Use Of Antiretroviral Medications Research Articles

Evaluating the Relationship between Various Risk Factors and COVID-19 Incidence In People Living with HIV: A Cross-Sectional Study.

People living with HIV (PLWH) are more susceptible to acquiring and having serious consequences from COVID-19. The objective of this study was to examine the correlation between COVID-19 infection and other risk factors in these patients. This is a descriptive-analytical study recruiting 160 PLWH referred to the Behavioral Disease Counselling Centre of Imam Khomeini Hospital in Tehran in 2021. The patients were selected through convenient sampling. A checklist was used to collect the necessary data. Descriptive statistical tests, such as mean and standard deviation, were employed alongside inferential statistics, including chi-square, Fisher, independent t-tests, and logistic regression, all evaluated at a significance level of p<0.05 using the R software. The patients' average age was 43.15 ± 11.23. Forty-four women and 116 men were present. A notable association was observed between the incidence of COVID-19 and variables such as hepatitis C and the duration of time since HIV diagnosis (p<0.001). Moreover, a strong correlation was found between the amount of COVID-19 vaccination doses given to patients and their probability of acquiring the disease. The first vaccination dose was linked to a 5.45 percent increase in COVID-19 incidence in patients, whereas the second and third doses (t=2.95, t=7.57) reduced the risk of getting COVID-19. Furthermore, no discernible link (p>0.05) was found between the use of various antiretroviral medications and COVID-19 infection. This study finds that vaccine type doesn't impact COVID-19 outcomes in HIV-positive patients, but receiving more doses decreases the probability of occurrence of COVID-19, advocating for multiple vaccinations. However, PLWH, especially those non-compliant with antiretrovirals, need strict adherence to health protocols due to heightened vulnerability to viral illnesses.

Determinants of anti-retroviral consumption adherence in people living with HIV/AIDS in the sub-district of Mejobo, Kudus, Central Java, Indonesia

Introduction: In Indonesia, the Human Immunodeficiency Virus (HIV) is a serious health concern. Since HIV/AIDS patients must adhere to anti-retroviral (ARV) treatment for the rest of their lives, treatment and care must have this as their main objective. Objective: This study was to identify the factors that influence People Living with HIV/ AIDS (PLWHA) to adhere their anti-retroviral (ARV) medication consumption and the determinants of this adherence. Method: This study uses a descriptive analytic design with cross-sectional approach, which provides an overview of adherence factors in taking ARV, such as gender, education, occupation, knowledge, family support, instructional perception, and motivation. This study was taken in Mejobo District, Kudus Regency, and Indonesia. This study's sample was taken using the total sampling technique involving 33 respondents. Result: This study showed that instructional perception is a determining factor in adherence to ARV medication use with OR of 2.746, followed by education (OR 2.24) and education (OR 2.197). Conclusion: The necessity of education on how to consume ARVs is critical, thus medical professionals must be more active in ensuring patient comprehension and motivation so that ARV therapy is sustained.

Uptake of retroviral pre-exposure prophylaxis and its associated factors among female sex workers, Northwest Ethiopia

BackgroundPre-exposure prophylaxis is the use of antiretroviral medications by HIV-negative individuals to prevent infection before exposure. Ethiopia has made progress in reducing new HIV infections, but the burden remains high with ongoing challenges in prevention uptake. This study examined the utilization and factors associated with pre-exposure prophylaxis among female sex workers.MethodsA community-based cross-sectional study design was conducted in Bahir Dar city administration among female sexual workers in 2022. The results were collected using a pre-tested and structured questionnaire. Epi data for data entry and social package for social science for analysis were used.ResultOverall, 15.9% (CI: 12.0-21.1) of female sexual workers received pre-exposure prophylaxis. Parents’ living condition (only father alive [AOR = 0.23, 95% CI, 0.02–0.64], only mother alive [AOR = 0.31, 95% CI, 0.02–0.74]), marital status being single (AOR = 0.27, 95% CI, 0.06–0.94), having history of STI (AOR = 2.82, 95% CI, 1.60–4.77) were associated with pre-exposure prophylaxis uptake.ConclusionThis study showed low pre-exposure prophylaxis uptake. The study identified a history of sexually transmitted infections, marital status, and parent living conditions as significant factors. To increase pre-exposure prophylaxis uptake and reduce HIV incidence, an awareness campaign, tailored support, targeted interventions, and addressing concerns of high-risk groups are needed.

Antiretrovirals for Human Immunodeficiency Virus Treatment and Prevention in Pregnancy

Safe and effective antiretroviral medications are needed during pregnancy to reduce maternal morbidity and mortality associated with untreated human immunodeficiency virus (HIV) infection and to prevent viral transmission to the infant. Pharmacokinetic studies have helped inform the appropriate dosing of antiretroviral medications during pregnancy. However, data from these studies consistently become available years after initial regulatory approvals in nonpregnant adults. In this article, the authors provide an overview of considerations in use of antiretroviral medications in pregnant people with or at risk for HIV, pharmacokinetic studies that helped support recommended options, and therapies either under active investigation or in need of prospective study.

Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study

Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown. Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups? Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n= 466; 92%virologically suppressed) and without (n= 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions:≥ 5 events/h based on an ODI with a 3%(ODI3) or 4%(ODI4) oxygen desaturation, or an AHI with a 3%oxygen desaturation or EEG arousal (AHI3a) or with a 4%oxygen desaturation (AHI4). SDB prevalence was similar in men with and without HIV using the ODI3 and AHI3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI4 (55.9%vs47.8%; P= .04) and the AHI4 definitions (57.9%vs50.4%; P= .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence. SDB prevalence was high overall but greater in men with than without HIV using the ODI4 threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.

A model for explaining adherence to antiretroviral therapy in patients with HIV/AIDS: A grounded theory study.

Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in-depth interviews and a focus-group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long-term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long-term use of antiretroviral medications and, hence, become more resilient.

Injectable Cabotegravir: A New Approach to HIV Pre-exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) involves use of antiretroviral medications to prevent HIV infection in higher-risk adolescent and adult populations. PrEP regimens conventionally used daily oral emtricitabine/tenofivir fumarate (FTC/TDF) or emtricitabine/tenofivir alafenamide (FTC/TAF). However, on December 20, 2021, the United States Food and Drug Administration approved use of injectable cabotegravir for PrEP in adolescents and adults. This article discusses indications and contraindications of injectable cabotegravir as PrEP, provides an overview of injectable cabotegravir’s safety, efficacy, and regimen, contrasts traditional oral PrEP regimens with the injectable cabotegravir regimen, and examines cost and accessibility.

Incidence, risk factors, and outcomes of acute kidney injury among hiv positive medical admissions at the Bamenda Regional Hospital

Background: There is a paucity of data on the burden of acute kidney injury (AKI) in hospitalized HIV-infected patients in Sub-Saharan Africa in the “test and treat” era. Objectives: To study the incidence, risk factors, and outcomes of AKI among HIV-positive medical admissions in a secondary hospital. Materials and methods: We prospectively screened adult HIV-positive patients who gave their informed consent and were admitted to the Bamenda Regional Hospital for AKI from February to June 2020. We excluded participants with Chronic Kidney Disease (CKD) Stage 5 and those with confounders of serum creatinine. On admission and after 2-7 days, we extracted a venous blood sample from each participant to evaluate serum creatinine and diagnose AKI. The participants were then followed up on until they were discharged or died. We measured the need for dialysis, access to dialysis, and renal recovery at three months for patients with AKI. The amended KDIGO 2012 criteria were used to define and classify AKI. The University of Bamenda’s institutional review board provided ethical approval. Results: A total of 206 participants (39.8% men) were enrolled, with a mean (SD) age of 45.71(13.13) years. On enrolment, 89.8% (n = 185) of the participants were on combination antiretroviral therapy (c-ART), with 81.6% (n = 151) on tenofovir-containing regimens. The WHO HIV clinical stages 3 and 4 were present in 81.5% (n = 168) of the individuals. The most common reason for hospitalization was opportunistic infections (69.8%; n = 142). AKI was found in 30.6% (n = 63) of the patients, with 58.7% (n = 37) of them being classified as KDIGO stage 3. A total of 12 (42.9%) participants out of the 28 in need, were dialyzed. AKI was independently associated with use of traditional medicines (aOR = 2.9; 95% CI 1.4-6.3; p = 0.006), WHO HIV stages 3 and 4 (aOR = 4.1; 95% CI 1.1-15.7; p = 0.038), hypotension (aOR = 3.3; 95% CI 1.4-7.8; p = 0.008) and low haemoglobin level ≤ 8.0 g/dl (aOR = 3.5; 95% CI 1.7-7.4; p = 0.001). The AKI group used to have a significantly higher mortality rate (42.9% vs. 16.1%; p &lt; 0.001). Renal recovery was complete in 66.7% of the 30 survivors at three months, partial in 13.3%, and no recovery in 20% of the survivors. Conclusion: Despite the growing use of combination antiretroviral medication, significant immunosuppression is still common in hospitalized HIV-positive patients, increasing the risk of AKI and worsening prognosis. In this high-risk population, early detection of AKI with renal function monitoring may improve results.

Pre-exposure prophylaxis (PrEP) uptake and adherence experiences of gay and bisexual men who engage in chemsex: A qualitative study.

Pre-exposure prophylaxis (PrEP) is the use of HIV antiretroviral medications to reduce the risk of HIV acquisition. PrEP is highly effective when used during periods of potential HIV exposure. Gay and bisexual men (GBM) who engage in unprotected chemsex (without condoms or PrEP) are at high-risk of acquiring HIV. Substance use has been shown to detrimentally impact on the effective use of HIV treatment among GBM living with HIV. This study aims to qualitatively explore PrEP uptake and adherence among GBM who engage in chemsex in the United Kingdom. Nineteen semi-structured in-depth telephone interviews were conducted with self-identifying HIV-negative GBM who reported recently engaging in chemsex and currently using or had recently used PrEP. We explored the ways in which chemsex influenced GBM's motivation to use, access to and effective use of PrEP. Interviews were audio recorded, transcribed, and coded using thematic analysis. Most of the men identified as gay, were of white ethnicity and had a median age of 41. Eighteen men were still using PrEP at the time of the interview and most used daily dosing. The perception of being at high risk of HIV acquisition was a key factor influencing PrEP initiation and after initiation, continued to influence high levels of adherence which was reported by the majority of participants. The few individuals who reported sub-optimal adherence, explained that psychosocial stressors or periods of impaired mental health led to more frequent or intense chemsex sessions, which in turn contributed to occasional non-adherence. Most participants used a variety of strategies to help them adhere, which included restricting the amount or intensity of chemsex they engaged in, strategic placement of PrEP and external triggers to remind them to take PrEP. In this study, the majority of GBM who engaged in chemsex, initiated PrEP in recognition of their potential risk of HIV acquisition and reported high levels of PrEP adherence. They used multiple strategies to support effective PrEP access and adherence. These findings support a growing body of evidence that PrEP is a viable prevention tool for GBM who engage in chemsex, and that chemsex does not negatively impact PrEP adherence.

Experiences of men who have sex with men when initiating, implementing and persisting with HIV pre-exposure prophylaxis.

IntroductionHIV pre‐exposure prophylaxis (PrEP) involves the use of antiretroviral medication in HIV‐negative individuals considered to be at risk of acquiring HIV. It has been shown to prevent HIV and has been available in Wales since July 2017. Measuring and understanding adherence to PrEP is complex as it relies on the simultaneous understanding of both PrEP use and sexual activity. We aimed to understand the experiences of men who have sex with men (MSM) living in Wales initiating, implementing and persisting with HIV PrEP.MethodsWe conducted semistructured interviews with MSM PrEP users in Wales who participated in a cohort study of PrEP use and sexual behaviour. Following completion of the cohort study, participants were invited to take part in a semistructured interview about their experiences of taking PrEP. We aimed to include both individuals who had persisted with and discontinued PrEP during the study. The interview topic guide was informed by the ABC taxonomy for medication adherence and the theory of planned behaviour. We analysed our data using reflexive thematic analysis.ResultsTwenty‐one participants were interviewed, five having discontinued PrEP during the cohort study. The developed themes focused on triggers for initiating PrEP, habitual behaviour, drivers for discontinuation and engagement with sexual health services. Stigma surrounding both PrEP and HIV permeated most topics, acting as a driver for initiating PrEP, an opportunity to reduce discrimination against people living with HIV, but also a concern around the perception of PrEP users.ConclusionThis is the first study to investigate PrEP‐taking experiences incorporating established medication adherence taxonomy. We highlight key experiences regarding the initiation, implementation and persistence with PrEP and describe how taking PrEP may promote positive engagement with sexual health services. These findings may be useful for informing PrEP rollout programmes and need to be explored in other key populations.Patient and Public ContributionPrEP users, in addition to PrEP providers and representatives of HIV advocacy and policy, were involved in developing the topic guide for this study.

69. Identifying and Connecting Adolescent Patients to HIV Pre-Exposure Prophylaxis

In the United States, approximately 34,800 people were diagnosed with HIV in 2019 and approximately 22% of those persons aged 13-24. HIV pre-exposure prophylaxis (PrEP), or use of antiretroviral medication for prevention of new HIV infection, has been a highly effective method of new HIV infection used in adults since 2012. In 2018, the FDA approved tenofivir disoproxil fumarate (TDF)/emtricitabine (FTC) for PrEP in adolescents weighing at least 35 kilograms and in 2019 expanded to include tenofivir alafenamide (TAF)/FTC for at-risk patients assigned male at birth.

Finnish HIV Quality of Care Register (FINHIV)

PurposeThe Finnish HIV Quality of Care Register (FINHIV) was created to: (1) estimate the number of people living with HIV (PLWH) in Finland, (2) evaluate the national level of antiretroviral...

HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis.

BackgroundHIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members.MethodologyThis retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes.ResultsIn total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively.ConclusionsThis study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.

Pre-exposure prophylaxis (PrEP) in Australia: are there challenges facing sexual health promotion?

Pre-exposure prophylaxis (PrEP) for HIV refers to the daily use of antiretroviral medications by HIV uninfected persons to block a potential HIV infection. There is evidence to show that as the use of PrEP increases, the use of other safer sex practices such as condoms decreases, which may lead to an increase in sexually transmitted infections (STIs). This study aimed to explore whether PrEP had caused any challenges for organizations undertaking sexual health promotion activities in Australia. In-depth, semi-structured interviews were conducted with 17 participants (15 males, 2 females) who were purposively sampled from a range of HIV advocacy and health promotion settings. These included publicly funded HIV/AIDS councils and organizations representing people living with HIV/AIDS. Guided by an exploratory, inductive approach, the interviews were analyzed using thematic analysis. Three themes were constructed from the data analysis. First, organizations in different jurisdictions came to support PrEP in different ways, and this influenced the way organizations engaged with PrEP and the messaging that they disseminated to their community. Second, organizations faced some barriers to promoting PrEP, with the most significant being overcoming decades of HIV prevention campaigns that focused on barrier methods only. Third, there were social benefits to PrEP, such as shifting the onus of preventing HIV transmission from HIV positive to HIV negative people. PrEP is a highly effective biomedical intervention to reduce HIV transmission, and future challenges include designing campaigns for those at risk for HIV transmission outside the MSM community.

An assessment of factors associated with neurocognitive decline in people living with HIV.

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) remains a health concern. However, limited research has been done to identify factors associated with neurocognitive decline. We assessed risk factors associated with neurocognitive decline in people living with HIV using a definition of decline that is statistically easy to adopt, is based on a commonly used neuropsychological cut-off and may be clinically relevant. Cox proportional hazards modeling was performed using the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study database. 581 participants were followed for up to 12years. Neurocognitive decline was defined as the first observed drop in global T-scores of at least 2.67. Lifetime methamphetamine use had the strongest association with neurocognitive decline (adjusted Hazard Ratio; aHR = 1.48; 95% CI = 0.92-2.39) followed by no current antiretroviral medication use (aHR = 1.32; 95% CI = 0.91-1.92). Other risk factors included Hispanic ethnicity, lifetime history of major depressive disorder, lifetime cannabis use, hepatitis-C infection, and difficulty eating, dressing, bathing, or using the toilet. Results indicate that consistent use of ART may be of high significance to preserving neurocognition. Furthermore, Hispanic patients, those with a history of depression and substance use, and those having difficulty in essential activities of daily living may require vigilant follow-up.

Clinical characteristics and impacts of HIV infection in people with bipolar disorders

People with bipolar disorders (BD) may be at increased risk of Human Immunodeficiency Virus (HIV) infection but our understanding of the impacts of HIV infection on psychiatric outcomes is poor. This study aimed to examine the prevalence, temporal relationship, and clinical impact of HIV infection in people with BD. In this retrospective case-control study, anonymised electronic case records of patients with BD who had been under the care of South London and Maudsley mental health services were used for data extraction. 54 HIV+ people with BD were identified and compared to a matched control group of 54 HIV- people with BD. The prevalence of HIV co-morbidity in the BD population was around 1%. 76% of HIV+ BD men identified as men who have sex with men (MSM). 65% of the HIV+ BD group were diagnosed with BD before becoming HIV+. The HIV+ BD group experienced significantly higher rates of stimulant, GBL/GHB and psychedelic use compared to the HIV- BD group. 85% of the HIV+ BD group were recorded as taking antiretroviral medications. Retrospective and cross-sectional study design, and a relatively small sample size CONCLUSIONS: The prevalence of HIV comorbidity in BD was comparable to the local general population. HIV infection in BD is associated with MSM status and stimulant, GHB/GBL and psychedelics use suggesting that HIV prevention strategies should particularly target these groups. Lower use of antiretroviral medications by people with BD underlines the importance of engaging HIV+ BD people in HIV services.

Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru.

Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru.Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH.Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04–2.86) in unadjusted analyses, but not in adjusted analyses.Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.

Minimum dataset for monitoring national human immunodeficiency virus pre-exposure prophylaxis (HIV PrEP) programmes: a five-nation consensus, 2019.

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), the use of antiretroviral medication to prevent HIV acquisition, is a highly effective biomedical prevention tool. The World Health Organization (WHO) recommends PrEP for people at substantial risk of HIV infection, as part of combination prevention, and highlights the need for robust evaluation of PrEP programmes. Based on suggested WHO core indicators, we created a concise set of HIV PrEP-related dataset variables, to harmonise the monitoring and evaluation of PrEP programmes across five closely related nations (England, Northern Ireland, Ireland, Scotland and Wales). The dataset is based on the PrEP cascade and is intended to represent the minimum variables needed for reporting and comparison of meaningful data at national and multinational level. The dataset can be modified for settings with different health and surveillance systems. It is intended for public health, academic, clinical and health planning, and public audiences. Here we describe the dataset and illustrate its use with data from the first year of the Scottish National PrEP programme.

Healthcare utilization and outcomes in HIV versus non-HIV patients with hepatocellular cancer: A nationwide analysis.

e16189 Background: Hepatocellular Carcinoma (HCC) remains a leading cause of cancer related mortality and has a 5-year survival after diagnosis of under 20%. HIV-HCC patients are reported to present with advanced disease and shorter survival compared to non-HIV-HCC patients. HIV has not been known to have a direct causal relationship with HCC but chronic immunosuppression, direct effects of HIV virus on liver parenchyma and use of hepatotoxic antiretroviral medications are thought to contribute to the pathogenesis of HCC (Curr Opin HIV AIDS 2017;12:20-25). We studied differences in outcomes and healthcare utilization between HIV and non-HIV-HCC from a national database. Methods: Healthcare Cost Utilization Project (HCUP) National Inpatient Sample (NIS) database was queried to identify all HIV and non-HIV HCC admissions between 2016-2018. The groups were compared for socio-demographic differences, inpatient mortality, length of stay (LOS) and total hospital charges (THC). Secondary outcomes studied were rates of acute kidney injury (AKI), encephalopathy, anemia, upper GI Bleed (LGIB), tumor lysis (TLS), portal hypertension (PH), sepsis, septic shock (SS), neutropenia and protein energy malnutrition (PEM). Statistics were performed using the t-test, univariate and multivariate logistic regression. Results: A total of 845 HIV-HCC and 88,805 non-HIV-HCC inpatient admissions were identified. Compared to non-HIV-HCC, HIV-HCC patients were significantly younger (mean age 59.3 vs 64.7 years, p &lt; 0.0001) with fewer over 65 years old (21.9 % vs 47.4%, p &lt; 0.0001), more males (87.6% vs 74.3%, p &lt; 0.0002) and African American (AA) (44.8% VS 15.9%, p &lt; 0.0001). HIV-HCC cohort were more likely to be treated at a teaching hospital (89% vs 81%, p &lt; 0.035) and had higher comorbidity burden as defined by a high Charlson comorbidity index (p &lt; 0.01) compared to non-HIV-HCC. Odds of adjusted inpatient mortality (aOR= 0.47, CI = 0.27–0.82, p = 0.007) was significantly lower in HIV-HCC with similar LOS (6.5 vs 6.1 days, p = NS) and THC ($85,930 vs $84,592, p = NS) compared to non-HIV-HCC. While rates of neutropenia (2.96% vs 0.62%, p &lt; 0.001) and PEM (26.0% vs 16.3%, p = 0.01) were higher in HIV-HCC, rates of other secondary outcomes were similar compared to non-HIV cohort. Conclusions: HIV-HCC patients are younger, AA, and men with significantly lower inpatient mortality and similar healthcare utilization compared to non-HIV-HCC, despite higher rates of PEM and neutropenia, possibly reflecting advancements in HIV-HCC treatment, and contributed to by younger age and treatment at teaching hospitals. Further studies are needed to evaluate and assess the effect of co-infection with hepatitis on HIV-HCC outcomes which was not evaluated in present study and investigate interventions aimed to reduce complications like PEM and neutropenia to further improve outcomes.

Hematological Abnormalities of Adult HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Treatment at Debre Tabor Comprehensive Specialized Hospital, Northcentral Ethiopia: A Cross-Sectional Study.

BackgroundHematological abnormalities have been associated with an increased risk of disease progression and death in people living with human immunodeficiency virus (HIV). The use of antiretroviral medications can have a positive or negative effect on the hematological disorder. However, little is known about its impact on hematological parameters in antiretroviral-treated patients in Ethiopia, especially in the study area.MethodsA cross-sectional study was conducted at Debre Tabor Comprehensive Specialized Hospital from September to November 2020. A total of 334 HIV-infected patients taking highly active antiretroviral treatment (HAART) at least for 6 months were selected using a simple random sampling technique. Socio-demographic and clinical characteristics of the study subjects were collected using a semi-structured questionnaire. Hematological and immunological parameters were determined using Sysmex kx-21 hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis was done using SPSS version 20 statistical software. A P-value <0.05 was considered statistically significant.ResultsA total of 334 HIV patients were included in this study. The prevalence of anemia, leucopenia, neutropenia, lymphopenia and thrombocytopenia were 37.1%, 22.8%, 8.4%, 10.5% and 17.1% before initiation of HAART and 17.4%, 34.2%, 18.8%, 13.1% and 8.3% after initiation of HAART, respectively. There was a significant difference in total white blood cell (WBC) count, absolute neutrophil count (ANC), red blood cell (RBC) count, hemoglobin value, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width (RDW), platelet and CD4+ T cell counts in HIV patients before and after initiation of HAART (P<0.05).ConclusionThe most common hematological abnormalities observed in this study before and after HAART initiation were anemia, leucopenia, neutropenia, lymphopenia, and thrombocytopenia. However, after beginning HAART, the prevalence of anemia and thrombocytopenia decreased dramatically.