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Ye L, Sun X, Li Y, Zeng Y, Zhuoma L, Zhou D, He Q, Wang J, Yang W, Yu H, Yang Y, Liang S, Yuan D. Survival Analysis of Antiretroviral Treatment for PLWH in Sichuan Province, China, 2003-2022: A Large Retrospective Cohort Study. Infect Drug Resist 2024; 17:3133-3143. [PMID: 39050836 PMCID: PMC11268743 DOI: 10.2147/idr.s463262] [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: 04/02/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
Background Sichuan Province was severely affected by the HIV, and there was a scarcity of data regarding the survival time and influencing factors for People Living with HIV/AIDS (PLWH) in Sichuan Province who have received Antiretroviral Therapy (ART). Therefore, it is necessary to conduct a survival analysis for PLWH receiving ART. Methods A retrospective cohort study was conducted on PLWH who had received ART≥6 months in Sichuan Province from January 1, 2003, to December 31, 2022. The Kaplan-Meier method was used to calculate median survival time and plot survival curves, while a Cox proportional hazards regression model was applied to analyze factors affecting survival time. Bilateral tests were performed, with P≤0.05 considered statistically significant. Results The cumulative survival rates at 1, 3, 5, and 10 years for the 223,386 subjects were 94.54%, 89.07%, 84.82%, and 76.44%, respectively. Multivariate analysis using the Cox regression model indicated lower mortality risks for females (HR=0.59, 95% CI: 0.54-0.65), homosexual transmission (HR=0.43, 95% CI: 0.33-0.55), and baseline BMI≥24 (HR=0.81, 95% CI: 0.72-0.90). Higher mortality risks were associated with age≥50 years at diagnosis (HR=3.21, 95% CI: 2.94-3.50), being unmarried or divorced (HR=1.23, 95% CI: 1.11-1.37), living separately (HR=1.32, 95% CI: 1.22-1.43), baseline BMI <18.5 (HR=1.27, 95% CI: 1.13-1.41), presence of single-drug resistance (HR=1.25, 95% CI: 1.15-1.36), baseline WHO stage IV (HR=1.27, 95% CI: 1.09-1.47), and a diagnosis-to-treatment interval >12 months (HR=1.27, 95% CI: 1.15-1.41). Compared to those with CD4(+) T cell count of 200-350cells/μL, 350-500cells/μL, and >500cells/μL at baseline, individuals with <200cells/μL had higher mortality risks (HR=0.73, 95% CI: 0.67-0.79; HR=0.57, 95% CI: 0.51-0.64; and HR=0.58, 95% CI: 0.51-0.66, respectively). Conclusion The survival rate for PLWH receiving ART in Sichuan Province was relatively high. Male gender, age over 50 at diagnosis, being unmarried, divorced, or living separately, presence of single-drug resistance, low baseline BMI, baseline CD4+ T cell <200cells/μL, baseline WHO stage IV, and a diagnosis-to-treatment interval >12 months were risk factors for the survival of PLWH.
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Affiliation(s)
- Li Ye
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Xiwei Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yiping Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Yali Zeng
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Lacuo Zhuoma
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Dinglun Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Qinying He
- Center for AIDS/STD Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Ju Wang
- Center for AIDS/STD Control and Prevention, Liangshan Center for Disease Control and Prevention, Xichang, Sichuan, People’s Republic of China
| | - Wei Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Hang Yu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Yihui Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Shu Liang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
| | - Dan Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China
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Bazyar M, Ghorabi ST, Sadeghifar J, Ranjbar M, Pakzad R, Bonyadi F, Khasi K, Shakiba E, Nourbakhsh M, Rezeghian L, Noshadi B, Bavandpour M, HasanBeigi A, Behzadi A. What may encourage or deter health services utilization by people living with or at the risk of HIV/AIDS in special health centers? Qualitative evidence from a stigmatized community. BMC Public Health 2024; 24:981. [PMID: 38589818 PMCID: PMC11000400 DOI: 10.1186/s12889-024-18480-3] [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: 09/05/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Behavioral Diseases Counseling Centers (BDCCs) and Vulnerable Women's Counseling Centers (VWCCs) in Iran are the main peripheral centers that offer educational, counseling, diagnostic, preventive, curative and protective services to individuals living with or at high risk of contracting HIV/AIDS and female sex workers respectively. Due to the social stigma surrounding HIV in Iran, this study aims to identify the factors that may hinder or encourage HIV/AIDS patients and women with risky sexual behaviors from visiting these centers. METHODS Conducted in 2023, this qualitative study involved individuals visiting BDCCs and VWCCs in two western provinces of Iran, Ilam and Kermanshah. The study participants included 21 health staff members working in BDCCs and VWCCs and 20 HIV/AIDS patients and vulnerable women with unsafe sexual behaviors referring to these centers. Purposive, snowball and maximum variation sampling techniques were applied to interview the participants. Interviews were conducted between January 5th and May 21st, 2023, using a semi-structure guideline. Interviews were transcribed and content analysis approach was applied to analyze data using MAXQDA20 software. RESULTS According to the findings, the barriers and facilitators of visiting specialized centers for HIV/AIDS patients and vulnerable women were categorized into three main categories, 10 subcategories and 35 sub-subcategories including: Medical and operational processes (4 subcategories and 12 sub-subcategories), mutual interactions between the personnel and visitors (people living with and at the risk of getting HIV/AIDS) (3 subcategory and 13 sub-subcategories), and physical characteristics of the centers (3 subcategories and 10 sub-subcategories). CONCLUSIONS To improve the performance of BDCCs and VWCCs and encourage people living with and at the risk of contracting HIV/AIDS to visit these centers regularly, health policy makers should consider modifying clinical processes, physical features, personnel behaviors and visitors' concerns raised by the interviewees and the issues identified in this study.
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Affiliation(s)
- Mohammad Bazyar
- Health Management and Economics Department, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Samaneh Tahmasebi Ghorabi
- Clinical Research Development Unit, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Jamil Sadeghifar
- Health Management and Economics Department, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
- Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ranjbar
- Health Policy & Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical sciences, Yazd, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatemeh Bonyadi
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Keyvan Khasi
- Behavioral Diseases Research Center, Public Health Deputy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Behavioral Diseases Research Center, Public Health Deputy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahtab Nourbakhsh
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Leila Rezeghian
- Behavioral Diseases Research Center, Public Health Deputy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Boshra Noshadi
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehrdad Bavandpour
- Behavioral Diseases Research Center, Public Health Deputy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azim HasanBeigi
- Communicable Diseases Department, Public Health Deputy, Ilam University of Medical Sciences, Ilam,, Iran
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Informatics Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Gheibi Z, Fararouei M, Afrashteh S, Akbari M, Afsar Kazerooni P, Shokoohi M. Pattern of contributing behaviors and their determinants among people living with HIV in Iran: A 30-year nationwide study. Front Public Health 2023; 11:1038489. [PMID: 36908430 PMCID: PMC9998994 DOI: 10.3389/fpubh.2023.1038489] [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: 09/07/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction A major shift in the routes of HIV transmission seams to be taking place in Iran. Our study aimed to investigate the 30-year trend of major HIV related behaviors in Iran. Methods The national HIV/AIDS registry database (from September 1986 to July 2016 with data on 32,168 people newly diagnosed with HIV) was used to study the 30 years trend and demographic determinants of major HIV related behaviors. Results The highest rate of drug injection (DI) among people living with HIV (PLHIV) was reported during 1996 to 1999 (p-for trend < 0.001) while the highest rate of sexual activity by minorities or hard to reach groups was during 2004 to 2011 (p-for trend < 0.001). Among males, drug injection was directly associated with being single (ORsingle/married = 1.34), being unemployed (ORunemployed/employed = 1.94) and having lower level of education (OR<highschool/≥highschool = 2.21). Regarding females, drug injection was associated with being housewife (ORhousewife/employed = 1.35) and lower level of education (OR<highschool/≥highschool = 1.85). In females, condomless sexual contact was more common among those younger (OR20-29/<20 = 6.15), and married (ORmarried/single = 7.76). However, among males those being single (ORmarried/single = 0.82), being more educated (OR≥highschool/<highschool = 1.24), and being unemployed (ORunemployed/employed = 1.53) reported more sexual activity by minoritised or hard to reach groups. Discussion The pattern of major HIV related behaviors among Iranian males and females have been rapidly changing and people living with HIV (PLHIV) are being diagnosed at a younger age. Health education to younger individuals is an essential HIV controlling strategy among Iranian population. Implementation of surveys in hidden and hard-to-reach populations is also recommended.
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Affiliation(s)
- Zahra Gheibi
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mojtaba Akbari
- Department of Epidemiology and Statistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mostafa Shokoohi
- HIV and Sexually Transmitted Infections Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Looha MA, Taraghikhah N, Amini M, Pormehr PS, Talaei N, Khodadoost M, Gholamzadeh S, Vafaee R, Mohammadi G. The impact of HIV on the risk of COVID-19 death among hospitalized patients. Hum Antibodies 2022; 30:165-175. [PMID: 36617778 DOI: 10.3233/hab-220011] [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: 01/05/2023]
Abstract
BACKGROUND Little is known about the association between Human Immunodeficiency Virus (HIV) infection and risk of death among hospitalized COVID-19 patients. We aimed to investigate this association using a multicenter study. MATERIAL AND METHODS This multicenter study was conducted using the registry database of Coronavirus Control Operations Headquarter from March 21, 2021 to January 18, 2020 in the province of Tehran, Iran. The interest outcome was COVID-19 death among hospitalized patients living with and without HIV. The Cox regression models with robust standard error were used to estimate the association between HIV infection and risk of COVID-19 death. The subgroup and interaction analysis were also performed in this study. RESULTS 326052 patients with COVID-19 were included in the study, of whom 127 (0.04%) were living with HIV. COVID-19 patients with HIV were more likely to be female, older, and to have symptoms such as fever, muscular pain, dyspnea and cough. The death proportion due to COVID-19 was 18 (14.17%) and 21595 (6.63%) among HIV and non-HIV patients, respectively. Patients living with HIV had lower mean survival time compared to those without HIV (26.49 vs. 15.31 days, P-value = 0.047). Crude risk of COVID-19 death was higher among HIV patients than in non-HIV group (hazard ratio[HR]: 1.60, 1.08-2.37). Compared to those without HIV, higher risk of COVID-19 death was observed among patients with HIV after adjusting for sex (1.60, 1.08-2.36), comorbidities (1.49, 1.01-2.19), cancer (1.59, 1.08-2.33), and PO2 (1.68, 1.12-2.50). However, the risk of COVID-19 death was similar in patients with and without HIV after adjusting for age (1.46, 0.98-2.16) and ward (1.30, 0.89-1.89). CONCLUSION We found no strong evidence of association between HIV infection and higher risk of COVID-19 death among hospitalized patients. To determine the true impact of HIV on the risk of COVID-19 death, factors such as age, comorbidities, hospital ward, viral load, CD4 count, and antiretroviral treatment should be considered.
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Affiliation(s)
- Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Taraghikhah
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maedeh Amini
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Salimi Pormehr
- Ergonomics and Human Factor, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Talaei
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Khodadoost
- School of Traditional Medicine, Traditional Medicine & Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Gholamzadeh
- Vice Chancellor in Administration and Resources Development Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Vafaee
- Proteomics Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gohar Mohammadi
- Vice Chancellor in Administration and Resources Development Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dzinza R, Ngwira A. Comparing parametric and Cox regression models using HIV/AIDS survival data from a retrospective study in Ntcheu district in Malawi. J Public Health Res 2022; 11:22799036221125328. [PMID: 36185416 PMCID: PMC9523851 DOI: 10.1177/22799036221125328] [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: 04/08/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The study was designed to compare parametric and Cox regression survival models. It was also aimed at determining risk factors of death due to HIV/AIDS. Design and methods: The models were fitted to time from ART initiation to death due to HIV/AIDS while using data that was collected from 6670 patients records who registered for ART from 2007 to 2012 at Ntcheu district hospital in Malawi. The best fitting model was used to determine risk factors of death due to HIV/AIDS. Results: The exponential and Gompertz model competed very well with the Cox regression. Patients in WHO clinical stage 4 (HR = 1.69, p-value <0.001) and males (HR = 1.74, p-value <0.001) were associated with increased hazard of death than those in WHO clinical stage 3 and females. Patients with high body mass index (HR = 0.82, p-value <0.001) were associated with lower hazard of death than those with lower body mass index. Conclusions: Parametric models may perform as good as the Cox regression and the plausibility of all models needs to be investigated to use the correct model for accurate inferences. Furthermore, strategies to limit deaths due to HIV/AIDS should initiate ART early before WHO clinical stage 4 and males should receive special attention. The strategies should also aim at improving the body mass index of patients.
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Affiliation(s)
- Rabson Dzinza
- Mathematics and Statistics Department, Nalikule College of Education, Lilongwe, Malawi
| | - Alfred Ngwira
- Basic Sciences Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
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Lorestani RC, Kazemisafa N, Rostamian M, Akya A, Rezaeian S, Bashiri H, Jasemi SV, Ghadiri K. Survival-related factors in HIV/AIDS patients: A retrospective cohort study from 2011 to 2019 in Kermanshah, Iran. Curr HIV Res 2022; 20:CHR-EPUB-124591. [PMID: 35718966 DOI: 10.2174/1570162x20666220617141619] [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: 02/10/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Accurate evaluation of the survival rate among HIV-positive populations is pivotal for HIV management. OBJECTIVE This study aimed to investigate the survival rate and potential survival-related factors in HIV/AIDS patients from 2011 to 2019 in the city of Kermanshah in the west of Iran. METHOD In this study, 915 HIV-positive patients registered by the Kermanshah Behavioral diseases counseling center, were surveyed from 2011 to 2019. By reading the patients' files, the proper data related to the survival factors were extracted and statistically analyzed. RESULTS Of 915 patients, 220 (24%) died. The one-year, five-year, and ten-year survival rates were 84%, 72%, and 62%, respectively. There was a significant relationship between the survival rate and many other parameters, including treatment variables, CD4+ T cell count, the way of HIV transmission, level of education, gender, and marital status. Over time, timely initiation of treatment has increased. The data also showed that HIV transmission through drug injection has decreased, while the sexual transmission of HIV has increased. CONCLUSIONS The results showed that in recent years, due to the appropriate treatment, the survival rate of HIV patients has increased. The highest risk factor of death was for people with low CD4+ T cell count, lack of antiretroviral therapy, low level of education, male gender, and people who inject drugs. These people need more attention to get tested for HIV- related indexes and to receive proper treatment.
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Affiliation(s)
- Roya Chegene Lorestani
- MSc Medical Microbiology, Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Kazemisafa
- Medical Doctorate, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alisha Akya
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Homayoon Bashiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Vahid Jasemi
- Department of Internal Medicine, School of Medicine, Kermanshah University of Medical Sciences, Iran
| | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mercadal-Orfila G, Font J, Pons M, Blasco Mascaró I, Piqué N. HIV-positive women have higher prevalence of comorbidities and anticholinergic burden: assessment of the HIV-positive population from Menorca (Balearic Islands). AIDS Care 2022; 35:800-809. [PMID: 35473442 DOI: 10.1080/09540121.2022.2067518] [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: 10/18/2022]
Abstract
Currently, the management of comorbidities and polypharmacy in HIV-infected patients requires a coordinated action, with special focus on gender differences. Observational, cross-sectional study was conducted to study the HIV population from Menorca (Illes Balears). Adult HIV-positive individuals on antiretroviral treatment attending the pharmacy service from Hospital Mateu Orfila (Menorca) were included. In a single visit, demographical and clinical characteristics, comorbidities and cotreatments were collected. Anticholinergic burden (Drug Burden Index, DBI), drug-to-drug interactions (BOT PLUS database) and symptoms associated with HIV treatment (HIV-SI index) were assessed. A total of 223 patients were included, 68.2% men, with a median age of 53.00 (44.50-58.00) years, median BMI of 24.07, 47.73% smokers and 9.90% drug consumers. Women had more advanced stages of the disease and significantly more symptoms (cough and anxiety) versus men (p = .033 and p = .048, respectively). Moreover higher exposures to anticholinergic drugs (DBI 0.51 vs. 0.27) were reported, together with more frequency of drug-to-drug interactions (57.7% vs. 37.5%; p = .005) that increased with age. Red interactions were more frequently reported in PI (2.69%), NNRTIs (1.92%) and booster drugs (1.92%). These results support the need to implement specific measures for the management of HIV-infected women and tools to assess polypharmacy and risk of drug-to-drug interactions.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Pharmacy Department, Hospital Mateu Orfila, Menorca, Spain.,Department of Biochemistry and Molecular Biology, Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - Julia Font
- Pharmacy Department, Hospital Mateu Orfila, Menorca, Spain
| | - Marta Pons
- Pharmacy Department, Hospital Mateu Orfila, Menorca, Spain
| | | | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona (UB), Barcelona, Spain.,Research Institute of Nutrition and Food Safety, Universitat de Barcelona (INSA-UB), Barcelona, Spain
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Exavery A, Charles J, Kuhlik E, Barankena A, Abdul R, Mubyazi GM, Kyaruzi C, Kikoyo L, Jere E, Balampama M. Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania. Front Public Health 2022; 9:719485. [PMID: 35265581 PMCID: PMC8898952 DOI: 10.3389/fpubh.2021.719485] [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: 06/02/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022] Open
Abstract
The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community–based, USAID–funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as “not having missed any ART dose in the last 30 days,” and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50–0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41–0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.
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Affiliation(s)
| | | | | | | | - Ramadhani Abdul
- Impact Evaluation, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Godfrey M Mubyazi
- Health Systems and Policy Research, National Institute for Medical Research, Dar es Salaam, Tanzania
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Khezri M, Shokoohi M, Mirzazadeh A, Tavakoli F, Ghalekhani N, Mousavian G, Mehmandoost S, Kazerooni PA, Haghdoost AA, Karamouzian M, Sharifi H. HIV Prevalence and Related Behaviors Among People Who Inject Drugs in Iran from 2010 to 2020. AIDS Behav 2022; 26:2831-2843. [PMID: 35195820 DOI: 10.1007/s10461-022-03627-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
Injection drug use has been the leading route of HIV transmission in Iran. We assessed HIV prevalence, risk behaviors, and uptake of prevention services among people who inject drugs (PWID) in Iran between 2010 and 2020. We also examined the individual and environmental determinants of HIV among PWID. PWID were recruited in major cities across the country in three national bio--behavioral surveillance surveys in 2010, 2014, and 2020. Participants were tested for HIV and interviewed using a behavioral questionnaire. Between 2010 and 2020, the prevalence of HIV (15.1% to 3.5%), receptive needle sharing (25.2% to 3.9%) and unprotected sex (79.4% to 65.2%) decreased. Moreover, uptake of free needle/syringe increased (57.4% to 87.9%), while uptake of free condoms remained relatively stable across the surveys (34.3% to 32.6%). Multivariable analysis for the 2020 survey showed that a history of homelessness, incarceration, and a longer injection career significantly increased the odds of HIV seropositivity. During the past decade, HIV prevalence and drug- and sexual-related risk behaviors decreased among Iranian PWID. However, individual and structural determinants continue to drive HIV among this population. HIV prevention, diagnosis, and treatment among marginalized PWID with a history of homelessness or incarceration and those who inject drugs for a longer period, should be further prioritized in HIV care planning and resource allocation in Iran.
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Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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10
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Yang Y, Li Y, Zhang X, Zhang W, Ma Y, Jia X, Gondwe T, Wang Y, Shi X. Effect of antiretroviral therapy initiation time and baseline CD4 + cell counts on AIDS-related mortality among former plasma donors in China: a 21-year retrospective cohort study. Glob Health Action 2021; 14:1963527. [PMID: 34592916 PMCID: PMC8491703 DOI: 10.1080/16549716.2021.1963527] [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] [Indexed: 11/29/2022] Open
Abstract
Background The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality. Objective To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4+ cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors. Methods A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios (sHRs) for AIDS-related mortality with baseline CD4+ cell counts and ART initiation time were determined using a competing risk model. Results Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22–0.27) or had baseline CD4+ counts of >500 cells/μL (sHR: 0.23, 95% CI: 0.19–0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4+ counts >350 cells/μL (sHR: 4.42, 95% CI: 3.30–5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4+ counts ≤350 cells/μL (sHR: 4.33, 95% CI: 3.58–5.23). Conclusions Our results demonstrate that patients with high CD4+ cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4+ cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China.
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Affiliation(s)
- Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xuening Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weiping Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yanmin Ma
- Institute of STD/AIDS Prevention and Control, Henan Provincial Center for Diseases Prevention and Control, Zhengzhou, China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.,Zhengzhou University Library, Zhengzhou University, Zhengzhou, China
| | - Theodore Gondwe
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuping Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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11
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Trikha R, Greig D, Kelley BV, Mamouei Z, Sekimura T, Cevallos N, Olson T, Chaudry A, Magyar C, Leisman D, Stavrakis A, Yeaman MR, Bernthal NM. Inhibition of Angiotensin Converting Enzyme Impairs Anti-staphylococcal Immune Function in a Preclinical Model of Implant Infection. Front Immunol 2020; 11:1919. [PMID: 33042111 PMCID: PMC7518049 DOI: 10.3389/fimmu.2020.01919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Evidence suggests the renin-angiotensin system (RAS) plays key immunomodulatory roles. In particular, angiotensin-converting enzyme (ACE) has been shown to play a role in antimicrobial host defense. ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) are some of the most commonly prescribed medications, especially in patients undergoing invasive surgery. Thus, the current study assessed the immunomodulatory effect of RAS-modulation in a preclinical model of implant infection. Methods:In vitro antimicrobial effects of ACEi and ARBs were first assessed. C57BL/6J mice subsequently received either an ACEi (lisinopril; 16 mg/kg/day), an ARB (losartan; 30 mg/kg/day), or no treatment. Conditioned mice blood was then utilized to quantify respiratory burst function as well as Staphylococcus aureus Xen36 burden ex vivo in each treatment group. S. aureus infectious burden for each treatment group was then assessed in vivo using a validated mouse model of implant infection. Real-time quantitation of infectious burden via bioluminescent imaging over the course of 28 days post-procedure was assessed. Host response via monocyte and neutrophil infiltration within paraspinal and spleen tissue was quantified by immunohistochemistry for F4/80 and myeloperoxidase, respectively. Results: Blood from mice treated with an ACEi demonstrated a decreased ability to eradicate bacteria when mixed with Xen36 as significantly higher levels of colony forming units (CFU) and biofilm formation was appreciated ex vivo (p < 0.05). Mice treated with an ACEi showed a higher infection burden in vivo at all times (p < 0.05) and significantly higher CFUs of bacteria on both implant and paraspinal tissue at the time of sacrifice (p < 0.05 for each comparison). There was also significantly decreased infiltration and respiratory burst function of immune effector cells in the ACEi group (p < 0.05). Conclusion: ACEi, but not ARB, treatment resulted in increased S. aureus burden and impaired immune response in a preclinical model of implant infection. These results suggest that perioperative ACEi use may represent a previously unappreciated risk factor for surgical site infection. Given the relative interchangeability of ACEi and ARB from a cardiovascular standpoint, this risk factor may be modifiable.
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Affiliation(s)
- Rishi Trikha
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Danielle Greig
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Benjamin V Kelley
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Zeinab Mamouei
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Troy Sekimura
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Thomas Olson
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Ameen Chaudry
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Clara Magyar
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Daniel Leisman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexandra Stavrakis
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
| | - Michael R Yeaman
- Divisions of Molecular Medicine and Infectious Diseases, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, United States
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12
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Oumer A, Kubsa ME, Mekonnen BA. Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis. BMC Pediatr 2019; 19:474. [PMID: 31801487 PMCID: PMC6892183 DOI: 10.1186/s12887-019-1823-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/07/2019] [Indexed: 01/24/2023] Open
Abstract
Background Approximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia. Method A retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance. Results A total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84). Conclusions Low nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.
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Affiliation(s)
- Abdu Oumer
- Department of Public Health, College of Heath Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Mina Edo Kubsa
- Department of Public Health, College of Heath Sciences and Medicine, Wolkite University, Wolkite, Ethiopia.
| | - Berhanu Abebaw Mekonnen
- Department of Nutrition and Dietetics, School of Public Heath, Bahir Dar University, Bahir Dar, Ethiopia
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