of Refractory Viral Infections, National Center for Global Heath and Medicine Research Institute, Shinjuku, Tokyo 162-8655, Japan
| | - Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Heath and Medicine Research Institute, Shinjuku, Tokyo 162-8655, Japan
| | - Irene T. Weber
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303
| | - Hiroaki Mitsuya
- Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan,Experimental Retrovirology Section, HIV and AIDS Malignancy, Branch, National Cancer Institute, Bethesda, MD 20892,Department of Refractory Viral Infections, National Center for Global Heath and Medicine Research Institute, Shinjuku, Tokyo 162-8655, Japan
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20
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Schomaker M, Luque-Fernandez MA, Leroy V, Davies MA. Using longitudinal targeted maximum likelihood estimation in complex settings with dynamic interventions. Stat Med 2019; 38:4888-4911. [PMID: 31436859 DOI: 10.1002/sim.8340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/12/2022]
Abstract
Longitudinal targeted maximum likelihood estimation (LTMLE) has very rarely been used to estimate dynamic treatment effects in the context of time-dependent confounding affected by prior treatment when faced with long follow-up times, multiple time-varying confounders, and complex associational relationships simultaneously. Reasons for this include the potential computational burden, technical challenges, restricted modeling options for long follow-up times, and limited practical guidance in the literature. However, LTMLE has desirable asymptotic properties, ie, it is doubly robust, and can yield valid inference when used in conjunction with machine learning. It also has the advantage of easy-to-calculate analytic standard errors in contrast to the g-formula, which requires bootstrapping. We use a topical and sophisticated question from HIV treatment research to show that LTMLE can be used successfully in complex realistic settings, and we compare results to competing estimators. Our example illustrates the following practical challenges common to many epidemiological studies: (1) long follow-up time (30 months); (2) gradually declining sample size; (3) limited support for some intervention rules of interest; (4) a high-dimensional set of potential adjustment variables, increasing both the need and the challenge of integrating appropriate machine learning methods; and (5) consideration of collider bias. Our analyses, as well as simulations, shed new light on the application of LTMLE in complex and realistic settings: We show that (1) LTMLE can yield stable and good estimates, even when confronted with small samples and limited modeling options; (2) machine learning utilized with a small set of simple learners (if more complex ones cannot be fitted) can outperform a single, complex model, which is tailored to incorporate prior clinical knowledge; and (3) performance can vary considerably depending on interventions and their support in the data, and therefore critical quality checks should accompany every LTMLE analysis. We provide guidance for the practical application of LTMLE.
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Affiliation(s)
- M Schomaker
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - M A Luque-Fernandez
- Biomedical Research Institute of Granada - Noncommunicable and Cancer Epidemiology Group, Andalusian School of Public Health, University of Granada, Granada, Spain.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - M A Davies
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
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21
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Ashaba S, Cooper-Vince CE, Vořechovská D, Rukundo GZ, Maling S, Akena D, Tsai AC. Community beliefs, HIV stigma, and depression among adolescents living with HIV in rural Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:169-180. [PMID: 31339461 DOI: 10.2989/16085906.2019.1637912] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The availability of and increased access to antiretroviral therapy (ART) has significantly reduced the morbidity and mortality associated with HIV. As a result, perinatally infected youth are increasingly able to reach adolescence. There is limited information about the psychosocial challenges facing adolescents living with HIV (ALWH) in rural settings of sub-Saharan Africa. We sought to understand psychosocial challenges facing ALWH in rural Uganda and their effects on mental health and HIV treatment outcomes. We conducted 5 focus group discussions and 40 one-on-one in-depth interviews in Mbarara, Uganda with adolescents (aged 13-17 years) and adult women caregivers. All interviews were audio-recorded, transcribed directly into English, and coded using thematic analysis to identify themes related to psychosocial adversities and mental health. Adversities faced by adolescents included negative community perceptions (perceived aggression, presumed early mortality), HIV stigma (enacted and internalized), vulnerability factors (loss of parents, poverty), and health challenges (depression, ART non-adherence). In the conceptual model that emerged from the findings, negative community perceptions (about perceived aggression or presumed early mortality) predisposed ALWH to experience enactments and internalization of stigma that led to depression and ART non-adherence. The data also identified several protective factors, including counselling, family and religious support, and timely serostatus disclosure. Interventions to correct community misperceptions about HIV can potentially reduce stigma and thereby improve physical and mental health outcomes of ALWH.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | | | | | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences , Makerere , Uganda
| | - Alexander C Tsai
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda.,Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
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22
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Belay GM, Engeda EH, Ayele AD. Late antiretroviral therapy initiation and associated factors among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: a cross-sectional study. BMC Res Notes 2019; 12:255. [PMID: 31064418 PMCID: PMC6505062 DOI: 10.1186/s13104-019-4279-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Highly active antiretroviral therapy reduces HIV related morbidity and mortality dramatically. Despite this fact, late ART initiation poses poor treatment outcome in pediatrics. However, the information is scarce in Ethiopia. Therefore, the study was aimed at determining the burden of late ART initiation and its associated factors among children on ART. Cross-sectional study was conducted among 422 children selected by simple random sampling. Patient charts were reviewed using pretested and structured data abstraction tool. Binary logistic regression model was fitted. Results A total of 402 child records with a completeness rate of 95.3% were included. The overall proportion of late antiretroviral therapy initiation among children on antiretroviral therapy was 53.2% (95% CI 48.5–58.4%). Under-5 years of age [AOR: 2.165 (95% CI 1.341, 3.495)], rural residence [AOR: 1.825 (95% CI 1.052, 3.166)], taking non-ART medication [AOR: 2.237 (95% CI 1.212, 4.130)], past opportunistic infection [AOR: 2.548 (95% CI 1.554, 4.178)], unmarried caregiver [AOR: 1.618 (95% CI 1.023, 2.559)], male caregiver [AOR: 1.903 (95% CI 1.026–3.527)] and null ANC visit [AOR: 1.721 (95% CI 1.077, 2.752)] were significantly associated factors. There is high burden of late ART initiation in children. Thus, focus should be started from pregnancy.
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Affiliation(s)
- Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetu Haileselassie Engeda
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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23
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Saumu WM, Maleche-Obimbo E, Irimu G, Kumar R, Gichuhi C, Karau B. Predictors of loss to follow-up among children attending HIV clinic in a hospital in rural Kenya. Pan Afr Med J 2019; 32:216. [PMID: 31312327 PMCID: PMC6620067 DOI: 10.11604/pamj.2019.32.216.18310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction African studies have reported high rates of loss to follow up (LTFU) among children in HIV care and treatment centres. Factors associated with LTFU may vary across populations. Few studies have been conducted among HIV infected children in care in rural areas of Kenya. Methods this involved children aged less than 15 years on follow up at Kangundo Level 4 Hospital HIV clinic from January 2010 to December 2015. We obtained sociodemographic and clinical information from patient files and electronic databases. Univariate and multivariate regression analyses were conducted to identify factors predictive of LTFU. Results a total of 261 HIV-infected children were followed up. The mean age was 10.0 years (IQR, 7-13) and median CD4 count of 582cells/ul (IQR 314-984). By December 2015, 171 children (65.5%) remained in active care, 32 (12.3%) transferred out, 13 (5%) died, while 45 (17.2%) were classified as LTFU. Out of the 45 children presumed as LTFU, we traced 44 out of the 45 children (98%) and found that their actual current status was as follows: 33 of the 44 children (75.0%) had dropped out of care (true LTFU). Factors strongly predictive of LTFU included low caregiver level of education (HR 2.3, 1.9-3.9, P = 0.001), WHO stage I and II at enrolment (HR 1.6, 1.4-2.1, P = 0.05). Conclusion LTFU of HIV infected children was common with an incidence of 32.9 per 1000 child years and occurred early in treatment and risk factors included poverty, low caregiver education, male child and early HIV disease stage.
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Affiliation(s)
- Winnie Mueni Saumu
- Department of Paediatrics and Child Health, Chuka County Referral Hospital, Tharaka Nithi KE, Kenya
| | | | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Rashmi Kumar
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Christine Gichuhi
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Bundi Karau
- Department of Internal Medicine, Kenya Methodist University, Nairobi, Kenya
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24
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Arage G, Assefa M, Worku T, Semahegn A. Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: A facility-based retrospective cohort. SAGE Open Med 2019; 7:2050312119838957. [PMID: 30937168 PMCID: PMC6434434 DOI: 10.1177/2050312119838957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: To determine the survival rate and predictors of HIV-infected children on antiretroviral therapy at two selected facilities in North Ethiopia. Methods: A facility-based retrospective cohort study was conducted in Debre Tabor General Hospital and Dessie Referral Hospital from December 2005 to November 2015. A total of 426 records were included in the study. Multivariable Cox proportional hazards regression model was used to identify independent predictors of survival. Results: At the end of follow-up, 97 (22.9%) HIV-infected children died and 325 (77.1%) were alive. The probabilities of survival at 12, 24, 36 and 48 months of on antiretroviral therapy were 0.91, 0.85, 0.84 and 0.80, respectively. The median survival time was 91.6 months (95% confidence interval: 89.0–94.2). Almost half (51%) of the deaths occurred within the first 2 years of treatment. Study participants who had poor adherence to antiretroviral therapy (adjusted hazard ratio = 3.0; 95% confidence interval: 1.2–7.5) and who started antiretroviral therapy with lower baseline weight-for-age Z-score (adjusted hazard ratio = 2.5; 95% confidence interval: 1.1–6.1) were significantly associated with high risk of mortality. On the other hand, study participants with a baseline CD4 count above 200 cells/mm3 (adjusted hazard ratio = 0.7; 95% confidence interval: 0.4–0.9) and those participants who had psychosocial support during follow-up (adjusted hazard ratio = 0.03; 95% confidence interval: 0.1–0.7) were significantly associated with less mortality event. Conclusion: Mortality of children on antiretroviral therapy was high. The risk of mortality is increased if the child was underweight at the commencement of antiretroviral therapy, had lower baseline CD4 count, had poor adherence to antiretroviral therapy and had no psychosocial support. Concerned stakeholders should focus on antiretroviral therapy adherence, nutritional interventions, psychological support and early initiation of antiretroviral therapy regardless of their CD4 count to enhance survival of HIV-infected children on antiretroviral therapy.
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Affiliation(s)
- Getachew Arage
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mekonnen Assefa
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Agumasie Semahegn
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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25
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Ghosh AK, Williams JN, Ho RY, Simpson HM, Hattori SI, Hayashi H, Agniswamy J, Wang YF, Weber IT, Mitsuya H. Design and Synthesis of Potent HIV-1 Protease Inhibitors Containing Bicyclic Oxazolidinone Scaffold as the P2 Ligands: Structure-Activity Studies and Biological and X-ray Structural Studies. J Med Chem 2018; 61:9722-9737. [PMID: 30354121 PMCID: PMC6541917 DOI: 10.1021/acs.jmedchem.8b01227] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We have designed, synthesized, and evaluated a new class of potent HIV-1 protease inhibitors with novel bicyclic oxazolidinone derivatives as the P2 ligand. We have developed an enantioselective synthesis of these bicyclic oxazolidinones utilizing a key o-iodoxybenzoic acid mediated cyclization. Several inhibitors displayed good to excellent activity toward HIV-1 protease and significant antiviral activity in MT-4 cells. Compound 4k has shown an enzyme Ki of 40 pM and antiviral IC50 of 31 nM. Inhibitors 4k and 4l were evaluated against a panel of highly resistant multidrug-resistant HIV-1 variants, and their fold-changes in antiviral activity were similar to those observed with darunavir. Additionally, two X-ray crystal structures of the related inhibitors 4a and 4e bound to HIV-1 protease were determined at 1.22 and 1.30 Å resolution, respectively, and revealed important interactions in the active site that have not yet been explored.
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Affiliation(s)
- Arun K. Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, United States,Corresponding Author Phone: (765) 494-5323. Fax: (765) 496-1612.
| | - Jacqueline N. Williams
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Rachel Y. Ho
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Hannah M. Simpson
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Shin-ichiro Hattori
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan
| | - Hironori Hayashi
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan
| | - Johnson Agniswamy
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, United States
| | - Yuan-Fang Wang
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, United States
| | - Irene T. Weber
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, United States
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan, Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences, Kumamoto 860-8556, Japan, Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
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Anigilaje EA, Aderibigbe SA. Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria. Adv Med 2018; 2018:6409134. [PMID: 30018988 PMCID: PMC6029505 DOI: 10.1155/2018/6409134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/15/2018] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria. METHODOLOGY A retrospective cohort study in children aged 0-15 years, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. Kaplan-Meier method analysed the cumulative probability of early mortality (EM) occurring at or before 6 months and after 6 months of follow-up (late mortality-LM) on a 12-month antiretroviral therapy (ART). Multivariate Cox proportional regression models were used to test for hazard ratios (HR). RESULTS 368 children were included in the analysis contributing 81 children per 100 child-years to the 12-month ART follow-up. A significant reduction in EM rates was noted at 17.3 deaths per 100 child-years (30 deaths) to LM rates of 3.0 deaths per 100 child-years (10 deaths), p < 0.01. At multivariate analysis, children with a high pretreatment viral load (≥10,000 copies/ml) were found to be at risk of EM (aHR; 18. 089, 95% CI; 2.428-134.77, p=0.005). Having severe immunosuppression at/or before 6 months of ART was the predictor of LM (aHR; 17.28, 95% CI; 3.844-77.700, p ≤ 0.001). CONCLUSIONS Although a lower mortality rate is seen at 12 months of ART in our setting, predictors of HIV mortality are having high pretreatment HIV viral load and severe immunosuppression. While primary prevention of HIV infection is paramount, early identification of these predictors among our HIV-infected children for an early ART initiation can reduce further the mortality in our setting. In addition, measures to ensure a good standard of care and retention in care for a sustained virologic suppression cannot be ignored and are hereby underscored.
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Igulot P, Magadi MA. Socioeconomic Status and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of AIDS Indicator Survey Data. AIDS Res Treat 2018; 2018:7812146. [PMID: 29983999 PMCID: PMC6011175 DOI: 10.1155/2018/7812146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/23/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is controversy on the association between socioeconomic status (SES) and HIV infection. Some evidence claims higher SES is negatively associated with HIV infection while others report the reverse. OBJECTIVES To examine the association between SES and HIV infection in Uganda and to examine whether the SES-HIV relationship varies by gender, rural-urban place of residence, and time (2004-2005 and 2011) in Uganda. METHODS Multilevel analysis was applied to 39,766 individual cases obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011. RESULTS Household wealth is associated with increased vulnerability in the general population and in rural areas. Compared with no educational attainment, secondary or higher education is associated with reduced vulnerability to the risk of HIV infection by 37% in the general population. However, this effect was stronger in urban than rural areas. Besides individual-level factors, unobserved community factors too play an important role and account for 9% of unexplained variance after individual-level factors are considered. CONCLUSION Household wealth increases vulnerability but education reduces it. The social environment influences vulnerability to HIV infection independent of individual-level factors. HIV/AIDS awareness targeting sexual practices of wealthy individuals and those with primary-level educational attainment together with improving educational attainment and addressing contextual factors influencing vulnerability to HIV infection are necessary strategies to reduce HIV infections in Uganda.
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28
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Ghosh AK, Nyalapatla PR, Kovela S, Rao KV, Brindisi M, Osswald HL, Amano M, Aoki M, Agniswamy J, Wang YF, Weber IT, Mitsuya H. Design and Synthesis of Highly Potent HIV-1 Protease Inhibitors Containing Tricyclic Fused Ring Systems as Novel P2 Ligands: Structure-Activity Studies, Biological and X-ray Structural Analysis. J Med Chem 2018; 61:4561-4577. [PMID: 29763303 PMCID: PMC6044451 DOI: 10.1021/acs.jmedchem.8b00298] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The design, synthesis, and biological evaluation of a new class of HIV-1 protease inhibitors containing stereochemically defined fused tricyclic polyethers as the P2 ligands and a variety of sulfonamide derivatives as the P2' ligands are described. A number of ring sizes and various substituent effects were investigated to enhance the ligand-backbone interactions in the protease active site. Inhibitors 5c and 5d containing this unprecedented fused 6-5-5 ring system as the P2 ligand, an aminobenzothiazole as the P2' ligand, and a difluorophenylmethyl as the P1 ligand exhibited exceptional enzyme inhibitory potency and maintained excellent antiviral activity against a panel of highly multidrug-resistant HIV-1 variants. The umbrella-like P2 ligand for these inhibitors has been synthesized efficiently in an optically active form using a Pauson-Khand cyclization reaction as the key step. The racemic alcohols were resolved efficiently using a lipase catalyzed enzymatic resolution. Two high resolution X-ray structures of inhibitor-bound HIV-1 protease revealed extensive interactions with the backbone atoms of HIV-1 protease and provided molecular insight into the binding properties of these new inhibitors.
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Affiliation(s)
- Arun K. Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA,The corresponding author: Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, IN 47907, Phone: (765)-494-5323; Fax: (765)-496-1612,
| | - Prasanth R. Nyalapatla
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Satish Kovela
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Kalapala Venkateswara Rao
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Margherita Brindisi
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Heather L. Osswald
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Masayuki Amano
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences, Kumamoto 860-8556, Japan,Department of Medical Technology, Kumamoto Health Science University, Kumamoto 861-5598, Japan
| | - Manabu Aoki
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences, Kumamoto 860-8556, Japan,Department of Medical Technology, Kumamoto Health Science University, Kumamoto 861-5598, Japan,Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Johnson Agniswamy
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, USA
| | - Yuan-Fang Wang
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, USA
| | - Irene T. Weber
- Department of Biology, Molecular Basis of Disease, Georgia State University, Atlanta, Georgia 30303, USA
| | - Hiroaki Mitsuya
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences, Kumamoto 860-8556, Japan,Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan,Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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GRL-079, a Novel HIV-1 Protease Inhibitor, Is Extremely Potent against Multidrug-Resistant HIV-1 Variants and Has a High Genetic Barrier against the Emergence of Resistant Variants. Antimicrob Agents Chemother 2018; 62:AAC.02060-17. [PMID: 29463535 DOI: 10.1128/aac.02060-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/19/2018] [Indexed: 01/12/2023] Open
Abstract
We identified four novel nonpeptidic human immunodeficiency virus type 1 (HIV-1) protease inhibitors (PIs), GRL-078, -079, -077, and -058, containing an alkylamine at the C-5 position of P2 tetrahydropyrano-tetrahydrofuran (Tp-THF) and a P2' cyclopropyl (Cp) (or isopropyl)-aminobenzothiazole (Abt) moiety. Their 50% effective concentrations (EC50s) were 2.5 to 30 nM against wild-type HIV-1NL4-3, 0.3 to 6.7 nM against HIV-2EHO, and 0.9 to 90 nM against laboratory-selected PI-resistant HIV-1 and clinical HIV-1 variants resistant to multiple FDA-approved PIs (HIVMDR). GRL-078, -079, -077, and -058 also effectively blocked the replication of HIV-1 variants highly resistant to darunavir (DRV) (HIVDRVrp51), with EC50s of 38, 62, 61, and 90 nM, respectively, while four FDA-approved PIs examined (amprenavir, atazanavir, lopinavir [LPV], and DRV) had virtually no activity (EC50s of >1,000 nM) against HIVDRVrp51 Structurally, GRL-078, -079, and -058 form strong hydrogen bond interactions between Tp-THF modified at C-5 and Asp29/Asp30/Gly48 of wild-type protease, while the P2' Cp-Abt group forms strong hydrogen bonds with Asp30'. The Tp-THF and Cp-Abt moieties also have good nonpolar interactions with protease residues located in the flap region. For selection with LPV and DRV by use of a mixture of 11 HIVMDR strains (HIV11MIX), HIV11MIX became highly resistant to LPV and DRV over 13 to 32 and 32 to 41 weeks, respectively. However, for selection with GRL-079 and GRL-058, HIV11MIX failed to replicate at >0.08 μM and >0.2 μM, respectively. Thermal stability results supported the highly favorable anti-HIV-1 potency of GRL-079 as well as other PIs. The present data strongly suggest that the P2 Tp-THF group modified at C-5 and the P2' Abt group contribute to the potent anti-HIV-1 profiles of the four PIs against HIV-1NL4-3 and a wide spectrum of HIVMDR strains.
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Ghosh AK, Rao KV, Nyalapatla PR, Kovela S, Brindisi M, Osswald HL, Reddy BS, Agniswamy J, Wang YF, Aoki M, Hattori SI, Weber IT, Mitsuya H. Design of Highly Potent, Dual-Acting and Central-Nervous-System-Penetrating HIV-1 Protease Inhibitors with Excellent Potency against Multidrug-Resistant HIV-1 Variants. ChemMedChem 2018; 13:803-815. [PMID: 29437300 PMCID: PMC5912973 DOI: 10.1002/cmdc.201700824] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/09/2018] [Indexed: 01/07/2023]
Abstract
Herein we report the design, synthesis, X-ray structural, and biological studies of an exceptionally potent HIV-1 protease inhibitor, compound 5 ((3S,7aS,8S)-hexahydro-4H-3,5-methanofuro[2,3-b]pyran-8-yl ((2S,3R)-4-((2-(cyclopropylamino)-N-isobutylbenzo[d]thiazole)-6-sulfonamido)-1-(3,5-difluorophenyl)-3-hydroxybutan-2-yl)carbamate). Using structure-based design, we incorporated an unprecedented 6-5-5-ring-fused crown-like tetrahydropyranofuran as the P2-ligand, a cyclopropylaminobenzothiazole as the P2'-ligand, and a 3,5-difluorophenylmethyl group as the P1-ligand. The resulting inhibitor 5 exhibited exceptional HIV-1 protease inhibitory and antiviral potency at the picomolar level. Furthermore, it displayed antiviral IC50 values in the picomolar range against a wide panel of highly multidrug-resistant HIV-1 variants. The inhibitor shows an extremely high genetic barrier against the emergence of drug-resistant variants. It also showed extremely potent inhibitory activity toward dimerization as well as favorable central nervous system penetration. We determined a high-resolution X-ray crystal structure of the complex between inhibitor 5 and HIV-1 protease, which provides molecular insight into the unprecedented activity profiles observed.
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Affiliation(s)
- Arun K. Ghosh
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA),
| | - Kalapala Venkateswara Rao
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Prasanth R. Nyalapatla
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Satish Kovela
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Margherita Brindisi
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Heather L. Osswald
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Bhavanam Sekhara Reddy
- Prof. Dr. A. K. Ghosh, Dr. K. V. Rao, Dr. P. R. Nyalapatla, Dr. S. Kovela, Dr. M. Brindisi, Dr. H. L. Osswald, Dr. B. Sekhara Reddy Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Johnson Agniswamy
- Dr. J. Agniswamy, Y.-F. Wang, Prof. Dr. I. T. Weber Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Yuan-Fang Wang
- Dr. J. Agniswamy, Y.-F. Wang, Prof. Dr. I. T. Weber Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Manabu Aoki
- Dr. M. Aoki, Prof. Dr. H. Mitsuya Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556 (Japan),Dr. M. Aoki, Prof. Dr. H. Mitsuya Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD 20892 (USA),Dr. M. Aoki, S.-i. Hattori, Prof. Dr. H. Mitsuya Center for Clinical Sciences, National Center for Global Heath and Medicine, Shinjuku, Tokyo 162-8655 (Japan)
| | - Shin-ichiro Hattori
- Dr. M. Aoki, S.-i. Hattori, Prof. Dr. H. Mitsuya Center for Clinical Sciences, National Center for Global Heath and Medicine, Shinjuku, Tokyo 162-8655 (Japan)
| | - Irene T. Weber
- Dr. J. Agniswamy, Y.-F. Wang, Prof. Dr. I. T. Weber Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Hiroaki Mitsuya
- Dr. M. Aoki, Prof. Dr. H. Mitsuya Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556 (Japan),Dr. M. Aoki, Prof. Dr. H. Mitsuya Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD 20892 (USA),Dr. M. Aoki, S.-i. Hattori, Prof. Dr. H. Mitsuya Center for Clinical Sciences, National Center for Global Heath and Medicine, Shinjuku, Tokyo 162-8655 (Japan)
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Schomaker M, Leroy V, Wolfs T, Technau KG, Renner L, Judd A, Sawry S, Amorissani-Folquet M, Noguera-Julian A, Tanser F, Eboua F, Navarro ML, Chimbetete C, Amani-Bosse C, Warszawski J, Phiri S, N'Gbeche S, Cox V, Koueta F, Giddy J, Sygnaté-Sy H, Raben D, Chêne G, Davies MA. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe. Int J Epidemiol 2018; 46:453-465. [PMID: 27342220 DOI: 10.1093/ije/dyw097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/08/2023] Open
Abstract
Background There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. Methods A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. Results Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. Conclusions Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.
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Affiliation(s)
- Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Valeriane Leroy
- Inserm, U1027, Université Paul Sabatier Toulouse 3 Toulouse, France
| | - Tom Wolfs
- Children's Hospital/UMCU, Department of Infectious Diseases, Utrecht, The Netherlands
| | - Karl-Günter Technau
- Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa.,Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana Medical School, Accra, Ghana
| | - Ali Judd
- MRC Clinical Trials Unit, University College London, London, UK
| | - Shobna Sawry
- University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Antoni Noguera-Julian
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa - CAPRISA, University of KwaZulu-Natal, Congella, South Africa
| | | | | | | | | | - Josiane Warszawski
- Centre de recherche en épidémiologie et santé des populations, 1018 Inserm, France
| | - Sam Phiri
- Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Sylvie N'Gbeche
- Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d'Ivoire
| | - Vivian Cox
- Médecins Sans Frontiéres South Africa, Cape Town, South Africa
| | - Fla Koueta
- Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso
| | - Janet Giddy
- Sinikithemba Clinic, McCord Hospital, Durban, South Africa
| | | | - Dorthe Raben
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geneviève Chêne
- University of Bordeaux Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d information médicale, F-33000 Bordeaux, France
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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32
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Schomaker M, Heumann C. Bootstrap inference when using multiple imputation. Stat Med 2018; 37:2252-2266. [PMID: 29682776 DOI: 10.1002/sim.7654] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 01/18/2018] [Accepted: 02/10/2018] [Indexed: 01/21/2023]
Abstract
Many modern estimators require bootstrapping to calculate confidence intervals because either no analytic standard error is available or the distribution of the parameter of interest is nonsymmetric. It remains however unclear how to obtain valid bootstrap inference when dealing with multiple imputation to address missing data. We present 4 methods that are intuitively appealing, easy to implement, and combine bootstrap estimation with multiple imputation. We show that 3 of the 4 approaches yield valid inference, but that the performance of the methods varies with respect to the number of imputed data sets and the extent of missingness. Simulation studies reveal the behavior of our approaches in finite samples. A topical analysis from HIV treatment research, which determines the optimal timing of antiretroviral treatment initiation in young children, demonstrates the practical implications of the 4 methods in a sophisticated and realistic setting. This analysis suffers from missing data and uses the g-formula for inference, a method for which no standard errors are available.
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Affiliation(s)
- Michael Schomaker
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Falmouth Building, Observatory, Cape Town, 7925, South Africa
| | - Christian Heumann
- Christian Heumann, Institut für Statistik, Ludwig-Maximilians Universität München, München, Germany
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33
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Ross J, Edmonds A, Hoover DR, Shi Q, Anastos K, Lelo P, Behets F, Yotebieng M. Association between pregnancy at enrollment into HIV care and loss to care among women in the Democratic Republic of Congo, 2006-2013. PLoS One 2018; 13:e0195231. [PMID: 29608618 PMCID: PMC5880386 DOI: 10.1371/journal.pone.0195231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
Background Loss to care is high among asymptomatic HIV-infected women initiated on antiretroviral therapy (ART) during pregnancy or in the postpartum period. However, whether pregnancy itself plays a role in the high loss to care rate is uncertain. We compared loss to care over seven years between pregnant and non-pregnant women at enrollment into HIV care in the Democratic Republic of Congo (DRC). Methods We conducted a retrospective analysis of all ART-naive women aged 15–45 initiating HIV care at two large clinics in Kinshasa, DRC, from 2007–2013. Pregnancy status was recorded at care enrollment. Patients were classified as having no follow-up if they did not return to care after the initial enrollment visit. Among those with at least one follow-up visit after enrollment, we classified patients as lost to care if more than 365 days had passed since their last clinic visit. We used logistic regression to model the association between pregnancy status and no follow-up, and Cox proportional hazards regression to model the association between pregnancy status and time to loss to care. Results Of 2175 women included in the analysis, 1497 (68.8%) were pregnant at enrollment. Compared to non-pregnant women, pregnant women were less likely to be over 35 years of age (19.1% vs. 31.9%, p<0.0001) and less likely to be in WHO stage III or IV (9.0% vs. 26.3%, p<0.0001). Among pregnant women, 106 (7.1%) were not seen after enrollment, versus 25 (3.7%) non-pregnant women (adjusted odds ratio 2.01, 95% CI 1.24–3.24). Of the 2,044 women with at least one follow-up visit, 46.5% of pregnant women and 46.7% of non-pregnant women were lost to care by 5 years; hazards of loss to care were similar for pregnant and non-pregnant women (adjusted hazard ratio 1.08, 95% CI 0.93–1.26). Conclusions In this large cohort of HIV-infected women, patients pregnant at care enrollment were more likely to never return for follow-up. Among those who attended at least one follow-up visit, loss to care was not different between pregnant and non-pregnant women, suggesting that pregnancy itself may not be the main driver of the high attrition observed in this cohort.
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Affiliation(s)
- Jonathan Ross
- Department of Medicine, Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, United States of America
- * E-mail:
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Donald R. Hoover
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, NJ, United States of America
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, United States of America
| | - Kathryn Anastos
- Department of Medicine, Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, United States of America
| | - Patricia Lelo
- Kalembelembe Pediatric Hospital, Kinshasa, The Democratic Republic of Congo
| | - Frieda Behets
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Marcel Yotebieng
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH, United States of America
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Moolasart V, Chottanapund S, Ausavapipit J, Likanonsakul S, Uttayamakul S, Changsom D, Lerdsamran H, Puthavathana P. The Effect of Detectable HIV Viral Load among HIV-Infected Children during Antiretroviral Treatment: A Cross-Sectional Study. CHILDREN-BASEL 2018; 5:children5010006. [PMID: 29301267 PMCID: PMC5789288 DOI: 10.3390/children5010006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Abstract
The RNA viral load of human immunodeficiency virus (HIV) is initially used to determine the status of the HIV infection. The goal of therapy following treatment failure is to achieve and maintain virologic suppression. A detectable viral load may relate to the progression of HIV infection. A cross-sectional survey was conducted from January 2013 to December 2014 at the Bamrasnaradura Infectious Diseases Institute, Thailand. The aim was to determine the prevalence of detectable HIV viral load (dVL) and analyze the factors associated with post-dVL conditions that occur independently of a switch to a new antiretroviral agent. The prevalence of dVL was 27% (27 of 101). The mean ages of dVL and non-dVL children were 12.0 and 12.3 years, respectively. Age, sex, body mass index for age z-scores, previous tuberculosis disease history and parental tuberculosis history of both groups were not significantly different (p > 0.05). The prevalence of poor adherence (<95%), influenza-like illness (ILI) and opportunistic infections were higher in dVL than non-dVL children (p < 0.05). The mean nadir CD4 cell count during the study was lower in dVL than non-dVL children (646 compared to 867, respectively; p < 0.05). Other factors were not significant (all p > 0.05). In multivariable analysis, dVL was significantly associated with ILI (odds ratio (OR) = 9.6, 95% confidence interval (CI) = 1.3–69.4), adherence (OR = 0.195, 95% CI = 0.047–0.811) and nadir CD4 during the study (OR = 1.102, 95% CI = 1.100–1.305). The prevalence of dVL was 27% with this dVL among HIV-infected children found to be associated with ILI, poor adherence and lower nadir CD4 during the study.
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Affiliation(s)
- Visal Moolasart
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000 Nonthaburi, Thailand.
| | - Suthat Chottanapund
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000 Nonthaburi, Thailand.
| | - Jarurnsook Ausavapipit
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000 Nonthaburi, Thailand.
| | - Sirirat Likanonsakul
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000 Nonthaburi, Thailand.
| | - Sumonmal Uttayamakul
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000 Nonthaburi, Thailand.
| | - Don Changsom
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand.
| | - Hatairat Lerdsamran
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand.
| | - Pilaipan Puthavathana
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand.
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35
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Ghosh AK, Fyvie WS, Brindisi M, Steffey M, Agniswamy J, Wang YF, Aoki M, Amano M, Weber IT, Mitsuya H. Design, Synthesis, Biological Evaluation, and X-ray Studies of HIV-1 Protease Inhibitors with Modified P2' Ligands of Darunavir. ChemMedChem 2017; 12:1942-1952. [PMID: 29110408 PMCID: PMC5896574 DOI: 10.1002/cmdc.201700614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/30/2017] [Indexed: 01/07/2023]
Abstract
The structure-based design, synthesis, and biological evaluation of a series of nonpeptidic HIV-1 protease inhibitors with rationally designed P2' ligands are described. The inhibitors are designed to enhance backbone binding interactions, particularly at the S2' subsite. Synthesis of inhibitors was carried out efficiently. The stereochemistry of alcohol functionalities of the P2' ligands was set by asymmetric reduction of the corresponding ketone using (R,R)- or (S,S)-Noyori catalysts. A number of inhibitors displayed very potent enzyme inhibitory and antiviral activity. Inhibitors 3g and 3h showed enzyme Ki values of 27.9 and 49.7 pm and antiviral activity of 6.2 and 3.9 nm, respectively. These inhibitors also remained quite potent against darunavir-resistant HIV-1 variants. An X-ray structure of inhibitor 3g in complex with HIV-1 protease revealed key interactions in the S2' subsite.
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Affiliation(s)
- Arun K. Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - W. Sean Fyvie
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Margherita Brindisi
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Melinda Steffey
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907 (USA)
| | - Johnson Agniswamy
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Yuan-Fang Wang
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Manabu Aoki
- Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556 (Japan)
| | - Masayuki Amano
- Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556 (Japan)
| | - Irene T. Weber
- Departments of Biology and Chemistry, Molecular Basis of Disease, Georgia State University, Atlanta, GA 30303 (USA)
| | - Hiroaki Mitsuya
- Departments of Hematology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto 860-8556 (Japan),Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD 20892 (USA),Center for Clinical Sciences, National Center for Global Heath and Medicine, Shinjuku, Tokyo 162-8655 (Japan)
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Amano M, Miguel Salcedo-Gómez P, Yedidi RS, Delino NS, Nakata H, Venkateswara Rao K, Ghosh AK, Mitsuya H. GRL-09510, a Unique P2-Crown-Tetrahydrofuranylurethane -Containing HIV-1 Protease Inhibitor, Maintains Its Favorable Antiviral Activity against Highly-Drug-Resistant HIV-1 Variants in vitro. Sci Rep 2017; 7:12235. [PMID: 28947797 PMCID: PMC5613016 DOI: 10.1038/s41598-017-12052-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/30/2017] [Indexed: 11/12/2022] Open
Abstract
We report that GRL-09510, a novel HIV-1 protease inhibitor (PI) containing a newly-generated P2-crown-tetrahydrofuranylurethane (Crwn-THF), a P2′-methoxybenzene, and a sulfonamide isostere, is highly active against laboratory and primary clinical HIV-1 isolates (EC50: 0.0014–0.0028 μM) with minimal cytotoxicity (CC50: 39.0 μM). Similarly, GRL-09510 efficiently blocked the replication of HIV-1NL4-3 variants, which were capable of propagating at high-concentrations of atazanavir, lopinavir, and amprenavir (APV). GRL-09510 was also potent against multi-drug-resistant clinical HIV-1 variants and HIV-2ROD. Under the selection condition, where HIV-1NL4-3 rapidly acquired significant resistance to APV, an integrase inhibitor raltegravir, and a GRL-09510 congener (GRL-09610), no variants highly resistant against GRL-09510 emerged over long-term in vitro passage of the virus. Crystallographic analysis demonstrated that the Crwn-THF moiety of GRL-09510 forms strong hydrogen-bond-interactions with HIV-1 protease (PR) active-site amino acids and is bulkier with a larger contact surface, making greater van der Waals contacts with PR than the bis-THF moiety of darunavir. The present data demonstrate that GRL-09510 has favorable features for treating patients infected with wild-type and/or multi-drug-resistant HIV-1 variants, that the newly generated P2-Crwn-THF moiety confers highly desirable anti-HIV-1 potency. The use of the novel Crwn-THF moiety sheds lights in the design of novel PIs.
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Affiliation(s)
- Masayuki Amano
- Departments of Infectious Diseases and Hematology, Kumamoto University School of Medicine, Kumamoto, 860-8556, Japan
| | - Pedro Miguel Salcedo-Gómez
- Departments of Infectious Diseases and Hematology, Kumamoto University School of Medicine, Kumamoto, 860-8556, Japan
| | - Ravikiran S Yedidi
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.,Department of Biochemistry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole S Delino
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Hirotomo Nakata
- Departments of Infectious Diseases and Hematology, Kumamoto University School of Medicine, Kumamoto, 860-8556, Japan
| | | | - Arun K Ghosh
- Departments of Chemistry and Medicinal Chemistry, Purdue University, West Lafayette, IN, 47907, USA
| | - Hiroaki Mitsuya
- Departments of Infectious Diseases and Hematology, Kumamoto University School of Medicine, Kumamoto, 860-8556, Japan. .,Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA. .,National Center for Global Health and Medicine Research Institute, Tokyo, 162-8655, Japan.
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Ghosh AK, Sean Fyvie W, Brindisi M, Steffey M, Agniswamy J, Wang YF, Aoki M, Amano M, Weber IT, Mitsuya H. Design, synthesis, X-ray studies, and biological evaluation of novel macrocyclic HIV-1 protease inhibitors involving the P1'-P2' ligands. Bioorg Med Chem Lett 2017; 27:4925-4931. [PMID: 28958624 DOI: 10.1016/j.bmcl.2017.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/03/2017] [Indexed: 11/30/2022]
Abstract
Design, synthesis, and evaluation of a new class of HIV-1 protease inhibitors containing diverse flexible macrocyclic P1'-P2' tethers are reported. Inhibitor 5a with a pyrrolidinone-derived macrocycle exhibited favorable enzyme inhibitory and antiviral activity (Ki=13.2nM, IC50=22nM). Further incorporation of heteroatoms in the macrocyclic skeleton provided macrocyclic inhibitors 5m and 5o. These compounds showed excellent HIV-1 protease inhibitory (Ki=62pM and 14pM, respectively) and antiviral activity (IC50=5.3nM and 2.0nM, respectively). Inhibitor 5o also remained highly potent against a DRV-resistant HIV-1 variant.
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Affiliation(s)
- Arun K Ghosh
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA; Department of Medicinal Chemistry, Purdue University, West Lafayette, IN 47907, USA.
| | - W Sean Fyvie
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | | | - Melinda Steffey
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Johnson Agniswamy
- Departments of Biology and Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Yuan-Fang Wang
- Departments of Biology and Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Manabu Aoki
- Departments of Hematology and Infectious Diseases, Kumamoto University of Medicine, Kumamoto 860-8556, Japan
| | - Masayuki Amano
- Departments of Hematology and Infectious Diseases, Kumamoto University of Medicine, Kumamoto 860-8556, Japan
| | - Irene T Weber
- Departments of Biology and Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Hiroaki Mitsuya
- Departments of Hematology and Infectious Diseases, Kumamoto University of Medicine, Kumamoto 860-8556, Japan; Experimental Retrovirology Section, HIV and AIDS Malignancy Branch National Cancer Institute, Bethesda, MD 20892, USA; Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan
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Teeraananchai S, Kerr SJ, Puthanakit T, Bunupuradah T, Ruxrungtham K, Chaivooth S, Law MG, Chokephaibulkit K. Attrition and Mortality of Children Receiving Antiretroviral Treatment through the Universal Coverage Health Program in Thailand. J Pediatr 2017; 188:210-216.e1. [PMID: 28606372 DOI: 10.1016/j.jpeds.2017.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/30/2017] [Accepted: 05/12/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess mortality and loss to follow-up of children with HIV infection who started antiretroviral therapy (ART) through the Universal Coverage Health Program (UC) in Thailand. STUDY DESIGN Children with HIV infection who initiated ART at age <15 years through the UC between 2008 and 2013 were included in the analysis. Death was ascertained through linkage with the National Death Registry. A competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for loss to follow-up. Death was considered a competing risk. Cox proportional hazards models were used to assess predictors of mortality. RESULTS A total of 4618 children from 497 hospitals in Thailand were included in the study. Median age at ART initiation was 9 years (IQR, 6-12 years), and the median duration of tracking was 4.1 years (a total of 18 817 person-years). Three hundred and ninety-five children (9%) died, for a mortality rate of 2.1 (95% CI, 1.9-2.3) per 100 person-years, and 525 children (11%) were lost to follow-up, for a lost to follow-up rate of 2.9 (95% CI, 2.7-3.2) per 100 person-years. The cumulative incidence of loss to follow-up increased from 4% at 1 year to 8.8% at 3 years. Children who started ART at age ≥12 years were at the greatest risk of loss to follow-up. The probability of death was 3.2% at 6 months and 6.4% at 3 years. Age ≥12 years at ART initiation, lower baseline CD4%, advanced HIV staging, and loss to follow-up were associated with mortality. CONCLUSION The Thai national HIV treatment program has been very effective in treating children with HIV infection, with low mortality and modest rates of loss to follow-up.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia
| | - Thanyawee Puthanakit
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | | | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University
| | - Suchada Chaivooth
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO)
| | - Matthew G Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Somi G, Majigo M, Manyahi J, Nondi J, Agricola J, Sambu V, Todd J, Rwebembera A, Makyao N, Ramadhani A, Matee MIN. Pediatric HIV care and treatment services in Tanzania: implications for survival. BMC Health Serv Res 2017; 17:540. [PMID: 28784131 PMCID: PMC5547461 DOI: 10.1186/s12913-017-2492-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/01/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time. CONCLUSIONS Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered.
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Affiliation(s)
- G Somi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - M Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Mwanza, Tanzania
| | - J Manyahi
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Mwanza, Tanzania
| | - J Nondi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - J Agricola
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Mwanza, Tanzania
| | - V Sambu
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - J Todd
- London School of Hygiene and Tropical Medicine and National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - A Rwebembera
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - N Makyao
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - A Ramadhani
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Mwanza, Tanzania
| | - MIN Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Mwanza, Tanzania
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Higashi-Kuwata N, Ogata-Aoki H, Hattori SI, Hayashi H, Danish M, Aoki M, Shiotsu C, Kawamura T, Ihn H, Kobayashi H, Okada S, Mitsuya H. Early phase dynamics of traceable mCherry fluorescent protein-carrying HIV-1 infection in human peripheral blood mononuclear cells-transplanted NOD/SCID/Jak3 -/- mice. Antiviral Res 2017; 144:83-92. [PMID: 28392419 PMCID: PMC7900919 DOI: 10.1016/j.antiviral.2017.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 01/30/2023]
Abstract
We attempted to elucidate early-phase dynamics of HIV-1 infection using replication-competent, red-fluorescent-protein (mCherry)-labeled HIV-1JR-FL (HIVJR-FLmC) and NOD/SCID/Jak3-/- mice transplanted with Individual-A's human peripheral blood mononuclear cells (hPBMC)(hNOJ mice). On day 7 following HIVJR-FLmC inoculation, mCherry-signal-emitting infection foci were readily identified in the subserosa of 10 of 10 HIVJR-FLmC-inoculated hNOJ mice, although infection foci were not located without the mCherry signal in unlabeled HIV-1JR-FL-inoculated mice (n = 6). Even on day 14, infection foci were hardly located in the unlabeled HIV-1JR-FL-inoculated mice, while in all of 7 HIVJR-FLmC-inoculated hNOJ mice examined, mCherry-signal-emitting lymph nodes were easily identified, in which active viral replication was present. On day 14, a significantly larger number of mesenteric lymph nodes were seen in HIVJR-FLmC-exposed hNOJ mice than in HIVJR-FLmC-unexposed mice (P = 0.0025). The weights of mesenteric lymph nodes of those HIVJR-FLmC-exposed hNOJ mice were also greater than those of HIVJR-FLmC-unexposed mice (P = 0.0005). When hNOJ mice were inoculated with HIVJR-FLmC-exposed hPBMC from Individual-B, significantly greater viremia was seen than in cell-free HIVJR-FLmC-inoculated hNOJ mice as examined on day 7. In the lymph nodes of those mice inoculated with HIVJR-FLmC-exposed hPBMC from Individual-B, a substantial number of Individual-B's HIVJR-FLmC-infected cells were identified together with Individual-A's cells as examined on day 14. The present HIVJR-FLmC-infected mouse model represents the first system reported using traceable HIVJR-FLmC and human target cells, not using SIV or simian cells, which should be of utility in studies of early-phases of HIV-1 transmission and in evaluating the effects of potential agents for post-exposure and pre-exposure prophylaxis.
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Affiliation(s)
- Nobuyo Higashi-Kuwata
- Experimental Retrovirology Section, Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute, Tokyo, Japan; Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan
| | - Hiromi Ogata-Aoki
- Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan; Experimental Retrovirology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shin-Ichiro Hattori
- Experimental Retrovirology Section, Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute, Tokyo, Japan; Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Hironori Hayashi
- Experimental Retrovirology Section, Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute, Tokyo, Japan; Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan
| | - Matthew Danish
- Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan
| | - Manabu Aoki
- Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan; Experimental Retrovirology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan
| | - Chiemi Shiotsu
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsuyoshi Kawamura
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisataka Kobayashi
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Mitsuya
- Experimental Retrovirology Section, Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute, Tokyo, Japan; Departments of Hematology and Infectious Diseases, Kumamoto University Graduate School of Biomedical Sciences, Japan; Experimental Retrovirology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life: Experiences From Kinshasa, DR Congo and Blantyre, Malawi. Pediatr Infect Dis J 2017; 36:654-658. [PMID: 28060044 PMCID: PMC5468473 DOI: 10.1097/inf.0000000000001539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Based on clinical trial results, the World Health Organization recommends infant HIV testing at age 4-6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV-infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age. METHODS Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation. RESULTS One hundred and twenty-one infants were diagnosed at a median age of 7 weeks (interquartile range, 6-8). The cumulative incidence of ART initiation was 46% [95% confidence interval (CI), 36%, 55%] at 6 months and 70% (95% CI 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI 0.52, 0.91) for each week increase in age at DNA polymerase chain reaction test. The 12-month cumulative incidence of mortality was 20% (95% CI 13%, 28%). CONCLUSIONS Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and World Health Organization's guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV-infected infants achieve optimal treatment outcomes under routine care settings.
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Ghosh AK, Rao KV, Nyalapatla PR, Osswald HL, Martyr CD, Aoki M, Hayashi H, Agniswamy J, Wang YF, Bulut H, Das D, Weber IT, Mitsuya H. Design and Development of Highly Potent HIV-1 Protease Inhibitors with a Crown-Like Oxotricyclic Core as the P2-Ligand To Combat Multidrug-Resistant HIV Variants. J Med Chem 2017; 60:4267-4278. [PMID: 28418652 DOI: 10.1021/acs.jmedchem.7b00172] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Design, synthesis, and evaluation of a new class of exceptionally potent HIV-1 protease inhibitors are reported. Inhibitor 5 displayed superior antiviral activity and drug-resistance profiles. In fact, this inhibitor showed several orders of magnitude improved antiviral activity over the FDA approved drug darunavir. This inhibitor incorporates an unprecedented 6-5-5 ring-fused crown-like tetrahydropyranofuran as the P2 ligand and an aminobenzothiazole as the P2' ligand with the (R)-hydroxyethylsulfonamide isostere. The crown-like P2 ligand for this inhibitor has been synthesized efficiently in an optically active form using a chiral Diels-Alder catalyst providing a key intermediate in high enantiomeric purity. Two high resolution X-ray structures of inhibitor-bound HIV-1 protease revealed extensive interactions with the backbone atoms of HIV-1 protease and provided molecular insight into the binding properties of these new inhibitors.
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Affiliation(s)
- Arun K Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University , 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Kalapala Venkateswara Rao
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University , 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Prasanth R Nyalapatla
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University , 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Heather L Osswald
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University , 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Cuthbert D Martyr
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University , 560 Oval Drive, West Lafayette, Indiana 47907, United States
| | - Manabu Aoki
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences , Kumamoto 860-8556, Japan.,Department of Medical Technology, Kumamoto Health Science University , Kumamoto 861-5598, Japan.,Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland 20892, United States
| | - Hironori Hayashi
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences , Kumamoto 860-8556, Japan.,Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute , Tokyo 162-8655, Japan
| | - Johnson Agniswamy
- Department of Biology, Molecular Basis of Disease, Georgia State University , Atlanta, Georgia 30303, United States
| | - Yuan-Fang Wang
- Department of Biology, Molecular Basis of Disease, Georgia State University , Atlanta, Georgia 30303, United States
| | - Haydar Bulut
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland 20892, United States
| | - Debananda Das
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland 20892, United States
| | - Irene T Weber
- Department of Biology, Molecular Basis of Disease, Georgia State University , Atlanta, Georgia 30303, United States
| | - Hiroaki Mitsuya
- Departments of Infectious Diseases and Hematology, Kumamoto University Graduate School of Biomedical Sciences , Kumamoto 860-8556, Japan.,Department of Refractory Viral Infection, National Center for Global Health and Medicine Research Institute , Tokyo 162-8655, Japan.,Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland 20892, United States
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Hampanda KM, Nimz AM, Abuogi LL. Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples. AIDS Res Ther 2017; 14:17. [PMID: 28320431 PMCID: PMC5360055 DOI: 10.1186/s12981-017-0142-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection of pediatric HIV through uptake of infant HIV testing is critical for access to treatment and child survival. While structural barriers have been well described, a greater understanding of social and behavioral factors that may relate to maternal uptake of early infant HIV testing services is urgently needed. The aim of this study was to explore how gender power dynamics within couples affect HIV-positive women's uptake of early infant HIV testing at a large health center in Lusaka, Zambia. METHODS In 2014, 320 HIV-positive married postpartum women were recruited at a large public health facility in Lusaka to participate in a cross-sectional survey. Data on uptake of early infant HIV testing by 4-6 weeks of age was collected through medical records. Simple and multiple logistic regression models determined significant predictors of maternal uptake of early infant HIV testing. RESULTS In the adjusted model, uptake of early infant HIV testing was associated with female-directed emotional intimate partner violence (aOR 0.41; 95% CI 0.21-0.79; p < 0.01), HIV status disclosure to the male partner (aOR 13.73, 95% CI 3.59-52.49, p < 0.001), and maternal postpartum ART adherence (aOR 2.28, 95% CI 1.15-4.55, p < 0.05). CONCLUSIONS Domestic relationship dynamics, including emotional violence and HIV status disclosure to the male partner, may play an important role in maternal uptake of early infant HIV testing. These findings provide additional evidence for the link between intimate partner violence against women and poor HIV-related health outcomes. Programs that adequately screen for and address various forms of intimate partner violence within the context of prevention of mother-to-child transmission are recommended.
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Survival Estimates and Mortality Risk Factors in a Cohort of HIV Vertically Infected Individuals in Salvador, Brazil. Pediatr Infect Dis J 2017; 36:e62-e68. [PMID: 27902650 DOI: 10.1097/inf.0000000000001439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are few data on long-term survival of Brazilian children with vertically acquired HIV infection. We assessed survival, mortality risk factors and response to antiretroviral therapy (ART). We compared children with early and late access to care. METHODS We used Kaplan-Meier survival curves with Log-rank tests to compare survival time and mortality rates of 245 HIV vertically infected children admitted for care during 2002-2014. RESULTS Total follow-up sum was 1584.4 person-years. Overall survival was 83.9%. Median age at start of ART was 51.6 (18.0-94.2) months, and median age at death was 8.2 (1.7-10.1) years (mortality rate: 1.7/100 person-years). Pneumonia and sepsis were the main causes of death. Male gender, viral load (VL) ≥100,000 copies, severe immunosuppression, moderate/severe symptoms and history of opportunistic infection were associated with higher mortality in bivariate analysis. Only severe symptoms remained associated in multivariate analysis (P = 0.03). There was no difference in mortality in early compared to late access group. Overall, 217 patients received ART; 192 had a recent VL, of which 116 (59.8%) had ≤400 copies. Variables associated with therapeutic failure were as follows: VL ≥100,000 copies, less immune suppression, age <12 months at admission and age <3 years at ART start. CONCLUSIONS We have a high mortality rate in comparison with developed countries. Although early access did not impact mortality, we detected a trend in favor of early treatment as a protecting factor against mortality. We need to increase adherence to care and treatment, and better drugs to optimize outcomes.
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Haileamlak A, Hagos T, Abebe W, Abraham L, Asefa H, Teklu AM. Predictors of Hospitalization among Children on ART in Ethiopia: a Cohort study. Ethiop J Health Sci 2017; 27:53-62. [PMID: 28465653 PMCID: PMC5402799 DOI: 10.4314/ejhs.v27i1.6s] [Citation(s) in RCA: 5] [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: 02/01/2016] [Accepted: 08/12/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia. METHODS A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical Monitoring (ACM) till December 31, 2012 were included. From the database, information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA. Descriptive analyses and modeling was done using logistic regression. RESULTS Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%) were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of the eighty four admitted children were hospitalized in the first six months of ART initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value <0.05). As the duration on ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P < 0.001). Whereas the incidence (number) of OI's increased by one, the risk of being hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002). CONCLUSION This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.
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Affiliation(s)
| | - Tesfalem Hagos
- Department of Pediatrics and Child Health, Mekelle University
| | | | - Loko Abraham
- Department of Pediatrics and Child Health, Addis Ababa University
| | - Henok Asefa
- Department of Epidemiology and Biostatistics, Jimma University
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Ben-Farhat J, Schramm B, Nicolay N, Wanjala S, Szumilin E, Balkan S, Pujades-Rodríguez M. Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001-2010. Trop Med Int Health 2017; 22:340-350. [PMID: 27992677 DOI: 10.1111/tmi.12830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010. METHODS Cohort analysis of data from HIV-infected children (<15 years old) initiating ART in four sub-Saharan HIV programmes in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, programme attrition and first-line clinico-immunological failure were calculated by age group (<2, 2-4 and 5-14 years), 1 or 2 years after ART initiation, and risk factors were examined. RESULTS A total of 3949 children, 22.7% aged <2 years, 32.2% 2-4 years and 45.1% 5-14 years, were included. At ART initiation, 60.8% had clinical stage 3 or 4, and 46.5% severe immunosuppression. Overall mortality, attrition and 1-year failure rates were 5.1, 10.8 and 9.0 per 100 person-years, respectively. Immunosuppression, stage 3 or 4, and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2-4 years (HR = 0.57, 95% CI 0.42-0.77 than children aged 5-14 years). One-year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR = 0.91, 95% CI 0.67-1.25 for <2 years; 1.01, 95% CI 0.83-1.23 for 2-4 years, vs. 5-14 years). CONCLUSIONS Good treatment outcomes were achieved during the first decade of HIV paediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother-to-child transmission programmes, and linkage to care services for early ART initiation, is needed to reduce mortality and delay treatment failure.
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Affiliation(s)
| | | | | | | | | | | | - Mar Pujades-Rodríguez
- Epicentre, Paris, France.,MRC Medical Bioinformatics Centre, University of Leeds, Leeds, UK
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A Modified P1 Moiety Enhances In Vitro Antiviral Activity against Various Multidrug-Resistant HIV-1 Variants and In Vitro Central Nervous System Penetration Properties of a Novel Nonpeptidic Protease Inhibitor, GRL-10413. Antimicrob Agents Chemother 2016; 60:7046-7059. [PMID: 27620483 DOI: 10.1128/aac.01428-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022] Open
Abstract
We report here that GRL-10413, a novel nonpeptidic HIV-1 protease inhibitor (PI) containing a modified P1 moiety and a hydroxyethylamine sulfonamide isostere, is highly active against laboratory HIV-1 strains and primary clinical isolates (50% effective concentration [EC50] of 0.00035 to 0.0018 μM), with minimal cytotoxicity (50% cytotoxic concentration [CC50] = 35.7 μM). GRL-10413 blocked the infectivity and replication of HIV-1NL4-3 variants selected by use of atazanavir, lopinavir, or amprenavir (APV) at concentrations of up to 5 μM (EC50 = 0.0021 to 0.0023 μM). GRL-10413 also maintained its strong antiviral activity against multidrug-resistant clinical HIV-1 variants isolated from patients who no longer responded to various antiviral regimens after long-term antiretroviral therapy. The development of resistance against GRL-10413 was significantly delayed compared to that against APV. In addition, GRL-10413 showed favorable central nervous system (CNS) penetration properties as assessed with an in vitro blood-brain barrier (BBB) reconstruction system. Analysis of the crystal structure of HIV-1 protease in complex with GRL-10413 demonstrated that the modified P1 moiety of GRL-10413 has a greater hydrophobic surface area and makes greater van der Waals contacts with active site amino acids of protease than in the case of darunavir. Moreover, the chlorine substituent in the P1 moiety interacts with protease in two distinct configurations. The present data demonstrate that GRL-10413 has desirable features for treating patients infected with wild-type and/or multidrug-resistant HIV-1 variants, with favorable CNS penetration capability, and that the newly modified P1 moiety may confer desirable features in designing novel anti-HIV-1 PIs.
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Brophy JC, Hawkes MT, Mwinjiwa E, Mateyu G, Sodhi SK, Chan AK. Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi. PLoS One 2016; 11:e0165772. [PMID: 27812166 PMCID: PMC5094712 DOI: 10.1371/journal.pone.0165772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/18/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pediatric uptake and outcomes in antiretroviral treatment (ART) programmes have lagged behind adult programmes. We describe outcomes from a population-based pediatric ART cohort in rural southern Malawi. METHODS Data were analyzed on children who initiated ART from October/2003 -September/2011. Demographics and diagnoses were described and survival analyses conducted to assess the impact of age, presenting features at enrolment, and drug selection. RESULTS The cohort consisted of 2203 children <15 years of age. Age at entry was <1 year for 219 (10%), 1-1.9 years for 343 (16%), 2-4.9 years for 584 (27%), and 5-15 years for 1057 (48%) patients. Initial clinical diagnoses of tuberculosis and wasting were documented for 409 (19%) and 523 (24%) patients, respectively. Median follow-up time was 1.5 years (range 0-8 years), with 3900 patient-years of follow-up. Over the period of observation, 134 patients (6%) died, 1324 (60%) remained in the cohort, 345 (16%) transferred out, and 387 (18%) defaulted. Infants <1 year of age accounted for 19% of deaths, with a 2.7-fold adjusted mortality hazard ratio relative to 5-15 year olds; median time to death was also shorter for infants (60 days) than older children (108 days). Survival analysis demonstrated younger age at ART initiation, more advanced HIV stage, and presence of tuberculosis to each be associated with shorter survival time. Among children <5 years, severe wasting (weight-for-height z-score </ = -3.0) was also associated with reduced survival. CONCLUSIONS Cumulative incidence of mortality was 5.2%, 7.1% and 7.7% after 1, 3, and 5 years, respectively, with disproportionate mortality in infants <1 year of age and those presenting with tuberculosis. These findings reinforce the urgent need for early diagnosis and treatment in this population, but also demonstrate that provision of pediatric care in a rural setting can yield outcomes comparable to more resourced urban settings of poor countries.
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Affiliation(s)
- Jason C. Brophy
- Dignitas International, Zomba, Malawi
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- * E-mail:
| | - Michael T. Hawkes
- Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Canada
| | - Edson Mwinjiwa
- Zomba Central Hospital, Ministry of Health, Zomba, Malawi
| | | | - Sumeet K. Sodhi
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, University Health Network, Toronto, Canada
| | - Adrienne K. Chan
- Dignitas International, Zomba, Malawi
- Department of Medicine, University of Toronto, Sunnybrook Hospital, Toronto, Canada
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Pediatric Access and Continuity of HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa. Pediatr Infect Dis J 2016; 35:981-6. [PMID: 27187757 DOI: 10.1097/inf.0000000000001213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of HIV-infected children starting antiretroviral treatment (ART) has increased in resource-limited settings during the past decades. However, there are still few published data on the characteristics of pediatric patients at program enrolment and on the dynamics of dropping out before the start of ART. METHODS We performed a retrospective cohort study among HIV-infected pediatric patients (age, 5-14 years) not yet started on ART enrolled in 4 HIV sub-Saharan African programs. Descriptive and risk factors for mortality and lost to follow-up (LFU) were investigated using adjusted parametric or Cox proportional hazard models. RESULTS A total of 2244 patients (52.8% girls) were enrolled in HIV care, a median of 2 days [interquartile range (IQR), 0-8 days] after HIV diagnosis. Baseline median CD4 cell count was 409 cells/μL (IQR, 203-478 cells/μL); 43% were in clinical stage 3 or 4, 71% required ART and 76.2% of these patients initiated therapy. Of those eligible not started on ART, 14% died and 59% were LFU. Median pre-ART follow-up was 4.4 months (IQR, 1.3-20 months) and was shorter for eligible patients. Mortality rates were 6.2 of 100 person-years [95% confidence interval (CI), 4.6-8.3] in the 0- to 6-month period and 1.3 of 100 person-years (95% CI, 0.9-2.0) in the 6- to 60-month period. LFU rates were 37.4 of 100 (95% CI, 33.0-42.4) and 8.3 of 100 person-years (95% CI, 7.1-9.8), respectively. Advanced HIV disease at presentation (low body mass index, stage 3 or 4, low CD4 count or tuberculosis diagnosis) was associated with increased mortality and LFU. CONCLUSIONS Late presentation and delays in initiating ART among eligible children were responsible for the large incidence of patient losses during pre-ART follow-up in sub-Saharan Africa.
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Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo. Tuberc Res Treat 2016; 2016:1027570. [PMID: 27595020 PMCID: PMC4993947 DOI: 10.1155/2016/1027570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022] Open
Abstract
Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services.
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