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Marin RC, Bungau SG, Tit DM, Negru PA, Radu AF, Moleriu RD. Immune recovery among Romanian HIV/AIDS patients receiving darunavir/ritonavir or darunavir/cobicistat regimens in cART management: A three-year study. Biomed Pharmacother 2023; 161:114427. [PMID: 36822019 DOI: 10.1016/j.biopha.2023.114427] [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: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Approximately two-thirds of Romanian HIV patients were parenterally infected with the F subtype of HIV in early childhood. They are now in the context of immunological aging, with immunosuppression posing an additional challenge in developing the most effective and well-tolerated regimens. The risk of an improper immune recovery is higher in these patients than in newly diagnosed patients. The primary goal of this retrospective study was to conduct a comparative analysis of the immune recovery, measured at three time points, on 462 HIV-infected patients who were registered at the "Matei Balş National Institute of Infectious Diseases", Bucharest, Romania, between 2018 and 2021, as follows: darunavir (DRV) 600 mg plus ritonavir (RTV) 100 mg (twice daily) was given to 384 patients, while DRV 800 mg plus cobicistat (COBI) 150 mg was given to 78 patients (once daily). The immune response was assessed by counting T lymphocytes, CD4 count cells/mm3, and the CD4/CD8 lymphocyte count ratio. Additionally, the study assessed the relationship between the immune and virological responses to therapy. Using various statistical tests, the results revealed that the immune response is normal in both groups, but with a statistically significant difference (p < 0.05) for the DRV/c group. Statistical associations between RNA viral plasma load and immune response (CD4 count and CD4/CD8 ratio) were assessed at all three visits and showed an insignificant association for the first two time points; however, at the final visit, the outcomes changed and reached statistical significance for both groups.
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Affiliation(s)
- Ruxandra-Cristina Marin
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Paul Andrei Negru
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Radu Dumitru Moleriu
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania.
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da Silva Calvo K, Knauth DR, Hentges B, Leal AF, da Silva MA, Silva DL, Vasques SC, Hamester L, da Silva DAR, Dorneles FV, Fraga FS, Bobek PR, Teixeira LB. Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil. BMC Public Health 2022; 22:1422. [PMID: 35883036 PMCID: PMC9327199 DOI: 10.1186/s12889-022-13791-9] [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: 07/30/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.
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Affiliation(s)
- Karen da Silva Calvo
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Daniela Riva Knauth
- Department of Social Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruna Hentges
- Department of Social Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Andrea Fachel Leal
- Graduate Studies Program in Public Policy, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Mariana Alberto da Silva
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Danielle Lodi Silva
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Samantha Correa Vasques
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Letícia Hamester
- Professional Master's in Family Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Paulo Ricardo Bobek
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Luciana Barcellos Teixeira
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil.
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil.
- Department of Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil.
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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Frange P, Montange T, Le Chenadec J, Batalie D, Fert I, Dollfus C, Faye A, Blanche S, Chacé A, Fourcade C, Hau I, Levine M, Mahlaoui N, Marcou V, Tabone MD, Veber F, Hoctin A, Wack T, Avettand-Fenoël V, Warszawski J, Buseyne F. Impact of Early Versus Late Antiretroviral Treatment Initiation on Naive T Lymphocytes in HIV-1-Infected Children and Adolescents - The-ANRS-EP59-CLEAC Study. Front Immunol 2021; 12:662894. [PMID: 33968064 PMCID: PMC8100053 DOI: 10.3389/fimmu.2021.662894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background The early initiation of antiretroviral therapy (ART) in HIV-1-infected infants reduces mortality and prevents early CD4 T-cell loss. However, the impact of early ART on the immune system has not been thoroughly investigated in children over five years of age or adolescents. Here, we describe the levels of naive CD4 and CD8 T lymphocytes (CD4/CD8TN), reflecting the quality of immune reconstitution, as a function of the timing of ART initiation (early (<6 months) versus late (≥24 months of age)). Methods The ANRS-EP59-CLEAC study enrolled 27 children (5-12 years of age) and nine adolescents (13-17 years of age) in the early-treatment group, and 19 children (L-Ch) and 21 adolescents (L-Ado) in the late-treatment group. T lymphocytes were analyzed by flow cytometry and plasma markers were analyzed by ELISA. Linear regression analysis was performed with univariate and multivariate models. Results At the time of evaluation, all patients were on ART and had a good immunovirological status: 83% had HIV RNA loads below 50 copies/mL and the median CD4 T-cell count was 856 cells/µL (interquartile range: 685-1236 cells/µL). In children, early ART was associated with higher CD8TN percentages (medians: 48.7% vs. 31.0%, P = 0.001), and a marginally higher CD4TN (61.2% vs. 53.1%, P = 0.33). In adolescents, early ART was associated with low CD4TN percentages and less differentiated memory CD8 T cells. CD4TN and CD8TN levels were inversely related to cellular activation and gut permeability. Conclusion In children and adolescents, the benefits of early ART for CD8TN were clear after long-term ART. The impact of early ART on CD4TN appears to be modest, because pediatric patients treated late respond to HIV-driven CD4 T-lymphocyte loss by the de novo production of TN cells in the thymus. Our data also suggest that current immune activation and/or gut permeability has a negative impact on TN levels. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02674867.
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Affiliation(s)
- Pierre Frange
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
- Laboratoire de microbiologie clinique, hôpital Necker–Enfants malades, AP–HP-Centre – Université de Paris, Paris, France
- EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France
| | - Thomas Montange
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Jérôme Le Chenadec
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Damien Batalie
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Ingrid Fert
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Catherine Dollfus
- Hémato-oncologie pédiatrique, Hôpital Trousseau, AP-HP, Paris, France
| | - Albert Faye
- Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Stéphane Blanche
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Anne Chacé
- Pédiatrie et néonatologie, Centre hospitalier intercommunal de Villeuneuve-Saint-Georges, Villeuneuve-Saint-Georges, France
| | | | - Isabelle Hau
- Pédiatrie Générale, Centre hospitalier intercommunal de Créteil, Créteil, France
| | - Martine Levine
- Immuno-hématologie pédiatrique, Hôpital Robert Debré, AP-HP, Paris, France
| | - Nizar Mahlaoui
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Valérie Marcou
- Médecine et réanimation néonatale, Hôpital Cochin, AP-HP-Centre – Université de Paris, Paris, France
| | | | - Florence Veber
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Alexandre Hoctin
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Thierry Wack
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Véronique Avettand-Fenoël
- Laboratoire de microbiologie clinique, hôpital Necker–Enfants malades, AP–HP-Centre – Université de Paris, Paris, France
- CNRS 8104/INSERM U1016, Institut Cochin, Université Paris Descartes, Paris, France
| | - Josiane Warszawski
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
- INED, Université Paris Sud, Le Kremlin-Bicêtre, Orsay, France
| | - Florence Buseyne
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
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