1
|
Boyce CL, Sils T, Milne RS, Wallner JJ, Hardy SR, Ko D, Wong-On-Wing A, Mackey M, Higa N, Beck IA, Styrchak SM, DeMarrais P, Tierney C, Fowler MG, Frenkel LM. Impact of Human Immunodeficiency Virus Drug Resistance Mutations Detected in Women Prior to Antiretroviral Therapy With Efavirenz + Tenofovir Disoproxil Fumarate + Lamivudine (or Emtricitabine). Open Forum Infect Dis 2024; 11:ofae383. [PMID: 39050228 PMCID: PMC11267229 DOI: 10.1093/ofid/ofae383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Background Two large studies suggest that resistance mutations to only nonnucleoside reverse transcriptase inhibitors (NNRTI) did not increase the risk of virologic failure during antiretroviral therapy (ART) with efavirenz/tenofovir disoproxil fumarate/lamivudine (or emtricitabine). We retrospectively evaluated a third cohort to determine the impact of NNRTI resistance on the efficacy of efavirenz-based ART. Methods Postpartum women living with human immunodeficiency virus (HIV) were studied if they initiated efavirenz-based ART because of the World Health Organization's recommendation for universal ART. Resistance was detected by Sanger genotyping plasma prior to efavirenz-based ART and at virologic failure (HIV RNA >400 copies/mL). Logistic regression examined relationships between pre-efavirenz genotypes and virologic failure. Results Pre-efavirenz resistance was detected in 169 of 1223 (13.8%) participants. By month 12 of efavirenz-based ART, 189 of 1233 (15.3%) participants had virologic failure. Rates of virologic failure did not differ by pre-efavirenz NNRTI resistance. However, while pre-efavirenz nucleos(t)ide reverse transcriptase inhibitors (NRTI) and NNRTI resistance was rare (8/1223 [0.7%]) this genotype increased the odds (adjusted odds ratio, 11.2 [95% confidence interval, 2.21-72.2]) of virologic failure during efavirenz-based ART. Age, time interval between last viremic visit and efavirenz initiation, clinical site, viremia at delivery, hepatitis B virus coinfection, and antepartum regimen were also associated with virologic failure. Conclusions Resistance to NNRTI alone was prevalent and dual-class (NRTI and NNRTI) resistance was rare in this cohort, with only the latter associated with virologic failure. This confirms others' findings that, if needed, efavirenz-based ART offers most people an effective alternative to dolutegravir-based ART.
Collapse
Affiliation(s)
- Ceejay L Boyce
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Tatiana Sils
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Ross S Milne
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jackson J Wallner
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha R Hardy
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Daisy Ko
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Annie Wong-On-Wing
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Malia Mackey
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Nikki Higa
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Ingrid A Beck
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Sheila M Styrchak
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Patricia DeMarrais
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Camlin Tierney
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary G Fowler
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa M Frenkel
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
2
|
Masika LV, Mboya IB, Maro RA, Mtesha B, Mtoro MJ, Ngowi K, Mahande MJ, Sumari-de Boer IM. Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania. HIV AIDS (Auckl) 2024; 16:245-257. [PMID: 38911143 PMCID: PMC11192192 DOI: 10.2147/hiv.s452875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Background Antiretroviral therapy (ART) adherence is crucial for virological suppression and positive treatment outcomes among people living with HIV (PLHIV), but remains a challenge in ensuring patients achieve and sustain viral load suppression. Despite the recommended use of digital tools medications uptake reminders, the contribution of forgetting to take medication is unknown. This study investigated the contribution of forgetting to take medication on the total missed medication and its effects on detectable viral load (VL). Methods This mixed-method research was conducted among children, adolescents, pregnant, and breastfeeding women living with HIV on ART in northern Tanzania. Forgetting to take medication constituted reporting to have missed medication due to forgetfulness. A multivariable logistic regression model was used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to determine the contribution of forgetting medication intakes on total missed medication and other factors associated with having a detectable VL. Results Of 427 respondents, 33.3% were children, 33.4% adolescents, and 33.3% pregnant and breastfeeding women, whose median age (interquartile range) was 9 (7-12), 18 (16-18), and 31 (27-36) years, respectively. Ninety-two (22.3%) reported missing medication over the past month, of which 72 (17.9%) was due to forgetting. Forgetting to take medication (AOR: 1.75 95% CI: 1.01-3.06) and being on second-line regimen (AOR: 2.89 95% CI: 1.50-5.55) increased the chances of a detectable VL, while females had lower chances of detectable VL (AOR: 0.62 95% CI: 0.41-0.98). The themes on the reasons for forgetting to take medication from qualitative results included being busy with work and the importance of reminders. Conclusion Forgetting to take medication is common among PLHIV and an important predictor of a detectable VL. This calls for the use of automated short message services (SMS) reminders or Digital Adherence Tools with reminders to improve and promote good ART adherence among PLHIV.
Collapse
Affiliation(s)
- Lyidia V Masika
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Data management Unit, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Innocent B Mboya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Benson Mtesha
- Data management Unit, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Mtoro J Mtoro
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kennedy Ngowi
- Data management Unit, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael Johnson Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Management and Development for Health, Dar Es Salaam, Tanzania
| | - I Marion Sumari-de Boer
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Data management Unit, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Belete MB, Bitew A, Mulatu K. Viral load suppression and its predictor among HIV seropositive people who receive enhanced adherence counseling at public health institutions in Bahir Dar, Northwest Ethiopia. Retrospective follow-up study. PLoS One 2024; 19:e0303243. [PMID: 38739646 PMCID: PMC11090359 DOI: 10.1371/journal.pone.0303243] [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: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND For those HIV seropositive people with high viral loads, the World Health Organization recommends more counseling before changing ART regimens. A high viral load can lead to increased HIV transmission and lower survival rates. Clients with viral loads above 1000 copies/mL should receive enhanced adherence counseling for 3-6 months before switching. Despite enhanced adherence counseling programs, most countries struggle with viral load suppression. Little is known about viral load suppression in Ethiopia and the research area after counseling. OBJECTIVE This study aims to assess viral load suppression and its predictors among HIV-positive individuals receiving enhanced adherence counseling in Bahir Dar, Northwest Ethiopia, in 2022. METHODS An institution-based retrospective follow-up study was conducted among randomly selected 546 clients on Enhanced Adherence Counseling at public health facilities in Bahir Dar city. The Epicollect5 mobile application was used to collect the data, which was then exported to Stata version 14 for analysis. A Log-Binomial regression model was fitted for each explanatory variable. Variables having a p-value <0.25 in bivariate analysis were entered into a multivariable Log-Binomial regression model. Finally, an adjusted risk ratio with a 95% confidence interval and a p-value <0.05 was used to measure the strength of the prediction. RESULTS Following enhanced adherence counseling, 312 (57.1%) people had their viral load suppressed. Absence of recurrent OI (ARR 1.40; CI 1.03-1.91), EAC stay less than 3 months (ARR 1.54; CI 1.19-1.99), EAC stay 3-6 months (ARR 1.38; CI 1.12-1.69), once-daily ARV dose regimen (ARR 1.28; CI 1.03-1.58), baseline viral load of 2879.00 copies/ml (ARR 1.30, CI 1.06-1.60), being orthodox Tewahido Christian (ARR 0.37; CI 0.18-0.75) were significant predictors of viral load suppression after Enhanced Adherence Counseling. CONCLUSION AND RECOMMENDATION Most importantly, this study found that most people had suppressed viral loads after receiving enhanced adherence counseling. Significant predictors of viral load suppression included recurrent OI, length of stay on EAC, daily ARV dosing regimen, baseline viral load, and religion. Clients with a high baseline viral load and those who experience recurring opportunistic infections should get extra care during EAC sessions.
Collapse
Affiliation(s)
- Minyichil Birhanu Belete
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebayehu Bitew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
4
|
Hashempour A, Khodadad N, Ziaei R, Rezaei B, Ghasabi F, Falahi S, Kenarkouhi A, Davarpanah MA. Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults. BMC Infect Dis 2024; 24:358. [PMID: 38549051 PMCID: PMC10976689 DOI: 10.1186/s12879-024-09251-x] [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: 10/04/2023] [Accepted: 03/24/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND HIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS. METHODOLOGY This cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure. RESULTS Clinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure. CONCLUSION As the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95-95-95 plan.
Collapse
Affiliation(s)
- Ava Hashempour
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Khodadad
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ziaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Rezaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ghasabi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab Falahi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Azra Kenarkouhi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ali Davarpanah
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
5
|
Tumwegamire A, Fatch R, Emenyonu NI, Lodi S, Muyindike WR, Kekibiina A, Adong J, Ngabirano C, Beesiga B, Marson K, Golabi N, Kamya M, Chamie G, Hahn JA. Association between smoking and lack of HIV virological suppression in a cross-sectional study of persons with HIV on antiretroviral therapy in Uganda. PLoS One 2024; 19:e0300508. [PMID: 38507431 PMCID: PMC10954112 DOI: 10.1371/journal.pone.0300508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Smoking and alcohol use frequently co-occur and are the leading causes of preventable death in sub-Saharan Africa (SSA) and are common among people living with HIV (PLWH). While alcohol use has been shown to be associated with reduced adherence to antiretroviral treatment (ART), which may affect HIV viral suppression, the independent effect of smoking on HIV outcomes in SSA is unknown. We aimed to 1) describe the prevalence of current smoking and correlates of smoking; 2) assess the association of smoking with viral suppression, adjusting for level of alcohol use; 3) explore the relationship between smoking and CD4 cell count <350 cells/mm3, among participants who are virally suppressed. METHODS We analyzed data from the Drinkers Intervention to Prevent Tuberculosis (DIPT) and the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) studies conducted in Southwest Uganda. The studies enrolled PLWH who were on ART for at least 6 months and co-infected with latent tuberculosis and dominated with participants who had unhealthy alcohol use. Current smoking (prior 3 months) was assessed by self-report. Alcohol use was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C, modified for prior 3 months) and phosphatidylethanol (PEth), an alcohol biomarker. We used logistic regression to estimate the cross-sectional association between smoking and lack of virological suppression (≥40 copies/ml), adjusting for level of alcohol use and other covariates, and to examine the association between smoking and CD4 cell counts among PLWH with viral suppression. RESULTS Of the 955 participants enrolled from 2017 to 2021 who had viral load (VL) results, 63% were men, median age was 40 years (interquartile range [IQR] 32-47), 63% engaged in high/very high-risk alcohol use (AUDIT-C≥6 or PEth≥200 ng/mL), and 22% reported smoking in the prior 3 months. Among 865 participants (91%) with viral suppression and available CD4 count, 11% had a CD4 cell count <350 cells/mm3. In unadjusted and adjusted analyses, there was no evidence of an association between smoking and lack of virological suppression nor between smoking and CD4 count among those with viral suppression. CONCLUSIONS The prevalence of smoking was high among a study sample of PLWH in HIV care with latent TB in Southwest Uganda in which the majority of persons engaged in alcohol use. Although there was no evidence of an association between smoking and lack of virological suppression, the co-occurrence of smoking among PLWH who use alcohol underscores the need for targeted and integrated approaches to reduce their co-existence and improve health.
Collapse
Affiliation(s)
- Adah Tumwegamire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Nneka I. Emenyonu
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Winnie R. Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine Ngabirano
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Kara Marson
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Nakisa Golabi
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Judith A. Hahn
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| |
Collapse
|
6
|
Nanyeenya N, Nakanjako D, Makumbi F, Nakigozi G, Nalugoda F, Kigozi G, Nasuuna E, Kibira SPS, Nabadda S, Kiyaga C, Huzaifah M, Kiwanuka N. Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low-level viraemia in Uganda. HIV Med 2024; 25:245-253. [PMID: 37853605 PMCID: PMC11047222 DOI: 10.1111/hiv.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Uganda was using a threshold of 1000 copies/mL to determine viral non-suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low-level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm. METHODS This cluster-randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once-monthly sessions of IAC, and those in the comparison non-intervention arm clinics received the standard of care. At the end of the study, all participants were re-tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross-tabulated variables using Fisher's exact test and then modified Poisson regression. RESULTS A total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non-intervention arm was lost to follow-up. The average follow-up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non-intervention arms, respectively. In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow-up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non-intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0-3.5), p = 0.037. CONCLUSION IAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub-Saharan African countries with similar settings. CLINICALTRIALS GOV IDENTIFIER NCT05514418.
Collapse
Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Mutyaba Huzaifah
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
7
|
Senteza I, Castelnuovo B, Mukunya D, Makumbi F. Virological non-suppression among adult males attending HIV care services in the fishing communities in Bulisa district, Uganda. PLoS One 2023; 18:e0293057. [PMID: 37856568 PMCID: PMC10586650 DOI: 10.1371/journal.pone.0293057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Virological non-suppression is a critical factor in driving HIV transmission rates, yet there is limited data available on the determinants of this phenomenon, particularly in fishing communities where the incidence of HIV is disproportionately high. We aimed to determine the prevalence and determinants of virological non-suppression among adult males (≥15 years) attending HIV care services in the fishing communities of Bulisa district. METHODS We conducted a cross-sectional study among all adult males (≥15 years) living with HIV who were resident within the fishing communities, and in care for atleast 6 months at the six health facilities offering HIV services in the fishing communities in Bulisa district. To obtain data on patient and health facility characteristics, we reviewed patients' records and conducted face-to-face interviews with the participants. We conducted descriptive and regression analyses using modified Poisson regression, accounting for data correlation of observation at the facility level to obtain prevalence ratios (PR) with 95% confidence intervals in Stata version 14.0. RESULTS 413 participants were studied and 379 (91.8%) were interviewed. The participant's average age (SD) was 40 (10.7) years and 70.5% (267/379) were engaged in the fishing business. The prevalence of virological non-suppression was 88/413-21.3% (95% CI: 18%-26%). Factors associated with higher odds of virological non-suppression included: Age 26-50 years (adj.PR = 1.53, 95%CI: 1.11-2.08) and 15-25 years (adj.PR = 2.99, 95%CI: 1.27-7.05) compared to age above 50 years; unemployment (adj.PR = 1.28, 95%CI: 1.10-1.49); hazardous use of alcohol (adj.PR = 1.34, 95%CI: 1.10-1.62); non-mobility between fish landing sites (adj.PR = 1.37, 95%CI: 1.003-1.87); distant HIV treatment services (adj.PR = 1.37, 95%CI: 1.11-1.69) and TB diagnosis (adj.PR = 1.87, 95%CI: 1.33-2.64). CONCLUSION Virological non-suppression among people living with HIV in fishing communities along the shores of Lake Albert is alarmingly high, exceeding the UNAIDS threshold of 10% by two-fold. Several key determinants were identified, including hazardous alcohol use, unemployment, and access barriers to HIV treatment services.
Collapse
Affiliation(s)
- Ignatius Senteza
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Busitema, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
8
|
De Castro N, Chazallon C, Brites C, Messou E, Khosa C, Laureillard D, Chau GD, Pilotto JH, Eholié S, Delaugerre C, Molina JM, Wittkop L, Grinsztejn B, Marcy O. Virologic response to antiretroviral therapy in people with HIV and tuberculosis in high tuberculosis burden countries. AIDS 2023; 37:1837-1842. [PMID: 36928120 DOI: 10.1097/qad.0000000000003521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE We sought to compare virologic outcomes on antiretroviral therapy (ART) between people with HIV (PWH) also treated for tuberculosis in the different countries who participated to two randomized trials. DESIGN Pooled analysis of two randomized clinical trials. METHODS In the phase II Reflate TB and phase III Reflate TB2 trials conducted in Brazil, Côte d'Ivoire, Mozambique and Vietnam, ART-naïve PWH treated for tuberculosis were randomized to receive raltegravir or efavirenz. We assessed country differences in baseline characteristic using Wilcoxon tests and chi-square, or Fisher's exact test. We used logistic regression to analyze determinants of virologic success, defined as week-48 plasma HIV-1 RNA <50 copies/ml. RESULTS Of 550 participants (140 from Brazil, 170 from Côte d'Ivoire, 129 from Mozambique and 111 from Vietnam) with median baseline HIV-1 RNA of 5.4 log 10 copies/ml, 362 (65.8%) achieved virologic success at week 48. Virologic success rates were: 105/140 (75.0%) in Brazil, 99/170 (58.2%) in Côte d'Ivoire, 84/129 (65.1%) in Mozambique and 74/111 (66.7%) in Vietnam ( P = 0.0233). Baseline HIV-1 RNA, but not the country, was independently associated with virologic success: baseline HIV-1 RNA ≥500 000 copies/ml (reference), HIV RNA <100 000 copies/ml odds ratio 3.12 [95% confidence interval (CI) 1.94; 5.01] and HIV-1 RNA 100 000-499 999 copies/ml odds ratio: 1.80 (95% CI 1.19; 2.73). Overall, 177/277 (63.9%) patients treated with raltegravir and 185/273 (67.9%) patients treated with efavirenz had a plasma HIV-1 RNA <50 copies/ml at week 48. CONCLUSIONS Virologic response to antiretroviral therapy in PWH with TB varied across countries but was mainly driven by levels of pretreatment HIV-1 RNA.
Collapse
Affiliation(s)
- Nathalie De Castro
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- Infectious Diseases Department, AP-HP-Hôpital Saint-Louis Lariboisière, Paris, France
| | - Corine Chazallon
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Carlos Brites
- Laboratório de Pesquisa em Doenças Infecciosas, Hospital Universitário Prof Edgar Santos, Bahia, Brazil
| | - Eugène Messou
- Programme PACCI/ANRS Research Center
- Centre de Prise en Charge de Recherche et de Formation, CePReF-Aconda-VS, Abidjan, Cote D'Ivoire
- Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Cote d'Ivoire
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, Nimes University Hospital, Nimes
- Research Unit 1058, Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier, Montpellier, France
| | - Giang D Chau
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - José H Pilotto
- Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil
| | - Serge Eholié
- Programme PACCI/ANRS Research Center
- Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Cote d'Ivoire
| | - Constance Delaugerre
- Virology department, APHP-Hôpital Saint-Louis
- INSERM U944
- Université Paris Cité, Paris
| | - Jean-Michel Molina
- Infectious Diseases Department, AP-HP-Hôpital Saint-Louis Lariboisière, Paris, France
- INSERM U944
- Université Paris Cité, Paris
| | - Linda Wittkop
- University Bordeaux, INSERM, Institut Bergonié, Bordeaux
- INRIA SISTM team, Talence
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, Bordeaux, France
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Olivier Marcy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| |
Collapse
|
9
|
Esber AL, Dear NF, King D, Francisco LV, Sing'oei V, Owuoth J, Maswai J, Iroezindu M, Bahemana E, Kibuuka H, Shah N, Polyak CS, Ake JA, Crowell TA. Achieving the third 95 in sub-Saharan Africa: application of machine learning approaches to predict viral failure. AIDS 2023; 37:1861-1870. [PMID: 37418549 DOI: 10.1097/qad.0000000000003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Viral failure in people with HIV (PWH) may be influenced by multiple sociobehavioral, clinical, and context-specific factors, and supervised learning approaches may identify novel predictors. We compared the performance of two supervised learning algorithms to predict viral failure in four African countries. DESIGN Cohort study. METHODS The African Cohort Study is an ongoing, longitudinal cohort enrolling PWH at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. Participants underwent physical examination, medical history-taking, medical record extraction, sociobehavioral interviews, and laboratory testing. In cross-sectional analyses of enrollment data, viral failure was defined as a viral load at least 1000 copies/ml among participants on antiretroviral therapy (ART) for at least 6 months. We compared the performance of lasso-type regularized regression and random forests by calculating area under the curve (AUC) and used each to identify factors associated with viral failure; 94 explanatory variables were considered. RESULTS Between January 2013 and December 2020, 2941 PWH were enrolled, 1602 had been on antiretroviral therapy (ART) for at least 6 months, and 1571 participants with complete case data were included. At enrollment, 190 (12.0%) had viral failure. The lasso regression model was slightly superior to the random forest in its ability to identify PWH with viral failure (AUC: 0.82 vs. 0.75). Both models identified CD4 + count, ART regimen, age, self-reported ART adherence and duration on ART as important factors associated with viral failure. CONCLUSION These findings corroborate existing literature primarily based on hypothesis-testing statistical approaches and help to generate questions for future investigations that may impact viral failure.
Collapse
Affiliation(s)
- Allahna L Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nicole F Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - David King
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Leilani V Francisco
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Valentine Sing'oei
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- U.S. Army Medical Research Directorate - Africa, Kericho, Kenya
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University-Walter Reed Project, Kampala, Uganda
| | - Neha Shah
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Filiatreau LM, Edwards JK, Masilela N, Gómez-Olivé FX, Haberland N, Pence BW, Maselko J, Muessig KE, Kabudula CW, Dufour MSK, Lippman SA, Kahn K, Pettifor A. Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: a retrospective cohort study. BMC Public Health 2023; 23:1724. [PMID: 37670262 PMCID: PMC10478421 DOI: 10.1186/s12889-023-16353-9] [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: 08/17/2022] [Accepted: 07/20/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Little is known about the effects of universal test and treat (UTT) policies on HIV care outcomes among youth living with HIV (YLHIV). Moreover, there is a paucity of information regarding when YLHIV are most susceptible to disengagement from care under the newest treatment guidelines. The longitudinal HIV care continuum is an underutilized tool that can provide a holistic understanding of population-level HIV care trajectories and be used to compare treatment outcomes across groups. We aimed to explore effects of the UTT policy on longitudinal outcomes among South African YLHIV and identify temporally precise opportunities for re-engaging this priority population in the UTT era. METHODS Using medical record data, we conducted a retrospective cohort study among youth aged 18-24 diagnosed with HIV from August 2015-December 2018 in nine health care facilities in South Africa. We used Fine and Gray sub-distribution proportional hazards models to characterize longitudinal care continuum outcomes in the population overall and stratified by treatment era of diagnosis. We estimated the proportion of individuals in each stage of the continuum over time and the restricted mean time spent in each stage in the first year following diagnosis. Sub-group estimates were compared using differences. RESULTS A total of 420 YLHIV were included. By day 365 following diagnosis, just 23% of individuals had no 90-or-more-day lapse in care and were virally suppressed. Those diagnosed in the UTT era spent less time as ART-naïve (mean difference=-19.3 days; 95% CI: -27.7, -10.9) and more time virally suppressed (mean difference = 17.7; 95% CI: 1.0, 34.4) compared to those diagnosed pre-UTT. Most individuals who were diagnosed in the UTT era and experienced a 90-or-more-day lapse in care disengaged between diagnosis and linkage to care or ART initiation and viral suppression. CONCLUSIONS Implementation of UTT yielded modest improvements in time spent on ART and virally suppressed among South African YLHIV- however, meeting UNAIDS' 95-95-95 targets remains a challenge. Retention in care and re-engagement interventions that can be implemented between diagnosis and linkage to care and between ART initiation and viral suppression (e.g., longitudinal counseling) may be particularly important to improving care outcomes among South African YLHIV in the UTT era.
Collapse
Affiliation(s)
- Lindsey M Filiatreau
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, USA.
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nkosinathi Masilela
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Suk Kang Dufour
- Biostatistics Division, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Gandhi AR, Hyle EP, Scott JA, Lee JS, Shebl FM, Joska JA, Andersen LS, O'Cleirigh C, Safren SA, Freedberg KA. The Clinical Impact and Cost-Effectiveness of Clinic-Based Cognitive Behavioral Therapy for People With HIV, Depression, and Virologic Failure in South Africa. J Acquir Immune Defic Syndr 2023; 93:333-342. [PMID: 37079899 PMCID: PMC10287047 DOI: 10.1097/qai.0000000000003205] [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: 06/24/2022] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Depression affects 25%-30% of people with HIV (PWH) in the Republic of South Africa (RSA) and is associated with both antiretroviral therapy (ART) nonadherence and increased mortality. We evaluated the cost-effectiveness of task-shifted, cognitive behavioral therapy (CBT) for PWH with diagnosed depression and virologic failure from a randomized trial in RSA. SETTING RSA. METHODS Using the Cost-Effectiveness of Preventing AIDS Complications model, we simulated both trial strategies: enhanced treatment as usual (ETAU) and ETAU plus CBT for ART adherence and depression (CBT-AD; 8 sessions plus 2 follow-ups). In the trial, viral suppression at 1 year was 20% with ETAU and 32% with CBT-AD. Model inputs included mean initial age (39 years) and CD4 count (214/μL), ART costs ($7.5-22/mo), and CBT costs ($29/session). We projected 5- and 10-year viral suppression, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs: $/QALY [discounted 3%/yr]; cost-effectiveness threshold: ≤$2545/QALY [0.5× per capita GDP]). In sensitivity analyses, we determined how input parameter variation affected cost-effectiveness. RESULTS Model-projected 5- and 10-year viral suppression were 18.9% and 8.7% with ETAU and 21.2% and 9.7% with CBT-AD, respectively. Compared with ETAU, CBT-AD would increase discounted life expectancy from 4.12 to 4.68 QALYs and costs from $6210/person to $6670/person (incremental cost-effectiveness ratio: $840/QALY). CBT-AD would remain cost-effective unless CBT-AD cost >$70/session and simultaneously improved 1-year viral suppression by ≤4% compared with ETAU. CONCLUSIONS CBT for PWH with depression and virologic failure in RSA could improve life expectancy and be cost-effective. Such targeted mental health interventions should be integrated into HIV care.
Collapse
Affiliation(s)
- Aditya R. Gandhi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for AIDS Research, Harvard University, Cambridge, MA
| | - Justine A. Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Jasper S. Lee
- Harvard Medical School, Boston, MA
- Department of Psychology, University of Miami, Miami, FL
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and
| | - Conall O'Cleirigh
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for AIDS Research, Harvard University, Cambridge, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
12
|
Owusu LB, Ababio C, Boahene S, Zakaria AFS, Emikpe AO, Dwumfour CK, Appiagyei KA, Apiribu F. The predictors of unsuppressed viremia among PLHIV: a cross-sectional study in Ghana. BMC Public Health 2023; 23:1113. [PMID: 37296400 PMCID: PMC10257285 DOI: 10.1186/s12889-023-16032-9] [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: 08/25/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Unsuppressed viremia in HIV infected patients is generally associated with increased rates of disease transmission and poor patient survival. This study assessed the socio-demographic determinants of People Living with HIV/AIDS, having viral load non-suppression and who are receiving antiretroviral therapy in a District Hospital in Ghana. METHODS The study utilized the cross-sectional research design with both primary and secondary data conducted from September to October 2021 in Ghana. Data were collected from 331 PLHIV who were placed on Anti-Retroviral Therapy (ART) for more than 12 months at the ART centre at a District Hospital in Ghana. Unsuppressed viremia was defined as plasma viral load of ≥ 1000 copies/mL after 12 months on an ART with effective adherent support. A structured questionnaire was used to collect primary data on participants and a Secondary data was also collected from patients' folders, hospital registers and the computerized health information systems at the study site. SPSS was used to analyse descriptive and inferential data. Pearson's chi-square and Fisher's exact test were used to assess the independent determinants of viral load non-suppression. Pearson's chi-square test was used for tests giving ≤ 20% of expected cell counts less than five while Fisher's exact test was used for tests giving > 20% of expected cell counts less than five. A p value of < 0.05 was considered statistically significant. RESULTS Out of the 331 PLHIV who participated in the study, 174 (53%) were female and 157 (47%) were Male. The study found viral load non-suppression of 19% with age (p = 0.03), income (p = 0.02), employment (p = 0.04), means of transportation (p = 0.02), cost of transportation to the ART centre (p = 0.03) and level of medication adherence (p = 0.02) as determinants of viral load non-suppression. CONCLUSION There was a low level of viral load non-suppression among PLHIV after 12 months of active antiretroviral therapy with age, income, employment, means of transportation, cost of transportation and level of medication adherence influencing viral non-suppression. Thus, ART drugs and services should be decentralized to the community health workers' level within the various localities of patients to decrease the economic consequences involved in accessing health care for PLHIV/AIDS. This will minimize defaulting, improve adherence and promote viral load suppression.
Collapse
Affiliation(s)
| | - Christiana Ababio
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | - Selina Boahene
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | | | | | | | | | - Felix Apiribu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
13
|
Boakye P, Safowaa A. Prevalence and predictors of viral load suppression in adults living with HIV in the western region of Ghana: A cross-sectional study. AIMS Public Health 2023; 10:469-479. [PMID: 37304596 PMCID: PMC10251059 DOI: 10.3934/publichealth.2023033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Although antiretroviral therapy is beneficial and available free of cost to patients, several roadblocks still prevent patients from reaching viral suppression. This research aimed to determine the prevalence rate of viral suppression among people living with HIV in the western region of Ghana and identify the factors contributing to viral non-suppression. Methods A cross-sectional study was conducted on 7199 HIV-positive adults. All data from the Sekondi Public Health Laboratory database was exported to Microsoft Excel and then verified and filtered before being exported to STATA 16.1. Viral non-suppression was modeled statistically using logistic regression. Results Viral load suppression was achieved in 5465 (75.91%) study participants who received antiretroviral treatment. However, 1734 participants (24.0%) did not achieve viral suppression. Patients with poor adherence to ARV (AOR 0.30; 95% CI 0.16, 0.58) and fair adherence to ARV (AOR 0.23; 95% CI 0.12, 0.45) were associated with a lower odd of viral non-suppression. Patients with six (6) months to two (2) years of treatment before viral load testing (AOR 0.67; 95% CI 0.46, 0.98) were also associated with a lower likelihood of viral non-suppression. Conclusions The rate of non-suppression was high, and the suppression rate fell short of the UNAIDS target. Poor ARV adherence, fair ARV adherence, and a treatment duration of six (6) months to two (2) years before viral load testing appear to be obstacles to viral load suppression. The research findings seem to suggest that viral load testing supports viral non-suppression. Therefore, using viral load tests to monitor medication's effects on health can motivate patients to adhere to their prescribed medication regimen. More research is needed to determine whether viral load testing can improve adherence. Given the high rate of virologic failure, the study highlights the importance of identifying antiretroviral resistance patterns.
Collapse
Affiliation(s)
- Philip Boakye
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Research in Epidemiology, Biostatistics and Informatics, Koachie Health Systems, Accra, Ghana
| | - Adwoa Safowaa
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Faculty of Health and Medical Sciences, Presbyterian University, Agogo, Ghana
- Department of Research in Epidemiology, Biostatistics and Informatics, Koachie Health Systems, Accra, Ghana
| |
Collapse
|
14
|
Nanyeenya N, Siu G, Kiwanuka N, Makumbi F, Nasuuna E, Nakanjako D, Nakigozi G, Nabadda S, Kiyaga C, Kibira SPS. Hopes, joys and fears: Meaning and perceptions of viral load testing and low-level viraemia among people on antiretroviral therapy in Uganda: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001797. [PMID: 37163527 PMCID: PMC10171654 DOI: 10.1371/journal.pgph.0001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
Uganda applies the World Health Organization threshold of 1,000 copies/ml to determine HIV viral non-suppression. While there is an emerging concern of low-level viraemia (≥50 to <1,000 copies/ml), there is limited understanding of how people on antiretroviral therapy perceive viral load testing and low-level viremia in resource-limited settings. This qualitative study used the health belief model to explore the meaning that people living with HIV attach to viral load testing and low-level viraemia in Uganda. We used stratified purposive sampling to select people on antiretroviral therapy from eight high volume health facilities from the Central, Eastern, Northern and Western regions of Uganda. We used an interview guide, based on the health belief model, to conduct 32 in-depth interviews, which were audio-recorded and transcribed verbatim. Thematic analysis technique was used to analyze the data with the help of ATLAS.ti 6. The descriptions of viral load testing used by the participants nearly matched the medical meaning, and many people living with HIV understood what viral load testing was. Perceived benefits for viral load testing were the ability to show; the amount of HIV in the body, how the people living with HIV take their drugs, whether the drugs are working, and also guide the next treatments steps for the patients. Participants reported HIV stigma, lack of transport, lack of awareness for viral load testing, delayed and missing viral load results and few health workers as the main barriers to viral load testing. On the contrary, most participants did not know what low-level viraemia meant, while several perceived it as having a reduced viral load that is suppressed. Many people living with HIV are unaware about low-level viraemia, and hence do not understand its associated risks. Likewise, some people living with HIV are still not aware about viral load testing. Lack of transport, HIV stigma and delayed viral load results are major barriers to viral load testing. Hence, there is an imminent need to institute more strategies to create awareness about both low-level viraemia and viral load testing, manage HIV related stigma, and improve turnaround time for viral load results.
Collapse
Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala Uganda
| | - Godfrey Siu
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
15
|
Mundamshimu JS, Malale K, Kidenya BR, Gunda DW, Bwemelo L, Mwashiuya M, Omar SS, Mlowe N, Kiyumbi M, Ngocho JS, Balandya E, Sunguya B, Mshana SE, Mteta K, Bartlett J, Lyamuya E, Mmbaga BT, Kalluvya S. Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling-What Can We Learn About Its Factors? Infect Drug Resist 2023; 16:1885-1894. [PMID: 37020794 PMCID: PMC10069435 DOI: 10.2147/idr.s393456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment. Purpose We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions. Patients and Methods This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure. Results This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18-25 years (AOR = 5.6, 95% CI, 1.1-29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13-0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3-12.3) remained the main predictors of virological failure after IAC intervention. Conclusion Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.
Collapse
Affiliation(s)
| | - Kija Malale
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson R Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Logious Bwemelo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Neema Mlowe
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Magwa Kiyumbi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical University College, Mosh, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Samuel Kalluvya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| |
Collapse
|
16
|
郭 悦, 张 燕, 朱 丹, 龚 芳, 高 钰, 朱 昆, 李 姗. [Abnormal Activation of T Cells in HIV-1 Infection After Antiretroviral Therapy]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:415-421. [PMID: 36949708 PMCID: PMC10409166 DOI: 10.12182/20230360208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 03/24/2023]
Abstract
Objective To investigate the relationship between abnormal activation of T cell subsets in peripheral whole blood and the recovery of immune function in persons infected with HIV-1, and to examine the relationship between the size of the viral reservoir of HIV-1 DNA and T cell subsets. Methods HIV-1-infected persons who underwent routine testing between July 2019 and May 2020 were the target population of the study. According to whether, at the time of enrollment, their CD4+ T cells reached 500 cells/μL after antiretroviral therapy (ART), HIV-1-infected persons were divided into two groups, 76 in the deficiency group and 61 in the immune recovery group. In addition, 22 people who were not exposed to HIV-1, and who were tested negative for HIV-1 antibody were selected as the control group. For the three groups of subjects, tests of the T cell subsets were conducted. A total of 77 HIV-1-infected persons, with 44 from the deficiency group and 33 from the recovery group, were examined for HIV-1 DNA reservoir. The deficiency group and the recovery group were followed up 6 months later and the CD4+ T cell test results of 133 blood samples were collected, with 74 from the deficiency group and 59 from the recovery group. Results The proportions of activated CD4+ and CD8+ T cells of the deficiency group were higher than those of the recovery group and the control group. The proportions of senescent CD4+ and CD8+ T cells in the deficiency group were comparable to those of the recovery group, which were higher than those of the control group, showing significant differences only in senescent CD8+ T cells, and no significant difference in senescent CD4+ T cells. The deficiency group expressed higher levels of effector memory CD4+ T and CD8+ T cells than the control group did, and the recovery group only expressed a higher level of effect memory CD8+ T cells. Both the deficiency group and the recovery group showed lower levels of central memory CD4+ T and CD8+ T cells than the control group did, and the recovery group had an even lower level of central memory CD4+ T cells than the deficiency group did. The recovery group showed a higher expression level of naïve CD4+ T cells, and the deficiency group and the recovery group had lower expression levels of naïve CD8+ T cells than the control group did. There was no correlation between the size of the viral reservoir of HIV-1 DNA and CD4+ T cell count or the T cell subsets. Activated CD4+ T cells, activated CD8+ T cells, and central memory CD4+ T cells were negatively correlated with the follow-up findings for CD4+ T cells, with r at -0.378, -0.334, and -0.322, respectively ( P<0.05). Naïve CD4+ T cells and naïve CD8+ T cells were positively correlated with the follow-up findings for CD4+ T cell subset, with r at 0.350 and 0.267, respectively ( P<0.05). Conclusion HIV-1 infected persons have varying degrees of abnormal immune activation of T cell subsets. The abnormal activation of some T-cell subsets is partly associated with the subsequent recovery of immune functions and the size of the viral reservoir of HIV-1 DNA was not associated with the T cell subsets.
Collapse
Affiliation(s)
- 悦 郭
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 燕琳 张
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 丹 朱
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 芳红 龚
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 钰双 高
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 昆蓉 朱
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| | - 姗珊 李
- 成都市疾病预防控制中心 性病艾滋病检测科 (成都 610041)Department of STD and AIDS Laboratory, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
| |
Collapse
|
17
|
Nanyeenya N, Chang LW, Kiwanuka N, Nasuuna E, Nakanjako D, Nakigozi G, Kibira SPS, Nabadda S, Kiyaga C, Makumbi F. The association between low-level viraemia and subsequent viral non-suppression among people living with HIV/AIDS on antiretroviral therapy in Uganda. PLoS One 2023; 18:e0279479. [PMID: 36638086 PMCID: PMC9838846 DOI: 10.1371/journal.pone.0279479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Uganda's efforts to end the HIV epidemic by 2030 are threatened by the increasing number of PLHIV with low-level viraemia (LLV). We conducted a study to determine the prevalence of LLV and the association between LLV and subsequent viral non-suppression from 2016 to 2020 among PLHIV on ART in Uganda. METHOD This was a retrospective cohort study, using the national viral load (VL) program data from 2016 to 2020. LLV was defined as a VL result of at least 50 copies/ml, but less than 1,000 copies/ml. Multivariable logistic regression was used to determine the factors associated with LLV, and cox proportional hazards regression model was used to determine the association between LLV and viral non-suppression. RESULTS A cohort of 17,783 PLHIV, of which 1,466 PLHIV (8.2%) had LLV and 16,317 (91.8%) had a non-detectable VL was retrospectively followed from 2016 to 2020. There were increasing numbers of PLHIV with LLV from 2.0% in 2016 to 8.6% in 2020; and LLV was associated with male sex, second line ART regimen and being of lower age. 32.5% of the PLHIV with LLV (476 out of 1,466 PLHIV) became non-suppressed, as compared to 7.7% of the PLHIV (1,254 out of 16,317 PLHIV) with a non-detectable viral load who became non-suppressed during the follow-up period. PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL (adjusted hazard ratio was 4.1, 95% CI: 3.7 to 4.7, p < 0.001). CONCLUSION Our study indicated that PLHIV with LLV increased from 2.0% in 2016 to 8.6% in 2020, and PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL. Hence the need to review the VL testing algorithm and also manage LLV in Uganda.
Collapse
Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Department of National Health Laboratory Services, Ministry of Health, Kampala Uganda
| | - Larry William Chang
- Department of Epidemiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Simon P. S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Department of National Health Laboratory Services, Ministry of Health, Kampala Uganda
| | - Charles Kiyaga
- Department of National Health Laboratory Services, Ministry of Health, Kampala Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
18
|
Tun NN, Smithuis F, Tun NL, Min M, Hlaing MMM, Olmen JV, Lynen L, Gils T. Near point-of-care HIV viral load testing: Cascade after high viral load in suburban Yangon, Myanmar. PLoS One 2023; 18:e0272673. [PMID: 37053171 PMCID: PMC10101411 DOI: 10.1371/journal.pone.0272673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/10/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION HIV viral load (VL) testing in resource-limited settings is often centralised, limiting access. In Myanmar, we assessed outcomes according to VL access and the VL cascade (case management after a first high VL result) before and after near point-of-care (POC) VL was introduced. METHODS Routine programme data from people living with HIV (PLHIV) on antiretroviral therapy (ART) were used. We assessed the odds of getting a VL test done by year. Attrition and mortality two years after ART initiation were compared between three groups of PLHIV with different access to VL testing using Kaplan-Meier analysis. We compared VL cascades in those with a first VL result before and after near POC VL testing became available. With logistic regression, predictors of confirmed virological failure after a first high VL in the POC era were explored. RESULTS Among 4291 PLHIV who started ART between July 2009 and June 2018, 794 (18.5%) became eligible for VL testing when it was not available, 2388 (55.7%) when centralised laboratory-based VL testing was available, and 1109 (25.8%) when near POC VL testing was available. Between 2010 and 2019, the odds of getting a VL test among those eligible increased with each year (OR: 5.21 [95% CI: 4.95-5.48]). Attrition and mortality were not different in the three groups. When comparing PLHIV with a first VL result before and after implementation of the near POC VL testing, in the latter, more had a first VL test (92% versus 15%, p<0.001), less had a first high VL result (5% versus 14%, p<0.001), and more had confirmed virological failure (67% versus 47%, p = 0.013). Having a first VL ≥5000 copies/mL after near POC implementation was associated with confirmed virological failure (adjusted OR: 2.61 [95% CI: 1.02-6.65]). CONCLUSION Near POC VL testing enabled rapid increase of VL coverage and a well-managed VL cascade in Myanmar.
Collapse
Affiliation(s)
- Ni Ni Tun
- HIV/TB, Medical Action Myanmar, Yangon, Myanmar
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Frank Smithuis
- HIV/TB, Medical Action Myanmar, Yangon, Myanmar
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Nyan Lynn Tun
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Myo Min
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | - Josefien van Olmen
- Spearhead Research Public Health & Primary Care, University of Antwerp, Antwerp, Belgium
| | - Lutgarde Lynen
- Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tinne Gils
- Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
19
|
Nzivo MM, Waruhiu CN, Kang'ethe JM, Budambula NLM. HIV Virologic Failure among Patients with Persistent Low-Level Viremia in Nairobi, Kenya: It Is Time to Review the >1000 Virologic Failure Threshold. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8961372. [PMID: 37152588 PMCID: PMC10159743 DOI: 10.1155/2023/8961372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 05/09/2023]
Abstract
Persistent low-level viremia (PLLV) of 200-999 copies/ml has been reported as a risk factor for HIV virologic failure (VF). This retrospective study was aimed at characterizing patients with PLLV, determining factors associated with VF, and determining the effect of regimen change. Data were extracted from electronic medical records for HIV care and treatment. Patients' characteristics (N = 705) were as follows: a mean age of 42 years, majority female (55%), and 51% married. A majority (78.7%) had a history of opportunistic infections in their ART lifetime. To determine factors associated with VF, 187 records on patients who maintained PLLV and 12 on deceased patients at the time of data review were eliminated from the analysis, leaving 506 patient records. Out of the 506, 89% (451/506) suppressed VL to nondetectable levels while 11% (55/506) had VF, and the difference was significant (P = 0.0001). Virologic failure was significantly associated with ages 10-30 years (P < 0.05). Baseline VL ≥ 1000 (OR 3.929; P = 0.002) and 200-999 copies/ml (OR 4.062; P = 0.004) were associated with VF. During PLLV, factors associated with VF included the following: PLLV of 200-999 copies/ml (P < 0.05), viral blips (OR 4.545; P = 0.0001), mean maximum VL (P < 0.05), and age (P = 0.043). Married marital status was inversely associated with VF (OR 0.318; P = 0.026). Regimen change was not significantly associated with virologic outcomes. However, patients who switched regimens to the second line had a high risk of VF (P = 0.028; OR 3.203). Regimen change was significantly high (P < 0.05) among adolescents and patients with a start regimen of 2NRTI+1NNRTI. Most of the PLLV patients (89%) achieved nondetectable VL after their continued ART monitoring for at least 12 months. Therefore, PLLV was not an indicator of VF. However, a consistent VL of ≥200-999 copies/ml at baseline and more than 12 months of ART care and treatment were significantly associated with VF. Patients with VL 200-999 copies/ml, adolescents, and young adults require intensive ART monitoring and support.
Collapse
Affiliation(s)
- Mirriam M. Nzivo
- School of Biological Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | - Cecilia N. Waruhiu
- The Africa Genomics Centre and Consultancy Ltd., P.O. Box 381-00517, Nairobi, Kenya
| | - James M. Kang'ethe
- Comprehensive Care Centre, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Nancy L. M. Budambula
- Department of Biological Sciences, University of Embu, P.O. Box 6-60100, Embu, Kenya
| |
Collapse
|
20
|
Anito AA, Lenjebo TL, Woticha E, Solomon F. Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia. HIV AIDS (Auckl) 2022; 14:529-538. [PMID: 36425750 PMCID: PMC9680672 DOI: 10.2147/hiv.s387787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A majority of clients on first-line antiretroviral therapy with an initial high viral load will resuppress following an adherence intervention. Some sociodemographic and clinical characteristics were found to affect resuppression. Few reports on the outcome of the intervention and its associated factors in our country, with inconsistent results and some missed clinical factors of potential association, have compelled this study. The study aimed to assess the proportion of viral load suppression and associated factors among clients on antiretroviral therapy in public hospitals of Hawassa City Administration, Ethiopia. METHODS An institution-based cross-sectional study with retrospective document review was conducted among 342 participants on antiretroviral therapy enrolled for counseling since its start in November 2016. Data were captured using a pretested and structured checklist from all client charts with complete data, entered into EpiData 3.1.0 and exported to SPSS 27 for analysis. The proportion of viral load suppression was determined. Bivariate and multivariate logistic regressions were performed to identify associated factors. Statistical significance was determined at a 95% CI and P<0.05. RESULTS The proportion of viral load suppression was found to be 40.9% (35.7%-46.5%). Nevirapine-based antiretroviral treatment regimens (AOR 0.125, 95% CI 0.034-0.464), malnutrition (AOR 0.565, 95% CI 0.329-0.971), poor adherence (AOR 0.504, 95% CI 0.287-0.886), lower CD4 count (AOR 0.149, 95% CI 0.071, 0.314), and fewer counseling sessions (AOR 0.330, 95% CI 0.149-0.729) were significantly associated with viral load suppression. CONCLUSION The proportion of viral load suppression is lower than that recommended by the World Health Organization. Nevirapine-based regimens, poor nutritional status, poor adherence, lower CD4 count, and fewer counseling sessions risk a lower proportion of viral load suppression. This calls for the need to devise strategies to address these factors and to revisit program implementation.
Collapse
Affiliation(s)
| | | | - Eskinder Woticha
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fithamlak Solomon
- School of Medical Laboratory, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
21
|
Nanyeenya N, Kiwanuka N, Nakanjako D, Nakigozi G, Kibira SP, Nabadda S, Kiyaga C, Sewanyana I, Nasuuna E, Makumbi F. Low-level viraemia: An emerging concern among people living with HIV in Uganda and across sub-Saharan Africa. Afr J Lab Med 2022; 11:1899. [PMID: 36353193 PMCID: PMC9639359 DOI: 10.4102/ajlm.v11i1.1899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2023] Open
Abstract
Attaining viral load (VL) suppression for over 95% of the people living with HIV on antiretroviral therapy is a fundamental step in enabling Uganda and other sub-Saharan African countries to achieve global Sustainable Development Goal targets to end the HIV/AIDS epidemic by 2030. In line with the 2013 World Health Organization recommendations, several sub-Saharan African countries, including Uganda, use a threshold of 1000 HIV viral RNA copies/mL to determine HIV viral non-suppression. The United States Centers for Disease Control and Prevention and the International Association of Providers of AIDS Care deem this threshold very high, and hence recommend using 200 copies/mL to determine viral non-suppression. Using 1000 copies/mL as a threshold ignores people living with HIV who have low-level viraemia (LLV; HIV VL of at least 50 copies/mL but less than 1000 copies/mL). Despite the 2021 World Health Organization recommendations of using intensive adherence counselling for people living with HIV with LLV, several sub-Saharan African countries have no interventions to address LLV. However, recent studies have associated LLV with increased risks of HIV drug resistance, virologic failure and transmission. The purpose of this narrative review is to provide insights on the emerging concern of LLV among people living with HIV receiving antiretroviral therapy in sub-Saharan Africa. The review also provides guidance for Uganda and other sub-Saharan African countries to implement immediate appropriate interventions like intensive adherence counselling, reducing VL thresholds for non-suppression and conducting more research to manage LLV which threatens progress towards ending HIV by 2030.
Collapse
Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Simon P.S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Isaac Sewanyana
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
22
|
Kiros T, Taye A, Workineh L, Eyayu T, Damtie S, Hailemichael W, Tiruneh T. Immuno-virological status and its associated factors among HIV-positive patients receiving highly active antiretroviral therapy at delgi primary hospital, northwest Ethiopia, 2020/2021: A cross-sectional study. Heliyon 2022; 8:e10169. [PMID: 36033289 PMCID: PMC9399164 DOI: 10.1016/j.heliyon.2022.e10169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Highly active antiretroviral therapy (HAART) improves clinical outcomes by suppressing viral replication and allowing immune reconstitution. It also reduces HIV-related complications including morbidity, mortality, and extended hospitalizations for HIV-positive individuals. Regular assessment for antiretroviral treatment response is fundamentally important to address the factors associated with the poor clinical outcome including immunologic failures among HIV-positive patients on HAART. Therefore, this study aimed to investigate the immuno-virological status and describe its determinants among HIV-positive patients receiving HAART at Delgi primary hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted at Delgi primary hospital from October 25th through June 19th 2021 among a total of 442 study participants. A systematic random sampling technique was employed to enrol participants in the study. Socio-demographic and clinically related data were collected using a semi-structured questionnaire. About 3–5 ml of venous blood was collected aseptically for CD4+ T cell count and viral load test. SPSS version 20 software was used for statistical analysis. Bivariate and multivariate logistic regression analyses were conducted to determine the factors associated with immuno-virologic status among HIV-positive patients on HAART. The odds ratio with 95% CI was computed to determine the strength of association. Then, a p-value < 0.05 was considered a statistically significant association. For this study, the results were presented by using frequency summary tables, and texts. Results Among the total study participants, 283 (64%) were males and the mean age of the study participants was 37 ± 11.5. The overall immunological and virological failure among highly active antiretroviral therapy (HAART) receiving participants was found to be 9.5% (42/442, 95%CI:3.23–15.09) and 12.2% (54/442, 95% CI: 2.81–23.04) respectively. In the multivariate analysis, study participants with age ≥50 years old [AOR = 1.97, p = 0.01, 95%CI (0.02–4.03)], participants having current viral load count greater ≥1000 copies/ml [AOR = 3.97, p = 0.03, 95%CI (1.09–5.01)] and having TB-co-infection [AOR = 2.51, p = 0.05, 95%CI (1.02–7.51)] were statistically associated with increased risk of immunological failure. Similarly, TB-coinfected participants were 1.88 (95%CI = 0.89–10.02) times at greater risk for virological failure. Conclusion In this study, the magnitude of immuno-virological failure is alarming. This may be shown the need for integrated and substantial commitment to enhancing patient antiretroviral treatment adherence in the study area. Also, regular assessment for antiretroviral treatment response is fundamentally important to address the determinants associated with virological and immunologic failures among HIV-positive patients taking HAART. Furthermore, early initiation of HAART may be imperative to achieve favourable virological suppression and immunological reconstitution.
Collapse
Affiliation(s)
- Teklehaimanot Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebe Taye
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
23
|
Nyongesa MK, Mwatasa MH, Kagonya VA, Mwambingu G, Ngetsa C, Newton CRJC, Abubakar A. HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast. BMC Infect Dis 2022; 22:449. [PMID: 35545757 PMCID: PMC9092782 DOI: 10.1186/s12879-022-07428-w] [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: 09/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18-24 years from the Kenyan coast. METHODS Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL. RESULTS Among these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH. CONCLUSIONS In this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.
Collapse
Affiliation(s)
- Moses K. Nyongesa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.12380.380000 0004 1754 9227Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mwaganyuma H. Mwatasa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Vincent A. Kagonya
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Gabriel Mwambingu
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Caroline Ngetsa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Charles R. J. C. Newton
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
24
|
El Bouzidi K, Murtala-Ibrahim F, Kwaghe V, Datir RP, Ogbanufe O, Crowell TA, Charurat M, Dakum P, Gupta RK, Ndembi N, Sabin CA. Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005-2017. J Acquir Immune Defic Syndr 2022; 90:88-96. [PMID: 35090157 PMCID: PMC8986580 DOI: 10.1097/qai.0000000000002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). METHODS We conducted a retrospective cohort study of PLHIV aged >15 years who started second-line ART at a tertiary center in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazard models were used to investigate factors associated with: (1) viral failure (HIV-1 RNA >1000 copies/mL), (2) immunologic failure (CD4 count decrease or <100 cells/mm3), and (3) severe weight loss (>10% of bodyweight), after >6 months of second-line ART. RESULTS Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (interquartile range 3.7-8.5). Of these, 26% (89/341) subsequently reentered care. Disengagement was associated with male gender, age <30 years, lower education level, and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared with elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04 to 0.70). CONCLUSION Adverse outcomes were common during second-line ART. However, reengagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and reengage those who have disengaged from care.
Collapse
Affiliation(s)
- Kate El Bouzidi
- Division of Infection & Immunity, University College London, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Vivian Kwaghe
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Rawlings P. Datir
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
| | - Obinna Ogbanufe
- U.S. Centers for Disease Control and Prevention, U.S. Embassy, Abuja, Nigeria
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, U.S
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, U.S
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, U.S
| | | | - Ravindra K Gupta
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
- Africa Health Research Institute, Durban, South Africa
| | - Nicaise Ndembi
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, U.S
- Africa Centres for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
25
|
Shorter Time to Discontinuation Due to Treatment Failure in People Living with HIV Switched to Dolutegravir Plus Either Rilpivirine or Lamivudine Compared with Integrase Inhibitor-Based Triple Therapy in a Large Spanish Cohort. Infect Dis Ther 2022; 11:1177-1192. [PMID: 35399147 PMCID: PMC9124284 DOI: 10.1007/s40121-022-00630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/18/2022] [Indexed: 11/27/2022] Open
|
26
|
Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Introduction Men are missing along the HIV care continuum. However, the estimated proportions of men in sub‐Saharan Africa meeting the UNAIDS 95‐95‐95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95‐95‐95 goals across studies in sub‐Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods We systematically searched PubMed and Embase for peer‐reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95‐95‐95 goal in sub‐Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion‐Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta‐synthesis. Results and discussion We screened 14,896 studies and included 129 studies in the meta‐analysis, compiling data over the data collection period. Forty‐seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41–0.58; range, 0.09–0.97]) or not being on treatment (0.58 [95% CI, 0.51–0.65; range, 0.07–0.97]), while over three‐quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77–0.81; range, 0.39–0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta‐synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions Psychosocial and systems‐level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
Collapse
Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Global Health Institute, Cambridge, Massachusetts, USA
| |
Collapse
|
27
|
Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
Collapse
Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
28
|
Demeke Alemu K, Abebe Moges N, Jara Boneya D, Assemu Asrade A, Degu Tsega T, Shitaw Tewachew A. Time to Switch to Second-Line Anti-Retroviral Treatment and Its Predictors Among HIV Infected Adults with Virological Failure in Northwest Ethiopia: A Retrospective Follow-Up Study. HIV AIDS (Auckl) 2022; 14:87-100. [PMID: 35281768 PMCID: PMC8906823 DOI: 10.2147/hiv.s348076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kasaye Demeke Alemu
- Department of HIV/AIDS Prevention Care and Treatment, International Center for AIDS Care Program/ICAP, Bahir Dar, Ethiopia
- Correspondence: Kasaye Demeke Alemu, Tel +251921668185, Email
| | - Nurilign Abebe Moges
- Departments of Public Health College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dube Jara Boneya
- Departments of Public Health College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abaynew Assemu Asrade
- Department of HIV/AIDS Prevention Care and Treatment, International Center for AIDS Care Program/ICAP, Bahir Dar, Ethiopia
| | - Tilahun Degu Tsega
- Departments of Public Health College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abrham Shitaw Tewachew
- Department of HIV/AIDS Prevention Care and Treatment, International Center for AIDS Care Program/ICAP, Bahir Dar, Ethiopia
- College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| |
Collapse
|
29
|
Azamar-Alonso A, Mbuagbaw L, Smaill F, Bautista-Arredondo SA, Costa AP, Tarride JE. Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study. Int J STD AIDS 2022; 33:363-373. [PMID: 35118929 PMCID: PMC8958557 DOI: 10.1177/09564624211067036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy. Methods A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation. Results We found a lower proportion of people with VF in 2014–2017 compared with 2008–2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48–0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014–2017, but not before. Conclusion This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014–2017, compared to 2008–2013 and the odds of VF were reduced.
Collapse
Affiliation(s)
- Amilcar Azamar-Alonso
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Gilead Sciences Inc., Foster City, CA, United States
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, Hamilton, ON, Canada
| | - Fiona Smaill
- ChB Department of Pathology and Molecular Medicine, Faculty of Health Sciences, 3710McMaster University, Hamilton, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, 3710McMaster University, Hamilton, Ontario, Canada.,The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada.,McMaster Chair in Health Technology Management Hamilton, Hamilton, ON, Canada
| |
Collapse
|
30
|
Singh R, Maurya SP, Das N, Kabra SK, Lodha R, Das BK. Immunological factors associated with discordant virological response postcombination antiretroviral therapy in pediatric human immunodeficiency virus infection. Indian J Pharmacol 2022; 54:278-281. [PMID: 36204811 PMCID: PMC9804125 DOI: 10.4103/ijp.ijp_616_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Evaluation of immunological factors responsible for discordant virological responses postcombination antiretroviral therapy (cART) in human immunodeficiency virus (HIV)-positive children aged <5 years. MATERIALS AND METHODS Immunological profiling of enrolled 30 HIV-positive children was done at enrollment, 6 and 12 months. Flow cytometric analysis was performed for enumeration of counts and percentage of CD4+, CD8+, and CD19+ cells; expression of CD19, CD86, PD-1, CD3, CD8 and CD28 on lymphocytes was evaluated using whole blood staining technique with monoclonal antibodies. HIV-1 viral load was quantified using a real-time polymerase chain reaction. Serum levels of immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin (IgM), and interleukin (IL)-7 were quantitated using quantitative enzyme-linked immunosorbent assay kits. The HIV-infected children were categorized into virological responders (VRs; HIV-1 plasma viral load <47 copies/mL) and virological nonresponders (VNRs; HIV-1 plasma viral load >1000 copies/mL) following 1-year cART. RESULTS The frequency of CD28+ CTLs cells was higher (P < 0.0001), and the frequency of CD28-CTLs cells was lower (P < 0.0001) in VRs than VNRs. CD28+ and CD28-CTLs cells correlated with HIV-1 plasma viremia (r = -0.4695, P = 0.01; r = 0.40, P = 0.03, respectively). VRs had higher CD19 percentage (P = 0.04) and count (P = 0.01) than VNRs. CD19+ B cells in the VRs had lower expression of CD86 (P = 0.03) and PD-1 (P = 0.002) than VNRs. VR had lower levels of serum IgG (P = 0.03), IgM (P = 0.04), and IL-7 (P = 0.01) than VNRs. CONCLUSIONS High baseline B-cell counts, lower serum IgG, IgM, IL-7 levels, lower activation and exhaustion of B cells, and higher frequency of CD28+ CTLs are associated with positive virological response, whereas elevated CD28-CTLs are associated with the poor virological outcomes in HIV-infected children.
Collapse
Affiliation(s)
- Ravinder Singh
- Department of Pediatrics, AIIMS, New Delhi, India,Department of Microbiology, AIIMS, New Delhi, India
| | | | - Namrata Das
- Department of Medicine, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
| | | | - Rakesh Lodha
- Department of Pediatrics, AIIMS, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, AIIMS, New Delhi, India,Address for correspondence: Prof. Bimal Kumar Das, Department of Microbiology, AIIMS, New Delhi, India. E-mail:
| |
Collapse
|
31
|
Study of the Factors that Influence Low-Level Viremias in Human Immunodeficiency Virus Patients in a Tertiary Hospital. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Adeniyi OV, Obi CL, Goon DT, Iweriebor B, Selanto-Chairman N, Carty C, Avramovic G, Ajayi AI, Lambert J, Okoh A. Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis. Clin Infect Dis 2021; 73:1750-1758. [PMID: 33677576 PMCID: PMC8599206 DOI: 10.1093/cid/ciab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study describes the characteristics of pregnant women on antiretroviral therapy (ART) and the rate of peripartum virologic suppression in a large prevention of mother-to-child transmission cohort who delivered in some selected maternity centers in Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort. METHODS This multicenter, retrospective cross-sectional analysis included medical data of 1709 women with human immunodeficiency virus between September 2015 and May 2016 in Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression, defined as viral load (VL) <1000 copies/mL and undetectable viremia (VL <20 copies/mL). Correlates of peripartum virologic suppression and undetectable viremia were examined by fitting logistic regression model analysis. RESULTS Of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viremia was 56.9%. Being aged 24 years or younger (adjusted odds ratio [AOR], 0.68 [95% confidence interval {CI}, .48-.94]), smoking during pregnancy (AOR, 0.50 [95% CI, .28-.90]), and starting ART in the first trimester were associated with lower odds of viral suppression (<1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable VL (AOR, 3.09 [95% CI, 2.12-4.49]) and virologic suppression (AOR, 3.88 [95% CI, 2.62-5.74]) compared to those who defaulted. CONCLUSIONS More than half of the women achieved undetectable VL, and 4 in 5 women achieved viral suppression at delivery in the region. Early antenatal booking, combined with enhanced adherence support for pregnant women on ART, would be crucial toward achieving the goal of elimination of mother-to-child transmission in the region.
Collapse
Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Chikwelu Larry Obi
- School of Science and Technology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Daniel Ter Goon
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Benson Iweriebor
- School of Science and Technology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Nonkosi Selanto-Chairman
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Craig Carty
- The Relevance Network, Johannesburg, South Africa
| | - Gordana Avramovic
- University College Dublin, Mater Misericordiae University Hospital, Catherine McAuley Education and Research Centre, Dublin, Ireland
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - John Lambert
- University College Dublin, Mater Misericordiae University Hospital, Catherine McAuley Education and Research Centre, Dublin, Ireland
| | - Anthony Okoh
- South African Medical Research Council Microbial Water Quality Monitoring Centre, Faculty of Science and Agriculture, University of Fort Hare, Alice, South Africa
| |
Collapse
|
33
|
Reynolds Z, McCluskey SM, Moosa MYS, Gilbert RF, Pillay S, Aturinda I, Ard KL, Muyindike W, Musinguzi N, Masette G, Moodley P, Brijkumar J, Rautenberg T, George G, Johnson BA, Gandhi RT, Sunpath H, Marconi VC, Bwana MB, Siedner MJ. Who's slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first-line HIV treatment in Uganda and South Africa. HIV Med 2021; 23:474-484. [PMID: 34755438 PMCID: PMC9010349 DOI: 10.1111/hiv.13203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV virological failure remains a major threat to programme success in sub-Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first-line antiretroviral therapy (ART). METHODS We enrolled a cohort of adults in HIV care experiencing virological failure on first-line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. RESULTS Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49-56%] stated that they had > 90% adherence and 75% (95% CI 72-77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86-92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. CONCLUSIONS Patients failing first-line ART in sub-Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic.
Collapse
Affiliation(s)
| | - Suzanne M McCluskey
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Isaac Aturinda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kevin L Ard
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Godfrey Masette
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Pravi Moodley
- University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Service, KwaZulu-Natal, Durban, South Africa
| | | | | | - Gavin George
- University of KwaZulu-Natal, Durban, South Africa
| | - Brent A Johnson
- Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA
| | - Rajesh T Gandhi
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Vincent C Marconi
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Global Health, Emory University, Atlanta, GA, USA.,Emory Vaccine Center, Atlanta, GA, USA
| | | | - Mark J Siedner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,University of KwaZulu-Natal, Durban, South Africa.,Mbarara University of Science and Technology, Mbarara, Uganda.,Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
34
|
Ortíz DW, Roberts-Sano O, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala. AIDS Res Ther 2021; 18:79. [PMID: 34706742 PMCID: PMC8554948 DOI: 10.1186/s12981-021-00400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
Collapse
Affiliation(s)
- Dean W Ortíz
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala.
| | - Olivia Roberts-Sano
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Hugo E Marroquin
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Katherine B Franco
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Johanna R Melendez
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Rodolfo Pinzón
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Ana J Samayoa
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| |
Collapse
|
35
|
Abdullahi SB, Ibrahim OR, Okeji AB, Yandoma RI, Bashir I, Haladu S, Idris SA, Oseni TIA, Suleiman BM, Yahaya M, Aworh MK, Sufiyan MB. Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009-December 2019. BMC Infect Dis 2021; 21:1031. [PMID: 34600477 PMCID: PMC8487150 DOI: 10.1186/s12879-021-06722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Immuno-Deficiency Virus (HIV) remains one of the world's significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. METHODS This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients' care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. RESULTS Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20-40) vs 19,989 (3311-110,340) cp/ml in virally suppressed, and unsuppressed respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. CONCLUSIONS Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.
Collapse
Affiliation(s)
- Suleiman Bello Abdullahi
- Department of Family Medicine, Federal Medical Centre, Murtala Mohammed Way (Jibia Bypass), P. M. B: 2121, Katsina, Nigeria. .,Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
| | | | | | - Rabilu Iliyasu Yandoma
- Department of Family Medicine, Federal Medical Centre, Murtala Mohammed Way (Jibia Bypass), P. M. B: 2121, Katsina, Nigeria
| | - Ibrahim Bashir
- Department of Haematology and Blood Transfusion, Federal Medical Centre, Katsina, Nigeria
| | - Suleiman Haladu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | - T I A Oseni
- Department of Family Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | | | - Mohammed Yahaya
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Mabel Kamweli Aworh
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | |
Collapse
|
36
|
Johnson LF, Kariminia A, Trickey A, Yiannoutsos CT, Ekouevi DK, Minga AK, Pascom ARP, Han WM, Zhang L, Althoff KN, Rebeiro PF, Murenzi G, Ross J, Hsiao NY, Marsh K. Achieving consistency in measures of HIV-1 viral suppression across countries: derivation of an adjustment based on international antiretroviral treatment cohort data. J Int AIDS Soc 2021; 24 Suppl 5:e25776. [PMID: 34546623 PMCID: PMC8454679 DOI: 10.1002/jia2.25776] [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: 01/26/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The third of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is to achieve a 90% rate of viral suppression (HIV viral load <1000 HIV-1 RNA copies/ml) in patients on antiretroviral treatment (ART) by 2020. However, some countries use different thresholds when reporting viral suppression, and there is thus a need for an adjustment to standardize estimates to the <1000 threshold. We aim to propose such an adjustment, to support consistent monitoring of progress towards the "third 90" target. METHODS We considered three possible distributions for viral loads in ART patients: Weibull, Pareto and reverse Weibull (imposing an upper limit but no lower limit on the log scale). The models were fitted to data on viral load distributions in ART patients in the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration (representing seven global regions) and the ART Cohort Collaboration (representing Europe), using separate random effects models for adults and children. The models were validated using data from the World Health Organization (WHO) HIV drug resistance report and the Brazilian national ART programme. RESULTS Models were calibrated using 921,157 adult and 37,431 paediatric viral load measurements, over 2010-2019. The Pareto and reverse Weibull models provided the best fits to the data, but for all models, the "shape" parameters for the viral load distributions differed significantly between regions. The Weibull model performed best in the validation against the WHO drug resistance survey data, while the Pareto model produced uncertainty ranges that were too narrow, relative to the validation data. Based on these analyses, we recommend using the reverse Weibull model. For example, if a country reports an 80% rate of viral suppression at <200 copies/ml, this model estimates the proportion virally suppressed at <1000 copies/ml is 88.3% (0.800.56 ), with uncertainty range 85.5-90.6% (0.800.70 -0.800.44 ). CONCLUSIONS Estimates of viral suppression can change substantially depending on the threshold used in defining viral suppression. It is, therefore, important that viral suppression rates are standardized to the same threshold for the purpose of assessing progress towards UNAIDS targets. We have proposed a simple adjustment that allows this, and this has been incorporated into UNAIDS modelling software.
Collapse
Affiliation(s)
- Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Didier K Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | | | - Ana Roberta Pati Pascom
- Department of Diseases of Chronic Condition and Sexually Transmitted Infections, Ministry of Health, Brasilia, Brazil
| | - Win Min Han
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Lei Zhang
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter F Rebeiro
- Department of Medicine and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Gad Murenzi
- Rwanda Military Hospital and Research for Development-Rwanda, Kigali, Rwanda
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nei-Yuan Hsiao
- Division of Virology, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | | |
Collapse
|
37
|
Kikaire B, Ssemanda M, Asiimwe A, Nakanwagi M, Rwegyema T, Seruwagi G, Lawoko S, Asiimwe E, Wamundu C, Musinguzi A, Lugada E, Turesson E, Laverentz M, Bwayo D. HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda. Int J Infect Dis 2021; 112:45-51. [PMID: 34481969 DOI: 10.1016/j.ijid.2021.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Uniformed service personnel have an increased risk of poor viral load suppression (VLS). This study was performed to evaluate the outcomes of interventions to improve VLS in the 28 military health facilities in Uganda. METHODS This operational research was conducted between October 2018 and September 2019, among people living with HIV (PLHIV) in the 28 health facilities managed by the military in Uganda. Patients with a viral load (VL) >1000 copies/ml received three sessions of intensive adherence counselling (IAC), 1 month apart, after which a repeat VL was done. The main outcome was the proportion with a suppressed VL following IAC. RESULTS Of the 965 participants included in this analysis, 592 (61.4%) were male and 367 (38.3%) were female. Average age was 35.5 ± 13.7 years, and 87.8% had at least one IAC session. At least 48.2% had a suppressed repeat VL. IAC increased the odds of VLS by 82% (P = 0.004), with adjusted OR of 1.56 (P = 0.054). An initial VL >10 000 copies/ml, being on antiretroviral therapy for at least 2 years, being male, and being <18 years of age were associated with repeat VL non-suppression. CONCLUSIONS IAC marginally improved VL suppression. There is a need to improve IAC in military health facilities.
Collapse
Affiliation(s)
- Bernard Kikaire
- Makerere University College of Health Sciences, Kampala, Uganda.
| | - Michael Ssemanda
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Alex Asiimwe
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda; Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Miriam Nakanwagi
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Twaha Rwegyema
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Gloria Seruwagi
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Evarlyne Asiimwe
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Cassette Wamundu
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Ambrose Musinguzi
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Eric Lugada
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Elizabeth Turesson
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Marni Laverentz
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Denis Bwayo
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| |
Collapse
|
38
|
Reed DM, Esber AL, Crowell TA, Ganesan K, Kibuuka H, Maswai J, Owuoth J, Bahemana E, Iroezindu M, Ake JA, Polyak CS. Persons living with HIV in sero-discordant partnerships experience improved HIV care engagement compared with persons living with HIV in sero-concordant partnerships: a cross-sectional analysis of four African countries. AIDS Res Ther 2021; 18:43. [PMID: 34294086 PMCID: PMC8296539 DOI: 10.1186/s12981-021-00363-x] [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: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background Persons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care. We assessed the association between sero-discordance status, antiretroviral therapy (ART) uptake, and viral suppression in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls PLWH and HIV-uninfected individuals at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, we determined ART use through self-report. Viral suppression was defined as HIV RNA < 1000 copies/mL. We analyzed PLWH who were index participants within two types of sexual dyads: sero-discordant or sero-concordant. Binomial regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ART use and viral suppression at study enrollment. Results From January 2013 through March 2018, 223 index participants from sero-discordant dyads and 61 from sero-concordant dyads were enrolled. The majority of the indexes were aged 25–34 years (50.2%), female (53.4%), and married (96.5%). Sero-discordant indexes were more likely to disclose their status to partners compared with sero-concordant indexes (96.4% vs. 82.0%, p < 0.001). After adjustment, sero-discordant index participants were more likely to be on ART (aPR 2.8 [95% CI 1.1–6.8]), but no more likely to be virally suppressed. Results may be driven by unique psycho-social factors and global implementation of treatment as prevention. Conclusions PLWH in sero-discordant sexual partnerships demonstrated improved uptake of ART compared with those in sero-concordant partnerships. Interventions are needed to increase care engagement by individuals in sero-concordant relationships to improve HIV outcomes.
Collapse
|
39
|
Cutrell AG, Schapiro JM, Perno CF, Kuritzkes DR, Quercia R, Patel P, Polli JW, Dorey D, Wang Y, Wu S, Van Eygen V, Crauwels H, Ford SL, Baker M, Talarico CL, Clair MS, Jeffrey J, White CT, Vanveggel S, Vandermeulen K, Margolis DA, Aboud M, Spreen WR, van Lunzen J. Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: a multivariable analysis. AIDS 2021; 35:1333-1342. [PMID: 33730748 PMCID: PMC8270504 DOI: 10.1097/qad.0000000000002883] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Efficacy and safety of long-acting cabotegravir (CAB) and rilpivirine (RPV) dosed intramuscularly every 4 or 8 weeks has been demonstrated in three Phase 3 trials. Here, factors associated with virologic failure at Week 48 were evaluated post hoc. DESIGN AND METHODS Data from 1039 adults naive to long-acting CAB+RPV were pooled in a multivariable analysis to examine the influence of baseline viral and participant factors, dosing regimen and drug concentrations on confirmed virologic failure (CVF) occurrence using a logistic regression model. In a separate model, baseline factors statistically associated with CVF were further evaluated to understand CVF risk when present alone or in combination. RESULTS Overall, 1.25% (n = 13/1039) of participants experienced CVF. Proviral RPV resistance-associated mutations (RAMs), HIV-1 subtype A6/A1, higher BMI (associated with Week 8 CAB trough concentration) and lower Week 8 RPV trough concentrations were significantly associated (P < 0.05) with increased odds of CVF (all except RPV trough are knowable at baseline). Few participants (0.4%) with zero or one baseline factor had CVF. Only a combination of at least two baseline factors (observed in 3.4%; n = 35/1039) was associated with increased CVF risk (25.7%, n = 9/35). CONCLUSION CVF is an infrequent multifactorial event, with a rate of approximately 1% in the long-acting CAB+RPV arms across Phase 3 studies (FLAIR, ATLAS and ATLAS-2M) through Week 48. Presence of at least two of proviral RPV RAMs, HIV-1 subtype A6/A1 and/or BMI at least 30 kg/m2 was associated with increased CVF risk. These findings support the use of long-acting CAB+RPV in routine clinical practice.
Collapse
Affiliation(s)
- Amy G. Cutrell
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Joseph W. Polli
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - David Dorey
- GlaxoSmithKline, Mississauga, Ontario, Canada
| | | | - Sterling Wu
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | - Susan L. Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | | | - Marty St Clair
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Jerry Jeffrey
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - C. Thomas White
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Mehari EA, Muche EA, Gonete KA. Virological Suppression and Its Associated Factors of Dolutegravir Based Regimen in a Resource-Limited Setting: An Observational Retrospective Study in Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:709-717. [PMID: 34234572 PMCID: PMC8254547 DOI: 10.2147/hiv.s316776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background Toxicity, treatment failure, and resistance to existing HIV treatment regimens have become a challenge in resource-limited settings. As a result, a dolutegravir based regimen has recently been utilized. However, there is a paucity of evidence in sub-Saharan countries regarding its virological suppression. Thus, this study aimed to assess virological suppression and associated factors of dolutegravir based regimen. Methods A retrospective follow-up study was conducted on 349 individuals. They were selected using a systematic random sampling technique among all treatment-experienced adult HIV patients who were on a dolutegravir based regimen. From this, 81.4% of them were virologically suppressed before the initiation of dolutegravir based regimen. The study was carried out at twelve months of therapy after shifting to dolutegravir based regimen (TDF-3TC-DTG) during the period May 2018–August 2020 at Debre Markos referral hospital. Retrospective data before and after dolutegravir based regimen initiation were collected from their medical records. The time on dolutegravir based regimen was one year. Bivariable and multivariable logistic regression was used to identify factors. Variables with p <0.05 were considered statistically significant. Results From a total of 359, 349 participated (97.2%) in the study, and the mean age of the participants was 40.28 ±11.6 years. Totally, 192 (55.0%) of them were female. The proportion of virological suppression was 92%. Good adherence (participants who reported an intake of ≥95% of the prescribed medication) (AOR=6.2, 95% CI: 1.93, 20.11) and overall duration of ART (AOR=1.02, 95% CI: 1.01, 1.04) were associated with virological suppression. Conclusion Dolutegravir based regimen maintains high virological suppression. Adherence and duration of ART were associated with virological suppression. Therefore, designing effective mechanisms to maintain virological suppression is important.
Collapse
Affiliation(s)
- Eden Abetu Mehari
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Esileman Abdela Muche
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
41
|
Mesic A, Spina A, Mar HT, Thit P, Decroo T, Lenglet A, Thandar MP, Thwe TT, Kyaw AA, Homan T, Sangma M, Kremer R, Grieg J, Piriou E, Ritmeijer K, Van Olmen J, Lynen L, Oo HN. Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis. AIDS Res Ther 2021; 18:16. [PMID: 33882962 PMCID: PMC8059266 DOI: 10.1186/s12981-021-00336-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00336-0.
Collapse
|
42
|
Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response? Curr Opin Infect Dis 2021; 33:20-27. [PMID: 31743122 DOI: 10.1097/qco.0000000000000613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine recent literature on the efficacy and effectiveness of HIV treatment in preventing HIV transmission through sexual exposure, at both an individual and at a population level. RECENT FINDINGS Two recent studies on the individual-level efficacy of treatment as prevention (TasP) have added to the now conclusive evidence that HIV cannot be transmitted sexually when the virus is suppressed. However, four large cluster-randomized population-level trials on universal HIV testing and treatment in Africa have not delivered the expected impact in reducing HIV incidence at a population level. Two of these trials showed no differences in HIV incidence between the intervention and control arms, one demonstrated a nonsignificant lower incidence in the intervention arm, and the fourth trial found a reduction between the communities receiving a combination prevention package and the control arm, but no difference between the immediate treatment plus the prevention package and the control arm. Factors contributing to the disconnect between individual high-level efficacy and population-level effectiveness of TasP include undiagnosed infection, delays in linkage to care, challenges in retention and adherence to antiretroviral therapy (ART), time between ART initiation and viral suppression, and stigma and discrimination. SUMMARY Suppressive ART renders people living with HIV sexually noninfectious. However, epidemic control is unlikely to be achieved by TasP alone.
Collapse
|
43
|
A transfer learning approach to drug resistance classification in mixed HIV dataset. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
44
|
Elgalib A, Al-Wahaibi A, Shah S, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, Al-Rawahi B, Al-Abri S. Predictors of virologic failure among people living with HIV in Oman: a national study from the Middle East. Int J STD AIDS 2020; 32:239-245. [DOI: 10.1177/0956462420956850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a cross-sectional analysis to determine HIV virologic failure and its associated factors among Omani people living with HIV who are on ART for > 6 months. Patients (n = 1427) were identified from a central national HIV surveillance dataset. Two-thirds (67%) of patients were male, and the median age was 39 years (IQR, 32-48 years). Out of 1427 patients, 14.4% had virologic failure (HIV viral load [VL] ≥ 200 copies/ml). The multivariate analysis showed that patients aged 25-49 years (adjusted odds ratio [aOR]: 1.76, 95% CI: 1.01-3.08) were significantly more likely to fail treatment, compared to those aged ≥ 50 years. Besides, having “Other” HIV risk factor (compared to heterosexuals, aOR: 1.82, 95% CI: 1.02-3.24) and receiving HIV care outside the capital Muscat (compared to those cared for in Muscat, aOR: 1.73, 95% CI: 1.11-2.7) were independently associated with virologic failure. HIV viral suppression (85.6%) in Oman is encouraging; however, further strategies, mainly targeting patients who are young (<50 years), those not disclosing their HIV risk factor and those attending HIV treatment centres outside Muscat, are required to enhance HIV treatment outcome in Oman.
Collapse
Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Adil Al-Wahaibi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Hanan Al-Kindi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| |
Collapse
|
45
|
Seid A, Cherie N, Ahmed K. Determinants of Virologic Failure Among Adults on Second Line Antiretroviral Therapy in Wollo, Amhara Regional State, Northeast Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:697-706. [PMID: 33204171 PMCID: PMC7666990 DOI: 10.2147/hiv.s278603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
Background Treatment failure among the population on second line antiretroviral therapy is a major public health threat. In Ethiopia there has been limited research done on second line treatment failure. Objective To identify determinants of virologic failure among adults on second line antiretroviral therapy in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Methods An institution-based unmatched case–control study was conducted from February 1, 2020 to April 30, 2020 on a total of 377 clients in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Clients whose viral load result >1,000 copies/mL in two consecutive results at least 3 month apart were cases, while ≤1,000 copies/mL were controls. The sample size was calculated by using Epi-Info version 7. Cases (94) and controls (283) were selected using a simple random sampling method in a ratio of cases-to-controls of 1:3. The model fitted and binary logistic assumptions were fulfilled with 95% confidence level and P-values<0.05 were taken as statistically significant. Results Virologic failure was predicted by poor adherence (AOR=6.060, 95% CI=2.837–12.944), not disclosing their HIV status (AOR=4.178, 95% CI=1.431–12.198), OI (AOR=4.11, 95% CI=1.827–9.246), CD4 count <100 cells/mm3 (AOR=3.497, 95% CI=1.233–9.923) and 100–350 cells/mm3 (AOR=5.442, 95% CI=2.191–13.513), low BMI <16 kg/m2 (AOR=7.223, 95% CI=2.218–23.520), and young age 15–29 years (AOR=2.898, 95% CI=1.171–7.170). Conclusion and Recommendations Determinants of second line ART virologic failure were patients who had poor adherence to ART, not disclosed, opportunistic infection, low CD4 counts <350 cell/mm3, low BMI (<16 kg/m2), and young age 15–29 year patients. Social support, disclosing their HIV status, and getting early treatment for any opportunistic infection is crucial to patients.
Collapse
Affiliation(s)
- Ali Seid
- Reproductive and Family Health Unit, Dessie Health Science College, Dessie, Ethiopia
| | - Niguss Cherie
- Reproductive and Family Health Unit, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kemal Ahmed
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
46
|
Han WM, Jiamsakul A, Jantarapakde J, Yunihastuti E, Choi JY, Ditangco R, Chaiwarith R, Sun LP, Khusuwan S, Merati TP, Do CD, Azwa I, Lee MP, Van Nguyen K, Chan YJ, Kiertiburanakul S, Ng OT, Tanuma J, Pujari S, Zhang F, Gani YM, Sangle S, Ross J, Kumarasamy N. Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV. HIV Med 2020; 22:294-306. [PMID: 33200864 DOI: 10.1111/hiv.13017] [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: 08/03/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). METHODS Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. RESULTS Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m2 ), while 26%, 10% and 2% were underweight (< 18.5 kg/m2 ), overweight (25-30 kg/m2) and obese (> 30 kg/m2 ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m2 ). PLHIV with BMIs of 25-30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed. CONCLUSIONS High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.
Collapse
Affiliation(s)
- W M Han
- The Kirby Institute, UNSW, Sydney, NSW, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - A Jiamsakul
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | - J Jantarapakde
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - E Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - R Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - L P Sun
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - S Khusuwan
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - T P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - I Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M-P Lee
- Queen Elizabeth Hospital, Hong Kong SAR, India
| | - K Van Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Y-J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - O T Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Y M Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | |
Collapse
|
47
|
Ndembi N, Murtala-Ibrahim F, Tola M, Jumare J, Aliyu A, Alabi P, Mensah C, Abimiku A, Quiñones-Mateu ME, Crowell TA, Rhee SY, Shafer RW, Gupta R, Blattner W, Charurat ME, Dakum P. Predictors of first-line antiretroviral therapy failure among adults and adolescents living with HIV/AIDS in a large prevention and treatment program in Nigeria. AIDS Res Ther 2020; 17:64. [PMID: 33143751 PMCID: PMC7640637 DOI: 10.1186/s12981-020-00317-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/10/2020] [Indexed: 01/09/2023] Open
Abstract
Background A substantial number of persons living with HIV (PLWH) in Nigeria do not experience durable viral suppression on first-line antiretroviral therapy (ART). Understanding risk factors for first-line treatment failure informs patient monitoring practices and distribution of limited resources for second-line regimens. We determined predictors of immunologic and virologic failures in a large ART delivery program in Abuja, Nigeria. Methods A retrospective cohort study was conducted at the University of Abuja Teaching Hospital, a tertiary health care facility, using data from February 2005 to December 2014 in Abuja, Nigeria. All PLWH aged ≥ 15 years who initiated ART with at least 6-month follow-up and one CD4 measurement were included. Immunologic failure was defined as a CD4 decrease to or below pre-ART level or persistent CD4 < 100 cells per mm3 after 6 months on ART. Virologic failure (VF) was defined as two consecutive HIV-1 RNA levels > 1000 copies/mL after at least 6 months of ART and enhanced adherence counselling. HIV drug resistance (Sanger sequences) was analyzed using the Stanford HIV database algorithm and scored for resistance to common nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Univariate and multivariate log binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results Of 12,452 patients followed, a total of 5928 initiated ART with at least 6 months of follow-up and one CD4 measurement. The entry point for 3924 (66.2%) was through the program’s own voluntary counseling and testing (VCT) center, while 1310 (22.1%) were referred from an outside clinic/program, 332 (5.6%) in-patients, and 373 (6.3%) through other entry points including prevention of mother to child transmission (PMTCT) and transferred from other programs. The mean CD4 at enrollment in care was 268 ± 23.7 cells per mm3, and the mean HIV-1 RNA was 3.3 ± 1.3.log10 copies/mL. A total of 3468 (80.5%) received nevirapine (NVP) and 2260 (19.5%) received efavirenz (EFV)—based regimens. A total of 2140 (36.1%) received tenofovir (TDF); 2662 (44.9%) zidovudine (AZT); and 1126 (19.0%) stavudine (d4T). Among those receiving TDF, 45.0% also received emtricitabine (FTC). In a multivariate model, immunologic failure was more common among PLWH with female gender as compared to male [RR (95% CI) 1.22 (1.07–1.40)] and less common among those who entered care at the program’s VCT center as compared to other entry points [0.79 (0.64–0.91)], WHO stage 3/4 as compared to 1/2 [0.19 (0.16–0.22)], or CD4 200 + cells per mm3 as compared to lower [0.19 (0.16–0.22)]. Virologic failure was more common among PLWH who entered care at the program’s VCT center as compared to other entry points [RR (95% CI) 1.45 (1.11–1.91) and those with CD4 < 200 cells per mm3 at entry into care as compared to higher [1.71 (1.36–2.16)]. Of 198 patient-derived samples sequenced during virologic failure, 42 (21%) were wild-type; 145 (73%) carried NNRTI drug resistance mutations; 151 (76.3%) M184I/V; 29 (14.6%) had ≥ 3 TAMs, and 37 (18.7%) had K65R, of whom all were on TDF-containing first-line regimens. Conclusions In this cohort of Nigerian PLWH followed for a period of 9 years, immunologic criteria poorly predicted virologic failure. Furthermore, a subset of samples showed that patients failing ART for extended periods of time had HIV-1 strains harboring drug resistance mutations.
Collapse
|
48
|
Molldrem S, Smith AKJ. Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:10-23. [PMID: 32945756 DOI: 10.1080/15265161.2020.1806373] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in "clusters" of others with genetically similar strains. This is called "molecular HIV surveillance" (MHS). In 2019, "cluster detection and response" (CDR) programs that re-use MHS data became the "fourth pillar" of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for "HIV data justice." The essay contributes to a "bioethics of the oppressed."
Collapse
|
49
|
Determinants of Virologic Failure among Adult HIV Patients on First-Line Antiretroviral Therapy at Waghimra Zone, Northern Ethiopia: A Case-Control Study. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/1929436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. The primary goal of antiretroviral therapy (ART) is to reduce the viral load in HIV-infected patients to promote quality of life, as well as to reduce HIV-related morbidity and mortality. A high rate of virologic failure was reported in Waghimra Zone, Northwest Ethiopia, in viral load assessment conducted among HIV-infected patients on ART in the Amhara region. However, there is limited evidence on the determinants of virological failure in the study area. This study aimed to identify the determinants of virological failure among HIV-infected patients on antiretroviral therapy in Waghimra zone, Northern Ethiopia, 2019. Methods. An institutional-based unmatched case-control study was conducted from May 21 to June 30, 2019. Cases were people living with HIV (PLHIV) on ART who had already experienced virological failure; controls were those without virological failure. Data were extracted from 92 cases and 184 controls through chart review using a pretested and structured checklist. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a P value <0.05 were considered statistically significant. Results. This study revealed that poor adherence to ART (adjusted odds ratio (AOR) = 4.24, 95% confidence interval (CI): 2.17, 8.31), taking ART for longer than five years (AOR = 3.11, 95% CI: 1.17, 8.25), having drug toxicity (AOR = 3.34, 95% CI: 1.54, 7.23), age of PLHIV ≥ 35 years (AOR = 2.45, 95% CI: 1.29,4.64), and recent CD4 count <200 cells/mm³ (AOR = 3.06, 95% CI: 1.52, 6.13) were factors associated with virologic failure. Conclusion and Recommendation. This study showed that poor adherence to treatment, longer duration on ART, experiencing drug toxicity, older age, and recent CD4 <200 cell/mm³ are factors that increase the risk of virologic failure.
Collapse
|
50
|
Dessie ZG, Zewotir T, Mwambi H, North D. Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach. Infect Dis Ther 2020; 9:367-388. [PMID: 32318999 PMCID: PMC7237593 DOI: 10.1007/s40121-020-00296-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Combination antiretroviral therapy has become the standard care of human immunodeficiency virus (HIV)-infected patients and has further led to a dramatically decreased progression probability to acquired immune deficiency syndrome (AIDS) for patients under such a therapy. However, responses of the patients to this therapy have recorded heterogeneous complexity and high dynamism. In this paper, we simultaneously model long-term viral suppression, viral rebound, and state-specific duration of HIV-infected patients. METHODS Full-parametric and semi-parametric Markov multistate models were applied to assess the effects of covariates namely TB co-infection, educational status, marital status, age, quality of life (QoL) scores, white and red blood cell parameters, and liver enzyme abnormality on long-term viral suppression, viral rebound and state-specific duration for HIV-infected individuals before and after treatment. Furthermore, two models, one including and another excluding the effect of the frailty, were presented and compared in this study. RESULTS Results from the diagnostic plots, Akaike information criterion (AIC) and likelihood ratio test showed that the Weibull multistate frailty model fitted significantly better than the exponential and semi-parametric multistate models. Viral rebound was found to be significantly associated with many sex partners, higher eosinophils count, younger age, lower educational level, higher monocyte counts, having abnormal neutrophils count, and higher liver enzyme abnormality. Furthermore, viral suppression was also found to be significantly associated with higher QoL scores, and having a stable sex partner. The analysis result also showed that patients with a stable sex partner, higher educational levels, higher QoL scores, lower eosinophils count, lower monocyte counts, and higher RBC indices were more likely to spend more time in undetectable viral load state. CONCLUSIONS To achieve and maintain the UNAIDS 90% suppression targets, additional interventions are required to optimize antiretroviral therapy outcomes, specifically targeting those with poor clinical characteristics, lower education, younger age, and those with many sex partners. From a methodological perspective, the parametric multistate approach with frailty is a flexible approach for modeling time-varying variables, allowing for dealing with heterogeneity between the sequence of transitions, as well as allowing for a reasonable degree of flexibility with a few additional parameters, which then aids in gaining a better insight into how factors change over time.
Collapse
Affiliation(s)
- Zelalem G Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|