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Salto JN, Volkow P, Herrera-Goepfert R, López-Garcia AI, Cortes-Garcia BY, García-Pérez FO, Arroyo-Hernandez M, Rivera-Rosales RM. Unmasked Kaposi and sarcoidosis immune reconstitution inflammatory syndrome in a patient with AIDS. AIDS 2024; 38:933-934. [PMID: 38578965 DOI: 10.1097/qad.0000000000003851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
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Kahabuka MS, Woldeamanuel Y, Mbelele PM, Mpolya EA, Mpagama SG, Kessy JP, Manyazewal T. HIV viral suppression and risk of viral rebound in patients on antiretroviral therapy: a two- year retrospective cohort study in Northern Tanzania. BMC Infect Dis 2024; 24:390. [PMID: 38605325 PMCID: PMC11007878 DOI: 10.1186/s12879-024-09161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/21/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The world is moving towards the third target of the Joint United Nations Programme on HIV/AIDS to ensure most people receiving antiretroviral therapy (ART) are virologically suppressed. Little is known about viral suppression at an undetectable level and the risk of viral rebound phenomenon in sub-Saharan Africa which covers 67% of the global HIV burden.This study aimed to investigate the proportion of viral suppression at an undetectable level and the risk of viral rebound among people living with HIV receiving ART in northern Tanzania. METHODOLOGY A hospital based-retrospective study recruited people living with HIV who were on ART for at least two years at Kibong'oto Infectious Disease Hospital and Mawenzi Regional Referral Hospital in Kilimanjaro Region, Tanzania. Participants' two-year plasma HIV were captured at months 6, 12, and 24 of ART. Undetectable viral load was defined by plasma HIV of viral load (VL) less than 20copies/ml and viral rebound (VR) was considered to anyone having VL of more than 50 copies/ml after having history of undetectable level of the VL less than 20copies/ml. A multivariable log-binomial generalized linear model was used to determine factors for undetectable VL and viral VR. RESULTS Among 416 PLHIV recruited, 226 (54.3%) were female. The mean (standard deviation) age was 43.7 (13.3) years. The overall proportion of undetectable VL was 68% (95% CI: 63.3-72.3) and 40.0% had viral rebound (95% CI: 34.7-45.6). Participants who had at least 3 clinic visits were 1.3 times more likely to have undetectable VL compared to those who had 1 to 2 clinic visits in a year (p = 0.029). Similarly, participants with many clinical visits ( > = 3 visits) per year were less likely to have VR compared to those with fewer visits ( = 2 visits) [adjusted relative risk (aRR) = 0.64; 95% CI: 0.44-0.93]. CONCLUSION Participants who had fewer clinic visits per year(ART refills) were less likely to achieve viral suppression and more likely to experience viral rebound. Enhanced health education and close follow-up of PLHIV on antiretroviral therapy are crucial to reinforce adherence and maintain an undetectable viral load.
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Affiliation(s)
- Monica S Kahabuka
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania.
| | - Yimtubezinash Woldeamanuel
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Peter M Mbelele
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - Emmanuel A Mpolya
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Institute for Health Metrics and Evaluation, Population Health Building/Hans Rosling Center, University of Washington, 3980 15th Avenue, 98195, Seattle, WA, USA
| | - Stellah G Mpagama
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Jonas P Kessy
- Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
| | - Tsegahun Manyazewal
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
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Vos WAJW, Vadaq N, Matzaraki V, Otten T, Groenendijk AL, Blaauw MJT, van Eekeren LE, Brinkman K, de Mast Q, Riksen NP, Stalenhoef AFH, van Lunzen J, van der Ven AJAM, Blok WL, Stalenhoef JE. Cardiometabolic Differences in People Living with HIV Receiving Integrase Strand Transfer Inhibitors Compared to Non-nucleoside Reverse Transcriptase Inhibitors: Implications for Current ART Strategies. Viruses 2024; 16:582. [PMID: 38675924 PMCID: PMC11054623 DOI: 10.3390/v16040582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
In people living with HIV (PLHIV), integrase strand transfer inhibitors (INSTIs) are part of the first-line combination antiretroviral therapy (cART), while non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens are alternatives. Distinct cART regimens may variably influence the risk for non-AIDS comorbidities. We aimed to compare the metabolome and lipidome of INSTI and NNRTI-based regimens. The 2000HIV study includes asymptomatic PLHIV (n = 1646) on long-term cART, separated into a discovery cohort with 730 INSTI and 617 NNRTI users, and a validation cohort encompassing 209 INSTI and 90 NNRTI users. Baseline plasma samples from INSTI and NNRTI users were compared using mass spectrometry-based untargeted metabolomic (n = 500) analysis. Perturbed metabolic pathways were identified using MetaboAnalyst software. Subsequently, nuclear magnetic resonance spectroscopy was used for targeted lipoprotein and lipid (n = 141) analysis. Metabolome homogeneity was observed between the different types of INSTI and NNRTI. In contrast, higher and lower levels of 59 and 45 metabolites, respectively, were found in the INSTI group compared to NNRTI users, of which 77.9% (81/104) had consistent directionality in the validation cohort. Annotated metabolites belonged mainly to 'lipid and lipid-like molecules', 'organic acids and derivatives' and 'organoheterocyclic compounds'. In pathway analysis, perturbed 'vitamin B1 (thiamin) metabolism', 'de novo fatty acid biosynthesis', 'bile acid biosynthesis' and 'pentose phosphate pathway' were detected, among others. Lipoprotein and lipid levels in NNRTIs were heterogeneous and could not be compared as a group. INSTIs compared to individual NNRTI types showed that HDL cholesterol was lower in INSTIs compared to nevirapine but higher in INSTIs compared to doravirine. In addition, LDL size was lower in INSTIs and nevirapine compared to doravirine. NNRTIs show more heterogeneous cardiometabolic effects than INSTIs, which hampers the comparison between these two classes of drugs. Targeted lipoproteomic and lipid NMR spectroscopy showed that INSTI use was associated with a more unfavorable lipid profile compared to nevirapine, which was shifted to a more favorable profile for INSTI when substituting nevirapine for doravirine, with evidently higher fold changes. The cardiovascular disease risk profile seems more favorable in INSTIs compared to NNRTIs in untargeted metabolomic analysis using mass-spectrometry.
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Affiliation(s)
- Wilhelm A. J. W. Vos
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine and Infectious Diseases, OLVG, 1091 AC Amsterdam, The Netherlands
| | - Nadira Vadaq
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Twan Otten
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Albert L. Groenendijk
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC, Erasmus University, 3015 CN Rotterdam, The Netherlands
| | - Marc J. T. Blaauw
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine and Infectious Diseases, Elizabeth-Tweesteden Ziekenhuis, 5022 GC Tilburg, The Netherlands
| | - Louise E. van Eekeren
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine and Infectious Diseases, OLVG, 1091 AC Amsterdam, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Niels P. Riksen
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Anton F. H. Stalenhoef
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Jan van Lunzen
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | - Willem L. Blok
- Department of Internal Medicine and Infectious Diseases, OLVG, 1091 AC Amsterdam, The Netherlands
| | - Janneke E. Stalenhoef
- Department of Internal Medicine and Infectious Diseases, OLVG, 1091 AC Amsterdam, The Netherlands
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Thornhill JP, Fox J, Martin GE, Hall R, Lwanga J, Lewis H, Brown H, Robinson N, Kuldanek K, Kinloch S, Nwokolo N, Whitlock G, Fidler S, Frater J. Rapid antiretroviral therapy in primary HIV-1 infection enhances immune recovery. AIDS 2024; 38:679-688. [PMID: 38133660 DOI: 10.1097/qad.0000000000003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We present findings from a large cohort of individuals treated during primary HIV infection (PHI) and examine the impact of time from HIV-1 acquisition to antiretroviral therapy (ART) initiation on clinical outcomes. We also examine the temporal changes in the demographics of individuals presenting with PHI to inform HIV-1 prevention strategies. METHODS Individuals who fulfilled the criteria of PHI and started ART within 3 months of confirmed HIV-1 diagnosis were enrolled between 2009 and 2020. Baseline demographics of those diagnosed between 2009 and 2015 (before preexposure prophylaxis (PrEP) and universal ART availability) and 2015-2020 (post-PrEP and universal ART availability) were compared. We examined the factors associated with immune recovery and time to viral suppression. RESULTS Two hundred four individuals enrolled, 144 from 2009 to 2015 and 90 from 2015 to 2020; median follow-up was 33 months. At PHI, the median age was 33 years; 4% were women, 39% were UK-born, and 84% were MSM. The proportion of UK-born individuals was 47% in 2009-2015, compared with 29% in 2015-2020. There was an association between earlier ART initiation after PHI diagnosis and increased immune recovery; each day that ART was delayed was associated with a lower likelihood of achieving a CD4 + cell count more than 900 cells/μl [hazard ratio 0.99 (95% confidence interval, 95% CI 0.98-0.99), P = 0.02) and CD4/CD8 more than 1.0 (hazard ratio 0.98 (95% CI 0.97-0.99). CONCLUSION Early initiation of ART at PHI diagnosis is associated with enhanced immune recovery, providing further evidence to support immediate ART in the context of PHI. Non-UK-born MSM accounts for an increasing proportion of those with primary infection; UK HIV-1 prevention strategies should better target this group.
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Affiliation(s)
- John Patrick Thornhill
- Department of Infectious Diseases, Imperial College
- Imperial College National Institute of Health Research Biomedical Research Centre
- Imperial College NHS Trust
| | - Julie Fox
- Department of Genitourinary Medicine and Infectious Disease, Guys and St Thomas' NHS Trust and Kings College London, London
| | | | - Rebecca Hall
- Department of Infectious Diseases, Imperial College
- Imperial College National Institute of Health Research Biomedical Research Centre
- Imperial College NHS Trust
| | - Julianne Lwanga
- Department of Genitourinary Medicine and Infectious Disease, Guys and St Thomas' NHS Trust and Kings College London, London
| | - Heather Lewis
- Department of Infectious Diseases, Imperial College
- Imperial College National Institute of Health Research Biomedical Research Centre
| | - Helen Brown
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford
- Oxford National Institute of Health Research Biomedical Research Centre, Oxford
| | - Nicola Robinson
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford
- Oxford National Institute of Health Research Biomedical Research Centre, Oxford
| | - Kristen Kuldanek
- Department of Infectious Diseases, Imperial College
- Imperial College National Institute of Health Research Biomedical Research Centre
| | | | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Fidler
- Department of Infectious Diseases, Imperial College
- Imperial College National Institute of Health Research Biomedical Research Centre
- Imperial College NHS Trust
| | - John Frater
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford
- Oxford National Institute of Health Research Biomedical Research Centre, Oxford
- Royal Free Hospital
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Hashempour A, Khodadad N, Ziaei R, Rezaei B, Ghasabi F, Falahi S, Kenarkouhi A, Davarpanah MA. Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults. BMC Infect Dis 2024; 24:358. [PMID: 38549051 PMCID: PMC10976689 DOI: 10.1186/s12879-024-09251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/24/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND HIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS. METHODOLOGY This cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure. RESULTS Clinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure. CONCLUSION As the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95-95-95 plan.
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Affiliation(s)
- Ava Hashempour
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Khodadad
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ziaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Rezaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ghasabi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab Falahi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Azra Kenarkouhi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ali Davarpanah
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Le X, Shen Y. Advances in Antiretroviral Therapy for Patients with Human Immunodeficiency Virus-Associated Tuberculosis. Viruses 2024; 16:494. [PMID: 38675837 PMCID: PMC11054420 DOI: 10.3390/v16040494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Tuberculosis is one of the most common opportunistic infections and a prominent cause of death in patients with human immunodeficiency virus (HIV) infection, in spite of near-universal access to antiretroviral therapy (ART) and tuberculosis preventive therapy. For patients with active tuberculosis but not yet receiving ART, starting ART after anti-tuberculosis treatment can complicate clinical management due to drug toxicities, drug-drug interactions and immune reconstitution inflammatory syndrome (IRIS) events. The timing of ART initiation has a crucial impact on treatment outcomes, especially for patients with tuberculous meningitis. The principles of ART in patients with HIV-associated tuberculosis are specific and relatively complex in comparison to patients with other opportunistic infections or cancers. In this review, we summarize the current progress in the timing of ART initiation, ART regimens, drug-drug interactions between anti-tuberculosis and antiretroviral agents, and IRIS.
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Affiliation(s)
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;
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Kanyara L, Lel R, Kageha S, Kinyua J, Matu S, Ongaya A, Matilu M, Mwangi P, Okoth V, Mwangi J, Olungae D. Diabetes mellitus and associated risk factors among HIV infected patients on HAART. BMC Public Health 2024; 24:846. [PMID: 38504229 PMCID: PMC10949814 DOI: 10.1186/s12889-024-18265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Understanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.
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Affiliation(s)
- Lucy Kanyara
- Kenya Medical Research Institute, Nairobi, Kenya.
| | - Rency Lel
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Sophie Matu
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Asiko Ongaya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Mary Matilu
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Paul Mwangi
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Dama Olungae
- Kenya Medical Research Institute, Nairobi, Kenya
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Elvstam O, Dahl V, Weibull Wärnberg A, von Stockenström S, Yilmaz A. Difficult-to-treat HIV in Sweden: a cross-sectional study. BMC Infect Dis 2024; 24:325. [PMID: 38500050 PMCID: PMC10946097 DOI: 10.1186/s12879-024-09214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Our aim was to examine the prevalence and characteristics of difficult-to-treat HIV in the current Swedish HIV cohort and to compare treatment outcomes between people with difficult and non-difficult-to-treat HIV. METHODS In this cross-sectional analysis of the Swedish HIV cohort, we identified all people with HIV currently in active care in 2023 from the national register InfCareHIV. We defined five categories of difficult-to-treat HIV: 1) advanced resistance, 2) four-drug regimen, 3) salvage therapy, 4) virologic failure within the past 12 months, and 5) ≥ 2 regimen switches following virologic failure since 2008. People classified as having difficult-to-treat HIV were compared with non-difficult for background characteristics as well as treatment outcomes (viral suppression and self-reported physical and psychological health). RESULTS Nine percent of the Swedish HIV cohort in 2023 (n = 8531) met at least one criterion for difficult-to-treat HIV. Most of them had ≥ 2 regimen switches (6%), and the other categories of difficult-to-treat HIV were rare (1-2% of the entire cohort). Compared with non-difficult, people with difficult-to-treat HIV were older, had an earlier first year of positive HIV test and lower CD4 counts, and were more often female. The viral suppression rate among people with difficult-to-treat HIV was 84% compared with 95% for non-difficult (p = 0.001). People with difficult-to-treat HIV reported worse physical (but not psychological) health, and this remained statistically significant after adjustment for age, sex, and transmission group. CONCLUSIONS Although 9% of the HIV cohort in Sweden in 2023 were classified as having difficult-to-treat HIV, a large proportion of these were virally suppressed, and challenges such as advanced resistance and need for salvage therapy are rare in the current Swedish cohort.
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Affiliation(s)
- Olof Elvstam
- Department of Translational Medicine, Lund University, Malmö, Sweden.
- Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden.
| | - Viktor Dahl
- Unit of Infectious Diseases/Venhälsan, Southern Hospital, Stockholm, Sweden
| | - Anna Weibull Wärnberg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Cherkos AS, Cranmer LM, Njuguna I, LaCourse SM, Mugo C, Moraa H, Maleche-Obimbo E, Enquobahrie DA, Richardson BA, Wamalwa D, John-Stewart G. Effect of tuberculosis-HIV co-treatment on clinical and growth outcomes among hospitalized children newly initiating antiretroviral therapy. AIDS 2024; 38:579-588. [PMID: 38016160 PMCID: PMC10922257 DOI: 10.1097/qad.0000000000003797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Evaluate effects of tuberculosis (TB)-HIV co-treatment on clinical and growth outcomes in children with HIV (CHIV). DESIGN Longitudinal study among Kenyan hospitalized ART-naive CHIV in the PUSH trial (NCT02063880). METHODS CHIV started ART within 2 weeks of enrollment; Anti-TB therapy was initiated based on clinical and TB diagnostics. Children were followed for 6 months with serial viral load, CD4%, and growth assessments [weight-for-age z -score (WAZ), height-for-age z -score (HAZ), and weight-for-height z -score (WHZ)]. TB-ART treated and ART-only groups were compared at 6 months post-ART for undetectable viral load (<40 c/ml), CD4% change, and growth using generalized linear models, linear regression, and linear mixed-effects models, respectively. RESULT Among 152 CHIV, 40.8% (62) were TB-ART treated. Pre-ART, median age was 2.0 years and growth was significantly lower, and viral load significantly higher in the TB-ART versus ART-only group. After 6 months on ART, 37.2% of CHIV had undetectable viral load and median CD4% increased by 7.2% (IQR 2.0-11.6%) with no difference between groups. The TB-ART group had lower WAZ and HAZ over 6 month follow-up [WAZ -0.81 (95% CI: -1.23 to -0.38], P < 0.001; HAZ -0.15 (95% CI: -0.29 to -0.01), P = 0.030] and greater rate of WAZ increase in analyses unadjusted and adjusted for baseline WAZ [unadjusted 0.62 (95% CI: 0.18-1.07, P = 0.006) or adjusted 0.58 (95% CI: 0.12-1.03, P = 0.013)]. CONCLUSION TB-HIV co-treatment did not adversely affect early viral suppression and CD4 + recovery post-ART. TB-ART-treated CHIV had more rapid growth reconstitution, but growth deficits persisted, suggesting need for continued growth monitoring.
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Affiliation(s)
- Ashenafi S Cherkos
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Lisa M Cranmer
- Department of Pediatrics, Emory School of Medicine
- Department of Epidemiology, Emory Rollins School of Public Health
- Children's Healthcare of Atlanta, Atlanta, GA
| | - Irene Njuguna
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
- Medical Research Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Sylvia M LaCourse
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Cyrus Mugo
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Hellen Moraa
- Department of Pediatrics and Child Health, University of Nairobi, Kenya
| | | | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Barbra A Richardson
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, School of Public Health
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
- Medical Research Department, Kenyatta National Hospital, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Zhao X, Hou JY, Zhu JJ, Zheng MN, Li L, Ning TL, Yu MH. [Characteristics of baseline viral load before antiretroviral therapy in newly reported HIV-infected patients in Tianjin, 2019-2022]. Zhonghua Liu Xing Bing Xue Za Zhi 2024; 45:353-357. [PMID: 38514311 DOI: 10.3760/cma.j.cn112338-20230912-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Objective: To understand the baseline viral load (VL) of newly reported HIV- infected patients before antiretroviral therapy and related factors in Tianjin. Methods: Data were obtained from the China Disease Control and Prevention Information System, and the study subjects were HIV-infected patients before the first antiretroviral therapy in Tianjin from 2019 to 2022, and the information about their socio-demographic characteristics, baseline CD4+T lymphocyte (CD4) counts before antiretroviral therapy and baseline VL test results were collected, the baseline high VL was defined as ≥100 000 copies/ml. The effect of different factors on viral load were analyzed. Software SPSS 24.0 was used for statistical analysis. Results: A total of 1 296 newly reported HIV-infected patients were included in the study, in whom 15.89% (206/1 296) had high baseline VL, and multifactorial logistic regression analysis showed that those with history of STD (aOR=1.45, 95%CI:1.00-2.08) were more likely to have high baseline VL. Compared with those with baseline CD4 counts <200 cells/μl, those with baseline CD4 counts 200-350 cells/μl (aOR=0.40, 95%CI: 0.27-0.57), 351-500 cells/μl (aOR=0.32, 95%CI: 0.20-0.49), and >500 cells/μl (aOR=0.30, 95%CI: 0.18-0.49) were less likely to have high baseline VL. Conclusions: The proportion of HIV-infected patients with high baseline VL before antiretroviral therapy was low in Tianjin during 2019-2022. History of STD and baseline CD4 counts <200 cells/μl were associated with high baseline VL in HIV-infected patients, to which close attention needs to be paid in AIDS prevention and control.
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Affiliation(s)
- X Zhao
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - J Y Hou
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - J J Zhu
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - M N Zheng
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - L Li
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - T L Ning
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
| | - M H Yu
- Department of AIDS/STD Prevention and Control, Tianjin Centers for Disease Control and Prevention/Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin 300011, China
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Sackeya E, Beru MM, Angmortey RN, Opoku DA, Boakye K, Baatira M, Yakubu MS, Mohammed A, Ayisi-Boateng NK, Boateng D, Nakua EK, Edusei AK. Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana. PLoS One 2024; 19:e0290810. [PMID: 38446777 PMCID: PMC10917304 DOI: 10.1371/journal.pone.0290810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/09/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs. METHODS A retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. "Stptime" per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk. RESULTS The cumulative survival probability was 0.8847 (95% CI: 0.8334-0.9209). The overall mortality rate was 51.89 (95% CI: 36.89-72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6-9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78-14.13) p = 0.002] were associated with mortality. CONCLUSION Survival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.
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Affiliation(s)
- Eugene Sackeya
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Tatale District Hospital, Tatale, Northern Region, Ghana
| | - Martin Muonibe Beru
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Tamale Teaching Hospital, Tamale Metropolitan, Tamale, Ghana
| | - Richard Nomo Angmortey
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Tamale Teaching Hospital, Tamale Metropolitan, Tamale, Ghana
| | - Douglas Aninng Opoku
- Allen Clinic, Family Health Services, Kumasi, Ghana
- Department of Global Health and Internal Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Boakye
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Musah Baatira
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- St. Joseph’s Midwifery Training College, Jirapa, Ghana
| | - Mohammed Sheriff Yakubu
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Nursing and Midwifery Training College, Nalerigu-Ghana
| | - Aliyu Mohammed
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Boateng
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Kweku Edusei
- Department of Health Promotion, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Castillo‐Rozas G, Tu S, Luz PM, Mejia F, Sierra‐Madero J, Rouzier V, Shepherd BE, Cortes CP. Clinical outcomes and risk factors for immune recovery and all-cause mortality in Latin Americans living with HIV with virological success: a retrospective cohort study. J Int AIDS Soc 2024; 27:e26214. [PMID: 38494667 PMCID: PMC10945036 DOI: 10.1002/jia2.26214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/16/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Immune reconstitution following antiretroviral therapy (ART) initiation is crucial to prevent AIDS and non-AIDS-related comorbidities. Patients with suppressed viraemia who fail to restore cellular immunity are exposed to an increased risk of morbidity and mortality during long-term follow-up, although the underlying mechanisms remain poorly understood. We aim to describe clinical outcomes and factors associated with the worse immune recovery and all-cause mortality in people living with HIV (PLWH) from Latin America following ART initiation. METHODS Retrospective cohort study using the CCASAnet database: PLWH ≥18 years of age at ART initiation using a three drug-based combination therapy and with medical follow-up for ≥24 months after ART initiation and undetectable viral load were included. Patients were divided into four immune recovery groups based on rounded quartiles of increase in CD4 T-cell count at 2 years of treatment (<150, [150, 250), [250, 350] and >350 cells/mm3 ). Primary outcomes included all-cause mortality, AIDS-defining events and non-communicable diseases that occurred >2 years after ART initiation. Factors associated with an increase in CD4 T-cell count at 2 years of treatment were evaluated using a cumulative probability model with a logit link. RESULTS In our cohort of 4496 Latin American PLWH, we found that patients with the lowest CD4 increase (<150) had the lowest survival probability at 10 years of follow-up. Lower increase in CD4 count following therapy initiation (and remarkably not a lower baseline CD4 T-cell count) and older age were risk factors for all-cause mortality. We also found that older age, male sex and higher baseline CD4 T-cell count were associated with lower CD4 count increase following therapy initiation. CONCLUSIONS Our study shows that PLWH with lower increases in CD4 count have lower survival probabilities. CD4 increase during follow-up might be a better predictor of mortality in undetectable PLWH than baseline CD4 count. Therefore, it should be included as a routine clinical variable to assess immune recovery and overall survival.
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Affiliation(s)
- Gabriel Castillo‐Rozas
- Laboratory of Molecular and Cellular VirologyInstitute of Biomedical SciencesFaculty of MedicineUniversity of ChileSantiagoChile
- HIV/AIDS Workgroup, Faculty of MedicineUniversity of ChileSantiagoChile
| | - Shengxin Tu
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Paula Mendes Luz
- Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Fernando Mejia
- Instituto de Medicina Tropical Alexander von HumboldtUniversidad Peruana Cayetano HerediaLimaPerú
| | - Juan Sierra‐Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCiudad de MéxicoMéxico
| | - Vanessa Rouzier
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections OpportunistesPort‐au‐PrinceHaiti
| | - Bryan E. Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Claudia P. Cortes
- HIV/AIDS Workgroup, Faculty of MedicineUniversity of ChileSantiagoChile
- Department of Internal MedicineFaculty of MedicineUniversity of ChileSantiagoChile
- Hospital Clínico San Borja Arriarán & Fundación ArriaránSantiagoChile
- Millenium Institute on Immunology and ImmunotherapySantiagoChile
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Konstantinov IE, Zubritskiy A. Do we all need to learn aortic valve repair the HAART way? J Thorac Cardiovasc Surg 2024; 167:e74-e75. [PMID: 37737790 DOI: 10.1016/j.jtcvs.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Victoria, Australia
| | - Alexey Zubritskiy
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
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14
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Akram B, Khan M, Humphrey MB. HIV-Associated Rheumatic Diseases: A Narrative Review. J Clin Rheumatol 2024; 30:e42-e45. [PMID: 37723618 DOI: 10.1097/rhu.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
ABSTRACT Human immunodeficiency virus (HIV) is widely prevalent among the world population. Although, historically, it has been linked to opportunistic infections in keeping with immunodeficiency and immune dysregulation, it has also been associated with a wide variety of autoimmune manifestations. With the introduction of highly active antiretroviral therapy and subsequent restoration of immunity, there have been multiple immune-mediated diseases that have resurfaced in the HIV population. Our review highlights autoimmune diseases in association with HIV and its targeted therapies in detail.
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15
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Arnold EM, Kamal S, Rotheram-Borus MJ, Bridges SK, Gertsch W, Norwood P, Swendeman D. Factors Associated With Antiretroviral Adherence Among Youth Living With HIV. J Acquir Immune Defic Syndr 2024; 95:215-221. [PMID: 37977178 PMCID: PMC10922292 DOI: 10.1097/qai.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Youth living with HIV (YLH) have an increased risk for psychosocial stressors that can affect their antiretroviral (ARV) adherence. We examined factors associated with self-reported ARV adherence among YLH ages 12-24 years old. SETTING YLH (N = 147) were recruited in Los Angeles, CA, and New Orleans, LA from 2017 to 2020. METHODS YLH whose self-reported recent (30 days) ARV adherence was "excellent" or "very good" were compared with nonadherent YLH on sociodemographic, clinical, and psychosocial factors using univariate and multivariate analyses. RESULTS Participants were predominantly male (88%), and 81% identified as gay, bisexual, transgender, queer, or other. The mean duration on ARV was 27 months (range 0-237 months). Most YLH (71.2%) self-reported being adherent, and 79% of those who self-reported adherence were also virally suppressed (<200 copies/mL). Multivariate analysis indicated being adherent was significantly associated with white race [aOR = 8.07, confidence intervals (CI): 1.45 to 74.0], Hispanic/Latinx ethnicity [aOR = 3.57, CI: 1.16 to 12.80], more social support [aOR = 1.11, CI: 1.05 to 1.18], and being on ARV for a shorter duration [aOR = 0.99, CI: 0.97 to 0.99]. Mental health symptoms, substance use, age, and history of homelessness or incarceration were unrelated to adherence. CONCLUSIONS Enhancing efforts to provide support for adherence to non-white youth, and those with limited social support and who have been on ARV treatment longer, may help increase viral suppression among YLH.
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Affiliation(s)
| | - Susan Kamal
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - S Kate Bridges
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX; and
| | - William Gertsch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Peter Norwood
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
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16
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Boyce CL, Frenkel LM. The role of HIV biology in defining virological failure. Lancet HIV 2024; 11:e133-e134. [PMID: 38417975 DOI: 10.1016/s2352-3018(24)00033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Ceejay L Boyce
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA 98109, USA
| | - Lisa M Frenkel
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA 98109, USA; Department of Pediatrics, Department of Laboratory Medicine, Department of Global Health, and Department of Medicine, University of Washington, Seattle, WA, USA.
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17
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Azzman N, Gill MSA, Hassan SS, Christ F, Debyser Z, Mohamed WAS, Ahemad N. Pharmacological advances in anti-retroviral therapy for human immunodeficiency virus-1 infection: A comprehensive review. Rev Med Virol 2024; 34:e2529. [PMID: 38520650 DOI: 10.1002/rmv.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/23/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
The discovery of anti-retroviral (ARV) drugs over the past 36 years has introduced various classes, including nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitor, fusion, and integrase strand transfer inhibitors inhibitors. The introduction of combined highly active anti-retroviral therapies in 1996 was later proven to combat further ARV drug resistance along with enhancing human immunodeficiency virus (HIV) suppression. As though the development of ARV therapies was continuously expanding, the variation of action caused by ARV drugs, along with its current updates, was not comprehensively discussed, particularly for HIV-1 infection. Thus, a range of HIV-1 ARV medications is covered in this review, including new developments in ARV therapy based on the drug's mechanism of action, the challenges related to HIV-1, and the need for combination therapy. Optimistically, this article will consolidate the overall updates of HIV-1 ARV treatments and conclude the significance of HIV-1-related pharmacotherapy research to combat the global threat of HIV infection.
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Affiliation(s)
- Nursyuhada Azzman
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Pulau Pinang Kampus Bertam, Permatang Pauh, Pulau Pinang, Malaysia
| | - Muhammad Shoaib Ali Gill
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sharifah Syed Hassan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Frauke Christ
- Laboratory for Molecular Virology and Gene Therapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Zeger Debyser
- Laboratory for Molecular Virology and Gene Therapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Wan Ahmad Syazani Mohamed
- Nutrition Unit, Nutrition, Metabolism and Cardiovascular Research Centre (NMCRC), Level 3, Block C, Institute for Medical Research (IMR), National Institutes of Health (NIH) Complex, Ministry of Health Malaysia (MOH), Shah Alam, Selangor, Malaysia
| | - Nafees Ahemad
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Kwizera E, Wampande EM, Kato CD, Mujinya P, Wandera A, Bwambale F, Mpumbya JR, Siida R, Ssekatawa K. Hepatoprotective effect of methanol fruit extract of Punica granatum L in highly active antiretroviral therapy-induced toxicity in Wistar rats. Drug Chem Toxicol 2024; 47:243-251. [PMID: 38303124 DOI: 10.1080/01480545.2023.2298891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/01/2023] [Indexed: 02/03/2024]
Abstract
Prolonged use of Highly Active Antiretroviral Therapy (HAART) has been linked to toxicity, particularly hepatotoxicity. There are few effective drugs for HAART patients that promote hepatic cell regeneration and prevent liver injury. Therefore, the purpose of this study was to investigate the hepato-protective activity of Methanol fruit extract of Punica granatum (MFEPG) in HAART-administered rats. Thirty rats weighing between 150-200 g were randomly divided into six groups and each group comprised of five rats. Distilled water was given to the rats in group one. Only HAART was given to the rats in group two. MFEPG at doses of 100 and 400 mg/kg was given to the rats in groups three and four. MFEPG dosages of 100 and 400 mg/kg along with HAART were given to the rats in groups five and six, respectively. All treatments were via oral gavage daily for 40 days. Under halothane anesthesia, all rats were sacrificed on day 41. Liver tissues were utilized for lipid peroxidation marker; Malondialdehyde (MDA), antioxidant enzymes; Superoxide dismutase (SOD) and Catalase (CAT) and histological evaluation, while blood samples were examined for biochemical parameters (AST, ALT, ALP, Total cholesterol, Total protein, and Albumin). The HAART-treated group exhibited a significantly higher amount of the lipid peroxidation end product; MDA, and significantly lower levels of antioxidant enzymes; SOD, and CAT. Liver enzymes and total cholesterol were significantly increased with a significant reduction in Total protein and Albumin levels in the HAART-treated group. Conversely, the liver function biomarkers were returned to normal levels in the HAART and MFEPG-treated groups. Histopathological studies revealed that when HAART-exposed rats were treated with MFEPG, both the biochemical and histological results significantly improved. Thus, the antioxidant activity of MFEPG provides protection against HAART-induced liver oxidative damage. More research is needed to determine the safety of using MFEPG in humans.
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Affiliation(s)
- Eliah Kwizera
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Eddie M Wampande
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Charles D Kato
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Pastori Mujinya
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Allan Wandera
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Fred Bwambale
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Jackie Rachael Mpumbya
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Robert Siida
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Kenneth Ssekatawa
- Department of Science Technical and Vocational Education, Makerere University, Kampala, Uganda
- Africa Center Excellence in Materials Product Development and Nanotechnology (MAPRONANO ACE), College of Engineering Design Art and Technology, Makerere University, Kampala, Uganda
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Gebremedhin T, Aynalem M, Adem M, Geremew D, Aleka Y, Kiflie A. Dolutegravir based therapy showed CD4 + T cell count recovery and viral load suppression among ART naïve people living with HIV AIDS: a pilot evaluation. Sci Rep 2024; 14:3297. [PMID: 38331983 PMCID: PMC10853173 DOI: 10.1038/s41598-024-53282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
Recently, dolutegravir (DTG)-based combined therapy, a more effective and safer first-line antiretroviral therapy (ART), has been recommended by the World Health Organization for the treatment of Human Immunodeficiency Virus (HIV) since July 2018. However, its effectiveness in CD4+ T-cells count recovery and viral load suppression has not been studied yet in Ethiopia, where HIV is endemic. Therefore, we aimed to conduct a pilot assessment on the effect of DTG-based therapy on CD4+ T-cell count and viral load count among people living with HIV (PLWH) in Ethiopia. A longitudinal prospective cohort study was conducted from July 2020 to February 2021. 109 PLWH who are ART naive but plan to initiate DTG-based therapy were recruited. HIV viral ribonucleic acid (RNA) copies were determined using polymerase chain reaction. To compute the difference in viral load and CD4+ T-cell counts between the baseline, 3rd, and 6th months, a Friedman test was used. The study included 109 PLWH who had never received antiretroviral medication. Participants taking DTG-based treatment showed significantly decreasing median (IQR) values of viral load count (copies/mL) from 446,812 (237649.5-732994.5) at baseline to 34 (23.5-46) at 3 months and 0.0 (0-19) at 6 months of treatment follow-up. Although the treatment increases the proportion of participants with HIV-1 RNA 50 copies/mL from 0 (0% at baseline) to 87 (79.8%) and 100 (91.7%) at the 3rd and 6th months of treatment, respectively, On the other hand, the CD4+ T-cell count increased significantly during treatment: median (IQR): 209 (81.5-417.5) versus 291 (132-522) versus 378 (181-632.5) cells/L at baseline, the 3rd and 6th months of the treatment follow-up period, respectively. We found dolutegravir-based therapy was a promising option with high virological suppression rates and CD4+ T-cell count recovery, demonstrating a restoration of cellular immunity. Moreover, Viral load suppression rates were high after the initiation of the treatment. We recommend further research should be conducted with a larger number of participants to acquire greater awareness of the treatment outcomes.
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Affiliation(s)
| | - Melak Aynalem
- Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia
| | - Mohammed Adem
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Demeke Geremew
- Department of Medical Laboratory Sciences, Immunology and Molecular Biology Unit, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yetemwork Aleka
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia.
| | - Amare Kiflie
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
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20
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Muhie NS. Predictors for viral load suppression among HIV positive adults under ART treatment in University of Gondar Comprehensive Specialized Hospital: retrospective cohort study. Sci Rep 2024; 14:3258. [PMID: 38332157 DOI: 10.1038/s41598-024-53569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
HIV continues to be a serious global public health concern, having 40.4 million lives up to now and continuing to spread throughout all countries. The objective of this study was to identify predictors for viral load suppression among HIV positive adults under ART treatment in University of Gondar Comprehensive Specialized Hospital, Ethiopia. An institution based retrospective cohort study design was carry out from 30th March 2017-30th March 2022.Accelerated failure time model were employed to get wide-ranging information about adult HIV positive patients. In this study out of 378 study participants, about 77.8% were suppressed viral load count and the rest were censored. The Weibull AFT model results revealed that predictors were older age (φ = 0.774, 95% CI 0.602-0.793), primary educators (φ = 0.931, 95% CI 0.809-0.964), patients disclosed the disease to family member (φ = 1.093, 95% CI 1.001-1.457), viral load < 10,000 copies/mL (φ = 1.153, 95% CI 1.015-1.309), hemoglobin level ≥ 11g/dL (φ = 1.145, 95% CI 1.028-1.275), CD4 cell count ≥ 200 per mm3 (φ = 1.147, 95% CI 1.019-1.290), weight ≥ 50 kg (φ = 1.151, 95% CI 1.033-1.275), BMI between 18.5 and 24.9 kg/m3 (φ = 1.143, 95% CI 1.007-1.296), fair treatment adherence (φ = 1.867, 95% CI 1.778-1.967), good treatment adherence (φ = 1.200, 95% CI 1.046-1.377), advanced WHO clinical stages (φ = 0.923, 95% CI 0.899-0.946), patients with OCC (φ = 0.821, 95% CI 0.720-0.936) and substance use (φ = 0.876, 95% CI 0.773-0.993) statistically significant predictors for viral load suppression at 5% level of significance. Then, near intensive care of adult patients' whose ages between 25 and 34 years, primary educational level, advanced WHO clinical stage, patients with OCC, and substance users can help them improve their health and live longer. Lastly, further studies should be done on HIV positive adult patients by considering other important independent variables that were not included in this study.
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Affiliation(s)
- Nurye Seid Muhie
- Department of Statistics, College of Natural and Computational Science, Mekdela Amba University, Tulu Awuliya, Ethiopia.
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21
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Prates GDS, Monteiro MA, Oliveira ÉC, Nascimento NADL, Veiga APR, Ferreira MD, Polis TJB, Caetano GP, Soares BRP, Magri MMC, Pereira LO, Fonseca LAM, Alves WS, Duarte AJDS, Casseb JSDR. Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection. Rev Inst Med Trop Sao Paulo 2024; 66:e7. [PMID: 38324873 PMCID: PMC10846540 DOI: 10.1590/s1678-9946202466007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 02/09/2024] Open
Abstract
Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.
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Affiliation(s)
- Gabriela da Silva Prates
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Mariana Amelia Monteiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Éricka Constantinov Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Najara Ataide de Lima Nascimento
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Ana Paula Rocha Veiga
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Mauricio Domingues Ferreira
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Thales José Bueno Polis
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Gabriela Prandi Caetano
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Beatriz Rodrigues Pellegrina Soares
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Luisa Oliveira Pereira
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Luiz Augusto Marcondes Fonseca
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Wagner Silva Alves
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Jorge Simão do Rosário Casseb
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
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22
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Mabhida SE, Mchiza ZJ, Mokgalaboni K, Hanser S, Choshi J, Mokoena H, Ziqubu K, Masilela C, Nkambule BB, Ndwandwe DE, Kengne AP, Dludla PV. High-sensitivity C-reactive protein among people living with HIV on highly active antiretroviral therapy: a systemic review and meta-analysis. BMC Infect Dis 2024; 24:160. [PMID: 38308222 PMCID: PMC10838000 DOI: 10.1186/s12879-024-09050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p < 0.001). Where lipid profiles, as a major predictor for CVD risk, were also impaired in PLWH on HAART when compared to PLWH not on HAART and HIV-negative participants. In conclusion, elevated levels of hs-CRP and lipid levels are prevalent in PLWH on HAART, this may increase the risk of CVD complications, especially for those people living in Africa. However, more evidence in larger population studies is required to confirm these outcomes and unveil any possible clinical implications of HAART-induced modulation of hs-CRP levels in PLWH.
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Affiliation(s)
- Sihle E Mabhida
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.
| | - Zandile J Mchiza
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, University of South Africa, Roodepoort, 1709, South Africa
| | - Sidney Hanser
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Joel Choshi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Haskly Mokoena
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Khanyisani Ziqubu
- Department of Biochemistry, North-West University, Mmabatho, 2745, South Africa
| | - Charity Masilela
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Richards Bay, 3880, South Africa
| | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Duduzile E Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - André P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa
- Department of Medicine, University of Cape Town, Cape Town, 7700, South Africa
| | - Phiwayinkosi V Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Richards Bay, 3880, South Africa
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23
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Lee CY, Lin YP, Lin CY, Chen TC, Kuo SH, Lo SH, Wang SF, Lu PL. Trends and the associated factors of optimal immunological response and virological response in late anti-retroviral therapy initiation HIV cases in Taiwan from 2009 to 2020. J Infect Public Health 2024; 17:339-348. [PMID: 38194765 DOI: 10.1016/j.jiph.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/22/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Late cART initiation (CD4 count ≤200 cells/μL or AIDS-defining opportunistic illnesses [AOIs] at cART initiation) impedes CD4 count recovery and virologic suppression after cART initiation. However, studies to evaluate trends of and modifiable factors for optimal immunological response (IR) and virological response (VR) in people living with HIV (PLWH) with late cART initiation with the current HIV treatment strategies are limited. METHODS We retrospectively identified 475 PLWH with late cART initiation in 2009-2020. Patients were grouped based on the presence of IR (CD4 count ≥200 cells/μL) or VR (plasma viral load [PVL] ≤ 50 copies/mL) within 18 months after cART initiation (403 [84.8%] IR(+) and 72 [15.2%] IR(-); 422 [88.8%] VR(+) and 53 [11.2%] VR(-)). We used Joinpoint regression to identify IR (+) and VR(+) proportion changes. RESULTS From 2009 to 2020, the proportion of IR(+) patients remained unchanged (75% to 90%, P = 0.102), whereas that of VR(+) patients increased significantly (75% to 95%, P = 0.007). No join point was identified for either IR(+) or VR(+), and the annual percentage change was 0.56% (nonsignificant) and 1.35% (significant) for IR(+) and VR(+), respectively. Compared to IR(-) patients, IR(+) patients were more likely to have a higher pre-cART PVL, to start with a first-line INSTI-based regimen, or to start cART within 14 days of HIV diagnosis but were less likely to have chronic kidney disease, composite AOIs, or a lower pre-cART CD4 count. Compared to VR(-) patients, VR(+) patients were more likely to start a single-tablet regimen but were less likely to have a higher pre-cART PVL. CONCLUSIONS Our study identified several modifiable factors for optimal IR (rapid cART initiation and INSTI-based regimen initiation) and for optimal VR (STR initiation) among late initiators, which may guide early treatment modifications to reduce their AIDS-defining event incidence and mortality.
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Affiliation(s)
- Chun-Yuan Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chun-Yu Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Tun-Chieh Chen
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Shin-Huei Kuo
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Shih-Hao Lo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan , ROC; Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Po-Liang Lu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Taiwan, ROC.
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24
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Lee EH, Lee JA, Kim CH, Lee KH, Kim J, Kim JH, Ahn JY, Ku NS, Choi JY, Yeom JS, Jeong SJ. Pentraxin 3 as an Immune Recovery Marker in HIV Infection After Combination Antiretroviral Therapy. AIDS Res Hum Retroviruses 2024; 40:110-113. [PMID: 37335044 DOI: 10.1089/aid.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection causes chronic inflammation in affected individuals. Chronic inflammation may hinder immunological recovery. Treatment with combination antiretroviral therapy (cART) is insufficient to reduce inflammation. Pentraxin 3 (PTX3) is an inflammatory marker associated with cardiovascular disease, malignancy, and acute infection. This study evaluated the usefulness of serum PTX3 levels in measuring inflammation levels, which may be associated with the probability of immune recovery in people living with HIV (PLH). In this single-center prospective study, we measured serum PTX3 levels in PLH treated with cART. Clinical information on HIV status, type of cART administered, and CD4+ and CD8+ T cell counts at the initial diagnosis of HIV and at study enrollment was obtained from each participant. PLH were divided into good and poor responder groups according to their CD4+ T cell counts at enrollment. A total of 198 PLH were enrolled in this study. A total of 175 and 23 participants were assigned to the good and poor responder groups, respectively. The poor responder group exhibited higher PTX3 levels (0.53 ng/mL vs. 1.26 ng/mL, p = .032). Logistic regression analysis demonstrated that low body mass index [odds ratio (OR) = 0.8, p = .010], low initial CD4+ T cell counts at diagnosis (OR = 0.994, p = .001), and high PTX3 levels (OR = 1.545, p = .006) are clinical factors that were significantly associated with poor immune recovery in PLH. According to the Youden index, PTX3 levels >1.25 ng/mL are associated with poor immune recovery. PLH should be clinically, virologically, and immunologically evaluated. Serum PTX level is a useful inflammatory marker associated with immune recovery in PLH treated with cART.
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Affiliation(s)
- Eun Hwa Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ah Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyup Kim
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hyun Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinnam Kim
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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25
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Du R, Huang J. Machine Learning Revealed a Novel Ferroptosis-Based Classification for Diagnosis in Antiretroviral Therapy-Treated HIV Patients with Defective Immune Recovery. AIDS Res Hum Retroviruses 2024; 40:90-100. [PMID: 37031354 DOI: 10.1089/aid.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
Despite virological suppression, the CD4+ T lymphocytes are not restored in some HIV-infected patients after antiretroviral therapy. These individuals are known as immune non-responders (INRs). INRs are at high risk of developing AIDS and non-AIDS-related events and have a shorter life expectancy. Hence, it is vital to identify INRs early and prevent their complications, but there are still no specific diagnostic indicators or models. Ferroptosis has lately been reported as a type of programmed cell death, which plays an indispensable part in diverse diseases. However, its particular regulatory mechanisms remain unclear and its function in the pathogenic process of defective immunological recovery is still unknown. Blood is mainly used for rapid diagnosis because it enables quick testing. To investigate the role of ferroptosis-related genes (FRGs) in early detection of INRs, we scrutinized Gene Expression Omnibus datasets of peripheral blood samples to estimate their effectiveness. To our knowledge, for the first time, gene expression data were utilized in this study to discover six FRGs that were explicitly expressed in peripheral blood from INRs. Later on, multiple machine-supervised learning algorithms were employed, and a superlative diagnostic model for INRs was built with the random forest algorithm, which displayed satisfactory diagnostic efficiency in the training cohort (area under the curve [AUC] = 0.99) and one external validation cohort (AUC = 0.727). Our findings suggest that FRGs are implicated in the development of defective immune recovery, presenting a potential route for early detection and potential biological targets for the most effective treatment of defective immune recovery.
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Affiliation(s)
- Ruoyang Du
- Department of Urology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jianfeng Huang
- Department of Urology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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26
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Jasinski MJ. HAART-anatomical internal annuloplasty technology still in evolution. Eur J Cardiothorac Surg 2024; 65:ezae004. [PMID: 38212997 DOI: 10.1093/ejcts/ezae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Marek J Jasinski
- Clinical Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, 50-556, POLAND
- Cardiothoracic Surgery, Royal Brompton Hospital, London, SW36NP, UK
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27
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Baba MM, Buba F, Talle MA, Garbati MA, Abdul H. Assessment of Right Ventricular Systolic Function using Tricuspid Annular Plane Systolic Excursion (TAPSE) among HIV Patients on HAART and Its Relationship with Viral Load and CD4 Cell Count. West Afr J Med 2024; 41:25-29. [PMID: 38412062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND The introduction of highly active antiretroviral therapy (HAART) has decreased the morbidity and mortality associated with HIV infection; however, this survival advantage is not free from complications. HIV patients are more likely to develop cardiovascular disease compared with the general population, and right ventricular systolic dysfunction is said to be associated with worse outcomes. We, therefore, sought to assess right ventricular systolic function using tricuspid annular plain systolic excursion (TAPSE) among HIV patients on HAART and its relationship with viral load and CD4 cell count. METHODS The study was a cross-sectional conducted among HIV patients receiving HAART at the Federal Medical Centre, Nguru, Yobe State, Northeastern Nigeria. Right ventricular systolic function was assessed using tricuspid annular plane systolic excursion. RESULTS One hundred and seven (107) subjects were recruited into the study comprising thirty-seven (34.6%) males and seventy (65.4%) females. The mean CD4 cell count and viral load of the studied patients were 612.65 ± 347.62 cells/μL and 315.44±271.11copies/mL, respectively. The distribution of RVSF according to CD4 cell count showed, fifteen (14.01%) patients with CD4 cell count less than 250 had reduced right ventricular systolic function (RVSF), 30 (28.03%) patients with CD4 cell count 250 - 500 had reduced RVSF, 1 (0.93%) patient with CD4 cell count 250 - 500 had normal RVSF, 47 (43.92%) patients with CD4 cell count 501 -1,000 had normal RVSF and 14(13.08%) patients with CD4 cell count greater than 1,000 had normal RVSF. Fourteen (13.08%) patients with undetectable viral load had normal RVSF, 47(43.92%) patients with viral load 50 - 1,500 had normal RVSF, 1(0.93%) patient with viral load 1,501 - 10,000 had normal RVSF, 30(28.03%) patients with viral load 1,501 - 10,000 had reduced RVSF and 15(14.01%) patients with viral load 10,000 - 50,000 had reduced RVSF. There was a positive and significant correlation between tricuspid annular plain systolic excursion with CD4 cell count and a negative but significant correlation HIV viral load. CONCLUSION We therefore concluded that asymptomatic right ventricular systolic dysfunction exists among patients with HIV infection and there was positive and significant correlation between tricuspid annular plain systolic excursion with CD4 cells count and a negative but significant correlation HIV viral load.
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Affiliation(s)
- M M Baba
- Department of Medicine, Yobe State University Teaching Hospital Damaturu, Nigeria. ; Phone: +2348065588144
| | - F Buba
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - M A Talle
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - M A Garbati
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Habu Abdul
- Department of Medicine, Yobe State University Teaching Hospital Damaturu, Nigeria. ; Phone: +2348065588144
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28
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Stam AJ, Buchholtz NVEJ, Bierman WFW, van Crevel R, Hoepelman AIM, Claassen MAA, Ammerlaan HSM, van Welzen BJ, van Kasteren MEE, van Lelyveld SFL, de Jong D, Tesselaar K, van Luin M, Nijhuis M, Wensing AMJ, Team LOWERITS. Dynamics of Low-Level Viremia and Immune Activation after Switching to a Darunavir-Based Regimen. Viruses 2024; 16:182. [PMID: 38399959 PMCID: PMC10893305 DOI: 10.3390/v16020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
There is an ongoing debate regarding whether low-level viremia (LLV), in particular persistent LLV, during HIV treatment with optimal adherence originates from low-level viral replication, viral production, or both. We performed an observational study in 30 individuals with LLV who switched to a boosted darunavir (DRV)-based therapy. In-depth virological analyses were used to characterize the viral population and the (activity) of the viral reservoir. Immune activation was examined using cell-bound and soluble markers. The primary outcome was defined as the effect on HIV-RNA and was categorized by responders (<50 cp/mL) or non-responders (>50 cp/mL). At week 24, 53% of the individuals were considered responders, 40% non-responders, and 7% could not be assigned. Sequencing showed no evolution or selection of drug resistance in the non-responders. Production of defective virus with mutations in either the protease (D25N) or RT active site contributed to persistent LLV in two individuals. We show that in about half of the study participants, the switch to a DRV-based regimen resulted in a viral response indicative of ongoing low-level viral replication as the cause of LLV before the switch. Our data confirm that in clinical management, high genetic barrier drugs like DRV are a safe choice, irrespective of the source of LLV.
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Affiliation(s)
- Arjen J. Stam
- Translational Virology Research Group, Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Infectious Diseases, Public Health Service Amsterdam, 1018 WT Amsterdam, The Netherlands
| | - Ninée V. E. J. Buchholtz
- Translational Virology Research Group, Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Wouter F. W. Bierman
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Andy I. M. Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Mark A. A. Claassen
- Department of Internal Medicine, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Heidi S. M. Ammerlaan
- Department of Internal Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Berend J. van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | | | - Dorien de Jong
- Translational Virology Research Group, Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Kiki Tesselaar
- Department of Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Monique Nijhuis
- Translational Virology Research Group, Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Annemarie M. J. Wensing
- Translational Virology Research Group, Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Cordeiro SA, Lopes TCP, Boechat AL, Gonçalves RL. Weight loss and mortality in people living with HIV: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:34. [PMID: 38166819 PMCID: PMC10762994 DOI: 10.1186/s12879-023-08889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In the first reported cases of human immunodeficiency virus (HIV) infection, people living with HIV (PLHIV) suffered weight loss, which was an independent predictor of mortality. Highly active antiretroviral therapy (HAART) has changed this scenario for ideal weight, overweight, and even obesity. However, some PLHIV, even on HAART, continue to lose weight. Thus, the guiding question of the study was: do PLHIV hospitalized using HAART with weight loss have higher mortality than hospitalized PLHIV using HAART without weight loss? METHOD A systematic review and meta-analysis of prospective cohort studies published in English, Spanish, or Portuguese, searched in the MedLine, Embase, and LILACS databases from March 2020, until October 2023, reported by MOOSE. We analyzed the methodological quality and risk of bias using the Joanna Briggs Institute Critical Appraisal Tool for Cohort Studies; used the risk ratio (RR) to calculate the probability of hospitalized PLWH who lost weight dying, applied the random effect model and created the funnel plot. We used the inverse variance test estimated by the Mantel-Haenszel method, considering a 95% confidence interval (CI), heterogeneity (I2), total effect size (Z), and significance value of p < 0.05. We performed a sensitivity analysis with meta-regression and meta-analyses on subgroups to diagnose influence and outliers. The quality of evidence and strength of recommendation were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE). RESULTS We included 10 of the 711 studies identified, totaling 1,637 PLHIV. The studies were from South Africa (1), Canada (1), China (1), Brazil (1), Cameroon (1), Ethiopia (1), Thailand (1), Colombia (1), and Tanzania (2), from 1996 to 2017. The average age of the participants was 33.1 years old, and the male was predominant. The leading causes of hospital admission were related to co-infections, and the average hospitalization time was 20.5 days. The prevalence of death in hospitalized PLHIV using HAART who lost weight was 57.5%, with a 1.5 higher risk of dying (RR: 1.50, 95% CI: 1.03, 2.19, p = 0.04) than hospitalized PLHIV who did not lose weight. CONCLUSION We concluded, with a very low confidence level, that that weight loss significantly increased the risk of death in hospitalized PLWH using HAART. TRIAL REGISTRATION AND FUNDING PROSPERO International Prospective Register of Systematic Reviews CRD42020191246 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020191246 .
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Affiliation(s)
- Sarah Almeida Cordeiro
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil.
| | - Tainá Costa Pereira Lopes
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
| | - Antonio Luiz Boechat
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
| | - Roberta Lins Gonçalves
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
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Alfar HR, Nthenge-Ngumbau DN, Saatman KE, Whiteheart SW. EcoHIV-Infected Mice Show No Signs of Platelet Activation. Viruses 2023; 16:55. [PMID: 38257755 PMCID: PMC10819473 DOI: 10.3390/v16010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Platelets express several surface receptors that could interact with different viruses. To understand the mechanisms of HIV-1's interaction with platelets, we chose the EcoHIV model. While EcoHIV is an established model for neuroAIDS, its effects on platelets are ill-defined. Our results indicate that EcoHIV behaves differently from HIV-1 and is cleared from circulation after 48 h post-infection. The EcoHIV course of infection resembles an HIV-1 infection under the effects of combined antiretroviral therapy (cART) since infected mice stayed immunocompetent and the virus was readily detected in the spleen. EcoHIV-infected mice failed to become thrombocytopenic and showed no signs of platelet activation. One explanation is that mouse platelets lack the EcoHIV receptor, murine Cationic Amino acid Transporter-1 (mCAT-1). No mCAT-1 was detected on their surface, nor was any mCAT-1 mRNA detected. Thus, mouse platelets would not bind or become activated by EcoHIV. However, impure virus preparations, generated by Polyethylene Glycol (PEG) precipitation, do activate platelets, suggesting that nonspecific PEG-precipitates may contain other platelet activators (e.g., histones and cell debris). Our data do not support the concept that platelets, through general surface proteins such as DC-SIGN or CLEC-2, have a wide recognition for different viruses and suggest that direct platelet/pathogen interactions are receptor/ligand specific.
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Affiliation(s)
- Hammodah R. Alfar
- Department of Molecular and Cellular Biochemistry, College of Medicine, University of Kentucky, Lexington, KY 40506, USA;
| | - Dominic Ngima Nthenge-Ngumbau
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40506, USA; (D.N.N.-N.); (K.E.S.)
| | - Kathryn E. Saatman
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40506, USA; (D.N.N.-N.); (K.E.S.)
| | - Sidney W. Whiteheart
- Department of Molecular and Cellular Biochemistry, College of Medicine, University of Kentucky, Lexington, KY 40506, USA;
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Matsui Y, Miura Y. Advancements in Cell-Based Therapies for HIV Cure. Cells 2023; 13:64. [PMID: 38201268 PMCID: PMC10778010 DOI: 10.3390/cells13010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
The treatment of human immunodeficiency virus (HIV-1) has evolved since the establishment of combination antiretroviral therapy (ART) in the 1990s, providing HIV-infected individuals with approaches that suppress viral replication, prevent acquired immunodeficiency syndrome (AIDS) throughout their lifetime with continuous therapy, and halt HIV transmission. However, despite the success of these regimens, the global HIV epidemic persists, prompting a comprehensive exploration of potential strategies for an HIV cure. Here, we offer a consolidated overview of cell-based therapies for HIV-1, focusing on CAR-T cell approaches, gene editing, and immune modulation. Persistent challenges, including CAR-T cell susceptibility to HIV infection, stability, and viral reservoir control, underscore the need for continued research. This review synthesizes current knowledge, highlighting the potential of cellular therapies to address persistent challenges in the pursuit of an HIV cure.
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Affiliation(s)
- Yusuke Matsui
- Gladstone Institute of Virology, Gladstone Institutes, 1650 Owens St., San Francisco, CA 941578, USA
| | - Yasuo Miura
- Department of Transfusion Medicine and Cell Therapy, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan
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Muhie NS, Tegegne AS. Predictors for CD4 cell count and hemoglobin level with survival time to default for HIV positive adults under ART treatment at University of Gondar Comprehensive and Specialized Hospital, Ethiopia. BMC Res Notes 2023; 16:357. [PMID: 38042846 PMCID: PMC10693704 DOI: 10.1186/s13104-023-06625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND HIV/AIDS is the most known powerful risk factor for morbidity and mortality in the world. The greatest biological markers in HIV patients are CD4 cell count and hemoglobin level, as they are independent predictors of survival of HIV patients. The objective of this study was to investigate the common socio-demographic, clinical, and behavioral Predictor's affecting the CD4 cell count, and hemoglobin level with survival time to default from ART treatment among HIV positive adults under ART treatment at university of Gondar comprehensive and specialized hospital, North-west Ethiopia. METHOD This study was conducted at University of Gondar comprehensive specialized hospital by using a retrospective cohort follow up study design. The source of data in this study was secondary data obtained from patients chart. Bayesian joint models were employed to get wide-ranging information about HIV/AIDS progression. RESULT From a total of 403 HIV positive adults, about 44.2% were defaulted from therapy and the rest were actively followed ART treatment. The estimate of the association parameter for the current true value of CD4 cell count ([Formula: see text]), and hemoglobin level ([Formula: see text]), trend of CD4 cell count ([Formula: see text]) and hemoglobin level ([Formula: see text]) is positive. Positive values indicating that the higher CD4 cell count and hemoglobin level is related with the higher time of defaulting from ART. Predictor's hematocrit, weight, platelet cell count, lymphocyte count, sex, adherence, and WHO clinical stage were joint determinate risk factors affecting CD4 cell count, hemoglobin level and time to default at 5% level of significance. CONCLUSION Current study results revealed that hematocrit, weight, BMI, platelet cell count, lymphocyte count, sex (female), and good treatment adherence were significantly associated with higher CD4 cell count, hemoglobin level and time to default while having advanced WHO clinical stage-IV had significantly decreased CD4 cell, hemoglobin level, and time to default from treatment. Patients with HIV should be given special attention based on these important factors to improve their health and prolong their lives.
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Wang J, Wang G, Zhu X, Li L, Kang D, Liu Y, Zhang N. The care status and factors affecting antiretroviral therapy timing for people living with HIV: a retrospective cohort study in Shandong Province, China. AIDS Care 2023; 35:1963-1970. [PMID: 36919489 DOI: 10.1080/09540121.2023.2185197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
This study described the care status of People Living with HIV (PLWH) including antiretroviral therapy (ART) and viral suppression from 2018 to 2020. We recognized that immediate ART was associated with improved viral suppression. Therefore, we also aimed to explore the factors affecting the early initiation of ART. We initiated a retrospective cohort study to evaluate the care status of people living with HIV in Shandong Province. From 2018 to 2020, patients infected by homosexual transmission in particular had a higher ART rate (78.82%, 79.69%, and 87.72%, respectively). Of PLWH who received ART, 79.57%, 77.63%, and 67.71% achieved viral suppression, respectively. However, COVID-19 may affect the rate of ART and viral suppression, which we need to explore in our research. From 2018 to 2020, the proportion of immediate antiretroviral therapy within 30 days of diagnosis increased from 48.12% to 65.42%. Multivariate logistic regression demonstrated that patients with junior college degree or above (OR, 1.39 [95%CI, 1.12-1.73]) and key population or medical institutions (OR, 3.62 [95%CI, 2.18-6.16]; OR, 3.88 [95%CI, 2.33-6.59]) were substantially likely to receive ART immediately, while patients outside the province (OR, 0.60 [95%CI, 0.50-0.73]) were less likely to receive ART immediately.
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Affiliation(s)
- Jiongjiong Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
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Viral, cellular and immune aspects of non-suppressible HIV-1 viremia. Nat Med 2023; 29:3016-3017. [PMID: 37996710 DOI: 10.1038/s41591-023-02688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
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Gregori N, Renzetti S, Izzo I, Faletti G, Fumarola B, Degli Antoni M, Arsuffi S, Storti S, Tiecco G, Calza S, Caruso A, Castelli F, Quiros-Roldan E, Focà E. Does the rapid initiation of antiretroviral therapy at HIV diagnosis impact virological response in a real-life setting? A single-centre experience in Northern Italy. AIDS Care 2023; 35:1938-1947. [PMID: 36795128 DOI: 10.1080/09540121.2023.2176425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
Rapid initiation of antiretroviral therapy (ART) has been proven efficacious and safe, but more investigations are needed to define feasibility of rapid ART approach in real-life settings.We conducted a retrospective, observational study on newly HIVdiagnosed patients referred to our Infectious Diseases Department from September 1st, 2015, to July 31st, 2019. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400-days-period. The hazard ratios of each predictor on viral suppression were estimated through the Cox proportional hazard model.The median time from HIV diagnosis to the first medical referral was 15 days and the median time from the first care access to therapy start was 24 days. Among patients, 37.6% started ART within 7 days, 20.6% between 8 and 30 days, and 41.8% after 30 days. Longer time to ART start and higher baseline viral load were associated with a lower probability of viral suppression. After one year, all groups showed a high viral suppression rate (99%). In a high-income setting the rapid ART approach seems useful to accelerate viral suppression which is great over time regardless of ART initiation timing.
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Affiliation(s)
- Natalia Gregori
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefano Renzetti
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ilaria Izzo
- Department of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Giulio Faletti
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Benedetta Fumarola
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Melania Degli Antoni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefania Arsuffi
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Samuele Storti
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giorgio Tiecco
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Emanuele Focà
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Huang Z, Liu J, Lin K, Yang F, Yan Y, Xie Y, Tan Z, Liu Q, Li J, Wang L, Zhou Y, Yao G, Huang S, Ye C, Cen M, Liao X, Xu L, Zhang C, Yan Y, Huang L, Li Y, Yang Y, Fu X, Jiang H. Factors Associated with Immediate Antiretroviral Therapy Initiation Among Newly Diagnosed People Living with HIV in Guangdong Province, China. AIDS Patient Care STDS 2023; 37:561-565. [PMID: 38096117 DOI: 10.1089/apc.2023.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Zhaoqian Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jun Liu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Kaihao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Fang Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yao Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yingqian Xie
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qicai Liu
- Supervision Ward, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Guangdong AIDS and HCV Diagnosis and Treatment Quality Control Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lihua Wang
- Department of HIV/AIDS Control and Prevention, Jiangmen Center for Disease Control and Prevention, Jiangmen, China
| | - Yi Zhou
- Department of HIV/AIDS Control and Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Gang Yao
- Department of HIV/AIDS Control and Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Department of HIV/AIDS Control and Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Chenglong Ye
- Department of HIV/AIDS Control and Prevention, Yangjiang Center for Disease Control and Prevention, Yangjiang, China
| | - Meixi Cen
- Department of HIV/AIDS Control and Prevention, Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Xiaowen Liao
- Department of HIV/AIDS Control and Prevention, Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Lu Xu
- Department of HIV/AIDS Control and Prevention, Shantou Center for Disease Control and Prevention, Shantou, China
| | - Chi Zhang
- Department of HIV/AIDS Control and Prevention, Shantou Center for Disease Control and Prevention, Shantou, China
| | - Yubin Yan
- Department of HIV/AIDS Control and Prevention, Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Lin Huang
- Department of HIV/AIDS Control and Prevention, Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Yan Li
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaobing Fu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Centre for Clinical Research, Epidimiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
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Getaneh Y, Getnet F, Rashid A, Kang L, Chu Q, Li S, Yi F, Shao Y. The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia. Emerg Microbes Infect 2023; 12:2271065. [PMID: 37824698 PMCID: PMC10614708 DOI: 10.1080/22221751.2023.2271065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
ABBREVIATIONS AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University.
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Affiliation(s)
- Yimam Getaneh
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fentabil Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- T.H. Chan School of Public Health, Boston, MA, USA
| | - Abdur Rashid
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Li Kang
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Qingfei Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Sisi Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Feng Yi
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yiming Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
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Cao B, Liu M, Zhu R, Yuan T, E'er A, Song S, Wang T, Zhong L. HIV-1 DNA drug resistance testing to guide successful suppression of low-level viraemia: a case report. Sex Transm Infect 2023; 99:575. [PMID: 37604681 DOI: 10.1136/sextrans-2023-055860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Affiliation(s)
- Bianchuan Cao
- Department of Infectious Disease, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Tuberculosis, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Mei Liu
- Antiviral Therapy Center, the First People's Hospital of Yuexi County, Liangshan, Sichuan, China
| | - Rui Zhu
- Antiviral Therapy Center, the First People's Hospital of Yuexi County, Liangshan, Sichuan, China
| | - Tianru Yuan
- Antiviral Therapy Center, the First People's Hospital of Yuexi County, Liangshan, Sichuan, China
| | - A'shamu E'er
- Antiviral Therapy Center, the First People's Hospital of Yuexi County, Liangshan, Sichuan, China
| | - Shaofang Song
- Antiviral Therapy Center, the First People's Hospital of Yuexi County, Liangshan, Sichuan, China
| | - Tong Wang
- MOE Key Laboratory of Tumor Molecular Biology, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Li Zhong
- Department of Infectious Disease, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Tuberculosis, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Kuse N, Gatanaga H, Zhang Y, Chikata T, Oka S, Takiguchi M. Epitope-dependent effect of long-term cART on maintenance and recovery of HIV-1-specific CD8 + T cells. J Virol 2023; 97:e0102423. [PMID: 37877716 PMCID: PMC10688310 DOI: 10.1128/jvi.01024-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
IMPORTANCE HIV-1-specific CD8+ T cells are anticipated to become effector cells for curative treatment using the "shock and kill" approach in people living with HIV-1 (PLWH) under combined antiretroviral therapy (cART). Previous studies demonstrated that the frequency of HIV-1-specific CD8+ T cells is reduced under cART and their functional ability remains impaired. These studies analyzed T-cell responses to a small number of HIV-1 epitopes or overlapping HIV-1 peptides. Therefore, the features of CD8+ T cells specific for HIV-1 epitopes under cART remain only partially clarified. Here, we analyzed CD8+ T cells specific for 63 well-characterized epitopes in 90 PLWH. We demonstrated that CD8+ T cells specific for large numbers of HIV-1 epitopes were maintained in an epitope-dependent fashion under long-term cART and that long-term cART enhanced or restored the ability of HIV-1-specific T cells to proliferate in vitro. This study implies that some HIV-1-specific T cells would be useful as effector cells for curative treatment.
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Affiliation(s)
- Nozomi Kuse
- Division of International Collaboration Research and Tokyo Joint Laboratory, Department of Frontier Research, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- AIDS Research Center, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yu Zhang
- Division of International Collaboration Research and Tokyo Joint Laboratory, Department of Frontier Research, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Takayuki Chikata
- Division of International Collaboration Research and Tokyo Joint Laboratory, Department of Frontier Research, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Takiguchi
- Division of International Collaboration Research and Tokyo Joint Laboratory, Department of Frontier Research, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
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Echefu SN, Udosen JE, Akwiwu EC, Akpotuzor JO, Obeagu EI. Effect of Dolutegravir regimen against other regimens on some hematological parameters, CD4 count and viral load of people living with HIV infection in South Eastern Nigeria. Medicine (Baltimore) 2023; 102:e35910. [PMID: 38013350 PMCID: PMC10681510 DOI: 10.1097/md.0000000000035910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Appropriate usage of highly active antiretroviral therapy (HAART) suppresses human immunodeficiency virus (HIV) replication. One of such HAART is dolutegravir (DTG) containing regimen which Nigeria included in her national protocol, as the preferred first-line option, with particularly fixed dose combination of tenofovir/lamivudine/dolutegravir (TLD) in 2018. AIM To access the impact of this regimen as against other regimens on some hematological parameters as well as cluster of differentiation 4 (CD4) count and viral load on people living with HIV infection. METHODS The study site is a health facility center supported by President Emergency Plan for acquired immunodeficiency syndrome (AIDS) Relief where people living with HIV infection (PLWHIV) visit for their routine management in Abakaliki, Ebonyi State. A hundred and twenty-two (122) subjects participated, 58 PLWHIV and 64 control subjects. CD4 + count by partec cyflow auto analyzer, while the Viral load assay was by Roche COBAS Ampriplep/COBAS TaqMan molecular systems. Full blood count determination was by Sysmex XE-2100 hematology auto analyzer, while the detection of antibody to HAART was by Petz and direct Coombs tests. RESULTS Mean values of hemoglobin (Hb), Total white cell count, Lymphocytes, Monocytes and CD4 + counts of people living with HIV infection (PLWHIV) were significantly (P = .0001) lower than the control subjects. The Hb level of PLWHIV on Efavirenz combination (TDF/3TC/EFV) are comparable 123 ± 32g/l with those on Ritonavir combination (TDF/3TC/LPV/R) 136 ± 16g/l and Dolutegravir (TLD)134 ± 20.0g/l (P = .307). On the other hand, total white cell count (4.55 ± 1.99 × 109/L) of those on Efavirenz combination (TDF/3TC/EFV) and Dolutegravir (TLD) (4.53 ± 1.31 × 109/L) were significantly higher than those on Ritonavir combination (TDF/3TC/LPV/R) (4.09 ± 1.15 × 109/L). The Viral Load of PLWHIV on Dolutegravir (TLD) was significantly lower 171.57 ± 4.56 copies/mL than those on Efavirenz combination (TDF/3TC/EFV) (86,395.91 ± 27,476.57copies/mL) and Ritonavir combination (TDF/3TC/LPV/R) (81,188.83 ± 13,393.47 copies/mL), respectively. CONCLUSION Some hematological parameters (such as Hb, total white cell counts and CD4 + count) were lower in people living with HIV than values seen in control group. The 3 regimens used in the management of HIV infection in the locality revealed comparable Packed cell volume and Hemoglobin levels. Total white cell count of those on Efavirenz and DTG is comparable with higher values than those on Ritonavir.
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Affiliation(s)
- Stella N. Echefu
- Alex Ekwume Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | | | - Euphoria C. Akwiwu
- Department of Haematology and Blood Transfusion Science, University of Calabar, Nigeria
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Munjoma PT, Chandiwana P, Wyss J, Mazhandu AJ, Jordi SBU, Gutsire R, Katsidzira L, Yilmaz B, Misselwitz B, Duri K. Immune activation and inflammation in lactating women on combination antiretroviral therapy: role of gut dysfunction and gut microbiota imbalance. Front Immunol 2023; 14:1280262. [PMID: 38045684 PMCID: PMC10693333 DOI: 10.3389/fimmu.2023.1280262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Combination antiretroviral therapy (cART) effectively controls HIV; however, chronic low-level viremia and gut microbiota dysbiosis remain significant drivers of gut and systemic inflammation. In this study, we explored the relationship between gut microbiota composition, intestinal inflammation, microbial translocation, and systemic inflammation in women on cART in Sub-Saharan Africa. Methods We conducted a study in HIV-infected and HIV-uninfected lactating women followed up at 6 weeks and 6 months postpartum in Harare, Zimbabwe. We used 16S ribosomal Ribonucleic Acid (rRNA) sequencing and MesoScale Discovery V-Plex assays to examine the gut microbiome and to quantify plasma inflammatory biomarkers, respectively. In addition, we measured fecal calprotectin, plasma lipopolysaccharide-binding protein (LBP), and soluble cluster of differentiation 14 (sCD14) by enzyme-linked immunosorbent assay to assess gut inflammation, microbial translocation, and monocyte/macrophage activation. Results A group of 77 lactating women were studied, of which 35% were HIV-infected. Fecal calprotectin levels were similar by HIV status at both follow-up time points. In the HIV-infected group at 6 weeks postpartum, fecal calprotectin was elevated: median (interquartile range) [158.1 µg/g (75.3-230.2)] in women who had CD4+ T-lymphocyte counts <350 cells/µL compared with those with ≥350 cells/µL [21.1 µg/g (0-58.4)], p = 0.032. Plasma sCD14 levels were significantly higher in the HIV-infected group at both 6 weeks and 6 months postpartum, p < 0.001. Plasma LBP levels were similar, but higher levels were observed in HIV-infected women with elevated fecal calprotectin. We found significant correlations between fecal calprotectin, LBP, and sCD14 with proinflammatory cytokines. Gut microbial alpha diversity was not affected by HIV status and was not affected by use of antibiotic prophylaxis. HIV significantly affected microbial beta diversity, and significant differences in microbial composition were noted. The genera Slackia and Collinsella were relatively more abundant in the HIV-infected group, whereas a lower relative abundance of Clostriduim sensu_stricto_1 was observed. Our study also found correlations between gut microbial taxa abundance and systemic inflammatory biomarkers. Discussion and conclusion HIV-infected lactating women had increased immune activation and increased microbial translocation associated with increased gut inflammation. We identified correlations between the gut inflammation and microbial composition, microbial translocation, and systemic inflammation. The interplay of these parameters might affect the health of this vulnerable population.
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Affiliation(s)
- Privilege Tendai Munjoma
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Panashe Chandiwana
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Jacqueline Wyss
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, Maurice Müller Laboratories, University of Bern, Bern, Switzerland
| | - Arthur John Mazhandu
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Sebastian Bruno Ulrich Jordi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, Maurice Müller Laboratories, University of Bern, Bern, Switzerland
| | - Rutendo Gutsire
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Leolin Katsidzira
- Department of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, Maurice Müller Laboratories, University of Bern, Bern, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, Maurice Müller Laboratories, University of Bern, Bern, Switzerland
| | - Kerina Duri
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
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Affiliation(s)
- Iulia Filip
- MedEd Medical Communications, LLC, Bluffton, South Carolina, USA
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Yarlagadda K, Werne R, Sinha N. Lung transplant in chronic HIV infection. BMJ Case Rep 2023; 16:e253855. [PMID: 37963662 PMCID: PMC10649389 DOI: 10.1136/bcr-2022-253855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Lung transplantation is the treatment of choice for many end-stage chronic lung conditions. Chronic Human Immunodeficiency Virus (HIV) infection is considered a relative contraindication for lung transplantation. In the era of Highly Active Antiretroviral Therapy (HAART), there has been an increase in the number of HIV-positive patients living with chronic lung conditions. In this paper, we aim to summarise the available literature in the field of lung transplantation in HIV-positive patients. We also present our experience of an HIV-positive woman who underwent lung transplantation for chronic interstitial lung disease from an HIV-negative donor.Careful candidate selection, along with management focused on closer monitoring, may result in favourable outcomes, including improved longevity among HIV-positive patients with chronic lung disease.
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Affiliation(s)
- Keerthi Yarlagadda
- Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rachel Werne
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neeraj Sinha
- Department of Pulmonary and Critical Care Medicine, Miami Transplant Institute, University of Miami, Jackson Health System, Miami, Florida, USA
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Piegas E, Ziolkowski M, Bittencourt R, Malheiros C, Miranda F, Dias C, Mocellin L, Haas S. Factors associated with adherence to antiretroviral therapy in HIV-infected subjects and the use of indicators to characterize the treatment adhesion profile. Braz J Med Biol Res 2023; 56:e12738. [PMID: 37970919 PMCID: PMC10644963 DOI: 10.1590/1414-431x2023e12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.
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Affiliation(s)
- E.M. Piegas
- Programa de Pós-Graduação em Ciências Farmacêuticas, Laboratório de Farmacologia e Farmacometria, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
| | - M.I. Ziolkowski
- Programa de Pós-Graduação em Ciências Farmacêuticas, Laboratório de Farmacologia e Farmacometria, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
- Departamento Municipal de Saúde, Uruguaiana, RS, Brasil
| | | | - C.K.C. Malheiros
- Programa de Pós-Graduação em Bioquímica, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
| | - F.F. Miranda
- Programa de Pós-Graduação em Ciências Farmacêuticas, Laboratório de Farmacologia e Farmacometria, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
| | - C.F. Dias
- Laboratório de Farmacologia e Farmacometria, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
| | - L.P. Mocellin
- Curso de Medicina, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
| | - S.E. Haas
- Programa de Pós-Graduação em Ciências Farmacêuticas, Laboratório de Farmacologia e Farmacometria, Universidade Federal do Pampa, Uruguaiana, RS, Brasil
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Jiang R, Song Z, Liu L, Mei X, Sun J, Qi T, Wang Z, Song W, Tang Y, Yang J, Xu S, Zhao B, Shen Y, Zhang R, Chen J. Survival and prognostic factors of progressive multifocal leukoencephalopathy in people living with HIV in modern ART era. Front Cell Infect Microbiol 2023; 13:1208155. [PMID: 38029233 PMCID: PMC10663249 DOI: 10.3389/fcimb.2023.1208155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background The incidence of progressive multifocal leukoencephalopathy (PML) in people living with HIV (PLWH) is 2%-4%. Currently, there is no effective therapeutic strategy for the treatment of PML in PLWH, resulting in a mortality of up to 50%. This study aimed to identify risk factors of death and prognostic markers in people living with HIV with PML. Methods A retrospective cohort study of AIDS-related PML individuals was conducted from January 1, 2015, to October 1, 2022, in Shanghai, China. PLWH who were diagnosed with PML for the first time were included. Kaplan-Meier curve and Cox regression were used to analyze the survival and its predictors. Levels of inflammatory markers and immune checkpoint inhibitors in blood and cerebrospinal fluid (CSF) were measured in the prestored samples using bead-based multiplex assay Indolamine 2,3-dioxygenase was determined using ELISA. Results Twenty of 71 subjects had initiated antiretroviral therapy (ART) before PML onset and no patients discontinued ART during this period. In total, 34 patients (47.9%) had opportunistic infections (OIs), the median CD4+ T cell count was 73.0 (33.0-149.0) cells/μL. The estimated probability of survival at six months was 78% (95% confidential intervals [CIs]:0.63-0.85). OIs, low CD4+ T cell count were associated with lower estimated six-month survival (hazard ratio 8.01, 95% CIs: 1.80-35.00, P=0.006 and 5.01, 95% CIs:1.57-16.03, p=0.007). Indolamine 2,3-dioxygenase activity in CSF of non-survivors group were higher than survivors group (p<0.05). Conclusions The survival rate of AIDS-related PML in the modern ART era was higher than the survival rate a decade ago. Low CD4+T cell count, OIs, were all associated with death of individuals with AIDS-related PML. The role of IDO in AIDS-related PML warrant further investigation.
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Affiliation(s)
- Rui Jiang
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zichen Song
- Scientifc Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Li Liu
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xue Mei
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jianjun Sun
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Tangkai Qi
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhenyan Wang
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Song
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yang Tang
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Junyang Yang
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shuibao Xu
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Bihe Zhao
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yinzhong Shen
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Renfang Zhang
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Tsiakalos A, Routsias JG, Schinas G, Georgiadou S, Sipsas NV, Akinosoglou K. Investigating the Role of Anti-TPO Antibodies in HIV-Associated Thrombocytopenia before and after Initiation of HAART: A Case-Control Longitudinal Study. Viruses 2023; 15:2226. [PMID: 38005902 PMCID: PMC10675467 DOI: 10.3390/v15112226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This longitudinal, case-control study aimed to investigate the role of thrombopoietin (TPO) and anti-TPO antibodies in HIV-associated thrombocytopenia, focusing on the changes seen before and after the initiation of highly active antiretroviral therapy (HAART). Patients were assessed before and at least six months after the initiation of HAART. In total, 75 PLWHIV (age/sex-matched and randomized at 2:1, according to thrombocytopenia status) were included in this study. The baseline assessment revealed significantly higher TPO levels in thrombocytopenic patients (140.45 vs. 106.8 mg/mL, p = 0.008). Furthermore, anti-TPO-positive patients displayed lower platelet counts (109,000 vs. 139,000/L, p = 0.002) and TPO levels (114.7 vs. 142.7 mg/mL, p = 0.047). Longitudinally, HAART initiation reduced the frequency of thrombocytopenia from 75.47% to 33.96% (p < 0.001) and elevated the median platelet counts from 131,000 to 199,000 (p < 0.001). No significant difference in median platelet counts was found post-HAART among the anti-TPO subgroups (p = 0.338), a result contrasting with pre-HAART findings (p = 0.043). Changes in anti-TPO status corresponded with significant platelet count alterations (p = 0.036). Notably, patients who became anti-TPO negative showed a median increase of 95,000 platelets (IQR: 43,750-199,500). These marked differences between subgroups underscore the potential role of anti-TPO antibodies in modulating the hematological response to HAART. Further research is needed to elucidate the complex interplay between HIV infection, HAART, and thrombocytopenia.
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Affiliation(s)
| | - John G. Routsias
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Sarah Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece;
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Brew BJ, Clifford DB. Antiretroviral therapy intensification for HIV-associated neurocognitive disorder? AIDS 2023; 37:2095-2096. [PMID: 37755427 DOI: 10.1097/qad.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Bruce J Brew
- Departments of Neurology and HIV Medicine and Peter Duncan Neurosciences Unit St Vincent's Hospital, University of New South Wales and Notre Dame, Sydney, New South Wales, Australia
| | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
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Shikuma CM, Wojna V, De Gruttola V, Siriwardhana C, Souza SA, Rodriguez-Benitez RJ, Turner EH, Kallianpur K, Bolzenius J, Chow D, Matos M, Shiramizu B, Clements DM, Premeaux TA, Ndhlovu LC, Paul R. Impact of antiretroviral therapy intensification with C-C motif chemokine receptor 5 antagonist maraviroc on HIV-associated neurocognitive impairment. AIDS 2023; 37:1987-1995. [PMID: 37418541 PMCID: PMC10538417 DOI: 10.1097/qad.0000000000003650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI). DESIGN A double-blind, placebo-controlled, 48-week, randomized study of MVC vs. placebo in people with HIV (PWH) on stable antiretroviral therapy (ART) for more than one year in Hawaii and Puerto Rico with plasma HIV RNA less than 50 copies/ml and at least mild NCI defined as an overall or domain-specific neuropsychological z (NPZ) score less than -0.5. METHODS Study participants were randomized 2 : 1 to intensification of ART with MVC vs. placebo. The primary endpoint was change in global and domain-specific NPZ modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed. RESULTS Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm, which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters. CONCLUSION This randomized controlled study found no definitive evidence in favor of MVC intensification among PWH with mild cognitive difficulties.
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Affiliation(s)
- Cecilia M. Shikuma
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Valerie Wojna
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victor De Gruttola
- Wertheim School of Public Health, University of California San Diego, California
| | | | - Scott A. Souza
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | - Emilee H. Turner
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Kalpana Kallianpur
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
- Kamehameha Schools - Kapalama, Honolulu, Hawaii
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
| | - Dominic Chow
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Miriam Matos
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Bruce Shiramizu
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Danielle M. Clements
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | | | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
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Thomas J, Rajmohan P, Jose P, Kannan R, Jose R, Uttumadathil Gopinathan U, Raphael L, Baiju NM, Krishna S, Attokaran T, Bency A. T J, Venugopal A, Sheela S, Kallempadam A, Jose L, Innah SJ, Varghese PR, George A. Real-World Effectiveness of COVID-19 Vaccine and Identification of SARS-CoV-2 Variants among People Living with HIV on Highly Active Antiretroviral Therapy in Central Kerala of India-An Ambi-Directional Cohort Study. Viruses 2023; 15:2187. [PMID: 38005865 PMCID: PMC10674822 DOI: 10.3390/v15112187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Vaccine effectiveness for first-generation coronavirus disease (COVID-19) vaccines among People Living with HIV (PLHIV) in India remains unexplored. This study entails the estimation of the real-world effectiveness of COVID-19 vaccines (AZD1222/Covishield, BBV152/Covaxin) among PLHIV and the identification of variants of SARS-CoV-2 among those infected with COVID-19. METHODS An ambi-directional cohort study was conducted among 925 PLHIV above 18 years of age in two districts of central Kerala, India, from February 2022 to March 2023. Selected PLHIV were recruited as Participant Liaison Officers (PLOs) for the follow-up on the study participants. At enrolment, basic details, baseline CD4 count, and a Nasopharyngeal (NP) swab for RT-PCR were collected. In the follow-up phase, NP swabs were collected from subjects with COVID-19 symptoms. Positive subjects had a CD4 count and genomic sequencing performed. RESULTS The mean age of the participants was 46.93 ± 11.00 years. The majority, 819 (93.6%), of participants had received at least one dose of any vaccine, while 56 (6.4%) were unvaccinated. A total of 649 (79.24%) participants were vaccinated with Covishield and 169 (20.63%) with Covaxin. In the vaccinated group, 158 (19.3%) reported COVID-19 infection. Vaccine Effectiveness (VE) for one dose of any vaccine was 43.2% (95% CI: 11.8-64.5), p = 0.015. The effectiveness of full vaccination with Covishied was 63.8% (95% CI: 39.3-79.2), p < 0.001, and Covaxin was 73.4% (95% CI: 44.3-87.3). VE was highest, at 60.7% (95% CI: 23.6-81.3), when the two doses of the vaccine were given at an interval of less than 6 weeks. Participants with a baseline CD4 count > 350 had greater protection from COVID-19, at 53.4% (95% CI: 19.6-75.3) p = 0.004. The incident cases were sub-variants of Omicron (BA.2, BA.2.38, BA.2.10). CONCLUSIONS Full vaccination with Covishield and Covaxin was effective against COVID-19 infection among PLHIV on treatment; albeit, that of Covaxin was higher. A gap of 4 to 6 weeks between the two doses of COVID-19 vaccine was found to have higher VE among PLHIV.
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Affiliation(s)
- Joe Thomas
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Priyanka Rajmohan
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Ponnu Jose
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Radhika Kannan
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Rosmi Jose
- Department of Microbiology, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India;
| | - Unnikrishnan Uttumadathil Gopinathan
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Lucy Raphael
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Nithya M. Baiju
- Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (N.M.B.); (S.J.I.)
| | - Swathi Krishna
- KEM Hospital Research Centre, Pune 412216, Maharashtra, India;
| | - Teny Attokaran
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Jubina Bency A. T
- Department of Community Medicine, PK DAS Medical College, Vaniyamkulam 679522, Kerala, India;
| | - Aiswarya Venugopal
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Soorya Sheela
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Akhila Kallempadam
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Lee Jose
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (J.T.); (P.R.); (P.J.); (U.U.G.); (L.R.); (T.A.); (A.V.); (S.S.); (A.K.); (L.J.)
| | - Susheela J. Innah
- Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (N.M.B.); (S.J.I.)
| | - Pulikkottil Raphael Varghese
- Jubilee Centre for Medical Research, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (P.R.V.); (A.G.)
| | - Alex George
- Jubilee Centre for Medical Research, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India; (P.R.V.); (A.G.)
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50
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Ismail I, Venter M, Ismail S, Ally N. Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J 2023; 113:20-24. [PMID: 37881908 DOI: 10.7196/samj.2023.v113i10.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa. OBJECTIVES To describe the ocular manifestations of HIV in patients attending the Nthabiseng HIV clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. METHODS A cross-sectional study was conducted in 2021 and 2022 using convenience sampling of patients at the HIV clinic. The participants' clinical history was taken, their files were reviewed, and they underwent ocular examination. Correlation between eyes was managed by taking disease in one eye as the presence of disease in the participant. Descriptive statistics were used to summarise participant characteristics. Univariate and multivariate logistic regression models were used to assess the odds ratio (OR) of developing HIV-associated ocular diseases, and a p-value of <0.05 was used to define statistical significance. RESULTS There were 182 participants (139 females and 43 males), with a mean (standard deviation) age of 48.9 (10.6) years. The most common anterior segment diagnoses were conjunctival microangiopathy (34.6%), pinguecula (31.3%) and cataracts (30.2%), while the most common posterior segment finding was peripheral retinal scarring with features in keeping of previous cytomegalovirus retinitis (24.2%). Notably, only 1.1% of patients had HIV retinopathy. A CD4 count <200 cells/μL showed an increased OR for cataracts (OR 4.24; p=0.003) and any anterior segment diagnoses (OR 10.05; p=0.029), while a CD4 count ≥200 cells/μL showed an increased risk of conjunctival microangiopathy (OR 2.14; p=0.017). CONCLUSION With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era.
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Affiliation(s)
- I Ismail
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Venter
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S Ismail
- Consultant ophthalmologist, Johannesburg, South Africa.
| | - N Ally
- Manchester Royal Eye Hospital, Manchester, UK; Division of Ophthalmology, Department of Neurosciences, St John Eye Hospital, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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