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1.
BMC Infect Dis ; 21(1): 431, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962558

RESUMO

BACKGROUND: Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS: We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS: We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION: Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019126313.


Assuntos
Infecções por HIV/tratamento farmacológico , Adolescente , África , Fármacos Anti-HIV/uso terapêutico , Doença Crônica , Ensaios Clínicos Controlados como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão , Tailândia , Resultado do Tratamento
2.
Environ Health Prev Med ; 26(1): 52, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33941074

RESUMO

INTRODUCTION: The survival of HIV/AIDS patients on antiretroviral therapy (ART) is determined by a number of factors, including economic, demographic, behavioral, and institutional factors. Understanding the survival time and its trend is crucial to developing policies that will result in changes. The aim of this study was to compare the survival estimates of different subgroups and look into the predictors of HIV/AIDS patient survival. METHODS: A retrospective cohort study of HIV/AIDS patients receiving ART at the University of Gondar teaching hospital was carried out. To compare the survival of various groups, a Kaplan-Meier survival analysis was performed. The Cox proportional hazards model was used to identify factors influencing HIV/AIDS patient survival rates. RESULTS: In the current study, 5.91% of the 354 HIV/AIDS patients under ART follow-up were uncensored or died. Age (HR = 1.051) and lack of formal education (HR = 5.032) were associated with lower survival rate, whereas family size of one to two (HR = 0.167), three to four (HR = 0.120), no alcoholic consumption (HR = 0.294), no smoking and chat use (HR = 0.101), baseline weight (HR = 0.920), current weight (HR = 0.928), baseline CD4 cell count (HR = 0.990), baseline hemoglobin (HR = 0.800), and no TB diseases were associated with longer survival rate. CONCLUSIONS: Fewer deaths were reported in a study area due to high patient adherence, compared to previous similar studies. Age, educational status, family size, alcohol consumption, tobacco and chat usage, baseline and current weight, baseline CD4 cell count, baseline hemoglobin, and tuberculosis (TB) diseases were all significant predictors of survival of HIV/AIDS patients.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
3.
AIDS ; 35(7): 1061-1072, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33946085

RESUMO

OBJECTIVES: The aim of this study was to understand how demographic and treatment-related factors impact responses to fostemsavir-based regimens. DESIGN: BRIGHTE is an ongoing phase 3 study evaluating twice-daily fostemsavir 600 mg and optimized background therapy (OBT) in heavily treatment-experienced individuals failing antiretroviral therapy with limited treatment options (Randomized Cohort 1-2 and Nonrandomized Cohort 0 fully active antiretroviral classes). METHODS: Virologic response rates (HIV-1 RNA <40 copies/ml, Snapshot analysis) and CD4+ T-cell count increases in the Randomized Cohort were analysed by prespecified baseline characteristics (age, race, sex, region, HIV-1 RNA, CD4+ T-cell count) and viral susceptibility to OBT. Safety results were analysed by baseline characteristics for combined cohorts (post hoc). RESULTS: In the Randomized Cohort, virologic response rates increased between Weeks 24 and 96 across most subgroups. Virologic response rates over time were most clearly associated with overall susceptibility scores for new OBT agents (OSS-new). CD4+ T-cell count increases were comparable across subgroups. Participants with baseline CD4+ T-cell counts less than 20 cells/µl had a mean increase of 240 cells/µl. In the safety population, more participants with baseline CD4+ T-cell counts less than 20 vs. at least 200 cells/µl had grade 3/4 adverse events [53/107 (50%) vs. 24/96 (25%)], serious adverse events [58/107 (54%) vs. 25/96 (26%)] and deaths [16/107 (15%) vs. 2/96 (2%)]. There were no safety differences by other subgroups. CONCLUSION: Week 96 results for BRIGHTE demonstrate comparable rates of virologic and immunologic response (Randomized Cohort) and safety (combined cohorts) across subgroups. OSS-new is an important consideration when constructing optimized antiretroviral regimens for heavily treatment-experienced individuals with limited remaining treatment options.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Humanos , Organofosfatos , Piperazinas , Resultado do Tratamento , Carga Viral
4.
BMC Womens Health ; 21(1): 220, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034719

RESUMO

BACKGROUND: Prior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women's experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California. METHODS: Three focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis. RESULTS: Twenty-two women participated in focus groups, with median age 44 (IQR 30-53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers. CONCLUSIONS: Although PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adulto , Afro-Americanos , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos
5.
Stud Health Technol Inform ; 281: 714-718, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042669

RESUMO

HIV Pre-Exposure Prophylaxis (PrEP) is effective in Men who have Sex with Men (MSM), and is reimbursed by the social security in France. Yet, PrEP is underused due to the difficulty to identify people at risk of HIV infection outside the "sexual health" care path. We developed and validated an automated algorithm that re-uses Electronic Health Record (EHR) data available in eHOP, the Clinical Data Warehouse of Rennes University Hospital (France). Using machine learning methods, we developed five models to predict incident HIV infections with 162 variables that might be exploited to predict HIV risk using EHR data. We divided patients aged 18 or more having at least one hospital admission between 2013 and 2019 in two groups: cases (patients with known HIV infection in the study period) and controls (patients without known HIV infection and no PrEP in the study period, but with at least one HIV risk factor). Among the 624,708 admissions, we selected 156 cases (incident HIV infection) and 761 controls. The best performing model for identifying incident HIV infections was the combined model (LASSO, Random Forest, and Generalized Linear Model): AUC = 0.88 (95% CI: 0.8143-0.9619), specificity = 0.887, and sensitivity = 0.733 using the test dataset. The algorithm seems to efficiently identify patients at risk of HIV infection.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Algoritmos , Fármacos Anti-HIV/uso terapêutico , França , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Hospitais , Humanos , Masculino
6.
BMC Infect Dis ; 21(1): 466, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022850

RESUMO

BACKGROUND: Pulmonary tuberculosis (TB) in people living with HIV (PLH) frequently presents as sputum smear-negative. However, clinical trials of TB in adults often use smear-positive individuals to ensure measurable bacterial responses following initiation of treatment, thereby excluding HIV-infected patients from trials. METHODS: In this prospective case cohort study, 118 HIV-seropositive TB patients were assessed prior to initiation of standard four-drug TB therapy and at several time points through 35 days. Sputum bacillary load, as a marker of treatment response, was determined serially by: smear microscopy, Xpert MTB/RIF, liquid culture, and colony counts on agar medium. RESULTS: By all four measures, patients who were baseline smear-positive had higher bacterial loads than those presenting as smear-negative, until day 35. However, most smear-negative PLH had significant bacillary load at enrolment and their mycobacteria were cleared more rapidly than smear-positive patients. Smear-negative patients' decline in bacillary load, determined by colony counts, was linear to day 7 suggesting measurable bactericidal activity. Moreover, the decrease in bacterial counts was comparable to smear-positive individuals. Increasing cycle threshold values (Ct) on the Xpert assay in smear-positive patients to day 14 implied decreasing bacterial load. CONCLUSION: Our data suggest that smear-negative PLH can be included in clinical trials of novel treatment regimens as they contain sufficient viable bacteria, but allowances for late exclusions would have to be made in sample size estimations. We also show that increases in Ct in smear-positive patients to day 14 reflect treatment responses and the Xpert MTB/RIF assay could be used as biomarker for early treatment response.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Antituberculosos/uso terapêutico , Carga Bacteriana/efeitos dos fármacos , Soropositividade para HIV , HIV/imunologia , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Testes Diagnósticos de Rotina , Feminino , Seguimentos , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/virologia , Humanos , Masculino , Microscopia , Técnicas de Amplificação de Ácido Nucleico , Estudos Prospectivos , Resultado do Tratamento , Tuberculose Pulmonar/virologia
7.
AIDS Educ Prev ; 33(3): 216-233, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34014108

RESUMO

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/prevenção & controle , Adesão à Medicação/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/métodos , Prisioneiros/estatística & dados numéricos , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Assunção de Riscos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos
8.
BMJ Open ; 11(5): e040955, 2021 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039570

RESUMO

INTRODUCTION: Men who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition. METHODS AND ANALYSIS: Through extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention's potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial. ETHICS AND DISSEMINATION: This study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations. REGISTRATION DETAILS: Registered under the National Institutes of Health's ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017-0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Navegação de Pacientes , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Hispano-Americanos , Homossexualidade Masculina , Humanos , Masculino , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
9.
BMC Infect Dis ; 21(1): 409, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941101

RESUMO

BACKGROUND: A large number of HIV-infected children continue to die despite reported scale-up of paediatric HIV services. AIM: The trend in attrition among children enrolled in an anti-retroviral therapy (ART) programme was evaluated. METHODS: This was a retrospective review of children enrolled into NAUTH ART programme between 2003 and 2019. RESULTS: 1114 children < 15 years at enrolment were studied. The male: female ratio was 1:1 while median age at enrolment was 4.3 years. About two-thirds had WHO stage 3 or 4 disease at enrolment. The rate of loss to follow-up (LTFU) and death were 41.0 and 8.4%, respectively, with overall attrition incidence of 108/1000PY. Despite the downward trend, spikes occurred among those enrolled in 2008 to 2011 and in 2017. The trend in 6-, 12-, 24- and 36-months attrition varied similarly with overall rates being 20.4, 27.7, 34.3 and 37.3%, respectively. Among those on ART, > 50% of attrition was recorded within 6 months of care. Advanced WHO stage, young age, non-initiation on ART or period of enrolment (P <  0.001), and caregiver (p = 0.026) were associated with attrition in bivariate analysis. Apart from caregiver category, these factors remained significant in multivariate analysis. Most LTFU could not be reached on phone. Among those contacted, common reasons for being lost to follow-up were financial constraints, caregiver loss, claim to divine healing, family disharmony/child custody issues and relocation of family/child. CONCLUSION/RECOMMENDATION: Attrition rate was high and was mostly due to LTFU. Predictors of attrition were late presentation, young age, delay in ART initiation and financial constraints. Efforts should be intensified at early diagnosis, linkage to care and implementation of "test and treat" strategy. Innovative child centered approaches should be adopted to enable the HIV-infected children remain in care despite challenges which can truncate treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adolescente , Cuidadores , Criança , Pré-Escolar , Família , Feminino , Infecções por HIV/mortalidade , Humanos , Lactente , Estudos Longitudinais , Perda de Seguimento , Masculino , Análise Multivariada , Nigéria/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Estudos Retrospectivos
10.
Artigo em Inglês | MEDLINE | ID: mdl-33947130

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Humanos , Itália , Masculino , Comportamento Sexual
11.
BMC Infect Dis ; 21(1): 423, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952212

RESUMO

BACKGROUND: In the US, one in six men who have sex with men (MSM) with HIV are unaware of their HIV infection. In certain circumstances, access to HIV testing and viral load (VL) monitoring is challenging. The objective of this study was to evaluate the feasibility of conducting laboratory-based HIV and antiretroviral (ARV) drug testing, and VL monitoring as part of two studies on self-collected dried blood spots (DBS). METHODS: Participants were instructed to collect DBS by self-fingerstick in studies that enrolled MSM online. DBS from the first study (N = 1444) were tested with HIV serological assays approved by the Food and Drug Administration (FDA). A subset was further tested with laboratory-modified serological and VL assays, and ARV levels were measured by mass spectrometry. DBS from the second study (N = 74) were only tested to assess VL monitoring. RESULTS: In the first study, the mail back rate of self-collected DBS cards was 62.9%. Ninety percent of DBS cards were received at the laboratory within 2 weeks from the day of collection, and 98% of the cards had sufficient spots for one assay. Concordance between FDA-approved and laboratory-modified protocols was high. The samples with undetectable ARV had higher VL than samples with at least one ARV drug. In the second study, 70.3% participants returned self-collected DBS cards, and all had sufficient spots for VL assay. High VL was observed in samples from participants who reported low ARV adherence. CONCLUSIONS: In these studies, MSM were able to collect and provide adequate DBS for HIV testing. The FDA-approved and laboratory-modified testing algorithms performed similarly. DBS collected at home may be feasible for HIV testing, ARV measurement, and monitoring viral suppression.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Teste em Amostras de Sangue Seco/métodos , Infecções por HIV/virologia , Carga Viral/métodos , Adulto , Fármacos Anti-HIV/farmacologia , Estudos de Viabilidade , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Humanos , Masculino , Adesão à Medicação , Minorias Sexuais e de Gênero , Estados Unidos
12.
AIDS Patient Care STDS ; 35(5): 145-157, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33960843

RESUMO

A sizable portion of youth (ages 13-24) living with HIV in the United States have unsuppressed viral load. The AIDS Interventions (ATN) 152 study [evaluating the Triggered Escalating Real-Time Adherence (TERA) intervention] baseline data were examined to identify correlates of high viremia (>5000 copies/mL) and self-reported adherence, which can help in planning of differentiated services for viremic youth. Depression, HIV-stigma, and cannabis use were common in this sample of 87 youth. Almost half (48%) had high viremia, which associated with enacted stigma, moderate- to high-risk alcohol use, mental health diagnosis, and age ≥21. Self-reported adherence was related to viral load and associated with mental and physical health functioning, depression, social support, self-confident decision-making, total and internalized stigma, adherence motivation, and report of a missed a care visit in the past 6 months. Mental health emerged as a common correlate of viral load and adherence. Clinical Trial Registration number: NCT03292432.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação , Estados Unidos/epidemiologia , Carga Viral , Viremia/tratamento farmacológico , Adulto Jovem
13.
Talanta ; 231: 122378, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-33965042

RESUMO

Human immunodeficiency virus (HIV) infection is a chronic disease that can be treated with antiretroviral (ARV) therapy. However, the success of this treatment has been jeopardized by the emergence of HIV infections resistant to ARV drugs. In low-to middle-income countries (LMICs), where transmission of resistant viruses has increased over the past decade, there is an urgent need to improve access to HIV drug resistance testing. Here, we present a proof-of-concept study of a rapid and simple molecular method to detect two major mutations (K103 N, Y181C) conferring resistance to first-line nonnucleoside reverse transcriptase inhibitor regimens. Our near-point-of-care (near-POC) diagnostic test, combining a sequence-specific primer extension and a lateral flow DNA microarray strip, allows visual detection of HIV drug resistance mutations (DRM) in a short turnaround time (4 h 30). The assay has a limit of detection of 100 copies of plasmid DNA and has a higher sensitivity than standard Sanger sequencing. The analytical performance was assessed by use of 16 plasma samples from individuals living with HIV-1 and results demonstrated the specificity and the sensitivity of this approach for multiplex detection of the two DRMs in a single test. Furthermore, this near-POC assay could be easily taylored to detect either new DRMs or DRM of from various HIV clades and might be useful for pre-therapy screening in LMICs with high levels of transmitted drug resistance.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Genótipo , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Humanos , Mutação , Sistemas Automatizados de Assistência Junto ao Leito
14.
Pan Afr Med J ; 38: 173, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33995780

RESUMO

Introduction: cardiovascular complications have become the 3th cause of death and the 4th reason for hospitalization in HIV-infected patients. The purpose of this study was to determine the frequency of asymptomatic myocardial ischemia in HIV-infected patients on antiretroviral therapy. Methods: we conducted a descriptive cross-sectional study in November 2015. Asymptomatic HIV-1-infected patients on ARV treatment and followed up in the Day Hospital Unit of the Department of Infectious Diseases of the University Hospital Sanon Sourou of Bobo-Dioulasso were included in the study. Among enrolled patients data on cardiovascular risk factors were collected as well as two sitting blood pressure measurements after 10 minutes of rest were taken during consultations and resting 12-lead electrocardiogram (ECG) was performed. Results: a total of 123 HIV-1-infected patients with a median age of 42 years (IQR: 36-50), among whom 79% were female subjects, were included in the study. Cardiovascular risk factors included: PAH (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%) and diabetes (0.8%). All patients with hypertension (5.7%) were insufficiently treated. The median duration of ARV treatment was 5.3 years (IQR: 3-7.7). Repolarization disorders were found in 26 cases (21.13%). They were divided into subepicardial ischaemia in 20 cases (16.26%), subendocardial damage in 2 cases (1.63%) and sequelae of necrosis in 4 cases (3.25%). Left ventricular hypertrophy (LVH) was found in 12 cases (9.76%) and, in particular, in hypertensive patients. Prolonged QTc interval was found in 7 patients (5.69%) regardless of the ARV drugs given. Conclusion: this study of HIV-1-infected patients highlights that asymptomatic myocardial ischemia is common. Screening programmes should be improved through more effective ischemia tests in order to better determine its severity in this sub-population with increased cardiovascular risk.


Assuntos
Infecções por HIV/complicações , Programas de Rastreamento , Isquemia Miocárdica/epidemiologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Burkina Faso/epidemiologia , Estudos Transversais , Eletrocardiografia , Feminino , Infecções por HIV/tratamento farmacológico , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico
15.
Pan Afr Med J ; 38: 176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995783

RESUMO

Introduction: Antiretroviral therapy (ART) significantly increases the life expectancy of HIV positive people by improving quality of life as well as enabling them to resume sexual activity. A growing number of people living with HIV became a source of exposure to sexually transmitted infections, including other strains of HIV that place others at risk unless they consistently use condoms. This study assessed the magnitude of unprotected sexual practices and associated factors among adult people living with HIV on ART in public hospitals of the Kembata Tembaro Zone, Southern Ethiopia. Methods: a facility-based cross-sectional study was conducted among adult people living with HIV on ART in public hospitals of the zone from March 1-30, 2016. Data were collected by a pretested and structured questionnaire. Binary logistic regression was used to investigate variables, independently associated with the outcome variable. The adjusted odds ratio with 95% CI used to show the strength of the association and a P-value < 0.05 was used to declare the cut-off point in determining the level of significance. Results: the study revealed that 40.9% of respondents practiced unprotected sexual intercourse. On multivariate logistic regression analyses, being females, having more than one sexual partner, mean monthly income of <530 Ethiopian birrs/ month, those who had a seropositive partner, a partner of unknown serostatus, and respondents who had insufficient knowledge of HIV transmission and prevention were statically significant with the outcome variable. Conclusion: the scarcity of knowledge on HIV transmission, negative attitude towards condom use, non-disclosure status and having more than one sexual partnership increased likelihood of have unprotected sex among the respondents.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Etiópia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
16.
Pan Afr Med J ; 38: 181, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995787

RESUMO

Introduction: incidence of adverse drug reactions (ADR) associated with antiretroviral therapy (ART) was higher in developing countries. In two teaching hospital in Ethiopia: Debremarkose 23% and Yirgalem 73.2% of study participants reported at least one ADR. Since there was limited information about ADR in the study area; we aimed to determine its incidence-rate and predictors. Methods: we conducted retrospective cohort study using medical records of HIV-infected patients enrolled on ART between 2006 and 2017 in government hospitals of Ethiopia. ADR was defined as report of at least one unwanted response to ART. We run descriptive and cox regression analysis (CRA). Results: incidence-rate of ADR was 4.1 per 100 person-years (py). Hazards of ADR among patients living at rural was almost two times than at urban; [Adjusted hazard ratio (AHR): 1.94(95% (CI): 1.18, 3.20)]. Stavudine (D4T)-Lamivudine (3TC)-Nevirapine (NVP) had about two times [AHR: 1.78(95%CI: 1.03, 3.08)], Zidovudine(AZT)-3TC-NVP had about two times [AHR: 2.34 (95%CI: 1.20, 4.57)], D4T-3TC-Efaviranze(EFV) had about three times [AHR: 2.86(95%CI: 1.38, 5.95)] and AZT-3TC-EFV had about two times [AHR: 2.16(95%CI: 1.21,3.90)] hazards of ADR than Tenofovir(TDF) based regimens. Being WHO clinical stage III had about two times hazard of ADR [AHR: 2.46 (95%CI: 1.22, 4.95)] and IV had about four times hazard of ADR [AHR: 4.32 (95%CI: 1.88, 9.93)] than stage I. Conclusion: risk of ADR was higher among adult HIV-infected patients on ART living in rural, WHO clinical stage III and IV, and patients on AZT and D4T based regimen. AZT should not be given as an alternative treatment, increase access of TDF regimens.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/administração & dosagem , Estudos de Coortes , Etiópia , Feminino , Hospitais Públicos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
Pan Afr Med J ; 38: 206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995812

RESUMO

Introduction: highly active antiretroviral therapy (HAART) has led to a decline in HIV-induced morbidity and mortality in recent years. However, it has been opined that this has led to elevated risks of cardiovascular diseases (CVDs). This study assessed the risks of CVDs among HAART experienced individuals living with HIV. Methods: a cross sectional study involving 196 adults consisting of 118 HAART experienced and 78 HAART naïve was conducted. Anthropometric and blood pressure measurements were recorded for all participants. Blood samples obtained from the volunteers were used to determine glucose, creatinine, HIV viral load, CD4 count and lipid profile using standard methods. Lipid ratios, atherogenic indices and QRISK3 risk score were calculated. Results: the median CD4 lymphocyte, mean body mass index (BMI) and HDL-c in HAART experienced participants were higher (P<0.05) than HAART naive individuals. The QRISK3 risk score and creatinine were higher (p<0.05) among HAART experienced group. In HAART experienced group, the risk of hypertension, increased low-density lipoprotein (LDL-c), atherogenic index of plasma (AIP) and QRISK3 were 3.7, 2.0, 2.38 and 3.85 times (p<0.05) higher respectively than in HAART naive. Atherogenic coefficient (AC) increase was more prevalent among male (p<0.05) participants. Risk of chronic renal disease (eGFR), hypertension and CVD (as measured by QRISK3) was higher (p<0.05) among the female and older participants respectively. Conclusion: the risk of CVDs and renal disease appeared to be higher among HAART experienced volunteers and older (>45 years) volunteers. The risk of renal disease appeared higher in females.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Cardiovasculares/etiologia , Infecções por HIV/tratamento farmacológico , Adulto , Fatores Etários , Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Contagem de Linfócito CD4 , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria , Fatores de Risco , Fatores Sexuais
18.
MMWR Morb Mortal Wkly Rep ; 70(21): 775-778, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34043612

RESUMO

One component of the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to end the HIV/AIDS epidemic by 2030, is that 95% of all persons receiving antiretroviral therapy (ART) achieve viral suppression.† Thus, testing all HIV-positive persons for viral load (number of copies of viral RNA per mL) is a global health priority (1). CDC and other U.S. government agencies, as part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), together with other stakeholders, have provided technical assistance and supported the cost for multiple countries in sub-Saharan Africa to expand viral load testing as the preferred monitoring strategy for clinical response to ART. The individual and population-level benefits of ART are well understood (2). Persons receiving ART who achieve and sustain an undetectable viral load do not transmit HIV to their sex partners, thereby disrupting onward transmission (2,3). Viral load testing is a cost-effective and sustainable programmatic approach for monitoring treatment success, allowing reduced frequency of health care visits for patients who are virally suppressed (4). Viral load monitoring enables early and accurate detection of treatment failure before immunologic decline. This report describes progress on the scale-up of viral load testing in eight sub-Saharan African countries from 2013 to 2018 and examines the trajectory of improvement with viral load testing scale-up that has paralleled government commitments, sustained technical assistance, and financial resources from international donors. Viral load testing in low- and middle-income countries enables monitoring of viral load suppression at the individual and population level, which is necessary to achieve global epidemic control. Although there has been substantial achievement in improving viral load coverage for all patients receiving ART, continued engagement is needed to reach global targets.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/virologia , Vigilância da População , Carga Viral , África ao Sul do Saara/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos
19.
Pan Afr Med J ; 38: 216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046122

RESUMO

Introduction: antiretroviral therapy (ART) has improved survival of People Living with HIV (PLWH); however, this has resulted in an increasingly high prevalence of non-communicable diseases (NCD) like hypertension. Hypertension is a major risk factor for cardiovascular and cerebral vascular disease, which are both associated with high morbidity and mortality rates. We studied the prevalence and factors associated with hypertension among PLWH on ART. Methods: we conducted a retrospective data analysis of PLWH on ART enrolled between 2011 and 2014 into a randomized double-blinded placebo-controlled trial investigating the safety of discontinuing cotrimoxazole prophylaxis (COSTOP) among PLWH in Central Uganda. We used the mean blood pressure (BP) measurements of the first four monthly clinic visits to define hypertension. Patients were categorised as: having normal BP (≤120/80mmHg), elevated BP (systolic >120-129, and diastolic ≤80), Stage 1 hypertension (systolic 130-139, or diastolic >80-89) and Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Multiple logistic regression was used to evaluate factors associated with hypertension. Results: data from 2026 COSTOP trial study participants were analysed, 74.1% were women and 77.2% were aged 35 years and above. The overall prevalence of hypertension was 29%, of whom 19.5% had Stage 1 hypertension and 9.5% had Stage 2 hypertension. About 21.4% were overweight or obese. Factors independently associated with hypertension among PLWH on ART included increasing age (p≤0.001) and high body mass index (p≤0.001). Efavirenz (p≤0.001) and lopinavir/ritonavir (p=0.036) based regimen had lower odds of hypertension than Nevirapine based regimens. Conclusion: PLWH on ART have a high prevalence of hypertension, which rises with increasing age and body mass index (BMI) and among those on nevirapine-based ART. Implementation of hypertension prevention measures among PLWH on ART and integration of NCD and HIV care to improve patients' management outcomes are required.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/epidemiologia , Hipertensão/epidemiologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
20.
Pan Afr Med J ; 38: 335, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046145

RESUMO

Introduction: high HIV-1 infection rates and genetic diversity especially in African population pose significant challenges in HIV-1 clinical management and drug design and development. HIV-1 is a major health challenge in Kenya and causes mortality and morbidity in the country as well as straining the healthcare system and the economy. This study sought to identify HIV-1 genetic subtypes circulating in Teso, Western Kenya which borders the Republic of Uganda. Methods: a cross-sectional study was conducted in January 2019 to December 2019. Sequencing of the partial pol gene was carried out on 80 HIV positive individuals on antiretroviral therapy. Subtypes and recombinant forms were generated using the jumping profile hidden Markov model. Alignment of the sequences was done using ClustalW program and phylogenetic tree constructed using MEGA7 neighbor-joining method. Results: sixty three samples were successful sequenced. In the analysis of these sequences, it was observed that HIV-1 subtype A1 was predominant 43 (68.3%) followed by D 8 (12.7%) and 1 (1.6%) each of C, G and B and inter-subtype recombinants A1-D 3 (4.8%), A1-B 2 (3.2%) and 1 (1.6%) each of A1-A2, A1-C, BC and BD. Phylogenetic analysis of these sequences showed close clustering of closely related and unrelated sequences with reference sequences. Conclusion: there was observed increased genetic diversity of HIV-1 subtypes which not only pose a challenge in disease control and management but also drug design and development. Therefore, there is need for continued surveillance to enhance future understanding of the geographical distribution and transmission patterns of the HIV epidemic.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Variação Genética , Infecções por HIV/virologia , HIV-1/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1/isolamento & purificação , Humanos , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Filogenia , Adulto Jovem
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