Highly Active Antiretroviral Therapy Regimen Research Articles

Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them.
 Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography.
 Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function.
 Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M2. Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M2) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p<0.001). Left ventricular systolic function was similar in subjects and controls. The prevalence of left ventricular diastolic dysfunction was significantly higher in subjects (15.5%) than in controls (4.0%); {χ2 = 37.89, p<00.1)
 Conclusion: This study shows that children with HIV on HAART regimen have a very high prevalence of ventricular dysfunction compared with normal controls.

Conserved broad HIV-1 Gag-specific responses associated with low viral load and high CD4+ T cell nadir and preserved HAART regimen.

Broad human immunodeficiency virus type 1 (HIV-1) Gag-specific cellular responses can control viremia and provide slow progression to Acquired immunodeficiency syndrome (AIDS). In this study, we evaluate multiple HIV-1 Gag-specific lymphoproliferative responses and find their connection with cluster of differentiation 4 (CD4)+ T cell count and viral load from chronically HIV-1-infected patients. We further search for the correlation between multiple Gag-specific lymphoproliferative responses and changes in highly active antiretroviral therapy (HAART) regimen. We found correlation between Gag-specific responses and higher CD4+ T cells nadir and low HIV-1 viral load. Additionally, we observed that HIV-1-infected subjects did not need to change HAART regimen, when multiple Gag responses are present. We concluded that the start of HAART when CD4+ T cell nadir is the highest as possible may promote Gag-specific cellular responses conservation. Multiple Gag responses must be important to suppress HIV-1 replication. Preserved Gag-specific responses reduce HIV-1 viral load and are associated with stability of HAART regimen. Keywords: HIV-1; Gag; lymphoproliferation; viral load; HAART.

Evaluating the effect of highly active antiretroviral therapy on visual acuity and intraocular pressure among HIV/AIDS patients in Kano State, Nigeria

Highly Active Anti-Retroviral Therapy (HAART) has been effective in reducing rapidly progressive retinopathies, there are other ocular manifestations of HIV and ocular side effects of HAART which are yet to be determined and evaluated. The aim of this study was to investigate and evaluate the effect of HAART on Visual Acuity (VA) and Intraocular Pressure (IOP) among HIV/AIDS patients in Kano State, Nigeria. This was a prospective hospital based cross-sectional study; consented patients that fulfilled the inclusion criteria were recruited and grouped into two groups A and B. Group A was those scheduled to commence HAART referred to as HAART naive, while group B was subdivided into four groups, comprising B1, B2, B3, B4, termed as HAART experience. There were 400 participants aged 25 to 55 years with mean age of 37.86 ± 7.5 years. Their mean CD4+ T cell count was 476.94 ± 272.3 cells/mm3. The mean IOP was 14.14 ± 2.65 mmHg and analysis of variance showed that there was no correlation of HAART on IOP. About 370 (92.5%) had the best corrected distance visual acuity (BCDVA) on OU of 6/6, while 30 (7.5%) had BCDVA of less than 6/6 or worse and there was a correlation between HAART and VA (p < 0.01), but statistically insignificant on CD4+ T-cells counts, HAART regimen and its durations. There was a correlation between VA and HAART among HIV/AIDS patients, but it showed no association with CD4+ T cell counts, HAART regimen and HAART duration. There was no correlation of HAART on IOP of the patients. Key words: Highly active antiretroviral therapy (HAART), visual acuity, intraocular pressure (IOP), CD4+ T cell counts.

Utility of CD4 Cell Count and Viral Load Assay in Hospitalized Patients with Known HIV Infection: High Value Care Exercise.

Healthcare spending as a percentage of Gross domestic product (GDP) is at all-time high and continues to rise in the United States. The Centers for Medicare and Medicaid Services estimate that 33% of resources spent on healthcare goes to waste. As part of a 'high value care' exercise, we studied if estimating CD4 cell counts and HIV viral load in hospitalized patients with a known diagnosis of HIV led to any meaningful change in HAART regimen and discharge diagnosis. Retrospective chart review for all patients admitted with a known diagnosis of HIV from January 1, through December 31, 2017. A total of 83 patient encounters were reviewed during the period. The mean age was 54.1 ± 16.4 years, 64.1 % of patients were males. 75 patients (90.3%) were already on highly active antiretroviral therapy (HAART). The median hospital length of stay (LOS) was 3 days (IQR 2.0 - 5.0). The mean turnaround time for CD4 counts and HIV viral load assay was 2.9 days (95% CI 2.1 - 3.7) and 3.9 days (95% CI, 3.2 - 4.6), respectively. A CD4 count estimation led to no change in HAART regimen. HIV viral load assay testing had no impact on a change in treatment or a change in diagnosis. In our study, testing CD4 counts and HIV viral load for inpatients did not confer any benefit in altering the diagnosis or HAART regimen. We believe that our study identifies a systems level opportunity to add to the concept of 'Choosing Wisely.'

The prevalence and risk factors for dyslipidaemia in human immunodeficiency virus-infected children on highly active antiretroviral therapy in Kano, Nigeria

Prolonged administration of Highly Active Anti Retroviral Therapy (HAART) is associated with metabolic side effects, especially dyslipidaemia, with potential increase in the risk of development of cardiovascular disease as the affected children mature into adulthood. This study determined the prevalence and risk factors for dyslipidaemia among HIV infected children aged 2-15 years. The study was a comparative study conducted on children aged 2- 15 years attending the Paediatric Infectious Disease Clinic of the Aminu Kano Teaching Hospital, Kano. Study subjects that fulfilled the inclusion criteria were recrutited using systematic sampling technique. Serum lipid profile parameters were measured on blood samples from eighty HIV-infected children on HAART and eighty HIV-infected HAART naive children as patients and controls respectively. Data was analysed using the SPSS software for Windows version16.0. P-values of &lt;0.05 were considered as statistically significant. The overall prevalence of dyslipidaemia in HIVinfected children on HAART was 62.5% (95% CI: 51.8% - 73.1%), while 52.5% (95% CI: 41.5% - 63.4%) of the HIV- infected HAART naive children also had dyslipidaemia. The risk factors associated with hypercholesterolaemia were: age at commencement of HAART less than 2 years (P&lt;0.048; Adjusted Odds Ratio,OR, of 0.38, 95% CI:0.13-1.08) and PI- based HAART regimen (P&lt;0.001; OR=0.18, 95% CI: 0.07-0.49), while age group greater than 5 years (P&lt;0.02; OR=2.78 (95% CI:0.76-10.23), duration of HIV diagnosis greater than one year (P&lt;0.02 fisher’s exact) and duration of treatment on HAART for more than one year (P&lt;0.04; OR=2.32, 95% CI:0.14-38.99) were the risk factors associated with hypertriglyceridaemia among the HIV infected children on HAART. However, on multivariate analysis, PI-based HAART regimen was the only independent predictor of hypercholesterolaemia in the HAART treated children (OR=0.18, 95% CI: 0.07-0.49). Duration of diagnosis greater than 1 year was associated with hypercholesterolaemia in HAART naïve HIV-infected children (P=0.05). The most common dyslipidaemia in HIV-infected children on HAART was hypertriglyceridaemia followed by hypercholesterolaemia while low HDL-cholesterol was the commonest lipid abnormality in the HIV-infected HAART naive children.

Accommodative-Convergence Mechanism failure in HIV-Positive Non Presbyopic Patient on Highly Active Anti-Retroviral Therapy: A case report

Purpose: Accommodative-convergence mechanism failure could occur in non presbyopic HIV- sero positive patients on Highly Active Anti-Retroviral Therapy (HAART). This could be due to either direct neuronal infection by HIV, pathologic changes of the lens or the ciliary body or adverse effects of some individual drugs constituting the HAART regimen on the cranial nerves which play vital roles in the mechanism of accommodation and convergence.&#x0D; Case report: This is a case report of an accommodative- convergence mechanism failure in HIV positive non presbyopic 32-year-old male patient that was on HAART for more than five years. He presented with distance visual acuity (VA) of OD: 6/9 +2, OS: 6/9, and near visual acuity (NVA) of N24 both eyes, 3Δ esophoria at distance and 4Δ esophoria at near. Amplitude of accommodation (AA) was 3.50D and accommodative convergence/accommodation (AC/A) ratio was 6/1. Following comprehensive evaluation, his refractive correction was OD: Plano/-0.50DC X 180 6/5 and OS: Plano/-0.50DC X 90 6/5 at distance with near addition (Add) 2.50D N5. This was prescribed for regular wear in form of D-Top bifocal lens.&#x0D; Conclusion: These findings showed that HIV sero-positive adults on HAART could develop accommodativeconvergence mechanism failure, which may be characterized by low amplitude of accommodation, receded near point of convergence and high non presbyopic reading addition. These conditions may be under-recognized and need for reading addition of a non presbyopic age is often overlooked.&#x0D; Key Words: Accommodative-Convergence, HIV, Lateral Phoria, Refractive error.

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

BackgroundThe impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA).MethodsThis study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period.ResultsSixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection (p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection.ConclusionsImmunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.

Do Highly Active Antiretroviral Therapy Drugs in the Management of HIV Patients Influence Success of Dental Implants?

HIV infection is a global pandemic that affects CD4 cells in the immune system and leads to lethal opportunistic infections. The advent of highly active antiretroviral therapy (HAART) has induced a marked reduction in the viral load and an increase in the CD4 cell count, thereby changing the course of the disease from an acute life-threatening condition to chronic disease. Accordingly, need and demand for oral rehabilitation in HIV positive population have increased in recent years. However, few drugs used in the HAART regimen have also known to be associated with osteopenia and osteoporosis. Although HAART reduces the morbidity in HIV patients, it remains unknown to what extent the therapy influences the implant healing. Few scientific literatures have identified osteoporosis and HIV infection as an unconducive milieu for dental implant placement and survival but demonstrated favorable outcomes in short-term assessments. The long-term impact of bone metabolic effects of HAART on implant success remains a conundrum.

Assessment of the Effect of HAART on Renal Function of HIV Patients Attending the Bamenda Regional Hospital, Cameroon

Background: Management of HIV involves a life-long administration of a cocktail of antiretroviral drugs, some of which have been known for their nephrotoxicity. Despite the increasing access to this combination therapy, Highly Active Antiretroviral Therapy (HAART) information on its renal effect is still scarce and contradictory. The aim of this study was to assess the effect of HAART on the renal function of HIV-infected patients attending the Bamenda Regional Hospital, Cameroon. Methods: This was a comparative hospital-based cross-sectional study involving HIV positive and negative individuals who visited the Day clinic of the Bamenda Regional Hospital during the study period. Spectrophotometry was used to quantify the renal markers. Glomerular Filtration Rate was determined by the 24 hours creatinine clearance method. Blood urea nitrogen was calculated from serum urea concentrations. Renal impairment was then classified according to the National Kidney Foundation clinical practice guideline. Data were analysed on SPSS version 21 using Student t-test, ANOVA, and Pearson’s correlation. The level of significance was set at p&lt;0.05. Results: A total of 201 participants were enrolled in this study, of which 144(71.6%) were females. Their ages ranged between 22 to 60 years with a mean age of 37.4 ± 9.6 years. The participants were divided into 3 study groups; HIV negative, HAART-naïve and the HAART experienced groups. The HAART experienced group had a significantly higher mean BUN and BUN-Creatinine ratio (p= 0.001 and 0.003 respectively) as well as the least creatinine clearance (p= 0.017) when compared to the other groups meanwhile the HAART-naive group had a significantly higher mean urine protein (p= 0.026) when compared to the other two categories. There was no association between renal dysfunction and the HAART regimen as well as adherence to treatment. Conclusion: This study demonstrated that though the participants on HAART had decreased renal function, the mean Creatinine clearance was not statistically different from that of the participants not yet on HAART. this is indicative that the decreased renal function could be as a result of the devastating effect of HIV. It further demonstrates no association between decreased renal function to the type of HAART regimen used, duration on HAART as well as the patient’s adherence to treatment.

Virologic Failure and its Determinant Factors among Children in First Line on Highly Active Anti Retroviral Therapy at Felegehiwot Referral Hospital, Bahir Dar, Northwest, Ethiopia: cross-sectional study

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. The aim at this study was to assess the prevalence of HIV-1 treatment failure and its determinants factors among children on first line HAART at Felegehiwot Referral Hospital. Methods: Cross sectional study was conducted on 238 children who had on first line HAART regimen using the inclusion criteria. Data were collected from patients’ chart starting from ART commencement (baseline data and other information) and interviewed using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, bi-variate and multiple logistic regression analysis were used to show determinant factors association. Independent associations were considered with p&lt;0.05. Result: Among the 238 participants enrolled, 137(57.6%) were females. The mean ages were 8.09 years and the median months on HAART from initiation were 51.93 months. A total of 25 (10.5%) participants were found to have virologic/treatment failure. The mean CD4 T-cells at base line were 342.33 cells/ml and 672.13 cells/ml respectively. Long duration on treatment, sub-optimal drug adherence, conducting faith healing, high medication dosage and ambulatory functional status at baseline were found to be significant predictors of treatment failure and showed positive odds ratio. Conclusion: This study demonstrates high virologic failure and the determinant factors of virologic failures among HAART first line children are still changing. Therefore, evidence-based intervention and early detection of treatment failure must be made to further identify the potential causes and set standardized protective mechanisms of virologic failures.

Assessment of liver and renal functions in human immunodeficiency virus-infected persons on highly active antiretroviral therapy: A mixed cohort study.

Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2-84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02-3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.

Protease Inhibitors for the Treatment of HIV/AIDS: Recent Advances and Future Challenges.

Acquired Immunodeficiency Syndrome (AIDS) is a chronic disease characterized by multiple life-threatening illnesses caused by a retro-virus, Human Immunodeficiency Virus (HIV). HIV infection slowly destroys the immune system and increases the risk of various other infections and diseases. Although, there is no immediate cure for HIV infection/AIDS, several drugs targeting various cruxes of HIV infection are used to slow down the progress of the disease and to boost the immune system. One of the key therapeutic strategies is Highly Active Antiretroviral Therapy (HAART) or ' AIDS cocktail' in a general sense, which is a customized combination of anti-retroviral drugs designed to combat the HIV infection. Since HAART's inception in 1995, this treatment was found to be effective in improving the life expectancy of HIV patients over two decades. Among various classes of HAART treatment regimen, Protease Inhibitors (PIs) are known to be widely used as a major component and found to be effective in treating HIV infection/AIDS. For the past several years, a variety of protease inhibitors have been reported. This review outlines the drug design strategies of PIs, chemical and pharmacological characteristics of some mechanism-based inhibitors, summarizes the recent developments in small molecule based drug discovery with HIV protease as a drug target. Further discussed are the pharmacology, PI drug resistance on HIV PR, adverse effects of HIV PIs and challenges/impediments in the successful application of HIV PIs as an important class of drugs in HAART regimen for the effective treatment of AIDS.

Desimplification to multi-tablet antiretroviral regimens in human immunodeficiency virus-type 1 infected adults: A cohort study.

BACKGROUNDHighly active antiretroviral therapy (HAART) is provided free of charge to all human immunodeficiency virus (HIV) positive residents in Italy. As fixed dose coformulations (FDCs) are often more expensive in comparison to the same drugs administered separately in a multi-tablet regimen (MTR), we considered a cost-effective strategy involving patients in the switch from their FDCs to corresponding MTRs including generic antiretrovirals.AIMTo verify if this would affect the virological and immunological response in comparison to maintaining the FDC regimens.METHODSFrom January 2012 to December 2013, we assessed the eligibility of all the HIV-1 positive adults on stable HAART being treated at our hospital-based outpatient clinic in Treviso, Italy. Participants who accepted to switch from their FDC regimen to the corresponding MTR joined the MTR group, while those who maintained a FDC regimen joined the FDC group. Clinical data, including changes in HAART regimens, respective reasons why and adverse effects, were recorded at baseline and at follow-up visits occurring at weeks 24, 48 and 96. All participants were assessed for virological and immunological responses at baseline and at weeks 24, 48 and 96.RESULTSTwo hundred and forty-three eligible HIV-1 adults on HAART were enrolled: 163 (67%) accepted to switch to a MTR, joining the MTR group, while 80 (33%) maintained their FDCs, joining the FDC group. In a parallel analysis, there were no significant differences in linear trend of distribution of HIV-RNA levels between the two groups and there were no significant odds in favour of a higher level of HIV-RNA in either group at any follow-up and on the overall three strata analysis. In a before-after analysis, both FDC and MTR groups presented no significant differences in distribution of HIV-RNA levels at either weeks 48 vs 24 and weeks 96 vs 24 cross tabulations. A steady increase of mean CD4 count was observed in the MTR group only, while in the FDC group we observed a slight decrease (-23 cells per mmc) between weeks 24 and 48.CONCLUSIONInvolving patients in the switch from their FDC regimens to the corresponding MTRs for economic reasons did not affect the effectiveness of antiretroviral therapy in terms of virological response and immunological recovery

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic.&#x0D; Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. &#x0D; Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results.&#x0D; Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82).&#x0D; Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Higher rates of rejection in HIV-infected kidney transplant recipients on ritonavir-boosted protease inhibitors: 3-year follow-up study.

Rejection rates in HIV-infected kidney transplant (KTx) recipients are higher than HIV-negative recipients. Immunosuppression and highly active antiretroviral therapy (HAART) protocols vary with potentially significant drug-drug interactions, likely influencing outcomes. This is an IRB-approved, single-center, retrospective study of adult HIV-infected KTx patients between 5/2009 and 12/2014 with 3-year follow-up, excluding antibody-depleting induction. A total of 42 patients were included; median age was 52years, 81% male, 50% African American, 29% Hispanic, 17% Caucasian. The most common renal failure etiology was hypertensive nephrosclerosis (50%) with 5.8 median years of pre-transplant dialysis. All patients received IL-2 receptor antagonist, were maintained on tacrolimus (76%) or cyclosporine (17%), and 40% received ritonavir-boosted PI-based HAART (rtv+) regimen. Patient and graft survival at 3years were 93% and 90%. At 1-, 2-, and 3-year time points, median serum creatinine was 1.49, 1.35, and 1.67; treated biopsy-proven rejection was 38%, 38%, and 40.5%; and 92% of episodes were acute rejection. At these time points, rejection rates were significantly higher with boosted PI HAART regimens compared to other HAART regimens, 59% vs 24% (P=0.029), 59% vs 24% (P=0.029), and 68% vs 24% (P=0.01). Despite higher rejection rates, HIV-infected KTx recipients have reasonable outcomes. Given significantly higher rejection rates using rtv+ regimens, alternative HAART regimens should be considered prior to transplantation.

English

Adherence to highly active antiretroviral therapy (HAART) regimen, of at least 95%, is necessary for effective therapeutic response among people living with human immunodeficiency virus (PLWHIV). This study determined the factors associated with non-adherence of PLWHIV to HAART regimen among patients attending a healthcare facility in Akwa Ibom State, Nigeria. Two hundred and fifty one patients, aged 18 to 70 years, attending a healthcare facility in Akwa Ibom State, Nigeria from 8th July to 8th August 2018, were adequately informed and their consent was obtained to enroll in the study. The enrollees were defined as non-adherent (NA), if, for any reason, they missed at least one dose of their drug within the last 30 days. These NA enrollees were purposively selected. The data was obtained using interviewer-administered semi-structured questionnaire. The data obtained was checked for completeness, coded and technique analyzed using Statistical Package for Social Science (SPSS) version 22 software. The statistical association between variables was described using logistic regression. Of the 251 PLWHIV, 100 (39.84%) were NA enrollees. Three major reasons provided by enrollees for missing medication were: (1) forgetfulness 41%, (2) travelling with incomplete medication and difficulty in the accessing drug from a new clinic, 15% and (3) not willing to take HIV/AIDS drugs with other prescribed drugs, 10%. This study has shown that a majority of PLWHIV (60.16%) complied with therapy regimen. Forgetfulness was the most common factor reported for non-adherence by the enrollees. This suggests that there is an increasing need for healthcare personnel to encourage patients to use memory aids, and to increase the awareness of the consequences of non-adherence during drug administration. Key words: Highly active antiretroviral therapy, HIV/AIDS, medication non-adherence, healthcare facility.

A study of compliance to highly active antiretroviral therapy in a tertiary care hospital in South India

Background: Compliance plays a major role in success of antiretroviral therapy (ART) since it requires lifelong treatment and is associated with side effects. Decrease in patient compliance attenuates the clinical effectiveness, so in this regard, both patient and the health-care providers face significant challenges with respect to adherence to highly active ART (HAART). Therefore, there is a need to identify the various factors which influence the patient compliance to ensure better outcome. Aims and Objectives: This study aims to assess the patient compliance of National AIDS Control Organization (NACO) recommended HAART regimen and to explore the impact of CD4 count with factors affecting compliance. Materials and Methods: The prospective study conducted to assess the patient adherence to NACO recommended HAART among newly enrolled patients in ART center at KIMS Hospital and Research Centre, Bangalore, during January 2010–June 2011 (18 months) after obtaining institutional ethics committee approval. HAART consisting of two NRTIs and one NNRTI was instituted in 158 properly selected subjects. The initial therapy in most of the subjects was AZT+3TC+NVP. AZT was substituted by d4T in patients with Hb% 95% compliance and only 2.07% were poorly compliant in adherence to medication. 10.12% of the subjects were lost to follow-up during ART and death occurred in 5.71% of subjects (n = 9). The good compliance was due to effective counseling and involvement of field workers for outreach follow-up. Conclusion: The NACO-sponsored HAART regimen was found to have good compliance with greater improvement in adherence during subsequent follow-up period due to providing the backup services for effective patient counseling, outreach field visits, and transport facilities that may uplift the quality of care.

Dyslipidemia in People Living with HIV on Anti-Retroviral Treatment: Case of the Ambulatory Treatment Center (ATC) of the Sylvanus Olympio University Hospital of Lome

Introduction: Dyslipidemia is a significant cardiovascular risk factor in patients living with HIV (PLWHIV). Few data are available in Togo. Objective: The purpose of this study is to assess the prevalence of dyslipidemia and associated factors in PLWHIV on Highly Active Antiretroviral Therapy (HAART). Methods: This is a descriptive and analytical cross-sectional study of patients followed at the Sylvanus Olympio University Hospital’s infectious diseases department for six months. The study population consisted of any PLWHIV patient on HAART over 18 years of age who had been regularly monitored and had a serum lipid fraction assay. Results: Two hundred and eighty-four patients were included. 75.4% were women. The median age was 46 years (IQR: 39 - 52) and the median CD4 count was 461 cel/U1 (IQR: 330 - 607). Eighty-three percent of the patients had suppressed viral load. The median duration of follow-up under antiretroviral treatment antiretroviral treatment was 4.18 years (IQR: 2 - 7). The prevalence of dyslipidemia was 72.5%. HDL hypocholesterolemia (HDL-c < 40 mg/dl) was the most represented dyslipidemia in 49.6%. Body mass index, past treated tuberculosis, HAART regimen substitution, abdominal obesity, past smoking and being exposed to Nucleoside reverse transcriptase inhibitors (NRITs) were found to be factors associated to dyslipidemia. Conclusion: Our study revealed a high prevalence of dyslipidemia in patients on HAART as well as associated factors. To this end, it is necessary to insist on screening for dyslipidemia before and after initiation of HAART in order to prevent the occurrence of cardiovascular events in PLWHIV.

Antiretroviral regimen change among people infected with HIV: evidence from a cross-sectional study in China

Abstract Background: The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy (HAART). However, the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern. The aim of this study was to determine factors influencing antiretroviral regimen changes among people living with HIV/AIDS in China. Methods: This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART, and gathered relevant information from infectious disease hospitals. The following information were collected: social-demographic characteristics, antiretroviral therapies, CD4 cell counts, virus loads, reasons for changing medication and other related data. Mean and percentages were used to describe the frequency of regimen change among patients, and binary logistic regression was employed to test the factors influencing regimen change. Results: 1,123 people who had experienced regimen change were included in the analysis. On average, patients remained on HAART for 10.2 months before changing regimen, and the average CD4 cell count and viral load (VL) were 383.1 cells/μl and 28,132.4 copies/mL respectively when changing regimen. The reasons for modification were determined as treatment failure (52.5%), adverse reactions (32.3%), and other reasons including pregnancy (15.2%). There are significant differences in regimen change among people with different genders (P Conclusion: Treatment failure was the main reason for the change of HAART regimen. Males, drug users, people on long-term medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

Highly active antiretroviral therapy adherence among perinatally infected HIV adolescents at a teaching hospital in Ghana

ABSTRACTIncreased accessibility to Antiretroviral Therapy (ART) has resulted in the decline of deaths among children with Perinatally Infected Human Immunodeficiency Virus (PIHIV). Their adherence to Highly Active ART (HAART) is vital for their survival and quality of life. This study aimed at determining HAART medication adherence among adolescents with PIHIV. The study was cross-sectional conducted from September 2015 to January 2016 at a teaching hospital in Ghana. It involved 106 adolescents aged 10–20 years. Morisky’s eight-item medication adherence scale was adapted and used to determine the adherence level. Factors influencing adherence were also determined by interviewing the adolescents. EpiData 3.1 and Stata version 12 were used for data entry and analysis respectively. There was low adherence in 76.4% of the adolescents, and the HAART regimen associated with high medication adherence was tenofovir, lamivudine and efavirenz combinations (p = .011). Forgetfulness (p = .001) and inability to come for refill (p = .013) were the main factors associated with low adherence. However adherence was not significantly associated with a lack of medication supply or stigmatization. Addressing the modifiable factors found in this study to be associated with low adherence are essential interventions for their long-term quality of life.