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1.
AIDS Care ; 30(6): 727-733, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29336591

RESUMO

We studied behavioral risks among HIV-infected and uninfected adolescents using an audio computer-assisted self-interview. A prospective cohort study was initiated between 2013 and 2014 in Malaysia, Thailand, and Vietnam. HIV-infected adolescents were matched to uninfected adolescents (4:1) by sex and age group (12-14 and 15-18 years). We enrolled 250 HIV-infected (48% male; median age 14.5 years; 93% perinatally infected) and 59 uninfected (51% male; median age 14.1 years) adolescents. At enrollment, HIV-infected adolescents were on antiretroviral therapy (ART) for a median (IQR) of 7.5 (4.7-10.2) years, and 14% had HIV-RNA >1000 copies/mL; 19% reported adherence <80%. Eighty-four (34%) HIV-infected and 26 (44%) uninfected adolescents reported having ever smoked cigarettes or drunk alcohol (p = 0.13); 10% of HIV-infected and 17% of uninfected adolescents reported having initiated sexual activity; 6 of the HIV-infected adolescents had HIV-RNA >1000 copies/mL. Risk behaviors were common among adolescents, with few differences between those with and without HIV.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação , Assunção de Riscos , Estigma Social , Adolescente , Estudos de Casos e Controles , Criança , Feminino , HIV , Humanos , Malásia , Masculino , Estudos Prospectivos , Fatores de Risco , Comportamento Sexual , Tailândia , Vietnã
2.
J Med Virol ; 88(2): 234-43, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26147742

RESUMO

HIV drug resistance assessments and interpretations can be obtained from genotyping (GT), virtual phenotyping (VP) and laboratory-based phenotyping (PT). We compared resistance calls obtained from GT and VP with those from PT (GT-PT and VP-PT) among CRF01_AE and subtype B HIV-1 infected patients. GT predictions were obtained from the Stanford HIV database. VP and PT were obtained from Janssen Diagnostics BVBA's vircoType(TM) HIV-1 and Antivirogram®, respectively. With PT assumed as the "gold standard," the area under the curve (AUC) and the Bland-Altman plot were used to assess the level of agreement in resistance interpretations. A total of 80 CRF01_AE samples from Asia and 100 subtype B from Janssen Diagnostics BVBA's database were analysed. CRF01_AE showed discordances ranging from 3 to 27 samples for GT-PT and 1 to 20 samples for VP-PT. The GT-PT and VP-PT AUCs were 0.76-0.97 and 0.81-0.99, respectively. Subtype B showed 3-61 discordances for GT-PT and 2-75 discordances for VP-PT. The AUCs ranged from 0.55 to 0.95 for GT-PT and 0.55 to 0.97 for VP-PT. Didanosine had the highest proportion of discordances and/or AUC in all comparisons. The patient with the largest didanosine FC difference in each subtype harboured Q151M mutation. Overall, GT and VP predictions for CRF01_AE performed significantly better than subtype B for three NRTIs. Although discrepancies exist, GT and VP resistance interpretations in HIV-1 CRF01_AE strains were highly robust in comparison with the gold-standard PT.


Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral , Genótipo , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Fenótipo , Ásia , Técnicas de Genotipagem/métodos , HIV-1/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana/métodos
3.
Hepatology ; 62(1): 31-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25581111

RESUMO

UNLABELLED: In resource-constrained countries where the prevalence of hepatitis C virus (HCV) disease is usually high, it is important to know which population should be treated first in order to increase treatment effectiveness. The aim was to estimate the effectiveness of different HCV treatment eligibility scenarios in three different countries. Using a Markov model, we estimated the number of life-years saved (LYS) with different treatment eligibility scenarios according to fibrosis stage (F1-F4 or F3-4), compared to base case (F2-F4), at a constant treatment rate, of patients between 18 and 60 years of age, at stages F0/F1 to F4, without liver complications or coinfections, chronically infected by HCV, and treated with pegylated interferon (IFN)/ribavirin or more-efficacious therapies (i.e. IFN free). We conducted the analysis in Egypt (prevalence = 14.7%; 45,000 patients treated/year), Thailand (prevalence = 2.2%; 1,000 patients treated/year), and Côte d'Ivoire (prevalence = 3%; 150 patients treated/year). In Egypt, treating F1 patients in addition to ≥F2 patients (SE1 vs. SE0) decreased LYS by 3.9%. Focusing treatment only on F3-F4 patients increased LYS by 6.7% (SE2 vs. SE0). In Thailand and Côte d'Ivoire, focusing treatment only on F3-F4 patients increased LYS by 15.3% and 11.0%, respectively, compared to treating patients ≥F2 (ST0 and SC0, respectively). Treatment only for patients at stages F3-F4 with IFN-free therapies would increase LYS by 16.7% versus SE0 in Egypt, 22.0% versus ST0 in Thailand, and 13.1% versus SC0 in Côte d'Ivoire. In this study, we did not take into account the yearly new infections and the impact of treatment on HCV transmission. CONCLUSION: Our model-based analysis demonstrates that prioritizing treatment in F3-F4 patients in resource-constrained countries is the most effective scenario in terms of LYS, regardless of treatment considered.


Assuntos
Antivirais/uso terapêutico , Países em Desenvolvimento , Hepatite C/tratamento farmacológico , Modelos Teóricos , Análise Custo-Benefício , Hepatite C/complicações , Humanos , Cirrose Hepática/virologia
4.
Clin Infect Dis ; 57(1): 147-55, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23511301

RESUMO

BACKGROUND: Prevalence and risk factors of cytomegalovirus (CMV) viremia in patients infected with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in developing countries are understudied. METHODS: We measured CMV DNA in stored plasma specimens of 293 Thai HIV patients starting ART at CD4 counts <200 cells/mm(3). We examined Cox proportional hazard ratios (HRs) of 24 months mortality and new AIDS-defining illness (ADI). RESULTS: Of 293 patients, 159 (54.3%) were male. The median age was 33 years. The median baseline CD4 count was 82 cells/mm(3), and the median HIV-1 RNA was 4.9 log10 copies/mL. In total, 273 (93.2%) patients started potent combination ART, and 20 (6.8%) started dual nucleoside reverse transcriptase inhibitor (NRTI) therapy. CMV DNA was detected in 77 of 293 patients (26.3%) at baseline, and 9 of 199 patients with available specimen (4.5%) after 6 months of ART. The median CMV DNA was 548 copies/mL (interquartile range [IQR], 129-3849) at baseline and 114 copies/mL (IQR, 75-1099) at 6 months. In univariate analysis, death was associated with baseline CDC stage C, hemoglobin <10 g/dL, lower CD4 count, and CMV viremia. In multivariate analysis, only CMV DNA >500 copies/mL was significantly associated with mortality (HR: 7.28; 95% CI, 1.32-40.29, P = .023). CD4 count was the only variable associated with new ADI (HR: 0.70 per 50 CD4 cells increase; 95% CI, .49-.997, P = .048). CONCLUSIONS: In these Thai patients with advanced HIV disease, CMV viremia was frequent, and CMV DNA >500 copies/mL predicted increased mortality despite ART initiation. This calls for increased attention to screening of active CMV infection in advanced HIV patients in developing countries. Trials assessing preemptive anti-CMV therapy may be warranted.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/mortalidade , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Viremia/epidemiologia , Viremia/mortalidade , Adulto , Terapia Antirretroviral de Alta Atividade , Sangue/virologia , Contagem de Linfócito CD4 , DNA Viral/sangue , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Tailândia/epidemiologia , Carga Viral
5.
Clin Infect Dis ; 57(9): 1351-61, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23899681

RESUMO

BACKGROUND: Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings. METHODS: We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients. RESULTS: We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%). CONCLUSIONS: Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Retinite por Citomegalovirus/epidemiologia , Infecções por HIV/complicações , África/epidemiologia , Ásia/epidemiologia , Países em Desenvolvimento , Humanos , Prevalência
6.
Artigo em Inglês | MEDLINE | ID: mdl-31330995

RESUMO

Access to health care and financial protection for migrants can be promoted through diverse health insurance schemes, designed to suit migrants' needs within a specific context. The Migrant Fund (M-Fund) is a voluntary, non-profit health insurance scheme operating along the Thai-Myanmar border in Thailand since 2017 and aims to protect the health of migrants uncovered by existing government insurance schemes. A qualitative evaluation was conducted between December 2018 and March 2019 to determine M-Fund's operational impacts, provide recommendations for improvement, and draw suggestions about its role in protecting migrant health. In-depth interviews with 20 individuals and 5 groups were conducted in three categories: (1) International, national, and local partners; (2) M-Fund clients; and (3) M-Fund staff. Interview information was triangulated with findings from other informants, a document review, and researchers' observations. Despite covering a small number of 9131 migrants, the M-Fund has contributed to improving access to care for migrants, raised awareness about migrant health protection, and reduced the financial burden for public hospitals. The M-Fund acts as a safety-net initiative for those left behind due to unclear government policy to protect the health of undocumented/illegal migrants. Despite clear merits, the issue of adverse selection to the scheme is a critical challenge. Evidence from this evaluation is useful to inform the future design of government insurance schemes for migrants.


Assuntos
Acessibilidade aos Serviços de Saúde/economia , Seguro Saúde/economia , Migrantes , Administração Financeira , Humanos , Mianmar , Tailândia
7.
Zhonghua Nei Ke Za Zhi ; 47(3): 228-31, 2008 Mar.
Artigo em Zh | MEDLINE | ID: mdl-18785509

RESUMO

OBJECTIVE: To evaluate the 3-year outcomes of the Medecins Sans Frontieres/Guangxi Center for Disease Control and Prevention comprehensive and free of charge HIV/AIDS treatment and care project. METHODS: We present a detailed retrospective analysis of treatment outcomes of 432 cases who received highly active antiretroviral therapy (HAART) from December 2003 to December 2006. RESULTS: Among the adult patients who received HAART, the mortality rate was 6.5% and only 12 (2.8%) patients were lost to follow up. The mean CD4+ T cell count increase was 147 cells/microl and 246 cells/microl for patients receiving HAART for 9-15 and 21-27 months respectively. An adherence assessment conducted during March to December 2006 indicated that 95.9% of the study cases reached an adherence of 95% or more of the prescribed medications. Among the 30 children patients who received HAART, 4 (13.3%) cases died and the mean CD4+ T cell increase after 9-15 and 21-27 months of HAART was 673 cells/microl and 658 cells/microl respectively. 148 of the adult patients starting HAART were current or ex-intravenous drug users (IDU) and showed global death rate and lost to follow-up rate comparable to those of non-IDU patients (Log rank test, P = 0.91). CONCLUSIONS: Good mid-term therapeutic outcomes with combination antiretroviral therapy have been achieved in this project. Total free of charge care and treatment and intensive patient support/ counseling are crucial to program success.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adulto , Contagem de Linfócito CD4 , Pré-Escolar , China , Feminino , Seguimentos , Infecções por HIV/mortalidade , Infecções por HIV/prevenção & controle , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Medicina Preventiva/organização & administração , Medicina Preventiva/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
8.
Sex Health ; 14(4): 345-354, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28482168

RESUMO

BACKGROUND: The widespread availability of direct-acting antivirals (DAAs) is expected to drastically improve the treatment uptake and cure rate of hepatitis C virus (HCV). In this paper, rates of and factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia were assessed before access to DAAs. METHODS: The medical records of patients in the Australian HIV Observational Database who were reported to be HCV antibody positive from 1999 to 2014 were reviewed for HCV treatment data. Patients with detectable HCV RNA were included in this analysis. Logistic regression models were applied to identify factors associated with treatment uptake and HCV sustained virological response (SVR) 24 weeks' post treatment. RESULTS: The median follow-up time of those with chronic HCV/HIV co-infection was 103 months (interquartile range 51-166 months). Of 179 HCV viraemic patients, 79 (44.1%) began treatment. In the adjusted model, a higher METAVIR score was the only significant factor associated with treatment uptake (odds ratio (OR) 8.87, 95% confidence interval (CI) 2.00-39.3, P=0.004). SVR was achieved in 37 (50%) of 74 treated patients. HCV genotypes 2/3 compared with 1/4 remained the only significant factor for SVR in an adjusted multivariable setting (OR 5.44, 95% CI 1.53-19.4, P=0.009). CONCLUSIONS: HCV treatment uptake and SVR have been relatively low in the era of interferon-containing regimens, in Australian HIV/HCV coinfected patients. With new and better tolerated DAAs, treatment of HCV is likely to become more accessible, and identification and treatment of HCV in co-infected patients should become a priority.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/complicações , Hepatite C Crônica/tratamento farmacológico , Adulto , Fármacos Anti-HIV/uso terapêutico , Austrália , Coinfecção , Quimioterapia Combinada , Feminino , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , RNA Viral/sangue , Estudos Retrospectivos , Resposta Viral Sustentada , Resultado do Tratamento
9.
J Clin Epidemiol ; 81: 129-139, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27771357

RESUMO

OBJECTIVES: To compare two human immunodeficiency virus (HIV) cohorts to determine whether a pseudo-random sample can represent the entire study population. STUDY DESIGN AND SETTING: HIV-positive patients receiving care at eight sites in seven Asian countries. The TREAT Asia HIV Observational database (TAHOD) pseudo-randomly selected a patient sample, while TREAT Asia HIV Observational database-Low Intensity Transfer (TAHOD-LITE) included all patients. We compared patient demographics, CD4 count, and HIV viral load testing for each cohort. Risk factors associated with CD4 count response, HIV viral load suppression (<400 copies/mL), and survival were determined for each cohort. RESULTS: There were 2,318 TAHOD patients and 14,714 TAHOD-LITE patients. Patient demographics, CD4 count, and HIV viral load testing rates were broadly similar between the cohorts. CD4 count response and all-cause mortality were consistent among the cohorts with similar risk factors. HIV viral load response appeared to be superior in TAHOD and many risk factors differed, possibly due to viral load being tested on a subset of patients. CONCLUSION: Our study gives the first empirical evidence that analysis of risk factors for completely ascertained end points from our pseudo-randomly selected patient sample may be generalized to our larger, complete population of HIV-positive patients. However, results can significantly vary when analyzing smaller or pseudo-random samples, particularly if some patient data are not completely missing at random, such as viral load results.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Projetos de Pesquisa Epidemiológica , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Vigilância da População/métodos , Adulto , Ásia , Contagem de Linfócito CD4/estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Demografia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida , Carga Viral/estatística & dados numéricos
10.
Antivir Ther ; 21(8): 725-730, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27124891

RESUMO

BACKGROUND: The Social Health Clinic at the National Center for HIV/AIDS, Dermatology & STDs (SHC-NCHADS) in Phnom Penh is a major provider of antiretroviral therapy (ART) in Cambodia. However, patient access to viral load monitoring is uncommon. We conducted a cross-sectional evaluation of HIV viral load in SHC-NCHADS patients on ART to determine the proportion experiencing virological failure and to identify factors associated with virological failure in this population. METHODS: Patients who had been using their current first- or second-line ART regimen for ≥6 months were eligible. Virological failure was defined as a viral load >1,000 copies/ml, death, lost-to-follow-up or the absence of viral load testing despite presenting for care. Factors associated with virological failure were evaluated using logistic regression. RESULTS: Overall, 463 patients (53.1% male, median age 42.1 years) were included in the investigation. At the time of current regimen initiation, median CD4+ T-cell count was 101 cells/mm3 and 89.0% of patients had experienced a WHO stage III/IV event. At the time of testing/last clinic visit, 28 (6.0%) patients met our definition of virological failure. Median viral load among those failing was 9,633 copies/ml. Shorter time on current ART regimen, low CD4+ T-cell count at the time of viral load testing/last clinic visit and a record of suboptimal adherence were the strongest predictors of virological failure. CONCLUSIONS: This work demonstrates the high rate of viral suppression being achieved by the treatment programme at SHC-NCHADS and the need for future work to phase-in routine viral load monitoring in Cambodia.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Carga Viral
11.
Antivir Ther ; 21(6): 517-527, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26961354

RESUMO

BACKGROUND: Antiretroviral treatment (ART) for HIV-positive patients has expanded rapidly in Asia over the last 10 years. Our study aimed to describe the time trends and risk factors for overall survival in patients receiving first-line ART in Asia. METHODS: We included HIV-positive adult patients who initiated ART between 2003-2013 (n=16,546), from seven sites across six Asia-Pacific countries. Patient follow-up was to May 2014. We compared survival for each country and overall by time period of ART initiation using Kaplan-Meier curves. Factors associated with mortality were assessed using Cox regression, stratified by site. We also summarized first-line ART regimens, CD4+ T-cell count at ART initiation, and CD4+ T-cell and HIV viral load testing frequencies. RESULTS: There were 880 deaths observed over 54,532 person-years of follow-up, a crude rate of 1.61 (95% CI 1.51, 1.72) per 100 person-years. Survival significantly improved in more recent years of ART initiation. The survival probability at 4 years follow-up for those initiating ART in 2003-2005 was 92.1%, 2006-2009 was 94.3% and 2010-2013 was 94.5% (P<0.001). Factors associated with higher mortality risk included initiating ART in earlier time periods, older age, male sex, injecting drug use as HIV exposure and lower pre-ART CD4+ T-cell count. Concurrent with improved survival was increased tenofovir use, ART initiation at higher CD4+ T-cell counts and greater monitoring of CD4+ T-cells and HIV viral load. CONCLUSIONS: Our results suggest that HIV-positive patients from Asia have improved survival in more recent years of ART initiation. This is likely a consequence of improvements in treatment, patient management and monitoring over time.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Adolescente , Adulto , Ásia/epidemiologia , Contagem de Linfócito CD4 , Estudos de Coortes , Feminino , Infecções por HIV/virologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Carga Viral , Adulto Jovem
12.
PLoS One ; 11(4): e0153243, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27073928

RESUMO

SETTING: World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. OBJECTIVE: To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. DESIGN: Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. RESULTS: ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03). CONCLUSIONS: Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Controle de Infecções , Isoniazida/uso terapêutico , Tuberculose/diagnóstico , Tuberculose/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , África , Ásia , Região do Caribe , Infecções por HIV/complicações , Humanos , Pobreza , América do Sul , Tuberculose/tratamento farmacológico , Organização Mundial da Saúde
13.
J Int AIDS Soc ; 19(1): 20965, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27774955

RESUMO

INTRODUCTION: Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. METHODS: Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. RESULTS: We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. CONCLUSIONS: We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Soroconversão , Sífilis/complicações , Sífilis/epidemiologia , Adolescente , Adulto , Ásia/epidemiologia , Feminino , Homossexualidade Masculina , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sífilis/diagnóstico
14.
AIDS Res Hum Retroviruses ; 32(3): 255-61, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26414065

RESUMO

Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003-2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/µl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31-40, 41-50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31-1.88; OR = 2.01, 95% CI 1.58-2.56; and OR = 1.69, 95% CI 1.23-2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42-3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35-0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36-0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care.


Assuntos
Diagnóstico Tardio , Infecções por HIV/diagnóstico , Adulto , Fatores Etários , Ásia/epidemiologia , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores Sexuais , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa
15.
PLoS One ; 11(3): e0150512, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26933963

RESUMO

BACKGROUND: We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. METHODS: Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. RESULTS: A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. CONCLUSION: In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality.


Assuntos
Antirretrovirais/uso terapêutico , Coinfecção/complicações , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite B/complicações , Hepatite C/complicações , Adulto , Terapia Antirretroviral de Alta Atividade , Ásia/epidemiologia , Contagem de Linfócito CD4 , Estudos de Coortes , Coinfecção/epidemiologia , Feminino , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , HIV-1/isolamento & purificação , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
16.
Antivir Ther ; 21(1): 27-35, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26069150

RESUMO

BACKGROUND: The World Health Organization recommends HBV-HIV-coinfected individuals start antiretroviral therapy containing tenofovir. Here we describe first-line tenofovir use and treatment outcomes in coinfected patients in Asia. METHODS: HBV surface antigen positive patients enrolled in the TREAT Asia HIV Observational Database who started first-line antiretroviral therapy were included. Logistic regression adjusted for period of treatment initiation was used to determine factors associated with tenofovir use. Generalized estimating equations were used to evaluate factors associated with alanine transaminase levels and CD4(+) T-cell count on treatment. RESULTS: There were 548 eligible patients, of whom 149 (27.2%) started tenofovir. Patients treated in high/high-middle income countries (odds ratio 4.4 versus low/low-middle, 95% CI 2.6, 7.4; P<0.001) and those with elevated baseline alanine transaminase (odds ratio 4.2 versus normal, 95% CI 2.4, 7.2; P<0.001) were more likely to receive tenofovir. Hepatitis C antibody positive patients (odds ratio 0.4 versus negative, 95% CI 0.2, 0.8; P=0.008) were less likely. In those starting antiretroviral therapy with elevated alanine transaminase, mean reduction after tenofovir initiation was 11.2 IU/l (95% CI 0.9, 21.6; P=0.034) lower compared with those using a non-tenofovir-based regimen although this did not significantly increase the chance of alanine transaminase normalization. Tenofovir use was not associated with a superior CD4(+) T-cell response. CONCLUSIONS: HBV-HIV-coinfected patients in Asia are most likely to receive tenofovir if they are treated in a high/high-middle income country, have elevated alanine transaminase levels and are hepatitis C antibody negative. Compared to other antiretroviral therapies, tenofovir-based regimens more effectively reduce liver inflammation in HBV-HIV-coinfection but do not result in superior CD4(+) T-cell recovery.


Assuntos
Antivirais/uso terapêutico , Coinfecção , Infecções por HIV/tratamento farmacológico , Hepatite B/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Tenofovir/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Antivirais/farmacologia , Biomarcadores , Contagem de Linfócito CD4 , Estudos de Coortes , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Infecções por HIV/mortalidade , Infecções por HIV/virologia , HIV-1 , Hepatite B/mortalidade , Hepatite B/virologia , Vírus da Hepatite B , Humanos , Testes de Função Renal , Testes de Função Hepática , Masculino , Mortalidade , Inibidores da Transcriptase Reversa/farmacologia , Fatores de Risco , Tenofovir/farmacologia , Resultado do Tratamento
17.
Medicine (Baltimore) ; 95(32): e4570, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27512885

RESUMO

Elevated CD8 counts with combination antiretroviral therapy (cART) initiation may be an early warning indicator for future treatment failure. Thus, we investigated whether elevated CD8 counts were associated with virological failure (VF) in the first 4 years of cART in Asian HIV-infected patients in a multicenter regional cohort.We included patients from the TREAT Asia HIV Observational Database (TAHOD). Patients were included in the analysis if they started cART between 1996 and 2013 with at least one CD8 measurement within 6 months prior to cART initiation and at least one CD8 and viral load (VL) measurement beyond 6 months after starting cART. We defined VF as VL ≥400 copies/mL after 6 months on cART. Elevated CD8 was defined as CD8 ≥1200 cells/µL. Time to VF was modeled using Cox regression analysis, stratified by site.In total, 2475 patients from 19 sites were included in this analysis, of whom 665 (27%) experienced VF in the first 4 years of cART. The overall rate of VF was 12.95 per 100 person-years. In the multivariate model, the most recent elevated CD8 was significantly associated with a greater hazard of VF (HR = 1.35, 95% CI 1.14-1.61; P = 0.001). However, the sensitivity analysis showed that time-lagged CD8 measured at least 6 months prior to our virological endpoint was not statistically significant (P = 0.420).This study indicates that the relationship between the most recent CD8 count and VF was possibly due to the CD8 cells reacting to the increase in VL rather than causing the VL increase itself. However, CD8 levels may be a useful indicator for VF in HIV-infected patients after starting cART.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Linfócitos T CD8-Positivos , Infecções por HIV/tratamento farmacológico , Adulto , Fármacos Anti-HIV/administração & dosagem , Linfócitos T CD8-Positivos/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Falha de Tratamento , Carga Viral/efeitos dos fármacos
18.
J Virus Erad ; 1(4): 272-5, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27482424

RESUMO

The Asia-Pacific region bears a high burden of hepatitis C virus (HCV) infections and the largest number of global deaths. Populations most at risk of infection and disease progression include people who inject drugs and those living with HIV. HCV treatment options have rapidly expanded in the past few years through the development of direct-acting antiviral (DAA) medicines, which can cure HCV in over 95% of cases, but are prohibitively expensive. While price is the major barrier to treatment access, voluntary licensing has resulted in limited availability of one DAA (sofosbuvir) through generic manufacturers in India. Regulatory barriers, such as the need for domestic clinical trials, cause further delays in local medicines approvals and access. Intensive advocacy by civil society in combination with mobilisation of global resources for HIV treatment were critical to achieving price reductions in HIV medicines in the early 2000s. While the current global economic situation is less conducive to substantial funding support for HCV treatment, community advocates are building awareness of the growing opportunities for HCV cure. Key immediate steps include the inclusion of DAAs in domestic essential medicines lists, as the World Health Organization has already done for globally, and fast-tracking domestic drug approvals to facilitate government-level price negotiations with originator and generic pharmaceutical companies. Urgent action by a broad range of stakeholders is needed to facilitate access to HCV treatment in order to ensure that the millions of people living with hepatitis C in the Asia-Pacific will not miss out on these life-saving treatments.

19.
J Acquir Immune Defic Syndr ; 68(2): 186-95, 2015 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-25590271

RESUMO

BACKGROUND: Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources, it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. METHODS: HIV-positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. RESULTS: There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells per cubic millimeter, and median HIV viral load was 16,224 copies per milliliter. Patients started second-line ART before 2007 (n = 105), 2007-2010 (n = 147) and after 2010 (n = 50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line therapy was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95% confidence interval: 7.1 to 10.9) and 1.1 (95% confidence interval: 0.6 to 1.9), respectively. Older age, high baseline viral load, and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. CONCLUSIONS: Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adulto , Ásia , Sulfato de Atazanavir , Contagem de Linfócito CD4 , Estudos de Coortes , Feminino , Seguimentos , Infecções por HIV/imunologia , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Humanos , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/uso terapêutico , Piridinas/uso terapêutico , Ritonavir/uso terapêutico , Análise de Sobrevida , Falha de Tratamento , Carga Viral , Adulto Jovem
20.
J Int AIDS Soc ; 17: 18804, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24598459

RESUMO

INTRODUCTION: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. METHODS: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm(3) or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. RESULTS: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm(3). Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm(3) in 2008 to a peak of 302 cells/mm(3) after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p<0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p=0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p<0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p=0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1.-4.36; p=0.035). CONCLUSIONS: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Adulto , Ásia/epidemiologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Infecções por HIV/imunologia , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
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