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Meng X, Yin H, Ma W, Gu J, Lu Z, Fitzpatrick T, Zou H. Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score-Matched Analysis of Surveillance Data From 2006 to 2021. JMIR Public Health Surveill 2023; 9:e43635. [PMID: 36961492 PMCID: PMC10131765 DOI: 10.2196/43635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. OBJECTIVE We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. METHODS We performed a propensity score-matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. RESULTS A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. CONCLUSIONS The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Hanlu Yin
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Wenjuan Ma
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Jing Gu
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Agunloye OM, Oboh G. Hypercholesterolemia, angiotensin converting enzyme and ecto-enzymes of purinergic system: Ameliorative properties of caffeic and chlorogenic acid in hypercholesterolemic rats. J Food Biochem 2018. [DOI: 10.1111/jfbc.12604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Odunayo Michael Agunloye
- Functional Foods, Nutraceuticals and Phytomedicine Unit, Department of Biochemistry; Federal University of Technology; Akure Nigeria
| | - Ganiyu Oboh
- Functional Foods, Nutraceuticals and Phytomedicine Unit, Department of Biochemistry; Federal University of Technology; Akure Nigeria
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Mortality in the First 3 Months on Antiretroviral Therapy Among HIV-Positive Adults in Low- and Middle-income Countries: A Meta-analysis. J Acquir Immune Defic Syndr 2017; 73:1-10. [PMID: 27513571 DOI: 10.1097/qai.0000000000001112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Previous meta-analyses reported mortality estimates of 12-month post-antiretroviral therapy (ART) initiation; however, 40%-60% of deaths occur in the first 3 months on ART, a more sensitive measure of averted deaths through early ART initiation. To determine whether early mortality is dropping as treatment thresholds have increased, we reviewed studies of 3 months on ART initiation in low- to middle-income countries. Studies of 3-month mortality from January 2003 to April 2016 were searched in 5 databases. Articles were included that reported 3-month mortality from a low- to middle-income country; nontrial setting and participants were ≥15. We assessed overall mortality and stratified by year using random effects models. Among 58 included studies, although not significant, pooled estimates show a decline in mortality when comparing studies whose enrollment of patients ended before 2010 (7.0%; 95% CI: 6.0 to 8.0) with the studies during or after 2010 (4.0%; 95% CI: 3.0 to 5.0). To continue to reduce early HIV-related mortality at the population level, intensified efforts to increase demand for ART through active testing and facilitated referral should be a priority. Continued financial investments by multinational partners and the implementation of creative interventions to mitigate multidimensional complex barriers of accessing care and treatment for HIV are needed.
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Rutin Attenuates Hepatotoxicity in High-Cholesterol-Diet-Fed Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:5436745. [PMID: 27239252 PMCID: PMC4863108 DOI: 10.1155/2016/5436745] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/29/2016] [Accepted: 03/10/2016] [Indexed: 01/06/2023]
Abstract
Background and Objective. High-cholesterol diet (HCD) intends to increase the oxidative stress in liver tissues inducing hepatotoxicity. Rutin is a natural flavonoid (vitamin p) which is known to have antioxidative properties. The aim of the present study was to investigate the potential effects of Rutin on hypercholesterolemia-induced hepatotoxicity in rats. Materials and Methods. Male Wistar rats were divided into four groups: G-I control, G-II Rutin, G-III HCD, and G-IV Rutin + HCD. The liver functions and lipid profile were used to evaluate the HCD-induced hepatotoxicity. Quantitative real time-PCR was carried out to evaluate the expression levels of genes in TGF-β/Smad signaling pathway. Results. Rutin in combination with HCD showed a significant protective effect against hepatotoxicity. HCD caused significant increase in the mRNA expression of transforming growth factor beta (TGF-β), Mothers Against Decapentaplegic Homolog 2 (Smad-2), Mothers Against Decapentaplegic Homolog 4 (Smad-4), Bcl-2-binding component 3 (Bbc3), caspase-3, P53 and Interleukin-6 (IL-6) and decrease in the expression levels of Cyclin depended kinase inhibitor (P21) and Interleukin-3 (IL-3) in hepatic cells. Conclusion. TGF-β/Smad signaling pathway is involved in HCD-induced hepatotoxicity and Rutin inhibits the hepatotoxicity via suppressing this pathway. Therefore, Rutin might be considered as a protective agent for hepatotoxicity.
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Farahani M, Mulinder H, Farahani A, Marlink R. Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis. Int J STD AIDS 2016; 28:636-650. [DOI: 10.1177/0956462416632428] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise. The objective of this study was to provide information about the global prevalence and distribution of non-AIDS causes of death in the last ten years among people living with HIV receiving antiretroviral therapy, by income levels of countries. We used broad search terms in Google Scholar, PubMed, and EMBASE to identify all studies that investigated the cause of death among people living with HIV receiving antiretroviral therapy, published after January 1, 2005. References were also identified from review articles and reference lists. Inclusion criteria were English language, the study’s end date was after 2005, all patients were HIV-positive, at least two-thirds of the patients were receiving antiretroviral therapy, at least one patient died of non-AIDS causes of death. Titles, abstracts, and articles were reviewed by at least two independent readers. Of 2951 titles identified in our original search, 151 articles were selected for further screening. We identified 19 studies meeting our full criteria, with patients from 55 different nations. Pooled non-AIDS causes of death prevalence estimates in high-income countries were 53.0% (95% confidence interval, 43.6–62.3), in developing countries 34.0% (95% confidence interval, 20.3–49.1), and in sub-Saharan countries 18.5% (95% confidence interval, 13.8–23.7). Statistically significant variation was noted within and between categories. Our findings show that a significant number of people living with HIV across the world die from cardiovascular disease, non-AIDS malignancies, and liver disease. There is a global need for further scrutiny in all regions to improve preventive measures and early detection according to distinct causes of death patterns.
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Affiliation(s)
| | - Holly Mulinder
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
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Essomba NE, Mbatchou Ngahane BH, Nida M, Temfack E, Mapoure Njankouo Y, Abeng RL, Fokalbo ZK, Achu Joko H, Mbenoun M, Meledie AP, Halle MP, Malongue A, Tchente C, Nana Njamen T, Halle Ekane G, Ngwane S, Barla E, Abena P, Ndobo P, Moungo Kuidjeu C, Adiogo D, Mouelle Sone A, Luma Namme H, Coppieters Y. [Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. ACTA ACUST UNITED AC 2015; 108:255-61. [PMID: 26296430 DOI: 10.1007/s13149-015-0444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 07/07/2015] [Indexed: 01/06/2023]
Abstract
The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.
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Affiliation(s)
- N E Essomba
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun. .,Comité national de lutte contre le sida du Cameroun, Douala, Cameroun.
| | - B H Mbatchou Ngahane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - M Nida
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - E Temfack
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - Y Mapoure Njankouo
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - R L Abeng
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - Z Kobe Fokalbo
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - H Achu Joko
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - M Mbenoun
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A P Meledie
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - M P Halle
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A Malongue
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - C Tchente
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - T Nana Njamen
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - G Halle Ekane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - S Ngwane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - E Barla
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - P Abena
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - P Ndobo
- Hôpital de District de Bonassama, Douala, Cameroun
| | | | - D Adiogo
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A Mouelle Sone
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - H Luma Namme
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - Y Coppieters
- École de santé publique, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgique
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Akinyemi JO, Adesina OA, Kuti MO, Ogunbosi BO, Irabor AE, Odaibo GN, Olaleye DO, Adewole IF. Temporal distribution of baseline characteristics and association with early mortality among HIV-positive patients at University College Hospital, Ibadan, Nigeria. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 14:201-7. [PMID: 26282931 DOI: 10.2989/16085906.2015.1052526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital, Ibadan, Nigeria from 2006-2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital, Ibadan, Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients' demographic characteristics remained virtually the same over time, there was significant decline in the prevalence of baseline opportunistic infections (2006-2007=55.2%; 2011-2013=38.0%). Overall, 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex, HIV encephalopathy, low CD4 count (< 50 cells), and anaemia. To reduce early mortality, community education should be promoted, timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients.
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Affiliation(s)
- Joshua O Akinyemi
- a Department of Epidemiology and Medical Statistics, College of Medicine , University of Ibadan , Nigeria
| | - Olubukola A Adesina
- b Department of Obstetrics and Gynaecology, College of Medicine , University of Ibadan , Nigeria
| | - Modupe O Kuti
- c Department of Chemical Pathology, College of Medicine , University of Ibadan , Nigeria
| | - Babatunde O Ogunbosi
- d Department of Paediatrics, College of Medicine , University of Ibadan , Nigeria
| | - Achiaka E Irabor
- e Department of Family Medicine, University College Hospital, Ibadan , Nigeria
| | - Georgina N Odaibo
- f Department of Virology, College of Medicine , University of Ibadan , Nigeria
| | - David O Olaleye
- f Department of Virology, College of Medicine , University of Ibadan , Nigeria
| | - Isaac F Adewole
- b Department of Obstetrics and Gynaecology, College of Medicine , University of Ibadan , Nigeria
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Otwombe KN, Petzold M, Modisenyane T, Martinson NA, Chirwa T. Factors associated with mortality in HIV-infected people in rural and urban South Africa. Glob Health Action 2014; 7:25488. [PMID: 25280741 PMCID: PMC4185089 DOI: 10.3402/gha.v7.25488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 12/31/2022] Open
Abstract
Background Factors associated with mortality in HIV-infected people in sub-Saharan Africa are widely reported. However rural–urban disparities and their association with all-cause mortality remain unclear. Furthermore, commonly used classical Cox regression ignores unmeasured variables and frailty. Objective To incorporate frailty in assessing factors associated with mortality in HIV-infected people in rural and urban South Africa. Design Using data from a prospective cohort following 6,690 HIV-infected participants from Soweto (urban) and Mpumalanga (rural) enrolled from 2003 to 2010; covariates of mortality were assessed by the integrated nested Laplace approximation method. Results We enrolled 2,221 (33%) rural and 4,469 (67%) urban participants of whom 1,555 (70%) and 3,480 (78%) were females respectively. Median age (IQR) was 36.4 (31.0–44.1) in rural and 32.7 (28.2–38.1) in the urban participants. The mortality rate per 100 person-years was 11 (9.7–12.5) and 4 (3.6–4.5) in the rural and urban participants, respectively. Compared to those not on HAART, rural participants had a reduced risk of mortality if on HAART for 6–12 (HR: 0.20, 95% CI: 0.10–0.39) and >12 months (HR: 0.10, 95% CI: 0.05–0.18). Relative to those not on HAART, urban participants had a lower risk if on HAART >12 months (HR: 0.35, 95% CI: 0.27–0.46). The frailty variance was significant and >1 in rural participants indicating more heterogeneity. Similarly it was significant but <1 in the urban participants indicating less heterogeneity. Conclusion The frailty model findings suggest an elevated risk of mortality in rural participants relative to the urban participants potentially due to unmeasured variables that could be biological, socio–economic, or healthcare related. Use of robust methods that optimise data and account for unmeasured variables could be helpful in assessing the effect of unknown risk factors thus improving patient management and care in South Africa and elsewhere.
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Affiliation(s)
- Kennedy N Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Tebogo Modisenyane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Center for TB Research, Johns Hopkins University, Baltimore, MD, USA
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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