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Kim JH, Jiamsakul A, Kiertiburanakul S, Huy BV, Khusuwan S, Kumarasamy N, Ng OT, Ly PS, Lee MP, Chan YJ, Gani YM, Azwa I, Avihingsanon A, Merati TP, Pujari S, Chaiwarith R, Zhang F, Tanuma J, Do CD, Ditangco R, Yunihastuti E, Ross J, Choi JY. Patterns and prognosis of holding regimens for people living with HIV in Asian countries. PLoS One 2022; 17:e0264157. [PMID: 35353840 PMCID: PMC8967045 DOI: 10.1371/journal.pone.0264157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/04/2022] [Indexed: 01/11/2023] Open
Abstract
The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - Oon Tek Ng
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Man-Po Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tuti Parwati Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Denpasar, Bali, Indonesia
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jeremy Ross
- TREAT Asia, amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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Oh KS, Seo GH, Choi HK, Han E. Effect of single tablet regimen on prescription trends for treatment-naïve patients with HIV/AIDS in Korea. Sci Rep 2022; 12:2031. [PMID: 35132147 PMCID: PMC8821544 DOI: 10.1038/s41598-022-06005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/14/2022] [Indexed: 11/09/2022] Open
Abstract
Single-tablet regimens (STRs) should be considered for patients with HIV/AIDS to increase medication compliance and improve clinical outcomes. This study compared variations in the prescription trends between STRs and multiple-tablet regimens (MTRs) for treatment-naïve patients with HIV/AIDS after the approval of the new STRs, a proxy indicator for improvement in medication adherence. The medical and pharmacy claim data were retrospectively obtained from the Health Insurance Review and Assessment service, which contains basic information on the patients' sociodemographic characteristics and treatment information for the entire Korean population. From 2013 to 2018, a total of 6737 patients with HIV/AIDS were included. Most patients were men (92.8%, n = 6251) and insured through the National Health Insurance (95.1%, n = 6410). The mean number of pills in their antiretroviral treatment regimens decreased from 2.8 ± 1.2 in 2013 to 1.2 ± 1.0 in 2018. After the first STR (EVG/c/TDF/FTC) was approved in 2014, prescription transitions from MTR to STR were observed among more than 38% of patients. In 2018, most treatment-naïve patients were prescribed STRs (91.2%). There was a time lag for STR prescription trends in non-metropolitan hospitals compared with those in metropolitan cities. Our data provide a valuable perspective for evaluating ART regimen prescription patterns on a national scale.
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Affiliation(s)
- Kyung Sun Oh
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu, Incheon, Republic of Korea.,Department of Pharmacy, Inha University Hospital, Incheon, Republic of Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| | - Hee Kyoung Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu, Incheon, Republic of Korea.,National Insurance Service Ilsan Hospital, Gyeonggi, Republic of Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu, Incheon, Republic of Korea.
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Cho YM, Chin B. Assessment of Human Immunodeficiency Virus Care Continuum in Korea using the National Health Insurance System Data. Infect Chemother 2021; 53:477-488. [PMID: 34623778 PMCID: PMC8511369 DOI: 10.3947/ic.2021.0025] [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: 03/07/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Antiretroviral therapy (ART) has been shown to significantly reduce the likelihood of transmission to other people as well as promoting the health of people living with Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLH). The purpose of this study was to assess the HIV care continuum of PLH in Korea using the national health insurance system (NHIS) database. Materials and Methods From 2006 to 2015, ART prescription/laboratory test claim data and enlisted accompanying comorbidities were extracted from the NHIS database. Utilizing these data, proportion of PLH on ART among those who registered to Korea Disease Control and Prevention Agency (KDCA), HIV viral load testing, prescription trends of ART, medication possession ratio (MPR) of ART, and accompanying comorbidities were reviewed. Factors related with MPR <90% was also investigated among demographic factors, ART prescription, and accompanying comorbidities. Results During the observation period, the number of people receiving ART prescription increased from 2,076 in 2006 to 9,201 in 2015. Considering the number of PLHs reported by the KDCA, the proportion of PLHs who received ART prescription increased from 55.4% to 87.6% during the study period. The median value of ART MPR increased from 76.4% to 94.2% and the proportion of patients with MPR >90% increased from 54.3% to 78.2%. The most commonly accompanying comorbidities were dyslipidemia (55.7%), osteoporosis (16.3%), hypertension (15.7%) and diabetes (13.7%), respectively. The proportion of PLH with two or more comorbid conditions increased from 22.0% to 31.6%. Regarding the factors associated with suboptimal compliance, age less than 50 years old, under support of National Medical Aid, alcoholic liver disease, mental and behavioral disorders due to use of alcohol, and ART regimen of protease inhibitor and non-single table regimen integrase strand transfer inhibitor were related with MPR <90%. Conclusion The proportion of PLHs who received ART prescription and median MPR of ART increased during the study period. However, proportion of patients with MPR >90% was 78.2% in 2015 and there are still much room for improvement in the aspect of compliance.
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Affiliation(s)
- Yoon-Min Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea.,Institute of Health & Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
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Kim JH, Noh J, Kim W, Seong H, Kim JH, Lee WJ, Baek Y, Hyun J, Sohn Y, Cho Y, Kim MH, Ahn S, Lee Y, Ahn JY, Jeong SJ, Ku NS, Yeom JS, Kim C, Choi JY. Trends of age-related non-communicable diseases in people living with HIV and comparison with uninfected controls: A nationwide population-based study in South Korea. HIV Med 2021; 22:824-833. [PMID: 34263511 DOI: 10.1111/hiv.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We aim to compare the trends of non-communicable diseases (NCDs) and death among people living with HIV (PLWH) and uninfected controls in South Korea. METHODS We identified PLWH from a nationwide database of all Korean citizens enrolled from 1 January 2004 to 31 December 2016. A control cohort was randomly selected for PLWH by frequency matching for age and sex in a 20:1 ratio. To compare NCD trends between the groups, adjusted incidence rate ratios for outcomes across ages, calendar years and times after HIV diagnosis were calculated. RESULTS We included 14 134 PLWH and 282 039 controls in this study; 58.5% of PLWH and 36.4% of the controls were diagnosed with at least one NCD. The incidence rates of cancers, chronic kidney disease, depression, osteoporosis, diabetes and dyslipidaemia were higher in PLWH than in the controls, whereas those of cardiovascular disease, heart failure, ischaemic stroke and hypertension were lower in PLWH. Relative risks (RRs) for NCDs in PLWH were higher than controls in younger age groups. Trends in the RRs of NCDs tended to increase with the calendar year for PLWH vs. controls and either stabilized or decreased with time after HIV diagnosis. The RR of death from PLWH has decreased with the calendar year, but showed a tendency to rise again after 2014 and was significant at the early stage of HIV diagnosis. CONCLUSIONS Although the RR of each NCD in PLWH showed variable trends compared with that in controls, NCDs in PLWH have been increasingly prevalent.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Juhwan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Woojin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Seong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Hyoung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Woon Ji Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - YaeJee Baek
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - JongHoon Hyun
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yujin Sohn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yunsuk Cho
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Moo Hyun Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - SangMin Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yongseop Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Oh KS, Han E. A comparison of medication adherence and viral suppression in antiretroviral treatment-naïve patients with HIV/AIDS depending on the drug formulary. PLoS One 2021; 16:e0245185. [PMID: 33417621 PMCID: PMC7793268 DOI: 10.1371/journal.pone.0245185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/23/2020] [Indexed: 11/18/2022] Open
Abstract
Antiretroviral treatment (ART) adherence is highlighted in management of patients living with human immunodeficiency virus. In South Korea, ART medication research has rarely been conducted due to the low economic burden associated with government-funded treatment. This cross-sectional study aimed to compare the pill burden impact between ART regimen compliance and HIV-RNA viral load suppression. Data were collected from 2008 to 2016 at a general hospital in South Korea. A total of 210 HIV/AIDS treatment-naïve patients were grouped as follows: single-tablet regimen (STR, one tablet/day), mild pill burden (two-four tablets/day), and heavy pill burden (≥ five tablets/day). Patients were analyzed according to gender, age at index date, medical insurance type, comorbidities, depression, HIV/AIDS disease burden as indicated by HIV-RNA viral load and CD4, and laboratory variables. In a multivariate logistic regression model, the STR group demonstrated adherence 5.10 times more often than the heavy pill burden group. Females and patients with an initial viral load of 500,000 or more were 0.090- and 0.040-fold less adherent to the ART regimen. Among these patients, 95% or more of the MPR group were 7.38 times more likely to have a lower limit of detection (LLOD) of viral load suppression. The highest initial viral load group was 0.090-fold less likely to have an LLOD than the reference group. These results suggest that a single-tablet regimen could improve medication adherence and the clinical virologic outcome. Therefore, general population research on ART adherence and polypharmacy is needed.
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Affiliation(s)
- Kyung Sun Oh
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea
- Department of Pharmacy, Inha University Hospital, Incheon, Republic of Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea
- * E-mail:
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Lee E, Kim J, Bang JH, Lee JY. Suboptimal medication adherence in young women living with HIV infection: a Korean nationwide claims study. AIDS Care 2020; 33:938-942. [PMID: 33172283 DOI: 10.1080/09540121.2020.1844863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The epidemiological characteristics of women living with human immunodeficiency virus (HIV) infection have gained little attention as the numbers are small compared with men living with HIV in the Republic of Korea. However, these data are important to achieve effective HIV infection control and to consider the influence of socioeconomic status on HIV transmission. This study utilized the claims database of the Korean National Health Insurance system to analyze women with a newly diagnosed HIV infection during the period 2009-2016. Adherence to antiretroviral agents was calculated using the medication possession ratio. Among 677 women with a newly diagnosed HIV infection, 219 (32.4%) were over 50 years of age; 291 (43.0%) were identified as having acquired immune deficiency syndrome (AIDS). A total of 99 women (14.6%) were National Medical Aid beneficiaries. Optimal medical adherence >95% was found in 62.2% of subjects. Teenage years (odds ratio(OR) 14.9, 95% confidence interval (95CI) 4.9-44.8), AIDS (OR 1.7, 95CI 1.2-2.3), and low economic status requiring National Medical Aid (OR 3.0, 95CI 2.0-4.6) were associated to adherence. Diagnosis prior to 2012 was also associated with poor adherence. In women, particularly young patients with low economic status, extra attention is required to enhance adherence to prescribed medication.
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Affiliation(s)
- Eunyoung Lee
- Division of Infectious diseases, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - Jungmee Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Yong Lee
- Department of Public Health and Community Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim YC, Ahn JY, Kim HY, Song JY, Park DW, Kim MJ, Choi HJ, Kim SW, Kee MK, Han MG, Yoo M, Kim SM, Choi Y, Choi BY, Kim SI, Choi JY. Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015. Yonsei Med J 2020; 61:705-711. [PMID: 32734734 PMCID: PMC7393295 DOI: 10.3349/ymj.2020.61.8.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. MATERIALS AND METHODS Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation. RESULTS Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5-303] in 2001-2003 to 273 (IQR, 108-399) in 2013-2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per 1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35-5.84] and low CD4 counts (<100 cells/mm³: adjusted hazard ratio, 2.99; 95% CI, 1.44-6.23) were significant risk factors for mortality. CONCLUSION Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.
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Affiliation(s)
- Yong Chan Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mee Kyung Kee
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myung Guk Han
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myeongsu Yoo
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Yunsu Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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8
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Choi SM, Lee DG. Principles of selecting appropriate antimicrobial agents. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.6.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio-Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim IS, Kim HH, Chang CL. Genetic Variants and Haplotypes in the IL10 Gene and Their Association with Opportunistic Infections among HIV-Infected Patients in Korea in the Era of Highly Active Antiretroviral Therapy. ANNALS OF CLINICAL MICROBIOLOGY 2019. [DOI: 10.5145/acm.2019.22.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- In-Suk Kim
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyung-Hoi Kim
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chulhun L. Chang
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
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Bijker R, Choi JY, Ditangco R, Kiertiburanakul S, Lee MP, Siwamogsatham S, Pujari S, Ross J, Wong CY, Wong WW, Yunihastuti E, Law M. Cardiovascular Disease and Cardiovascular Disease Risk in HIV-Positive Populations in the Asian Region. Open AIDS J 2017; 11:52-66. [PMID: 29302277 PMCID: PMC5753029 DOI: 10.2174/1874613601711010052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction: Cardiovascular diseases (CVD) are becoming more prevalent in HIV-infected populations as they age largely due to improved treatment outcomes. Assessment of CVD risk and CVD risk factors in HIV-positive populations has focused on high income settings, while there are limited studies evaluating CVD in HIV-positive populations in the Asian region. Materials and Methods: We provided an overview of the prevalence and incidence of CVD and its risk factors in adult HIV-positive populations, and of the strategies currently in place for CVD management in the Asian region. Results: Studies from the Asian region showed that CVD and CVD risk factors, such as dyslipidaemia, elevated blood glucose, obesity and smoking, are highly prevalent in HIV-positive populations. A number of studies suggested that HIV infection and antiretroviral therapy may contribute to increased CVD risk. National HIV treatment guidelines provide some directions regarding CVD risk prevention and management in the HIV-infected population, however, they are limited in number and scope. Conclusion: Development and consolidation of guidelines for integrated CVD and HIV care are essential to control the burden of CVD in HIV-positive populations. To inform guidelines, policies and practice in the Asian region, research should focus on exploring appropriate CVD risk screening strategies and estimating current and future CVD mortality and morbidity rates.
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Affiliation(s)
- Rimke Bijker
- The Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Sarawut Siwamogsatham
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | - Matthew Law
- The Kirby Institute, UNSW, Sydney, NSW 2052, Australia
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11
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Kim MJ, Chang HH, Kim SI, Kim YJ, Park DW, Kang C, Kee MK, Choi JY, Kim SM, Choi BY, Kim WJ, Kim JM, Choi JY, Choi YH, Lee JS, Kim SW. Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015. Infect Chemother 2017; 49:101-108. [PMID: 28608664 PMCID: PMC5500264 DOI: 10.3947/ic.2017.49.2.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/17/2017] [Indexed: 12/23/2022] Open
Abstract
Background CD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study. Materials and Methods The Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm3). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL. Results Median values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm3 and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm3 and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm3) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012. Conclusion CD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.
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Affiliation(s)
- Min Jung Kim
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Ha Chang
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Il Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chun Kang
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Mee Kyung Kee
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ju Yeon Choi
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea.,Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea.
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Abstract
PURPOSE OF REVIEW To benefit very early treatment for an HIV cure, HIV infection must be diagnosed immediately after infection. We review potential strategies for expansion of HIV testing in preparation for a potential HIV cure in the distant future. RECENT FINDINGS Very early antiretroviral therapy (ART) initiated during acute or early HIV infection may result in long-term viral control. Such strategies will require programmatic systems for very early diagnosis and very early ART. Yet, most HIV-infected individuals start treatment late and presumably are diagnosed late. Operational issues will have to address the treatment cascade much earlier starting from HIV testing, test result notification, posttest counseling, immunological and clinical assessment and ultimately starting treatment. Well designed implementation research studies are needed to determine effective interventions to diagnose HIV as early as during acute and early HIV infection. SUMMARY Approaches for earlier HIV diagnosis and very early ART for a potential functional HIV cure remain elusive unless early HIV diagnosis can be radically expanded.
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13
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Lo YR, Chu C, Ananworanich J, Excler JL, Tucker JD. Stakeholder Engagement in HIV Cure Research: Lessons Learned from Other HIV Interventions and the Way Forward. AIDS Patient Care STDS 2015; 29:389-99. [PMID: 26061668 DOI: 10.1089/apc.2014.0348] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders.
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Affiliation(s)
- Ying-Ru Lo
- HIV, Hepatitis and STI Unit, World Health Organization, Regional Office for the Western Pacific, Manila, The Philippines
| | - Carissa Chu
- University of California San Francisco School of Medicine, San Francisco, California
- University of North Carolina Project-China, Guangzhou, P.R. China
| | - Jintanat Ananworanich
- US Military HIV Research Program, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Jean-Louis Excler
- US Military HIV Research Program, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, P.R. China
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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