Adult Human Immunodeficiency Virus Patients Research Articles

Viral Load Suppression in People Living with HIV Before and During the COVID-19 Pandemic in Brooklyn, New York.

Consistent care is crucial for the health maintenance of people living with human immunodeficiency virus (HIV) (PWH). The coronavirus 2019 (COVID-19) epidemic disrupted patient care in New York City (NYC), yet few studies investigated the association between COVID-19 and viral load suppression in PWH in NYC. This study aims to assess how the COVID-19 pandemic impacted HIV viral load and CD4 + T-cell counts in PWH. Medical records of 1130 adult HIV patients who visited the Special Treatment and Research Health Center in Brooklyn, NY, between January 2019 and May 2023 were compared across three timeframes (pre-pandemic, January 1, 2019 to December 31, 2019; first pandemic phase, March 19, 2020 to December 31, 2020; and second pandemic phase, January 1, 2021 to May 11, 2023). Demographic and clinical variables (e.g. viral load and CD4 + T cell count) were assessed. About 40% of patients did not have routine laboratory monitoring during the first pandemic phase compared with pre-pandemic. The mean HIV viral load was higher during the second pandemic phase compared with pre-pandemic (p = 0.009). The percentages of patients with undetectable HIV viral load and numbers (mm3) of CD4 + T-cells were similar for all time periods. These findings indicate that the COVID-19 pandemic may have exacerbated challenges for individuals who already had barriers to medication adherence or access. However, most individuals remained consistently on their antiretrovirals throughout the pandemic. Further studies are warranted to determine how to mitigate the impact of future pandemics for the health of PWH.

Dyslipidemia among adult HIV patients on antiretroviral therapy and its association with age and body mass index in Ethiopia: A systematic review and meta-analysis.

Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. Protocol registered with PROSPERO (CRD42023440125).

Burden of Anemia among Human Immunodeficiency Virus-Positive Adults on Highly Active Antiretroviral Therapy at Hawassa University Compressive Specialized Hospital, Hawassa, Ethiopia.

Anemia is the most common hematologic abnormality associated with human immunodeficiency virus (HIV)-infected patients and affects 60% to 80% of patients in late-stage disease. It has a considerable impact on the progression of HIV to advanced stages. This study aimed at assessing the burden of anemia in adult HIV-infected patients who are on highly active antiretroviral therapy (HAART) and have follow-up at Hawassa University Comprehensive Specialized Hospital (HUCSH) Antiretroviral therapy (ART) clinic. A hospital-based retrospective study was conducted among HIV-positive adults on HAART at Hawassa University Compressive Specialized Hospital. The systematic sampling method was used to choose a total of 244 study participants. Data on demographic characteristics, related factors of anemia, latest hemoglobin, CD4, and ART regimens were collected using a structured data abstraction format. The data were cleaned and analyzed using SPSS version 21.0 after being manually checked for completeness. Multivariable logistic regression was carried out to detect elements associated with anemia. A P value of <0.05 was used as a cutoff point to announce statistical significance. The records of 244 patients were examined in total. Anemia was present in 29.9% (95% CI 23.8-35.2) among adult HIV patients. Female sex (AOR: 2.576, 95% (CI: 1.295-5.127)), having tuberculosis (TB) (AOR: 4.873, 95% (CI: 1.534-15.484)), taking a zidovudine (ZDV)-containing ART regimen (AOR: 5.216, 95% (CI: 1.239-21.962)), having clinical WHO stage IV and III diseases (AOR: 3.077, 95% CI (1.244-7.612)), having body mass index (BMI) <18.5 kg/m2 (AOR: 2.391, 95% (CI: 1.138-5.023)), and taking cotrimoxazole prophylaxis (AOR: 3.860 95% (CI: 1.097-13.576)) were substantially linked to the development of anemia among adult HIV patients. Conclusion and Recommendation. This study showed that anemia is still a problem among HIV patients on HAART. The burden of anemia was found to be high among patients with advanced WHO clinical stages, having a BMI less than 18.5 kg/m2, TB/HIV coinfection, being on AZT-based ART regimens, and taking cotrimoxazole preventive therapy (CPT). Consequently, it is suggested that early preventative interventions, such as serial hemoglobin follow-up, iron supplementation, and education about dietary consumption, be undertaken targeting the aforementioned groups. In addition, the preferred first-line ART regimen as per the latest national and WHO guidelines is recommended, especially for the above groups.

Early drug-induced hepatotoxicity in newly diagnosed HIV-positive patients on ARV therapy: A retrospective follow-up study of liver function profiles

Antiretroviral therapy (ART) is a primary therapeutic modality for managing individuals with Human Immunodeficiency Virus (HIV) infection, and its efficacy has been established. However, the safety profiles of ART need to be continually monitored, including early elevated liver function test (LFT) after antiretroviral (ARV) initiation. This study aimed to assess the incidence of abnormal LFT among HIV-positive patients receiving initial ARV and to identify factors associated with abnormal LFT. A retrospective cohort study without a control group summarised medical records from Dr Sardjito General Hospital, Yogyakarta between January 2014 and December 2021. The study subjects were adult HIV patients taking their first ARV and underwent follow-up visits for at least two weeks. Study outcomes were LFT levels, abnormal LFT, and factors associated with abnormal LFT during follow-up visits at 2 wk, 6 mo, and 12 mo. Univariate and multivariate analyses will be performed with a significance level of p&lt;0.05. A total of 137 subjects with 203 visits were retrieved from medical records. The subjects' mean age was 33.4 years, predominantly male, younger, unmarried, in the early stage of HIV infection, and without comorbidities. The findings showed a significant increase in alanine transaminase (ALT) at all three follow-up visits: 2 wk (p=0.02), 6 mo (p=0.003), 12 mo (p=0.001) and an increase in aspartate aminotransferase (AST) after 6 mo (p=0.007) and 12 mo (p=0.04). Abnormal LFT levels (AST and/or ALT) were observed in 23.4% of patients after a normal baseline, with ALT increase being more common. Furthermore, homosexuality was identified as a significant independent factor associated with abnormal LFT (AOR=3.1; 95% CI 1.27-7.51; p=0.01). The findings indicate exceptionally elevated LFT levels and the occurrence of abnormal LFTs among HIV-positive patients initiating ARVs. The increase in abnormal LFTs was significantly associated with patients identifying as homosexual, where hepatitis co-infection may be a contributing factor. The limited study design and measured variables warrant further investigation.

Death and Transferred Out as Competing Event for Lost to Follow-up among HIV-positive Adults on ART, in Eastern Ethiopia Governmental Hospitals from January 2015 to December 2021; (Multicenter Competing Risk Regression Analysis)

Background: Lost to follow-up (LTFU) among patients on antiretroviral therapy accounts for the most of all attrition. In Sub-Saharan Africa,there is a concern regarding high rates of LTFU and early mortality in antiretroviral therapy programs. Mortality and transferred out are the potential competing events for LTFU. Ignoring these events may give an invalid estimate by overestimating the probability of the occurrence of LTFU. Objective: This study aims to assess the incidence and predictors of LTFU among adult HIV (Human Immunodeficiency Virus) patients who started antiretroviral therapy (ART) in Jigjiga Governmental Hospitals’ ART clinics between January 2015 and December 2021. Methods: A multi-center Institution-based retrospective follow-up study has been conducted in Jigjiga Governmental Hospitals. Gray’s test was used to compare the cumulative incidence function (CIF) of LTFU across variable categories. A graphical examination of CIF for each category of variables, as well as the Schoenfeld residuals global test, validate the proportional sub-hazard assumption. We fitted both univariable and multivariable competing risk regression models. In the multivariable analysis, variables with p-values of 0.05 were considered statistically significant predictors of LTFU. Result: A total of 842 clients were included in the study, and the LTFU incidence rate is 5.25 per 100 PYO. The participants’ median age ranged from 29 to 43 years. Those not disclosed their HIV status (aSHR=4.22; 95%CI (2.11-8.47)), those were a fair and poor level of recent adherence (aSHR=2.17; 95%CI (1.18-4.23)) and (aSHR=1.48; 95%CI (2.97-5.34)), patients with severe anemia (aSHR 4.58; 95% CI (1.28-16.39)) ambulatory functional status (aSHR 2.38; 95% CI (1.21-4.68)), patients who do not took cotrimoxazole prophylactic therapy (CPT) (aSHR 2.47; 95% CI (2.99-6.15)) were significant predictors of LTFU. Conclusion: In this study, the incidence of LTFU was decreased with additional years on ART. Patients on ART who did not disclose their HIV status had poor levels of adherence, did not take CPT prophylaxis, on severe anemia and ambulatory functional status were at higher risk of LTFU. As a result, close monitoring and proper tracing mechanisms aimed at this higher-risk group would reduce AIDS (Acquired immunodeficiency syndrome)-related LTFU.

Rate of and Risk Factors for Loss to Follow Up in HIV-Infected Patients in Korea: The Korea HIV/AIDS Cohort Study.

Owing to antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-related mortality has significantly decreased. Retaining in care is an essential step for human immunodeficiency virus (HIV) care cascade. This study investigated the incidence of and risk factors for loss to follow-up (LTFU) in Korean people living with HIV (PLWH). Data from the Korea HIV/AIDS cohort study (including prospective interval cohort and retrospective clinical cohort) were analyzed. LTFU was defined as not visiting the clinic for more than 1 year. Risk factors for LTFU were identified using the Cox regression hazard model. The study enrolled 3,172 adult HIV patients (median age, 36 years; male 92.97%). The median CD4 T cell count at enrollment was 234 cells/mm3 (interquartile range [IQR]: 85 - 373) and the median viral load at enrollment was 56,100 copies/mL (IQR: 15,000 - 203,992). The total follow-up duration was 16,487 person-years, and the overall incidence rate of LTFU was 85/1,000 person-years. In the multivariable Cox regression model, subjects on ART were less likely to have LTFU than subjects not on ART (hazard ratio [HR] = 0.253, 95% confidence interval [CI]: 0.220 - 0.291, P <0.0001). Among PLWH on ART, female sex (HR = 0.752, 95% CI: 0.582 - 0.971, P = 0.0291) and older age (>50: HR = 0.732, 95% CI: 0.602 - 0.890; 41 - 50: HR = 0.634, 95% CI: 0.530 - 0.750; 31 - 40: HR = 0.724, 95% CI: 0.618 - 0.847; ≤30: reference, P <0.0001) were associated with high rate of retention in care. The viral load at ART initiation ≥1,000,001 (HR = 1.545, 95% CI: 1.126 - 2.121, ≤10,000: reference) was associated with a higher rate of LTFU. Young and male PLWH may have a higher rate of LTFU, and an increased rate of LTFU may induce virologic failure.

A systematic review of four decades of prevalence of oral soft tissue infections and conditions among adult HIV patients in India.

Oral lesions are a cue for decreased immunity among Human Immunodeficiency Virus (HIV) positive patients. There is no cumulative data available related to the prevalence of oral soft tissue lesions among the HIV positive patients. Hence, the present review was carried out to assess the various oral lesions reported among adult HIV patients across India. Two search engines were used-Google Scholar and PubMed, with key words of HIV/Acquired Immune Deficiency Symdrome(AIDS), soft tissue, oral cavity, India, and adults for searching the articles from January 1990 to December 2020. After initial review, 21 articles that fulfilled the criteria were included in the review. We used 9 parameters to access the quality of the reports. Most common lesion reported was that of oral candidiasis. Not all articles reported about sample size determination or of sampling design and technique. Other lesions like hyperpigmentation, gingivitis, and periodontitis were also found to be highly prevalent. Most reports were from South India. Further epidemiological data are required from different regions for using it to develop planning and execution related to oral health care for the HIV positive patients in India.

Treatment Satisfaction and Its Associated Factors of Dolutegravir Based Regimen in a Resource Limited Setting.

IntroductionTreatment satisfaction is patient’s evaluation of the process of taking the medication and its use. Currently dolutegravir based regimen is first-line agent for treatment of human immunodeficiency virus. But evidence is scarce regarding treatment satisfaction. Thus, the aim of the current study was to assess treatment satisfaction and associated factors of dolutegravir based regimen among adult human immunodeficiency virus patients attending at Debre Markos referral 2020.MethodsInstitutional-based cross-sectional study was conducted. A systematic random sampling technique was used to collect data from June 25 to August 25, 2020 at Debre Markos referral hospital. It was entered into Epi Info and exported to SPSS version 23 for analysis. Bivariable and multivariable logistic regression was used to identify factors. Variables with p<0.05 were considered as statistically significant.ResultsFrom a total of 359, 349 participants (97.2%) responded to the study. In this study, 70.5% of participants reported higher treatment satisfaction. Monthly average income of ≥3500 birr (AOR: 2.88; 95% CI: 1.26, 6.58), 1600–2500 birr (AOR: 2.47; 95% CI: 1.11, 5.48), 800–1600 birr (AOR: 3.11; 95% CI: 1.31, 7.37), positive belief about medications (AOR: 3.05; 1.76, 5.28), having a discussion with health care providers (AOR: 3.05, 95% CI: 1.58, 5.88), patients without concurrent medication (AOR: 7.72, 95% CI: 3.29, 18.07), and being male (AOR: 2.10, 95% CI: 1.14, 3.87) were associated with treatment satisfaction.ConclusionOverall, dolutegravir based regimen showed high treatment satisfaction. Monthly income, positive beliefs about medications, discussing about treatment options, sex and concurrent medications were associated with treatment satisfaction. Thus, it is crucial to improve treatment satisfaction by promoting positive belief towards medication and also by engaging patients in treatment decisions.

Racecadotril (Acetorphan) for Diarrhea in Adults Infected with HIV/AIDS: A Meta-Analysis and Systematic Review

Background. Diarrhea is a common and disabling symptom seen in patients with Human Immunodeficiency Virus (HIV) infection and the Acquired Immune Deficiency Syndrome (AIDS). The diarrhea is chronic and results in malabsorption contributing to cachexia. Symptomatic treatment can improve the quality of life and nutritional status of these patients.&#x0D; The endogenous group of opiates known as enkephalins function as anti-secretory agents without affecting intestinal transit. Racecadotril (acetorphan) is an orally active enkephalinase inhibitor. Available studies have focused on the use of racecadotril in healthy adults and children with acute infectious diarrhea.&#x0D; Objectives. To assess the efficacy of racecadotril (acetorphan) in reducing the duration and frequency of bowel movement in adult HIV patients with chronic diarrhea.&#x0D; Methods. Electronic databases were searched for randomized controlled trials which used racecadotril for chronic diarrhea in HIV patients. Three independent reviewers assessed the quality of the two studies based on the Cochrane Infectious Disease Group prior to inclusion in study. Data extracted were analyzed using Revman Version 5. Test for heterogeneity was performed using the chi square test.&#x0D; Results. Results showed the standardized mean difference for the two trials comparing racecadotril to placebo and octreotide in reducing bowel movements from baseline was -1.00 (95% CI -1.16 to -0.84, Z=12.08, p&lt;0.00001), showing a beneficial effect. Response rate for the two trials comparing racecadotril to placebo or octreotide in reducing bowel movements from baseline was -0.13 (95% CI -0.26 to 0.01, Z=1.84, p&lt;0.07), showing a trend towards benefit in terms of response rates. Heterogeneity was statistically insignificant (p=1, I2=0%).&#x0D; Conclusions. There is evidence pointing to a benefit in using racecadotril in HIV and AIDS-associated, non-infectious diarrhea by decreasing the frequency of loose stools. An individualized approach is still recommended in its use for HIV patients with chronic diarrhea.

Standard precaution adherence among clinical medical students in HIV and non-HIV ward in Indonesia.

INTRODUCTION:Health-care workers, especially medical intern, are at risk of exposed to blood and other body fluids in the course of their work. To reduce the risk, standard precaution (SP) is introduced. Among all communicable diseases that could be transmitted, human immunodeficiency virus (HIV) is the most stigmatized disease. However, there are some government hospitals that separated adult HIV patients with other patients to prevent additional infection. This study aims to evaluate the impact of ward separation on SP adherence.MATERIALS AND METHODS:This was an observational study conducted in March 2017 in a tertiary referral hospital for the eastern part of Indonesia. The participants were 150 medical students who underwent the past year of their clinical rotation. They were given a three-part questionnaire, consisting of their background, their SP practice in the HIV ward and non-HIV wards, and their perception and attitude regarding SP. McNemar's test and Fisher's exact test were used for the statistical analysis, using SPSS version 23.0 for Windows.RESULTS:Participants were more adhered to SP (hand hygiene, wear mask as indicated, and wear glove as indicated) in the HIV ward compare to non-HIV wards (P = 0.002, P = 0.001, and P = 0.001, respectively). Almost all participants were more careful in implementing SP in the HIV ward than in non-HIV wards and were more concerned of getting needlestick injury in the HIV ward than in non-HIV ward.CONCLUSION:HIV and non-HIV ward separation negatively impact medical students' SP adherence.

Evaluation of response to hepatitis B virus vaccine in adults with human immunodeficiency virus

Introduction and aimViral hepatitis is a serious public health problem. The risk of progression to chronic hepatitis in hepatitis B virus (HBV) infection occurs in 5–10% of adults and is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Individuals infected with human immunodeficiency virus (HIV) may have coinfection with HBV. The existence of unvaccinated groups represents a significant risk not only individually but also at the community level. The aim of this study was to evaluate HBV vaccine response in adults with HIV infection. Materials and methodsA retrospective, descriptive study of the cross-sectional type was carried out in an outpatient HIV referral center in southern Brazil. All medical records of adult HIV patients seen during January 2006 to December 2015 were selected. In statistical analysis, a significance level of 5% was used. ResultsOf the 201 patients evaluated with a complete vaccination scheme, 55.72% were males, with a mean age of 43.86±12.68 years. Vaccine response occurred in 80.10% (161/201) of the patients, and it did not correlate with age, CD4+ cell count or viral load. ConclusionHBV vaccine response in a HIV population was satisfactory, highlighting the importance of vaccination for prevention, cost reduction and better prognosis in preventing HBV/HIV coinfection.

Moderate incidence of lost follow-up and risk factors among adult HIV patients on second-line ART regimens in Amhara region hospitals, Ethiopia

Background and Objectives: Loss to follow-up is a common problem of most patients on antiretroviral therapy in Ethiopia. Second-line antiretroviral therapy is the drug that would be used when the first-line therapy fails. Thus this study intends to determine the incidence and risk factors of time to losses to follow up among Human Immunodeficiency Virus (HIV) patients on second line regimens of Antiretroviral Therapy(ART) in Amhara region Hospitals, Ethiopia.&#x0D; Methods: Institutional based retrospective cohort study was conducted in the Amhara region hospitals from February to March 2016. A total of 1246 patient from eight hospitals in Amhara region were selected using simple random sampling method and data were extracted from patient charts. The log rank test was used to assess presence of significant difference in time to losses to follow among levels of categorical variables. Both bi-variiable and multivariable Cox proportional hazards models were used to identify factors that affect the time to losses to follow up. &#x0D; Results: The cumulative incidence of loss to follow up was 5.41% over the entire (eight) years of follow-up. The cumulative incidence rates of death and transfer out were 10.99%,10.02 %, respectively. In multivariable Cox regression analysis, ambulatory functional status (AHR=0.1967, 95% CI: 0.049- 0 .794), male gender (AHR=2.135, 95% CI: 1.053- 4.330), adherence to ART (AHR=0.442, 95% CI: 0.198- 0.989) were significant predictors of time to losses to follow up. The use of 2a, 2e and 2g types of second line regimen reduced the risk of loss to follow up.&#x0D; Interpretations and Conclusions: The incidence of loss to follow up in Amhara region hospitals was low. Loss to folow up was negatively associated with female gender, ambulatory baseline functional status, adherence, &amp; types of second line regimen types. Further research on the effect of types of drug is recommended by acertaining whether the reduction in loss to follow up for patients who took drug types of 2a, 2e, and 2g is associaed with improved or worsened health outcomes by trafcking lost patients closely.

Coping Strategies for Adverse Effects of Antiretroviral Therapy among Adult HIV Patients Attending University of Gondar Referral Hospital, Gondar, Northwest Ethiopia: A Cross-Sectional Study.

Background Adverse effects from antiretroviral therapy (ART) have an impact on quality of life and medication adherence. There is no clear understanding of how people manage the adverse effects of ART. The individual taking medications which cause serious adverse effects may choose to stop or reduce the medications to relieve the adverse effects. Hence, this study was aimed at assessing coping strategies for adverse effects of ART among adult human immunodeficiency virus (HIV) patients. Methods A cross-sectional study was conducted at HIV clinic of University of Gondar Referral Hospital (UoGRH). A total of 394 study participants were recruited by systematic random sampling. Data were collected through interviewing patients. Data were entered to Epi-Info 3.5.4 and analyzed using SPSS-20.0. Descriptive statistics were used to summarize patient's sociodemographic data and the adverse effects of their ART regimen. Binary and multivariate logistic regressions were used to investigate the potential predictors of nonadherence coping strategies. Results The majorities of study participants were females (66%) and aged between 35 and 44 years (38.1%). The major adverse effects reported by the participants were headache (48.2%) followed by fatigability (18%) and loss of appetite (17.5%). Coping strategies used by HIV patients for adverse effect of ART were positive emotion coping strategy (91.1%), social support seeking (76.6%), taking other medications (76.6%), information seeking (48.7%), and nonadherence (35.5%). Younger age (AOR = 29.54, 95% CI = 2.49–35.25, p = 0.007), low level of education (AOR = 5.70, 95% CI = 2.16-15.05, p < 0.001), and living far from the health institution (AOR = 2.68, 95% CI = 1.29–5.57, p = 0.008) were associated with nonadherence coping strategy to relieve the adverse effects of ART. Conclusion The present study revealed that positive emotion coping was the most commonly used strategy. Age, level of education, and distance from health institution were the predictors of nonadherence coping strategy.

Tenofovir-induced renal tubular dysfunction among human immunodeficiency virus patients on antiretroviral therapy in Nigeria: Prospects for early detection of presymptomatic nephrotoxicity.

BackgroundTenofovir disoproxil fumarate (TDF) is relatively safe, although renal toxicity has been reported. In Nigeria, there is insufficient data on renal toxicity among patients on TDF. This study assesses TDF-associated tubular dysfunction among human immunodeficiency virus (HIV) patients at a hospital in Nigeria.MethodsIn this cohort study, 104 adult HIV patients were recruited with a simple random technique from the outpatient clinic. Biochemical indices of renal function were estimated from serum and urine at the 16th and 24th week after an initial assessment at baseline.ResultsThere were no significant differences in baseline proteinuria or glycosuria between TDF and non-TDF groups. Mean baseline urine and serum parameters did not differ significantly between the two groups (P > 0.05). In the TDF group, all urine parameters differed significantly between baseline and 24th week values (P < 0.001). After 16 weeks, mean urine phosphate and urine uric acid increased significantly (P < 0.05) by 2.97 mg/dL and 50.9 mg/dL, respectively, in the TDF group. The rise in mean urine glucose from baseline to the 24th week was more marked in the TDF than the non-TDF group (0.25 vs. 0.07 mmol/L). Higher mean differences in urine albumin were also recorded in the TDF group from baseline to the 24th week.ConclusionIndicators of tubular dysfunction were markedly higher among patients on the TDF-based treatment regimen. Biomarkers of tubular dysfunction could be useful for detecting pre-symptomatic nephrotoxicity before marked reduction of glomerular filtration rate in HIV patients on TDF.

Early experiences integrating hypertension and diabetes screening and treatment in a human immunodeficiency virus clinic in Malawi.

Human immunodeficiency virus (HIV) programmes can be leveraged to manage the growing burden of non-communicable diseases (NCDs). In October 2015, a model of integrated HIV-NCD care was developed at a large HIV clinic in southeast Malawi. Blood pressure was measured in adults at every visit and random blood glucose was determined every 2 y. Uncomplicated antiretroviral therapy (ART)-only care was provided by nurses, integrated HIV-NCD management was provided by clinical officers. Waiting times were assessed using the electronic medical record system. The team met monthly to identify bottlenecks. All (n=6036) adult HIV patients were screened and 765 were diagnosed with hypertension (prevalence 12.7% [95% confidence interval {CI} 11.9-13.5). A total of 2979 adult HIV patients were screened and 25 were diagnosed with diabetes mellitus (prevalence 0.8% [95% CI 0.6-1.2]). The mean duration of ART visits by clinical officers increased from 80.5 to 90 min during the first quarter following HIV-NCD integration but returned to 75 min the following quarter. The mean number of patients seen per day by clinical officers increased from 6 to 11 and for nurses decreased from 92 to 82 in that time period. The robust vertical HIV system made the design of integrated tools demanding. Challenges of integrated HIV-NCD care were related to patient flow, waiting times, NCD drug availability, data collection, clinic workload and the timing of diabetes and hypertension screening. Integrated HIV-NCD services provision was feasible in our clinic.

Factors affecting first month adherence due to antiretroviral therapy among HIV-positive adults at Felege Hiwot Teaching and Specialized Hospital, north-western Ethiopia; a prospective study

BackgroundNon-adherence to Highly Active Antiretroviral Therapy (HAART) is one of the factors for treatment failure in human immunodeficiency virus (HIV) infected patients in developing countries. The main objective of this study was to identify factors for treatment failure among adult HIV patients based on the assessment of first month adherence in the study area.MethodsThe study was conducted using secondary data from antiretroviral unit at Felege Hiwot Teaching and Specialized Hospital. A prospective study was undertaken on 792 randomly selected adult HIV positive patients who have started HAART. The variable of interest, adherence to HAART was categorized as non-adherence if a patient had taken less than 95% of the prescribed medication and this was measured using pill counts. Descriptive statistics, Chi-square tests of association, independent samples t-test and binary logistic regression were used for data analysis.ResultsIn first month therapy, 68.2% of the patients belong to adherence group to HAART. As age increases, a patient without cell phone was less likely to be adherent to HAART as compared to patients with cell phone (AOR = 0.661, 95% CI: (0.243, 0.964)). Compared to urban patients, rural patients were less likely to adhere to HAART (AOR = 0.995, 95% CI: (0.403, 0.999)). A patient who did not disclose his/her disease to families or communities had less probability to be adherent to HAART (AOR = 0.325, 95% CI: (0.01, 0.64)). Similarly, a patient who did not get social support (AOR = 0.42, 95% CI: (0,021, 0.473)) had less probability of adherence to HAART. The main reasons for patients to be non-adherent were forgetfulness, side effects, feeling sick and running out of medication.ConclusionThis study indentified certain groups of patients who are at higher risk and who need counseling. Such groups should be targeted and tailored for improvement of adherence to HAART among HIV positive adults. The health care providers should advise the community to provide social support to HIV positive patients whenever their disease is disclosed. On the other hand, patients should disclose their disease to community to get integrated supports. HIV infected patients who are directed to start HAART should adhere the prescribed medication. For the adherence to be effective, patients who have cell phone should use them as reminder to take pills on time.

Time to immunologic recovery and determinant factors among adults who initiated ART in Felege Hiwot Referral Hospital, northwest Ethiopia

BackgroundCD4 cells are the major targets for human immunodeficiency virus (HIV) and treatment with Antiretroviral Therapy (ART) influences the CD4 cell count of HIV patients. In addition to ART, the time required to reach normal range of CD4 counts (500 cells/mm3) can be affected by clinical, socio-demographic, and behavioral factors. This retrospective cohort study was conducted to determine the incidence of having the normal range of CD4 cell counts and factors that affect the time required to reach this normal range among adult HIV patients who initiated into ART.MethodsData of 4 years were retrospectively retrieved from routinely registered characteristics of 937 ART users enrolled in 2010. Survival time until immunologic recovery and its determinant factors were examined using the frailty model with different parametric distributions alternatively.ResultsMost (80.8%) of the ART attendants had CD4 cell count of 200 cells/mm3 or less at initiation. The overall incidence rate of immunologic recovery was 12.67 persons per 1000 person-months (95% CI 11.30, 14.20). The dependency of frailties of immunologic recovery by residence was statistically significant (Theta = 0.05, p value = 0.006). Baseline age (Adjusted Hazard Ratio (AHR) = 0.98, 95% CI 0.97, 0.99), baseline CD4 count (AHR = 1.006, 95% CI 1.005, 1.008), and female sex (AHR = 1.34, 95% CI 1.03, 1.73) were significantly associated with shorter survival time for immunologic recovery.ConclusionHigher baseline CD4 count, lower baseline age, and female sex were positively associated with the time to immunologic recovery, which also dependent on proximity/residence of ART users. Therefore, further scale up of ART services with due emphasis to patients with low CD4 count at baseline particularly for male and older ART users are recommended to reach the normal range of CD4 count in a shorter time of treatment.

A histological autopsy study of the thyroid gland in HIV infected adults at the University Teaching Hospital in Lusaka, Zambia

Background: Despite the high prevalence of Human Immunodeficiency Virus (HIV) in Zambia, not much is known about the spectrum of thyroid lesions in patients with Acquired Immune Deficiency Virus, (AIDS). Patients with AIDS have increased prevalence of thyroid function abnormalities. It is therefore postulated the thyroid gland would be involved in AIDS patients. This study focused on the histologic appearances of the thyroid gland in HIV and AIDS patients on post mortem. The findings will provide evidence based recommendations on the management of thyroid diseases in the HIV infected in Zambia.&#x0D; Objective: The aim of the study was to determine the histological appearances of adult thyroid glands in patients who died of HIV related diseases at UTH in the period 2010 to 2012.&#x0D; Materials and Methods: This research was a descriptive retrospective study of adult thyroid glands collected at autopsy during the period 2010 to 2012. The study took place at the University Teaching Hospital (UTH) in the Department of Pathology and Microbiology in Lusaka, Zambia. A total of 200 thyroid gland paraffin blocked samples were obtained from the parent study tissue bank by convenient sampling. The inclusion criteria included samples from adult HIV patients who were admitted to UTH and died in hospital. The Paraffin blocked thyroid tissue samples were processed according to standard histopathology laboratory protocols at UTH which included sectioning and staining with hematoxylin and eosin. The slides were examined at light microscopic level. Clinical data was obtained from the available case notes.&#x0D; Results: The sample size was 200 thyroid glands of which 123(62%) were males. Thyroid histopathological lesions were seen in 111 (56%) of the cases, of which 60 (54%) were male. The lesions included: Interstitial fibrosis 104 (52%), nonspecific chronic thyroiditis 42 (21%). Infectious diseases included Mycobacterium tuberculosis 2 (1%) and Cryptococcus neoformans 1(0.5%).&#x0D; Conclusion: These findings outline the importance of thyroid function testing in HIV infected patients who may have subclinical thyroid dysfunction and infection.

Hepatitis B co-infection in HIV-infected patients receiving antiretroviral therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape.

BackgroundHepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection in South Africa is estimated to be between 5% and 23%; however, only limited evidence is available. Co-infection increases the risk of chronification of HBV, liver cirrhosis and death.ObjectiveTo assess the HBV and/or HIV co-infection rate amongst the adult antiretroviral treatment cohort at the TC Newman ART Clinic in Paarl, Western Cape.MethodsIn a retrospective, cross-sectional study, the routine hepatitis B surface antigen screening results for all adult HIV patients who were started on antiretroviral treatment over a period of 19 months were collected and analysed for gender, CD4 count and age.ResultsAmongst the 498 participants (60% female participants), the Hepatitis B surface Antigen positivity rate was 7.6%. Male gender, age between 50 and 59 years and a low CD4 count were correlated with higher rates.ConclusionUseful insight could be obtained by analysing routine data. The prevalence of almost 8% confirms the need for testing of HIV-positive patients for hepatitis B.

Rate of initial highly active anti-retroviral therapy regimen change and its predictors among adult HIV patients at University of Gondar Referral Hospital, Northwest Ethiopia: a retrospective follow up study.

BackgroundRegimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. In a resource limited setting where treatment options are limited, designing strategies to increase the durability of original regimen are essential. However, information’s on rate of initial regimen change and its predictors is scarce in Ethiopia. Therefore, the purpose of this study was to assess the rate of initial highly active anti retroviral therapy (HAART) regimen change and its predictors among adult HIV patients at the University of Gondar Referral Hospital, Northwest Ethiopia.MethodsAn institutional based retrospective follow up study was conducted among 410 adult HIV patients started HAART from January 2010 to December 2014. Simple random sampling technique was used to select patient records using computer generated random number. Data were collected from patient chart using data extraction tool. The Kaplan–Meier curve was used to estimate the median duration of regimen change. Life table was used to estimate the cumulative survival for initial regimen change and log rank test to compare regimen change survival curves between the different categories of explanatory variables. Bivariate and multivariate Cox proportional hazard model were used to identify predictors of initial regimen change.ResultsThe overall incidence rate of initial regimen change was 10.11 (95 % CI 8.29, 12.6) per 100 person years (PY). Baseline WHO clinical stage III (AHR = 1.92, 95 % CI 1.12–3.35), occurrence of tuberculosis (TB) on the initial regimen (AHR = 8.33, 95 % CI 4.47–15.53), side effect on the initial regimen (AHR = 25.27, 95 % CI 15.12–42.00) and co-medication with ART (AHR = 2.5, 95 % CI 1.46–4.34) were significant predictors of initial regimen change.ConclusionsThe rate of initial HAART regimen change was found to be high. Having WHO clinical stage III, co-medication with ART, occurrence of tuberculosis and side effect on initial regimen were independent predictors of regimen change. Hence, close follow-up and screening of patient for side effect and tuberculosis is important.