scholarly journals No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL

2021 ◽  
Vol 24 (6) ◽  
Author(s):  
Andrew Atkinson ◽  
Jose M. Miro ◽  
Amanda Mocroft ◽  
Peter Reiss ◽  
Ole Kirk ◽  
...  
Keyword(s):  
Cell Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

scholarly journals The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY

2020 ◽  
pp. 68-71
Author(s):  
NOVIANA JOENPUTRI ◽  
KETUT SURYANA
Keyword(s):  
Retrospective Study ◽  
Marital Status ◽  
Cell Count ◽  
Associated Factors ◽  
Opportunistic Infections ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Highly Active ◽  
Living With Hiv ◽  
Cd4 Cell

Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali. Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients. Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively. Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.

scholarly journals CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV

AIDS ◽  
2020 ◽  
Vol 34 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Lelia H. Chaisson ◽  
Valeria Saraceni ◽  
Silvia Cohn ◽  
Dena Seabrook ◽  
Solange C. Cavalcante ◽  
...  
Keyword(s):  
Cell Count ◽  
Preventive Therapy ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

Progressive phasing out of baseline CD4 cell count testing for people living with HIV in Kinshasa, DRC

AIDS ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nadine Mayasi Ngongo ◽  
Hippolyte Situakibanza Nani-Tuma ◽  
Marcel Mbula Mambimbi ◽  
Murielle Longokolo Mashi ◽  
Ben Bepouka Izizag ◽  
...  
Keyword(s):  
Cell Count ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

scholarly journals A comparative study: long and short term effect of a nutrition sensitive approach to delay the progression of HIV to AIDS among people living with HIV (PLWH) in Nigeria

2016 ◽  
Vol 6 (2) ◽  
pp. 79
Author(s):  
Abraham Mainaji Amlogu ◽  
Sundus Tewfik ◽  
Charles Wambebe ◽  
Ihab Tewfik
Keyword(s):  
Cell Count ◽  
Negative Impact ◽  
Scale Up ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Biochemical Indices ◽  
Nutrition Sensitive ◽  
Living With Hiv ◽  
Cd4 Cell

ABSTRACTBackground: Malnutrition has a negative impact on optimal immune function, thus increasing susceptibility to morbidity and mortality among HIV positive patients. Evidence indicates that the prevalence of macro and micronutrient deficiencies (particularly magnesium, selenium, zinc, and vitamin C) has a negative impact on optimal immune function, through the progressive depletion of CD4 T-lymphocyte cells, which thereby increases susceptibility to morbidity and mortality among PLWH. Objective: To assess the effectiveness of a nutrition sensitive intervention to delay the progression of human immune-deficiency virus (HIV) to AIDS among people living with HIV in Abuja, Nigeria.Methods: A randomised control trial was carried out on 400 PLWH (adult, male and female of different religious background) in Abuja, Nigeria between January and December, 2012. Out of these 400 participants, 100 were randomly selected for the six months pilot study (January to June, 2012). The participants in the pilot study overlapped to form part of the scale-up participants (n 400) monitored from June to December, 2012. The comparative effect of daily consumed 354.92 kcal/d optimised meal for six and twelve months was ascertained through the nutritional status and biochemical indices of the study participants (n 100 pilot and n 400 scale-up interventions) who were/were not taking the intervention meal. The meal consisted of: Glycine max 50g; Pennisetum americanum 20g; Moringa oleifera 15g; Daucus carota spp.sativa 15g.Results: At the end of six months of the scale-up intervention, mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 6.31% and 12.12% respectively. Mean mid upper arm circumference (MUAC) for Pre-ART and ART Test groups increased by 2.72% and 2.52% within the same period (n 400). Comparatively, participants who overlapped from pilot to scale-up intervention (Long term use, n 100) were assessed for 12 months. Mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 2.21% and 12.14%. Mean MUAC for Pre-ART and ART Test groups increased by 2.08% and 3.95% respectively. Moreover, Student’s t-test analysis suggests a strong association between the intervention meal,  MUAC and CD4 count on long term use of optimised meal in the group of participants on antiretroviral therapy (ART) (P<0.05). Conclusion: Although the achieved results take the form of specific technology, it suggests that a prolong consumption of the intervention meal will be suitable to sustain the gained improvements in the anthropometric and biochemical indices of PLWHIV in Nigeria. Keywords: HIV; AIDS; Nutrition-sensitive approach; CD4 cell count; Macro and Micronutrients; ART; Tailored Functional Recipe - TFR.

scholarly journals The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons

2019 ◽  
Vol 30 (13) ◽  
pp. 1257-1264 ◽  
Author(s):  
Nima Ghalehkhani ◽  
Behnam Farhoudi ◽  
Mohammad Mehdi Gouya ◽  
Hamid Sharifi ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Cell Count ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Treatment Cascade ◽  
Cascade Analysis ◽  
Hiv Treatment Cascade ◽  
Living With Hiv ◽  
Cd4 Cell

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

scholarly journals Immunologic Restoration of People Living with Human Immunodeficiency Virus on Highly Active Anti-retroviral Therapy in Ethiopia: The Focus of Chronic Non-Communicable Disease Co-Morbidities

2019 ◽  
Vol 13 (1) ◽  
pp. 36-48 ◽  
Author(s):  
Tsegaye Melaku ◽  
Girma Mamo ◽  
Legese Chelkeba ◽  
Tesfahun Chanie
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Highly Active Antiretroviral Therapy ◽  
Communicable Disease ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Highly Active ◽  
Living With Hiv ◽  
Cd4 Cell ◽  
Non Communicable Disease

Background: The life expectancy of people living with Human Immunodeficiency Virus (HIV) has dramatically improved with the much-increased access to antiretroviral therapy. Consequently, a larger number of people living with HIV are living longer and facing the increased burden of non-communicable diseases. This study assessed the effect of chronic non-communicable disease(s) and co-morbidities on the immunologic restoration of HIV infected patients on highly active antiretroviral therapy. Methods: A nested case-control study was conducted among people living with HIV at Jimma University Medical Center from February 20 to August 20, 2016. Cases were HIV infected patients living with chronic non-communicable diseases and controls were people living with HIV only. Patient-specific data were collected using a structured data collection tool to identify relevant information. Data were analyzed using the Statistical Package for Social Science version 20.0. Logistic regressions were used to identify factors associated with outcome. Statistical significance was considered at p-value <0.05. A patient's written informed consent was obtained after explaining the purpose of the study. Results: A total of 240 participants (120 cases and 120 controls) were included in the analysis. Prevalence of hypertension was 12.50%, and diabetes was 10.84%. About 10.42% of study participants were living with multi-morbidity. At baseline, the mean (±SD) age of cases was 42.32±10.69 years, whereas it was 38.41±8.23 years among controls. The median baseline CD4+ cell count was 184.50 cells/µL (IQR: 98.50 - 284.00 cells/µL) for cases and 177.0 cells/µL (IQR: 103.75 - 257.25 cells/µL) for controls. Post-6-months of highly active antiretroviral therapy initiation, about 29.17% of cases and 16.67% of controls had poor immunologic restoration. An average increase of CD4+ cell count was 6.4cells/µL per month among cases and 7.6 cells/µL per month among controls. Male sex [AOR, 3.51; 95% CI, 1.496 to 8.24; p=0.004], smoking history [AOR, 2.81; 95% CI, 1.072, to 7.342; p=0.036] and co-morbidity with chronic non-communicable disease(s) [AOR, 3.99; 95% CI, 1.604 to 9.916; p=0.003)] were independent predictors of poor immunologic restoration. Conclusions: Chronic non-communicable disease(s) have negative effects on the kinetics of CD4+ cell count among HIV-infected patients who initiated antiretroviral therapy. So the integration of chronic non-communicable disease-HIV collaborative activities will strengthen battle to control the double burden of chronic illnesses.

scholarly journals Estimating Optimal Dynamic Treatment Strategies Under Resource Constraints Using Dynamic Marginal Structural Models

2019 ◽  
Author(s):  
Ellen Caniglia ◽  
Eleanor Murray ◽  
Miguel Hernan ◽  
Zach Shahn
Keyword(s):  
Cell Count ◽  
Resource Constraints ◽  
Resource Constraint ◽  
People Living With Hiv ◽  
Resource Usage ◽  
Monitoring Strategy ◽  
Cd4 Cell Count ◽  
Optimal Dynamic ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Background: Existing methods for estimating the optimal treatment or monitoring strategy typically assume unlimited access to resources. However, when a health system has resource constraints, such as limited funds, access to medication, or monitoring capabilities, medical decisions must balance impacts on both individual and population health outcomes. That is, decisions should account for competition between individuals in resource usage. A simple solution is to estimate the (counterfactual) resource usage under the possible interventions and choose the optimal strategy for which resource usage is within acceptable limits. Methods: We propose a method to identify the optimal dynamic intervention strategy that leads to the best expected health outcome accounting for a health system's resource constraints. We then apply this method to determine the optimal dynamic monitoring strategy for people living with HIV when resource limits on monitoring exist using observational data from the HIV-CAUSAL Collaboration. In our example, we identify the optimal CD4 cell count at which to decrease monitoring frequency from every 3-6 months to every 9-12 months among the subset of strategies that satisfy a hypothetical constraint on monitoring. We find the resource constrained dynamic strategy (RCDS) that minimizes the risk of virologic failure given a hypothetical resource constraint where individuals can only be monitored on average every 6 months. Results: Given the hypothetical resource constraint, the optimal monitoring strategy is "monitor CD4 cell count and HIV-RNA every 3-6 months when CD4 is below 320 cells/ml and every 9-12 months when CD4 is above 320 cells/ml." Conclusions: We describe and and apply a method to identify the optimal RCDS given a hypothetical resource constraint. Similar applications may be useful in settings with limited availability of or capacity for monitoring individuals living with HIV or other chronic diseases.

scholarly journals Dietary Components and Metabolites Are Associated with Liver Fibrosis in People Living with HIV (PLWH) in the MASH cohort

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1574-1574
Author(s):  
Haley Martin ◽  
Sabrina Sales Martinez ◽  
Vitalii Stebliankin ◽  
Javier Tamargo ◽  
Adriana Campa ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Cell Count ◽  
Disease Progression ◽  
Plant Protein ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Cd4 Cell Count ◽  
Dietary Components ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Objectives Distinct dietary components and microbiome metabolites may affect liver disease progression, a common comorbidity among people living with HIV (PLWH). Similarly, diet composition, including micronutrients, have been associated with markers of HIV disease progression (CD4 cell count). The objective of this study was to investigate the associations between dietary components, plasma metabolites, and liver fibrosis in PLWH. Methods A cross-sectional pilot study that enrolled 50 PLWH on antiretroviral therapy from the Miami Adult Studies on HIV (MASH) cohort. Diet quality was measured with the USDA Healthy Eating Index (HEI) and liver fibrosis was measured via the Fibrosis-4 Index (FIB-4). Microbiome metabolites were measured from plasma samples via metabolomics-non-targeted gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Statistical analysis included T-test, Chi-square, Spearman correlation, and Partial Least Squares Discriminant Analysis (PLS-DA). Results The participants’ mean age was 55 ± 6.81, 58% were male, and 68% were African Americans. FIB-4 and HEI seafood/plant protein score were inversely correlated (rho = -0.320, P = 0.022). There were also trends towards significance between CD4 cell count and seafood/plant protein score (rho = 0.251; P = 0.078), and CD4 cell count and greens/beans HEI score (rho = 0.269; P = 0.059). Microbiome metabolites that differed between the high and the low FIB-4 group using PLS-DA included 3-methylhistidine and phosphatidylcholine (PC) metabolites, often associated with meat consumption. Conclusions Lower liver fibrosis and higher CD4 cell count, a measure of HIV disease progression, were associated with consumption of foods typically high in micronutrients and fiber (seafood, plant protein, greens, and beans) in PLWH. Additionally, higher levels of 3-methylhistidine and PC metabolites, biomarkers associated with higher meat intake, were associated with higher liver fibrosis scores. These relationships confirm similar findings in the literature. Higher meat and lower vegetable intake are known risk factors for liver disease. These findings may provide the basis for larger studies and potential targets for dietary intervention in this population. Funding Sources National Institute on Drug Abuse and National Institute on Minority Health and Health Disparities.

scholarly journals Estimating Optimal Dynamic Treatment Strategies Under Resource Constraints Using Dynamic Marginal Structural Models

2019 ◽  
Author(s):  
Ellen Caniglia ◽  
Eleanor Murray ◽  
Miguel Hernan ◽  
Zach Shahn
Keyword(s):  
Cell Count ◽  
Resource Constraints ◽  
Resource Constraint ◽  
People Living With Hiv ◽  
Resource Usage ◽  
Monitoring Strategy ◽  
Cd4 Cell Count ◽  
Optimal Dynamic ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Background: Existing methods for estimating the optimal treatment or monitoring strategy typically assume unlimited access to resources. However, when a health system has resource constraints, such as limited funds, access to medication, or monitoring capabilities, medical decisions must balance impacts on both individual and population health outcomes. That is, decisions should account for competition between individuals in resource usage. A simple solution is to estimate the (counterfactual) resource usage under the possible interventions and choose the optimal strategy for which resource usage is within acceptable limits. Methods: We propose a method to identify the optimal dynamic intervention strategy that leads to the best expected health outcome accounting for a health system's resource constraints. We then apply this method to determine the optimal dynamic monitoring strategy for people living with HIV when resource limits on monitoring exist using observational data from the HIV-CAUSAL Collaboration. In our example, we identify the optimal CD4 cell count at which to decrease monitoring frequency from every 3-6 months to every 9-12 months among the subset of strategies that satisfy a hypothetical constraint on monitoring. We find the resource constrained dynamic strategy (RCDS) that minimizes the risk of virologic failure given a hypothetical resource constraint where individuals can only be monitored on average every 6 months. Results: Given the hypothetical resource constraint, the optimal monitoring strategy is `monitor CD4 cell count and HIV-RNA every 3-6 months when CD4 is below 320 cells/ml and every 9-12 months when CD4 is above 320 cells/ml.' Conclusions: We describe and and apply a method to identify the optimal RCDS given a hypothetical resource constraint. Similar applications may be useful in settings with limited availability of or capacity for monitoring individuals living with HIV or other chronic diseases.

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