Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa

SUMMARYScale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage <5%) and 2013 (ART coverage 41%) at four public hospitals in rural Mopani District, South Africa. Data were obtained from TB registers and patients’ clinical records. There was a 13% decrease in overall number of TB cases, which was similar for cases registered as EPTB (n = 399 in 2009 vs. 336 in 2013; P < 0·01) and for PTB (1031 vs. 896; P < 0·01). Among EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P < 0·01), TB meningitis and TB of bones increased significantly (P < 0·01 and P = 0·02, respectively) and TB pleural effusion and lymphadenopathy remained the same. This study shows a reduction of EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.

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Human Immunodeficiency Virus (HIV) Infection, Antiretroviral Therapy (ART) Use and Access to Care for Diabetes and Hypertension in Agincourt, South Africa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw194.58 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Cited By ~ 1

Author(s):

Jennifer Manne-Goehler ◽

Livia Montana ◽

Xavier Gomez-Olive ◽

Julia Rohr ◽

Ryan Wagner ◽

...

Keyword(s):

South Africa ◽

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Access To Care ◽

Immunodeficiency Virus

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Noninfectious Comorbidity in the African Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy981 ◽

2018 ◽

Vol 69 (4) ◽

pp. 639-647 ◽

Cited By ~ 8

Author(s):

Julie A Ake ◽

Christina S Polyak ◽

Trevor A Crowell ◽

Francis Kiweewa ◽

Michael Semwogerere ◽

...

Keyword(s):

Renal Insufficiency ◽

Hiv Infection ◽

Scale Up ◽

Metabolic Complications ◽

Relative Risks ◽

Physical Laboratory ◽

Health Strategy ◽

Immunodeficiency Virus ◽

Neuropsychological Assessments ◽

Rich Countries

Abstract Background Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)–infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy. Methods At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants. Results Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22–1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27–1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13–1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06–1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency. Conclusions HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.

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Gynaecomastia, hyperprolactinaemia and HIV infection

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563054255542 ◽

2005 ◽

Vol 42 (4) ◽

pp. 301-303 ◽

Cited By ~ 1

Author(s):

Sashi Acharya ◽

J J Rufus Fernando ◽

Rousseau Gama

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Immune Reconstitution ◽

Serum Prolactin ◽

Diagnosis And Management ◽

Hypogonadotrophic Hypogonadism ◽

Immunodeficiency Virus ◽

Hiv Seropositive ◽

Endocrine Complications

Endocrine complications of human immunodeficiency virus (HIV) and its treatment are being increasingly recognized. We discuss the diagnosis and management of an HIV seropositive man who presented with bilateral gynaecomastia and 'hyperprolactinaemia' due to macroprolactin within six months of starting antiretroviral therapy. We suggest that the gynaecomastia may be a feature of immune reconstitution disease. Measurement of serum prolactin in the investigation of gynaecomastia should be reserved for those with hypogonadotrophic hypogonadism. Since macroprolactin contributes to circulating prolactin in HIV-seropositive subjects, hyperprolactinaemic samples in these patients should be tested for macroprolactin.

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Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands

International Journal of Molecular Sciences ◽

10.3390/ijms19092747 ◽

2018 ◽

Vol 19 (9) ◽

pp. 2747 ◽

Cited By ~ 1

Author(s):

Imran Nizamuddin ◽

Peter Koulen ◽

Carole McArthur

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Exocrine Function ◽

Lacrimal Glands ◽

Immunodeficiency Virus ◽

And Function ◽

The Impact

The structure and function of exocrine glands are negatively affected by human immunodeficiency virus (HIV) infection and its co-morbidities, including innate and adaptive immune responses. At the same time, exocrine function may also be influenced by pharmacotherapies directed at the infectious agents. Here, we briefly review the role of the salivary glands and lacrimal glands in normal physiology and exocrine pathogenesis within the context of HIV infection and acquired immune deficiency syndrome (AIDS), including the contribution of antiretroviral therapies on both. Subsequently, we discuss the impact of HIV infection and the types of antiretroviral therapy on disease management and therapy development efforts.

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Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a retrospective record review

BMC Public Health ◽

10.1186/s12889-019-7912-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Belisty Temesgen ◽

Getiye Dejenu Kibret ◽

Nakachew Mekonnen Alamirew ◽

Mamaru Wubale Melkamu ◽

Yitbarek Tenaw Hibstie ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Opportunistic Infections ◽

Preventive Therapy ◽

Hemoglobin Level ◽

Disease Stage ◽

Hiv Positive ◽

Immunodeficiency Virus ◽

Hiv Positive Adults ◽

Record Review

Abstract Background Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention.

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Primitive Neuroectodermal Tumor in a Child with Human Immunodeficiency Virus Infection: A Rare Association

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz034 ◽

2019 ◽

Author(s):

Aman Gupta ◽

Dharmagat Bhattarai ◽

Bishnu Kumar Thapa ◽

Mayur Parkhi ◽

Pandiarajan Vignesh ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Virus Infection ◽

Hiv Infection ◽

Primitive Neuroectodermal Tumor ◽

Neuroectodermal Tumor ◽

Rare Association ◽

Non Hodgkin Lymphoma ◽

Wide Range ◽

Immunodeficiency Virus

Abstract Children with human immunodeficiency virus (HIV) infection are reported to have various malignancies, most common being Non-Hodgkin lymphoma. Despite higher risk of malignancies, brain tumors are infrequently described in these children. We report Primitive Neuroectodermal tumor (PNET) in a young boy with HIV infection. PNET has never been described in association with HIV infection. Though a causative association cannot be established, it does emphasize that with longer survivals on effective antiretroviral therapy, we may see a wide range of malignancies more frequently.

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The Need for Pediatric Formulations to Treat Children with HIV

AIDS Research and Treatment ◽

10.1155/2016/1654938 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Adrienne F. Schlatter ◽

Andrew R. Deathe ◽

Rachel C. Vreeman

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Current Data ◽

Pediatric Hiv ◽

Art Adherence ◽

Pill Burden ◽

Immunodeficiency Virus ◽

Dosing Intervals ◽

Crucial Part

Over 3.2 million children worldwide are infected with HIV, but only 24% of these children receive antiretroviral therapy (ART). ART adherence among children is a crucial part of managing human-immunodeficiency virus (HIV) infection and extending the life and health of infected children. Important causes of poor adherence are formulation- and regimen-specific properties, including poor palatability, large pill burden, short dosing intervals, and the complex storage and transportation of drugs. This review aims to summarize the various regimen- and formulation-based barriers to ART adherence among children to support the need for new and innovative pediatric formulations for antiretroviral therapy (ART). Detailing the arguments both for and against investing in the development of pediatric HIV medications, as well as highlighting recent advances in pediatric ART formulation research, provides a synopsis of the current data related to pediatric ART formulations and adherence.

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