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1.
BMC Infect Dis ; 19(1): 1024, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795955

RESUMO

BACKGROUND: In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. METHODS: A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. RESULT: A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. CONCLUSION: Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Nevirapina/uso terapêutico , Adulto , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Etiópia , Feminino , Seguimentos , Soropositividade para HIV/tratamento farmacológico , Hospitais Gerais , Humanos , Modelos Logísticos , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infecções Oportunistas/tratamento farmacológico , Centros de Cuidados de Saúde Secundários , Falha de Tratamento , Adulto Jovem
2.
BMC Infect Dis ; 19(1): 876, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640585

RESUMO

BACKGROUND: Blastocystis is one of the most common intestinal protozoa in human faecal samples with uncertain impact on public health. Studies on the prevalence of Blastocystis in HIV-positive patients are limited and dated. METHODS: A cross-sectional study was carried out involving 156 HIV-positive patients to evaluate the prevalence of Blastocystis-subtypes by molecular amplification and sequencing the small subunit rRNA gene (SSU rDNA), to identify the risk factors for its transmission, to examine the relationship between the presence of the protist and gastrointestinal disorders. Furthermore, the evaluation of the faecal calprotectin by immunoassay from a sample of subjects was performed to evaluate the gut inflammation in Blastocystis-carriers. RESULTS: Blastocystis-subtypes ST1, ST2, ST3, ST4 were identified in 39 HIV-positive patients (25%). No correlation was found between the presence of the protist and virological or epidemiological risk factors. Blastocystis was more frequently detected in homosexual subjects (p = 0.037) infected by other enteric protozoa (p = 0.0001) and with flatulence (p = 0.024). No significant differences in calprotectin level was found between Blastocystis-carriers and free ones. CONCLUSIONS: Blastocystis is quite common in HIV-positive patients on ART showing in examined patients 25% prevalence. Homosexual behaviour may represent a risk factor for its transmission, while CD4 count and viremia didn't correlate with the presence of the protist. The pathogenetic role of Blastocystis remains unclear and no gut inflammation status was detected in Blastocystis-carriers. The only symptom associated with Blastocystis was the flatulence, evidencing a link between the presence of the protist and the composition and stability of gut microbiota.


Assuntos
Infecções por Blastocystis/epidemiologia , Blastocystis/patogenicidade , Soropositividade para HIV/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Adulto , Idoso , Animais , Animais Domésticos , Blastocystis/genética , Infecções por Blastocystis/etiologia , Infecções por Blastocystis/transmissão , Estudos Transversais , Fezes/química , Fezes/parasitologia , Feminino , Soropositividade para HIV/tratamento farmacológico , Homossexualidade Masculina , Humanos , Complexo Antígeno L1 Leucocitário/análise , Masculino , Pessoa de Meia-Idade , Filogenia , Prevalência , Fatores de Risco , Adulto Jovem
3.
BMC Cancer ; 19(1): 989, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646975

RESUMO

BACKGROUND: Cervical cancer is a global public health problem and the second most common cancer causing morbidity and mortality in Ethiopia. Few available evidences revealed that despite distribution and severity of cervical cancer among HIV-positive women and the ease with which it can be prevented, cervical cancer screening practice in Ethiopia among them is considerably low. Thus, this study aims to assess predictors of cervical cancer screening practice among HIV-positive women by applying health belief model concepts. METHODS: Facility based cross-sectional study was conducted in Bishoftu. Data was collected from 475 women who visit the health facilities for anti-retroviral services using interviewer-administered questionnaires. Champion's revised Health Belief Model sub-scales were used as data collection tools containing sources of information, knowledge, perception on cervical cancer screening and cervical cancer screening practice as variables. Frequencies, percentage, mean and standard deviation were used to describe findings. Multi-variable logistic regression and 95% confidence intervals were considered to identify predictors of cervical cancer screening practice by controlling possible confounders. RESULTS: Cervical cancer screening practice among HIV-positive women in this study was 25%. Health proffesionals were the main sources of information about cervical cancer and its screening. There was a difference between the 'ever' and 'never' screened groups in mean scores of their perceived severity, perceived benefit, perceived barrier, perceived self-efficacy, perceived threat and net-benefit towards screening (P < 0.05). Perceived self-efficacy (AOR 1.24, 95%CI 1.13-1.37), perceived threat (AOR 1.08, 95%CI 1.05-1.12) and perceived net-benefit (AOR 1.18, 95% CI 1.12, 1.24) were the predictors of cervical cancer screening practice. CONCLUSIONS: Cervical cancer screening practice in this study was lower than that of the recommended coverage of the target group by the national guideline (80%). This finding has an important implication for public health intervention aimed at cervical cancer prevention. Morever, womens' perceptions on cervical cancer screening had a significant influence on the utilization of cervical cancer screening service. Therefore, educational programmes geared towards severity of the case, availability of screeningand helpfulness of being screened can significantly improve the uptake of cervical cancer screening.


Assuntos
Detecção Precoce de Câncer/psicologia , Soropositividade para HIV/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Antirretrovirais/uso terapêutico , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Soropositividade para HIV/tratamento farmacológico , Instalações de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
4.
Afr J Prim Health Care Fam Med ; 11(1): e1-e8, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31478742

RESUMO

BACKGROUND: Since the roll-out of antiretroviral therapy (ART) in sub-Saharan Africa (sSA) in the early 2000s, the life expectancy of people infected with the human immunodeficiency virus (HIV) has increased. However, the gains made in reducing mortality from HIV-related complications have been mitigated by the emergence of age-related chronic non-communicable diseases (NCDs), such as hypertension. Protease inhibitors (PIs), and prolonged exposure to highly active ART (HAART) have been implicated in the development of hypertension in HIV-positive people. AIM: To investigate the prevalence of hypertension and its associated risk factors among HIV-positive patients receiving ART. SETTING: The study was carried out at an urban-based clinic that provides HAART and primary care to HIV-positive people in Harare, Zimbabwe. METHODS: A descriptive, cross-sectional study was conducted among non-pregnant adults on HAART attending the clinic between July and August 2018. RESULTS: We studied 600 HIV-positive adult patients, of which 56% were women. The prevalence rate of hypertension was 29.9%. Of the participants in the hypertensive group, 11.2% were not previously diagnosed or on treatment. Factors associated with hypertension were advanced age, use of HAART for longer than 10 years, being overweight, a family history of hypertension and smoking. There was a 68.8% prevalence of body mass index greater than 25 kg/m2 among all participants. CONCLUSION: High hypertension prevalence was recorded. Hypertension was not associated with gender or use of PI regimens but being overweight was highly prevalent. Greater vigilance and integration of resources is required in the overall treatment and monitoring of HIV-positive patients for co-morbidities.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Infecções por HIV/complicações , Soropositividade para HIV/complicações , HIV , Hipertensão/epidemiologia , Adulto , Antirretrovirais/uso terapêutico , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/virologia , Humanos , Hipertensão/virologia , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Sobrepeso/virologia , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , População Urbana/estatística & dados numéricos , Adulto Jovem , Zimbábue
5.
BMC Res Notes ; 12(1): 556, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481133

RESUMO

OBJECTIVE: This study was to determine and compare the prevalences of polypharmacy and comorbidities in patients aged 50 years or older with those patients younger than 50 years in a Mexican population. RESULTS: One hundred and twenty-five patients were enrolled, 60 (48%) were aged 50 years or older. The median CD4+ cell counts were 509 cells/µL (interquartile range [IQR]: 324-730) for the older patients and 384 cells/µL (IQR: 262-562) (P = 0.021) for the younger patients. Viral suppression were significantly higher in the older group: 80% vs. 63% (P = 0.037). The number of comorbidities was significantly higher in the older group, with a median of 2 (IQR: 2-3) vs. 1 (IQR: 0-1) (P ≤ 0.001). After adjustment of the logistic regression model in the older group, the following comorbidities differed between the age groups: systemic arterial hypertension (odds ratio [OR]: 15.75; 95% confidence interval [CI] 3.49-71.05; P = < 0.001), diabetes mellitus (OR: 14.36; 95% CI 1.79-115.07; P = 0.001), osteoarthritis (OR: 10.33; 95% CI 2.88-37.05; P = < 0.001), hyperlipidemia (OR: 2.78; 95% CI 1.22-6.34; P = 0.001), and polypharmacy (OR: 6.58; 95% CI 3.01-14.39; P = 0.001).


Assuntos
Comorbidade , Soropositividade para HIV/tratamento farmacológico , Polimedicação , Adulto , Estudos de Casos e Controles , Soropositividade para HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência
7.
BMC Infect Dis ; 19(1): 663, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345169

RESUMO

BACKGROUND: Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection. However, China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners' PrEP. METHODS: Six intervention scenarios were evaluated in terms of their impact on HIV transmission and their cost-effectiveness for 36 months post-infection. Three scenarios were based on observed data: non-ART, standard-ART, and early-ART. Another three scenarios were based on observed and hypothetical data: non-ART plus partners' PrEP, standard-ART plus partners' PrEP, and early-ART plus partners' PrEP. The number of onward transmissions was calculated according to viral load and self-reported sexual behaviors, and calibrated by the prevalence and incidence of HIV among Chinese MSM. Cost-effectiveness outcomes were quality-adjusted life-years (QALYs) and cost-utility ratio (CUR). RESULTS: The estimated number of onward transmissions by every 100 HIV-positive cases 36 months post-infection was 41.83 (95% credible interval: 30.75-57.69) in the non-ART scenario, 7.95 (5.85-10.95) in the early-ART scenario, and 0.79 (0.58-1.09) in the early-ART plus partners' PrEP scenario. Compared with non-ART, the early-ART and early-ART plus partners' PrEP scenarios were associated with an 81.0 and 98.1% reduction in HIV transmission, and had a CUR of $12,864/QALY and $16,817/QALY, respectively. CONCLUSIONS: Integrated delivery of early ART and sexual partners' PrEP could nearly eliminate HIV transmission and reduce costs during the first 36 months of HIV infection. Our results suggest a feasible and cost-effective strategy for reversing the HIV epidemic among MSM in China.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/economia , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/economia , China , Estudos de Coortes , Análise Custo-Benefício , Infecções por HIV/economia , Soropositividade para HIV/tratamento farmacológico , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/métodos , Prevalência , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Prevenção Secundária/economia , Resultado do Tratamento
8.
AIDS Behav ; 23(9): 2629-2633, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31292826

RESUMO

To improve outcomes among HIV-positive adolescents, the Malawi Ministry of Health is supporting scale-up of "Teen Clubs," a facility-based antiretroviral treatment (ART) delivery model. Teen Clubs are monthly ART clinics for adolescents (10-19 years old) that provide clinical services and peer psychosocial support. This paper assesses ART adherence among Teen Club attendees in Malawi. We performed a retrospective analysis of medical records and Teen Club attendance data on 589 HIV-positive adolescents at 16 Partners in Hope (PIH)-Extending Quality Improvement for HIV/AIDS in Malawi (EQUIP) supported facilities across Malawi, from January to June of 2017, who attended at least two Teen Club sessions. Multi-level logistic regression models were used to examine the role of gender and age on optimal ART adherence (≥ 95% based on pill count) among HIV-positive adolescents enrolled in Teen Clubs. The median age of adolescents in this sample was 14 years, and 47% were male. Older adolescent males (15-19 years) were 64% more likely to achieve ≥ 95% ART adherence (aOR 1.64, 95% CI 1.16-2.31, p < 0.01) compared to younger (10-14 years) males. The effect of age on adherence was smaller and not significant among females (aOR 1.36, 95% CI 0.96-1.94, p = 0.08). In the full model including males and females, older adolescence was associated with higher odds of optimal adherence (aOR 1.48, 95% CI 1.16-1.90, p < 0.01). These results reinforce the need for age-specialized programming for adolescents, and future research should evaluate this in achieving optimal ART adherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/psicologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Adolescente , Criança , Aconselhamento , Feminino , Infecções por HIV/etnologia , Soropositividade para HIV/tratamento farmacológico , Humanos , Malaui/epidemiologia , Masculino , Adesão à Medicação/etnologia , Estudos Retrospectivos , Adulto Jovem
10.
PLoS One ; 14(7): e0219111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31265479

RESUMO

Early changes in nutritional status may be predictive of subsequent HIV disease progression in people living with HIV (PLHIV). In addition to conventional anthropometric assessment using body mass index (BMI) and mid-upper arm circumferences (MUAC), measures of strength and fatigability may detect earlier changes in nutrition status which predict HIV disease progression. This study aims to examine the association between various nutritional metrics relevant in resource-scarce setting and HIV disease progression. The HIV disease progression outcome was defined as any occurrence of an incident AIDS-defining illnesses (ADI) among antiretroviral treatment (ART)-naïve PLHIV. From 2008-2009, HIV+ Zambian adult men and non-pregnant women were followed for 9 months at a Doctors without Borders (Medecins Sans Frontiers, MSF) HIV clinic in Kapiri Mposhi, Zambia. Since the study was conducted in the time period when former WHO recommendations on ART (i.e., ≤200 CD4 cell count as opposed to treating all individuals regardless of CD4 cell count or disease stage) were followed, caution should be applied when considering the implications from this study's results to improve HIV case management under current clinical guidelines, or when comparing findings from this study with studies conducted in recent years. Bivariable and multivariable logistic regression was used to assess the associations between baseline nutritional measurements and the outcome of incident ADI. Self-reported loss of appetite study (AOR 1.90, 95% CI 1.04, 3.45, P = 0.036) and moderate wasting based on MUAC classification (AOR 2.40, 95% CI 1.13, 5.10, P = 0.022) were independently associated with increased odds of developing incident ADI within 9 months, while continuous increments (in psi) of median handgrip strength (AOR 0.74, 95%CI 0.60, 0.91, P = 0.004) was independently associated with decreased odds of incident ADI only among women. The association between low BMI and the short-term outcome of ADI was attenuated after controlling for these nutritional indicators. These findings warrant further research to validate the consistency of these observed associations among larger ART-naïve HIV-infected populations, as well as to develop nutritional assessment tools for identifying disease progression risk among ART-naïve PLHIV.


Assuntos
Síndrome de Imunodeficiência Adquirida/etiologia , Infecções por HIV/epidemiologia , Estado Nutricional , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Índice de Massa Corporal , Contagem de Linfócito CD4 , Progressão da Doença , Feminino , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/epidemiologia , Força da Mão , Humanos , Masculino , Desnutrição/complicações , Análise Multivariada , Avaliação Nutricional , Razão de Chances , Prognóstico , População Rural , Zâmbia/epidemiologia
11.
J Acquir Immune Defic Syndr ; 81(4): 456-462, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31241541

RESUMO

BACKGROUND: The benefit of immediate antiretroviral therapy (ART) at CD4 >500 cells/µL was established in the Strategic Timing of Antiretroviral Treatment (START) study. The benefits and risks of immediate ART in participants with low pretreatment viremia, including virologic suppressors, were further assessed. SETTING: Randomized prospective international study. METHODS: START participants with enrollment viremia <3000 c/mL were included. We compared clinical outcomes (grade 4 adverse events, hospitalizations, or death), plasma viremia, CD4 counts, and changes in biomarkers in immediate versus deferred ART groups. RESULTS: Participants (N = 1134 including 93 with viremia ≤50 c/mL) had a median age of 37 years, 40% were women, and median CD4 was 713 cells/µL. Ninety-seven percent in the immediate and 29% in the deferred arm initiated ART at a median of 6 and 699 days, respectively. Clinical outcomes were experienced in 64 versus 61 patients in immediate and deferred arms (hazard ratio 1.10, 95% confidence interval: 0.77 to 1.56). The CD4 count difference was 125 cells/µL at 12 and 235 cells/µL at 36 months higher in the immediate versus deferred groups. D-dimer and VCAM levels decreased, and C-reactive protein increased, in the immediate arm at month 8. No significant changes in CD4 counts or biomarkers were observed in persons who maintained spontaneous virologic suppression. CONCLUSIONS: START participants with low enrollment viremia experienced higher CD4 counts, greater proportion with suppressed viremia, and decreases in D-dimer levels on immediate ART despite the lack of difference in serious clinical outcomes. These data support immediate ART in people with low viremia, although equipoise remains for suppressors.


Assuntos
Antirretrovirais/uso terapêutico , Soropositividade para HIV/tratamento farmacológico , Viremia/tratamento farmacológico , Adulto , Biomarcadores , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , RNA Viral/sangue
12.
AIDS Behav ; 23(9): 2634-2639, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236749

RESUMO

Among HIV-positive people who use illicit drugs (PWUD) in our setting, repeated periods of incarceration adversely affect ART adherence in a dose-dependent manner. However, the impact of non-custodial criminal justice involvement on HIV-related outcomes has not been previously investigated. Data were obtained from a longitudinal cohort of HIV-positive PWUD in a setting of universal no-cost ART and complete dispensation records. Multivariate generalized estimating equations were used to calculate the longitudinal odds of having a detectable HIV VL (VL) associated with custodial and non-custodial CJS exposure. Between 2005 and 2014, 716 HIV-positive ART-exposed PWUD were recruited. In multivariate analysis, both custodial [Adjusted odds ratio (AOR) 0.61, 95% CI 0.45-0.82] and noncustodial (AOR 0.78, 95% CI 0.62-0.99) involvement in the criminal justice system was associated with detectable HIV VL. Among HIV-positive PWUD, both custodial and non-custodial criminal justice involvement is associated with worse HIV treatment outcomes. Our findings highlight the need for increased ART adherence support across the full spectrum of the criminal justice system.


Assuntos
Direito Penal , Infecções por HIV/psicologia , Soropositividade para HIV/sangue , RNA Viral/sangue , Transtornos Relacionados ao Uso de Substâncias/complicações , Carga Viral , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/complicações , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Testes Sorológicos
13.
BMJ Case Rep ; 12(5)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151970

RESUMO

A 34-year-old HIV-positive man presented in clinic with generalised erythroderma, having been lost to follow-up for the previous 3 years. He was CD4 lymphopenic (100×106/L) and was antiretroviral therapy naive. Initial histology from a skin punch biopsy was non-specific and he was treated with topical steroids and emollients for a suspected eczema. However, the erythroderma worsened with development of cervical lymphadenopathy and significant weight loss over a 6-week period. An incisional biopsy from the left tonsil confirmed a diagnosis of diffuse large B-cell lymphoma. The erythroderma was considered to be a paraneoplastic skin phenomenon. The patient received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone (CHOP) immunochemotherapy with gradual but complete resolution of the erythroderma. Paraneoplastic dermatoses can manifest as first clinical sign of underlying malignancy, heralding a cancer diagnosis. This is particularly important in people living with HIV given the increased incidence of malignancy in this patient group.


Assuntos
Dermatite Esfoliativa/etiologia , Linfoma Difuso de Grandes Células B/complicações , Síndromes Paraneoplásicas/etiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Diagnóstico Diferencial , Soropositividade para HIV/tratamento farmacológico , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Resultado do Tratamento
14.
Skinmed ; 17(2): 128-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145067

RESUMO

A 34-year-old man presented with a painless lesion of the glans present for more than 4 years. The patient became HIV-positive in 2011, and he has been treated with tenofovir, emtricitabine, and efavirenz. A CD4 count performed 4 months prior was 570 cells/mL3; syphilis, hepatitis B, and hepatitis C serologies performed on the same date were non-reactive.


Assuntos
Linfangioma/etiologia , Linfangite/complicações , Vasos Linfáticos/patologia , Neoplasias Penianas/etiologia , Adulto , Soropositividade para HIV/complicações , Soropositividade para HIV/tratamento farmacológico , Humanos , Masculino , Esclerose/complicações
17.
Soins ; 64(834): 31-35, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31023465

RESUMO

Infection with the human immunodeficiency virus is no longer synonymous with premature death. The arrival and development of antiretroviral drugs has enabled it to evolve into a chronic disease, which nevertheless leads to a higher risk of comorbidities. These add to the other issues facing patients due to their advancing age. Therapeutic education provided by the nurse is essential in this context.


Assuntos
Envelhecimento , Soropositividade para HIV/enfermagem , Antirretrovirais/uso terapêutico , Comorbidade , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/epidemiologia , Humanos , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto , Medição de Risco
18.
PLoS One ; 14(4): e0214820, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964884

RESUMO

The DC Cohort is an ongoing longitudinal observational study of persons living with HIV. To better understand HIV-1 drug resistance and potential transmission clusters among these participants, we performed targeted, paired-end next-generation sequencing (NGS) of protease, reverse transcriptase and integrase amplicons. We elected to use free, publicly-available software (HyDRA Web, Stanford HIVdb and HIV-TRACE) for data analyses so that laboratory personnel without extensive bioinformatics expertise could use it; making the approach accessible and affordable for labs worldwide. With more laboratories transitioning away from Sanger-based chemistries to NGS platforms, lower frequency drug resistance mutations (DRMs) can be detected, yet their clinical relevance is uncertain. We looked at the impact choice in cutoff percentage had on number of DRMs detected and found an inverse correlation between the two. Longitudinal studies will be needed to determine whether low frequency DRMs are an early indicator of emerging resistance. We successfully validated this pipeline against a commercial pipeline, and another free, publicly-available pipeline. RT DRM results from HyDRA Web were compared to both SmartGene and PASeq Web; using the Mantel test, R2 values were 0.9332 (p<0.0001) and 0.9097 (p<0.0001), respectively. PR and IN DRM results from HyDRA Web were then compared with PASeq Web only; using the Mantel test, R2 values were 0.9993 (p<0.0001) and 0.9765 (p<0.0001), respectively. Drug resistance was highest for the NRTI drug class and lowest for the PI drug class in this cohort. RT DRM interpretation reports from this pipeline were also highly correlative compared to SmartGene pipeline; using the Spearman's Correlation, rs value was 0.97757 (p<0.0001). HIV-TRACE was used to identify potential transmission clusters to better understand potential linkages among an urban cohort of persons living with HIV; more individuals were male, of black race, with an HIV risk factor of either MSM or High-risk Heterosexual. Common DRMs existed among individuals within a cluster. In summary, we validated a comprehensive, easy-to-use and affordable NGS approach for tracking HIV-1 drug resistance and identifying potential transmission clusters within the community.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/efeitos dos fármacos , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , Mutação/genética , Adulto , Estudos de Coortes , Análise de Dados , District of Columbia , Feminino , Soropositividade para HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , HIV-1/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Homossexualidade/efeitos dos fármacos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Software , Carga Viral/efeitos dos fármacos , Carga Viral/genética
19.
J Acquir Immune Defic Syndr ; 81(2): 202-206, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30865182

RESUMO

BACKGROUND: Objective adherence measures are of increasing interest in antiretroviral treatment (ART) monitoring. Hair ART levels predict virologic suppression, and hair is easy to collect and store. No previous study has examined hair levels in an India-based cohort or laboratory. METHODS: Small hair samples were collected from HIV-positive participants on either efavirenz (EFV)-based or nevirapine (NVP)-based ART in a South India-based study. Hair samples were split and analyzed for EFV or NVP in the University of California, San Francisco -based Hair Analytical Laboratory and the analytic laboratory of the Division of Nutrition at St. John's Research Institute, Bangalore, India, using liquid chromatography/tandem mass spectrometry. Agreement (using Bland-Altman methods) and rank correlation between the 2 laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the previous month using a visual analog scale and hair ART levels was calculated. RESULTS: Among 75 participants (38 on NVP; 37 on EFV), the correlation between NVP levels generated by the 2 laboratories was 0.66 (P < 0.0001) and between EFV levels was 0.87 (P < 0.0001). Measurements from St. John's Research Institute were usually within 20% of those from the University of California, San Francisco Hair Analytical Laboratory. SRA was essentially uncorrelated with hair antiretroviral levels for either drug (all correlations < 0.04). Hair levels showed variability in adherence although SRA was >85% in all participants. CONCLUSIONS: Hair ART levels measured by both an India-based laboratory and the standard U.S.-based laboratory showed generally high agreement and correlation, demonstrating local capacity. As in many other cohorts, hair ART levels and SRA were not well-correlated, likely indicating limitations in self-report and the need for objective adherence monitoring in resource-limited settings.


Assuntos
Antirretrovirais/uso terapêutico , Soropositividade para HIV/tratamento farmacológico , Cabelo/química , Adesão à Medicação , Adolescente , Adulto , Benzoxazinas/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Feminino , Humanos , Índia , Masculino , Nevirapina/uso terapêutico , São Francisco , Autorrelato , Adulto Jovem
20.
J Acquir Immune Defic Syndr ; 81(2): 216-223, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30865184

RESUMO

BACKGROUND: Combination antiretroviral therapy (ART) improves HIV-associated neurocognitive disorder (HAND) stage in the United States where subtype B predominates, but the effect of ART and subtype on HAND stage in individuals in Uganda with subtypes D and A is largely unknown. SETTING: A community-based cohort of participants residing in Rakai, Uganda. METHODS: Three hundred ninety-nine initially ART-naive HIV-seropositive (HIV+) individuals were followed up over 2 years. Neurological and neuropsychological tests and functional assessments were used to determine HAND stage. Frequency and predictors of HAND and HIV-associated dementia (HAD) were assessed at baseline and at follow-up after ART initiation in 312 HIV+ individuals. HIV subtype was determined from gag and env sequences. RESULTS: At 2-year follow-up, HAD frequency among HIV+ individuals on ART (n = 312) decreased from 13% to 5% (P < 0.001), but the overall frequency of HAND remained unchanged (56%-51%). Subtype D was associated with higher rates of impaired cognition (global deficit score ≥ 0.5) compared with HIV+ individuals with subtype A (55% vs. 24%) (P = 0.008). Factors associated with HAD at baseline were older age, depression, and plasma HIV viral load >100,000 copies/mL. At follow-up, age and depression remained significantly associated with HAD. CONCLUSIONS: HIV+ individuals on ART in rural Uganda had a significant decrease in the frequency of HAD, but HAND persists after 2 years on ART. The current guideline of immediate ART initiation after HIV diagnosis is likely to greatly reduce HAD in sub-Saharan Africa. Further studies of the effect of HIV subtype and neurocognitive performance are warranted.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Transtornos Neurocognitivos/tratamento farmacológico , Complexo AIDS Demência/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Soropositividade para HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , População Rural , Uganda , Carga Viral , Adulto Jovem
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