Months Of Antiretroviral Therapy Research Articles

SARS-CoV-2 mRNA vaccination and short-term changes in viral load and CD4/CD8 T-cell counts in people living with HIV

ObjectivesTo investigate whether SARS-CoV-2 messenger RNA (mRNA) vaccination has an impact on HIV-related viro-immunological parameters. MethodsPeople with HIV (PWH) in the VAXICONA-ORCHESTRA cohort who received one or more doses of SARS-CoV-2 mRNA vaccine and for whom paired measures of immuno-virological markers (viral load, clusters of differentiation [CD]4, and CD8 count 1 month before and after a vaccine dose [VD]) were available were included. Paired t-test and generalized estimating equation linear regression analyses were used to study changes over ± 1 month around the VD. Subgroup analyses were performed. ResultsA total of 510 PWH were enrolled: the median age was 55 years (interquartile range 46-60 years), the CD4 and CD8 count were 489 (287-719) and 790 (59-1104) cells/mm3, respectively, and 81% received three VDs. After a median of 28 (3-53) days from VD, CD4 count increased by +15 cells/mm3 (SD ± 129.7, P = 0.001) and CD8 by +12 (±250.5, P = 0.199) and the viral load decreased by −0.11 log10 (±0.88, P = 0.001). Similar results were observed after restricting the analysis to viro-suppressed PWH, with CD4 ≤200/mm3, more than 6 months of antiretroviral therapy before VD and after excluding previous COVID-19. ConclusionsA small significant increase in CD4 count and a negligible drop in HIV RNA were observed. Our findings are consistent with the hypothesis that SARS-CoV-2 mRNA vaccine can prime CD4 T spike-specific cells, even in the more immuno-compromised PWH.

Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design.

Intensive adherence counseling (IAC) is recommended for people living with HIV (PLHIV) with viral load (VL) ≥1,000 copies/ml after ≥6 months of anti-retroviral therapy (ART). We evaluated the effect of IAC on VL suppression and all-cause mortality among PLHIV on first-line ART with VL ≥1,000 copies/ml after ≥6 months of ART in Kampala, Uganda using regression discontinuity design, a quasi-experimental method for effect estimation when interventions depend on a cut-off. PLHIV just above VL ≥1,000 copies/ml cut-off who received ≥3 IAC sessions formed the intervention group while those just below the cut-off who received routine psychosocial support constituted the control group. Primary outcome was repeat VL suppression defined as VL <1,000 copies/ml approximately 9-12 months following initial VL assessment. Secondary outcome was all-cause mortality. We used logistic regression for causal-effect analysis, reported as odds ratio (OR) with a 95% confidence interval (CI). We performed sensitivity analyses to assess the robustness of findings to varying bandwidths at the cut-off. We found 3,735 PLHIV were started on ART between Nov 2020 and Nov 2021 of whom 3,199 were included in the analysis (3,085 control, 114 intervention). Within an optimal bandwidth, there were 236 participants (222 control, 14 intervention) with similar demographic and clinical characteristics. Repeat VL suppression was lower in the intervention than in the control group (85.7% versus 98.6%, p = 0.021) while all-cause mortality was similar (0% versus 0.5%, p = 1.000). In multivariable analysis, the odds of repeat VL suppression were 91% lower in the intervention than control group (OR = 0.09; 95% CI, 0.01-0.66). Findings are robust to varying bandwidths around the cut-off. We concluded IAC is ineffective in suppressing VL among PLHIV on first-line ART in Kampala, Uganda. Findings suggest a need to investigate the IAC implementation fidelity for successful translation in practice and the reasons for VL persistence beyond the suppression threshold.

Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens.

To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency virus who started antiretroviral therapy between 2015 and 2017 in Minas Gerais, Brazil. The outcome was viral suppression, defined as the achievement of the first viral load <50 copies/mL within 12 months after initiating antiretroviral therapy. This outcome was also compared with viral load <1,000 copies/mL and analyzed in two scenarios: intention-to-treat versus per-protocol. Time to viral suppression and adjusted odds ratio accompanied by 95% confidence intervals were estimated. Of the 2,599 participants enrolled, 77.5% were men, and the median age was 34 years. In the intention-to-treat analysis, viral suppression was 58.1% for efavirenz and 76.7% for dolutegravir. People living with HIV on dolutegravir-based regimen were more likely to achieve viral suppression (aOR: 2.44; 95%CI: 2.01-2.95) and had a shorter median time to viral suppression (p<0.0001). Antiretroviral therapy initiation within <120 days, baseline CD4⁺T-cells ≥200 cells/mm3, and viral load <100,000 copies/mL had higher odds of viral suppression. According to the per-protocol analysis, viral suppression ≥90% was observed by considering viral load <1,000 copies/mL. Our study demonstrated that viral suppression improved after introducing dolutegravir, although the proportion of patients with viral load <50 copies/mL was lower than expected. Improved access to routine viral load examinations and continuous surveillance of the effectiveness of antiretroviral therapy should be considered.

Effect of Antiretroviral Therapy to Thyroid Function Status on New Stage 1 and 2 Human Immunodeficiency Virus Patient

Background: Thyroid hormone is very important in regulating energy metabolism in all tissues of the human body. Thyroid dysfunction plays an important role in osteoporosis, hyperlipidemia and cardiovascular disease, all of which are associated with Human Immunodeficiency Virus (HIV) infection or therapy for HIV. Medications used to treat HIV infection are also said to be important factors that can cause thyroid abnormalities. This study aim is to see the effect of giving Antiretroviral Therapy (ART) to the thyroid function of new HIV patients in stage 1 and 2.&#x0D; Method: This prospective cohort study was conducted at Medan city health center and Medan Haji Adam Malik Hospital in March-June 2019. HIV patients who met the inclusion criteria were tested for thyroid function (Ft4 and TSH) before and after 3 months on ART, BMI, routine blood, CD4 and quality of life using the SF-36 questionnaire. Data analysis used paired t test and Pearson correlation.&#x0D; Result: 34 patients with stage 1 and 2 HIV showed normal thyroid function ; the average FT4 level was 1.03 ± 0.14 ng / dl and the average TSH level was 1.44 ± 0.68 µIU / mL. After 3 months of antiretroviral therapy, the mean thyroid function changes were obtained from the study subjects, where the mean FT4 results were 0.87 ± 0.13 ng / dl and the average TSH results were 1.76 ± 0.91 µIU / mL and the results were statistically significant with p 0.006 (p &lt;0.05). There was a statistically significant relationship between TSH and CD4 levels with BMI after ART administration (p &lt;0.05), but no statistically significant relationship was found between FT4 and BMI (p = 0.957). No statistically significant relationship was found between CD4 levels in study subjects and changes in fT4 levels (p = 0.557, r = 0.104) and TSH (p = 0.267, r = 0.196). There was also no significant difference in the quality of life of study subjects as seen from the SF-36 questionnaire both from changes in thyroid function and from CD4 levels.&#x0D; Conclusion: Stage 1 and 2 HIV patients who are on ART for 3 months experienced thyroid dysfunction.

Evaluation of Apolipoprotein Profile in Hiv/Aids Subjects in Pre and Post 12 Months Antiretroviral Therapy Using 1.5 Mg/Ml Troponin Diagnostic Cut-Off for Myocardial Infarction in Nauth Nnewi, South Eastern Nigeria

Patients infected with HIV have an increased risk of developing heart disease. HIV causes Acquired Immune Deficiency Syndrome AIDS by invading the host cells and depleting the immune system. It has been reported that acute myocardial infarction might occur at 1.5 ng/ml troponin level. Information on cardiac status in HIV infected subjects in Nigeria is scanty. The aim is to evaluate the serum apolipoproteins in HIV subjects, in pre- and post- 12 months antiretroviral therapy (ART) using 1.5ng/ml troponin diagnostic cut-off for myocardial infarction. A total of 100 HIV subjects not on ART devoid of malaria co-infection were recruited in this study. Apolipoprotein parameters were re-classified based on 1.5 ng/ml troponin diagnostic cut-off for myocardial infection. 30 out of the 100 participants that were within 1.5 ng/ml troponin diagnostic cut-off for myocardial infection were followed up on commencement of ART for 12 months. Their blood samples were drawn at 3, 6, 9 and 12 months for some apolipoproteins and CD4 analyses using standard laboratory methods. The results showed that as months of antiretroviral therapy deepened or lengthened, the numbers of HIV positive subjects with values higher than the troponin diagnostic value reduces when compared with values before therapy (p&lt;0.05). Paired-wise comparison showed that there were significantly higher levels of CD4 counts, Apo A2, Apo C2, Apo E but lower levels ApoA1, Apo B and Apo C3 in symptomatic HIV individuals before ART when compared with values after therapy at p&lt;0.05 respectively. These lower levels ApoA1, Apo B and Apo C3 in symptomatic HIV individuals after therapy may indicate possible cardio- protective effect of the drug on the heart, which may connote immune recovery. The troponin values were significantly higher than the diagnostic cut off for acute myocardial infarction (AMI) studied amongst the group at p&lt;0.05 respectively. This may imply that AMI may occur at any group of study.

Blood Pressure and Body Composition During First Year of Antiretroviral Therapy in People With HIV Compared With HIV-Uninfected Community Controls.

Body composition changes may explain the rapid increase in blood pressure (BP) in people with HIV (PWH) during the first year of antiretroviral therapy. We analyzed data from a cohort of PWH and HIV-uninfected adults from the same communities in Mwanza, Tanzania. Blood pressure (BP, mm Hg) and body composition data were collected at baseline and 12-month follow-up. We used multivariable linear regression to compare BP changes in PWH and HIV-uninfected adults, and the relationship between changes in body composition and changes in BP. BP data were available for 640 PWH and 299 HIV-uninfected adults. Sixty-four percent were women and the mean age was 38 years. In PWH, systolic BP (SBP) increased (114-118) whereas SBP decreased (125-123) in HIV-uninfected participants. Fat mass increased by 1.6 kg on average in PWH and was strongly associated with the change in BP (P < 0.001). The greater increase in SBP in PWH was partly explained by the lower baseline SBP but PWH still experienced a 2.2 (95% CI: 0.3-4.2) greater increase in SBP after adjustment. Weight gain partially mediated the relationship between HIV and SBP increase in PWH; a 1-kg increase in fat mass accounted for 0.8 (95% CI: 0.6-1.1) increase in SBP. Weight and fat mass increase rapidly in PWH during the first 12 months of antiretroviral therapy and contribute to a rapid increase in SBP. Interventions to prevent excessive increase in fat mass are needed for PWH.

Risk Factors for Hospitalization or Death Among Adults With Advanced HIV at Enrollment for Care in South Africa: A Secondary Analysis of the TB Fast Track Trial.

BackgroundIndividuals with advanced HIV experience high mortality, especially before and during the first months of antiretroviral therapy (ART). We aimed to identify factors, measurable in routine, primary health clinic–based services, associated with the greatest risk of poor outcome.MethodsWe included all individuals enrolled in the standard-of-care arm of a cluster-randomized trial (TB Fast Track); adults attending participating health clinics with CD4 ≤150 cells/µL and no recent ART were eligible. Associations between baseline exposures and a composite outcome (hospitalization/death) over 6 months were estimated using multivariable Cox regression.ResultsAmong 1515 individuals (12 clinics), 56% were female, the median age was 36 years, and the median CD4 count was 70 cells/μL. Within 6 months, 89% started ART. The overall rate of hospitalization/death was 32.5 per 100 person-years (218 outcomes/671 person-years). Lower baseline CD4 count (adjusted hazard ratio [aHR], 2.27 for <50 vs 100–150 cells/µL; 95% CI, 1.57–3.27), lower body mass index (aHR, 2.13 for BMI <17 vs ≥25 kg/m2; 95% CI, 1.31–3.45), presence of tuberculosis-related symptoms (aHR, 1.87 for 3–4 symptoms vs none; 95% CI, 1.20–2.93), detectable urine lipoarabinomannan (aHR, 1.97 for 1+ positivity vs negative; 95% CI, 1.37–2.83), and anemia (aHR, 4.42 for severe anemia [hemoglobin <8 g/dL] vs none; 95% CI, CI 2.38–8.21) were strong independent risk factors for hospitalization/death.ConclusionsSimple measures that can be routinely assessed in primary health care in resource-limited settings identify individuals with advanced HIV at high risk of poor outcomes; these may guide targeted interventions to improve outcomes.

Aterm Pregnancy Woman with Human Immunodeficiency Virus Infection and Antiretroviral Therapy as Risk Factor of High Caspase-3 Expression in Placenta

Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and affiliated hospitals. Subjects were termed pregnant women with HIV (+) who received a minimum of six months of antiretroviral therapy as a risk group and pregnant women with HIV (-) as a non-risk group. Caspase-3 expression was assessed by immunohistochemical examination of placental tissue. The cut-off value for caspase-3 levels was determined by constructing a receiver operating characteristics (ROC) curve. The difference in proportion was assessed by the chi-square test, and the prevalence ratio (PR) was reported. The significance of this study was p&lt;0.05. Results: Each 20 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity, and body mass index (BMI) between the two groups. The mean expression of caspase-3 was significantly higher HIV (+) group than in the HIV (-) group (162.62 vs. 105.83; p = 0.000). The selected cut-off value of Caspase-3 was 127.05, with a sensitivity of 75% and a specificity of 75%. After classification, a significantly higher proportion of Caspase-3 expression was found in the HIV (+) group than in the HIV (-) group (75% vs. 25%; p=0.002). Pregnant women with HIV (+) and receiving antiretroviral therapy for a minimum of six months had a three times higher chance of having a high Caspase-3 prevalence than pregnant women who were not (RP=3.0; 95% CI = 1.348 – 6.678). Conclusion: Pregnant women with HIV infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta.

Cost and factors associated with the prescription of non-antiretroviral drugs among HIV-infected patients under antiretroviral therapy in a reference hospital in Morocco

RésuméObjectifDéterminer les coûts des médicaments non antirétroviraux et identifier les facteurs associés à leur prescription chez les patients VIH-1 sous thérapie antiretrovirale au Maroc.MéthodesÉtude rétrospective d’une cohorte de 264 malades vivant avec le VIH-1 mis sous thérapie antirétrovirale dans le service de dermatologie-vénérologie à l’hôpital militaire d’instruction Mohammed V de Rabat au cours de la période du 1er janvier 2014 au 31 décembre 2018. Les coûts retenus étaient ceux de la pharmacie de l’hôpital pour les médicaments essentiels, sinon le prix de vente en officine. Le modèle de régression logistique a été utilisé pour analyser les facteurs associés à la prescription.RésultatsSur les 264 patients inclus, la prédominance masculine était de 75 %. L’âge médian des patients était de 49 ans [41-57]. À l’inclusion, 21,2 % des patients étaient déjà au stade sida. Après une durée moyenne de suivi de traitement antirétroviral estimée à 11,1 ± 6,8 mois, 71,6 % des patients avaient bénéficié d’au moins une prescription de médicament non antirétroviral. Sur toute la durée de suivi, la dépense moyenne par patient était de 24,2 € par an, dont 22,1 € à la charge du patient. Après le cotrimoxazole (30,7 % des patients), les médicaments les plus fréquemment prescrits étaient le fer (29,2 % des patients), les antibiotiques (20,8 % des patients), les hypolipémiants (20,1 % des patients) et les antimycosiques généraux (16,3 % des patients). L’âge (RR: 1,01; IC 95 %: 1,00–1,07), le stade sida (RR: 2,15; IC 95 %: 1,61–4,19), l’anémie (RR: 2,02; IC 95 %: 2,10–5,41) et le nombre de comorbidités (RR: 2,45; IC 95 %: 2,10–5,41) étaient significativement associés à la prescription de médicaments non antirétroviraux.ConclusionNotre travail souligne la grande fréquence de la prescription des médicaments non antirétroviraux chez les patients vivant avec le VIH au Maroc; particulièrement à ceux qui sont plus âgés, anémiques à l’inclusion et ceux qui sont déjà au stade sida.

Association of the VACS Index With Hospitalization Among People With HIV in the NA-ACCORD.

People with HIV (PWH) have a higher hospitalization rate than the general population. The Veterans Aging Cohort Study (VACS) Index at study entry well predicts hospitalization in PWH, but it is unknown if the time-updated parameter improves hospitalization prediction. We assessed the association of parameterizations of the VACS Index 2.0 with the 5-year risk of hospitalization. PWH ≥30 years old with at least 12 months of antiretroviral therapy (ART) use and contributing hospitalization data from 2000 to 2016 in North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Three parameterizations of the VACS Index 2.0 were assessed and categorized by quartile: (1) "baseline" measurement at study entry; (2) time-updated measurements; and (3) cumulative scores calculated using the trapezoidal rule. Discrete-time proportional hazard models estimated the crude and adjusted associations (and 95% confidence intervals [CIs]) of the VACS Index parameterizations and all-cause hospitalizations. The Akaike information criterion (AIC) assessed the model fit with each of the VACS Index parameters. Among 7289 patients, 1537 were hospitalized. Time-updated VACS Index fitted hospitalization best with a more distinct dose-response relationship [score <43: reference; score 43-55: aHR = 1.93 (95% CI: 1.66 to 2.23); score 55-68: aHR = 3.63 (95% CI: 3.12 to 4.23); score ≥68: aHR = 9.98 (95% CI: 8.52 to 11.69)] than study entry and cumulative VACS Index after adjusting for known risk factors. Time-updated VACS Index 2.0 had the strongest association with hospitalization and best fit to the data. Health care providers should consider using it when assessing hospitalization risk among PWH.

A study on HIV-infected individuals who reported CD4+ cell count below 100 cells/μl multiple times after more than 6 months of antiretroviral therapy at the apex tertiary referral hospital of India.

A study on HIV-infected individuals who reported CD4+ cell count below 100 cells/μl multiple times after more than 6 months of antiretroviral therapy at the apex tertiary referral hospital of India.

Reduction in cerebral oxygen metabolism in subcortical regions may be a biomarker of cognitive decline in people living with human immunodeficiency virus.

Regional cerebral blood flow (rCBF) and oxygen metabolism (rCMRO2 ) in whole brain, white matter, gray matter and lenticular nuclei were studied in people living with human immunodeficiency virus (PLHIV) as well as HIV-associated neurocognitive disorder (HAND). Treatment-naïve PLHIV underwent neurocognitive assessment and magnetic resonance (MR) measurement of rCBF and rCMRO2 with repeat after 12months of antiretroviral therapy (ART). Age- and sex-matched controls underwent single MR measurements. Regional CBF and rCMRO2 were compared amongst symptomatic, asymptomatic, normal HAND and controls using analysis of variance. Longitudinal analysis of HAND worsening (≥1 category) was assessed after 12 months of ART and correlated with rCBF and rCMRO2 measured by MR imaging using the paired-sample t test. Thirty PLHIV completed baseline and 12-month assessments (29 with rCMRO2 measurement). At baseline HAND assessment, 13% had no cognitive impairment, 27% had asymptomatic neurocognitive impairment, 60% had mild neurocognitive disorder and none had HIV-associated dementia. At 12months, 13% had no cognitive impairment, 20% had asymptomatic neurocognitive impairment, 50% had mild neurocognitive disorder and 17% had HIV-associated dementia. In those without HAND worsening (N=21) rCMRO2 remained stable and in those with HAND worsening (N=8) rCMRO2 measurement declined from baseline to 12 months in white matter (2.05±0.40 to 1.73±0.51, p=0.03) and lenticular nuclei (4.32±0.39 to 4.00±0.51, p=0.05). In recently diagnosed PLHIV, no association was found between rCBF or rCMRO2 and cognitive impairment at baseline. There was a reduction in rCMRO2 in those with worsening of cognitive function at 12months on ART. Reduction in rCMRO2 may be a biomarker of cognitive decline in PLHIV.

Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study.

ABSTRACT.Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomised, non-blinded, non-inferiority trial

Facility-based, multimonth dispensing of antiretroviral therapy (ART) for HIV could reduce burdens on patients and providers and improve retention in care. We assessed whether 6-monthly ART dispensing was non-inferior to standard of care and 3-monthly ART dispensing. We did a pragmatic, cluster-randomised, unblinded, non-inferiority trial (INTERVAL) at 30 health facilities in Malawi and Zambia. Eligible participants were aged 18 years or older, HIV-positive, and were clinically stable on ART. Before randomisation, health facilities (clusters) were matched on the basis of country, ART cohort size, facility type (ie, hospital vs health centre), and region or province. Matched clusters were randomly allocated (1:1:1) to standard of care, 3-monthly ART dispensing, or 6-monthly ART dispensing using a simple random allocation sequence. The primary outcome was retention in care at 12 months, defined as the proportion of patients with less than 60 consecutive days without ART during study follow-up, analysed by intention to treat. A 2·5% margin was used to assess non-inferiority. This study is registered with ClinicalTrials.gov, NCT03101592. Between May 15, 2017, and April 30, 2018, 9118 participants were randomly assigned, of whom 8719 participants (n=3012, standard of care group; n=2726, 3-monthly ART dispensing group; n=2981, 6-monthly ART dispensing group) had primary outcome data available at 12 months and were included in the primary analysis. The median age of participants was 42·7 years (IQR 36·1-49·9) and 5774 (66·2%) of 8719 were women. The primary outcome was met by 2478 (82·3%) of 3012 participants in the standard of care group, 2356 (86·4%) of 2726 participants in the 3-monthly ART dispensing group, and 2729 (91·5%) of 2981 participants in the 6-monthly ART dispensing group. After adjusting for clustering, for retention in care at 12 months, the 6-monthly ART dispensing group was non-inferior to the standard of care group (percentage-point increase 9·1 [95% CI 0·9-17·2]) and to the 3-monthly ART dispensing group (5·0% [1·0-9·1]). Clinical visits with ART dispensing every 6 months was non-inferior to standard of care and 3-monthly ART dispensing. 6-monthly ART dispensing is a promising strategy for the expansion of ART provision and achievement of HIV treatment targets in resource-constrained settings. US Agency for International Development.

Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: the current state of the problem

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an enhanced inflammatory immune response to Mycobacterium tuberculosis antigens due to immune system recovery in HIV-infected patients within 6 months of antiretroviral therapy (ART).&#x0D; Objective — to assess the incidence of TB-IRIS in patients with tuberculous meningitis. Evaluation of mortality caused by TB-IRIS.&#x0D; Materials and methods. A retrospective analysis of 60 cases of confirmed tuberculous meningitis in patients who were treated in anti-tuberculosis institutions in Kiev and Kiev region in 2017—2019 was carried out. The medical records of the patients were studied.Results and discussion. Co-infection with HIV-TB among patients was confirmed in 57 (95 %) cases. In 21 patients (36.8 %; CI 24.7—50.0 %) with HIV-TB co-infection, a link was established between the appointment of ART and the development of tuberculous meningitis. 19 (90.5 %) of them had risk factors at the time of ART. Fifteen (71.4 %) patients had other localizations of tuberculosis besides tuberculosis of the central nervous system (pulmonary tuberculosis, tuberculosis of intrathoracic lymph nodes, tuberculosis of peripheral lymph nodes, tuberculosis of the genitourinary system). The mean CD4+-lymphocyte count before ART was (61.6 ± 16.9) cells/µL (p ≤ 0.05). All patients were prescribed standard antimycobacterial therapy and ART. 9 (42.8 %) patients were cured. One (4.7 %) developed severe disability: peripheral tetraparesis and severe cerebrosthenia. 11 patients died, mortality was 52.4 % (CI 30.2—74.1 %).&#x0D; Conclusions. TB-IRIS is the cause of tuberculous meningitis in HIV-infected patients in 36.8 % of cases; (CI 24.7—50.0 %). Tuberculous meningitis always complicates the prognosis with TB-IRIS, while the mortality rate is 52.4 % (CI 30.2—74.1 %).

The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings.

The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings.

Immune Reconstitution Inflammatory Syndrome and Hodgkin’s Lymphoma

Immune reconstitution inflammatory syndrome (IRIS) is defined as a clinically significant exacerbation of known oligosymptomatic serious, more often infectious, diseases with considerably increased CD4+ T-lymphocyte count in response to highly active anti-retroviral therapy (HAART) of HIV infection. The review comprehensively discusses tuberculosis issues in HIV-positive HAART recipients. Related recommendations contain strict guidelines on compulsory treatment of tuberculosis prior to HAART assignment. Similar recommendations for specific therapy preceding HAART are provided for other opportunistic infections (mycotic and cryptococcal infections, parasitosis, molluscum contagiosum, toxoplasmosis, herpes-zoster virus, leishmaniasis, syphilis, and lepra). Without prior specific therapy of an opportunistic infection its exacerbation with pronounced symptoms and signs on HAART can be fatal for the patient. Lymphomas including Hodgkin’s lymphoma (HL) are dealt with in the context of the same challenge. However, what remains unclear is the specificity of targeted T-lymphocytes in the microenvironment to hitherto unclarified cause-specific antigens of the tumor. As opposed to other malignant lymphoid tumors arising with low level of CD4+ T-lymphocytes, HL develops when the level of CD4+ T-lymphocytes is increased in response to HAART in HIV-positive patients during the first months of anti-retroviral therapy. HL is diagnosed in 8 % of HIV-positive off-HAART subjects. After HAART assignment the HL incidence goes up to 17 %. Therefore, IRIS can be considered the main challenge in the study of etiology and pathogenesis of HL in HIV-positive patients. In this context, the demand to extend the research in this field becomes not only obvious but crucial for practical applications.

Incidence and predictors of sexually transmitted infections among adult HIV-positive patients receiving antiretroviral therapy at Themba Lethu HIV clinic in Johannesburg, South Africa.

Sexually transmitted infections (STIs) among people living with HIV/AIDS can facilitate the spread of HIV. To estimate STI incidence and identify predictors of STI acquisition among HIV-positive patients during their first 24months of antiretroviral therapy (ART) in Johannesburg, South Africa. We conducted a cohort study using prospectively collected routine data on patients who initiated ART between January 2004 and January 2015 at the Themba Lethu HIV clinic in Johannesburg. Kaplan-Meier analysis was used to estimate STI incidence rates (based on evidence of laboratory diagnosis and STI syndromic treatment prescription records). STI predictors were identified using Cox regression analysis. Among 26 762 adult patients on ART, there were 1 906 (7.1%) cases of STI (incidence 4.8/100 person-years; 95% confidence interval (CI) 4.7 - 5.1). Non-pregnant women were 60% more likely than men to be diagnosed with an STI (adjusted hazard ratio (aHR) 1.6; 95% CI 1.4 - 1.8). The risk of STI decreased with increasing baseline CD4 count (aHR 0.8, 0.5 and 0.4 for CD4 counts 101 - 200, 201 - 350 and &gt;350 cells/µL, respectively, compared with CD4 count &lt;100 cells/µL). Patients with advanced baseline World Health Organization (WHO) clinical stages had a higher risk (aHR 1.6 for WHO stage 4; 95% CI 1.3 - 1.9) compared with those with WHO stage 1. However, there was a 20% increase in the risk of STI among obese patients compared with underweight patients (aHR 1.3; 95% CI 1.0 - 1.7). Over 80% of obese patients diagnosed with an STI had a CD4 count &lt;200 cells/µL. STIs are common in HIV-infected patients who are receiving ART. While both ART and the syndromic management of STIs are high-impact interventions for controlling the spread of HIV, closer monitoring of STI occurrences is warranted, particularly among immunologically vulnerable patients.

Nutritional status and other predictors of immune response recovery among HIV-AIDS patients receiving antiretroviral therapy in Dr. Sardjito Hospital, Yogyakarta, Indonesia: a retrospective cohort study

Introduction: Nutritional status and immune response of Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-AIDS) patients are closely connected. There are limited studies assessing the influence of Body Mass Index (BMI) on immune response recovery among HIV patients in Indonesia. This study aimed to identify the BMI and other predictors of immune response recovery among HIV-AIDS patients following two years of Antiretroviral (ARV) therapy. Methods: This research was a retrospective cohort study among HIV-AIDS patients who started ARV therapy from January 2014 to December 2016 at Dr. Sardjito Hospital, Yogyakarta. Data were collected from ARV registry and medical reports. Data were analysed using linear regression. Results: A total of 255 patients were included in the study, with a median BMI of 20.07 kg/m2. Results showed that BMI was not significantly correlated with immune response recovery at the 6th, 12th, 18th, and 24th months of ARV therapy (p&gt;0.05). But, the increase in cluster of differentiation 4 (CD4) cell count was higher in overweight and pre-obese patients than underweight patients, especially in the 18th and 24th months of therapy. Factors related to immune response recovery were the regularity of treatment at the 12th, 18th, and 24th months of ARV therapy, and the use of Tenofovir at 18th-month therapy (p&lt;0.05). Conclusion: Immune response recovery was higher in overweight and pre-obese patients. Using Tenofovir type ARV and doing treatment regularly can increase CD4 cell counts. Underweight patients need to enhance their nutritional status to improve their immune response during ARV therapy.

Temporal trends of early mortality and its risk factors in HIV-infected adults initiating antiretroviral therapy in Uganda.

BackgroundA decline in mortality rates during the first 12 months of antiretroviral therapy (ART) has been mainly linked to increased ART initiation at higher CD4 counts and at less advanced World Health Organization (WHO) clinical stages of HIV infection; however, the role of improved patient care has not been well studied. We estimated improvements in early mortality due to improved patient care.MethodsWe conducted a retrospective cohort study of HIV-infected individuals ages 18 and older who initiated ART at the Mengo HIV Counseling and Home Care Clinic between 2006 and 2016. We conducted a mediation analysis using generalized structural equation models with inverse odds ratio weighting to estimate the natural direct and indirect effects of ART initiation time on early mortality.FindingsAmong 6,847 patients, most were female (69%), with a median age of 32 (interquartile range [IQR] = 28–38), versus a median age of 38 (IQR = 32–45) for males. The median CD4 count at ART initiation increased from 142 cells/ul (95% confidence interval [CI] = 135–150) in 2006–2010 to 302 cells/ul (95% CI = 283–323) in 2015–2016 (p < 0·001). The number of patients at WHO clinical stages I/II increased from 52% in 2006–2010 to 78% in 2015–2016 (p < 0·001). Annual early mortality decreased from 8·8 deaths/100 person years (PYS) in 2006 to 2.5 deaths/100 pys in 2016 (p < 0·001). Mediation by CD4 counts and WHO clinical stages accounted for 54% of the total effect of ART initiation timing on early mortality. In comparison, 46% remained as the direct effect, reflecting the contribution of improved patient care.InterpretationImproved patient care practices should be promoted as a strategy for reducing early mortality after ART initiation, above and beyond the effects from ART initiation at higher CD4 counts and less advanced WHO clinical stage alone.FundingThis research was supported by the President's Emergency Plan for AIDS Relief (PEPFAR), the National Institute of Allergy and Infectious Diseases Division of Intramural Research, and the National Cancer Institute.