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Sandfort TGM, Kreniske P, Mbeda C, Reynolds D, Tshabalala G, Madiwati B, Ogendo A, Dominquez K, Panchia R, Gondwe D, Hamilton EL, Guo X, Cummings V. Interest in I-PrEP and Willingness to Participate in Clinical Trials Among Men and Transfeminine Persons Who have Sex with Men in Sub-Saharan Africa: Quantitative and Qualitative Findings from HPTN 075. AIDS Behav 2024:10.1007/s10461-024-04334-x. [PMID: 38761334 DOI: 10.1007/s10461-024-04334-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
This study explored interest in injectable PrEP (I-PrEP) and willingness to participate in clinical trials testing new biomedical HIV prevention strategies among men and transfeminine persons who have sex with men (MSM & TGP), using data collected in the HIV Prevention Trials Network (HPTN) 075 study, which took place at sites in Kenya, Malawi, and South Africa. Data result from a survey among 267 18-44 years old HIV negative participants, complemented with semi-structured interviews with 80 purposively recruited persons. Correlations coefficients were calculated to identify demographic and psychosocial factors associated with interest in I-PrEP. Qualitative interviews were analyzed using concept-driven and subsequent data-driven coding. Most surveyed participants expressed an interest in I-PrEP. Quantitatively, only being interested in other HIV prevention measures was associated with interest in I-PrEP. Qualitatively, most participants preferred I-PrEP to O-PrEP and remained interested in I-PrEP despite barriers such as the somewhat invasive nature of the procedure and potential side effects of I-PrEP. Interest in I-PrEP was driven by the possibility of avoiding sexual or HIV stigma. Access to healthcare and altruism-such as assisting in the development of new HIV prevention methods-positively impacted willingness to participate in clinical trials. With I-PrEP favored by most participants, it is potentially a critical tool to prevent HIV infection among MSM & TGP in sub-Saharan Africa, with the mitigation of stigma as a major advance. Recruitment of MSM & TGP in biobehavioral clinical trials seems feasible, with altruistic reasons and receiving I-PrEP and free medical care as major motivators.
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Affiliation(s)
- Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Philip Kreniske
- Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, USA
| | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Gugulethu Tshabalala
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | | | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Daniel Gondwe
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | | | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Riou C, Bhiman JN, Ganga Y, Sawry S, Ayres F, Baguma R, Balla SR, Benede N, Bernstein M, Besethi AS, Cele S, Crowther C, Dhar M, Geyer S, Gill K, Grifoni A, Hermanus T, Kaldine H, Keeton RS, Kgagudi P, Khan K, Lazarus E, Le Roux J, Lustig G, Madzivhandila M, Magugu SFJ, Makhado Z, Manamela NP, Mkhize Q, Mosala P, Motlou TP, Mutavhatsindi H, Mzindle NB, Nana A, Nesamari R, Ngomti A, Nkayi AA, Nkosi TP, Omondi MA, Panchia R, Patel F, Sette A, Singh U, van Graan S, Venter EM, Walters A, Moyo-Gwete T, Richardson SI, Garrett N, Rees H, Bekker LG, Gray G, Burgers WA, Sigal A, Moore PL, Fairlie L. Safety and immunogenicity of booster vaccination and fractional dosing with Ad26.COV2.S or BNT162b2 in Ad26.COV2.S-vaccinated participants. PLOS Glob Public Health 2024; 4:e0002703. [PMID: 38603677 PMCID: PMC11008839 DOI: 10.1371/journal.pgph.0002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/18/2024] [Indexed: 04/13/2024]
Abstract
We report the safety and immunogenicity of fractional and full dose Ad26.COV2.S and BNT162b2 in an open label phase 2 trial of participants previously vaccinated with a single dose of Ad26.COV2.S, with 91.4% showing evidence of previous SARS-CoV-2 infection. A total of 286 adults (with or without HIV) were enrolled >4 months after an Ad26.COV2.S prime and randomized 1:1:1:1 to receive either a full or half-dose booster of Ad26.COV2.S or BNT162b2 vaccine. B cell responses (binding, neutralization and antibody dependent cellular cytotoxicity-ADCC), and spike-specific T-cell responses were evaluated at baseline, 2, 12 and 24 weeks post-boost. Antibody and T-cell immunity targeting the Ad26 vector was also evaluated. No vaccine-associated serious adverse events were recorded. The full- and half-dose BNT162b2 boosted anti-SARS-CoV-2 binding antibody levels (3.9- and 4.5-fold, respectively) and neutralizing antibody levels (4.4- and 10-fold). Binding and neutralizing antibodies following half-dose Ad26.COV2.S were not significantly boosted. Full-dose Ad26.COV2.S did not boost binding antibodies but slightly enhanced neutralizing antibodies (2.1-fold). ADCC was marginally increased only after a full-dose BNT162b2. T-cell responses followed a similar pattern to neutralizing antibodies. Six months post-boost, antibody and T-cell responses had waned to baseline levels. While we detected strong anti-vector immunity, there was no correlation between anti-vector immunity in Ad26.COV2.S recipients and spike-specific neutralizing antibody or T-cell responses post-Ad26.COV2.S boosting. Overall, in the context of hybrid immunity, boosting with heterologous full- or half-dose BNT162b2 mRNA vaccine demonstrated superior immunogenicity 2 weeks post-vaccination compared to homologous Ad26.COV2.S, though rapid waning occurred by 12 weeks post-boost. Trial Registration: The study has been registered to the South African National Clinical Trial Registry (SANCTR): DOH-27-012022-7841. The approval letter from SANCTR has been provided in the up-loaded documents.
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Affiliation(s)
- Catherine Riou
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Jinal N. Bhiman
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Yashica Ganga
- Africa Health Research Institute, Durban, South Africa
| | - Shobna Sawry
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Ayres
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Richard Baguma
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Sashkia R. Balla
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Ntombi Benede
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Asiphe S. Besethi
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Sandile Cele
- Africa Health Research Institute, Durban, South Africa
| | - Carol Crowther
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Mrinmayee Dhar
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sohair Geyer
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Gill
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Alba Grifoni
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, California, United States of America
| | - Tandile Hermanus
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Haajira Kaldine
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Roanne S. Keeton
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Prudence Kgagudi
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Khadija Khan
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Erica Lazarus
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean Le Roux
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gila Lustig
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Mashudu Madzivhandila
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyabulela F. J. Magugu
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zanele Makhado
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Nelia P. Manamela
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Qiniso Mkhize
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Paballo Mosala
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Thopisang P. Motlou
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Hygon Mutavhatsindi
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nonkululeko B. Mzindle
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anusha Nana
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Rofhiwa Nesamari
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Amkele Ngomti
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Anathi A. Nkayi
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandeka P. Nkosi
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Millicent A. Omondi
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, California, United States of America
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), La Jolla, California, United States of America
| | - Upasna Singh
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Strauss van Graan
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Elizabeth M. Venter
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Avril Walters
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandeka Moyo-Gwete
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Simone I. Richardson
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Wendy A. Burgers
- Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Alex Sigal
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Penny L. Moore
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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3
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Riou C, Bhiman JN, Ganga Y, Sawry S, Ayres F, Baguma R, Balla SR, Benede N, Bernstein M, Besethi AS, Cele S, Crowther C, Dhar M, Geyer S, Gill K, Grifoni A, Hermanus T, Kaldine H, Keeton RS, Kgagudi P, Khan K, Lazarus E, Roux JL, Lustig G, Madzivhandila M, Magugu SFJ, Makhado Z, Manamela NP, Mkhize Q, Mosala P, Motlou TP, Mutavhatsindi H, Mzindle NB, Nana A, Nesamari R, Ngomti A, Nkayi AA, Nkosi TP, Omondi MA, Panchia R, Patel F, Sette A, Singh U, van Graan S, Venter EM, Walters A, Moyo-Gwete T, Richardson SI, Garrett N, Rees H, Bekker LG, Gray G, Burgers WA, Sigal A, Moore PL, Fairlie L. Safety and immunogenicity of booster vaccination and fractional dosing with Ad26.COV2.S or BNT162b2 in Ad26.COV2.S-vaccinated participants. medRxiv 2023:2023.11.20.23298785. [PMID: 38045321 PMCID: PMC10690356 DOI: 10.1101/2023.11.20.23298785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background We report the safety and immunogenicity of fractional and full dose Ad26.COV2.S and BNT162b2 in an open label phase 2 trial of participants previously vaccinated with a single dose of Ad26.COV2.S, with 91.4% showing evidence of previous SARS-CoV-2 infection. Methods A total of 286 adults (with or without HIV) were enrolled >4 months after an Ad26.COV2.S prime and randomized 1:1:1:1 to receive either a full or half-dose booster of Ad26.COV2.S or BNT162b2 vaccine. B cell responses (binding, neutralization and antibody dependent cellular cytotoxicity-ADCC), and spike-specific T-cell responses were evaluated at baseline, 2, 12 and 24 weeks post-boost. Antibody and T-cell immunity targeting the Ad26 vector was also evaluated. Results No vaccine-associated serious adverse events were recorded. The full- and half-dose BNT162b2 boosted anti-SARS-CoV-2 binding antibody levels (3.9- and 4.5-fold, respectively) and neutralizing antibody levels (4.4- and 10-fold). Binding and neutralizing antibodies following half-dose Ad26.COV2.S were not significantly boosted. Full-dose Ad26.COV2.S did not boost binding antibodies but slightly enhanced neutralizing antibodies (2.1-fold). ADCC was marginally increased only after a full-dose BNT162b2. T-cell responses followed a similar pattern to neutralizing antibodies. Six months post-boost, antibody and T-cell responses had waned to baseline levels. While we detected strong anti-vector immunity, there was no correlation between anti-vector immunity in Ad26.COV2.S recipients and spike-specific neutralizing antibody or T-cell responses post-Ad26.COV2.S boosting. Conclusion In the context of hybrid immunity, boosting with heterologous full- or half-dose BNT162b2 mRNA vaccine demonstrated superior immunogenicity 2 weeks post-vaccination compared to homologous Ad26.COV2.S, though rapid waning occurred by 12 weeks post-boost. Trial Registration South African National Clinical Trial Registry (SANCR): DOH-27-012022-7841. Funding South African Medical Research Council (SAMRC) and South African Department of Health (SA DoH).
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Affiliation(s)
- Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Jinal N Bhiman
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Yashica Ganga
- Africa Health Research Institute, Durban, South Africa
| | - Shobna Sawry
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Ayres
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Richard Baguma
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Sashkia R Balla
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Ntombi Benede
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | | | - Asiphe S Besethi
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Sandile Cele
- Africa Health Research Institute, Durban, South Africa
| | - Carol Crowther
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Mrinmayee Dhar
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sohair Geyer
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Katherine Gill
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Alba Grifoni
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Tandile Hermanus
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Haajira Kaldine
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Roanne S Keeton
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Prudence Kgagudi
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Khadija Khan
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Erica Lazarus
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean Le Roux
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gila Lustig
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Mashudu Madzivhandila
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyabulela FJ Magugu
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Zanele Makhado
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Nelia P Manamela
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Qiniso Mkhize
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Paballo Mosala
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Thopisang P Motlou
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Hygon Mutavhatsindi
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Nonkululeko B Mzindle
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anusha Nana
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Rofhiwa Nesamari
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Amkele Ngomti
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Anathi A Nkayi
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Thandeka P Nkosi
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Millicent A Omondi
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, California, USA
| | - Upasna Singh
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Strauss van Graan
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Elizabeth M. Venter
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Avril Walters
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Thandeka Moyo-Gwete
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Simone I. Richardson
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Wendy A. Burgers
- Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Alex Sigal
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Penny L Moore
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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4
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Mbilizi Chimwaza YR, Dadabhai SS, Nyondo Mipando AL, Mbeda C, Panchia R, Lucas JP, Chege W, Hamilton EL, Sandfort TGM. HIV risk perception and sexual behavior among HIV-uninfected men and transgender women who have sex with men in sub-Saharan Africa: Findings from the HPTN 075 qualitative sub-study. PLOS Glob Public Health 2022; 2:e0001408. [PMID: 36962926 PMCID: PMC10021518 DOI: 10.1371/journal.pgph.0001408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/26/2022] [Indexed: 12/29/2022]
Abstract
There remains a limited understanding of how men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) perceive their risk for HIV and how risk influences behavior during sexual interactions. We performed thematic analysis on in-depth interviews from the qualitative sub-study of HPTN 075 in Kenya, Malawi, and South Africa. Using the Integrated Behavioral Model (IBM) constructs, we found that most MSM and TGW perceived themselves to be at risk for HIV, leading them to regularly engage in safer sexual behaviors. Notably, even though these MSM and TGW perceived themselves to be at risk for HIV, some of them reported engaging in transactional sex, sex under the influence of alcohol, and intentional non-use of condoms. This indicates that HIV risk perception was not always associated with safer sexual behaviors or a reduction in risk behaviors. Attitudes (negative attitudes toward condom use), perceived norms (social pressures), and environment constraints (contextual barriers) were related to MSM and TGW not engaging in safe sexual behavior. Hearing the perspectives of MSM and TGW on their sexual behavior continues to be important for the development and implementation of effective prevention policies and interventions. Eliminating structural barriers such as stigma, discrimination, and criminalization of same-sex sexuality is a crucial prerequisite for the success of interventions to promote sexual health among MSM and TGW in SSA.
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Affiliation(s)
| | - Sufia S. Dadabhai
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Blantyre, Malawi
| | | | - Calvin Mbeda
- Kenya Medical Research Institute, Kisumu Clinical Research Site, Kisumu, Kenya
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Jonathan P. Lucas
- Science Facilitation Department, FHI 360, Durham, NC, United States of America
| | - Wairimu Chege
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Erica L. Hamilton
- Science Facilitation Department, FHI 360, Durham, NC, United States of America
| | - Theodorus G. M. Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America
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5
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Delany-Moretlwe S, Hughes JP, Bock P, Ouma SG, Hunidzarira P, Kalonji D, Kayange N, Makhema J, Mandima P, Mathew C, Spooner E, Mpendo J, Mukwekwerere P, Mgodi N, Ntege PN, Nair G, Nakabiito C, Nuwagaba-Biribonwoha H, Panchia R, Singh N, Siziba B, Farrior J, Rose S, Anderson PL, Eshleman SH, Marzinke MA, Hendrix CW, Beigel-Orme S, Hosek S, Tolley E, Sista N, Adeyeye A, Rooney JF, Rinehart A, Spreen WR, Smith K, Hanscom B, Cohen MS, Hosseinipour MC. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial. Lancet 2022; 399:1779-1789. [PMID: 35378077 PMCID: PMC9077443 DOI: 10.1016/s0140-6736(22)00538-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oral pre-exposure prophylaxis has been introduced in more than 70 countries, including many in sub-Saharan Africa, but women experience considerable barriers to daily pill-taking, such as stigma, judgement, and the fear of violence. Safe and effective long-acting agents for HIV prevention are needed for women. We aimed to evaluate the safety and efficacy of injectable cabotegravir compared with daily oral tenofovir diphosphate plus emtricitabine (TDF-FTC) for HIV prevention in HIV-uninfected women. METHODS HPTN 084 was a phase 3, randomised, double-blind, double-dummy, active-controlled, superiority trial in 20 clinical research sites in seven countries in sub-Saharan Africa. Participants were eligible for enrolment if they were assigned female sex at birth, were aged 18-45 years, reported at least two episodes of vaginal intercourse in the previous 30 days, were at risk of HIV infection based on an HIV risk score, and agreed to use a long-acting reversible contraceptive method. Participants were randomly assigned (1:1) to either active cabotegravir with TDF-FTC placebo (cabotegravir group) or active TDF-FTC with cabotegravir placebo (TDF-FTC group). Study staff and participants were masked to study group allocation, with the exception of the site pharmacist who was responsible for study product preparation. Participants were prescribed 5 weeks of daily oral product followed by intramuscular injections every 8 weeks after an initial 4-week interval load, alongside daily oral pills. Participants who discontinued injections were offered open-label daily TDF-FTC for 48 weeks. The primary endpoints of the study were incident HIV infection in the intention-to-treat population, and clinical and laboratory events that were grade 2 or higher in all women who had received at least one dose of study product. This study is registered with ClinicalTrials.gov, NCT03164564. FINDINGS From Nov 27, 2017, to Nov 4, 2020, we enrolled 3224 participants (1614 in the cabotegravir group and 1610 in the TDF-FTC group). Median age was 25 years (IQR 22-30); 1755 (54·7%) of 3209 had two or more partners in the preceding month. 40 incident infections were observed over 3898 person-years (HIV incidence 1·0% [95% CI 0·73-1·40]); four in the cabotegravir group (HIV incidence 0·2 cases per 100 person-years [0·06-0·52]) and 36 in the TDF-FTC group (1·85 cases per 100 person-years [1·3-2·57]; hazard ratio 0·12 [0·05-0·31]; p<0·0001; risk difference -1·6% [-1·0% to -2·3%]. In a random subset of 405 TDF-FTC participants, 812 (42·1%) of 1929 plasma samples had tenofovir concentrations consistent with daily use. Injection coverage was 93% of the total number of person-years. Adverse event rates were similar across both groups, apart from injection site reactions, which were more frequent in the cabotegravir group than in the TDF-FTC group (577 [38·0%] of 1519 vs 162 [10·7%] of 1516]) but did not result in injection discontinuation. Confirmed pregnancy incidence was 1·3 per 100 person-years (0·9-1·7); no congenital birth anomalies were reported. INTERPRETATION Although both products for HIV prevention were generally safe, well tolerated, and effective, cabotegravir was superior to TDF-FTC in preventing HIV infection in women. FUNDING National Institute of Allergy and Infectious Diseases, ViiV Healthcare, and the Bill & Melinda Gates Foundation. Additional support was provided through the National Institute of Mental Health, the National Institute on Drug Abuse, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. ViiV Healthcare and Gilead Sciences provided pharmaceutical support.
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Affiliation(s)
- Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
| | - James P Hughes
- Statistical Centre for HIV/AIDS Research and Prevention, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter Bock
- Desmond Tutu TB Centre, University of Stellenbosch, Stellenbosch, South Africa
| | - Samuel Gurrion Ouma
- Kisumu Clinical Research Site, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Portia Hunidzarira
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Dishiki Kalonji
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Noel Kayange
- Blantyre Clinical Research Site, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
| | - Patricia Mandima
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Carrie Mathew
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth Spooner
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Juliet Mpendo
- International AIDS Vaccine Initiative, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Nyaradzo Mgodi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gonasagrie Nair
- Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Harriet Nuwagaba-Biribonwoha
- Eswatini Prevention Center, International Center for AIDS Care and Treatment Program at Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nishanta Singh
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Bekezela Siziba
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Peter L Anderson
- Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark A Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie Beigel-Orme
- Statistical Centre for HIV/AIDS Research and Prevention, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | | | | | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | | | | | | | | | - Brett Hanscom
- Statistical Centre for HIV/AIDS Research and Prevention, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Myron S Cohen
- University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, USA; UNC Project-Malawi, Lilongwe, Malawi
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6
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Liu G, Mugo NR, Brown ER, Mgodi NM, Chirenje ZM, Marrazzo JM, Winer RL, Mansoor L, Palanee-Phillips T, Siva SS, Naidoo L, Jeenarain N, Gaffoor Z, Nair GL, Selepe P, Nakabiito C, Mkhize B, Mirembe BG, Taljaard M, Panchia R, Baeten JM, Balkus JE, Hladik F, Celum CL, Barnabas RV. Prevalent human papillomavirus infection increases the risk of HIV acquisition in African women: advancing the argument for human papillomavirus immunization. AIDS 2022; 36:257-265. [PMID: 34172672 PMCID: PMC8702475 DOI: 10.1097/qad.0000000000003004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Vaccine-preventable human papillomavirus (HPV) infection is common, especially in sub-Saharan Africa where HIV risk is also high. However, unlike other sexually transmitted infections (STIs), HPV's role in HIV acquisition is unclear. We evaluated this relationship using data from MTN-003, a clinical trial of HIV chemoprophylaxis among cisgender women in sub-Saharan Africa. DESIGN A case-control study. METHODS We matched 138 women who acquired HIV (cases) to 412 HIV-negative controls. Cervicovaginal swabs collected within 6 months before HIV seroconversion were tested for HPV DNA. We estimated the associations between carcinogenic (high-risk) and low-risk HPV types and types targeted by HPV vaccines and HIV acquisition, using conditional logistic regression models adjusted for time-varying sexual behaviors and other STIs. RESULTS Mean age was 23 (±4) years. Any, high-risk and low-risk HPV was detected in 84, 74 and 66% of cases, and 65, 55 and 48% of controls. Infection with at least two HPV types was common in cases (67%) and controls (49%), as was infection with nonavalent vaccine-targeted types (60 and 42%). HIV acquisition increased with any [adjusted odds ratio (aOR) 2.5, 95% confidence interval (95% CI) 1.3-4.7], high-risk (aOR 2.6, 95% CI 1.5-4.6) and low-risk (aOR 1.8, 95% CI 1.1-2.9) HPV. Each additional type detected increased HIV risk by 20% (aOR 1.2, 95% CI 1.1-1.4). HIV acquisition was associated with HPV types targeted by the nonavalent (aOR 2.1, 95% CI 1.3-3.6) and quadrivalent vaccines (aOR 1.9, 95% CI 1.1-3.2). CONCLUSION HPV infection is associated with HIV acquisition in sub-Saharan African women. In addition to preventing HPV-associated cancers, increasing HPV vaccination coverage could potentially reduce HIV incidence.
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Affiliation(s)
- Gui Liu
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
| | - Nelly R. Mugo
- Department of Global Health, University of Washington,
Seattle, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
- Department of Biostatistics, University of Washington,
Seattle, USA
| | - Nyaradzo M. Mgodi
- Clinical Trials Research Centre, University of Zimbabwe,
Harare, Zimbabwe
| | | | - Jeanne M. Marrazzo
- Department of Medicine/Division of Infectious Diseases,
University of Alabama at Birmingham, Alabama, USA
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington,
Seattle, USA
- Kaiser Permanente Washington Health Research Institute,
Seattle, USA
| | - Leila Mansoor
- Centre for the AIDS Programme of Research in South Africa,
University of KwaZulu-Natal, Durban, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute in
Johannesburg, South Africa
- Faculty of Health Sciences, University of Witwatersrand,
Johannesburg, South Africa
| | | | | | | | - Zakir Gaffoor
- South Africa Medical Research Council, Durban, South
Africa
| | - Gonasagrie L. Nair
- Desmond Tutu HIV Centre, University of Cape Town, Cape
Town, South Africa
| | | | | | - Baningi Mkhize
- Faculty of Health Sciences, University of Witwatersrand,
Johannesburg, South Africa
| | | | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath
Hospital, Soweto, South Africa
| | - Jared M. Baeten
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
| | - Jennifer E. Balkus
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
| | - Floriand Hladik
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of
Washington, Seattle, USA
| | - Connie L. Celum
- Department of Global Health, University of Washington,
Seattle, USA
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
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7
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Rees H, Chersich MF, Munthali RJ, Brumskine W, Palanee-Phillips T, Nkala B, Ahmed K, Sebe M, Mabude Z, Nchabeleng M, Bekker LG, Kotze P, Mogodiri T, Naidoo I, Panchia R, Myer L, Lombard C, Doncel GF, Gray G, Delany-Moretlwe S. HIV Incidence Among Pregnant and Nonpregnant Women in the FACTS-001 Trial: Implications for HIV Prevention, Especially PrEP Use. J Acquir Immune Defic Syndr 2021; 88:376-383. [PMID: 34710071 DOI: 10.1097/qai.0000000000002785] [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: 04/23/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission. SETTING Nine sites in 4 South African provinces. METHODS Women aged 18-30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status. RESULTS Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use. CONCLUSIONS Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings.
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Affiliation(s)
- Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Francis Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Munthali
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Zonke Mabude
- MATCH, University of the Witwatersrand, Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Centre, Ladysmith, South Africa
| | - Thembisile Mogodiri
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ishana Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa ; and
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Glenda Gray
- Setshaba Research Centre, Soshanguve, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Seneviratne HK, Hamlin AN, Li S, Grinsztejn B, Dawood H, Liu AY, Kuo I, Hosseinipour MC, Panchia R, Cottle L, Chau G, Adeyeye A, Rinehart AR, McCauley M, Eron JJ, Cohen MS, Landovitz RJ, Hendrix CW, Bumpus NN. Correction to “Identification of Novel UGT1A1 Variants Including UGT1A1 454C>A through the Genotyping of Healthy Participants of the HPTN 077 Study”. ACS Pharmacol Transl Sci 2021; 4:1462. [PMID: 35783008 PMCID: PMC9241154 DOI: 10.1021/acsptsci.1c00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/28/2022]
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9
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Noguchi LM, Marrazzo JM, Richardson B, Hillier SL, Balkus JE, Palanee-Phillips T, Nair G, Panchia R, Piper J, Gomez K, Ramjee G, Chirenje ZM. Prevalence and Incidence of Sexually Transmitted Infection in Injectable Progestin Contraception Users in South Africa. Front Reprod Health 2021; 3. [PMID: 35669097 PMCID: PMC9165437 DOI: 10.3389/frph.2021.668685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Whether intramuscular depot medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN) have a differential impact on the incidence of sexually transmitted infection (STI) remains unclear. In the Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial, HIV-1 acquisition was higher for DMPA-IM users vs. NET-EN users. We compared DMPA-IM and NET-EN users with regard to chlamydia, gonorrhea, trichomoniasis, syphilis, and herpes simplex virus type 2 (HSV-2) infection.Materials and Methods: Prospective data were analyzed from VOICE, a randomized trial of HIV-1 chemoprophylaxis. Participants were evaluated annually and as indicated for chlamydia, gonorrhea, trichomoniasis, and syphilis. Stored specimens were tested for HSV-2. Proportional hazards models compared the risk of STI between DMPA-IM and NET-EN users.Results: Among 2,911 injectable contraception users in South Africa, 1,800 (61.8%) used DMPA-IM and 1,111 used NET-EN (38.2%). DMPA-IM and NET-EN users did not differ in baseline chlamydia: 15.1 vs. 14.3%, p = 0.54; gonorrhea: 3.4 vs. 3.7%, p = 0.70; trichomoniasis: 5.7 vs.5.0%, p = 0.40; or syphilis: 1.5 vs. 0.7%, p = 0.08; but differed for baseline HSV-2: (51.3 vs. 38.6%, p < 0.001). Four hundred forty-eight incident chlamydia, 103 gonorrhea, 150 trichomonas, 17 syphilis, and 48 HSV-2 infections were detected over 2,742, 2,742, 2,783, 2,945, and 756 person-years (py), respectively (chlamydia 16.3/100 py; gonorrhea 3.8/100 py; trichomoniasis 5.4/100 py; syphilis 0.6/100 py; HSV-2 6.4/100 py). Comparing DMPA-IM with NET-EN users, no difference was noted in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV-2 infections, including when adjusted for confounders [chlamydia (aHR 1.03, 95% CI 0.85–1.25), gonorrhea (aHR 0.88, 95% CI 0.60–1.31), trichomoniasis (aHR 1.07, 95% CI 0.74–1.54), syphilis (aHR 0.41, 95% CI 0.15–1.10), and HSV-2 (aHR 0.83, 95% CI 0.45–1.54, p = 0.56)].Discussion: Among South African participants enrolled in VOICE, DMPA-IM and NET-EN users differed in prevalence of HSV-2 at baseline but did not differ in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV-2 infection. Differential HIV-1 acquisition, previously demonstrated in this cohort, does not appear to be explained by differential STI acquisition. However, the high incidence of multiple STIs reinforces the need to accelerate access to comprehensive sexual and reproductive health services.
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Affiliation(s)
- Lisa M. Noguchi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: Lisa M. Noguchi
| | - Jeanne M. Marrazzo
- Division of Infectious Diseases, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Barbara Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Sharon L. Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and the Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Jennifer E. Balkus
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Thesla Palanee-Phillips
- Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Jeanna Piper
- Division of AIDS, NIAID, U.S. National Institutes of Health, Bethesda, MD, United States
| | | | - Gita Ramjee
- South African Medical Research Council, Durban, South Africa
| | - Z. Mike Chirenje
- University of Zimbabwe Clinical Trials Research Centre, Department of Obstetrics and Gynaecology, Harare, Zimbabwe
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10
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Sivay MV, Palumbo PJ, Zhang Y, Cummings V, Guo X, Hamilton EL, McKinstry L, Ogendo A, Kayange N, Panchia R, Dominguez K, Chen YQ, Sandfort TGM, Eshleman SH. Human Immunodeficiency Virus (HIV) Drug Resistance, Phylogenetic Analysis, and Superinfection Among Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: HIV Prevention Trials Network (HPTN) 075 Study. Clin Infect Dis 2021; 73:60-67. [PMID: 32761071 DOI: 10.1093/cid/ciaa1136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The HIV Prevention Trials Network (HPTN) 075 study evaluated the feasibility of enrolling and retaining men who have sex with men (MSM) and transgender women (TGW) from Kenya, Malawi, and South Africa. During the study follow-up, 21 participants acquired human immunodeficiency virus (HIV) (seroconverters). We analyzed HIV subtype diversity, drug resistance, transmission dynamics, and HIV superinfection data among MSM and TGW enrolled in HPTN 075. METHODS HIV genotyping and drug resistance testing were performed for participants living with HIV who had viral loads >400 copies/mL at screening (prevalent cases, n = 124) and seroconverters (n = 21). HIV pol clusters were identified using Cluster Picker. Superinfection was assessed by a longitudinal analysis of env and pol sequences generated by next-generation sequencing. RESULTS HIV genotyping was successful for 123/124 prevalent cases and all 21 seroconverters. The major HIV subtypes were A1 (Kenya) and C (Malawi and South Africa). Major drug resistance mutations were detected in samples from 21 (14.6%) of 144 participants; the most frequent mutations were K103N and M184V/I. Phylogenetic analyses identified 11 clusters (2-6 individuals). Clusters included seroconverters only (n = 1), prevalent cases and seroconverters (n = 4), and prevalent cases only (n = 6). Superinfections were identified in 1 prevalent case and 2 seroconverters. The annual incidence of superinfection was higher among seroconverters than among prevalent cases, and was higher than the rate of primary HIV infection in the cohort. CONCLUSIONS This report provides important insights into HIV genetic diversity, drug resistance, and superinfection among MSM and TGW in sub-Saharan Africa. These findings may help to inform future HIV prevention interventions in these high-risk groups.
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Affiliation(s)
- Mariya V Sivay
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip J Palumbo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yinfeng Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Erica L Hamilton
- Science Facilitation Department, Family Health International 360, Durham, North Carolina, USA
| | - Laura McKinstry
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Arthur Ogendo
- Kenya Medical Research Institute Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Noel Kayange
- Department of Internal Medicine, Johns Hopkins Project, College of Medicine, Malawi, Blantyre, Malawi
| | - Ravindre Panchia
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Soweto Human Immunodeficiency Virus Prevention Trials Network Clinical Research Site, Soweto, South Africa
| | - Karen Dominguez
- Desmond Tutu Human Immunodeficiency Virus Centre, University of Cape Town Medical School, Cape Town, South Africa
| | - Ying Q Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Theodorus G M Sandfort
- Human Immunodeficiency Virus Center for Clinical and Behavioral Studies, Columbia University, New York, New York, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Chagomerana MB, Hosseinipour MC, Pilotto JH, Badal-Faesen S, Nyirenda M, Shava E, Godbole SV, Akelo V, Chariyalertsak S, Panchia R, Cohen M. Sexually transmitted infections among HIV serodiscordant partners: A secondary analysis of HIV Prevention Trial Network 052. Int J STD AIDS 2021; 32:1204-1211. [PMID: 34233535 DOI: 10.1177/09564624211030368] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sexually transmitted infections (STIs) remain a public health concern because of their interaction(s) with HIV. In the HPTN 052 study, STIs were evaluated in both HIV-positive index cases and their HIV-negative partners at enrollment and at yearly follow-up visits. Our definition for STI was based on any infection with Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, or Trichomonas vaginalis. We used log-binomial regression models to identify factors associated with prevalent STIs. Generalized estimating equation models with the Poisson distribution were used to compare STI incidence between HIV-positive index cases and HIV-negative partners. 8.1% of the participants had STIs at enrollment. The prevalence of STIs (8.9 vs. 7.2) was higher in HIV-positive index cases than HIV-negative partners. Being female (prevalence ratio (PR) = 1.61; 95% CI: 1.20-2.16) or unmarried (PR = 1.92; 95% CI: 1.17-3.14) was associated with prevalent STIs. Compared to HIV-negative male partners, HIV-positive female index cases had a higher risk of STI acquisition (incidence rate ratio (IRR) = 2.25; 95% CI: 1.70-2.97). While we are implementing HIV prevention interventions for HIV-negative people, we should also intensify targeted STI prevention interventions, especially among HIV-positive women.
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Affiliation(s)
- Maganizo B Chagomerana
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jose Henrique Pilotto
- Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Mulinda Nyirenda
- Johns Hopkins Project, 37610University of Malawi College of Medicine, Blantyre, Malawi
| | - Emily Shava
- Botswana Harvard Aids Institute Partnership, Gaborone, Botswana
| | | | - Victor Akelo
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand.,Faculty of Public Health, 26682Chiang Mai University, Suthep, Thailand
| | - Ravindre Panchia
- Perinatal HIV Research Unit, 37707University of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
| | - Myron Cohen
- Department of Medicine, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Rael CT, Roberts S, Ibitoye M, Gorbach PM, Palanee-Phillips T, Harkoo I, Mbilizi Y, Panchia R, Siva S, Tembo T, Agwau Akello C, Balkus J, Riddler S, Carballo-Diéguez A. Likely clinical depression and HIV-related decline in antiretroviral therapy untreated women who seroconverted during participation in microbicide trials in sub-Saharan Africa. Int J STD AIDS 2021; 32:620-628. [PMID: 33752534 DOI: 10.1177/0956462420975935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression worsens HIV outcomes in populations treated with antiretroviral therapy (ART) medications. Data are limited on the relationship between depression and HIV in untreated populations in sub-Saharan Africa. We aimed to identify associations between likely clinical depression, alcohol use, social support by partners, and HIV viral load (VL) among ART untreated women who recently became HIV positive and enrolled in the Microbicide Trials Network (MTN)-015 study. Analyses used cross-sectional data collected at baseline in MTN-015. Participants in this analysis (N = 190) enrolled from other MTN trials were not receiving ART and provided data on their HIV disclosure status to their husband or male partner and alcohol use behavior. The dependent variable, VL, was categorized as: low (≤400 RNA copies/mL; 9.1% of participants), medium (401-20,000 RNA copies/mL; 48.8%), and high (>20,000 RNA copies/mL; 42.0%). Depression was assessed using eight items from Hopkins Symptom Checklist; a cutoff of ≥1.75 indicated likely clinical depression. Independent variables with a significance of p ≤ 0.05 in unadjusted regressions were included in a regression adjusted for age, education, and time since seroconversion. Depressive symptoms were positively associated with high VL, in the adjusted regression (OR = 1.80; 95% CI = 1.07-3.01). Results suggest that likely having clinical depression may have a biological relationship with HIV disease progression.
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Affiliation(s)
- Christine T Rael
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.,Program for the Study of LGBT Health, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia University Psychiatry and he Columbia University School of Nursing, New York, NY, USA
| | - Sarah Roberts
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Mbolaji Ibitoye
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, 8783University of California, Los Angeles, Los Angeles, CA, USA
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, School of Clinical Medicine, Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Ishana Harkoo
- Center for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Academic Hospital, 196579University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | | | | | - Jennifer Balkus
- Department of Epidemiology, 7284University of Washington, Seattle, WA, USA
| | - Sharon Riddler
- Department of Medicine/Infectious Diseases, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex Carballo-Diéguez
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
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13
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Sandfort TGM, Mbilizi Y, Sanders EJ, Guo X, Cummings V, Hamilton EL, Akelo V, Panchia R, Dominguez K, Stirratt MJ, Chege W, Lucas J, Gaydos CA, Chen YQ, Eshleman SH. HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075. PLoS One 2021; 16:e0247195. [PMID: 33630925 PMCID: PMC7906338 DOI: 10.1371/journal.pone.0247195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
Few studies have assessed HIV incidence in men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA). We assessed HIV incidence and its correlates among MSM and TGW in SSA enrolled in the prospective, multi-country HIV Prevention Trials Network (HPTN) 075 study, conducted from 2015 to 2017. Participants were enrolled at four sites in SSA (Kisumu, Kenya; Blantyre, Malawi; Cape Town and Soweto, South Africa). Eligible participants reported male sex assignment at birth, were 18 to 44 years of age, and had engaged in anal intercourse with a man in the preceding three months. Participation involved five study visits over 12 months. Visits included behavioral assessments and testing for HIV and sexually transmitted infections. Twenty-one of 329 persons acquired HIV during the study [incidence rate: 6.96/100 person-years (PY) (95% CI: 4.3, 10.6)]. Among TGW, HIV incidence was estimated to be 8.4/100 PY (95% CI: 2.3, 21.5). Four participants were found to have acute HIV infection at their first HIV-positive visit. HIV incidence varied among the four study sites, ranging from 1.3/100 PY to 14.4/100 PY. In multivariate longitudinal analysis, factors significantly associated with HIV acquisition were engagement in unprotected receptive anal intercourse [adjusted hazard ratio (AHR) 5.8, 95% confidence interval (CI): 2.4, 14.4] and incident rectal gonorrhea and/or chlamydia (AHR: 2.7, 95% CI: 1.1, 6.8). The higher HIV incidence in Cape Town compared to Blantyre could be explained by the higher prevalence of several risk factors for HIV infection among participants in Cape Town. Annual HIV incidence observed in this study is substantially higher than reported HIV incidence in the general populations in the respective countries and among MSM in the United States. Intensification of HIV prevention efforts for MSM and TGW in SSA is urgently needed.
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Affiliation(s)
- Theodorus G. M. Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- * E-mail:
| | | | - Eduard J. Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, University of Oxford, Oxford, England, United Kingdom
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Erica L. Hamilton
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
| | - Victor Akelo
- Kenya Medical Research Institute, Kisumu Clinical Research Site, Kisumu, Kenya
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Univ. of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
| | - Karen Dominguez
- Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa
| | - Michael J. Stirratt
- National Institute of Mental Health, Division of AIDS Research, Bethesda, Maryland, United States of America
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jonathan Lucas
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
| | - Charlotte A. Gaydos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ying Q. Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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14
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Seneviratne HK, Hamlin AN, Li S, Grinsztejn B, Dawood H, Liu AY, Kuo I, Hosseinipour MC, Panchia R, Cottle L, Chau G, Adeyeye A, Rinehart AR, McCauley M, Eron JS, Cohen MS, Landovitz RJ, Hendrix CW, Bumpus NN. Identification of Novel UGT1A1 Variants Including UGT1A1 454C>A through the Genotyping of Healthy Participants of the HPTN 077 Study. ACS Pharmacol Transl Sci 2021; 4:226-239. [PMID: 33615175 PMCID: PMC7888308 DOI: 10.1021/acsptsci.0c00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Indexed: 11/30/2022]
Abstract
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Cabotegravir (CAB) is an integrase strand-transfer inhibitor of HIV that has proven
effective for HIV treatment and prevention in a long-acting injectable formulation,
typically preceded by an oral formulation lead-in phase. Previous in
vitro studies have demonstrated that CAB is primarily metabolized via
glucuronidation by uridine diphosphate glucuronosyltransferase (UGT) 1A1 and 1A9. In
this study, we performed next-generation sequencing of genomic DNA isolated from the
HPTN 077 participants to explore the variants within UGT1A1 and
UGT1A9. Additionally, to enable correlation of
UGT1A1 and UGT1A9 genotypes with plasma
CAB-glucuronide levels, we quantified glucuronidated CAB following both oral
administration of CAB and intramuscular injection of long-acting CAB. From these
studies, 48 previously unreported variants of UGT1A1 and
UGT1A9 were detected. Notably, 5/68 individuals carried a
UGT1A1 454C>A variant that resulted in amino acid substitution
P152T, and the use of in silico tools predicted a deleterious effect of
the P152T substitution. Thus, the impact of this mutant on a range of UGT1A1 substrates
was tested using a COS-7 cell-based assay. The glucuronide conjugates of CAB,
dolutegravir, and raltegravir, were not formed in the COS-7 cells expressing the UGT1A1
P152T mutant. Further, formation of glucuronides of raloxifene and
7-ethyl-10-hydroxycamptothecin were reduced in the cells expressing the UGT1A1 P152T
mutant. Using the same approach, we tested the activities of two UGT1A9 mutants, UGT1A9
H217Y and UGT1A9 R464G, and found that these mutations were tolerated and decreased
function, respectively. These data provide insight into previously unreported genetic
variants of UGT1A1 and UGT1A9.
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Affiliation(s)
- Herana Kamal Seneviratne
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Allyson N Hamlin
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Sue Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban 4041, South Africa
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Health, San Francisco, California 94102, United States
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia 20052, United States
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto 1864, South Africa
| | - Leslie Cottle
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Gordon Chau
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20852, United States
| | - Alex R Rinehart
- ViiV Healthcare, Durham, North Carolina 27709, United States
| | | | - Joseph S Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Myron S Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, California 90035, United States
| | - Craig W Hendrix
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Namandjé N Bumpus
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
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15
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Palumbo PJ, Zhang Y, Clarke W, Breaud A, Sivay M, Cummings V, Hamilton EL, Guo X, Ogendo A, Kayange N, Panchia R, Dominguez K, Chen YQ, Sandfort TGM, Eshleman SH. Uptake of antiretroviral treatment and viral suppression among men who have sex with men and transgender women in sub-Saharan Africa in an observational cohort study: HPTN 075. Int J Infect Dis 2021; 104:465-470. [PMID: 33440260 PMCID: PMC8091139 DOI: 10.1016/j.ijid.2020.12.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives: HPTN 075 enrolled men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa. Persons in HIV care or on antiretroviral treatment (ART) were not eligible to enroll. We evaluated antiretroviral (ARV) drug use, viral suppression, and drug resistance in this cohort over a 12-month follow-up period. Methods: Assessments included 64 participants with HIV (39 MSM, 24 TGW, and one gender not specified). ARV drugs were detected using a qualitative assay. Viral load (VL) and drug resistance testing were performed using commercial assays. Results: Over 12 months, the proportion of participants using ARV drugs increased from 28.1% to 59.4% and the proportion with VLs <400 copies/mL increased from 21.9% to 57.8%. The rate of ART failure (detection of drugs without viral suppression) was similar at screening and 12 months (12.0% and 11.1%, respectively) and was similar among MSM and TGW. Two participants developed HIV drug resistance during follow-up. Conclusions: Over 12 months, ARV drug use in the cohort more than doubled and viral suppression increased nearly threefold without a significant increase in ART failure or drug resistance. These results suggest that ART can be successfully scaled up for HIV prevention and treatment in this high-risk population.
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Affiliation(s)
- Philip J Palumbo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Yinfeng Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Mariya Sivay
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Erica L Hamilton
- Science Facilitation Department, FHI 360, Durham, North Carolina, USA.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Arthur Ogendo
- HIV Research Division, Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya.
| | - Noel Kayange
- Department of Internal Medicine, Johns Hopkins Project, College of Medicine, Malawi, Blantyre, Malawi.
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa.
| | - Karen Dominguez
- Desmond Tutu HIV Centre, UCT Medical School, Cape Town, South Africa.
| | - Ying Q Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University, New York, New York, USA.
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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16
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Landovitz RJ, Zangeneh SZ, Chau G, Grinsztejn B, Eron JJ, Dawood H, Magnus M, Liu AY, Panchia R, Hosseinipour MC, Kofron R, Margolis DA, Rinehart A, Adeyeye A, Burns D, McCauley M, Cohen MS, Currier JS. Cabotegravir Is Not Associated With Weight Gain in Human Immunodeficiency Virus-uninfected Individuals in HPTN 077. Clin Infect Dis 2021; 70:319-322. [PMID: 31125395 DOI: 10.1093/cid/ciz439] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/23/2019] [Indexed: 12/21/2022] Open
Abstract
Studies in human immunodeficiency virus (HIV)-infected individuals suggest excess weight gain with integrase inhibitor-based antiretroviral therapy. The HIV Prevention Trials Network Study 077 evaluated changes in weight and fasting metabolic parameters in HIV-uninfected individuals randomized to cabotegravir or a placebo. No differences between arms were found for change in weight or fasting metabolic parameters overall or for subgroups.
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Affiliation(s)
- Raphael J Landovitz
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research and Education & Center for HIV Prevention, David Geffen School of Medicine at University of California, Los Angeles
| | - Sahar Z Zangeneh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gordon Chau
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Beatriz Grinsztejn
- Laboratório de HIV, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Joseph J Eron
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | - Halima Dawood
- Department of Medicine, University of KwaZulu-Natal, Pietermaritzburg, Durban, South Africa
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Public Health, California
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, South Africa
| | - Mina C Hosseinipour
- Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine
| | - Ryan Kofron
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research and Education & Center for HIV Prevention, David Geffen School of Medicine at University of California, Los Angeles
| | | | - Alex Rinehart
- ViiV Healthcare, Research Triangle Park, Durham, North Carolina
| | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, Maryland
| | - David Burns
- Division of AIDS, National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, Maryland
| | | | - Myron S Cohen
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research and Education & Center for HIV Prevention, David Geffen School of Medicine at University of California, Los Angeles
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17
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Sandfort TGM, L Hamilton E, Marais A, Guo X, Sugarman J, Chen YQ, Cummings V, Dadabhai S, Dominguez K, Panchia R, Schnabel D, Zulu F, Reynolds D, Radebe O, Mbeda C, Kamba D, Kanyemba B, Ogendo A, Stirratt M, Chege W, Lucas J, Fawzy M, McKinstry LA, Eshleman SH. The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub-Saharan Africa (HPTN 075). J Int AIDS Soc 2020; 23 Suppl 6:e25600. [PMID: 33000911 PMCID: PMC7527761 DOI: 10.1002/jia2.25600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) are profoundly affected by HIV with high HIV prevalence and incidence. This population also faces strong social stigma and legal barriers, potentially impeding participation in research. To date, few multi-country longitudinal HIV research studies with MSM/TGW have been conducted in SSA. Primary objective of the HIV Prevention Trials Network (HPTN) 075 study was to assess feasibility of recruiting and retaining a multinational prospective cohort of MSM/TGW in SSA for HIV prevention research. METHODS HPTN 075, conducted from 2015 to 2017, was designed to enroll 400 MSM/TGW at four sites in SSA (100 per site: Kisumu, Kenya; Blantyre, Malawi; Cape Town, South Africa; and Soweto, South Africa). The number of HIV-positive persons was capped at 20 per site; HIV-positive persons already in care were excluded from participation. The one-year study included five biobehavioural assessments. Community-based input and risk mitigation protocols were included in study design and conduct. RESULTS Of 624 persons screened, 401 were enrolled. One in five participants was classified as transgender. Main reasons for ineligibility included: (a) being HIV positive after the cap was reached (29.6%); (b) not reporting anal intercourse with a man in the preceding three months (20.6%); and (c) being HIV positive and already in care (17.5%). Five (1.2%) participants died during the study (unrelated to study participation). 92.9% of the eligible participants (368/396) completed the final study visit and 86.1% participated in all visits. The main, overlapping reasons for early termination included being (a) unable to adhere to the visit schedule, predominantly because of relocation (46.4%), and (b) unable to contact the participant (32.1%). Participants reported strong motivation to participate and few participation barriers. Four participants reported social harms (loss of confidentiality and sexual harassment by study staff) that were successfully addressed. CONCLUSIONS HPTN 075 successfully enrolled a multinational sample of MSM/TGW in SSA in a prospective HIV prevention research study with a high retention rate and few documented social harms. This supports the feasibility of conducting large-scale research trials in this population to address its urgent, unmet HIV prevention needs.
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Affiliation(s)
- Theodorus GM Sandfort
- HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | | | - Anita Marais
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | - Xu Guo
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Jeremy Sugarman
- Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Ying Q Chen
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Vanessa Cummings
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Sufia Dadabhai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | - Karen Dominguez
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Ravindre Panchia
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | | | - Fatima Zulu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | | | | | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Dunker Kamba
- Centre for the Development of People (CEDEP)BlantyreMalawi
| | - Brian Kanyemba
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Michael Stirratt
- Division of AIDS ResearchNational Institute of Mental HealthBethesdaMDUSA
| | - Wairimu Chege
- Division of AIDNational Institute of Allergy and Infectious DiseaseNational Institutes of HealthBethesdaMDUSA
| | | | | | - Laura A McKinstry
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Susan H Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
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Mbeda C, Ogendo A, Lando R, Schnabel D, Gust DA, Guo X, Akelo V, Dominguez K, Panchia R, Mbilizi Y, Chen Y, Chege W. Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study. AIDS Care 2020; 32:1052-1060. [PMID: 32500722 DOI: 10.1080/09540121.2020.1776824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.
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Affiliation(s)
| | | | | | - David Schnabel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah A Gust
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Yamikani Mbilizi
- Malawi College of Medicine - Johns Hopkins University Research Project, Blantyre, Malawi
| | - Ying Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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19
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Landovitz RJ, Li S, Eron JJ, Grinsztejn B, Dawood H, Liu AY, Magnus M, Hosseinipour MC, Panchia R, Cottle L, Chau G, Richardson P, Marzinke MA, Eshleman SH, Kofron R, Adeyeye A, Burns D, Rinehart AR, Margolis D, Cohen MS, McCauley M, Hendrix CW. Tail-phase safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in HIV-uninfected adults: a secondary analysis of the HPTN 077 trial. Lancet HIV 2020; 7:e472-e481. [PMID: 32497491 DOI: 10.1016/s2352-3018(20)30106-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Long-acting injectable cabotegravir is a novel integrase inhibitor currently in advanced clinical development for HIV prevention and treatment. We aimed to assess the terminal phase pharmacokinetics and safety of long-acting injectable cabotegravir in participants included in the HPTN 077 trial. METHODS HPTN 077 was a multicentre, double-blind, randomised, placebo-controlled phase 2a trial done at eight sites in Brazil, Malawi, South Africa, and the USA. Participants (aged 18-65 years), who were HIV-uninfected and at low-risk for HIV, were randomly assigned (3:1) to long-acting injectable cabotegravir (800 mg given three times at 12 week intervals or 600 mg given five times, administered at one 4 week interval, and every 8 weeks thereafter) or placebo. Participants were followed up to 76 weeks after final injection. In a prespecified analysis of secondary and exploratory outcomes, we assessed the safety, measured by the proportion of participants with grade 2 or worse adverse events, and pharmacokinetics, measured by apparent terminal phase half-life (t1/2app) and estimated time to lower limit of quantification (LLOQ) of long-acting injectable cabotegravir during the injection phase (defined as the time between first injection and 12 weeks or 8 weeks after the last injection in cohort 1 or cohort 2 respectively) and tail phase (defined as the time between final injection and 52-76 weeks post-final injection). Safety was analysed in all participants who received at least one injection. Pharmacokinetic analyses included all participants who had received at least one injection and had at least three cabotegravir measurements higher than the LLOQ after the final injection. Pharmacokinetic outcomes were estimated using non-compartmental methods. The trial is completed, and was registered with ClinicalTrials.gov, NCT02178800. FINDINGS Between Feb 9, 2015, and May 27, 2016, 177 participants (134 participants in the cabotegravir group [74 participants in cohort 1; 60 participants in cohort 2] and 43 participants in the placebo group [25 participants in cohort 1; 18 participants in cohort 2) were enrolled and received at least one injection and thus were included in the safety analysis. The incidence of grade 2 or worse adverse events was significantly lower during the tail phase than the injection phase (p<0·0001). At 52-60 weeks after final injection, nine (23%) of 40 male participants had detectable cabotegravir concentrations and at week 76, four (13%) of 30 male participants had detectable cabotegravir concentrations compared with 52 (63%) of 82 female participants and 27 (42%) of 64 female participants at the same timepoints. The median time from the last injection to the time when cabotegravir concentration decreased below the LLOQ was 43·7 weeks (IQR 31·1-66·6; range 20·4-152·5) for male participants and 67·3 weeks (29·1-89·6; 17·7-225·5) for female participants (p=0·0003). t1/2app was longer for female participants than male participants (geometric mean fold-change 1·33, 95% CI 1·06-1·68; p=0·014), and longer for participants with a high body-mass index (BMI) than those with a low BMI (1·31, 1·06-1·63; p=0·015). INTERPRETATION The clinical significance of the long pharmacokinetic tail of cabotegravir observed in female participants compared with male participants, and those with higher BMI compared with a lower BMI, need to be addressed in future trials. FUNDING National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sue Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Health, San Francisco, CA, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Leslie Cottle
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gordon Chau
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul Richardson
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Marzinke
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan H Eshleman
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan Kofron
- UCLA Center for Clinical AIDS Research and Education, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - David Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | | | - Myron S Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Craig W Hendrix
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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20
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Sandfort TGM, Dominguez K, Kayange N, Ogendo A, Panchia R, Chen YQ, Chege W, Cummings V, Guo X, Hamilton EL, Stirratt M, Eshleman SH. HIV testing and the HIV care continuum among sub-Saharan African men who have sex with men and transgender women screened for participation in HPTN 075. PLoS One 2019; 14:e0217501. [PMID: 31150447 PMCID: PMC6544251 DOI: 10.1371/journal.pone.0217501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/12/2019] [Indexed: 01/24/2023] Open
Abstract
Throughout the world, men who have sex with men (MSM) are at increased risk for HIV infection compared to heterosexual men. Little is known about awareness of HIV infection and other gaps in the HIV care continuum for MSM, especially in sub-Saharan Africa (SSA). This information is urgently needed to address the HIV epidemic in this population. This study assessed gaps in the HIV care continuum among persons screened for participation in a multi-country prospective study that evaluated the feasibility of recruiting and retaining MSM for HIV prevention studies in SSA (HIV Prevention Trials Network (HPTN) 075, conducted in four cities in Kenya, Malawi, and South Africa). Participants were recruited using site-specific strategies, that included outreach and informal networks. Transgender women (TW) were eligible to participate. During screening, 601 MSM and TW were tested for HIV infection and asked about prior HIV testing, HIV status, engagement in care, and HIV treatment. Viral load testing and retrospective antiretroviral (ARV) drug testing were performed for HIV-infected participants. Most participants (92.2%) had a prior HIV test; 42.1% were last tested >6 months earlier. HIV prevalence was 30.4%. HIV infection was associated with older age and identifying as female or transgender; 43.7% of the HIV-infected participants were newly diagnosed, especially younger persons and persons with a less recent HIV test. Almost a third of previously-diagnosed participants were not linked to care. Most participants (88.7%) in care were on ARV treatment (ART). Only about one-quarter of all HIV-infected participants were virally suppressed. These findings demonstrate substantial prevalence of undiagnosed HIV infection and sub-optimal HIV care engagement among MSM and TW in SSA. Increased HIV testing frequency and better linkage to care represent critical steps in preventing further HIV transmission in this population. Once in care, gaps in the HIV care continuum appear less critical.
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Affiliation(s)
- Theo G. M. Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Karen Dominguez
- Desmond Tutu HIV Centre, UCT Medical School, Cape Town, South Africa
| | - Noel Kayange
- Johns Hopkins Medical College, Malawi, Blantyre, Malawi
| | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Univ. of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
| | - Ying Q. Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA, United States of America
| | - Wairimu Chege
- National Institute of Allergy and Infectious Disease, National Institutes of Health (NIH), Bethesda MD, United States of America
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA, United States of America
| | - Erica L. Hamilton
- Science Facilitation Department, FHI, Durham, NC, United States of America
| | - Michael Stirratt
- National Institute of Mental Health, Division of AIDS Research, Bethesda MD, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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21
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Fogel JM, Sandfort T, Zhang Y, Guo X, Clarke W, Breaud A, Cummings V, Hamilton EL, Ogendo A, Kayange N, Panchia R, Dominguez K, Chen YQ, Eshleman SH. Accuracy of Self-Reported HIV Status Among African Men and Transgender Women Who Have Sex with Men Who were Screened for Participation in a Research Study: HPTN 075. AIDS Behav 2019; 23:289-294. [PMID: 30051192 DOI: 10.1007/s10461-018-2231-1] [Citation(s) in RCA: 15] [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] [Indexed: 11/25/2022]
Abstract
Some HIV-infected individuals in research studies may choose not to disclose knowledge of their HIV status to study staff. We evaluated the accuracy of self-reported HIV status among African men and transgender women who have sex with men and who were screened for a research study. Sixty-seven of 183 HIV-infected participants reported a prior HIV diagnosis. Samples from the remaining 116 participants were tested for antiretroviral (ARV) drugs. Thirty-six of the 116 participants had ARV drugs detected, indicating that they were on antiretroviral treatment; these participants were classified as previously diagnosed based on ARV drug testing. Among participants classified as previously diagnosed, disclosure of a prior HIV diagnosis varied among study sites (p = 0.006) and was more common among those who reported having sex with men only (p = 0.002). ARV drug testing in addition to self-report improves the accuracy for identifying individuals with a prior HIV diagnosis.
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Affiliation(s)
- Jessica M Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Yinfeng Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | - Noel Kayange
- College of Medicine - Johns Hopkins Project, Blantyre, Malawi
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
| | - Karen Dominguez
- Desmond Tutu HIV Centre, UCT Medical School, Cape Town, South Africa
| | - Ying Q Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Pathology, The Johns Hopkins Medical Institutions, Ross Building, Room 646, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
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22
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Delany-Moretlwe S, Lombard C, Baron D, Bekker LG, Nkala B, Ahmed K, Sebe M, Brumskine W, Nchabeleng M, Palanee-Philips T, Ntshangase J, Sibiya S, Smith E, Panchia R, Myer L, Schwartz JL, Marzinke M, Morris L, Brown ER, Doncel GF, Gray G, Rees H. Tenofovir 1% vaginal gel for prevention of HIV-1 infection in women in South Africa (FACTS-001): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2018; 18:1241-1250. [PMID: 30507409 DOI: 10.1016/s1473-3099(18)30428-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Young women in southern Africa have substantial risk of HIV acquisition. Female-controlled biomedical interventions are needed to mitigate this risk. We aimed to assess the safety and efficacy of a pericoitally applied tenofovir 1% gel. METHODS We did a phase 3, double-blind, randomised, placebo-controlled trial at nine community-based clinical trial sites in South Africa to evaluate the safety and efficacy of tenofovir 1% gel. Sexually active women who were HIV negative and aged 18-30 years were enrolled. Participants were randomly assigned (1:1) using sequential participant numbers to either tenofovir 1% gel or a placebo gel (one dose within 12 h before sex and one dose within 12 h after sex [BAT-24 regimen]), using dynamic permuted block sizes of 8 and 16 within each site. Women received monthly HIV-1 testing, risk reduction support, physical examinations, and product dispensing for up to 27 months. The primary efficacy outcome was incident HIV infection and the primary safety outcome was occurrence of grade 2-4 adverse events, both analysed in the modified intention-to-treat population. To assess the efficacy of tenofovir gel, the cumulative probability of HIV infection was calculated for each treatment using the Kaplan-Meier method. This trial is registered with ClinicalTrials.gov, number NCT01386294. FINDINGS From Oct 11, 2011, to Aug 29, 2014, 3844 women were screened, 2059 enrolled, and 2029 included in the primary analysis (1032 in the tenofovir group and 1027 in the placebo group); 39 (4%) in the tenofovir group and 36 (4%) in the placebo group were lost to follow-up. 123 HIV-1 infections occurred over 3036 woman-years of observation; 61 in the tenofovir group (HIV incidence 4·0 per 100 woman-years, 95% CI 3·1-5·2) and 62 in the placebo group (4·0 per 100 woman-years, 3·1-5·2; incidence rate ratio [IRR] 0·98, 95% CI 0·7-1·4). A higher incidence of grade 2 adverse events was observed in the tenofovir group than in the placebo group (IRR 1·09, 95% CI 1·0-1·2; p=0·02). The most common grade 2 or higher product-related adverse events were hypophosphataemia (n=22 for tenofovir vs n=22 for placebo), genital symptoms (n=6 for tenofovir vs n=2 for placebo), or elevated transaminases (n=2 for tenofovir vs n=2 for placebo). No product-related serious adverse events were reported, and no differences in product-related adverse events (p=0·78), grade 3 events (p=0·64), or grade 4 events (p=0·74) were observed between treatment groups. INTERPRETATION Overall, pericoital tenofovir gel did not prevent HIV-1 acquisition in this population of young women at risk of HIV infection in South Africa. Alternate safe and effective products that are less user dependent than this product or do not require high adherence are needed. FUNDING The US Agency for International Development (USAID), the Bill & Melinda Gates Foundation, and the South African Department of Science and Technology and Department of Health.
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Affiliation(s)
| | - Carl Lombard
- Biostatistics Unit, Cape Town, South Africa; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Deborah Baron
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Maposhane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | | | | | - Sidney Sibiya
- Qhakaza Mbokodo Research Centre, Ladysmith, South Africa
| | - Emilee Smith
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Mark Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lynn Morris
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Elizabeth R Brown
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Glenda Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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23
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Landovitz RJ, Li S, Grinsztejn B, Dawood H, Liu AY, Magnus M, Hosseinipour MC, Panchia R, Cottle L, Chau G, Richardson P, Marzinke MA, Hendrix CW, Eshleman SH, Zhang Y, Tolley E, Sugarman J, Kofron R, Adeyeye A, Burns D, Rinehart AR, Margolis D, Spreen WR, Cohen MS, McCauley M, Eron JJ. Safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in low-risk HIV-uninfected individuals: HPTN 077, a phase 2a randomized controlled trial. PLoS Med 2018; 15:e1002690. [PMID: 30408115 PMCID: PMC6224042 DOI: 10.1371/journal.pmed.1002690] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/08/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cabotegravir (CAB) is a novel strand-transfer integrase inhibitor being developed for HIV treatment and prevention. CAB is formulated both as an immediate-release oral tablet for daily administration and as a long-acting injectable suspension (long-acting CAB [CAB LA]) for intramuscular (IM) administration, which delivers prolonged plasma exposure to the drug after IM injection. HIV Prevention Trials Network study 077 (HPTN 077) evaluated the safety, tolerability, and pharmacokinetics of CAB LA in HIV-uninfected males and females at 8 sites in Brazil, Malawi, South Africa, and the United States. METHODS AND FINDINGS HPTN 077 was a double-blind, placebo-controlled phase 2a trial. Healthy individuals age 18-65 years at low HIV risk were randomized (3:1) to receive CAB or placebo (PBO). In the initial oral phase, participants received 1 daily oral tablet (CAB or PBO) for 4 weeks. Those without safety concerns in the oral phase continued and received injections in the injection phase (Cohort 1: 3 injections of CAB LA 800 mg or 0.9% saline as PBO IM every 12 weeks for 3 injection cycles; Cohort 2: CAB LA 600 mg or PBO IM for 5 injection cycles; the first 2 injections in Cohort 2 were separated by 4 weeks, the rest by 8 weeks). The primary analysis included weeks 5 to 41 of study participation, encompassing the injection phase. The cohorts were enrolled sequentially. Primary outcomes were safety and tolerability. Secondary outcomes included pharmacokinetics and events occurring during the oral and injection phases. Between February 9, 2015, and May 27, 2016, the study screened 443 individuals and enrolled 110 participants in Cohort 1 and 89 eligible participants in Cohort 2. Participant population characteristics were as follows: 66% female at birth; median age 31 years; 27% non-Hispanic white, 41% non-Hispanic black, 24% Hispanic/Latino, 3% Asian, and 6% mixed/other; and 6 transgender men and 1 transgender woman. Twenty-two (11%) participants discontinued the oral study product; 6 of these were for clinical or laboratory adverse events (AEs). Of those who received at least 1 CAB LA injection, 80% of Cohort 1 and 92% of Cohort 2 participants completed all injections; injection course completion rates were not different from those in the PBO arm. Injection site reactions (ISRs) were common (92% of Cohort 1 and 88% of Cohort 2 participants who received CAB LA reported any ISR). ISRs were mostly Grade 1 (mild) to Grade 2 (moderate), and 1 ISR event (Cohort 1) led to product discontinuation. Grade 2 or higher ISRs were the only AEs reported more commonly among CAB LA recipients than PBO recipients. Two Grade 3 (severe) ISRs occurred in CAB recipients, 1 in each cohort, but did not lead to product discontinuation in either case. Seven incident sexually transmitted infections were diagnosed in 6 participants. One HIV infection occurred in a participant 48 weeks after last injection of CAB LA: CAB was not detectable in plasma both at the time of first reactive HIV test and at the study visit 12 weeks prior to the first reactive test. Participants in Cohort 2 (unlike Cohort 1) consistently met prespecified pharmacokinetic targets of at least 95% of participants maintaining CAB trough concentrations above PA-IC90, and 80% maintaining trough concentrations above 4× PA-IC90. Study limitations include a modest sample size, a short course of injections, and a low-risk study population. CONCLUSIONS In this study, CAB LA was well tolerated at the doses and dosing intervals used. ISRs were common, but infrequently led to product discontinuation. CAB LA 600 mg every 8 weeks met pharmacokinetic targets for both male and female study participants. The safety and pharmacokinetic results observed support the further development of CAB LA, and efficacy studies of CAB LA for HIV treatment and prevention are in progress. TRIAL REGISTRATION ClinicalTrials.gov Registry: ClinicalTrials.gov Trial number: NCT02178800.
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Affiliation(s)
- Raphael J. Landovitz
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, California, United States of America
| | - Sue Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa
| | - Albert Y. Liu
- Bridge HIV, Population Health Division, San Francisco Department of Health, San Francisco, California, United States of America
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, United States of America
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Leslie Cottle
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Gordon Chau
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Paul Richardson
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Craig W. Hendrix
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Susan H. Eshleman
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yinfeng Zhang
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Jeremy Sugarman
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ryan Kofron
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, California, United States of America
| | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - David Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Alex R. Rinehart
- ViiV Healthcare, Durham, North Carolina, United States of America
| | - David Margolis
- ViiV Healthcare, Durham, North Carolina, United States of America
| | | | - Myron S. Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Joseph J. Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Kistan J, Laher F, Otwombe K, Panchia R, Mawaka N, Lebina L, Diacon A, Kana B, Martinson N. Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa. Trans R Soc Trop Med Hyg 2018. [PMID: 28633335 DOI: 10.1093/trstmh/trx028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background HIV-uninfected individuals with pulmonary TB (PTB) commonly present with radiological features of upper lobe cavitatory disease. In contrast, individuals with HIV and PTB may present differently. This study compared radiological features of individuals with laboratory-confirmed PTB by HIV status from the largest study in South Africa. Methods We conducted a cross-sectional analysis of adults recruited between 2012 and 2015 with laboratory-confirmed PTB in Soweto, South Africa. Baseline characteristics and chest radiograph (CXR) findings were compared by χ2 test stratified by HIV status. Results Of the 474 individuals with PTB, 348 (73.4%) had HIV. Individuals with HIV had a higher proportion of infiltrates (58.9% vs 46.8%, p=0.02) and a lower proportion of cavitations (40.8% vs 68.3%; p<0.0001) compared to HIV-uninfected individuals. Additionally, individuals with HIV had a lower proportion of cavitations sized ≥4 cm (16.7% vs 36.5%, p<0.001) and a lower proportion of disease extent involving half or more of the total lung area radiologically (25.9% vs 45.3%, p<0.0001). Conclusions Individuals with HIV co-infected with PTB have a higher proportion of infiltrates and a lower proportion of cavitations relative to the HIV-uninfected PTB individuals. The absence of classical upper lobe cavitatory disease on CXR does not exclude PTB in individuals with HIV.
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Affiliation(s)
- Jesne Kistan
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Fatima Laher
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Nohemie Mawaka
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Limakatso Lebina
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Andreas Diacon
- Division of Physiology, Department of Medical Biochemistry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bavesh Kana
- DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, MD, USA
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Lewis J, Payne H, Walker AS, Otwombe K, Gibb DM, Babiker AG, Panchia R, Cotton MF, Violari A, Klein N, Callard RE. Thymic Output and CD4 T-Cell Reconstitution in HIV-Infected Children on Early and Interrupted Antiretroviral Treatment: Evidence from the Children with HIV Early Antiretroviral Therapy Trial. Front Immunol 2017; 8:1162. [PMID: 28979264 PMCID: PMC5611383 DOI: 10.3389/fimmu.2017.01162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Early treatment of HIV-infected children and adults is important for optimal immune reconstitution. Infants' immune systems are more plastic and dynamic than older children's or adults', and deserve particular attention. This study aimed to understand the response of the HIV-infected infant immune system to early antiretroviral therapy (ART) and planned ART interruption and restart. METHODS Data from HIV-infected children enrolled the CHER trial, starting ART aged between 6 and 12 weeks, were used to explore the effect of ART on immune reconstitution. We used linear and non-linear regression and mixed-effects models to describe children's CD4 trajectories and to identify predictors of CD4 count during early and interrupted ART. RESULTS Early treatment arrested the decline in CD4 count but did not fully restore it to the levels observed in HIV-uninfected children. Treatment interruption at 40 or 96 weeks resulted in a rapid decline in CD4 T-cells, which on retreatment returned to levels observed before interruption. Naïve CD4 T-cell count was an important determinant of overall CD4 levels. A strong correlation was observed between thymic output and the stable CD4 count both before and after treatment interruption. CONCLUSION Early identification and treatment of HIV-infected infants is important to stabilize CD4 counts at the highest levels possible. Once stabilized, children's CD4 counts appear resilient, with good potential for recovery following treatment interruption. The naïve T-cell pool and thymic production of naive cells are key determinants of children's CD4 levels.
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Affiliation(s)
- Joanna Lewis
- CoMPLEX, University College London, London, United Kingdom
- NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Helen Payne
- Institute of Child Health, University College London, London, United Kingdom
| | - A. Sarah Walker
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Abdel G. Babiker
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F. Cotton
- Children’s Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Klein
- Institute of Child Health, University College London, London, United Kingdom
| | - Robin E. Callard
- CoMPLEX, University College London, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
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Riddler SA, Husnik M, Ramjee G, Premrajh A, Tutshana BO, Pather A, Siva S, Jeenarain N, Nair G, Selepe P, Kabwigu S, Palanee-Phillips T, Panchia R, Mhlanga F, Levy L, Livant E, Patterson K, Elharrar V, Balkus J. HIV disease progression among women following seroconversion during a tenofovir-based HIV prevention trial. PLoS One 2017; 12:e0178594. [PMID: 28658251 PMCID: PMC5489164 DOI: 10.1371/journal.pone.0178594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background Little is known regarding HIV disease outcomes among individuals who become infected with HIV while receiving antiretroviral medications for prevention. We compared HIV disease parameters among women who seroconverted while receiving tenofovir-containing oral or vaginal pre-exposure prophylaxis (PrEP) to placebo. Methods Participants with HIV seroconversion in a randomized placebo-controlled trial of oral tenofovir, oral tenofovir/emtricitabine, and vaginal tenofovir gel (MTN-003) were followed in a longitudinal cohort study (MTN-015). The effect of oral and vaginal tenofovir-containing PrEP on HIV disease progression was compared to placebo using linear mixed effects and Cox proportional hazard models, as appropriate. Additional analyses were performed to compare the outcomes among participants with detectable tenofovir or emtricitabine in plasma at the first quarterly visit in MTN-003. Results A total of 224 participants were included in the analysis; 93% from South Africa and 94% clade C virus. No differences in HIV RNA at steady state or the trajectory over 12 months were observed for each active arm compared to placebo; tenofovir gel recipients had higher CD4+ T cell counts (722 vs 596 cells/mm3; p = 0.02) at 90 days after estimated HIV seroconversion and higher average rates of change over 12 months compared to placebo (-181 vs -92 cells/mm3 per year; p = 0.08). With a median follow-up of 31 months, no significant differences were observed for time to CD4+ T cell count ≤350 cells/mm3, or the composite endpoint of CD4+ T cells ≤350 cells/mm3, initiation of antiretroviral therapy or death for each active arm compared to placebo. Additionally, there were no significant differences in the HIV RNA or CD4+ T cell counts at baseline, the change to month 12, or any disease progression outcomes among participants with oral drug detected and no oral drug detected compared to placebo. Conclusions No clinically significant differences in HIV seroconversion outcomes were observed among women randomized to tenofovir-containing oral or vaginal PrEP regimens, however low overall adherence limits the generalizability of these findings.
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Affiliation(s)
- Sharon A. Riddler
- University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Marla Husnik
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA, United States of America
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Anamika Premrajh
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Bomkazi Onini Tutshana
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Arendevi Pather
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Nitesha Jeenarain
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | | | | | - Samuel Kabwigu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Mhlanga
- University of Zimbabwe, UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - Lisa Levy
- FHI 360, Durham, NC, United States of America
| | - Edward Livant
- Magee-Womens Research Institute, Pittsburgh, PA, United States of America
| | - Karen Patterson
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA, United States of America
| | | | - Jennifer Balkus
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- University of Washington, Seattle, WA, United States of America
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Palumbo PJ, Wilson EA, Piwowar-Manning E, McCauley M, Gamble T, Kumwenda N, Makhema J, Kumarasamy N, Chariyalertsak S, Hakim JG, Hosseinipour MC, Melo MG, Godbole SV, Pilotto JH, Grinsztejn B, Panchia R, Chen YQ, Cohen MS, Eshleman SH, Fogel JM. Association of HIV diversity and virologic outcomes in early antiretroviral treatment: HPTN 052. PLoS One 2017; 12:e0177281. [PMID: 28481902 PMCID: PMC5421787 DOI: 10.1371/journal.pone.0177281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/24/2017] [Indexed: 11/19/2022] Open
Abstract
Higher HIV diversity has been associated with virologic outcomes in children on antiretroviral treatment (ART). We examined the association of HIV diversity with virologic outcomes in adults from the HPTN 052 trial who initiated ART at CD4 cell counts of 350-550 cells/mm3. A high resolution melting (HRM) assay was used to analyze baseline (pre-treatment) HIV diversity in six regions in the HIV genome (two in gag, one in pol, and three in env) from 95 participants who failed ART. We analyzed the association of HIV diversity in each genomic region with baseline (pre-treatment) factors and three clinical outcomes: time to virologic suppression after ART initiation, time to ART failure, and emergence of HIV drug resistance at ART failure. After correcting for multiple comparisons, we did not find any association of baseline HIV diversity with demographic, laboratory, or clinical characteristics. For the 18 analyses performed for clinical outcomes evaluated, there was only one significant association: higher baseline HIV diversity in one of the three HIV env regions was associated with longer time to ART failure (p = 0.008). The HRM diversity assay may be useful in future studies exploring the relationship between HIV diversity and clinical outcomes in individuals with HIV infection.
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Affiliation(s)
- Philip J Palumbo
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, Maryland, United States of America
| | - Ethan A Wilson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Estelle Piwowar-Manning
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, Maryland, United States of America
| | - Marybeth McCauley
- Science Facilitation Department, FHI 360, Washington DC, United States of America
| | - Theresa Gamble
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
| | | | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - James G Hakim
- Dept. of Medicine, Univ. of Zimbabwe, Harare, Zimbabwe
| | - Mina C Hosseinipour
- Division of Infectious Diseases, Univ. of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- UNC Project-Malawi, Institute for Global Health and Infectious Diseases, Lilongwe, Malawi
| | - Marineide G Melo
- Hospital Nossa Senhora da Conceição, Serviço de Infectologia, Porto Alegre, Brazil
| | | | - Jose H Pilotto
- Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-INI-Fiocruz, Rio de Janeiro, Brazil
| | - Ravindre Panchia
- Univ. of the Witwatersrand, Perinatal HIV Research Unit, Soweto HPTN CRS, Soweto, South Africa
| | - Ying Q Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Myron S Cohen
- Dept. of Medicine, Univ. of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Susan H Eshleman
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, Maryland, United States of America
| | - Jessica M Fogel
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, Maryland, United States of America
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Eshleman SH, Wilson EA, Zhang XC, Ou SS, Piwowar-Manning E, Eron JJ, McCauley M, Gamble T, Gallant JE, Hosseinipour MC, Kumarasamy N, Hakim JG, Kalonga B, Pilotto JH, Grinsztejn B, Godbole SV, Chotirosniramit N, Santos BR, Shava E, Mills LA, Panchia R, Mwelase N, Mayer KH, Chen YQ, Cohen MS, Fogel JM. Virologic outcomes in early antiretroviral treatment: HPTN 052. HIV Clin Trials 2017; 18:100-109. [PMID: 28385131 DOI: 10.1080/15284336.2017.1311056] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. OBJECTIVE To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. METHODS 1566 participants who had a viral load (VL) > 400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350-550 cells/mm3 at ART initiation) and 734 in the delayed ART arm (204 with a CD4 < 250 cells/mm3 at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤ 400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs > 1000 copies/mL > 24 weeks after ART initiation. RESULTS Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by three months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. CONCLUSIONS Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention.
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Affiliation(s)
- Susan H Eshleman
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ethan A Wilson
- b Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Xinyi C Zhang
- b Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - San-San Ou
- b Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Estelle Piwowar-Manning
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Joseph J Eron
- c Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - Theresa Gamble
- e Science Facilitation Department , FHI 360 , Durham , NC , USA
| | | | - Mina C Hosseinipour
- g University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases , Chapel Hill , NC , USA.,h UNC Project-Malawi, Institute for Global Health and Infectious Diseases , Lilongwe , Malawi
| | | | - James G Hakim
- j Department of Medicine , University of Zimbabwe , Harare , Zimbabwe
| | - Ben Kalonga
- k College of Medicine-Johns Hopkins Project , Blantyre , Malawi
| | - Jose H Pilotto
- l Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz , Rio de Janeiro , Brazil
| | - Beatriz Grinsztejn
- m Instituto Nacional de Infectologia Evandro Chagas-INI-Fiocruz , Rio de Janeiro , Brazil
| | | | | | | | - Emily Shava
- q Botswana Harvard AIDS Institute , Gaborone , Botswana
| | - Lisa A Mills
- r Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention and Kenya Medical Research Institute (KEMRI)/CDC Clinical Research Site , Kisumu , Kenya
| | - Ravindre Panchia
- s University of the Witwatersrand, Perinatal HIV Research Unit, Soweto HPTN CRS , Soweto , South Africa
| | - Noluthando Mwelase
- t Clinical HIV Research Unit, Department of Medicine , University of the Witwatersrand , Johannesburg , South Africa
| | - Kenneth H Mayer
- u The Fenway Institute, Fenway Health/Infectious Disease Division, Beth Israel Deaconess Medical Center, Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Ying Q Chen
- b Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Myron S Cohen
- c Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Jessica M Fogel
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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29
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Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JHS, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, Mills LA, Panchia R, Faesen S, Eron J, Gallant J, Havlir D, Swindells S, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano DD, Essex M, Hudelson SE, Redd AD, Fleming TR. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med 2016; 375:830-9. [PMID: 27424812 PMCID: PMC5049503 DOI: 10.1056/nejmoa1600693] [Citation(s) in RCA: 1101] [Impact Index Per Article: 137.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission. METHODS We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked HIV-1 infection in the previously HIV-1-negative partner in an intention-to-treat analysis. RESULTS Index participants were followed for 10,031 person-years; partners were followed for 8509 person-years. Among partners, 78 HIV-1 infections were observed during the trial (annual incidence, 0.9%; 95% confidence interval [CI], 0.7 to 1.1). Viral-linkage status was determined for 72 (92%) of the partner infections. Of these infections, 46 were linked (3 in the early-ART group and 43 in the delayed-ART group; incidence, 0.5%; 95% CI, 0.4 to 0.7) and 26 were unlinked (14 in the early-ART group and 12 in the delayed-ART group; incidence, 0.3%; 95% CI, 0.2 to 0.4). Early ART was associated with a 93% lower risk of linked partner infection than was delayed ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22). No linked infections were observed when HIV-1 infection was stably suppressed by ART in the index participant. CONCLUSIONS The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners. (Funded by the National Institute of Allergy and Infectious Diseases; HPTN 052 ClinicalTrials.gov number, NCT00074581 .).
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Affiliation(s)
- Myron S Cohen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Ying Q Chen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Marybeth McCauley
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Theresa Gamble
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Mina C Hosseinipour
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Nagalingeswaran Kumarasamy
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - James G Hakim
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Johnstone Kumwenda
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Beatriz Grinsztejn
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Jose H S Pilotto
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sheela V Godbole
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Suwat Chariyalertsak
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Breno R Santos
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Kenneth H Mayer
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Irving F Hoffman
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Susan H Eshleman
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Estelle Piwowar-Manning
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Leslie Cottle
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Xinyi C Zhang
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joseph Makhema
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Lisa A Mills
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Ravindre Panchia
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sharlaa Faesen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joseph Eron
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joel Gallant
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Diane Havlir
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Susan Swindells
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Vanessa Elharrar
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - David Burns
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Taha E Taha
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Karin Nielsen-Saines
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - David D Celentano
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Max Essex
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sarah E Hudelson
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Andrew D Redd
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Thomas R Fleming
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
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Noguchi L, Hillier S, Richardson B, Chirenje Z, Ramjee G, Nair G, Selepe P, Palanee-Phillips T, Panchia R, Gomez K, Balkus J, Taha T, Piper J, Watts D, Marrazzo J. 5: Injectable progestin contraception and vaginal infection among south african women participating in the VOICE trial. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lange CM, Hué S, Violari A, Cotton M, Gibb D, Babiker A, Otwombe K, Panchia R, Dobbels E, Jean-Philippe P, McIntyre JA, Pillay D, Gupta RK. Single Genome Analysis for the Detection of Linked Multiclass Drug Resistance Mutations in HIV-1-Infected Children After Failure of Protease Inhibitor-Based First-Line Therapy. J Acquir Immune Defic Syndr 2015; 69:138-44. [PMID: 25923117 PMCID: PMC4679142 DOI: 10.1097/qai.0000000000000568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 10/23/2022]
Abstract
The WHO recommends protease inhibitor (PI)-based antiretroviral therapy (ART) for vertically infected children after failed nevirapine (NVP) prophylaxis. Emergence of PI resistance on the backdrop of preexisting non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance could compromise long-term treatment options in such children. We characterized multiclass drug resistance using single genome sequencing (SGS) in children with viremia while receiving PI-based ART. We applied SGS of HIV-1 protease (PR) and reverse transcriptase to longitudinal samples from a cohort of the Children with HIV Early Antiretroviral Therapy trial with viral loads >1000 copies per milliliter after 40 weeks of early ART. Bulk sequencing revealed NVP-selected resistance in 50% of these children, whereas SGS revealed NVP-selected resistance in 70%. Two children had baseline NRTI and PI mutations, suggesting previous maternal ART. Linked multiclass drug resistance after PI-based ART was detected by SGS in 2 of 10 children. In one child, the majority species contained M184V in reverse transcriptase linked to L10F, M46I/L, I54V, and V82A in PR and a triple-class drug-resistant variant with these mutations linked to the NNRTI mutation V108I. In the second child, the majority species contained M184V and V82A linked within viral genomes. We conclude that when PI-based ART is initiated soon after birth after single dose-NVP prophylaxis, PI and NRTI resistance can occur in the majority species as expected and also be selected on the same genomes as preexisting NNRTI-resistant mutations. These observations highlight a future therapeutic challenge for vertically infected children where antiretroviral drug classes are limited.
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Affiliation(s)
- Camille Marie Lange
- *Division of Infection and Immunity, University College London, London United Kingdom; †Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡Children's Infectious Diseases Clinical Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; §Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom; ||HJF-DAIDS, a Division of the Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Contractor, NIAID, NIH, Department of Health and Human Services, Bethesda, MD; ¶Anova Health Institute, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and #Africa Centre for Health and Population Studies, University of KwaZulu Natal
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Payne H, Mkhize N, Otwombe K, Lewis J, Panchia R, Callard R, Morris L, Babiker A, Violari A, Cotton MF, Klein NJ, Gibb DM. Reactivity of routine HIV antibody tests in children who initiated antiretroviral therapy in early infancy as part of the Children with HIV Early Antiretroviral Therapy (CHER) trial: a retrospective analysis. Lancet Infect Dis 2015; 15:803-9. [PMID: 26043884 DOI: 10.1016/s1473-3099(15)00087-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early antiretroviral therapy (ART) and virological suppression can affect evolving antibody responses to HIV infection. We aimed to assess frequency and predictors of seronegativity in infants starting early ART. METHODS We compared HIV antibody results between two of three treatment groups of the Children with HIV Early Antiretroviral Therapy (CHER) trial, done from July, 2005, until July, 2011, in which infants with HIV infection aged 5·7-12·0 weeks with a percentage of CD4-positive T lymphocytes of at least 25% were randomly assigned to immediate ART for 96 weeks (ART-96W) or deferred ART until clinical or immunological progression (ART-Def). We measured antibody from all available stored samples for ART-96W and ART-Def at trial week 84 using three assays: fourth-generation enzyme immunoassay HIV antigen-antibody combination, HIV-1 and HIV-2 rapid antibody test, and quantitative anti-gp120 IgG ELISA. We also assessed odds of seropositivity with respect to age of ART initiation and cumulative viral load. The CHER trial was registered with ClinicalTrials.gov, number NCT00102960. FINDINGS The median age of the infants from when samples were taken (184 samples from 268 infants) was 92 weeks (IQR 90·6-93·4). More specimens from the ART-96W group were seronegative than from the ART-Def group by enzyme immunoassay (ART-96W 49 [46%] of 107 vs ART-Def eight [11%] of 75; p<0·0001) and rapid antibody test (54 [53%] of 101 vs eight [11%] of 74; p<0·0001). Median anti-gp120 IgG concentration was lower in the ART-96W group (230 μg/μL [IQR 133-13 129]) than in the ART-Def group (6870 μg/μL [1706-53 645]; p<0·0001). If ART was started between 12 and 24 weeks of age, odds of seropositivity were increased 13·7 times (95% CI 3·1-60·2; p=0·001) compared with starting it between 0 and 12 weeks. All children starting ART aged older than 24 weeks were seropositive. Cumulative viral load to week 84 correlated with anti-gp120 IgG concentrations (coefficient 0·54; p<0·0001) and increased odds of seropositivity (odds ratio 1·59 [95% CI 1·1-2·3]) adjusted for ART initiation age. INTERPRETATION About half of children starting ART before 12 weeks of age were HIV seronegative by almost 2 years of age. HIV antibody tests cannot be used to reconfirm HIV diagnosis in children starting early ART. Long-term effects of seronegativity need further study. Clear guidelines are needed for retesting alongside improved diagnostic tests. FUNDING Wellcome Trust, Medical Research Council, and National Institutes of Health.
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Affiliation(s)
- Helen Payne
- Institute of Child Health, University College London, London, UK.
| | - Nonhlanhla Mkhize
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanna Lewis
- Centre for Maths and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robin Callard
- Institute of Child Health, University College London, London, UK; Centre for Maths and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | - Lynn Morris
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Abdel Babiker
- Clinical Trials Unit, Medical Research Council, London, UK
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Nigel J Klein
- Institute of Child Health, University College London, London, UK
| | - Diana M Gibb
- Clinical Trials Unit, Medical Research Council, London, UK
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Kabwigu S, Noguchi L, Moodley J, Palanee T, Kintu K, Nair L, Panchia R, Selepe P, Balkus JE, Torjesen K, Piper J, Scheckter R, Hazra R, Beigi R. The MTN-016 Pregnancy Registry: Baseline Characteristics of Enrollees from the VOICE Study and Reasons for Non-enrollment of Eligible Women. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5599.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lisa Noguchi
- MTN/Johns Hopkins University, Baltimore MD USA, Baltimore, MD, United States
| | | | - Thes Palanee
- Wits Reproductive Health & HIV Institute, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | | | - Richard Beigi
- University of Pittsburgh/Magee-Womens Hospital, Pittsburgh, PA, United States
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Balkus JE, Nair G, Montgomery E, Mishra A, Palanee T, Ramjee G, Panchia R, Selepe P, Richardson BA, Chirenje ZM, Marrazzo JM. Age-disparate Partnerships and Risk of HIV-1 Acquisition among South African Women Participating in the VOICE Trial. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5465.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer E. Balkus
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
| | | | | | - Anu Mishra
- University of Washington, Seattle, WA, United States
| | - Thesla Palanee
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Gita Ramjee
- South African Medical Research Council, Durban, South Africa
| | | | | | - Barbra A. Richardson
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
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Kiweewa FM, Noguchi L, Richardson B, Balkus J, Kamira B, Gati BM, Nakabiito C, Ramjee G, Palanee T, Nair G, Selepe P, Panchia R, Ndase P, Livant E, Van der Straten A, Gomez K, Singh D, Fowler MG, Piper J, Chirenje ZM, Marrazzo J. Prevalent and Incident Gonorrhea and Chlamydia Infections among Oral Contraceptive and Depot Medroxyprogesterone Acetate Users in MTN-003 (VOICE). AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5627.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lisa Noguchi
- Johns Hopkins University, Baltimore, MD, United States
| | | | - Jen Balkus
- SCHARP-FHCRC, Seattle, WA, United States
| | | | | | | | | | | | | | | | | | - Patrick Ndase
- University of Washington, Seattle, WA, United States
| | - Edward Livant
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | | | | | - Devika Singh
- University of Washington, Seattle, WA, United States
| | - Mary Glenn Fowler
- MU-JHU Research Collaboration, Kampala, Uganda
- Johns Hopkins University, Baltimore, MD, United States
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Govender S, Otwombe K, Essien T, Panchia R, de Bruyn G, Mohapi L, Gray G, Martinson N. CD4 counts and viral loads of newly diagnosed HIV-infected individuals: implications for treatment as prevention. PLoS One 2014; 9:e90754. [PMID: 24595317 PMCID: PMC3942485 DOI: 10.1371/journal.pone.0090754] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/03/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report the viral load and CD4 count in HIV-infected, antiretroviral naïve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines. DESIGN This was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa. METHODS We enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load. RESULTS Between March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART naïve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml. CONCLUSIONS A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.
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Affiliation(s)
- Sarishen Govender
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
- Canada-Africa Prevention Trials Network, The Ottawa Hospital General Campus, Ottawa, Canada
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Thandekile Essien
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Guy de Bruyn
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Lerato Mohapi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa
- Johns Hopkins University, Center for TB Research, Baltimore, Maryland, United States of America
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Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, Wang L, Ou SS, Anderson M, McCauley M, Gamble T, Kumarasamy N, Hakim JG, Kumwenda J, Pilotto JHS, Godbole SV, Chariyalertsak S, de Melo MG, Mayer KH, Eshleman SH, Piwowar-Manning E, Makhema J, Mills LA, Panchia R, Sanne I, Gallant J, Hoffman I, Taha TE, Nielsen-Saines K, Celentano D, Essex M, Havlir D, Cohen MS. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis 2014; 14:281-90. [PMID: 24602844 DOI: 10.1016/s1473-3099(13)70692-3] [Citation(s) in RCA: 384] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Use of antiretroviral treatment for HIV-1 infection has decreased AIDS-related morbidity and mortality and prevents sexual transmission of HIV-1. However, the best time to initiate antiretroviral treatment to reduce progression of HIV-1 infection or non-AIDS clinical events is unknown. We reported previously that early antiretroviral treatment reduced HIV-1 transmission by 96%. We aimed to compare the effects of early and delayed initiation of antiretroviral treatment on clinical outcomes. METHODS The HPTN 052 trial is a randomised controlled trial done at 13 sites in nine countries. We enrolled HIV-1-serodiscordant couples to the study and randomly allocated them to either early or delayed antiretroviral treatment by use of permuted block randomisation, stratified by site. Random assignment was unblinded. The HIV-1-infected member of every couple initiated antiretroviral treatment either on entry into the study (early treatment group) or after a decline in CD4 count or with onset of an AIDS-related illness (delayed treatment group). Primary events were AIDS clinical events (WHO stage 4 HIV-1 disease, tuberculosis, and severe bacterial infections) and the following serious medical conditions unrelated to AIDS: serious cardiovascular or vascular disease, serious liver disease, end-stage renal disease, new-onset diabetes mellitus, and non-AIDS malignant disease. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00074581. FINDINGS 1763 people with HIV-1 infection and a serodiscordant partner were enrolled in the study; 886 were assigned early antiretroviral treatment and 877 to the delayed treatment group (two individuals were excluded from this group after randomisation). Median CD4 counts at randomisation were 442 (IQR 373-522) cells per μL in patients assigned to the early treatment group and 428 (357-522) cells per μL in those allocated delayed antiretroviral treatment. In the delayed group, antiretroviral treatment was initiated at a median CD4 count of 230 (IQR 197-249) cells per μL. Primary clinical events were reported in 57 individuals assigned to early treatment initiation versus 77 people allocated to delayed antiretroviral treatment (hazard ratio 0·73, 95% CI 0·52-1·03; p=0·074). New-onset AIDS events were recorded in 40 participants assigned to early antiretroviral treatment versus 61 allocated delayed initiation (0·64, 0·43-0·96; p=0·031), tuberculosis developed in 17 versus 34 patients, respectively (0·49, 0·28-0·89, p=0·018), and primary non-AIDS events were rare (12 in the early group vs nine with delayed treatment). In total, 498 primary and secondary outcomes occurred in the early treatment group (incidence 24·9 per 100 person-years, 95% CI 22·5-27·5) versus 585 in the delayed treatment group (29·2 per 100 person-years, 26·5-32·1; p=0·025). 26 people died, 11 who were allocated to early antiretroviral treatment and 15 who were assigned to the delayed treatment group. INTERPRETATION Early initiation of antiretroviral treatment delayed the time to AIDS events and decreased the incidence of primary and secondary outcomes. The clinical benefits recorded, combined with the striking reduction in HIV-1 transmission risk previously reported, provides strong support for earlier initiation of antiretroviral treatment. FUNDING US National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Beatriz Grinsztejn
- Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Mina C Hosseinipour
- University of North Carolina School of Medicine, Chapel Hill, NC, USA; UNC Project-Malawi, Lilongwe, Malawi
| | | | | | - Joseph Eron
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ying Q Chen
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lei Wang
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - San-San Ou
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maija Anderson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | - Jose H S Pilotto
- Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil
| | | | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chaing Mai, Thailand
| | | | | | | | | | | | | | - Ravindre Panchia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Gallant
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irving Hoffman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Taha E Taha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - David Celentano
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Max Essex
- Harvard School of Public Health, Boston, MA, USA
| | - Diane Havlir
- University of California, San Francisco, CA, USA
| | - Myron S Cohen
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Cotton MF, Violari A, Otwombe K, Panchia R, Dobbels E, Rabie H, Josipovic D, Liberty A, Lazarus E, Innes S, van Rensburg AJ, Pelser W, Truter H, Madhi SA, Handelsman E, Jean-Philippe P, McIntyre JA, Gibb DM, Babiker AG. Early time-limited antiretroviral therapy versus deferred therapy in South African infants infected with HIV: results from the children with HIV early antiretroviral (CHER) randomised trial. Lancet 2013; 382:1555-63. [PMID: 24209829 PMCID: PMC4104982 DOI: 10.1016/s0140-6736(13)61409-9] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Interim results from the children with HIV early antiretroviral (CHER) trial showed that early antiretroviral therapy (ART) was life-saving for infants infected with HIV. In view of the few treatment options and the potential toxicity associated with lifelong ART, in the CHER trial we compared early time-limited ART with deferred ART. METHODS CHER was an open-label randomised controlled trial of HIV-infected asymptomatic infants younger than 12 weeks in two South African trial sites with a percentage of CD4-positive T lymphocytes (CD4%) of 25% or higher. 377 infants were randomly allocated to one of three groups: deferred ART (ART-Def), immediate ART for 40 weeks (ART-40W), or immediate ART for 96 weeks (ART-96W), with subsequent treatment interruption. The randomisation schedule was stratified by clinical site with permuted blocks of random sizes to balance the numbers of infants allocated to each group. Criteria for ART initiation in the ART-Def group and re-initiation after interruption in the other groups were CD4% less than 25% in infancy; otherwise, the criteria were CD4% less than 20% or Centers for Disease Control and Prevention severe stage B or stage C disease. Combination therapy of lopinavir-ritonavir, zidovudine, and lamivudine was the first-line treatment regimen at ART initiation and re-initiation. The primary endpoint was time to failure of first-line ART (immunological, clinical, or virological) or death. Comparisons were done by intention-to-treat analysis, with use of time-to-event methods. This trial is registered with ClinicalTrials.gov, number NCT00102960. FINDINGS 377 infants were enrolled, with a median age of 7·4 weeks, CD4% of 35%, and HIV RNA log 5·7 copies per mL. Median follow-up was 4·8 years; 34 infants (9%) were lost to follow-up. Median time to ART initiation in the ART-Def group was 20 weeks (IQR 16-25). Time to restarting of ART after interruption was 33 weeks (26-45) in ART-40W and 70 weeks (35-109) in ART-96W; at the end of the trial, 19% of patients in ART-40W and 32% of patients in ART-96W remained off ART. Proportions of follow-up time spent on ART were 81% in the ART-Def group, 70% in the ART-40W group, and 69% in the ART-96W group. 48 (38%) of 125 children in the ART-Def group, 32 (25%) of 126 in the ART-40W group, and 26 (21%) of 126 in the ART-96W group reached the primary endpoint. The hazard ratio, relative to ART-Def, was 0·59 (95% CI 0·38-0·93, p=0·02) for ART-40W and 0·47 (0·27-0·76, p=0·002) for ART-96W. Three children in ART-Def, three in ART-40W, and one in ART-96W switched to second-line ART. INTERPRETATION Early time-limited ART had better clinical and immunological outcomes than deferred ART, with no evidence of excess disease progression during subsequent treatment interruption and less overall ART exposure than deferred ART. Longer time on primary ART permits longer subsequent interruption, with marginally better outcomes. FUNDING US National Institutes of Health.
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Affiliation(s)
- Mark F Cotton
- Children's Infectious Diseases Clinical Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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Walensky RP, Ross EL, Kumarasamy N, Wood R, Noubary F, Paltiel AD, Nakamura YM, Godbole SV, Panchia R, Sanne I, Weinstein MC, Losina E, Mayer KH, Chen YQ, Wang L, McCauley M, Gamble T, Seage GR, Cohen MS, Freedberg KA. Cost-effectiveness of HIV treatment as prevention in serodiscordant couples. N Engl J Med 2013; 369:1715-25. [PMID: 24171517 PMCID: PMC3913536 DOI: 10.1056/nejmsa1214720] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The cost-effectiveness of early antiretroviral therapy (ART) in persons infected with human immunodeficiency virus (HIV) in serodiscordant couples is not known. Using a computer simulation of the progression of HIV infection and data from the HIV Prevention Trials Network 052 study, we projected the cost-effectiveness of early ART for such persons. METHODS For HIV-infected partners in serodiscordant couples in South Africa and India, we compared the early initiation of ART with delayed ART. Five-year and lifetime outcomes included cumulative HIV transmissions, life-years, costs, and cost-effectiveness. We classified early ART as very cost-effective if its incremental cost-effectiveness ratio was less than the annual per capita gross domestic product (GDP; $8,100 in South Africa and $1,500 in India), as cost-effective if the ratio was less than three times the GDP, and as cost-saving if it resulted in a decrease in total costs and an increase in life-years, as compared with delayed ART. RESULTS In South Africa, early ART prevented opportunistic diseases and was cost-saving over a 5-year period; over a lifetime, it was very cost-effective ($590 per life-year saved). In India, early ART was cost-effective ($1,800 per life-year saved) over a 5-year period and very cost-effective ($530 per life-year saved) over a lifetime. In both countries, early ART prevented HIV transmission over short periods, but longer survival attenuated this effect; the main driver of life-years saved was a clinical benefit for treated patients. Early ART remained very cost-effective over a lifetime under most modeled assumptions in the two countries. CONCLUSIONS In South Africa, early ART was cost-saving over a 5-year period. In both South Africa and India, early ART was projected to be very cost-effective over a lifetime. With individual, public health, and economic benefits, there is a compelling case for early ART for serodiscordant couples in resource-limited settings. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Fogel JM, Wang L, Parsons TL, Ou SS, Piwowar-Manning E, Chen Y, Mudhune VO, Hosseinipour MC, Kumwenda J, Hakim JG, Chariyalertsak S, Panchia R, Sanne I, Kumarasamy N, Grinsztejn B, Makhema J, Pilotto J, Santos BR, Mayer KH, McCauley M, Gamble T, Bumpus NN, Hendrix CW, Cohen MS, Eshleman SH. Undisclosed antiretroviral drug use in a multinational clinical trial (HIV Prevention Trials Network 052). J Infect Dis 2013; 208:1624-8. [PMID: 23908493 DOI: 10.1093/infdis/jit390] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The HIV Prevention Trials Network 052 study enrolled serodiscordant couples. Index participants infected with human immunodeficiency virus reported no prior antiretroviral (ARV) treatment at enrollment. ARV drug testing was performed retrospectively using enrollment samples from a subset of index participants. ARV drugs were detected in 45 of 96 participants (46.9%) with an undetectable viral load, 2 of 48 (4.2%) with a low viral load, and 1 of 65 (1.5%) with a high viral load (P < .0001); they were also detected in follow-up samples from participants who were not receiving study-administered treatment. ARV drug testing may be useful in addition to self-report of ARV drug use in some clinical trial settings.
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Madhi SA, Izu A, Violari A, Cotton MF, Panchia R, Dobbels E, Sewraj P, van Niekerk N, Jean-Philippe P, Adrian PV. Immunogenicity following the first and second doses of 7-valent pneumococcal conjugate vaccine in HIV-infected and -uninfected infants. Vaccine 2012; 31:777-83. [PMID: 23228814 DOI: 10.1016/j.vaccine.2012.11.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/14/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The immunogenicity of pneumococcal conjugate vaccine (PCV) has not been evaluated in HIV-infected infants following the first and second PCV-doses. We studied antibody kinetics of serotypes included in 7-valent PCV in HIV-infected and HIV-uninfected infants prior to and following each of three PCV-doses. METHODS HIV-uninfected infants born to HIV-uninfected (HUU) and HIV-infected mothers (HEU); and perinatal HIV-infected children with CD(4+)<25% randomized to initiate antiretroviral treatment (ART) when clinically and/or immunologically indicated (ART-) or immediately (ART+) were enrolled. Vaccination occurred at approximately 7.4, 11.5 and 15.5 weeks of age. Serotype-specific antibody was measured by ELISA following each PCV-dose and opsonophagocytic activity (OPA) to three serotypes following the second and third doses. RESULTS Pre-vaccination, antibody geometric mean concentrations (GMCs) were higher in HUU compared to HIV-exposed groups for most serotypes. GMCs and proportion of infants with antibody ≥0.35 μg/ml were similar in HUU compared to other groups following the second PCV-dose. In all groups, GMCs were greater following the third compared to post-second dose; and a higher proportion within each group had antibody ≥0.35 μg/ml to 6B and 23F. OPA GMTs increased after the third compared to post-second dose for studied-serotypes; as did the proportion with OPA ≥8 to 23F. CONCLUSION A two-dose primary-series of PCV probably confers similar protection against invasive pneumococcal disease in HIV-infected compared to HUU children. The inferior response to serotypes 6B and 23F, and lower GMCs and OPA GMTs, following two compared to after three PCV-doses may have implications in the prevention of pneumococcal disease in high-burden countries.
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Affiliation(s)
- Shabir A Madhi
- National Institute for Communicable Diseases - Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Sandringham, South Africa.
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Rabie H, Violari A, Duong T, Madhi SA, Josipovic D, Innes S, Dobbels E, Lazarus E, Panchia R, Babiker AG, Gibb DM, Cotton MF. Early antiretroviral treatment reduces risk of bacille Calmette-Guérin immune reconstitution adenitis. Int J Tuberc Lung Dis 2012; 15:1194-200, i. [PMID: 21943845 DOI: 10.5588/ijtld.10.0721] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SETTING Two centres in Soweto and Cape Town, South Africa. OBJECTIVE To assess the effects of timing of initiation of antiretroviral treatment (ART) and other factors on the risk of bacille Calmette-Guérin (BCG) related regional adenitis due to immune reconstitution inflammatory syndrome (BCG-IRIS) in human immunodeficiency virus (HIV) infected infants. DESIGN HIV-infected infants aged 6-12 weeks with CD4 count ≥25% enrolled in the Children with HIV Early Antiretroviral Therapy (CHER) Trial received early (before 12 weeks) or deferred (after immunological or clinical progression) ART; infants with CD4 count <25% all received early ART. All received BCG vaccination after birth. Reactogenicity to BCG was assessed prospectively during routine study follow-up. RESULTS Of 369 infants, 32 (8.7%) developed BCG-IRIS within 6 months of starting ART, 28 (88%) within 2 months after ART initiation. Of the 32 cases, 30 (93.8%) had HIV-1 RNA > 750 000 copies/ml at initiation. Incidence of BCG-IRIS was 10.9 and 54.3 per 100 person-years (py) among infants with CD4 count ≥25% at enrolment receiving early (at median age 7.4 weeks) vs. deferred (23.2 weeks) ART, respectively (HR 0.24, 95%CI 0.11-0.53, P < 0.001). Infants with CD4 count <25% receiving early ART had intermediate incidence (41.7/100 py). Low CD4 counts and high HIV-1 RNA at initiation were the strongest independent risk factors for BCG-IRIS. CONCLUSIONS Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis.
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Affiliation(s)
- H Rabie
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics & Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa.
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Sanne I, Orrell C, Fox M, Conradie F, Ive P, Zeinecker J, Cornell M, Heiberg C, Ingram C, Panchia R, Rassool M, Gonin R, Stevens W, Truter H, Dehlinger M, van der Horst C, McIntyre J, Wood R. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet 2010; 376:33-40. [PMID: 20557927 PMCID: PMC3145152 DOI: 10.1016/s0140-6736(10)60894-x] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. METHODS This randomised non-inferiority trial was undertaken at two South African primary-care clinics. HIV-positive individuals with a CD4 cell count of less than 350 cells per microL or WHO stage 3 or 4 disease were randomly assigned to nurse-monitored or doctor-monitored ART care. Patients were randomly assigned by stratified permuted block randomisation, and neither the patients nor those analysing the data were masked to assignment. The primary objective was a composite endpoint of treatment-limiting events, incorporating mortality, viral failure, treatment-limiting toxic effects, and adherence to visit schedule. Analysis was by intention to treat. Non-inferiority of the nurse versus doctor group for cumulative treatment failure was prespecified as an upper 95% CI for the hazard ratio that was less than 1.40. This study is registered with ClinicalTrials.gov, number NCT00255840. FINDINGS 408 patients were assigned to doctor-monitored ART care and 404 to nurse-monitored ART care; all participants were analysed. 371 (46%) patients reached an endpoint of treatment failure: 192 (48%) in the nurse group and 179 (44%) in the doctor group. The hazard ratio for composite failure was 1.09 (95% CI 0.89-1.33), which was within the limits for non-inferiority. After a median follow-up of 120 weeks (IQR 60-144), deaths (ten vs 11), virological failures (44 vs 39), toxicity failures (68 vs 66), and programme losses (70 vs 63) were similar in nurse and doctor groups, respectively. INTERPRETATION Nurse-monitored ART is non-inferior to doctor-monitored therapy. Findings from this study lend support to task shifting to appropriately trained nurses for monitoring of ART. FUNDING National Institutes of Health; United States Agency for International Development; National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Ian Sanne
- Faculty of Health Sciences, University of the Witwatersrand
| | | | - Matthew Fox
- Center for Global Health and Development, Boston University
| | | | - Prudence Ive
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | | | | | | | | | | | - Wendy Stevens
- Faculty of Health Sciences, University of the Witwatersrand
| | - Handré Truter
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | - James McIntyre
- Faculty of Health Sciences, University of the Witwatersrand
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Sanne I, Orrell C, Fox M, Conradie F, Ive P, Zeinecker J, Cornell M, Heiberg C, Ingram C, Panchia R, Rassool M, Gonin R, Stevens W, Truter H, Dehlinger M, van der Horst C, McIntyre J, Wood R. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet 2010. [PMID: 20557927 PMCID: PMC3145152 DOI: 10.1016/s0140-6736%2810%2960894-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. METHODS This randomised non-inferiority trial was undertaken at two South African primary-care clinics. HIV-positive individuals with a CD4 cell count of less than 350 cells per microL or WHO stage 3 or 4 disease were randomly assigned to nurse-monitored or doctor-monitored ART care. Patients were randomly assigned by stratified permuted block randomisation, and neither the patients nor those analysing the data were masked to assignment. The primary objective was a composite endpoint of treatment-limiting events, incorporating mortality, viral failure, treatment-limiting toxic effects, and adherence to visit schedule. Analysis was by intention to treat. Non-inferiority of the nurse versus doctor group for cumulative treatment failure was prespecified as an upper 95% CI for the hazard ratio that was less than 1.40. This study is registered with ClinicalTrials.gov, number NCT00255840. FINDINGS 408 patients were assigned to doctor-monitored ART care and 404 to nurse-monitored ART care; all participants were analysed. 371 (46%) patients reached an endpoint of treatment failure: 192 (48%) in the nurse group and 179 (44%) in the doctor group. The hazard ratio for composite failure was 1.09 (95% CI 0.89-1.33), which was within the limits for non-inferiority. After a median follow-up of 120 weeks (IQR 60-144), deaths (ten vs 11), virological failures (44 vs 39), toxicity failures (68 vs 66), and programme losses (70 vs 63) were similar in nurse and doctor groups, respectively. INTERPRETATION Nurse-monitored ART is non-inferior to doctor-monitored therapy. Findings from this study lend support to task shifting to appropriately trained nurses for monitoring of ART. FUNDING National Institutes of Health; United States Agency for International Development; National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Ian Sanne
- Faculty of Health Sciences, University of the Witwatersrand
| | | | - Matthew Fox
- Center for Global Health and Development, Boston University
| | | | - Prudence Ive
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | | | | | | | | | | | - Wendy Stevens
- Faculty of Health Sciences, University of the Witwatersrand
| | - Handré Truter
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | - James McIntyre
- Faculty of Health Sciences, University of the Witwatersrand
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Govender V, Bhana R, Pillay A, Panchia R, Padayachee GN, de Beer M. Perceptions and knowledge about AIDS among family planning clinic attenders in Johannesburg. S Afr Med J 1992; 81:71-4. [PMID: 1733026] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Many studies assessing the impact of national AIDS prevention programmes on knowledge, attitudes and practices have been published world-wide. Most have found that, while general knowledge increased, there was little change in behaviour. A survey of a random sample of 50 women attending a family planning clinic in Johannesburg determined the current knowledge, attitudes and practices of these sexually active women, aged 20-29 years. All selected respondents agreed to participate and a pretested structured questionnaire was completed. Most individuals had in excess of 7 years' schooling (78.0%), were single (58.0%) and domestic workers (28.6%). The majority were aware of AIDS (88.0%), but only 13.7% felt their knowledge was adequate. Fifty-two per cent knew sexual intercourse was a mode of transmission. Many misconceptions existed, 64.0% cited toilet seats, 47.1% sharing of utensils and 70.1% donating blood as routes by which HIV infection could be acquired. Only 47.1% and 34.1%, respectively, knew that the contraceptive pill and intra-uterine contraceptive device did not protect against HIV infection. Eighty-six per cent of the women were sexually active and 8.0% admitted to currently having more than one sexual partner. None used condoms and, generally, feelings regarding condom use were negative. Most (88.6%) believed AIDS patients should be hospitalised, 68.2% said in isolation wards, and 27.3% felt that AIDS patients should not be allowed to stay in the community. The implications of these findings are discussed and certain recommendations are made.
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Affiliation(s)
- V Govender
- Department of Community Health, University of the Witwatersrand, Johannesburg
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