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Matsumoto S, Nagai M, Luong DAD, Nguyen HDT, Nguyen DT, Van Dinh T, Van Tran G, Tanuma J, Pham TN, Oka S. Evaluation of SARS-CoV-2 Antibodies and the Impact of COVID-19 on the HIV Care Continuum, Economic Security, Risky Health Behaviors, and Mental Health Among HIV-Infected Individuals in Vietnam. AIDS Behav 2022; 26:1095-1109. [PMID: 34570314 PMCID: PMC8475817 DOI: 10.1007/s10461-021-03464-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
Coronavirus disease 2019 (COVID-19) and associated social responses may uniquely affect people living with HIV (PLHIV). SARS-CoV-2 antibody testing and a cross-sectional survey on COVID-19's socio-behavioral impacts were conducted among a large PLHIV cohort in Hanoi, Vietnam. We examined anonymous antibody test results for 1243 PLHIV (99.8%) from whom plasma was obtained and completed surveys were collected in June/July 2020, just after the end of the first COVID-19 outbreak and nationwide lockdown. Three participants (0.2%) tested positive for anti-SARS-CoV-2 IgG antibodies. HIV treatment was generally maintained without antiretroviral therapy interruption, but COVID-19 had substantial impacts on economic security and risky health behaviors among PLHIV, which may have amplified psychological stress. These findings highlight the need for continuous monitoring of COVID-19's impacts on PLHIV and for efforts to mitigate these impacts.
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Affiliation(s)
- Shoko Matsumoto
- AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan.
| | - Moeko Nagai
- AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Dieu An Dang Luong
- AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | | | | | | | - Giang Van Tran
- National Hospital for Tropical Diseases, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | | | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
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Dat VQ, Lyss S, Dung NTH, Hung LM, Pals SL, Anh HTV, Kinh NV, Bateganya M. Prevalence of Advanced HIV Disease, Cryptococcal Antigenemia, and Suboptimal Clinical Outcomes Among Those Enrolled in Care in Vietnam. J Acquir Immune Defic Syndr 2021; 88:487-496. [PMID: 34446679 PMCID: PMC8575167 DOI: 10.1097/qai.0000000000002786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People living with advanced HIV disease are at high risk of morbidity and mortality. We assessed the prevalence of cryptococcal antigenemia (CrAg) and clinical outcomes among patients newly presenting with CD4 ≤100 cells/μL in Vietnam. SETTING Twenty-two public HIV clinics in Vietnam. METHODS During August 2015-March 2017, antiretroviral therapy (ART)-naïve adults presenting for care with CD4 ≤100 cells/μL were screened for CrAg. Those who consented to study enrollment were followed up for up to 12 months and assessed for clinical outcomes. RESULTS Of 3504 patients with CD4 results, 1354 (38.6%) had CD4 ≤100 cells/μL, of whom 1177 (86.9%) enrolled in the study. The median age was 35 years (interquartile range 30-40); 872 (74.1%) of them were men, and 892 (75.8%) had CD4 <50 cells/μL. Thirty-six patients (3.1%) were CrAg-positive. Overall, 1151 (97.8%) including all who were CrAg-positive initiated ART. Of 881 patients (76.5%) followed up for ≥12 months, 623 (70.7%) were still alive and on ART at 12 months, 54 (6.1%) had transferred to nonstudy clinics, 86 (9.8%) were lost to follow-up, and 104 (11.8%) had died. Among all 1177 study participants, 143 (12.1%) died, most of them (123, 86.0%) before or within 6 months of enrollment. Twenty-seven patients (18.9%) died of pulmonary tuberculosis, 23 (16.1%) died of extrapulmonary tuberculosis, 8 (5.6%) died of Talaromyces marneffei infection, and 6 (4.2%) died of opioid overdose. Eight deaths (5.8%) occurred among the 36 CrAg-positive individuals. CONCLUSIONS Late presentation for HIV care was common. The high mortality after entry in care calls for strengthening of the management of advanced HIV disease.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
- Intensive Care Unit, Hanoi Medical University, Hanoi, Vietnam
| | - Sheryl Lyss
- U.S. Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam
- Dr. Lyss Iis now with the Division of HIV/AIDS Prevention, U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA
| | - Nguyen Thi Hoai Dung
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
| | - Le Manh Hung
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Sherri L. Pals
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Division of Global HIV &TB (DGHT), U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA; and
| | - Ho Thi Van Anh
- U.S. Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam
| | - Nguyen Van Kinh
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
| | - Moses Bateganya
- Division of Global HIV &TB (DGHT), U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA; and
- FHI 360, Durham, NC
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Hoang NT, Foo TJ, Tran BX, Do NT, Vu GT, Nguyen CT, Pham HQ, Latkin CA, Ho CSH, Ho RCM. Structural barriers for retention of HIV/AIDS patients after initiating antiretroviral therapy in outpatient clinics of Vietnam. AIDS Care 2021; 34:992-999. [PMID: 34018428 DOI: 10.1080/09540121.2021.1929816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little evidence is available about structural factors associated with the retention in care for people living with HIV/AIDS (PLWH) in Vietnam. This retrospective longitudinal study was conducted among PLWH initiating antiretroviral therapy (ART) in 62 ART clinics from 15 provinces, to estimate retention rates and identify specific related structural factors. Facility-related factors such as location, duration of HIV service implantation, level of healthcare facility, frequency of drugs dispensed, integration of HIV care were examined. Cox proportional hazard model was employed to estimate the retention rate and association between facility-level factors and loss-to-follow up (LTFU). Among 20,119 patients, the retention rates after 6, 12, 24, 36 and 48 months were 96.5% (95% CI = 96.2%-96.7%), 93.6% (95% CI = 93.2%-93.9%), 90.2% (95% CI = 89.8%-90.6%), 87.9% (95% CI = 87.4%-88.4%) and 86.0% (95% CI = 85.4%-86.5%), respectively. Facility-level factors associated with increased risk of LTFU included duration of HIV service implementation, frequency of drug dispensed per month, integration of HIV care and of treatment procedures into general care, clinics at central or provincial level and in the Middle region of Vietnam. Such association should be addressed in future care planning and HIV/AIDS management to ensure greater coverage of therapy in Vietnam.
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Affiliation(s)
- Nhien Thi Hoang
- EPIC Project, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
| | - Tiara J Foo
- Department of Internal Medicine, National University of Singapore, Singapore
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nhan Thi Do
- EPIC Project, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Viet Nam.,Faculty of Medicine, Duy Tan University, Danang, Vietnam
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Danang, Viet Nam.,Faculty of Medicine, Duy Tan University, Danang, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
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Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS 2020; 34:1261-1288. [PMID: 32287056 DOI: 10.1097/qad.0000000000002523] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Loss to follow-up (LTFU) rates from antiretroviral treatment (ART) programmes in low- and middle-income countries (LMIC) are high, leading to poor treatment outcomes and onward transmission of HIV. Knowledge of risk factors is required to address LTFU. In this systematic review, risk factors for LTFU are identified and meta-analyses performed. METHODS PubMed, Embase, Psycinfo and Cochrane were searched for studies that report on potential risk factors for LTFU in adults who initiated ART in LMICs. Meta-analysis was performed for risk factors evaluated by at least five studies. Pooled effect estimates and their 95% confidence intervals (95% CI) were calculated using random effect models with inverse variance weights. Risk of bias was assessed and sensitivity analyses performed. RESULTS Eighty studies were included describing a total of 1 605 320 patients of which 87.4% from sub-Saharan Africa. The following determinants were significantly associated with an increased risk of LTFU in meta-analysis: male sex, older age, being single, unemployment, lower educational status, advanced WHO stage, low weight, worse functional status, poor adherence, nondisclosure, not receiving cotrimoxazole prophylactic therapy when indicated, receiving care at secondary level and more recent year of initiation. No association was seen for CD4 cell count, tuberculosis at baseline, regimen, and geographical setting. CONCLUSION There are several sociodemographic, clinical, patient behaviour, treatment-related and system level risk factors for LTFU from ART programs. Knowledge of risk factors should be used to better target retention interventions and develop tools to identify high-risk patients.
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Chandy S, Heylen E, Ravikumar BN, Ekstrand ML. Examining engagement in care of women living with HIV in South India. Health Care Women Int 2019; 41:553-566. [PMID: 31242078 DOI: 10.1080/07399332.2019.1623799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10 years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided.
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Affiliation(s)
- Sara Chandy
- Department of Medicine, St. John's Medical College, Bangalore, India
| | - Elsa Heylen
- Department of Medicine, University of California, San Francisco, CA, USA
| | - B N Ravikumar
- Karnataka State AIDS Prevention Society, Bangalore, India
| | - Maria L Ekstrand
- Department of Medicine, University of California, San Francisco, CA, USA.,St. John's Research Institute, Bangalore, India
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Rahmalia A, Price MH, Hartantri Y, Alisjahbana B, Wisaksana R, van Crevel R, van der Ven AJAM. Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study. PLoS One 2019; 14:e0218781. [PMID: 31237899 PMCID: PMC6592601 DOI: 10.1371/journal.pone.0218781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/11/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide. METHODS We examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in Bandung, West Java. Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) LTFU, and (4) death. RESULTS We followed 3215 patients (33% females), for a total of 8430 person-years. ART was used by 59% of patients at some point. One-year retention was 73% for females and 77% for males (p = 0.06). One-year survival was 98% for both females and males (p = 0.15). Females experienced a higher relative hazard to transition from HIV to LTFU (adjusted hazard ratio 1.21; 95% confidence interval 1.00-1.45), but this decreased after adjustments for clinical variables (aHR 0.94; 95% CI 0.79-1.11). Similarly, a lower relative hazard in females to transition from ART to death (aHR 0.59; 95% CI 0.35-0.99) decreased after adjustments for demographic variables. CONCLUSION This Indonesian cohort has low ART uptake and poor overall pre- and post-ART retention. Female-male differences in survival and retention were gone after adjusting for clinical and sociodemographic factors such as CD4 count and education level. Efforts should be made to improve retention among patients with lower education.
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Affiliation(s)
- Annisa Rahmalia
- Infectious Disease Research Center, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Holton Price
- Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania, United States of America
- Santa Fe Institute, Santa Fe, New Mexico, United States of America
| | - Yovita Hartantri
- Infectious Disease Research Center, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Bachti Alisjahbana
- Infectious Disease Research Center, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rudi Wisaksana
- Infectious Disease Research Center, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Gezae KE, Abebe HT, Gebretsadik LG. Incidence and predictors of LTFU among adults with TB/HIV co-infection in two governmental hospitals, Mekelle, Ethiopia, 2009-2016: survival model approach. BMC Infect Dis 2019; 19:107. [PMID: 30717705 PMCID: PMC6360725 DOI: 10.1186/s12879-019-3756-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/29/2019] [Indexed: 02/02/2023] Open
Abstract
Background Lost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and thus, increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization. However, the incidence and predictors of loss to follow up (LTFU) among adults with TB/HIV co-infection have not yet well-investigated in Ethiopia. Therefore, this study was aimed at investigating the incidence and predictors of LTFU in the study setting in particular. Methods A facility based retrospective cohort study was employed among 305 (114 anemic and 191 normal) TB/HIV co-infected adults in two governmental hospitals (Mekelle Hospital and Ayder Comprehensive Specialized Hospital), Mekelle, Ethiopia from 2009 to 2016 and data were collected using checklist. Besides to descriptive statistics, a cox regression analysis was applied to identify statistically significant predictors of LTFU at 5% level of significance. Eventually, the Adjusted Hazard Ratio (AHR) and 95% Confidence Interval (CI) were estimated and interpreted for predictors of LTFU in the final cox model. Results Generally, 45 of 305 (14.8%) of TB/HIV co-infected adults were LTFU with an incidence rate of 4.5 new LTFUs per 100 Person Years (PYs) and a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8–5.3 Years). Hemoglobin level ≤ 11.0 g/dl (AHR = 2.660; 95%CI: 1.459–4.848), and any history of OI/s (AHR = 3.795; 95%CI: 1.165–12.364) were risk factors of LTFU. While, adverse drug events (AHR = 0.451; 95%CI: 0.216–0.941), TB treatment completion (AHR = 0.121; 95% CI: 0.057–0.254), and being on Isoniazid Preventive Therapy (IPT) (AHR = 0.085; 95%CI: 0.012–0.628) had protective effect against LTFU. Conclusions One in approximately seven TB/HIV co-infected adults had experienced of LTFU with an incidence rate 4.5 LTFUs per 100 PYs. The LTFU rate was higher among adults with low baseline hemoglobin level, no adverse drug events, presence of OI/s, failure to complete TB treatment, and being not on IPT. Therefore, it is advisable to treat anemia and active TB, and preventing the occurrence of OIs including TB using IPT to reduce the incidence of LTFU among TB/HIV co-infected adults.
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Affiliation(s)
- Kebede Embaye Gezae
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, P.O. Box: 1871, Mekelle, Ethiopia.
| | - Haftom Temesgen Abebe
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, P.O. Box: 1871, Mekelle, Ethiopia
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Tran BX, Nguyen LH, Vu GT, Fleming M, Latkin CA. Workability of patients with HIV/AIDS in Northern Vietnam: a societal perspective on the impact of treatment program. AIDS Care 2018; 30:1532-1537. [PMID: 30099883 DOI: 10.1080/09540121.2018.1510098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Vietnam, the antiretroviral therapy (ART) program has been widely scaled up across the country since 2005, and now covers treatment for about half the HIV population. However, limited data exist about the workability and productivity outcome of ART in Vietnam. We aim to assess the employment status and work productivity among HIV patients taking ART in Northern Vietnam. A cross-sectional study was conducted in Hanoi and Nam Dinh with 1133 participants taking ART at the selected clinics. The Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH) was applied. We found that 23% of patients with HIV/AIDS reported overall work productivity loss, and 12% had activity impairment. Among those having a job, their monthly income, however, was significantly lower than national averages 2806 thousand VND vs. 4120 thousand VND). The average education level of participants was low, with only 41.61% having greater than secondary education. Health problems and lower CD4 cell counts decreased workability of the patients while having a more dependent family, being a smoker or having a later HIV stage was associated with being less likely to have a job. The rate of employment among HIV/AIDS patients in this study was high however incomes were substantially lower than average. This could be due to low education levels or social stigma regarding these patients. Vocational education programs and public awareness could empower the patients economically. Similarly, a number of social and behavioral problems were associated with decreasing the working rate and productivity. Addressing these health issues may improve productivity among patients.
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Affiliation(s)
- Bach Xuan Tran
- a Institute for Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam.,b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Vietnam Young Physician Association , Hanoi , Vietnam
| | - Long Hoang Nguyen
- d Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Giang Thu Vu
- e Institute for Global Health Innovations, Duy Tan University , Da Nang , Vietnam
| | | | - Carl A Latkin
- b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Johns B, Chau LB, Hanh KH, Manh PD, Do HM, Duong AT, Nguyen LH. Association Between User Fees and Dropout from Methadone Maintenance Therapy: Results of a Cohort Study in Vietnam. Health Syst Reform 2018. [DOI: 10.1080/23288604.2018.1440347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Benjamin Johns
- International Development Division, Abt Associates, Rockville, MD, USA
| | - Le Bao Chau
- Hanoi School of Public Health, Ba Đình, Hà Nội, Vietnam
| | - Kieu Huu Hanh
- Health Financing and Governance Project Vietnam, Ba Đình, Hà Nội, Vietnam
| | - Pham Duc Manh
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Ba Dinh, Hanoi, Vietnam
| | - Hoa Mai Do
- Hanoi School of Public Health, Ba Đình, Hà Nội, Vietnam
| | - Anh Thuy Duong
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Ba Dinh, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Ba Dinh, Hanoi, Vietnam
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Tanuma J, Matsumoto S, Haneuse S, Cuong DD, Vu TV, Thuy PTT, Dung NT, Dung NTH, Trung NV, Kinh NV, Oka S. Long-term viral suppression and immune recovery during first-line antiretroviral therapy: a study of an HIV-infected adult cohort in Hanoi, Vietnam. J Int AIDS Soc 2018; 20. [PMID: 29211347 PMCID: PMC5810334 DOI: 10.1002/jia2.25030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/07/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Achieving viral suppression is key in the global strategy to end the HIV epidemic. However, the levels of viral suppression have yet to be described in many resource-limited settings. METHODS We investigated the time to virologic failure (VF; defined as a viral load of ≥1000 copies/ml) and changes in CD4 counts since starting antiretroviral therapy (ART) in a cohort of HIV-infected adults in Hanoi, Vietnam. Factors related to the time to VF and impaired early immune recovery (defined as not attaining an increase in 100 cells/mm3 in CD4 counts at 24 months) were further analysed. RESULTS From 1806 participants, 225 were identified as having VF at a median of 50 months of first-line ART. The viral suppression rate at 12 months was 95.5% and survival without VF was maintained above 90% until 42 months. An increase in CD4 counts from the baseline was greater in groups with lower baseline CD4 counts. A younger age (multivariate hazard ratio (HR) 0.75, vs. <30), hepatitis C (HCV)-antibody positivity (HR 1.43), and stavudine (d4T)-containing regimens (HR 1.4, vs. zidovudine (AZT)) were associated with earlier VF. Factors associated with impaired early immune recovery included the male sex (odds ratio (OR) 1.78), HCV-antibody positivity (OR 1.72), d4T-based regimens (OR 0.51, vs. AZT), and nevirapine-based regimens (OR 0.53, vs. efavirenz) after controlling for baseline CD4 counts. CONCLUSION Durable high-rate viral suppression was observed in the cohort of patients on first-line ART in Vietnam. Our results highlight the need to increase adherence support among injection drug users and HCV co-infected patients.
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Affiliation(s)
- Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.,Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shoko Matsumoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Molloy SF, Chiller T, Greene GS, Burry J, Govender NP, Kanyama C, Mfinanga S, Lesikari S, Mapoure YN, Kouanfack C, Sini V, Temfack E, Boulware DR, Dromer F, Denning DW, Day J, Stone NRH, Bicanic T, Jarvis JN, Lortholary O, Harrison TS, Jaffar S, Loyse A. Cryptococcal meningitis: A neglected NTD? PLoS Negl Trop Dis 2017; 11:e0005575. [PMID: 28662028 PMCID: PMC5490932 DOI: 10.1371/journal.pntd.0005575] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Síle F. Molloy
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
- * E-mail:
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gregory S. Greene
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Burry
- Medecins Sans Frontières Access Campaign, Médecins Sans Frontières, Geneva, Switzerland
| | - Nelesh P. Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), Johannesburg, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Sayoki Mfinanga
- National Institute of Medial Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania
| | - Sokoine Lesikari
- National Institute of Medial Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania
| | | | - Charles Kouanfack
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Victor Sini
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | | | - David R. Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Francoise Dromer
- Institut Pasteur, Molecular Mycology—CNRS URA3012, Department of Mycology, Paris, France
| | - David W. Denning
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Jeremy Day
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Neil R. H. Stone
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Tihana Bicanic
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Joseph N. Jarvis
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Olivier Lortholary
- Institut Pasteur, Molecular Mycology—CNRS URA3012, Department of Mycology, Paris, France
| | - Thomas S. Harrison
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela Loyse
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
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Tanuma J, Lee KH, Haneuse S, Matsumoto S, Nguyen DT, Nguyen DTH, Do CD, Pham TT, Nguyen KV, Oka S. Incidence of AIDS-Defining Opportunistic Infections and Mortality during Antiretroviral Therapy in a Cohort of Adult HIV-Infected Individuals in Hanoi, 2007-2014. PLoS One 2016; 11:e0150781. [PMID: 26939050 PMCID: PMC4777554 DOI: 10.1371/journal.pone.0150781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/17/2016] [Indexed: 11/23/2022] Open
Abstract
Background Although the prognosis for HIV-infected individuals has improved after antiretroviral therapy (ART) scale-up, limited data exist on the incidence of AIDS-defining opportunistic infections (ADIs) and mortality during ART in resource-limited settings. Methods HIV-infected adults in two large hospitals in urban Hanoi were enrolled to the prospective cohort, from October 2007 through December 2013. Those who started ART less than one year before enrollment were assigned to the survival analysis. Data on ART history and ADIs were collected retrospectively at enrollment and followed-up prospectively until April 2014. Results Of 2,070 cohort participants, 1,197 were eligible for analysis and provided 3,446 person-years (PYs) of being on ART. Overall, 161 ADIs episodes were noted at a median of 3.20 months after ART initiation (range 0.03–75.8) with an incidence 46.7/1,000 PYs (95% confidence interval [CI] 39.8–54.5). The most common ADI was tuberculosis with an incidence of 29.9/1,000 PYs. Mortality after ART initiation was 8.68/1,000 PYs and 45% (19/45) died of AIDS-related illnesses. Age over 50 years at ART initiation was significantly associated with shorter survival after controlling for baseline CD4 count, but neither having injection drug use (IDU) history nor previous ADIs were associated with poor survival. Semi-competing risks analysis in 951 patients without ADIs history prior to ART showed those who developed ADIs after starting ART were at higher risk of death in the first six months than after six months. Conclusion ADIs were not rare in spite of being on effective ART. Age over 50 years, but not IDU history, was associated with shorter survival in the cohort. This study provides in-depth data on the prognosis of patients on ART in Vietnam during the first decade of ART scale-up.
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Affiliation(s)
- Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kyu Ha Lee
- Epidemiology and Biostatistics Core, The Forsyth Institute, Cambridge, Massachusetts, United States of America
| | - Sebastien Haneuse
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shoko Matsumoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Dung Thi Nguyen
- HIV Department, National Hospital of Tropical Disease, Hanoi, Vietnam
| | | | - Cuong Duy Do
- Infectious Disease Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Thuy Thanh Pham
- Infectious Disease Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Kinh Van Nguyen
- HIV Department, National Hospital of Tropical Disease, Hanoi, Vietnam
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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