CDC Stage Research Articles

Variation blueprints: A prospective cohort study of chronic HIV infected subjects on HAART

This study was designed to evaluate a six-month variation in CD8, cytotoxic molecules, CD4, viral load, CD4/CD8 ratio, inflammatory cytokines and oxidative stress parameters in chronic HIV infection. A total of 58 HIV sero-positive subjects on HAART were recruited for this study. CDC staging method with CD4 count was used to classify the study subjects. After a baseline sampling, subjects were followed up for 6 months, samples were collected and evaluated every 3 months. The result of the study showed significant (p<0.05) differences in viral load of test subjects when comparing the baseline, 3-month and the 6-month follow-up values. Stage I individuals' PCV values showed a significant (p<0.05) change from baseline to six months, indicating a considerable potential fluctuation in six months. A significant variation was seen between 3months (32.91±1.51%) and 6months (35.18±2.44 %) PCV follow up values for stage II subjects. There was a steady significant (p<0.05) reduction in mean CD8 values for stage I participants from baseline to the 6-month follow-up. In stage II group, CD8 count decreased significantly (p<0.05) between three and six months follow up period. PEF and GRZM values for stage I individuals revealed significant (p<0.05) decrease within the first three months of the follow-up. Stage II participants likewise demonstrated a substantial (P=0.022) decline in PEF values in the first three months but no significant (p>0.05) difference was seen with GRZM. We observed a significant (p=0.034) variation in IL-10 values for stage I individuals between the baseline and 6-month follow-up. Stage II participants showed a substantial (p<0.05) change within the period. TNF-α values for stage I subjects showed no discernible change (p>0.05) over the course of the 6-month period. Nonetheless, there were notable (p<0.05) variations in TNF-α levels among stage II participants within the follow up period. TAC values for stage I individuals revealed a sizeable (p<0.05) difference between baseline and the 6-month. Likewise, for individuals in stage II, there were notable (p<0.05) modifications in their overall antioxidant capacity between three and six months follow up period. Conclusively, there may be notable changes in the health indices of seropositive individuals in three to six months.

Torque Teno Virus load is associated with CDC stage and CD4+ cell count in people living with HIV but unrelated to AIDS-defining events and Human Pegivirus load.

Torque Teno Virus (TTV) is a non-enveloped, circular single-strand DNA virus and part of the human virome. The replication of TTV was related to the immune status in patients treated with immunosuppressive drugs after organ transplantation. We hypothesize that TTV load could be an additional marker for immune function in people living with HIV (PLWH). In this analysis serum samples of PLWH from the RESINA multicenter cohort were reanalysed for TTV. Investigated clinical and epidemiological parameters included Pegivirus (HPgV) load, age, sex, HIV load, CD4+ cell count (CDC 1, 2, 3) and CDC clinical stages (1993 CDC classification system, A, B, C) before initiation of antiretroviral treatment. Regression analysis was used to detect possible associations among parameters. Our analysis confirmed TTV as a strong predictor of CD4+ cell count and CDC class 3. This relationship was used to propose a first classification of TTV load in regard to clinical stage. We found no association with clinical CDC stages A, B and C. HPgV load was inversely correlated with HIV load but not TTV load. TTV load was associated with immunodeficiency in PLWH. Neither TTV- nor HIV load were predictive for the clinical categories of HIV infection.

IP-10 and MIG are sensitive markers of early virological response to HIV-1 integrase inhibitors.

Interferon-inducible protein-10 (IP-10) and monokine induced by interferon-gamma (MIG) are chemokines recognized as inflammatory biomarkers during HIV-1 infection. We assessed their early and long-term dynamics after initiation of antiretroviral treatment (ART). Persons with HIV-1 (PWH) aged>18 years starting their first ART in 2015-2021 in a prospective cohort (n=73) were included. IP-10 and MIG plasma levels were quantified using a multiplexed bead-based assay. IP-10 and MIG plasma levels showed a significant and consistent reduction following ART (80% integrase inhibitor [INSTI]-based) initiation, starting at day 20 and maintained throughout the study period (48 months), paralleling the HIV-1 RNA decay and CD4+ count recovery (p<0·001). At baseline, PWH≥ 50 years, CDC stage C and CD4+ count<350cells/mm3 had higher levels of IP-10 (p=0·022, p=0·001 and p=0·002, respectively) and MIG (p<0·001, p=0·024 and p=0·069, respectively). All of them matched their counterparts several months following ART initiation. MIG levels showed a greater decrease at day 10 in those treated with INSTI (p=0·038). Low-level HIV-1 viremia did not impact MIG or IP-10 levels. Plasma IP-10 and MIG showed an early significant decline following ART initiation, with greater early declines in MIG levels in INSTI-based regimens. These findings suggest a strong impact of HIV-1 viremia on IP-10 and MIG levels.

Reasons for antiretroviral switching in Colombia: A retrospective cohort study.

Long-term use of antiretroviral therapy (ART) for HIV infection might lead to the necessity of switching regimens. We aimed to analyze the reasons for the ART switch, the time-to-switch of ART, and its associated factors in a Colombian cohort. We conducted a retrospective cohort in 20 HIV clinics, including participants ≥18years old with confirmed HIV infection who underwent an ART switch from January 2017 to December 2019 with at least 6 months of follow-up. A time-to-event analysis and an exploratory Cox model were performed. 796 participants switched ART during the study period. The leading cause of ART switch was drug intolerance (n = 449; 56.4%) with a median time-to-switch of 12.2months. The longest median time-to-switch was due to regimen simplification (42.4months). People ≥50years old (HR = 0.6; 95% CI (0.5-0.7) and CDC stage 3 at diagnosis (HR = 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. In this Colombian cohort, drug intolerance was the main cause of the ART switch, and the time-to-switch is shorter than reports from other countries. In Colombia, it is crucial to apply current recommendations for ART initiation to choose regimens with a better tolerability profile.

People living with HIV, HCV and HIV/HCV coinfection in intensive care in a German tertiary referral center 2014-2019.

The epidemiology of HIV-infected individuals on the Medical Intensive Care Units (MICU) has changed after profound progress in treatment of AIDS-defining illnesses and anti-retroviral therapy (ART). Changes of MICU utilization of Hepatitis C (HCV) patients following roll-out of direct-acting antivirals (DAA) are yet to evaluate. We performed a retrospective study on all patients with HIV, HIV/HCV and HCV admitted to the MICU of University Hospital Bonn 2014-2019. We assessed sociodemographic data, available clinical data from HIV patients (CDC stage, CD4 + lymphocyte cell count, HIV-1-RNA, ART) and HCV patients (HCV-RNA, stage of liver cirrhosis, treatment history) and outcome. 237 patients (46 HIV, 22 HIV/HCV, 169 HCV; 168 male, median age 51.3 years) with 325 MICU admissions were included. Admission criteria for HIV patients were infections (39.7% AIDS-associated, 23.8% with controlled HIV-infection) and cardiopulmonary diseases (14.3%). HIV/HCV coinfected patients had infections in controlled/uncontrolled HIV-infection (46.4%), cardiopulmonary diseases and intoxication/drug abuse (17.9% each). Reasons for HCV-mono-infected patients were infections (24.4%), sequelae of liver disease (20.9%), intoxication/drug abuse (18.4%) and cardiopulmonary diseases (15%). 60 patients deceased; most important risk factor was need for mechanical ventilation. The number of HCV-patients admitted to MICU with chronic active disease and sequelae of liver disease decreased while the proportion of patients with completed DAA-treatment increased. Infections remain the most important reason for MICU admission in patients with HIV and/or HCV infection while non-AIDS related conditions increased. DAA roll-out has a beneficial effect on liver-associated morbidity in HCV patients admitted to MICU.

Effect of Direct Antiviral Therapy Against HCV on CD4+ T Cell Count in Patients with HIV-HCV Coinfection.

HCV-related liver disease is an important cause of morbidity and mortality in patients with HIV infection. It is well known that the response rates to HCV therapy are similar between HCV-monoinfected patients and HIV-HV coinfected ones. The aim of this study was to evaluate the impact of HCV eradication on CD4 + T cell count in a population of HIV-HCV coinfected patients. We enrolled patients with HIV-HCV coinfection attending the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from January 2016 to February 2019, treated with ART (AntiRetroviral Therapy) and DAAs (Direct Antiviral Agents). For each patient, we evaluated HIV and HCV viral load and CD4+ T cell count before starting therapy with DAAs, by SVR12 time and by SVR48 time. Fibrosis was evaluated by the mean of Fibroscan®. Fifty-two patients were enrolled, 40 males. Fibrosis score was F0-F3 in 15 patients and cirrhosis in the remaining 11 (all in Child-Pugh class A). All had been receiving ART, and all were treated with DAAs. Only patient who had not achieved HIV viral suppression for non-compliance also experienced a relapse of HCV infection after the end of DAAs. In all patients, we observed that the CD4+ T cell count at baseline did not show significant variations compared to SVR12 and SVR48 time. We also assessed CD4 count in relation to HIV categories and stage of liver disease, see Table 1. Also, based on the assessments of the subclasses considered, there were no significant changes in the CD4 + T cell count. Our study shows that HCV viral eradication obtained with DAAs in patients with HIV-HCV coinfection is not associated with significant changes in the CD4 + T cell count, regardless of CDC category and stage of liver disease.

1256. Antiretroviral Switching in Colombia: A Retrospective Cohort Study.

Abstract Background Antiretroviral therapy (ART) for the human immunodeficiency virus (HIV) has improved life expectancy in people living with HIV/AIDS (PLWHA). Between 2.4% and 50% of PLWHA who initiate ART require a regimen switch within the first year. This variable range depends on local treatment guidelines, available ART, and the prevalence of resistance. We aimed to analyze the causes of ART Switch, time to ART switch and its associated factors in a Colombian Cohort. 1. a. Kaplan Meier Curves and Log-Rank test for time to antiretroviral therapy switch by sex in a cohort of people living with HIV in Colombia 2017-2019. Log-rank test, p: 0.0091. b. Kaplan Meier Curves and Log-Rank test for time to antiretroviral therapy switch by age in a cohort of people living with HIV in Colombia 2017-2019. Log rank test, p: &amp;lt;0.0001. c. Kaplan Meier Curves and Log-Rank test for time to antiretroviral therapy switch by CDC Stage in a cohort of people living with HIV in Colombia 2017-2019. Log rank test, p: 0.006. d. Kaplan Meier Curves and Log-Rank test for time to antiretroviral therapy switch by CD4 cell count in a cohort of people living with HIV in Colombia 2017-2019. Log rank test, p: 0.096 Methods We conducted a retrospective cohort study in 20 different HIV clinics including patients ≥18 years with confirmed HIV who underwent ART switching from 2017 to 2019 and with at least 6 months of follow up in their HIV Clinic. A time to event analysis and an exploratory Cox model were performed. Also, we conducted a logistic regression for comparing people with only one switch versus those who had 2 or more switches. Results 796 patients switched ART during the study period. Most of the patients were man (77.1%) and younger than 50 years (71.6%). The main cause of ART switch was tolerability (56.4%) followed by virologic failure (17.2%). Tolerability had a median time to switch of 12.2 months being the shortest, whereas the longest median time to switch was due to simplification (42.4 months). The Kaplan Meier curve and log-rank test for time to antiretroviral therapy switch by age, sex, CD4 count, and CDC stage are shown in Figure 1. In the Cox model we found that people with 50 years or older (HR= 0.6; 95% CI (0.5-0.7) and CDC stage 3 (HR= 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. When comparing patients with only one ART switch versus those who had two or more ART switches, we found that having dyslipidemia increased the odds of switching ART more than one time (aOR=1.6; 95%CI (1.1-2.4). As opposed to having CD4 counts greater than 200 cell/mL which decreases the odds of having more than one ART switch. (aOR= 0.5; 95%CI (0.2-0.9) Table 1. Conclusion In this Colombian cohort, tolerability was the main cause of ART switch and the time to change the first ART is shorter than reports in other countries. Dyslipidemia and having CD4 counts smaller than 200 cells/mL increased the odds for requiring two or more changes. In Colombia is crucial to apply current recommendations of ART initiation in order to choose regimens with a better tolerability profile. Disclosures Sandra Valderrama, Infectologa, MSD: Advisor/Consultant.

Impact of COVID-19 on HIV late diagnosis in a specialized German centre.

The ongoing COVID-19 pandemic has been impeding HIV diagnosis and treatment worldwide. Data on the impact of COVID-19 on late diagnosis (LD) in Germany are lacking. Here we present novel data of a single-centre German HIV cohort assessing LD during COVID-19. This is a non-interventional, single-centre retrospective cohort assessing the rate of LD comparing HIV diagnoses pre-COVID-19 with those during the COVID-19 pandemic. New diagnoses between 1 January 2019 and 1 February 2020 were classified as pre-COVID-19, and diagnoses between 1 February 2020 and 1 October 2021 were classified as during COVID-19. Between 1 January 2019 and 1 October 2021, 75 patients presented with newly diagnosed HIV infection, 34 pre-COVID-19 and 41 during COVID-19. LD increased to 83% (n=34/41) during COVID-19 versus 59% (n=20/34) pre-COVID-19, and CDC stage C3 rose to 44% (n=18) versus 27%. Hospitalization rate increased to 49% (n=20) during COVID-19 versus 29% pre-COVID-19, and 12% (n=5) presented with HIV-associated neurological disease, whereas none were observed in the pre-COVID-19 group. The incidence of LD (p=0.020), CD4 count < 350 cells/μL (p=0.037) and < 200 cells/μL (p=0.022) were statistically significantly associated with the ongoing COVID-pandemic. An association with HIV transmission risk was borderline significant (p=0.055). Despite comparable annual rates of new HIV diagnoses, LD has been increasing during the COVID-19 pandemic, resulting in more opportunistic infections and higher hospitalization rates, possibly reflecting pandemic-related shortages in HIV testing and care facilities. Maintaining HIV testing opportunities and access to treatment during a pandemic is crucial so as not to impede WHO elimination goals and so as to prevent an increase in AIDS-related morbidity and mortality.

Reversibility of Central Nervous System Adverse Events in Course of Art.

The purpose of this study is to evaluate the frequency of central nervous system adverse events (CNS-AE) on dolutegravir (DTG) and non-DTG containing ART, and their reversibility, in the observational prospective SCOLTA cohort. Factors associated with CNS-AE were estimated using a Cox proportional-hazards model. 4939 people living with HIV (PLWH) were enrolled in DTG (n = 1179) and non-DTG (n = 3760) cohorts. Sixty-six SNC-AE leading to ART discontinuation were reported, 39/1179 (3.3%) in DTG and 27/3760 (0.7%) in non-DTG cohort. PLWH naïve to ART, with higher CD4 + T count and with psychiatric disorders were more likely to develop a CNS-AE. The risk was lower in non-DTG than DTG-cohort (aHR 0.33, 95% CI 0.19–0.55, p < 0.0001). One-year follow-up was available for 63/66 PLWH with CNS-AE. AE resolution was reported in 35/39 and 23/24 cases in DTG and non-DTG cohorts, respectively. The probability of AE reversibility was not different based on ART class, sex, ethnicity, CDC stage, or baseline psychiatric disorder. At the same time, a lower rate of event resolution was found in PLWH older than 50 years (p = 0.017). In conclusion, CNS-AE leading to ART discontinuation was more frequent in DTG than non-DTG treated PLWH. Most CNS-AE resolved after ART switch, similarly in both DTG and non-DTG cohorts.

The use of Semi-Markov Model to determine the efficacy of CDC staging criterion in Nigeria (A case study of General Hospital Minna, Niger State)

Semi-Markov model in discrete state and time to study the trajection among the various defined HIV/AIDs stages has been presented in this paper. The model was used to determine the staging of HIV- infected clients reported at heart-to-heart clinic of General Hospital Minna, Niger State, Nigeria for a period of 10 years. The result shows that there is no transition from asymptomatic stage of HIV to late/advance AIDs such that φ14 (n) = 0; which led to gradual increment in the graphs of interval transition probabilities for all n ∈ N.The study shows that there are some increments in the transition probabilities from stages 2, 3 and 4 to stage 1 from about 0.05745, 0.01055 and 0.00379 in the first month (n = 1) to about 0.37163, 0.17821 and 0.05862 in the forty four months (n = 44) and in the forty five months (n = 45) respectively. From the virtual transition probabilities, the graph is gradually decreasing after forty-five (45) months. The result show that φ11 (n), φ22 (n), φ33 (n) and φ44 (n)attained the values of about 0.56516, 0.50353, 0.53343 and 0.65623 respectively for the first few months or years. The percentage decrease is about 37.1%, 17.8% for stages 2, 3 in forty-four months and 5.8% for stage 4 in forty-five month duration. However, client’s transitions dropped slowly and attain stability of stage at infinity. In compliance to the medical view, all HIV-naïve patients transit to AIDs stage especially when therapeutic intervention is lacking. The model established in this study could assist the Medical Personnels’ (MP), Health Care Providers (HCP), Epidemiologists, Medical Statisticians and other funding organizations to plan for the treatment, tracking and intervention for the ever increasing scourge of HIV/AIDs.

Women with HIV transitioning through menopause: Insights from the Swiss HIV Cohort Study (SHCS).

ObjectivesWe aimed to assess prevalence and age at menopause, identify factors associated with early menopause and explore the provision and utilization of healthcare in women living with HIV in Switzerland.MethodsThis was a retrospective Swiss HIV Cohort Study analysis from January 2010 to December 2018. Descriptive statistics to characterise the population and menopause onset. Logistic regression analysis to identify risk factors for early menopause.ResultsOf all women in the SHCS, the proportion of postmenopausal women tripled from 11.5% (n = 274) in 2010 to 36.1% (n = 961) in 2018. The median age at menopause was 50 years. Early menopause (< 45 years) occurred in 115 (10.2%) women and premature ovarian insufficiency (POI) (< 40 years) in 23 (2%) women. Early menopause was associated with black ethnicity (52.2% vs. 21.6%, p < 0.001), but not with HIV acquisition mode, CDC stage, viral suppression, CD4 cell count, hepatitis C, smoking or active drug use. While 92% of the postmenopausal women underwent a gynaecological examination during the 36 months before menopause documentation, only 27% received a bone mineral density measurement within 36 months after the last bleed and 11% were on hormone replacement therapy at the time of menopause documentation.ConclusionsThe median age of women living with HIV at menopause is around 2 years lower than that reported for HIV‐negative women in Switzerland. HIV care providers need to adapt their services to the requirements of the increasing number of women living with HIV transitioning through menopause. They should be able to recognize menopause‐associated symptoms and improve access to bone mineral density measurement as well as hormone replacement therapy.

A randomized prospective study to compare early versus delayed access to antiretroviral therapy over clinical and immunological sequel in HIV-positive adults.

Antiretroviral therapy (ART) is the cornerstone for the treatment of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Our study aimed to compare the impact of early versus delayed access to ART over clinical and immunological outcomes in HIV-positive adults. The prospective, randomized, open-label study was conducted for nine months, and comprised HIV-positive adults who presented to the ART center. Patients who presented early in their course of disease with baseline cluster of differentiation (CD) 4 count ≥350/mm3 were recruited in the early arm and in the late arm, if <350/mm3. The primary objectives were to evaluate disease progression in terms of the Centers for Disease Control and Prevention (CDC) stages, functional status, and opportunistic infections. Statistical analysis was done by applying an unpaired t-test, analysis of variance (ANOVA), Chi-square test, and Kaplan-Meier analysis with a P value <0.05 as significant at a 95% confidence interval. A total of 134 HIV-positive patients meeting eligibility criteria were randomized. All patients including 60 in the early and 74 in the late arm received tenofovir + lamivudine + efavirenz (TLE). There was a significant difference in CDC stages and immunological status at baseline and post ART initiation (p-value < 0.001). TB-HIV co-infections were significantly (p-value = 0.006) more in late arm. The study suggests CD4 counts at ART initiation, as the most important factor in predicting post-treatment recovery in terms of clinical and immunological outcomes.

Incidence of and factors associated with SARS-CoV-2 infection among people living with HIV in Southern Spain after one year of pandemic.

Whether people living with HIV (PLWH) are at greater risk of acquiring SARS‐CoV‐2 infection is currently unknown. Prospective serologic studies may allow seroincidence analyses, where all infections are accurately identified. Because of this, we evaluated the incidence of associated factors with and the clinical outcome of SARS‐CoV‐2 infection in PLWH in Southern Spain.This prospective cohort study included PLWH from a Tertiary University Hospital in Southern Spain. Patients were enrolled in the study if (1) they had attended as outpatients our Unit from 1 August 2019 to 8 February 2020 and (2) had two subsequent evaluations from 9 February 2020 to 4 March 2021. SARS‐CoV‐2 infections were diagnosed by PCR, antigen detection or serology.Seven hundred and nine PLWH were included in the study. Of them, 55 [7.8%, 95% confidence interval (95% CI) 5.9%–9.9%] patients developed SARS‐CoV‐2 infection. Between 18 May and 29 November 2020, the rate of seroconversion was 5.3% (95% CI: 3.1%–9.0%) for the general population in the area of Seville and 2.3% (95% CI: 1.3%–2.6%) for PLWH in this study (p = .001). After multivariable analysis, adjusted by age, sex, and risk factors for HIV infection, active tobacco use and CDC stage, active tobacco smoking was the only factor independently associated with lower risk of SARS‐Cov‐2 infection [Incidence rate ratio: 0.29 (95% CI 0.16–0.55) p < .001].In conclusion, the incidence of SARS‐CoV‐2 infection among PLWH in Southern Spain during the ongoing pandemic was lower than that reported for the general population in the same area.

A STUDY ONCYTOPENIAS AND THE FACTORS ASSOCIATED WITH CYTOPENIAS AMONG HIV INFECTED PATIENTS ADMITTED AT A TERTIARY CARE HOSPITAL

Introduction: India has the third highest burden of HIV in the world. Haematological complications are common in HIV patients, of which cytopenias are the most frequently encountered. The cytopenias have been found to adversely affect the outcome of HIV patients with greater mortality and decreased quality of life. Aims and Objective: To assess the prevalence of cytopenias among patients admitted in a tertiary care hospital and to assess the factors associated with the cytopenias. Materials and Methods: The present study was conducted in the department of general medicine at a tertiary care hospital and 191 patients admitted in the hospital during the study period were taken for the study. The baseline investigations at the time of admission were taken into consideration. Patients were interviewed and charts reviewed to collect the data. The data collected was analysed with SPSS-2018. Continuous variables were expressed as mean +/- standard deviation and as median and interquartile ranges as appropriate. Categorical variables were expressed as percentages and frequencies. Comparisons between data was done by student’s t test and chi square. The factors associated with various cytopenias was assessed using log binomial regression. A p value of &lt; 0.05 was taken as significant. Results: The overall prevalence of any cytopenia was found to be 85.9%. The most common cytopenia was anaemia with a prevalence of 78.5% followed by thrombocytopenia and leucopenia with prevalences of 28.8% and 24.1% respectively. Anaemia was found to be more prevalent among females with a prevalence ratio of 3.05 (95% CI: 1.39- 10.16, p value 0.009) when compared to males. The most common cause of anaemia was found to be B12 deficiency. There was significant association between leucopenia and CDC staging with the prevalence of leucopenia being higher among patient with CDC stage 3. [Prevalence ratio:1.46 (95% CI 0.67-3.17, p 0.024)]. No significant association was found with gender, duration of HIV, ART regimen, CDC stage or presence of opportunistic infections and thrombocytopenia. Conclusion: The prevalence of cytopenias among HIV patients was found to high – 85.9% especially compared to other developed countries. The most common cytopenia among the patients was found to be anaemia with a prevalence of 78%. The next most common cytopenia was thrombocytopenia, followed by leucopenia. The factors associated with these cytopenias can help to screen for patients at higher risk of developing these cytopenias and hence establish preventive strategies against them.

Long-term clinical, virological and immunological outcomes following planned treatment interruption in HIV-infected children.

ObjectivesPlanned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV‐infected children to continuous ART (CT) vs. CD4‐driven PTIs. We report 5 years’ follow‐up after the end of main trial.MethodsPost‐trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub‐study investigated more detailed immunophenotype. CT and PTI arms were compared using intention‐to‐treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time.ResultsIn all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post‐trial follow‐up. Post‐trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post‐trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub‐study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post‐trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT – PTI) = −0.15; 95% CI: −0.34–0.05), P = 0.14]. The sub‐study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells.ConclusionsChildren tolerated PTI with few long‐term clinical, virological or immunological consequences.

Obstacles to HBV functional cure: Late presentation in HIV and its impact on HBV seroconversion in HIV/HBV coinfection

Several cohorts have shown that long-term tenofovir-containing combination antiretroviral therapy (cART) leads to higher HBsAg seroclearance rates in HIV/HBV coinfected patients vs HBV-monoinfected patients under tenofovir disoproxil fumarate (TDF)-based therapy. We have analysed data on determinants of HBsAg loss in a retrospective multicentric cohort of 359 HIV/HBV coinfected patients. Median CD4 T-cell count at baseline was 359/ul (321-404), CDC stage was C in 20% (n=70). Most patients (68%) were ART-naïve when TDF- or tenofovir alafenamide (TAF)-containing cART was initiated (baseline). After a median follow-up of 11years HBsAg loss had occurred in 66/359 (18%) patients. However, patients with stage CDC C (P≤.001), lower CD4 gain (P=.043) and not receiving TDF/FTC (P=.008) were less likely to lose HBsAg. Long-term TDF-containing cART appears to achieve higher rates of HBsAg seroclearance compared to published data for HBV monoinfected subjects. However, late presentation for HIV and poor immune recovery significantly impair HBV seroconversion rates.

Rheumatological Manifestations in HIV-Positive Patients: A Single-Center Study

Rheumatological manifestations (RM) are very common in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the clinical spectrum of musculoskeletal involvement and relationship with the Centers for Disease Control and Prevention (CDC) stage and CD4+ cells and other factors. A cross-sectional study was conducted involving 75 patients of over 18years of either sex with confirmed HIV status attending a tertiary care hospital in north India in one calendar year. Baseline demographic details, relevant history including duration of combination antiretroviral therapy (cART), RM, joints involved, CD4 cell count, and biochemical parameters were evaluated. Of 75 patients, 54 were male and 21 were female (mean age 33.15 ± 5.00years, range 21-48years). Most common RM was arthralgia (26.67%), followed by myalgia (18.67%), and arthritis (13.33%). Keratoderma blennorrhagicum (1.33%), tendo-achilles tendinitis (2.67%), and plantar fasciitis (2.67%) were other manifestations. Spondyloarthritis (SpA) was seen in 8% patients (undifferentiated SpA 4%, reactive arthritis 2.67%, psoriatic arthritis 1.67%). HIV-associated arthritis was seen in 2.67% while septic arthritis, rheumatoid arthritis, vasculitis, and diffuse infiltrative lymphocytic syndrome were seen in one patient (1.33%) each. The mean duration of disease in patients with RM was significantly less than patients without RM (p < 0.01). The erythrocyte sedimentation rate in patients with RM was significantly higher than in patients without RM (p < 0.05). Mean CD4 + cells were also significantly lower in patients with RM as compared to patients without RM (p < 0.05). Significantly fewer patients on cART had RM in comparison to patients not on cART (p < 0.001). Of 35 patients with RM, 25 were in CDC stage IV. RM are common in HIV-infected patients. HIV arthralgia, myalgia, and undifferentiated SpA are the common manifestations. RM were associated with low CD4 counts. Most of the cases with RM were in CDC stage IV.

Is the use of the QPC cognitive complaints questionnaire relevant for the screening strategy of HIV-Associated neurocognitive disorders?

ABSTRACT Background: The screening strategy for HIV-Associated Neurocognitive Disorders (HAND) is challenging. The French Expert Report recommend the use of the Cognitive Complaints Questionnaire (QPC) and the Montreal Cognitive assessment. However, the QPC has never been studied in People Living with HIV (PLWH). This study aims to determine the degree of agreement between QPC and the presence of HAND according to Frascati criteria, established by a battery of neuropsychological tests. Methods: Data from patients who performed both a QPC and a battery of neuropsychological tests over a six-month follow-up period were evaluated retrospectively. Results: A total of 121 patients were selected, with a median age of 53.1 years old. Among participants, 92.6% had an undetectable plasma viral load, 49.6% had a nadir CD4 less than 200/mm3 and 23.1% had a CDC stage C. Median CD4 cell count was 686/mm3. Prevalence of HAND was 57%, including 28.9% of Asymptomatic Neurocognitive Impairment, 24.8% of Mild Neurocognitive Disorder and 3.3% of HIV-associated Dementia. This analyze shows no agreement between QPC and HIV-associated neurocognitive disorders (kappa = −0.007). Conclusions: The QPC is not relevant in the screening for HAND. Thus, it urges to develop a specific tool to assess cognitive complaints among PLWH.

Partial Achievement of the 90-90-90 UNAIDS Target in a Cohort of HIV Infected Patients from Central Italy.

BackgroundDespite progress in the prevention and treatment of HIV, persistent issues concerning the evaluation of continuum in care from the serological diagnosis to virologic success remains. Considering the 2020 UNAIDS target 90-90-90 for diagnosis, treatment, and viral suppression of people living with HIV (PLWH), our purpose was to verify if, starting from new diagnoses, the viral suppression rate of our cohort of new PLWH satisfied the second and the third steps.MethodsThis retrospective study regards all patients aged ≥15 undergoing HIV test at our clinic between January 2005 and December 2017. We evaluated the second and the third ‘90 UNAIDS targets and the unclaimed tests, linkage to care, retention in ART, and the viral suppression at 1 and 2 years. Logistic regression (odds ratio, 95% confidence interval) was performed.ResultsWe observed 592 new diagnoses for HIV infection: 61.4% on Italians, 38.5% on foreigners. An antiretroviral treatment was started on 78.8% of the new diagnoses (467/592) (second UNAIDS target), and a viral suppression was obtained at 2 years on 82% of PLWH who had started ART (383/467) (third UNAIDS target), namely only 64.7% of the new diagnoses instead of the hoped-for 81% of the UNAIDS target. Logistic regressions demonstrated that second and third ‘90 UNAIDS targets were unrelated to sex, nationality, CD4 cells count, HIV-RNA and CDC stage (p>0.05). The age class 25–50 years (OR=2.24; 95% CI = 1.06–4.37; p=0.04) achieves more likely viral suppression when compared with patients <25 years. Considering the continuum of care, 88 (15%) PLWH were lost to engagement in care (55 unclaimed tests and 33 unlinked to care), 37 didn’t start ART, 51 were LFTU at 2 years.ConclusionsUNAIDS goal was far to be reached. The main challenges were unreturned tests as well as the retention in ART. Rapid tests for a test-treat strategy and frequent phone communications in the first ART years could facilitate UNAIDS target achievement.

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea.

To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea. Children <18years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-for-age Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis. A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <-2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <-2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (height-for-age <-2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5years than in children >5years (36.4% vs. 19.1%, P=0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P=0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P=0.010). We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.