WHO Stage Research Articles

Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh

Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence. Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospital. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and adherence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS. Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found significant were sex of the patient, the education, the socioeconomic status, financial constraints, family support, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors namely having less than college education, WHO stage at diagnosis, alcohol intake and lack of family support were found to predictors of non-adherence. Conclusions: Family support, treatment of alcohol addiction will improve adherence in HIV positive patients.

Ischemic Cerebrovascular Accidents in HIV Patients on Antiretroviral Therapy: Clinical, Paraclinical And Prognostic Aspects in The Neurology Department of The University Hospital Center of Conakry

Introduction: Ischemic stroke (Stroke) constitute, due to the demographic and epidemiological transition, a real challenge for developing countries and HIV infection, a real public health problem in these countries. The objective of our study was to describe aspects of clinical, paraclinical and prognostic ischemic stroke in people living with HIV (PLHIV) on antiretrovirals (ARVs). Material and methods: This was a prospective study of the descriptive type lasting 6 months from January 1, 2022 to June 31, 2022, relating to ischemic cerebrovascular accidents (DALYs) in HIV patients on ARVs.Were included patients admitted or hospitalized in the service for seropositive ischemic stroke under ARV for an average duration of 35.5 months. Patients recently put on ARVs and those with an obvious cause of DALY such as (diabetes, uncontrolled hypertension, emboligenic heart disease) were excluded. Results: During our study period, 336(94%) patients were listed. Among them, 20 have ischemic stroke associated with HIV on ARVs, i.e. 6%. This study showed that the average age of onset of ischemic stroke in PLHIV on ARV was 49 ± 11.6 years with a sex ratio F/M of 1.22. The risk factors were high blood pressure 13 (65%), diabetes 05 (25%), followed by alcohol 04 (20%). HIV type 1 was represented at 100%, then 16 (80%) of our patients were at WHO stage III with a CD4 count between 200 and 300 cells/µl09 (45%). The therapeutic line of ARVs was dominated by TDF+3TC+EFV at 14 (70%) followed by AZT+3TC+LPV/r at 04 (20%) and the average duration of patients on ARV was 35.5 months. The favorable evolution was marked 13 (65%), followed by a death in (10%) or 02. The location on the cerebral scanner was dominated by the sylvian artery in 12 (60%) of cases followed by the anterior cerebral artery (ACA) 06 (30%) and the posterior cerebral artery ( PCA) 02 (10%). Conclusion: Ischemic stroke in HIV patients on ARVs requires early management and regular monitoring

Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19.

Background: Although most children may experience mild to moderate symptoms and do not require hospitalization, there are little data on cardiac involvement in COVID-19. However, cardiac involvement is accurately demonstrated in children with MISC. The objective of this study was to evaluate cardiac mechanics in previously healthy children who recovered from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up by means of two-dimensional speckle-tracking echocardiography (STE). Methods: We analyzed a cohort of 157 paediatric patients, mean age 7.7 ± 4.5 years (age range 0.3−18 years), who had a laboratory-confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent a standard transthoracic echocardiogram and STE at an average time of 148 ± 68 days after diagnosis and were divided in three follow-up groups (<180 days, 180−240 days, >240 days). Patients were compared with 107 (41 females—38%) age- and BSA-comparable healthy controls (CTRL). Results: Left ventricular (LV) global longitudinal strain (post-COVID-19: −20.5 ± 2.9%; CTRL: −21.8 ± 1.7%; p < 0.001) was significantly reduced in cases compared with CTRLs. No significant differences were seen among the three follow-up groups (p = NS). Moreover, regional longitudinal strain was significantly reduced in LV apical-wall segments of children with disease onset during the second wave of the COVID-19 pandemic compared to the first wave (second wave: −20.2 ± 2.6%; first wave: −21.2 ± 3.4%; p = 0.048). Finally, peak left atrial systolic strain was within the normal range in the post-COVID-19 group with no significant differences compared to CTRLs. Conclusions: Our study demonstrated for the first time the persistence of LV myocardial deformation abnormalities in previously healthy children with an asymptomatic or mildly symptomatic (WHO stages 0 or 1) COVID-19 course after an average follow-up of 148 ± 68 days. A more significant involvement was found in children affected during the second wave. These findings imply that subclinical LV dysfunction may also be a typical characteristic of COVID-19 infection in children and are concerning given the predictive value of LV longitudinal strain in the general population.

Clinico-epidemiological profile of children living with HIV/AIDS managed at Heal Africa Hospital, Goma, Democratic Republic of the Congo.

Conflict in the DRC led to a poor health care. HIV/AIDS in children remains one of the leading causes of pediatric morbidity and mortality. This cross-sectional study used a sample size of 238 files and aimed to determine the epidemiological profile of children living with HIV at Heal Hospital in 2015. The age ranged from zero to fifteen, with a mean of 6.1 (±3.9) years. Records of PMTCT were noted in 12%. The mean birth weight was 3(±0.8) kg, most cases (88 percent) had normal vaginal delivery. Many of them (71 percent) were living with at least one parent. The majority of the children (92 percent) were from Goma, and 75 percent were diagnosed at WHO Stage 3. At least one episode of hospital admission was reported in 71 percent. Respiratory tract infections were the most common disease, and they were also the leading cause of death. Based on the CD4, which was the most cost-effective method of monitoring, there was an improvement in immunity at the last visit. This study pointed out the importance of PMTC and early management of children leaving with HIV/AIDS. Outreach would encourage voluntary HIV/AIDS testing for pregnant women in armed conflict zone.

The urgent need to scale-up fungal diagnostics in Africa

Africa is home to two-thirds of the global population of people living with HIV infection.1 Despite a steady scale-up of antiretroviral treatment (ART), efforts to curtail HIV-related mortality are consistently thwarted by the high burden of advanced HIV disease, defined by WHO as a CD4 count of less than 200 cells/mL or WHO stage 3 or 4.2 In 2020, approximately 20–25% of people who commenced HIV care in Uganda and Botswana had advanced HIV disease.3 Besides denoting a failure in the HIV cascade of care, advanced HIV disease is increasingly documented in patients on ART who disengage from care and return with virological non-suppression.

Dolutegravir-Based Regimen Ensures High Virological Success despite Prior Exposure to Efavirenz-Based First-LINE ART in Cameroon: An Evidence of a Successful Transition Model.

To ensure optimal prescribing practices in the dolutegravir-era in Cameroon, we compared first-line virological response (VR) under tenofovir + lamivudine + dolutegravir (TLD) according to prior exposure to tenofovir + lamivudine + efavirenz (TLE). A facility-based survey was conducted among patients initiating antiretroviral therapy (ART) with TLD (I-TLD) versus those transitioning from TLE to TLD (T-TLD). HIV viral load was performed and unsuppressed participants (VL > 1000 copies/mL) had genotyping performed by Sanger sequencing. Of the 12,093 patients followed, 310 (mean-age: 41 ± 11 years; 52.26% female) complied with study criteria (171 I-TLD vs. 139 T-TLD). The median ART-duration was 14 (12−17) months among I-TLDs versus 28 (24.5−31) months among T-TLDs (15 (11−19) on TLE and 14 (9−15) on TLD), and 83.15% (148/178) were at WHO clinical stages I/II. The viral suppression rate (<1000 copies/mL) was 96.45%, with 97.08% among I-TLDs versus 95.68% among T-TLDs (p = 0.55). VR was similar in I-TLD versus T-TLD at <400 copies/mL (94.15% versus 94.42%) and age, gender, residence, ART-duration, and WHO stages were not associated with VR (p > 0.05). Genotyping was successful for 72.7% (8/11), with no major mutations to integrase inhibitors found. VR is optimal under first-line TLD after 14 months, even among TLE-exposed, thus confirming the effectiveness of transitioning from TLE to TLD in similar settings, supported by strong pharmacological potency and genetic barrier of dolutegravir.

1346. Viral Suppression Rates Among Children and Adolescents Living with HIV in Baringo County, Kenya

Abstract Background Annually, 220,000 infants are infected with HIV globally. Kenya has 139,000 children living with HIV and among this, 78.9% know their HIV status, 93.2% are on ART and 67.1% are virally-suppressed. Achieving viral suppression is challenging in children and adolescents residing in resource limited settings. Contributing factors include variability in weight and anti-retroviral pharmacokinetics, pre-treatment drug resistance and poor palatability of drugs. Adolescents’ developmental stage does affect their psychosocial and emotional functions which can have an adverse effect on their health seeking behavior and adherence to ART care and treatment. The study objective was to determine the viral suppression rates among children and adolescents in Baringo county Kenya for the period 2016-2020. Methods This was a cross sectional study where retrospective data was analyzed. The study sites were Baringo County hospital (BCRH) and Marigat sub-county hospital comprehensive care clinics (CCC). Electronic medical records of children and adolescents currently enrolled in care were retrieved from the Kenya EMR system. Data collected included demographics, clinical and laboratory data. Descriptive analysis was carried out. Results A total of 54 cases were retrieved. Mean age was 8.5 years (SD=5.4), males being 15/29 (52%). Majority, 51/54(94%) had WHO Stage 1 classification, while 4/54 (7.4%) had TB co-infection. The most widely-used treatment regimen was ABC/3TC/LPV/r 19/54 (35%). Regarding viral suppression status, 31/54(57%) were suppressed 10/54; (18.5%) had virologic failure and 13/45 (24%) had missing viral load tests. Majority, 45/53(85%) were retained in care; 4/53(7.5%) lost to follow up and 1/53 (2%) having died. Conclusion Viral-suppression was low with significant TB-HIV co-infection while retention to care was good. We recommend intensification of TB screening and improved viral load monitoring rates in this age-cohort. Treatment plans need to be designed to meet the clients’ specific needs. Community ART groups should be optimized and treatment peer champions engaged to support drug distribution and psychosocial support. Learning institutions should be involved in addressing barriers in accessing treatment by school-going children. Disclosures All Authors: No reported disclosures.

Factors associated with anti-retroviral therapy (ART) adherence among adult people living with HIV (PLWH): A 5-year retrospective multi-centre study in Kumasi, Ghana.

Combined antiretroviral therapy (cART) is the recommended treatment regimen for people living with HIV (PLWH). Long-term HIV treatment of over 95% adherence inhibits increase in viral load and boosts immune system performance. On the contrary, non-adherence results in treatment failure, accelerated development of HIV drug-resistance and increased mortality. However, there is paucity of data on the prevalence of antiretroviral therapy (ART) adherence and its associated factors in Ghana. We assessed the prevalence, sociodemographic and clinical factors associated with ART adherence among registered PLWH. In a multi-centre hospital-based retrospective study, we collected data on 720 registered PLWH 18 years and above, who attend the HIV clinic at the University Hospital (KNUST), Komfo Anokye Teaching Hospital (KATH), and the Bomso Clinic, on ART and with up-to-date medical records. They were enrolled using a multistage sampling technique. Adherence was assessed retrospectively using missed doses and prescriptions renewal. All analysis were done using SPSS Version 26.0 and GraphPad prism version 8.0. Of 720 registered PLWH, 51.8% had good ART adherence, 35.3% had fair ART adherence and 12.9% had poor ART adherence. Those diagnosed at WHO stage II (aOR = 0.45, 95% CI: (0.30-0.68); p < 0.0001) and stage III (aOR = 0.40, 95% CI: (0.27-0.59) < 0.0001) were independently associated with lower chances of good adherence to ART. Moreover, those treated with AZT/3TC/EFV (aOR = 0.33, 95% CI: (0.16-0.68); p = 0.0030), and AZT/3TC/NVP (aOR = 0.50, 95% CI: (0.26-0.98); p = 0.0410) were independently associated with lower likelihood of good ART adherence. On the contrary, PLWH who have been on treatment for 4 years (aOR = 3.56, 95% CI: (1.10-11.54); p = 0.0340) was an independent predictor of good ART adherence. About half of PLWH on treatment have good adherence to ART. Being diagnosed at WHO stage II and stage III, being treated with AZT/3TC/EFV, and AZT/3TC/NVP ART combination are associated with lesser chances of good ART adherence. However, increased duration of ART among PLWH influence good ART adherence. PLWH on ART should be monitored to achieve over 95% ART adherence for effective management of HIV/AIDS.

Incidence and predictors of tuberculosis among children on antiretroviral therapy at northeast Ethiopia comprehensive specialized hospitals, 2022; A multicenter retrospective follow-up study

IntroductionAround the world, tuberculosis (TB) is the most common cause of mortality and morbidity in both adults and children. The incidence of tuberculosis (TB) is increased worldwide by co-infection with the human immunodeficiency virus (HIV), particularly in Sub-Saharan Africa. As a result, the study aimed to determine the incidence and predictors of tuberculosis among children on antiretroviral therapy at northeast Ethiopia Comprehensive Specialized Hospitals. MethodsAn institution-based retrospective follow-up study was carried out in northeast Ethiopia’s Comprehensive Specialized Hospitals, among 362 children on antiretroviral therapy from January 1, 2007, to September 30, 2021. The data were entered into Epi Data version 4.6.1 and then exported to STATA version 16 for analysis. Bivariate and multivariable Cox proportional hazards model was used to discover tuberculosis predictors. Variables with a p-value of <0.05 at 95% confidence intervals in the multivariable Cox proportional hazard model were considered statistically significant. ResultsAmong the 358 Human Immunodeficiency Virus-infected children, two-thirds (69.3%) were over ten years old. The overall tuberculosis incidence rate was 2.0 (95%CI: 1.5–2.6) per 100 person-years with a total of 2452 years of observations. WHO clinical stages III and IV [AHR: 3.2 (95% CI 1.8–5.5)], being severely stunted [AHR = 2.1 (95% CI, 1.5–358)], and “Fair” and “poor” adherence levels to antiretroviral therapy [AHR = 4.0 (95% CI 1.5–10.8)] were independent predictors of tuberculosis. ConclusionThe incidence of tuberculosis in children infected with HIV/AIDS was high in this study. The risk of tuberculosis (TB) in HIV/AIDS-infected children has been linked to WHO stages III and IV, severe stunting, and "Fair" and "Poor" ART adherence. As a result, children with HIV/ADIS should be evaluated on a regular basis in order to improve the quality of ART services and reduce the incidence rate of tuberculosis among children.

Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study

Nowadays, Tuberculosis remains the major cause of HIV-associated mortality, which accounts for 1 out of every 5 HIV-related mortality worldwide. This study aimed to determine the survival rate and predictors of mortality among TB/HIV co-infected patients. An institution-based retrospective cohort study was undertaken on adult TB/HIV co-infected individuals between 1st February 2014 and 30th January 2022 at Mettu Karl Referral Hospital. A Cox regression model was used to identify predictors of survival time to death among TB/HIV co-infected patients. This study comprised 402 TB and HIV co-infected adult patients. Among these, 84 (20.9%) died, and 318 (79.1%) were censored. The study subjects have been followed up for 6920 person-months with an overall median survival time of 17.6 months. The overall incidence rate was 12.1 per 1000 person months [95% CI: 9.77–14.98]. The results of a multivariable Cox regression analysis showed that being at an older age, urban residence, WHO clinical stage II & IV, CD4 count of ≥ 200 cells/mm3, bedridden functional status, using INH, and using CPT were associated with the survival time of TB and HIV co-infected patients at a significance level of alpha = 0.05. This retrospective study found that high mortality of TB/HIV co-infected patients occurred in the earlier months of treatment initiation. Close monitoring of patients with low CD4, who do not utilize CPT, who are in advanced WHO stages, and who have poor functional levels can help them improve their health and live longer.

Predictors of Lost to Follow Up (LTFU) among HIV Positive Patients Enrolled in 70 PEPFAR Supported Treatment Facilities in Edo, Bayelsa and Lagos States, Nigeria

This retrospective cross-sectional study examined demographic factors that predict Lost to Follow-up (LTFU) among HIV-positive patients on treatment based on patient-level data from 2000 to 2021 from 70 the President&amp;#39;s Emergency Plan for AIDS Relief (PEPFAR)-supported facilities in Edo, Lagos and Bayelsa states of Nigeria. A total of 32,910 patients were identified for the descriptive analysis, although only 26,797 were included in the final model due to missing values for certain variables. Descriptive statistics describe the basic features of the data, while logistic regression identified patient characteristics at ART initiation that predicted LTFU. A stepwise forward and backward regression were used to select the variables to include in the model.&#x0D; &#x0D; Despite improving adherence in each cohort initiated since 2005, a large proportion of patients (72%) were LTFU between 2005 and 2015. However, thereafter (2016 to 2020) Anti-Retroviral Therapy (ART)&amp;rsquo;s adherence improved with the average retrospective cumulative LFTU dropping to 27% for the period. &#x0D; &#x0D; The predictive analysis suggests the following patient variables are significantly associated with LTFU at 95% CI: Patients initiated prior to 2018 were 57% more likely to become LTFU. HIV patients who reported post-secondary education as their highest education level were twice as likely to become LTFU in comparison to those with no education. Compared to their counterparts aged 25+, the patients&amp;rsquo; ages 0-19 and 20-24 subset are less likely to become LTFU. HIV patients who were divorced or separated were about 1.3 times more likely to be LTFU compared to their married counterparts. The tendency to be LTFU increases at WHO stage 2 and decreases as the patient&amp;rsquo;s WHO clinical stage progresses from stage 3 to stage 4. Lastly, patients in Edo were 23 times more likely to become LTFU, while patients in Lagos were 4 times more likely to become LTFU compared to their Bayelsa counterparts.

Incidence and factors associated with being lost to follow-up among people living with HIV and receiving antiretroviral therapy in Nyarugenge the central business district of Kigali city, Rwanda.

BackgroundLost to follow-up (LTFUP) continues to threaten the sustainability of antiretroviral therapy (ART) benefits and success of ART programs. We determined the incidence and predictors of LTFUP among people living with HIV (PLHIV) on ART in Nyarugenge the Central Business District of Kigali city.MethodsA cohort of PLHIV who initiated ART in 2018 was retrospectively studied for 24 months. Using health facility records, a person who had no record of contact with the health facility for at least three consecutive months was considered LTFUP. LTFUP incidence rates were computed, and the Fine-Gray’s competing risk regression models were used to determine factors associated with time to first LTFUP. Generalized estimating equations (GEEs) were used to analyze repeated measurement outcomes of LTFUP and predictors of LTFUP.ResultsOf 950 participants, 581 (61.2%) were females and 866 (91.2%) were 15 to 49 years old. From 1,586.1 person years of observation (pyo), 148 participants got LTFUP for 451 times. The incidence rate to first event was 9.4 per 100 pyo (95%CI:7.9–10.9) and 31.8 per 100 pyo (95%CI:29.0–34.4) to multiple events. WHO stage, marital status, employment status and person to contact when PLHIV is not reachable were associated with time to first LTFUP event. However, an average participant with a contact person who was not a Community Health Worker (CHW) or a peer educator had higher incidence of LTUP (aIRR = 2.69, 95%CI: 1.43–5.06), an average single patients had higher incidence of LTFUP (aIRR = 1.74, 95%CI: 1.28–2.34) compared to married/co-habiting, and an average self-employed had higher incidence of LTFUP (aIRR = 1.51, 95%CI: 1.14–2.01) compared to participants employed by others. Furthermore, an average PLHIV living out-of-the health facility catchment area had higher incidence of LTFUP (aIRR = 1.55, 95%CI: 1.19–2.01) compared to an average PLHIV living in the health facility catchment area whereas, an average children initiated on first line had lower incidence of LTUP (aIRR = 0.43, 95%CI: 0.21–0.86) compared to adults.ConclusionUsing CHW and peer educators as contact persons can help to reduce LTFUP while, targeted sensitization and service delivery are needed for single, self-employed and, patients living out of the health facility catchment area.

Utilization of ART Services Among People Living with HIV During the COVID-19 Pandemic: A Case of Kampala District

Introduction: The intense pressure on the health system coupled with strict measures have interrupted ART service utility during the COVID 19 pandemic. In this study, we assessed the Utilization of ART services among People Living with HIV during the COVID-19 pandemic in Kampala District, Uganda. Methods: We studied 9952 records of patient encounters between 24th March and 1st June 2020 from the Open Medical Records System (EMR) and obtained an analytical sample of 647 encounters for PLHIV enrolled in Kampala district; 243 from the Mbuya site, 274 from Kinawataka site and 130 from Banda site. We assessed factors associated with inadequate ART utilization using the modified poison regression (generalized linear model with a poisoned family and a log link) and reported clustered robust standard errors with their corresponding Prevalence Ratios. Results and Discussion: The rate of ART utilization during the COVID-19 pandemic in the Kampala district was inadequate (14.71%). PLHIV who were in WHO clinical stage 3 had aPR=18.065, 95%CI=17.396 18.759, and P-value =0.001 as compared to those in WHO stage 1. PLHIV who were obese had aPR=1.439, 95% CI=1.103 1.879, P-value =0.007 as compared to those with normal BMI. Conclusion: The factors associated with inadequate ART utilization were body mass index and WHO clinical staging of the disease. This information is crucial for strengthening HIV programs and interventions in terms of access to ART services, with a focus on obese infected individuals and those with advanced HIV disease during pandemics that require lock-down measures.

Same Day Antiretroviral Therapy Initiation, Prevalence and Co-factors of Advanced HIV Disease in an African Population- A 1 Year Report

Background: Advanced HIV disease (AHD) represents a stage of HIV infection characterized by severe immunosuppression and a high risk of mortality. An understanding of the burden and associated risk factors for AHD is important in order to design programs targeted at prevention and treatment with the aim of reducing HIV associated morbidity and mortality. This study set out to determine the prevalence and risk factors for AHD in a tertiary health facility in Southern Nigeria as well as to ascertain the frequency of Same day initiation of Highly Active Antiviral Therapy in AHD patients.&#x0D; Methodology: This was a retrospective cross-sectional review of data from 419 adults and children diagnosed with AHD seen at the antiretroviral therapy clinic and Emergency department of the Rivers State University Teaching Hospital (RSUTH) over a 1year period. Details including personal bio-data and clinical information were obtained from the HIV registry of the hospital.&#x0D; Results: Four hundred and nineteen (419) patients were diagnosed with Advanced HIV disease between January 2021- January 2022 with a mean age of 35.8 years. Regarding the co-factors, Sixty- four (29.4%) of the 218 persons tested were positive for tuberculosis while 18(9.2%) of the 196 patients tested for cryptococcus infection were positive. One hundred and forty-eight (148) of the AHD population had CD4 cell count of &lt;200cells comprising 144 (97%) adults and 4(3%) children. AHD, defined by a CD4 count of &lt;200 cells was more prevalent within the age bracket of 40-49years (n=51, 34%) and among females [F:M 81 (55%) vs 67 (45%)]. Majority of the patients presented with WHO stage 3 disease (n=64, 43.2%) closely followed by stage 2 disease (n=47, 31.79%). Stage 4 disease was found in only 2.02%. The overall same day initiation (SDI) of AHD patients was 97% (n=144).&#x0D; Conclusion: Advanced HIV disease is highly prevalent despite the test and treat approach to care. Interventions aimed at prevention, adherence to therapy as well as early recognition and treatment is paramount in reducing the burden of AHD.

P258 Incidence of Histoplasmosis, Cryptococcosis, and TB Among People Living with HIV in Paraguay-Preliminary Report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesEndemic fungal infections such as Histoplasmosis and Cryptococcosis as well as tuberculosis (TB) are important causes of mortality among people living with HIV (PLHIV) in Latin America. Rapid diagnostic assays (RDAs) could decrease the time to diagnosis and treatment of these infections, resulting in a reduction in mortality. The objectives of this study were to determine the incidence of Histoplasmosis, Cryptococcosis, and TB using RDAs in PLHIV with advanced HIV disease (AHD) and calculate 30-day mortality.MethodsPLHIV 18 years and older, treated at the Institute of Tropical Medicine hospital in Asuncion, Paraguay, not receiving ART and presenting CD4 count ≤ 200 cells/μL or clinical symptoms suggestive of WHO stage 3 or 4 diseases were enrolled and followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was performed by enzyme immunoassay (EIA), Cryptococcus Ag (CrAg) detection in serum and cerebrospinal fluid specimens by lateral flow assay (LFA), and liparabinomannan (LAM) detection in urine by LFA (TB LAM) (limited to those patients with CD4 counts ≤ 100 cells/μL) and by GeneXpert (limited to patients with respiratory symptoms).ResultsFrom August 2021 to 25 March 2022, a total of 335 PLHIV were enrolled. Patient median age was 37 years [Interquartile Range (IQR) 16 years], median CD4 count at enrollment was 91 cells/μL (IQR 147 cell/μL). A total of 80% (n = 269) of patients were symptomatic for one or more of the three diseases being screened for. Ag positivity rate was 20% (40/196) for TB-LAM, 10% (32/314) for HisAg, and 11% (35/329) for CrAg (15 diagnosed with cryptococcal meningitis). GeneXpert testing showed a positivity of 14% (15/108), and six of these patients with positive GeneXpert also tested positive for TB-LAM.In total, 100/335 (30%) of patients tested had a positive result and coinfections were observed among 14/335 (4.2%) patients (Table 1). Histoplasmosis + TB was the most frequent co-infection observed 12/335 (3.6%).Mortality among those who completed 30-day follow-up was 12.6% (32/254) and 11% among those with an OI (11/102)Conclusions: Preliminary results show that TB and fungal opportunistic infections, including co-infection were common in people with advanced HIV. Longitudinal follow-up will help to evaluate the feasibility and cost of implementing RDAs for the early detection of opportunistic infections in PLHIV with AHD in Paraguay. Early diagnosis could impact mortality reduction.

Mortality and Its Predictors among Adult Human Immune-Deficiency Virus-Infected Patients Attending Their Antiretroviral Treatment at Health Centers, Addis Ababa, Ethiopia: Multicenter Retrospective Cohort Study.

Introduction In resource-limited settings such as Ethiopia, where the prevalence of HIV/AIDS is high, a number of factors, including economic, demographic, behavioral risk, and health factors, affect how long people with AIDS are treated with antiretroviral therapy. Since several aspects of the clinical setup may have an impact on ART patients' survival, this study was conducted in health centers. Determining the mortality rate and survival factors among adult HIV-infected patients receiving ART at health centers in Addis Abeba's Kirkos subcity is the primary goal of this study. Methods A retrospective cohort study was carried out at the health center in Addis Abeba's Kirkos subcity. The source population consisted of all adult HIV-positive patients who were being followed up between December 1, 2014, and October 30, 2019. A total of 665 samples were collected using a computer-generated simple random sampling method in each of the three health centers that were chosen by a lottery system depending on the number of patients in the follow-up. Trained data collectors took the information out of the patient card and the electronic database. Regressions using the Kaplan‐Meier and Cox proportional hazards were employed. Results The incidence of death rate in adult HIV-positive patients was 55 (8.5%) fatalities, translating to a death rate of 3.25 per 100 person-years. The majority of deaths occurred within 6 months of ART initiation. Predictors of mortality were: age above 50 years (AHR = 4.90, 95% CI: 2.00, 11.98), tuberculosis comorbidity (AHR = 3.46, 95% CI: 1.23, 3.33), lack of drug adherence (AHR = 1.76, 95% CI: 1.23, 3.33), co-trimoxazole therapy (AHR = 2.59, 95% CI: 1.37, 4.90), and CD4 cell count less than 200/dl (AHR = 2.77, 95% CI: 1.30, 5.92). Conclusion and Recommendation. Adult HIV-positive individuals had an incidence of the death rate of 55 (8.5%), which equates to 3.25 deaths per 100 person-years. Age category over 50, TB comorbidity, WHO stage IV, lack of medication adherence, co-trimoxazole therapy, body mass index under 18.5 kg/m2, and CD4 cell count under 200/dl were predictors of mortality. Therefore, it is important to focus on prevention, early identification, and treatment of HIV/AIDS for these predictors at all levels of the HIV/AIDS chronic care package in order to increase survival.

Risk factors and prognostic significance of platelet count abnormalities in children with HIV infection on antiretroviral therapy.

To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH). A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014. Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival. Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival. Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.

Associated factors with mortality in people living with HIV in Ziguinchor, Southern-region, Senegal: about 804 cases.

Background: The generalization of antiretroviral treatment to all People living with HIV (PLHIV) contributes to the considerable decrease of HIV-related mortality. However, this remains higher than in the general population, hence the importance of identifying its determining factors. The objective of our study was to determine the factors associated with death in PLHIV followed in Ziguinchor. Patients and method: This was a cross-sectional, descriptive and analytical study on the cohorts of PLHIV followed in the health districts of Ziguinchor and Bignona in Senegal over a period of 5 years. We included all the patients infected with HIV, aged 15 years and over, regularly followed and under antiretroviral treatment during the study period. Results: Of the 804 patients included, 597 (74.25%) were female, i.e. a sex ratio (F/M) of 2.88. The average age was 45.61 ± 13.01 years [15 to 96 years]. The diagnosis was made at WHO stages 3 and 4 in 286 patients (35.58%). The predominant serotype was HIV-1 (82.34%) followed by HIV-2 (15.17%) and HIV-1+2 (2.49%). Lethality was 6.34% after 12 months of follow-up under treatment. In multivariate analysis, death was associated with: age over 65 years (p=0.027), treatment duration &lt; 12 months (p&lt;0.005), insufficient immunological restoration (CD4+&lt;500/mm3; p=0.001) and a viral load &gt; 1000 copies (p=0.000). Conclusion: Advanced age and insufficient immunovirological response are the main factors associated with death in our patients. The introduction of more effective treatments based on integrase inhibitors, good therapeutic education and better monitoring of seniors will improve their prognosis.

Risk factors and prognostic significance of anemia in children with HIV infection on antiretroviral therapy.

To establish the incidence, risk factors and prognostic effect of anemia in children living with HIV (CLWH). Retrospective nested case-control study of patients 0-18 years in five centers in sub-Saharan Africa, 2004-2014. Incident cases of anemia were identified from electronic records and matched with CLWH without anemia. We calculated the incidence density of anemia and used conditional logistic regression to evaluate its association with risk factors, stratified by severity and type of anemia. We used a Cox proportional hazards model to evaluate the impact of anemia on survival. Two thousand, one hundred and thirty-seven children were sampled. The incidence density of anemia was 1 per 6.6 CLWH-years. Anemia was moderate in 31.8% and severe in 17.3% of anemia cases, which had 10-year mortality hazards of 3.4 and 4.5, respectively. Microcytic anemia (36% cases) was associated with 2.3-fold hazard of 10-year mortality, and with malnutrition and CD4 + suppression. Normocytic anemia (50.5% cases) was associated with 2.6-fold hazards of 10-year mortality, and with more severe malnutrition, CD4 + suppression, and WHO stage, but inversely associated with lamivudine and nevirapine therapy. Macrocytic anemia (13.5% cases) was neither associated with higher 10-year mortality nor with severe malnutrition or CD4 + suppression but was associated with WHO stage II/III and negatively associated with lamivudine therapy. This large multicountry study of CLWH found a high incidence density of anemia. Higher severity, normocytic and microcytic types of anemia were independently associated with long-term mortality. Laboratory studies are needed to decipher the mechanisms of anemia and how it impacts mortality in CLWH.

Once-daily dolutegravir-based antiretroviral therapy in infants and children living with HIV from age 4 weeks: results from the below 14 kg cohort in the randomised ODYSSEY trial

Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and <14 kg). Children weighing less than 14 kg starting first-line or second-line ART were enrolled in seven HIV treatment centres in South Africa, Uganda, and Zimbabwe. Randomisation, which was computer generated by the trial statistician, was stratified by first-line or second-line ART and three weight bands. Dispersible 5 mg dolutegravir was dosed according to WHO weight bands. The primary outcome was the Kaplan-Meier estimated proportion of children with virological or clinical failure by 96 weeks, defined as: confirmed viral load of at least 400 copies per mL after week 36; absence of virological suppression by 24 weeks followed by a switch to second-line or third-line ART; all-cause death; or a new or recurrent WHO stage 4 or severe WHO stage 3 event. The primary outcome was assessed by intention to treat in all randomly assigned participants. A primary Bayesian analysis of the difference in the proportion of children meeting the primary outcome between treatment groups incorporated evidence from the higher weight cohort (≥14 kg) in a prior distribution. A frequentist analysis was also done of the lower weight cohort (<14 kg) alone. Safety analyses are presented for all randomly assigned children in this study (<14 kg cohort). ODYSSEY is registered with ClinicalTrials.gov, NCT02259127. Between July 5, 2018, and Aug 26, 2019, 85 children weighing less than 14 kg were randomly assigned to receive dolutegravir (n=42) or standard of care (n=43; 32 [74%] receiving protease inhibitor-based ART). Median age was 1·4 years (IQR 0·6-2·0) and median weight 8·1 kg (5·4-10·0). 72 (85%) children started first-line ART and 13 (15%) started second-line ART. Median follow-up was 124 weeks (112-137). By 96 weeks, treatment failure occurred in 12 children in the dolutegravir group (Kaplan-Meier estimated proportion 31%) versus 21 (48%) in the standard-of-care group. The Bayesian estimated difference in treatment failure (dolutegravir minus standard of care) was -10% (95% CI -19% to -2%; p=0·020), demonstrating superiority of dolutegravir. The frequentist estimated difference was -18% (-36% to 2%; p=0·057). 15 serious adverse events were reported in 11 (26%) children in the dolutegravir group, including two deaths, and 19 were reported in 11 (26%) children in the standard-of-care group, including four deaths (hazard ratio [HR] 1·08 [95% CI 0·47-2·49]; p=0·86). 36 adverse events of grade 3 or higher were reported in 19 (45%) children in the dolutegravir group, versus 34 events in 21 (49%) children in the standard-of-care group (HR 0·93 [0·50-1·74]; p=0·83). No events were considered related to dolutegravir. Dolutegravir-based ART was superior to standard of care (mainly protease inhibitor-based) with a lower risk of treatment failure in infants and young children, providing support for global dispersible dolutegravir roll-out for younger children and allowing alignment of adult and paediatric treatment. Paediatric European Network for Treatment of AIDS Foundation, ViiV Healthcare, UK Medical Research Council.