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1.
Infect Dis Poverty ; 9(1): 28, 2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32169118

RESUMEN

BACKGROUND: By the end of October 2019, there were 958 thousand people were reported living with HIV/AIDS in China. Unhealthy lifestyle factors, such as smoking, drinking alcohol, using illicit drugs and no physical activity have been found to mitigate the positive impact of antiretroviral therapy (ART) on viral load and HIV-related quality of life. Moreover, risky sexual behavior among HIV-positive persons places their partners at risk for HIV transmission and other sexually transmitted infections. The aim of the study is to determine the prevalence of unhealthy behavior of people living with HIV/AIDS and related influencing factors, particularly those that are closely connected with HIV infection and ART effects. METHODS: An institutional based cross-sectional study design was used to collect data from people living with HIV/AIDS (PLWHA) in Beijing and Yunnan Province. The following information was included in the questionnaire survey: social-demographic characteristics, health behavior information, sexual risk behaviors. Binary logistic regression model was conducted to analyze the influencing factors of unhealthy general health behaviors and risky sexual behaviors. RESULTS: In total, 2575 PLWHA were included in the study and 78.3% (2017/2575) were male. For the general health behaviors, 34.2% (987/2544) smoke; 33.8% (870/2575) drank alcohol and 2.3% (49/2134) reported the use of illicit drugs in the previous 6 months. From the sexual behaviors perspective, 59.0% (1519/2575) had sex in the previous 6 months. Among people who had sex, 92.0% (1398/1519) had fixed sexual partners. Among those with no fixed sexual partner, 38.0% (46/121) had more than three partners. Among men who had sex, 34.7% (448/1292) reported having sex with men in the previous 6 months and 16.7% (75/448) of these had group sexual activity. Among participants, 72.2% (1053/1458) used condoms every time they had sex while 6.4% (94/1458) of people never used condom. Male people living with HIV/AIDS were more likely to have sexual risk behaviors (adjusted odds ratio [OR] = 2.208, 95% confidence interval [CI]: 1.147-4.252) and unhealthy general health behaviors (adjusted OR = 2.029, 95% CI: 1.480-2.783). The odds of higher risk sexual behaviors was 1.546 times (95% CI: 1.302-1.827, P = 0.001) greater among participants who drank alcohol compared with their non-drinking counterparts. CONCLUSIONS: PLWHA is a group that is vulnerable to problematic health behaviors, especially for men who were more likely to drink alcohol, have more sexual partners, more sexual risk behaviors including group sexual activity, not using condoms and using drugs. Therefore, interventions focusing on gender-specific risk behaviors reduction for people living with HIV/AIDS are now necessary to control the spread of HIV infection and improve the efficacy of antiviral treatment.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Condones/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conductas Relacionadas con la Salud , Conducta Sexual , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , China/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores de Riesgo , Asunción de Riesgos , Parejas Sexuales , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
2.
Rev Bras Epidemiol ; 23: e200020, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159630

RESUMEN

INTRODUCTION: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. METHODOLOGY: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. RESULTS: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. CONCLUSION: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Diagnóstico Tardío , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
3.
Medicine (Baltimore) ; 99(7): e18777, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049783

RESUMEN

This study sought to determine the dominant circulating human immunodeficiency virus type 1 (HIV-1) subtype and associated drug resistance mutations in Ghana.This cross-sectional study was conducted with archived samples collected from patients who received care at 2 hospitals in Ghana from 2014 to 2016. Blood samples were earlier processed into plasma and peripheral blood mononuclear cells and stored at -80 °C. Ribonucleic acid (RNA) was extracted from the archived plasma. Two HIV-1 genes; protease and reverse transcriptase, were amplified, sequenced using gene-specific primers and analyzed for subtype and drug resistance mutations using the Stanford HIV Database.Of 16 patient samples successfully sequenced, we identified the predominance of HIV-1 subtype CRF02_AG (11/16, 68%). Subtypes G (2/16, 13%), dual CRF02_AG/G (2/16, 13%), and CRF01_AE (1/16, 6%) were also observed. Major nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations, M184I/V, D67N, T215F, and K70R/E were found. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations, K103N, Y181C, V90I, F227L, and V106A were also prevalent. Additionally, and at a lower level, protease inhibitor (PI)-resistance mutations, M46I, I54 V, V82A, L90 M, and I471 V, were also present in the sequences from antiretroviral therapy (ART)-experienced individuals. Two NRTI-associated drug resistance mutations (DRMs) (D67N and T69N) were present in sequences from 1 ART-naive individual.HIV-1 subtype CRF02_AG was most frequently detected in this study thus confirming earlier reports of dominance of this subtype in the West-African sub-region and Ghana in particular. The detection of these drug resistance mutations in individuals on first-line regimen composed of NRTI and NNRTI is an indication of prolonged drug exposure without viral load monitoring. Routine viral load monitoring is necessary for early detection of virologic failure and drug resistance testing will inform appropriate choice of regimens for such patients.


Asunto(s)
Farmacorresistencia Viral , Infecciones por VIH/virología , VIH-1/clasificación , Mutación , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Evolución Molecular , Femenino , Ghana , Infecciones por VIH/tratamiento farmacológico , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , VIH-1/genética , VIH-1/fisiología , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Carga Viral
4.
West Afr J Med ; 37(1): 40-47, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030710

RESUMEN

BACKGROUND: Haematological abnormalities such as anaemia, leucopenia, and thrombocytopenia are common complications of Human Immunodeficiency Virus (HIV) infection. Few researchers have studied the changes in HIV positive patients before and during antiretroviral therapy (ART) in Ghana. This study is aimed at determining the haematological profile of people living with HIV (PLHIV) at baseline and whilst on ART in a tertiary facility in Cape Coast, Ghana. METHODS: This was an analytical cross-sectional study with a retrospective component among PLHIV assessing ART services at the Cape Coast Teaching Hospital, Ghana. Full blood count (FBC) test was performed on blood samples and the results were analyzed and categorized based on WHO definitions. RESULTS: A total of 440 participants were included. The mean haemoglobin level (g/dL) for females at baseline, 6 months after ART and during this study were 9.6 (±1.8), 10.9 (±1.4) and 11.6 (±1.4); and 10.2 (±2.1), 11.6 (±1.7) and 11.8 (±1.6) for males. At baseline, the commonest type of anaemia for both females and males was microcytic hypochromic anaemia. The mean platelet count was 382 x 109/l at baseline but reduced to 298 x 109/L after 6 months on ART. Among male participants in this study, the main factor associated with being anaemic after 6 months on ART was the ART regimen with non-Zidovudine based regimen, having reduced odds of anaemia of OR 0.3 (95%CI 0.1 - 0.9), p-value of 0.04. Among females, having plasma viral load >1000 copies per ml was found to have increased odds of being anaemic (OR 1.4, 95%CI 0.7 - 2.6), though not statistically significant (P-value of 0.32). CONCLUSION: The prevalence of anaemia, though improved on ART, was high among PLHIV. It is essential to ensure that full blood count of PLHIV in Ghana are done regularly, at all levels of service provision, with appropriate referral systems in place. The change to the current TDF based preferred first line ART regimen must also be enforced to reduce the potential risks associated with AZT use. This will improve outcome for PLHIV.


Asunto(s)
Anemia/inducido químicamente , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Anemia/epidemiología , Estudios Transversales , Femenino , Ghana , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria
5.
West Afr J Med ; 37(1): 53-57, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030712

RESUMEN

BACKGROUND: Pruritic papular eruption (PPE) is a frequent cause of substantial morbidity in Human Immunodeficiency Virus (HIV) patients in Nigeria. This skin condition remains the most common cutaneous manifestation in HIV-infected patients and it is more prevalent in developing countries. AIMS: To describe the clinical and pathologic features of PPE in our patients, and compare with those seen in other parts of the world. MATERIALS AND METHODS: Specimen collection, analysis and write-up of the study lasted 18 months (January 2015 to June 2016) after ethical approval of the proposal. The study design was a cross-sectional descriptive study of confirmed HIV-infected patients with clinically active PPE lesions presenting at the Dermatology outpatient clinic, the HIV/ART clinic, and those admitted as in-patients in the medical wards of the University of Benin Teaching Hospital, Benin. Data generated from the study were entered into and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Only 106 patients were histologically confirmed to be PPE and subsequently recruited for the study. The pattern of distribution of PPE-HIV suggested that the rash has a predilection for exposed parts of the body. The body regions most significantly affected were lateral surface of lower limb, upper limb extensor surface, dorsal surface of foot and dorsal surface of hand. The most common secondary changes observed among the patients were excoriated papules, post-inflammatory hyper- and hypopigmentation, scarring, lichenification. CONCLUSION: Lesions of pruritic papular eruptions (PPE) of HIV in this study were distributed predominantly on the exposed parts of the body especially the upper and lower limbs.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Exantema/patología , Infecciones por VIH/tratamiento farmacológico , Prurito/patología , Estudios Transversales , Exantema/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Nigeria/epidemiología , Prurito/epidemiología , Prurito/etiología
6.
Viruses ; 12(2)2020 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-31991737

RESUMEN

Combination antiretroviral therapy (cART) controls but does not eradicate HIV infection; HIV persistence is the principal obstacle to curing infections. The proportion of defective proviruses increases during cART, but the dynamics of this process are not well understood, and a quantitative analysis of how the proviral landscape is reshaped after cART is initiated is critical to understanding how HIV persists. Here, we studied longitudinal samples from HIV infected individuals undergoing long term cART using multiplexed Droplet Digital PCR (ddPCR) approaches to quantify the proportion of deleted proviruses in lymphocytes. In most individuals undergoing cART, HIV proviruses that contain gag are lost more quickly than those that lack gag. Increases in the fraction of gag-deleted proviruses occurred only after 1-2 years of therapy, suggesting that the immune system, and/or toxicity of viral re-activation helps to gradually shape the proviral landscape. After 10-15 years on therapy, there were as many as 3.5-5 times more proviruses in which gag was deleted or highly defective than those containing intact gag. We developed a provirus-specific ddPCR approach to quantify individual clones. Investigation of a clone of cells containing a deleted HIV provirus integrated in the HORMAD2 gene revealed that the cells underwent a massive expansion shortly after cART was initiated until the clone, which was primarily in effector memory cells, dominated the population of proviruses for over 6 years. The expansion of this HIV-infected clone had substantial effects on the overall proviral population.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH-1/genética , VIH-1/aislamiento & purificación , Leucocitos Mononucleares/virología , Provirus/aislamiento & purificación , Terapia Antirretroviral Altamente Activa , Linfocitos T CD4-Positivos/virología , Proteínas de Ciclo Celular/genética , ADN Viral/sangre , ADN Viral/genética , Virus Defectuosos/genética , Genes gag , Duplicado del Terminal Largo de VIH , VIH-1/efectos de los fármacos , Humanos , Memoria Inmunológica , Reacción en Cadena de la Polimerasa Multiplex , Provirus/genética , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/virología , Factores de Tiempo , Resultado del Tratamiento , Carga Viral
7.
Int J Antimicrob Agents ; 55(3): 105893, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31926287

RESUMEN

This was a retrospective study on the efficacy and drug resistance mutations selected at virological failure (VF) in prospectively-followed HIV-infected patients switched to dolutegravir plus rilpivirine (DTG+RPV) or lamivudine (DTG+3TC) while virologically suppressed (HIV-RNA <50 copies/mL). VF was defined as HIV-RNA >50 copies/mL in two consecutive determinations or in a single determination if followed by treatment modification, or >1000 copies/mL in a single determination. Totally, 374 patients were analysed (307 switched to DTG+3TC and 67 to DTG+RPV); 220 had documented historical resistance. The median (IQR) time with HIV-RNA <50 copies/mL before switch was 4.52 (1.93-8.14) years. VF occurred in 17 patients after a median of 1.74 (0.90-2.46) years of follow-up in the 3TC group [incidence rate (95% CI) 3.34 (2.08-5.37) per 100-PYFU] and in 2 patients after a median of 1.78 (1.10-2.99) years of follow-up in the RPV group [incidence rate (95% CI) 1.57 (0.4-6.28) per 100-PYFU]. The 48-week estimated probabilities to maintain virological suppression during treatment with a two-drug regimen were 97.8% (95% CI 95.1-99.0%) vs. 98.3% (95% CI 88.6-99.8%) in the 3TC versus RPV group (P = 0.311). At switch, patients with VF had undetectable HIV-RNA since 0.71 (0.23-1.07) years versus 1.49 (0.64-2.2) years in those without VF (P = 0.001). In the 3TC group, VF was not associated with the presence of historical resistance to nucleoside analogues, and DTG-resistant variants were not selected at VF. One VF to DTG+RPV occurred because of historical resistance to RPV, accompanied by newly selected G140A and Q148R mutations. VF was infrequent with these regimens and was negatively associated with duration of viral undetectability. Drug resistance mutations selected at failure of these regimens were those expected in case of failure of any regimen including DTG, 3TC or RPV, but the impact of resistance to NRTIs on efficacy of DTG+3TC seems lower than expected.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Lamivudine/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Rilpivirina/uso terapéutico , Fármacos Anti-VIH/administración & dosificación , Farmacorresistencia Viral , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Humanos , Lamivudine/administración & dosificación , Estudios Retrospectivos , Rilpivirina/administración & dosificación , Resultado del Tratamiento
9.
Nurse Pract ; 45(3): 28-38, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31996579

RESUMEN

Current treatments for patients with HIV are not only effective at controlling viral replication but are also associated with a more favorable adverse reaction profile, may often be taken once daily, and are increasingly available in combination single-tablet regimens. This article provides an overview and prescribing considerations for several primary drugs currently recommended by the US Department of Health and Human Services.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Quimioterapia Combinada , Humanos , Guías de Práctica Clínica como Asunto , Estados Unidos , United States Dept. of Health and Human Services
10.
Int J Cancer ; 146(6): 1667-1673, 2020 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-31325316

RESUMEN

Cervical cancer remains a significant cause of morbidity and mortality in women worldwide and is the leading cause of cancer-related death in Botswana. It is well established that women with HIV have a higher risk of persistent HPV infection leading to cervical cancer. We assessed HPV prevalence and genotype distribution in 126 tissue specimens from confirmed invasive cervical cancer cases using Abbott real-time PCR assay. Overall, 88 (69.8%) women were HIV-infected. Fifty-seven (64.8%) of the HIV-infected women had a baseline CD4+ count ≥350 cells/µl, and 82 (93.2%) were on antiretroviral therapy at the time of cervical cancer diagnosis. The median age of HIV-infected patients was significantly younger than that of HIV-uninfected patients (p < 0.001). HPV DNA was detected in all of 126 (100%) of tissues analyzed in our study. The HPV genotypes identified included the HPV-16 (75.4%), HPV-18 (28.6%) and other high-risk (hr) HPV genotypes (16.7%). HIV infection was positively associated with the presence of the HPV-16 genotype (p = 0.036), but not with HPV-18 or with other high-risk (hr)-HPV genotypes. Thirty-three percent of the patients had multiple hr-HPV genotypes, with higher rates in HIV-infected women. These results highlight the importance and potential impact of large-scale HPV vaccination programs covering HPV-16 and HPV-18 genotypes in countries like Botswana with high burden of HIV infection.


Asunto(s)
Infecciones por VIH/virología , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 18/aislamiento & purificación , Infecciones por Papillomavirus/virología , Neoplasias del Cuello Uterino/virología , Fármacos Anti-VIH/uso terapéutico , Botswana/epidemiología , Cuello del Útero/patología , Cuello del Útero/virología , Costo de Enfermedad , Estudios Transversales , ADN Viral/genética , ADN Viral/aislamiento & purificación , Femenino , Genotipo , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Prevalencia , Estudios Retrospectivos , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Vacunación
11.
Chemistry ; 26(6): 1166-1195, 2020 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-31479550

RESUMEN

Bryostatins are a class of naturally occurring macrocyclic lactones with a unique fast developing portfolio of clinical applications, including treatment of AIDS, Alzheimer's disease, and cancer. This comprehensive account summarizes the recent progress (2014-present) in the development of bryostatins, including their total synthesis and biomedical applications. An emphasis is placed on the discussion of bryostatin 1, the most-studied analogue to date. This review highlights the synthetic and biological challenges of bryostatins and provides an outlook on their future development.


Asunto(s)
Antineoplásicos/química , Brioestatinas/síntesis química , Fármacos Anti-VIH/síntesis química , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Brioestatinas/farmacología , Brioestatinas/uso terapéutico , Senescencia Celular/efectos de los fármacos , Enfermedades del Sistema Nervioso Central/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Humanos , Proteína Quinasa C/antagonistas & inhibidores , Proteína Quinasa C/metabolismo
12.
Medicine (Baltimore) ; 98(50): e18232, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852085

RESUMEN

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Prevención Primaria/métodos , Conducta Sexual , Parejas Sexuales , Personas Transgénero , Adulto , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Cumplimiento de la Medicación , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
13.
PLoS One ; 14(12): e0226391, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31860677

RESUMEN

INTRODUCTION: There is a risk of mother-to-child transmission of HIV (MTCT) during pregnancy and breastfeeding. The aim of this study was to assess vertical transmission of HIV among pregnant women who initially had false-negative rapid HIV tests in South African antenatal care (ANC) clinics. METHODS: Pregnant participants were enrolled in a diagnostic study that used nucleic acid amplification testing (NAAT) to screen for early HIV infection among individuals who tested negative on rapid HIV tests used at the point-of-care (POC) facilities. Participants were enrolled from four ANC clinics in the Tshwane district of South Africa. All NAAT-positive participants were recalled to the clinics for further management. Vertical transmission was assessed among exposed infants whose HIV polymerase chain reaction (PCR) results were available. RESULTS: This study enrolled 8208 pregnant participants who tested negative on rapid HIV tests between 2013 and 2016. Their median age was 26 years (interquartile range [IQR]: 23-30). NAAT detected HIV infections in 0.6% (n = 49; 95% confidence interval {CI}: 0.5-0.8) of all study participants. The distribution of these infections among the four clinics ranged from 0.3%- 1.1%, but this was not statistically significant (p = 0.07). Forty-seven participants (95.9%) were successfully recalled and referred for antiretroviral treatment initiation as part of prevention of MTCT (PMTCT). Most women with newly diagnosed HIV infection presented for the first ANC visit in the second (61.9%, n = 26) and third (31.0%, n = 13) trimesters. HIV PCR results were available for thirty-two infants, three of whom tested positive (9.4%; 95% CI: 1.98-25.02). CONCLUSIONS: This study showed that supplemental HIV testing for pregnant women led to earlier linkage to the PMTCT programme. Inaccurate diagnosis of HIV infection at ANC clinics is likely to undermine the efforts of eliminating MTCT particularly in HIV-endemic settings.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/diagnóstico , VIH/genética , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/virología , Adulto , Reacciones Falso Negativas , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo , Edad Materna , Técnicas de Amplificación de Ácido Nucleico , Sistemas de Atención de Punto , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Atención Prenatal/métodos , Sudáfrica , Adulto Joven
14.
PLoS One ; 14(12): e0225415, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31869342

RESUMEN

A significant proportion of HIV-infected patients experiencing a late diagnosis highlights the need to define immunological protocols able to help the clinicians in identifying patients at higher risk for immunological failure. The aim of the study was to evaluate the feasibility of easy cytometric tests in defining the effect of antiretroviral treatment (cART) on immunological homeostasis and in identifying predictive markers of early immune recovery. Chronic HIV infected patients (n = 202) were enrolled in a prospective multicentric study, and their immunological profile was studied before (w0) and after 24 weeks (w24) of antiretroviral treatment (cART) using a standardized flow cytometric panel. Based on CD4 T cell count before treatment, patients were divided in late (LP: CD4 <350/mmc), intermediate (IP: 350/mmc500/mmc) presenters. In all groups, cART introduction increased CD4 and CD4/CD8 T cell ratio, naïve T cell (CD4 and CD8) and CD127-expressing CD4 T cells. In parallel, cART significantly reduced effector memory T cells (CD4 and CD8) and T cell activation (CD38+CD8 and CD95+CD4 T cells). Moreover, the frequency of Naïve and Effector CD4 T cells before treatment correlated with several immune parameters key associated with the pathogenesis of HIV, thus mirroring the health of immune system. Interestingly, we identified the Naïve/Effector CD4 T cell ratio (N/EM) at w0 as a marker able to predict early immune recovery. Specifically, in LP, N/EM ratio was significantly higher in immunological responder patients (CD4>500/mmc at w24) when compared to immunological non responder (CD4 T cells <500/mmc at w24). Finally, a multivariate analysis indicates that after 24w patients with N/EM ratio higher than 1.86 at w0 recovered 96 CD4 T cells more than those with N/EM ratio lower than 0.46. Altogether, our data define an easy protocol able to define reliable immunological markers useful for the characterization of immune profile in viremic HIV patients and identify the naïve/effector CD4 T cell ratio as a new tool able to predict an early immune reconstitution potential.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/inmunología , Reconstitución Inmune , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
15.
Rev Chilena Infectol ; 36(4): 475-489, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859772

RESUMEN

BACKGROUND: The pharmacokinetics of anti-retrovirals (ARVs) can be modified by other concomitant medicinal products. It is timely to update the interactions between new ARVs and drugs of chronic use to maintain therapeutic success. AIM: To update information about drug interactions in patients with HIV/AIDS on antiretroviral therapy. METHODS: Comprehensive literature review in MEDLINE/PubMed database from January of 2015 to June of 2017, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into levels according to seriously and probability of occurrence. RESULTS: 466 articles were identified; full text was accessed in 444. Of these, 164 provided interactions, which allowed the identification of a total of 534 pairs of drug interactions. The interactions that presented a higher risk of generating safety and effectiveness problems were 308 (57.7%) of level 2 and 35 (6.6%) of level 1. CONCLUSIONS: We identify 534 new pairs of drug interactions, of which 308 (64.2%) are the most clinically relevant.


Asunto(s)
Fármacos Anti-VIH/farmacología , Interacciones de Drogas , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Proteasas/farmacología , Fármacos Anti-VIH/uso terapéutico , Humanos , Inhibidores de Proteasas/uso terapéutico , Factores de Riesgo
16.
BMC Public Health ; 19(1): 1683, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842822

RESUMEN

BACKGROUND: Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. METHODS: We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. RESULTS: Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/µl), 22% presented with advanced HIV (CD4 < 200 cells/µl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. CONCLUSIONS: While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.


Asunto(s)
Infecciones por VIH/terapia , Refugiados/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adulto , Fármacos Anti-VIH/uso terapéutico , Resistencia a Medicamentos/genética , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Quebec , Estudios Retrospectivos
17.
BMC Public Health ; 19(1): 1516, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718615

RESUMEN

BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.


Asunto(s)
Sesgo , Mortalidad del Niño , Métodos Epidemiológicos , Infecciones por VIH/mortalidad , Mortalidad Infantil , Madres/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Tasa de Natalidad , Causas de Muerte , Preescolar , Epidemias , Femenino , VIH , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Tanzanía/epidemiología , Adulto Joven
19.
Afr J AIDS Res ; 18(4): 289-296, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31779574

RESUMEN

Sustaining HIV and AIDS responses depends on a mix of donor, government and private funders. Their decisions about investing in HIV treatment may be informed by various types of economic evaluations, which may be more or less useful for different contexts. This paper benchmarks methods against each other. Epidemiological and demographic impacts of HIV and antiretroviral therapy (ART) from 1996-2015 were quantified using country- specific spectrum files. The study compared societal benefits of ART using the full income (FI) methodology with "conventional" benefit, utility and effectiveness estimates produced with the same data. The FI estimates suggested $3.50 in benefits per dollar spent on ART globally, 2.6 times larger than productivity-related measures of benefits, of $1.33 in benefits per dollar. Higher benefit-cost ratios are mainly because FI reflects value of life beyond what people produce at work and in non-working age groups, and allocates the future stream of benefits in the year that death is avoided. ART costs were 0.78 times per capita GDP per quality-adjusted life-years gained globally. FI benefit-cost ratios are considerably higher in upper- and lower-middle-income countries than in low- or high-income countries. Productivity-based benefits also exceeded costs in all but one region but had smaller ratios and different regional patterns. Per capita GDP per quality-adjusted life-years ratios were below 1.2 for all regions and country income bands, suggesting cost effectiveness. The fact that FI returns of ART are higher than productivity returns, helps to quantify developmental benefits of interventions that directly extend life and its quality, arguably the objective of development. They provide an important argument to increase budget allocations to health sectors for ART scale-up, and not just reallocate existing health resources. Benchmarking FI returns against cost per quality- adjusted life-years may allow comparison to other "cost effective" health interventions. However, caution should be taken in extrapolations between measures, because they produce different rankings across country categories.


Asunto(s)
Fármacos Anti-VIH/economía , Análisis Costo-Beneficio/métodos , Infecciones por VIH/economía , Recursos en Salud , Fármacos Anti-VIH/uso terapéutico , Benchmarking , Infecciones por VIH/tratamiento farmacológico , Costos de la Atención en Salud , Humanos , Renta , Años de Vida Ajustados por Calidad de Vida
20.
Top Antivir Med ; 27(3): 123-127, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31634859

RESUMEN

Antiretroviral therapy (ART) should be started as soon as possible after HIV diagnosis. Recommended starting ART regimens in patients with any baseline viral load include ictegravir plus tenofovir alafenamide (TAF)/emtricitabine (FTC), dolutegravir (DTG) plus abacavir/lamivudine, DTG plus TAF (or TDF)/FTC, or DTG plus 3TC. Initial laboratory evaluation includes CD4+ cell count, plasma HIV-1 RNA, and testing for HIV reverse transcriptase and protease resistance mutations. ART regimens do not need to be altered for virologic blips due to release of virus from chronically latently infected cells in patients otherwise exhibiting viral suppression. Patients with continuously undetectable viral load on ART pose virtually no risk of transmitting infection through sexual contact. This article is based on a case-based presentation by Michael S. Saag, MD, at the 2018 Clinical Conference at the National Ryan White Conference on HIV Care & Treatment in December 2018 and intended for clinicians who are new to HIV disease management.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Adenina/análogos & derivados , Adenina/uso terapéutico , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4 , Didesoxinucleósidos/uso terapéutico , Combinación de Medicamentos , Quimioterapia Combinada , Emtricitabina/uso terapéutico , Femenino , Infecciones por VIH/transmisión , Transcriptasa Inversa del VIH/efectos de los fármacos , VIH-1/genética , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Humanos , Inhibidores de Integrasa/uso terapéutico , Lamivudine/uso terapéutico , Estadios del Ciclo de Vida/efectos de los fármacos , Masculino , Persona de Mediana Edad , Mutación , ARN Viral/sangre , Tenofovir/uso terapéutico , Carga Viral
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