Side Effects Of Antiretroviral Therapy Research Articles

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa

BackgroundContext-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa.MethodsThis was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence.ResultsA high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART.ConclusionsNon-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

ANGKA FIB-4 DAN HIGHLY ACTIVE ANTI RETROVIRAL THERAPY DI ANTARA PASIEN PENGIDAP INFEKSI HIV

Liver disease in patients with HIV infection can be caused by hepatotropical virus co infection or as a side effect of antiretroviraltherapy. The cause of HAART effects on liver fibrosis among patients with HIV infection is not yet known. The monitoring of the incidenceof liver fibrosis can be done with non-invasive markers, such as FIB 4 score. FIB-4 score is calculated by the formula: Age x AST/totalplatelet x √ALT. This is carried out to know the comparison of the FIB-4 score in HIV patients before and after first-line HAART therapy,with or without HCV coinfection. This study was a comparative analysis of retrospective data of patients at the Outpatient Teratai Clinic,Dr. Hasan Sadikin Hospital, from 2003 through 2013. The research subjects consisted of 64 patients with HIV infection who receivedfirst-line HAART therapy for more than 12 months. Statistical analysis was performed by Wilcoxon test for two paired samples. Themedian scores of FIB-4 from HIV infection patients with or without HCV co infection before and after the administration of first-lineHAART therapy were 0.854 and 0.906 (p=0.837). The HCV co infected patients had median scores of FIB-4 before and after treatment at0.854 and 0.899 (p=0.204). Those without HCV co infection had median scores of FIB-4 before and after treatment at 2.726 and 0.912(p=0.013).Treatment with first-line HAART did not lead to a change in the FIB-4 score. Those who were co infected with HCV showed nodifferences in the FIB-4 scores before and after treatment with first-line HAART.

Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study

ABSTRACTThe acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in high-burden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic about lifelong ART, however postpartum and LTFU women expressed conditionalities for acceptance and adherence, including minimal ART side effects and potentially serious maternal illness. Providers corroborated user findings, identifying the postpartum period as problematic for lifelong ART acceptability/adherence. Option B plus scale-up in Nigeria will require proactively addressing PMTCT user fears about ART side effects, and continuous education on long-term maternal and infant benefits. Structural barriers such as the availability of trained providers, long clinic wait times and patient access to ART should also be addressed.

“I will take ARVs once my body deteriorates”: an analysis of Swazi men’s perceptions and acceptability of Test and Start

Swaziland has the highest HIV prevalence in the world. To mitigate the spread and devastation caused by HIV and to improve the wellbeing of people living with HIV, the country has adopted the latest available HIV prevention campaigns, including “Test and Start”. Because evidence from randomised controlled trials has demonstrated a significant risk reduction in HIV transmission when HIV-positive people start antiretroviral therapy (ART) early, Swaziland aims to find these people and link them to treatment. This study presents findings regarding the perceptions of this promising HIV-prevention intervention among men aged 17–69 years. A combination of qualitative methods including focus group discussions (12), in-depth interviews (17), informal conversations and participant observation (21) were used to collect data in two peri-urban communities in 2013–2014. Findings illustrate that men still fear taking an HIV test because of a relatively high probability of a positive test which some still interpret as a death sentence. Other potential barriers to the effectiveness of Test and Start programmes include lack of hospitality in hospitals, fear of starting treatment early related to side effects of ART, poverty, and lack of trust in the financial stability of the Swazi government. We argue that several social factors need to be considered for the Test and Start programme to be more effective.

‘Side effects’ are ‘central effects’ that challenge retention in HIV treatment programmes in six sub-Saharan African countries: a multicountry qualitative study

ObjectivesTo explore the bodily and relational experience of taking antiretroviral therapy (ART) and the subsequent effect on retention in HIV care in six sub-Saharan African countries.MethodsIn-depth interviews were conducted with...

Nutritional status and metabolic risk in HIV-infected university students: challenges in their monitoring and management

Objective: This study aims to describe challenges in the management of HIV-infected university students focusing on their nutritional status and metabolic risk.
 
 Methods: A cross-sectional, descriptive study design was used to assess the anthropometry, food intake and clinical status of a cohort of known HIV-infected registered students at a South African university.
 
 Results: Participants n = 63) had a mean CD4 cell count of 411 (SD = 219.9) cells/mm3, a mean body mass index (BMI) of 28.05 (SD = 7.9) kg/m2 and only half of the participants (n = 31) were on antiretroviral therapy (ART). A higher BMI (> 25 kg/m2) was significantly (p < 0.05; V = 0.32) associated with higher CD4 cell counts of > 350 cells/mm3. Some 40% (n = 25) of students were at risk for metabolic complications based on their waist circumference and 11% (n = 7) had clinical signs of lipodystrophy. The ‘obese’ group consumed a mean energy intake of 24 kcal/kg bodyweight which was lower than the ‘overweight’ and normal weight groups.
 
 Conclusions: In total 51% of HIV-positive students in the sample presented with signs of metabolic complications. Side effects of ART can be prevented and/or treated by regular physical activity, adequate nutritional intake, monitoring of side effects and BMI, combined with optimal care and support.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1248143

How are women living with HIV in France coping with their perceived side effects of antiretroviral therapy? Results from the EVE study

ObjectiveSide effects of antiretroviral therapy (ART) can have a negative impact on health-related quality of life threatening long-term retention in HIV care and adherence to ART. The aim of the French community-based survey EVE was to document personal experiences with side effects, the related physician-patient communication, and solutions found to deal with them.DesignCross-sectional study of women between September 2013 to September 2014MethodsAn anonymous online questionnaire included the HIV Symptom Distress Module, which explores 20 symptoms.ResultsIn all, 301 women on ART participated in the study (median age: 49 years; median duration of ART: 14 years). They reported having experienced a median of 12 symptoms (Q1-Q3: 9–15) during the previous 12 months. Overall, 56% of them reported having found at least a partial solution to dealing with their symptoms. Women reporting financial difficulties were twice less likely to have found solutions to coping with their side effects (AOR: 0.5; 95% CI: 0.3–0.8). Feeling supported by the health-care provider (AOR: 2.1; 95% CI: 1.1–3.9) and being in contact with HIV/AIDS organisations (AOR: 1.9; 95% CI: 1.2–3.2) were positively associated with coping. Seventeen percent reported having modified their ART regimen to improve tolerance, with only 2 in 3 informing their physician afterwards. Reporting financial difficulties and living with more bothersome symptoms increased the risk of ART regimen modification without health-care provider consultation.ConclusionThe EVE study has called attention to the large number of side effects experienced by WLWHIV, only half of whom have found self-care strategies to manage their symptoms. Modification of ART regimen by the women themselves was not uncommon.

Caretakers' barriers to pediatric antiretroviral therapy adherence in Vietnam – A qualitative and quantitative study

BackgroundPoor antiretroviral therapy (ART) adherence leads to drug resistance and treatment failures. The options for second and third line ART regimens, particularly for pediatric patients, are very limited in low and middle-income countries. HIV-infected children are mostly passive drug-takers, thus caretakers play a very important role in assuring ART adherence. Pediatric ART adherence is still a challenging problem in Vietnam since non-adherence is the major risk factor for treatment failure. Our study explores and measures caretakers' barriers in order to improve pediatric ART adherence in future. MethodsExploring caretakers' barriers was conducted through a qualitative study with Focus Group Discussion (FGD) on two topics: 1. Current society – family support and difficulties in taking care children under ART; 2. Stigma experience. Based on the finding from the qualitative study a quantitative study measuring caretakers' barriers was conducted through a designed questionnaire. Study methods strictly followed the consolidated criteria with 32-item checklist for interviews and focus groups. ResultsIn total eight FGDs with 53 participants were conducted. Common caretakers' barriers to children's ART adherence, were financial burden, lack of ART KP (Knowledge-Practice), stigma, depression, shifting caretaker, drug taste and side effects, lack of family support, fixed health check-up schedule and HIV non-disclosure. In the questionnaire study a total of 209 caretakers participated. The most commonly reported caretakers' barriers were: financial burden (144; 69%), KP burden (143; 68%), depression (85; 41%) and stigma (30; 14.8%). Some caretakers' characteristics that significantly associated with reported barriers (p<0.05). Rural caretakers reported significantly more financial burden (OR=2.26) and stigma (OR=3.53) than urban. Caretakers with under high school level education reported significantly more financial burdens (OR=2.08) and stigma (OR=4.15) compared to caretakers with high school education or over. ConclusionFinancial burden, KP burden, depression and stigma were common reported caretakers' barriers to pediatric ART adherence. Family residence, caretaker's education level and job were considered as the key factors determining caretakers' barriers related to financial burden and stigma. These findings may be important for policy makers and researchers in order to develop effective interventions regarding to caretakers' burdens and associated factors. Furthermore, a tool for nurses in monitoring caretakers' barriers to pediatric ART adherence was developed first with FDG, and then interview questionnaire. This tool could be applied and modified easily in any pediatric ART clinic settings in accordance to economic, social and cultural circumstances.

A study to Assess the Factors Affecting Compliance of art among HIV Patients at Selected Artcenters of Pune city

Background -Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS), was first recognized on 1 st December 1981 and has since become one of the most destructive pandemics in recorded history. In India the first AIDS case was reported in May 1986 in Madras, South India. There are 5.7 million people infected with HIV. By 2015 India has the world's fourth largest population suffering from AIDS. ART increases the length, quality of life, and productivity of the people living with HIV (PLWH) by improving survival and decreasing the incidence of opportunistic infections through reduction of the viral load and increase of the level of CD4 cells .The effectiveness of ART relies on a strict adherence to it. 6 In 2014, 14.9 million people living with HIV were receiving antiretroviral therapy (ART) globally, of which 13.5 million were receiving ART in low- and middle-income countries. The 14.9 million people on ART represent 40% [37–45%] of people living with HIV globally 1 . According to the census done by ART center of District Wenlock hospital, Mangalore, Dakshina Kannada in December 2012, revealed that out of 3,836 cases, only 2,218 patients were on regular ART, 126 belonged to the 'stopped treatment' status, and 117 patients were lost to follow-up from the last three months. 2 . Aims and Objectives- (1)To identify the factors affecting compliance of ART treatment of HIV among HIV patients.(2)To find out the association between factors affecting compliance of ART with selected demographic variable. Material and Methods- Data was collected from 100 patients with structured questionnaire to assess the factors affecting compliance of ART. And interview schedule technique was used. Result- Majority of the patients with HIV In the study 53% of the patients was males. And the maximum 33% of them was from age group 31-40 years. And Maximum 38% of them had primary education. The majority of the samples 32% of them was housewives. And 84% of them had caregivers as family members. The findings of the study were 73% patients believe in ART, 72% aware about ART, 79% manage daily routine with ART,69% believe that ART increase life span.92% family member know the diagnosis of patient and 74% behave well with them,92% disclosed diagnosis in society and 31% behave good after knowing diagnosis, 75% stigma affect, 74%respond that special consideration given for ART where they doing job,89% patient said cost of transportation affect and 52% family members support for finances. 91% said counselor cooperate with them, 62% have time to Attend OPD, 78% said counselor maintain good relation with them, and only 55% said counseling was effective for them. And 77% patient knows the side effects of ART and 71% experience the side effect, 49% patient said side effect of ART has impact in regularity of treatment, 58% patient said other medicine affects in compliance to ART. Conclusion- The overall experience of conducting this study was satisfying one, as there was good co-operation from patient. The study was a new learning experience for the Researcher. The aim of the study was to assess the factors affecting to compliance of antiretroviral treatment, were 73% patients believe in ART, 72% aware about ART, 69% believe that ART increase life span. 75% stigma affect, 74%respond that special consideration given for ART where they doing job,89% patient said cost of transportation affect 71% experience the side effect, 49% patient said side effect of ART has impact in regularity of treatment, 58% patient said other medicine affects in compliance to ART. These data will assist the health workers to detect the high risk patient who need intervention for compliance to ART.

The Effect of HIV and Art on the Development of Hypertension and Type 2 Diabetes Mellitus

Diabetes mellitus and hypertension [DM] are among the major causes of morbidity and mortality among people living with human immunodeficiency virus [PLHIV]. Diabetes mellitus alone is associated with morbidities that consequently reduce life expectancy and quality of life, and causes demoralising complications inclusive of ischaemic heart disease, stroke, blindness and peripheral vascular disease. Hypertension is an important and treatable cause of cardiovascular morbidity and mortality. It is an independent risk factor for myocardial infarction, chronic kidney disease ischemic and haemorrhagic stroke, heart failure and premature death. HIV infection is associated with morbidities that consequently reduce life expectancy and quality of life. There is a perceived link between HIV infection and DM and hypertension. This is a scoop review of studies on the link between HIV and DM and hypertension, that is, both epidemiologic and biological evidence to date. The literature review shows that the incidence and prevalence of type 2 diabetes [T2DM] is higher among PLHIV on ART compared to the HIV negative population. Being infected by human immunodeficiency virus (HIV) is implied to trigger an inflammatory response that, in turn, results in insulin resistance, a risk for T2DM. HIV is linked to hypertension through alterations in triglycerides, T cells and angiotensin II as well as the aggressive use of ART. The roll out of antiretroviral therapy (ART), as means to combat HIV, has benefits for PLHIV, inclusive of increased survival and living longer; yet older age is associated with hypertension and T2DM. The side effects of ART and long term use of ART are implicated in increasing the risk of T2DM among PLHIV. The co-occurrence of HIV, hypertension and T2DM in developing countries presents an overload to the burden of diseases because these countries are already experiencing high prevalence rates of HIV thereby complicating the health status of the population. Notwithstanding the contrasting research reports on the link between HIV, hypertension and DM hypertension and DM among PLHIV is a cause for concern, and there is a need for more studies, particularly in areas most hit by HIV.

Metabolic Disorders in Patients with HIV

AbstractHuman Immunodeficiency Virus (HIV) infection and subsequent antiretroviral therapy (ART) are known to be related to different metabolic disorders. Although ART decreased HIV-associated mortality and morbidity, mortality rates in patients with HIV and ART are 3 to 15 higher than those in the general population. More than 50% of the mortality is due to diseases like: diabetes mellitus (DM), hypertension, cardiovascular diseases (CVD), chronic renal disease and complications following bone fractures. In patients with HIV the metabolic disorders are mainly caused by mithocondrial toxicity, a side effect of ART, and they are represented by: dyslipidemia, lipoatrophy, insulin resistance and diabetes mellitus.

How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area

RationaleFood-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive. ObjectiveWe aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods. MethodsSemi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach. ResultsFood insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions. ConclusionOur study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.

What happens to cardiovascular system behind the undetectable level of HIV viremia?

Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.

Managing Cardiovascular Risk in People Living with HIV

People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD) due to bi-directional interactions between traditional cardiovascular risk factors, HIV-associated inflammation and immune activation, and the prothrombotic and dyslipidemic side effects of antiretroviral therapy (ART). As in the general population, prevention of disease is the key to reducing the significant morbidity and mortality associated with cardiovascular disease. All PLHIV should be screened for cardiovascular risk factors such as hypertension and dyslipidemia. Regardless of their perceived level of risk, all individuals should receive counseling on healthy diet habits, exercise, and smoking cessation. Statins should be considered in any HIV-positive individual who has a history of cardiovascular disease or known diabetes and also in those who are at high risk for developing cardiovascular disease due to elevated lipid levels, cigarette smoking status, or blood pressure. Second-line lipid-lowering agents, such as ezetimibe, fibrates, and omega-3 supplementation, can be considered in patients with persisting dyslipidemia despite statin therapy or in whom statins are contraindicated. Monitoring and management of hypertension is also important and can lead to significant reductions in cardiovascular event rates. A combination of angiotensin-converting enzyme inhibition and thiazide diuretic is most likely to successfully lead to reductions in blood pressure and has minimal drug interactions with ART.

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey.

BackgroundPerinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.MethodsCross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher’s exact test and χ2 test for categorical variables.ResultsA quarter (27 % (49/180) antenatally and 25 % (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58 % (7/12) vs 25 % (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40 % (17/43) vs 23 % (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43 % (12/28) vs 23 % (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44 % (20/45) vs 21 % (18/84) of cohabiting and 19 % (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40 % (20/45) vs 18 % (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30 % (44/146) vs 14 % (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48 % (11/23) vs 27 % (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82 % (37/45) postnatally but only 31 % (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.ConclusionsA quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

Abstract 17992: Observed versus Predicted Myocardial Infarction Among Individuals With Human Immunodeficiency Virus by American College of Cardiology/American Heart Association Pooled Cohort Equation Risk Strata: Center for AIDS Research Network of Integrated Clinical Systems

Background: Human immunodeficiency virus (HIV)-infected individuals are at elevated risk for cardiovascular disease (CVD) due to an interplay between traditional CVD risk factors, chronic inflammation persisting despite HIV viral suppression, and side effects of antiretroviral therapy. Previous studies evaluating CVD risk prediction models in HIV populations have generally been small in size and assessed non-U.S. cohorts. The 2013 ACC/AHA ASCVD Risk Estimator has not been evaluated in a large, multi-center HIV cohort. Hypothesis: Our primary hypothesis was that the ACC/AHA ASCVD Risk Estimator would underestimate ASCVD risk across risk strata for HIV-infected patients. Methods: We evaluated this risk prediction tool in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) multi-center U.S.-based cohort of approximately 30,000 HIV-infected adults with rigorous central adjudication of myocardial infarction (MI) and differentiation between type I and II MI. We compared MI and ASCVD risks predicted by the ASCVD Risk Estimator to actual rates of MI observed in the CNICS cohort. Results: A total of 132 MIs were observed during follow-up, compared with 103 MIs that would have been expected based on the ASCVD risk estimator. Observed MI rates were higher than expected across most predicted risk levels, particularly among black participants and those with low (&lt;5%) predicted 10-year ASCVD risk. This under-prediction was relatively uniform across risk strata among white men; the observed MI rates were 68%, 68%, 67%, and 67% greater than expected, respectively, for white men with &lt;5%, 5% to &lt;7.5%, 7.5% to &lt;10%, and 10% or greater predicted 10-year ASCVD risk. Conclusions: These data suggest that the ACC/AHA Risk Estimator under-predicts MI risk among HIV-infected individuals. The under-prediction was relatively uniform across risk strata for white men. These data highlight the need for accurate HIV-specific CVD risk prediction tools.

Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013

With widespread availability and the use of antiretroviral therapy, patients with human immunodeficiency virus (HIV) in the United States are living long enough to experience non-AIDS-defining illnesses. HIV is associated with an increased risk for cardiovascular disease (CVD) because of traditional CVD risk factors, residual virally mediated inflammation despite HIV treatment, and side effects of antiretroviral therapy. No United States population-wide studies have evaluated patterns of CVD mortality for HIV-infected subjects. Our central hypothesis was that the proportionate mortality from CVD (CVD mortality/total mortality) in the HIV-infected population increased from 1999 to 2013. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online database of the United States public health data to assess proportionate CVD mortality from 1999 to 2013 in the HIV-infected, general, and inflammatory polyarthropathy populations; the inflammatory polyarthropathy population was included as a positive control group. Total mortality in the HIV-infected population decreased from 15,739 in 1999 to 8,660 in 2013; however, CVD mortality increased from 307 to 400 during the same period. Thus, proportionate CVD mortality for the HIV-infected population increased significantly from 1999 to 2013 (p <0.0001); this pattern was consistent across races, particularly for men. In contrast, proportionate CVD mortality decreased for the general and inflammatory polyarthropathy populations from 1999 to 2013. In conclusion, CVD has become an increasingly common cause of death in HIV-infected subjects since 1999; understanding evolving mortality risks in the HIV-infected population is essential to inform routine clinical care of HIV-infected subjects as well as CVD prevention and treatment.

HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.

IntroductionLipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.MethodsWe conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.Results and DiscussionOf the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.ConclusionsLipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.

Comparison of home and hospital deaths among patients on anti-retroviral therapy (ART): A clinical and verbal autopsy study

AimTo identify factors associated with home and hospital deaths among human immunodeficiency virus (HIV) infected adult patients in Nigeria. BackgroundCauses of mortality among HIV infected hospitalized patients on anti-retroviral therapy (ART) have been characterized in sub-Saharan Africa. However, majority of deaths occur outside hospitals. Materials and methodsWe undertook a retrospective clinical review on patients who were on ART and died at home or in the hospital. We obtained additional information on those who died at home through verbal autopsy and qualitative interview by our Home Based Care Team (HBCT). ResultsA total of 101 patient deaths over three years were reviewed. Those who died at home (51) or hospital (50) had similar ages, gender, co-morbidities, proportions with stages III/IV disease and opportunistic diseases. The median pre-ART CD4 cell counts for those who died at home and hospital was 108cells/μl and 72.0cells/μl respectively and they had been on similar ART regimens. Adherence was less 14/51 (27.5%) versus 30/50 (60%) (p=0.040) and use of traditional medicines (TM) higher 41/51 (80.4%) versus 16/50 (32%) (p=0.014) among those who died at home. Tuberculosis (TB) was the commonest cause of death accounting for 33/51 (64.7%) and 31/50 (62.0%) (p=0.979) of the home and hospital deaths respectively. Verbal autopsy and qualitative interview also identified TB, poor adherence, ART drug resistance and side effects as well as poverty, stigma, use of TM and spiritual alternatives as important causes of deaths. Tuberculosis is the overall cause of death. ConclusionStrategies for improving adherence, prevention and treatment of TB should be explored.

Socioepidemiologic profile and treatment-seeking behaviour of HIV/AIDS patients in a tertiary-care hospital in south India.

India has the third largest number of people living with HIV/AIDS. Provision of free antiretroviral therapy (ART) for eligible persons living with HIV (PLHA) has been scaled up significantly both in terms of facilities for treatment and number of beneficiaries. This study aimed at describing the profile of HIV/AIDS patients on ART from a tertiary-care hospital and to explore the factors associated with treatment-seeking behaviour, family support, and perceptions regarding HIV and ART. This is a descriptive study conducted at the ART centre in a tertiary-care hospital in Puducherry. Study population consisted of 130 HIV-positive patients aged more than 18 years on free firstline ART for at least 6 months. Data on sociodemographic details, clinical details, treatment-seeking behaviour, family support, and perceptions regarding HIV and ART were collected using a pretested questionnaire. Data are presented as percentages. In total, 130 patients on ART for at least 6 months were included in the study--61% were males (n=79), 39% were females (n=51); half of them belonged to the age-group of 36-50 years. Half of the participants were diagnosed to have HIV/AIDS between 1 and 3 year(s); two-thirds had one or more co-infection(s). The majority were aware of the side-effects of ART. After advice to start ART, there was a delay in starting treatment in one-fifth of the subjects due to depression, fear of stigma, disclosure to family, and side-effects. More than two-thirds of the patients travelled more than 30 km distance. Families of HIV-positive subjects were supportive in accompanying to the ART centre, collecting drugs, reminders to take medication, and motivation to complete the treatment. Alcohol (50%) and tobacco consumption (39%) was common among the subjects. Half of the respondents stated stigma, death, and pain as the main fears, and all of them stated high levels of trust and rapport with their doctors. This study reveals several positive aspects among ART beneficiaries. However, issues, like tobacco and alcohol consumption, travelling long distance for drug collection, fear of stigma and death, and concerns regarding the future, need to be addressed.