Line Highly Active Antiretroviral Therapy Research Articles

Point prevalence of metabolic syndrome in HIV positive patients.

Human immunodeficiency virus (HIV)-related morbidity and mortality have declined over time, but this increased longevity may lead to the development of other diseases, which may further manifest as the metabolic syndrome (MS). To find out the point prevalence of MS in HIV positive patients, a cross-sectional prospective observational study was conducted on 200 patients who approached ART plus Centre of Government Medical College and Hospital Jammu, including 50 symptomatic patients HIV negative as controls. The mean age group in MS was 37.85 ± 6.61. Males consisted of 55% (110) and females consisted of 45% (90). The overall prevalence of MS was 13.5%, with prevalence in males being 16.3% and in females 10%. Patients receiving first line highly active antiretroviral therapy (HAART) showed a 24% prevalence, while that of second line HAART showed a 14% prevalence. Central obesity (47.3%) was the most common component of MS followed by hyperglycemia (43.3%), hypertriglyceridemia (38.6%), and low high density cholesterol (HDL-C) level (38.6%). Out of 84 males with MS, 94% (79) males were having hypertriglyceridemia, 88% (74) were hypertensive, and 72% (60) were having FBS >=100. Out of 66 females with MS, 100% (66) females had central obesity and 88% (58) had hypertriglyceridemia and low HDL-C levels. The metabolic complications as a result of treatment with HAART leave HIV patients at a risk of developing cardiovascular disease and diabetes in spite of improvements in morbidity and mortality. Risk factors like central obesity, hypertension, hyperglycemia, and hypertriglyceridemia should be taken into consideration well before to prevent the add-on effect of developing MS.

Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia

BackgroundPeople living with human immunodeficiency virus (HIV) with immuno-virological discordant responses are at an increased risk to develop acquired immunodeficiency syndrome (AIDS) and severe non AIDS events which are risk factors for death. This study was aimed to assess prevalence of immuno- virological discordant responses and associated risk factors among highly active antiretroviral therapy (HAART) users in Tigray, Northern Ethiopia.MethodsA cross sectional study was conducted from September to December 30, 2016 on 260 people living with HIV who started first line HAART from January 2008 to March 2016 at Mekelle hospital and Ayder comprehensive specialized hospital. Baseline and follow-up clinical data and CD4+ result were collected from patient charts. Besides, socio-demographic data and blood samples for CD4 + count and viral load measurement were collected during data collection period. Fisher’s exact test, bivariate and multivariate logistic regressions were used for data analysis. P-value < 0.05 with 95% CI was considered as statistically significant.ResultAmong the 260 study participants, 8.80% (95% Confidence Interval (CI) =8.77–8.84%) and 2.70% (95% CI = 2.68–2.72%) had virological and immunological discordant responses, respectively with an overall immuno-virological discordance response of 11.50% (95% CI = 11.46–11.54%). The median age of the study participants at HAART initiation was 35 (IQR: 28–44 years). More than half (58.1%) of the study participants were females. Age at or below 35 years old at HAART initiation (AOR ((95% CI) = 4.25(1.48–12.23), p = 0.007)), male gender ((Adjusted Odds Ratio (AOR) (95% CI) =1.71(1.13–1.10), p = 0.029)), type of regimen given ((AOR(95% CI) = 0.30 (0.10–0.88), p = 0.028)) and good treatment adherence ((AOR (95% CI) = 0.12 (0.030–0.0.48), p = 0.003)) were associated risk factors for virological discordant response. Likewise, immunological discordant response was associated with tuberculosis co-infections (p = 0.016), hepatitis B virus co-infections (p = 0.05) and low CD4+ count (≤100 cells/μl) at baseline (p = 0.026).ConclusionsOver all, immuno-virological discordance response was 11.5% in the study area. Males, low baseline CD4+ count, poor/fair treatment adherence, and TB and HBV co-infections were significantly associated with higher immuno-virological discordance. We recommend that decision of patient treatment outcome, regimen change and patient management response should be done using trends of both viral load and CD4+ count concurrently.

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.

Magnitude of Virological Treatment Failure and Its Determinate Factors Among Adults on First Line Antiretroviral Treatment at Defence Main Health Department - Level II & Level III Hospitals In Ethiopia

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. Objective: The aim of this study was to assess the virological treatment failure and its determinant factors of patients on first line HAART at five commandant Hospitals, Ethiopia. Methods: A Retrospective hospital based study design was used to determine magnitude of treatment/virology failure and its determinant factors, among HIV positive adults enrolled to HAART program at five commandant Hospitals from February 1 to May 30, 2018. Data abstracted from patient charts or electronic data base was cleaned, coded, entered and analyzed using EPI data version 3.1 and SPSS version 23 statistical software package. Descriptive statistics, proportion of treatment failure cases among those diagnosed to have treatment failure was calculated. Bi-variate and multiple logistic regressions were used to analysis association between the outcome and the independent variables were taken as significant at P&lt;0.05 (2 tail test) and 95% confidence intervals (CIs). Result: Among the 326 participants enrolled, 229(70.2%) were males. The mean ages were 36.84 years (SD+7.716) years and the median months on HAART from initiation were 81.50 months. A total of 75(23%) participants were found to have treatment failure among those 50(15.3%) immunological failure, 7(2.1%) virological failure and 16(4.9%) all Treatment failure (VF, IF&amp;CF in one). The mean CD4 T-cells at base line and at study time were 213.3 cells/ µl. Long duration on treatment (AOR= 4.231, 95% CI: 1.453-12.320) , IPT cycle (AOR = 3.060, 95% CI: 1.388-6.746), Type of drug AZT based therapy (AOR= 2.572, 95% CI: 1.357-4.875), experience of PEP (AOR=7.950, 95% CI: 1.945-66.915) and lost to follow up (AOR= 9.104, 95% CI: 2.973-27.873) were found to be significant predictors of treatment/virologic failure and showed positive odds ratio. Conclusion: This study demonstrates high treatment /virologic failure and the determinant factors of treatment/virologic failures among HAART first line adult 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 treatment/virologic failures.

Five-year trends in treatment changes in an adult cohort of HIV/AIDS patients in Ghana: a retrospective cohort study

BackgroundThere is limited information on patterns of treatment change among new initiators of highly active antiretroviral therapy (HAART) in the regions most affected by HIV/AIDS. This makes it difficult to identify the determinants of treatment change. In this retrospective cohort study, we examined treatment change patterns over a five-year period among initiators of HAART.MethodsDe-identified data were obtained from the Fevers’ Unit Database at the Korle-Bu Teaching Hospital. All adult treatment-naive patients who started treatment with first line HAART between 1st January, 2008 and 31st December, 2012 were followed over a minimum period of three months. The main outcome was the first treatment change, defined as the first substitution/switch in accordance with the standard treatment guidelines. Data were analyzed stratified by year of treatment initiation. Crude and adjusted hazard ratios were calculated.ResultsA total of 3933 patients were followed with almost equal numbers of initiators per year. The mean age (standard deviation) at treatment initiation was 39 (10.3) years. The most prescribed HAART combination was AZT/3TC/EFV and overall for initiators zidovudine combination therapy was about 60%. Utilization of stavudine containing HAART increased gradually until 2010 and then dropped to zero. Over the study period, 44.9% of recorded deaths were from those initiated with a stavudine backbone, 41.1% from a zidovudine backbone, and 11.5% from a tenofovir backbone. Females had a significantly higher rate of treatment change compared to males (p-value = 0.0002), and d4T/3TC/EFV and d4T/3TC/NVP recorded independent treatment change hazard ratios of 12.05 (CI 9.58 to 15.16) and 12.03 (CI 9.27 to 15.61) respectively.. Kaplan-Meier curves showed that treatment change was higher among those who started treatment later in the study period compared with those who started earlier.ConclusionA major treatment change in the utilization of antiretroviral medicines in Ghana occurred during the study period which was associated with type of treatment, year of treatment, gender and disease stage. The influence of a policy change during the period may have made a significant impact.. For diseases involving life-long treatment in particular, it is important to monitor and periodically evaluation treatment utilization patterns.

English

Antiretroviral (ART) regimen switch is a common occurrence in resource-limited settings where patients present late for care or with an AIDS-defining event. ART regimen switch can be attributed to several factors emanating from either the individual, program or facility level. This retrospective study was carried out in a resource-limited comprehensive facility in North-central Nigeria. Treatment records of 4,206 Adult HIV/AIDS patients initiated on first line ART regimen from 2006 to 2013 were extracted and examined for switch to second line ART regimen for the purpose of this study after ethical clearance had been sought. Absolute CD4 count, World Health Organisation (WHO) clinical stage and viral load results at treatment initiation, point of switch to second line and at the end of 2014 (end-point for the study) were obtained. About 75% of the 4,206 patients initiated on first line highly active antiretroviral therapy (HAART) were retained in care and were still on first line HAART at the end of 2014 with a significant difference in median CD4 count, BMI, WHO clinical staging and viral load at baseline compared to the end of the study period. Out of the 4,206 adults patients initiated on first line HAART, 71 were later switched to second line regimen due to either first-line immunological or virological failures although only 57 patients without traces of co-infection were included in this study. At end-point, a very high (87.7%) WHO defined immunological response was achieved. The study revealed that although immunologic and virologic response in patients before ART regimen switch was low, it improved tremendously after switch to second line regimen in all patients including those with available viral load results. The study results showed a 96.5% retention rate of patients switched to second line HAART and a correlation between virological suppression and immunological response. Key words: Immunological assessment, virologic response, HIV diagnosis, first line regimen, second line regimen.

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

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. Objective: The aim at this study was to assess the prevalence of HIV/AIDS treatment failure and its determinants factors of patients on first line HAART at Felegehiwot Referral Hospital. Methods: Cross sectional study was conducted on 421 participants who had started first line HAART during August 2016 to September 2016. Data were collected from patients’ chart starting from ART commencement and face to face interview using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were enter in to EPI info version 3.5.1 and transfer to and analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, positive and negative predictive values, life table, receiver operating characteristics curves, bi-variate and multiple logistic regression were used to analysis. Independent associations were considered with p<0.05. Result: Among the 421 participants enrolled, 292 (69.4%) were adult and 129 (30.6%) were children. More than half 243 (57.7%) of the participants were females. The adult median age at ART initiation was 38.0 years with inter quartile rage (IQR) 10 and for children 9.8 years with IQR 4.The median duration of treatment failure from initiation of treatment was 87 months (IQR 110-65 months). A total of 45 (10.7%) participants were found to have treatment failure. The median CD4 T-cells at initiation of Anti retroviral therapy were 147 cells/μl (IQR 226-84.5). The median time to detect virological failure was 47 months. Sensitivity of immunologic failure of predicting virological failure was 62.2%. Clinical stage II 374 (88.8%) was the predominant clinical stage. Conclusion: The prevalence of treatment failure in this study was 10.7%. Long duration on treatment, conducting faith healing, immunologic failure, high medication dosage, and ambulatory functional status at baseline and not feeling privacy during consultation and counseling were found to be significant predictors of treatment failure.Therefore early identification of associated factors and monitoring treatment failure has to be strengthened to benefit patients from prevent further complication.

English

English

Assessment of the magnitude and associated factors of immunological failure among adult and adolescent HIV-infected patients in St. Luke and Tulubolo Hospital, Oromia Region, Ethiopia.

IntroductionThe use of antiretroviral therapy (ART) has become a standard of care for the treatment of HIV infection. However, cost and resistance to ART are major obstacles for access to treatment especially in resource-limited settings. In this study, we aimed to assess the magnitude and associated factors of Immunological failure among adult and adolescent HIV infected Patients (with age ‘15yrs) on Highly Active Antiretroviral Therapy (HAART) in St. Luke and Tulu Bolo Hospitals, Oromia Region, Ethiopia.MethodsA retrospective follow-up study was conducted among HIV-infected patients initiated 1st line ART at St. Luke and Tulu Bolo Hospitals, South West Shoa Zone, Oromia, Ethiopia.ResultsA total of 828 patient charts were reviewed. 477(57.6%) were female and the median age was 32 years. The median baseline CD4 count was 148cells/mm3. The most common prescribed ART was TDF based (36.7%). Out of 828 patients chart reviewed 6.8% (56) were developed immunological failure. Out of them only 20 (2.4%) were detected and put on second line regimen. The incidence of immunological failure was 1.8 cases per 100 person years of follow-up. Patients who had not disclosed their HIV status to any one had high risk of immunological failure compared with patients those who had disclosed their HIV status (AHR, 0.429; 95% CI 0.206 - 0.893; P-value=0.024).ConclusionNon disclosures of HIV status and with ambulatory of baseline functional status were found to be predictors of immunological failure. Most of the immunological failure cases were not detected early and not switched to second line ARV regimen. So patients with the above risk factors should be considered for a timely switch to second line HAART.

Predictors of immunological failure of antiretroviral therapy among HIV infected patients in Ethiopia: a matched case-control study.

BackgroundIn resource constrained settings, immunological assessment through CD4 count is used to assess response to first line Highly Active Antiretroviral Therapy (HAART). In this study, we aim to investigate factors associated with immunological treatment failure.MethodsA matched case-control study design was used. Cases were subjects who already experienced immunological treatment failure and controls were those without immunological failure after an exactly or approximately equivalent duration of first line treatment with cases. Data were analyzed using SPSS v16.0. Conditional logistic regression was carried out.ResultsA total of 134 cases and 134 controls were included in the study. At baseline, the mean age ±1 SD of cases was 37.5±9.7 years whereas it was 36.9±9.2 years among controls. The median baseline CD4 counts of cases and controls were 121.0 cells/µl (IQR: 47–183 cells/µl) and 122.0 cells/µl (IQR: 80.0–189.8 cells/µl), respectively. The median rate of CD4 cells increase was comparable for the two groups in the first six months of commencing HAART (P = 0.442). However, the median rate of CD4 increase was significantly different for the two groups in the next 6 months period (M6 to M12). The rate of increment was 8.8 (IQR: 0.5, 14.6) and 1.8 (IQR: 8.8, 11.3) cells/µl/month for controls and cases, respectively (Mann-Whitney U test, P = 0.003). In conditional logistic regressions grouped baseline CD4 count (P = 0.028), old age group and higher educational status (P<0.001) were significant predictors of immunological treatment failure.ConclusionSubjects with immunological treatment failure have an optimal rate of immunological recovery in the first 6 months of treatment with first line HAART, but relative to the non-failing group the rate declines at a later period, notably between 6 and 12 months. Low baseline CD4 count, old age and higher educational status were associated with immunological treatment failure.

Use of third line antiretroviral therapy in Latin America.

BackgroundAccess to highly active antiretroviral therapy (HAART) is expanding in Latin America. Many patients require second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART, essential for program planning, is not known.MethodsAntiretroviral-naïve patients ≥18 years who started first HAART after January 1, 2000 in Caribbean, Central and South America Network (CCASAnet) sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART.ResultsOf 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3%) failed a second line regimen and 44 (0.8%) received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18–2.00, p = 0.001), younger age (HR = 2.76 for 20 vs. 40 years, 95% CI 1.86–4.10, p<0.001), and prior AIDS (HR = 2.17, 95% CI 1.62–2.90, p<0.001).ConclusionsThird line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third line regimens is warranted.

Treatment of Molluscum Contagiosum with KOH in a HIV patient with Immunological and Virological failure on HAART

Molluscum Contagiosum is a common viral disease caused by Pox Virus (DNA Virus). 10 to 30% of patients with symptomatic HIV disease or AIDS have Molluscum Contagiosum. We report a case of Molluscum Contagiosum in a HIV patient with immunological and virological failure on first line Highly Active Anti Retroviral Therapy (HAART) who showed clinical cure of Molluscum Contagiosum lesions to local application of 10% potassium hydroxide (KOH) and second line HAART despite having persistent low CD 4 count with effective maintained HIV viral suppression after 11 months of starting second line HAART.

Comparison of Serum Lipid Profile in HIV Positive Patients on ART with ART Naïve Patients.

The widespread use of effective highly active antiretroviral therapy (HAART) in HIV patients has coincided with increasing reports of complications like HIV-associated lipodystrophy syndrome and the metabolic alterations, affecting the lipid and glucose metabolism. Evidences in support of lipodystrophy and dyslipidaemia associated with First- line HAART in our area is scarce. The aim of the present study was 1) to study and compare Lipid profile in HIV positive patients on ART with that of freshly diagnosed HIV positive patients who were yet to be started on ART. 2) To assess lipodystrophy syndrome in patients on ART. Hundred newly diagnosed HIV positive patients who were yet to be started on ART were taken as controls (ART-Naïve).Hundred randomly selected HIV+ patients who were already on First-line ART regimen (Stavudine/Zudovudine + Lamivudine + Nevirapine) for more than 12 months were taken as cases (ART). This study was conducted for a period of 12 months at the VIMS ART centre, Bellary, Karnataka, India. There was a significant increase (p<0.001) in serum Total Cholesterol, LDL-C, TG, VLDL, Non-HDL -C & TC/HDL-C ratio in ART patients compared to ART-naïve patients. Of the 100 ART patients 23 had lipodystrophy syndrome (buffalo hump, abnormal fat deposition around neck & back, buccal fat resorption, increase in abdominal fat). To conclude, it is evident from our study that there is increase in lipid profile (except HDL) in ART patients compared to ART Naïve group and 23 ART patients showed lipodystrophy syndrome. Hence it appears reasonable to measure fasting lipid levels before and 3-6 months after antiretroviral therapy is initiated or when ART regimen is changed.

Effects of pill burden on discontinuation of the initial HAART regimen in minority female patients prescribed 1 pill/day versus any other pill burden

Highly active antiretroviral therapy (HAART) is a mainstay of treatment for patients with Human Immunodeficiency Virus (HIV). Since second line HAART therapies can be costlier and less effective, it is essential to understand the duration of initial HAART therapies. The overall aim of this study was to estimate the effects of daily pill burden on the time to discontinuation of the initial HAART regimen. Patients were initially identified through the clinic's CAREWARE database. A chart review was conducted for data collection, where only adult, female, HIV-positive patients initiating therapy at the study clinic between 1 January 2001 and 31 December 2011 were included. All study subjects were followed up from the initiation of HAART to treatment discontinuation. A Kaplan–Meier curve was generated to describe time to discontinuation by regimens, and a Cox proportional hazards model was developed to assess the impact of different regimen and patient demographic characteristics on the hazard of discontinuation of the initial regimen. A total of 498 charts were initially reviewed. After assessment of these patients for inclusion criteria, a cohort of 115 adult female patients who initiated HAART at the study clinic was included. Patients treated with 1 pill/day regimen had a significantly longer time to discontinuation than regimens of >1 pills/day (mean duration of initial therapy was 1062.56 days vs. 631.70 days, respectively, p = 0.003). Compared to 1 pill/day regimens, >1 pills/day regimens were associated with a higher hazard of discontinuation (hazard ratio (HR) =3.44 with 95% confidence interval (CI) = 1.25, 9.48). A higher viral load and patients without insurance were also found to be significantly associated with increased hazards of discontinuation. Overall, female HIV patients initiating therapy with the 1 pill/day HAART regimen were less likely to discontinue their treatment compared to patients initiating with >1 pills/day HAART regimen.

Hepatotoxicity from first line antiretroviral therapy: an experience from a resource limited setting.

Highly active antiretroviral therapy (HAART) has been associated with liver toxicity. The role of monitoring for liver toxicity has not been well studied in resource-limited settings (RLS). To determine the background prevalence and incidence of liver injury and describe the associated signs and symptoms of acute hepatitis after initiating HAART; and to determine the role of liver enzyme tests in monitoring hepatotoxicity. In this prospective study, in Mulago Hospital AIDS Clinics, we consecutively enrolled adult patients initiated on one of three first line HAART regimens [Stavudine (d4T)-Lamivudine (3TC) and nevirapine (NVP); Zidovudine (AZT)-3TC and Efavirenz (EFV) or d4T-3TC-EFV]. We monitored ALT (alanine aminotransferase) and clinical evidence of acute hepatitis at baseline, 2(nd), 6(th), 10(th) and 14(th) week of therapy. Two hundred and forty HIV-positive HAART- naïve patients were enrolled in the study. The baseline prevalence of transaminitis was 1.7% with an incidence of 4.2% at 14 weeks. Grade 3-4 hepatotoxicity was documented in 1.3%. Jaundice was seen in grade 2-4 ALT elevations. Being on concurrent HAART and antituberculous drugs was associated with grade 2-4 toxicity compared to those who were only on HAART [OR; 16.0 (95% CI; 2.4-104.2)]. Incidence of severe hepatotoxicity within three months of first-line antiretroviral therapy was low, suggesting that routine measurement of transaminases may not be necessary in all patients initiating HAART in RLS. Routine measurement may be important in following patients on HAART and concurrent TB treatment as well as those with jaundice to avoid missing hepatotoxicity.

Évolution des conditions d’initiation du traitement antirétroviral des patients infectés par le VIH en Afrique de l’Ouest

Objective We studied the evolution of drug combinations used, as well as the clinical and immunological profile of patients at initiation of highly active antiretroviral therapy (HAART) between 1996 and 2006 in West Africa. Settings and method IeDEA West Africa is a network of HIV care programs established in 2006. We analyzed data from 12 clinical centers treating adults in five countries: Benin, Cote d’Ivoire, Senegal, Gambia, and Mali. Patients 16 years of age or over were included in the study and the following was documented: sex, date of birth and date of initiation of HAART. Results We included 14,496 adult patients having started HAART, among these 55 % had started HAART between 2005–2006. The proportion of HIV-infected women increased from 46 % in 1996–2000 to 63 % in 2005–2006. The median age at HAART initiation remained constant: 35 years for women and 40 years for men. The proportion of patients having started HAART with a CD4 count < 200 cells/μl was 54 % in 1996–2000, and 64 % in 2005–2006. The most frequently prescribed HAART was: AZT/3TC (or d4T/DDI)/IDV (27 %) in 1996–2000; d4T (or AZT)/3TC/EFV (49 %) in 2003–2004, and d4T/3TC/NVP (49 %) in 2005–2006. Conclusion The first line HAART regimen recommended by WHO was initiated in 83 % of cases in 2005–2006. New approaches to an earlier initiation of ART should be explored to reduce mortality in HIV-infected patients on HAART.

The diagnosis and management of tuberculosis in HIV-infected children

Human immunodeficiency virus (HIV) infection has made the diagnosis of tuberculosis (TB) in children more complex, despite it presenting in similar ways as in HIV-uninfected chilren. A history of contact with an infectious source case is often the first hint of the diagnosis. Both TB and HIV cause failure to thrive. HIV is often associated with other chronic lung disease and pulmonary TB may present as acute pneumonia. Current South African National Tuberculosis Control Programme guidelines recommend a six-month rifampicin (RMP)-based treatment regimen for HIV-infected and HIV-uninfected TB cases. Alternative regimens without RMP are not recommended. Drug-drug interactions occur with antituberculosis treatment and highly active antiretroviral therapy (HAART), mainly between RMP,which induces the P450iso-enzyme system, and the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. Current recommendations for first line HAART in children on RMP-based TB treatment are: stavudine/lamivudine/ritonavir for children less than 3 years of age, and stavudine/lamivudine/efavirenz for children older than 3 years of age. Antituberculosis drugs and antiretroviral drugs have many toxicity profiles in common. For this reason, initiation of HAART should be delayed in children with dual infection unless HIV infection is at an advanced stage.

Salvage Lopinavir-Ritonavir Therapy in Human Immunodeficiency Virus-Infected Children

To study the control of viral replication in human immunodeficiency virus (HIV)-infected children on different salvage therapies. A retrospective observational study in 120 HIV-infected children was conducted. The children were divided into 3 groups according to their salvage therapies: (1) children receiving first line highly active antiretroviral therapy (HAART); (2) protease inhibitor-experienced children receiving second line HAART; (3) protease inhibitor-experienced children receiving HAART including lopinavir-ritonavir (LPV/r). The outcome variables examined were time to achieve viral load (VL) < or =400 copies/mL, success in achieving VL < or =400 copies/mL and time to virologic failure (VL >400 copies/mL). VL (HIV-RNA copies/mL) was quantified with reverse transcription-polymerase chain reaction molecular assay. For each protocol, survival analyses were conducted to determine the probability of achieving VL < or =400 copies/mL and rebound of VL. VL < or =400 copies/mL was achieved by 52.4% of children receiving first line HAART, 48.3% receiving second line HAART and 71.5% receiving HAART including LPV/r. Children receiving HAART including LPV/r reached VL < or =400 copies/mL in a shorter time than children receiving second line HAART (P = 0.017), but quite similar to children receiving first line HAART. In terms of adjusted relative risk, children receiving HAART including LPV/r were 3.36 [95% confidence interval (95% CI), 1.59, 7.07] more likely to achieve VL < or =400 copies/mL than children receiving a different second line HAART. VL rebound occurred in 68.2% children receiving first line HAART, 73.4% receiving second line HAART and 32.4% receiving HAART including LPV/r. Children receiving HAART that includes LPV/r has less incidence of VL rebound (P=0.013) and 3.29 (95% CI 1.04, 10.3) times less risk to achieve a VL rebound than children receiving a different second line HAART. HAART that includes LPV/r is able to control HIV replication more efficiently than other classic salvage antiretroviral therapies.