HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia

A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations

Background

Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) has become one of the major health problems worldwide, including Indonesia. East Java is one of the provinces in Indonesia with the highest prevalence of HIV infection. One of the causes of HIV infection transmission is lesbian, gay, bisexual, and transgender (LGBT) practice. Furthermore, the treatment using antiretroviral (ARV) drugs in HIV-1 patients can fail due to the presence of HIV drug resistance.

Objective

The aim of this study is to identify the behavior at risk of HIV transmission among LGBT, patterns of genetic variation and antiretroviral (ARV) resistance.

Methods

A systematic review and meta-analysis based on the PRISMA guidelines was conducted. We searched three databases including PubMed, ScienceDirect, and Google scholar for studies investigating the non-heterosexual behavior as risk factor of HIV infection and antiretroviral resistance. Only studies published in English are considered. The adjusted estimates of the risk were carried out using best-adjusted OR with 95% confidence interval (CI) and significant p value < 0.05.

Results

In the quantitative analysis of HIV infection risk factors, a total of 13 studies were included, which investigated non-heterosexual behavior as a potential factor. The studies involved a total of 37,129 participants, comprising 10,449 individuals in the non-heterosexual behavior group (LGBTQ+) and 26,680 individuals in the heterosexual group. The majority of the participants in this study were from the USA, Japan, China, and Brazil, and the main HIV subgenotypes were B and CRF. Additionally, the antiretroviral resistance of HIV patients was examined, involving a total of 3062 individuals, with 1296 individuals in the non-heterosexual behavior group and 1766 individuals in the heterosexual group. Our calculation showed that non-heterosexual behavior was significant as risk factor of HIV infection (OR = 2.17, 95% CI = 1.94-2.43, p < 0.001) and antiretroviral resistance (OR = 1.31, 95% CI = 1.00-1.71, p = 0.05).

Conclusion

This study concludes that non heterosexual behavior is significant risk factor of HIV infection. A quite prevalent of antiretroviral resistance were found among non heterosexual behavior. The main subgenotype of HIV are B and CRF.

Antiretroviral stewardship in a tertiary academic hospital: The need for a clinical pharmacist

Background

South Africa has the highest prevalence of people living with HIV globally. Although antiretroviral therapy provides solutions, evidence of antiretroviral resistance emerged, requiring the application of antiretroviral-stewardship programmes to curb medication-related problems.

Aim

Identify and describe antiretroviral-stewardship pharmacist interventions in an active antiretroviral-stewardship programme.

Setting

HIV-positive adults admitted to medical wards at a tertiary academic hospital in South Africa.

Methods

A descriptive quantitative study was performed, utilising an antiretroviral-stewardship assessment tool to determine antiretroviral-related recommendations in the treatment of HIV-positive adults. The study employed purposive sampling. Treatment charts were evaluated to identify antiretroviral-stewardship recommendations. The number of recommendations highlighted the need for a clinical pharmacist in an active antiretroviral-stewardship programme. Descriptive data analysis with Pearson correlations was employed to display the data.

Results

Medication-related problems were identified in 100% of study patients (n = 41), with an average of 2.46 interventions per patient. One-hundred-and-one medication-related problems were identified by using the antiretroviral-stewardship assessment tool. The identified problems included a lack of viral load testing (41, 100%), lack of CD4 count monitoring (15; 36.6%) and lack of prophylactic treatment against opportunistic infections (10; 24.4%). Medication-related problems included the presence of clinically significant drug-drug interactions and serious side effects, CD4 count decline despite being on antiretroviral therapy, unnecessary treatment interruptions including risk for IRIS, inappropriate antiretroviral therapy regimen, non-adherence and absence of treating tuberculosis as co-morbidity.

Conclusion

Present study demonstrates the need of an active antiretroviral-stewardship programme's benefits. The possible role of the clinical pharmacist as active participant and leader in this programme is highlighted.

Contribution

Highlight the role of clinical pharmacists in antiretroviral stewardship.

The Frequency and Predictors of Unsuppressed HIV Viral Load Among People with HIV in Nyaruguru District, Rwanda

Background

By the end of 2015, epidemiological studies approximated 37 million people living with HIV (PLHIV) and 46.3% of them were initiated to antiretroviral therapies. From the 90-90-90 strategy, by 2020 at global level, 90% of all people living with HIV were expected to suppress viral load (VL). Although VL suppression is an important indicator of treatment success in PLHIV, studies on this indicator remain scarce in Rwanda where the prevalence of HIV is 3% with 9% for non-suppression. This work, thus, determined the prevalence of VL non-suppression and its associated predictors among PLHIV.

Methods

A cross-sectional study was conducted among 637 PLHIV enrolled in healthcare services between 2016 and 2017 in Nyaruguru district. Socio-demographic, treatment, clinical, immunological and VL data were extracted from medical records. Bivariate and multivariate logistic regression analyses were performed to determine associated factors with VL suppression considering 95% confidence intervals and statistical significance of p<0.005.

Results

More than half of participants were female (57.77%). The prevalence of unsuppressed HIV VL was 8.9% and 88.7% of respondents were satisfied with the service provided. Males were more likely to be unsuppressed HIV VL [aOR = 3.02; 95% CI (1.19–7.64), p = 0.02] than females. Higher likelihoods of VL non-suppression were among those with history of clinical failure [aOR = 3.14; 95% CI (1.70–14.03), p = 0.034] or history of treatment interruption [aOR = 8.29; 95% CI (2.60–26.42) p = 0.002]. Those with a bad perception toward the whole life treatment were more likely to be unsuppressed [aOR = 4.32; 95% CI (1.98–18.99), p = 0.049] than their counterparts.

Conclusion

Sex, treatment interruption, bad perception toward the whole life treatment, clinical failure and lack of confidentiality were the major predictors of being unsuppressed. More efforts on counseling HIV patients to improve their knowledge would drop levels of VL non-suppression, so improving the quality of service should be prioritized to increase suppression.

Time to Immunologic Recovery and Its Determinant Factors Among Adult HIV Patients Who Initiated Antiretroviral Treatment at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Objective

Methods

Results

Conclusion