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1.
J Acquir Immune Defic Syndr ; 89(Suppl 1): S1-S2, 2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-35015738

RESUMEN

ABSTRACT: Our understanding of HIV/AIDS has been reframed during the recent past because the use of novel antiretroviral therapy has enabled clinicians and patients to control the progression of the disease. This supplement provides an overview of the HIV and Aging in the Era of ART and COVID-19, a virtual symposium held on February 8-9, 2021, organized by the Miami Center for AIDS Research along with articles contributed by some of the speakers and members of the organizing committee and presentations by junior investigators.


Asunto(s)
Envejecimiento/inmunología , Fármacos Anti-VIH/uso terapéutico , COVID-19 , Continuidad de la Atención al Paciente , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Terapia Antirretroviral Altamente Activa/efectos adversos , COVID-19/epidemiología , COVID-19/psicología , Infecciones por VIH/inmunología , Infecciones por VIH/psicología , Humanos , SARS-CoV-2
2.
BMC Infect Dis ; 22(1): 55, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-35033018

RESUMEN

BACKGROUND: Early start of highly active antiretroviral therapy (HAART) in perinatally HIV-1 infected children is the optimal strategy to prevent immunological and clinical deterioration. To date, according to EMA, only 35% of antiretroviral drugs are licenced in children < 2 years of age and 60% in those aged 2-12 years, due to the lack of adequate paediatric clinical studies on pharmacokinetics, pharmacodynamics and drug safety in children. METHODS: An observational retrospective study investigating the rate and the outcomes of off-label prescription of HAART was conducted on 225 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. RESULTS: 22.2% (50/225) of included children were receiving an off-label HAART regimen at last check. Only 26% (13/50) of off-label children had an undetectable viral load (VL) before the commencing of the regimen and the 52.0% (26/50) had a CD4 + T lymphocyte percentage > 25%. At last check, during the off label regimen, the 80% (40/50) of patients had an undetectable VL, and 90% (45/50) of them displayed CD4 + T lymphocyte percentage > 25%. The most widely used off-label drugs were: dolutegravir/abacavir/lamivudine (16%; 8/50), emtricitbine/tenofovir disoproxil (22%; 11/50), lopinavir/ritonavir (20%; 10/50) and elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide (10%; 10/50). At logistic regression analysis, detectable VL before starting the current HAART regimen was a risk factor for receiving an off-label therapy (OR: 2.41; 95% CI 1.13-5.19; p = 0.024). Moreover, children < 2 years of age were at increased risk for receiving off-label HAART with respect to older children (OR: 3.24; 95% CI 1063-7.3; p = 0.001). Even if our safety data regarding off-label regimens where poor, no adverse event was reported. CONCLUSION: The prescription of an off-label HAART regimen in perinatally HIV-1 infected children was common, in particular in children with detectable VL despite previous HAART and in younger children, especially those receiving their first regimen. Our data suggest similar proportions of virological and immunological successes at last check among children receiving off-label or on-label HAART. Larger studies are needed to better clarify efficacy and safety of off-label HAART regimens in children, in order to allow the enlargement of on-label prescription in children.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , VIH-1 , Pediatría , Adolescente , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Niño , Infecciones por VIH/tratamiento farmacológico , Humanos , Uso Fuera de lo Indicado , Estudios Retrospectivos , Carga Viral
3.
BMC Infect Dis ; 22(1): 20, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983387

RESUMEN

BACKGROUND: The CD4 cell count signifies the health of an individual's immune system. The use of data-driven models enables clinicians to accurately interpret potential information, examine the progression of CD4 count, and deal with patient heterogeneity due to patient-specific effects. Quantile-based regression models can be used to illustrate the entire conditional distribution of an outcome and identify various covariates effects at the respective location. METHODS: This study uses the quantile mixed-effects model that assumes an asymmetric Laplace distribution for the error term. The model also incorporated multiple random effects to consider the correlation among observations. The exact maximum likelihood estimation was implemented using the Stochastic Approximation of the Expectation-Maximization algorithm to estimate the parameters. This study used the Centre of the AIDS Programme of Research in South Africa (CAPRISA) 002 Acute Infection Study data. In this study, the response variable is the longitudinal CD4 count from HIV-infected patients who were initiated on Highly Active Antiretroviral Therapy (HAART), and the explanatory variables are relevant baseline characteristics of the patients. RESULTS: The analysis obtained robust parameters estimates at various locations of the conditional distribution. For instance, our result showed that baseline BMI (at [Formula: see text] 0.05: [Formula: see text]), baseline viral load (at [Formula: see text] 0.05: [Formula: see text] [Formula: see text]), and post-HAART initiation (at [Formula: see text] 0.05: [Formula: see text]) were major significant factors of CD4 count across fitted quantiles. CONCLUSIONS: CD4 cell recovery in response to post-HAART initiation across all fitted quantile levels was observed. Compared to HIV-infected patients with low viral load levels at baseline, HIV-infected patients enrolled in the treatment with a high viral load level at baseline showed a significant negative effect on CD4 cell counts at upper quantiles. HIV-infected patients registered with high BMI at baseline had improved CD4 cell count after treatment, but physicians should not ignore this group of patients clinically. It is also crucial for physicians to closely monitor patients with a low BMI before and after starting HAART.


Asunto(s)
Infecciones por VIH , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Humanos , Sudáfrica/epidemiología , Carga Viral
4.
BMC Infect Dis ; 22(1): 4, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983408

RESUMEN

BACKGROUND: We aimed to clarify the characteristics, risk factors, and prognosis of stroke among HAART-naive people living with HIV (PLWH) in China. METHODS: We selected HAART-naive PLWH admitted to Beijing Ditan Hospital, Capital Medical University, from 1 January 2009 to 31 December 2019. Demographic and clinical data were obtained by searching an anonymous electronic case system. Descriptive analysis and logistic regression and Cox proportional hazard models were used to determine the characteristics and predictors of stroke among all HAART-naive PLWH and evaluate the risk factors of mortality in HAART-naive PLWH with stroke. RESULTS: Stroke was diagnosed in 105 cases (3.7%) of 2867 HAART-naive PLWH. Multivariate logistic regression indicated that age of 30-55 years (OR 1.903, 95% CI 1.005-3.603, p = 0.048), age of ≥ 55 years (OR 4.104, 95% CI 1.928-8.737, p < 0.001), and CD4 count of < 200 cells/µL (OR 2.005, 95% CI 1.008-3.985, p = 0.047) were associated with increased odds of stroke. Diabetes (OR 3.268, 95% CI 1.744-6.125, p < 0.001), hypertension (OR 2.301, 95% CI 1.425-3.717, p = 0.001), syphilis (OR 2.003, 95% CI 1.300-3.089, p = 0.002), and complicated AIDS-defining CNS diseases (OR 7.719, 95% CI 4.348-13.703, p < 0.001) were risk factors for stroke. Of the 105 stroke patients, 12 (11.4%) died during hospitalisation, and the risk factors for mortality among patients with stroke were age of > 65 years (AHR: 8.783, 95% CI 1.522-50.668, p = 0.015), complicated severe pneumonia (AHR: 3.940, 95% CI 1.106-14.029, p = 0.034), and AIDS-defining CNS diseases (AHR: 19.766, 95% CI 3.586-108.961, p = 0.001). CONCLUSIONS: For HAART-naive people living with HIV (PLWH), stroke occurred in various age groups, and early screening for stroke, timely intervention for risk factors among patients in various age groups, and controlling the CD4 count are extremely important in reducing the burden of stroke.


Asunto(s)
Infecciones por VIH , Accidente Cerebrovascular , Adulto , Anciano , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , China/epidemiología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
5.
BMC Infect Dis ; 22(1): 29, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983418

RESUMEN

BACKGROUND: In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017. We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change. RESULTS: Majority of the patients were females and the average CD4 count at start of treatment was 362.1 [Formula: see text]. The CD4 count measurements increased nonlinearly over time and these trends were similar regardless of the treatment regimen administered to the patients. The change of logarithm CD4 cell count rises fast for in the first 450 days of antiretroviral initiation. The average time to first regimen change was 2142 days. Tenoforvir (TDF) based regimens had a lower drug substitution(aHR 0.2682, 95% CI:0.08263- 0.8706) compared to Zidovudine(AZT). CONCLUSION: The backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the rate of change in logarithm CD4 count over time.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Atención Integral de Salud , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Kenia , Estudios Retrospectivos , Carga Viral
7.
J Assoc Physicians India ; 70(1): 11-12, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35062808

RESUMEN

OBJECTIVE: This retrospective study was conducted to evaluate the behaviour of AIDS associated cancers treated with comprehensive cancer treatment along with highly active anti-retroviral therapy (HAART). METHODS: 172 AIDS-associated cancers were diagnosed and treated during 2003 to 2021. HIV status was evaluated by ELISA, viral load and CD4/CD8 counts. They were treated with different cancer treatment modalities for cancers, HAART for HIV infection and followed up periodically. RESULTS: Of 172 cases of AIDS associated cancers, AIDS-Defining Cancers (ADCs) were seen in 84 (48.84%) and non-AIDS-Defining Cancers (NADC) in 88 patients (51.16%). Non-Hodgkin Lymphoma was the commonest AIDS-defining cancer in 58 (69.05%) patients. Extranodal presentations of ARLs was seen in 28 cases (19.86%) followed by cervical cancers in 26 (30.95%) women with HIV infection. Kaposi's sarcoma was not found. Head and neck cancers were the most common cancers in NADCs, followed by breast cancers and other types of cancers. Only two patients had HIV-2 associated cancers. One patient had immune reconstitution syndrome (IRIS).Long-term non-progressor HIV infection with cancer was seen in one patient. 49 patients (28.49%) were receiving HAART. CONCLUSIONS: AIDS-associated cancers are seen in advanced stage of HIV infection. Concurrent chemotherapy and anti-retroviral therapy for ADCs show good control of both diseases. Non-AIDS-defining cancers do not show predictable response to anti-retroviral therapy. KS is not seen in our study.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Neoplasias , Sarcoma de Kaposi , Neoplasias del Cuello Uterino , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Neoplasias/complicaciones , Neoplasias/epidemiología , Estudios Retrospectivos , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/epidemiología
8.
Emerg Microbes Infect ; 11(1): 158-167, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34895083

RESUMEN

There are great disparities of the results in immune reconstruction (IR) of the HIV-1 infected patients during combined antiretroviral therapy (cART), due to both host polymorphisms and viral genetic subtypes. Identifying these factors and elucidating their impact on the IR could help to improve the efficacy. To study the factors influencing the IR, we conducted a 15-year retrospective cohort study of HIV-1 infected individuals under cART. The trend of CD4+ count changes was evaluated by the generalized estimating equations. Cox proportional model and propensity score matching were used to identify variables that affect the possibility of achieving IR. The tropism characteristics of virus were compared using the coreceptor binding model. In addition to baseline CD4+ counts and age implications, CRF01_AE cluster 1 was associated with a poorer probability of achieving IR than infection with cluster 2 (aHR, 1.39; 95%CI, 1.02-1.90) and other subtypes (aHR, 1.83; 95%CI, 1.31-2.56). The mean time from cART initiation to achieve IR was much longer in patients infected by CRF01_AE cluster 1 than other subtypes/sub-clusters (P < 0.001). In-depth analysis indicated that a higher proportion of CXCR4 viruses were found in CRF01_AE clusters 1 and 2 (P < 0.05), and showed tendency to favour CXCR4 binding to V3 signatures. This study indicated the immune restoration impairment found in patients were associated with HIV-1 CRF01_AE cluster 1, which was attributed to the high proportion of CXCR4-tropic viruses. To improve the effectiveness of cART, more efforts should be made in the early identification of HIV-1 subtype/sub-cluster and monitoring of virus phenotypes.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , VIH-1/genética , Reconstitución Inmune , Adulto , Terapia Antirretroviral Altamente Activa , Linfocitos T CD4-Positivos/inmunología , Femenino , Genotipo , Proteína gp120 de Envoltorio del VIH/química , Proteína gp120 de Envoltorio del VIH/metabolismo , Infecciones por VIH/virología , VIH-1/clasificación , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/química , Fragmentos de Péptidos/metabolismo , Receptores CXCR4/química , Receptores CXCR4/metabolismo , Estudios Retrospectivos , Tropismo Viral
9.
Washington, D.C.; OPS; 2021-12-02. (OPS/CDE/HT/21-0017).
No convencional en Español | PAHO-IRIS | ID: phr-55245

RESUMEN

Para alcanzar los objetivos 95-95-95 con vistas a la eliminación del VIH, es esencial contar con datos de calidad que permitan orientar de la mejor manera posible las acciones programáticas. En esta línea, conocer con exactitud el número de personas en tratamiento antirretroviral (TAR) permite valorar la efectividad de los servicios y determinar aspectos clave de su planificación, como las necesidades de medicamentos y otros insumos. Es frecuente que existan imprecisiones en el número estimado de personas en TAR, que puede estar subestimado cuando no se contabilizan a través de otros subsectores del sistema de salud —instituciones penitenciarias, servicios privados o seguridad social—. Asimismo, y de manera más frecuente, el número de personas en TAR puede estar sobreestimado si al actualizar los registros no se tiene en cuenta a las personas fallecidas o que han emigrado, las personas que se trasladan entre centros de atención o aquellas que han abandonado el tratamiento. Las directrices consolidadas de la OMS sobre información estratégica relativa al VIH establecen recomendaciones para mejorar el monitoreo y la gestión de los programas de VIH e incluyen orientaciones para conocer mejor el número de personas en TAR. La presente nota técnica resume las directrices consolidadas y las adapta al contexto de América Latina y el Caribe, a fin de monitorear de manera adecuada el número de personas en TAR. Para ello, se presenta orientación sobre los indicadores y la metodología para conocer de la manera más precisa el número de personas que se encuentran en TAR.


Asunto(s)
Enfermedades Transmisibles , VIH , Antirretrovirales , Terapia Antirretroviral Altamente Activa , Prueba de VIH , Sistemas de Salud , América Latina , Región del Caribe
10.
Rev Fac Cien Med Univ Nac Cordoba ; 78(4): 359-366, 2021 12 28.
Artículo en Español | MEDLINE | ID: mdl-34962748

RESUMEN

Introduction: continuous growth monitoring allows the identification of anthropometric and metabolic disorders as an integral part of HIV treatment. It was proposed to analyze the evolution of nutritional status, with the immunological and virological parameters in children infected with vertically transmitted HIV and its association with highly active antiretroviral treatment (HAART). Material and Methods: were included 56 children aged 0 to 12 years, attending the Hospital Materno Neonatal of Córdoba, Argentina between 1998-2014. Anthropometric and biochemical, immunological, virological nutritional status and clinical manifestations were evaluated by age group (younger or older than 6 years) and HAART administered in three medical controls. Results: in the third control the analysis of the anthropometric nutritional status according to the body mass index (BMI) diagnosed 47 children (83.93%) with a normal BMI and 6 (10.71%) overweight/obesity, without statistically significant difference by age group (p=0.10). Thirty six children (64.29%) presented hypertriglyceridemia, with higher concentrations at the second (p=0.003) and third control (p=0.06) in those treated with scheme II and III with protease inhibitors (PI), unlike scheme I without IP. Normoglycemia prevailed in 54 children (96.43%) and anemia in 29 (51.79%). The clinical manifestations decreased in the successive controls and in the last one, 3 children (5.36%) older than 6 years, had pneumonia and one (1.79%) severe immunosuppression. Conclusions: hypertriglyceridemia was the main adverse effect of the medication, which, added to the high prevalence of anemia, constitute important parameters for interdisciplinary treatment


Introducción: la vigilancia del crecimiento de manera continua permite la identificación de alteraciones antropométricas y metabólicas como parte integral del tratamiento en VIH. Se propuso analizar la evolución del estado nutricional, con los parámetros inmunológicos y virológicos en niños infectados con VIH de transmisión vertical y su asociación con el tratamiento antirretroviral de gran actividad (TARGA). Material y Métodos: se incluyeron 56 niños de 0-12 años, asistentes al Hospital Materno Neonatal de Córdoba, Argentina entre 1998-2014. Se evaluó, por grupo etario (menor o mayor de 6 años) y TARGA administrado, el estado nutricional antropométrico y bioquímico, inmunológico, virológico y manifestaciones clínicas en tres controles médicos. Resultados: en el tercer control el análisis del estado nutricional antropométrico según el índice de masa corporal (IMC) diagnosticó 47 niños (83,93%) con un IMC normal y 6 (10,71%) sobrepeso/obesidad, sin diferencia estadísticamente significativa por grupo etario (p=0,10). Treinta y seis niños (64,29%) presentaron hipertrigliceridemia, siendo mayores las concentraciones al segundo (p=0,003) y tercer control (p=0,06) en los tratados con esquema II y III con inhibidores de proteasa (IP), a diferencia del esquema I sin IP. La normoglucemia prevaleció en 54 niños (96,43%) y la anemia en 29 (51,79%). Las manifestaciones clínicas disminuyeron en los sucesivos controles y en el último, 3 niños (5,36%) mayores de 6 años, tuvieron neumonía y uno (1,79%) inmunosupresión grave. Conclusiones: la hipertrigliceridemia fue el principal efecto adverso de la medicación que, sumados a la alta prevalencia de anemia, constituyen parámetros importantes para el tratamiento de manera interdisciplinaria.


Asunto(s)
Infecciones por VIH , Estado Nutricional , Terapia Antirretroviral Altamente Activa/efectos adversos , Índice de Masa Corporal , Niño , Infecciones por VIH/tratamiento farmacológico , Humanos , Sobrepeso
11.
Nutrients ; 13(12)2021 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-34959964

RESUMEN

BACKGROUND: In people living with HIV, combination antiretroviral therapy (cART) reduces the risk of death, but the persistent immune-deficient state predisposes them to pneumococcal infections. Current guidelines encourage administering pneumococcal vaccine Prevenar 13 to patients living with HIV. Since probiotic supplementation could act as adjuvants and improve vaccine immunogenicity by modulating gut microbiota, the present study aimed to assess whether the effect of a formulation containing a combination of specific probiotics (Vivomixx®) could improve the immune response to 13-valent pneumococcal conjugate vaccine (PCV13) in adult people living with HIV. METHODS: Thirty patients who were clinically stable and virologically suppressed, without opportunistic infections during this time and no ART changes in the 12 months before the study started were enrolled. Patients were divided into two groups: (1) received a placebo dose and (2) received Vivomixx® (1800 billion CFU) for four weeks before and after the vaccination with a single dose of PCV13. RESULTS: Vivomixx® supplementation induced a better response to PCV13 immunization, as shown by greater change in anti-Pn CPS13 IgG and increase in salivary IgA, IL-10 and IL-8. CONCLUSIONS: Additional investigations will help to clearly and fully elucidate the optimal strains, doses, and timing of administration of probiotics to improve protection upon vaccination in immunocompromised individuals and the elderly.


Asunto(s)
Suplementos Dietéticos , Infecciones por VIH/inmunología , Inmunidad/inmunología , Vacunas Neumococicas/inmunología , Probióticos/administración & dosificación , Adulto , Anciano , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido/inmunología , Inmunoglobulina A , Inmunoglobulina G , Interleucina-10 , Interleucina-8 , Masculino , Persona de Mediana Edad
12.
Dokl Biol Sci ; 501(1): 206-209, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34962608

RESUMEN

Immunological non-responders (INR) are HIV-infected subjects that fail to restore CD4+ T-cell counts despite undetectable HIV viral load, which is controlled by highly active antiretroviral therapy (HAART). In INR, impaired immune restoration is linked to low-productive proliferation of memory CD4+ T-lymphocytes. Taking into account that T-cell ability to divide depends on the activity of metabolic pathways, we aimed to determine rates of mitochondrial respiration and glycolysis in memory CD4+ T-cells of INR. Two groups of HIV-infected HAART-treated patients were studied: immunological non-responders and subjects with an adequate immunological response to therapy (immunological responders - IR). Control (C) group comprised uninfected volunteers. In both groups of HIV-infected patients glycolytic activity of memory CD4+ T-cells was lower than that in C. Mitochondrial respiration rate in memory CD4+ T-cells derived from IR was comparable to that of C at basal state, however, after stimulation IR failed to reach the values of uninfected subjects. INR had the lowest mitochondrial respiration rate both at basal state and after stimulation. Taken together, the data presented herein demonstrate that low regenerative potential of memory CD4+ T-cells derived from INR might be linked to diminished lymphocytes' metabolic activity.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos , Infecciones por VIH/tratamiento farmacológico , Humanos
13.
Afr J AIDS Res ; 20(4): 270-276, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34905452

RESUMEN

With the introduction of antiretroviral therapy (ART), many HIV-infected children are growing into adolescence and adulthood. A facility-based cross-sectional study was conducted at the Fevers Unit of one of the teaching hospitals in Ghana. The Morisky Medication Adherence Scale (MMAS-8) and pill count were used to assess adherence, while measured viral load levels of participants were used to assess viral suppression. The rate of viral suppression (<400 copies/ml) was 68.2%. Participants with high MMAS-8 scores were 8.4 times more likely to be virally suppressed compared to those with low MMAS-8 scores (OR = 8.4, p = 0.003, 95% CI: 2.11-33.48). The commonest reason for missing doses of their antiretroviral drugs (ARVs) was forgetfulness. Efforts must be made by all stakeholders involved in HIV care to engage adolescents and young adults living with HIV (AYALHIV) on personal and/or group levels to help identify and improve particular ART adherence issues so as to increase viral suppression rates.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Niño , Estudios Transversales , Ghana/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Cumplimiento de la Medicación , Centros de Atención Terciaria , Carga Viral , Adulto Joven
14.
PLoS One ; 16(12): e0258644, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34919554

RESUMEN

BACKGROUND: Assays and multi-assay algorithms (MAAs) have been developed for population-level cross-sectional HIV incidence estimation. These algorithms use a combination of serologic and/or non-serologic biomarkers to assess the duration of infection. We evaluated the performance of four MAAs for individual-level recency assessments. METHODS: Samples were obtained from 220 seroconverters (infected <1 year) and 4,396 non-seroconverters (infected >1 year) enrolled in an HIV prevention trial (HPTN 071 [PopART]); 28.6% of the seroconverters and 73.4% of the non-seroconverters had HIV viral loads ≤400 copies/mL. Samples were tested with two laboratory-based assays (LAg-Avidity, JHU BioRad-Avidity) and a point-of-care assay (rapid LAg). The four MAAs included different combinations of these assays and HIV viral load. Seroconverters on antiretroviral treatment (ART) were identified using a qualitative multi-drug assay. RESULTS: The MAAs identified between 54 and 100 (25% to 46%) of the seroconverters as recently-infected. The false recent rate of the MAAs for infections >2 years duration ranged from 0.2%-1.3%. The MAAs classified different overlapping groups of individuals as recent vs. non-recent. Only 32 (15%) of the 220 seroconverters were classified as recent by all four MAAs. Viral suppression impacted the performance of the two LAg-based assays. LAg-Avidity assay values were also lower for seroconverters who were virally suppressed on ART compared to those with natural viral suppression. CONCLUSIONS: The four MAAs evaluated varied in sensitivity and specificity for identifying persons infected <1 year as recently infected and classified different groups of seroconverters as recently infected. Sensitivity was low for all four MAAs. These performance issues should be considered if these methods are used for individual-level recency assessments.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Seroconversión , Adulto , Terapia Antirretroviral Altamente Activa , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Técnicas para Inmunoenzimas , Incidencia , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Sudáfrica/epidemiología , Factores de Tiempo , Carga Viral/efectos de los fármacos , Zambia/epidemiología
15.
PLoS One ; 16(12): e0261581, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34932611

RESUMEN

BACKGROUND: Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. METHODS: An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. RESULTS: A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2-56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. CONCLUSION: Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Condones/estadística & datos numéricos , Conducta Anticonceptiva/psicología , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Sexo Seguro/psicología , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Terapia Antirretroviral Altamente Activa , Conducta Anticonceptiva/estadística & datos numéricos , Consejo/organización & administración , Estudios Transversales , Escolaridad , Etiopía/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Hospitales Generales , Humanos , Masculino , Estado Civil/estadística & datos numéricos , Persona de Mediana Edad , Sexo Seguro/estadística & datos numéricos , Parejas Sexuales/psicología , Encuestas y Cuestionarios
16.
Retrovirology ; 18(1): 39, 2021 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-34922576

RESUMEN

Highly active antiretroviral therapy (HAART) successfully suppresses human immunodeficiency virus (HIV) replication and improves the quality of life of patients living with HIV. However, current HAART does not eradicate HIV infection because an HIV reservoir is established in latently infected cells and is not recognized by the immune system. The successful curative treatment of the Berlin and London patients following bone marrow transplantation inspired researchers to identify an approach for the functional cure of HIV. As a promising technology, gene editing-based strategies have attracted considerable attention and sparked much debate. Herein, we discuss the development of different gene editing strategies in the functional cure of HIV and highlight the potential for clinical applications prospects.


Asunto(s)
Edición Génica , Infecciones por VIH , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Humanos , Calidad de Vida , Tecnología , Latencia del Virus
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(9): 1594-1600, 2021 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-34814589

RESUMEN

Objective: To analyze the mortality in HIV/AIDS cases aged ≥15 years under antiretroviral treatment (ART) in Henan province from 2002 to 2019, and provide evidence for reducing the mortality rate of HIV/AIDS and AIDS prevention and treatment. Methods: Data of HIV/AIDS cases aged ≥15 years who received ART in Henan from 2002 to 2019 were obtained from "Infectious Disease Surveillance System - Basic Information on AIDS Prevention and Control". In this retrospective study, Cox proportional risk model was used to analyze the influencing factors for HIV/AIDS related deaths. Software SPSS 23.0 was used for statistical analysis. Results: From 2002 to 2019, a total of 72 986 HIV/AIDS cases aged ≥15 years received ART, in whom, 16 634 died during this period. Most of the death cases were aged ≥40 years old (68.5%,11 393/16 634), males (62.6%,10 419/16 634), infected through blood-borne transmission (71.7%,11 927/16 634), and farmers or migrant workers (91.7%,15 249/16 634). Most of the deaths were due to AIDS related diseases (73.7%, 12 261/16 634), and the case fatality rate was 16.8% (12 261/72 986). A total of 34.6% (4 237/12 261) of HIV/AIDS cases died of AIDS-related diseases in the first year of ART, and the cumulative survival rates at 10 and 18 years of ART were 78.3% and 71.8%, respectively. The proportion of the HIV/AIDS cases with baseline CD4+T lymphocyte (CD4) counts <200 cells/µl at age 15 years when ART started was 45.5% (30 432/66 898). Cox proportional risk regression model showed that, compared with the cases with baseline CD4 counts ≥350 cells/µl, the risk of death was 1.78 times higher than in the cases with CD4 counts <200 cells/µl (95%CI: 1.64-1.94) and 1.24 times higher in the cases with CD4 counts ≥200 cells/µl (95%CI: 1.13-1.36), respectively. The risk of death in symptomatic cases at baseline survey was 1.25 times higher than that in asymptomatic cases (95%CI: 1.16-1.35). The cases with a latest viral load ≥1 000 copies/ml had 7.09 times higher risk of death than those with a last viral load<1 000 copies/ml (95%CI: 6.65-7.54). Conclusions: The majority of HIV/AIDS deaths occurred in the cases aged ≥15 years receiving ART in Henan province during 2002-2019, who were infected through blood-borne transmission and farmers/migrant workers, and AIDS-related diseases were the main causes of the deaths. With the gradual implementation of ART policy, the high survival rate in HIV/AIDS cases can be maintained for a long time in Henan. To reduce the case fatality rate and improve the quality of life of HIV/AIDS patients, CD4 counts test should be further strengthened and eligible HIV/AIDS patients should be covered by standard ART in a timely manner.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adolescente , Adulto , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Humanos , Masculino , Calidad de Vida , Estudios Retrospectivos
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(10): 1829-1834, 2021 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-34814619

RESUMEN

Objective: To analyze the HIV and HBV coinfection in HIV/AIDS cases who newly received highly active antiretroviral therapy during 2005-2019 in Jiangsu province. Methods: According to the base data of HIV/AIDS cases on HAART enrolled between January 2005 and December 2019; the National Information system was retrospectively collected for HIV/AIDS Control and Prevention of Chinese System Disease for Control and Prevention. Excel database was established, and statistical analysis was performed using the SPSS 16.0 software. A Chi-square test was used to assess differences in rates of HBsAg testing and HIV/HBV coinfection between potential risk factors. The unconditional logistic regression model entered risk factors with P values <0.05 in the Chi-square test. Results: There were 29 288 HIV/AIDS cases newly received HAART during 2005-2019. The rate of HBsAg test was 49.8% (14 594/29 288) the rate of HBsAg test increased from 0.0% (0/80)to 75.2%(3 448/4 586), showing an increasing trend year by year during 2005 to 2019. Among HIV/AIDS cases tested HBsAg, 81.6% (11 915/14 594) cases were from Jiangsu province; the ratio of male to female was 7.34∶1 (12 845∶1 749), the average age was (38.5±13.8) years old, 96.1% (14 023/14 594) were Han nationality,48.9% (7 131/14 594) of the HIV/AIDS cases married, 97.9%(14 294/14 594) were infected with HIV through homosexual and heterosexual transmission. Unconditional logistic regression modeling showed that the proportion of HIV/AIDS cases initiated HAART in 2015 or after that, married, not Jiangsu province resident, college education or above, and drug injection infected were more likely to have HBsAg testing. 8.6%(95%CI:8.2%-9.1%) were HBsAg positive. The HIV and HBV coinfection rates were more than 10% before 2016 while showed stability from 6.7% to 8.2% since 2016. Unconditional logistic regression modeling showed that the proportion of HIV/AIDS cases who were male, elder, married, non-Han, primary education or below were more likely to have HBV coinfection. Conclusion: More HBsAg testing should be strengthened when the HIV/AIDS cases initiated HAART in Jiangsu province, 2005-2019.


Asunto(s)
Coinfección , Infecciones por VIH , Adulto , Anciano , Terapia Antirretroviral Altamente Activa , Coinfección/epidemiología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Virus de la Hepatitis B , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
19.
Einstein (Sao Paulo) ; 19: eAO5800, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34817033

RESUMEN

OBJECTIVE: To characterize the sociodemographic profile of the population undergoing antiretroviral treatment in the state of Paraná, Brazil, to investigate the proportion of people undergoing treatment among all those diagnosed, and to analyze the proportion of patients with suppressed viral load in different regions of the state. METHODS: Observational descriptive and analytical study carried out with information referring to the period from January 2018 to January 2019. Data were obtained from the Sistema Informatizado de Monitoramento Clínico das Pessoas Vivendo com HIV/AIDS [Computerized System for Clinical Monitoring of People Living with HIV/AIDS] and Sistema de Controle Logístico de Medicamentos[Drug Supply Control System]. The proportion of people on antiretroviral treatment in the state and the proportion of patients with viral load ≤1,000 copies/mL and ≤50 copies/mL were calculated. The results were compared with the corresponding parameters of the World Health Organization goal 90-90-90. RESULTS: The state of Paraná managed to reach the second and third parameters of the 90-90-90 goal of the World Health Organization. Among those diagnosed, 93.12% were on antiretroviral treatment, and 90.0% of them had a viral load below 50 copies of viral RNA/mL of blood, indicating virologic success. CONCLUSION: The health policy aimed at the population living with HIV/AIDS, and the health services available in Paraná have been successful in parameters relevant to the control of the epidemic. However, it is necessary to ensure the diagnosis of people infected with HIV in the population.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Brasil , Infecciones por VIH/tratamiento farmacológico , Humanos , ARN Viral , Carga Viral
20.
Artículo en Inglés | PAHO-IRIS | ID: phr-55177

RESUMEN

[ABSTRACT]. Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 2004–2018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 0–14 years (HR = 0.23, p < 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p < 0.001), and having WHO stage 3 (HR = 0.73, p < 0.001) or stage 4 disease (HR = 0.49, p < 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.


[RESUMO]. Objetivo. Descrever as tendências para o momento do início da terapia antirretroviral (TAR) em pessoas recém diagnosticadas vivendo com HIV antes de e após o Haiti adotar a política Testar e Tratar com a TAR universal para HIV, em julho de 2016, e analisar os preditores do início precoce da TAR em pessoas recém ou previamente diagnosticadas que vivem com HIV após a adoção da política Testar e Tratar. Métodos. Este estudo de coorte retrospectivo analisou o momento do início da TAR de 147 900 pacientes diagnosticados com HIV em 94 ambulatórios de TAR entre 2004 e 2018, usando dados de registros médicos eletrônicos secundários. O estudo usou métodos de análise de sobrevivência para avaliar as tendências temporais e os fatores de risco para o início da TAR. Resultados. A adoção precoce da TAR foi ampliada com a política Testar e Tratar de tal maneira que as taxas do início da TAR no mesmo dia do diagnóstico aumentaram de 3,7% para 45%. Porém, somente 11% dos pacientes previamente diagnosticados iniciaram a TAR após a política Testar e Tratar. Nas análises ajustadas entre as pessoas recém diagnosticadas vivendo com HIV, os fatores negativamente associados ao início precoce da TAR incluíram: ser paciente pediátrico de 0 a 14 anos de idade (HR = 0,23, p < 0,001), ser do sexo masculino (HR = 0,92, p = 0,03), ter 50 anos de idade ou mais (HR = 0,87, p = 0,03), ter peso inferior ao normal (HR = 0,79, p < 0.001) e estar na fase 3 da OMS (HR = 0,73, p < 0,001) ou fase 4 da doença (HR = 0,49, p < 0,001). Foi observada variação no início precoce da TAR por região geográfica e instituição de saúde. Conclusões. O Haiti obteve avanços substanciais na ampliação da política Testar e Tratar, mas é necessário mais trabalho para inscrever pacientes previamente diagnosticados e para assegurar a TAR rápida em subgrupos-chave de pacientes. Mais pesquisas são necessárias sobre fatores geográficos e de instituições de saúde e sobre estratégias para a melhoria do início precoce da TAR entre subgrupos vulneráveis.


[RESUMEN]. Objetivo. Describir las tendencias en cuanto al momento de iniciar el tratamiento antirretroviral (TAR) de personas con infección por el VIH recién diagnosticadas antes y después de julio del 2016, cuando Haití adoptó la política de prueba e inicio del tratamiento con el TAR universal contra el VIH, y explorar los factores predictivos del inicio oportuno del TAR en personas con infección por el VIH recién diagnosticada y diagnosticada con anterioridad después de la adopción de esta política. Métodos. En este estudio de cohortes retrospectivo se exploró el momento en que se inició el TAR en 147 900 pacientes con diagnóstico de infección por el VIH en 94 consultorios que administran TAR del 2004 al 2018 mediante datos secundarios de expedientes médicos electrónicos. El estudio empleó métodos de análisis de supervivencia para evaluar las tendencias temporales y los factores de riesgo del inicio del TAR. Resultados. La observancia oportuna del TAR se amplió con la política de prueba e inicio del tratamiento, de tal manera que el inicio del TAR en el mismo día aumentó de 3,7 % a 45,0 %. Sin embargo, solo 11,0 % de los pacientes anteriormente diagnosticados iniciaron el TAR tras la adopción de la política. En los análisis ajustados con personas con infección por el VIH recién diagnosticadas, los factores asociados negativamente con el inicio oportuno del TAR comprendían ser un paciente pediátrico entre 0 y 14 años de edad (HR = 0,23, p < 0,001), ser varón (HR = 0,92, p = 0,03), tener más de 50 años (HR = 0,87, p = 0,03), tener un peso bajo (HR = 0,79,p < 0.001) y estar en el estadio 3 (de HR = 0,73, p < 0,001) o en estadio 4 (HR = 0,49, p < 0,001) de la enfermedad según la OMS. Se consideró la variación en el inicio oportuno del TAR según departamento geográfico y establecimiento de salud. Conclusiones. Haití ha logrado avances considerables en la ampliación a mayor escala de la política de prueba e inicio del tratamiento, pero es necesario seguir trabajando para registrar a los pacientes diagnosticados con anterioridad y para asegurar el inicio rápido del TAR en los subgrupos de pacientes clave. Es preciso llevar a cabo investigaciones adicionales sobre los factores geográficos y los relacionados con los establecimientos y sobre las estrategias para mejorar el inicio oportuno del TAR en los subgrupos vulnerables.


Asunto(s)
VIH , Terapia Antirretroviral Altamente Activa , Ciencia de la Implementación , Haití , VIH , Terapia Antirretroviral Altamente Activa , Ciencia de la Implementación , Haití , Terapia Antirretroviral Altamente Activa , Ciencia de la Implementación
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