scholarly journals Hepatotoxicity and Liver-Related Mortality in Women of Childbearing Potential Living With Human Immunodeficiency Virus and High CD4 Cell Counts Initiating Efavirenz-Containing Regimens

2020 ◽  
Author(s):  
Debika Bhattacharya ◽  
Amita Gupta ◽  
Camlin Tierney ◽  
Sharon Huang ◽  
Marion G Peters ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Severe Hepatotoxicity ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Related Mortality

Abstract Background Severe hepatotoxicity in people with human immunodeficiency virus (HIV) receiving efavirenz (EFV) has been reported. We assessed the incidence and risk factors of hepatotoxicity in women of childbearing age initiating EFV-containing regimens. Methods In the Promoting Maternal and Infant Survival Everywhere (PROMISE) trial, ART-naive pregnant women with HIV and CD4 count ≥ 350 cells/μL and alanine aminotransferase ≤ 2.5 the upper limit of normal were randomized during the antepartum and postpartum periods to antiretroviral therapy (ART) strategies to assess HIV vertical transmission, safety, and maternal disease progression. Hepatotoxicity was defined per the Division of AIDS Toxicity Tables. Cox proportional hazards models were constructed with covariates including participant characteristics, ART regimens, and timing of EFV initiation. Results Among 3576 women, 2435 (68%) initiated EFV at a median 121.1 weeks post delivery. After EFV initiation, 2.5% (61/2435) had severe (grade 3 or higher) hepatotoxicity with an incidence of 2.3 (95% confidence interval [CI], 2.0–2.6) per 100 person-years. Events occurred between 1 and 132 weeks postpartum. Of those with severe hepatotoxicity, 8.2% (5/61) were symptomatic, and 3.3% (2/61) of those with severe hepatotoxicity died from EFV-related hepatotoxicity, 1 of whom was symptomatic. The incidence of liver-related mortality was 0.07 (95% CI, .06–.08) per 100 person-years. In multivariable analysis, older age was associated with severe hepatotoxicity (adjusted hazard ratio per 5 years, 1.35 [95% CI, 1.06–1.70]). Conclusions Severe hepatotoxicity after EFV initiation occurred in 2.5% of women and liver-related mortality occurred in 3% of those with severe hepatotoxicity. The occurrence of fatal events underscores the need for safer treatments for women of childbearing age.

scholarly journals Deaths Attributable to Cancer in the US Human Immunodeficiency Virus Population During 2001–2015

2020 ◽  
Author(s):  
Marie-Josèphe Horner ◽  
Meredith S Shiels ◽  
Ruth M Pfeiffer ◽  
Eric A Engels
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Kaposi Sarcoma ◽  
Cancer Registries ◽  
The United States ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Attributable Mortality ◽  
Immunodeficiency Virus ◽  
The Us

Abstract Background Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001–2015. Methods We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality, we could perhaps cut these words to accommodate the word limit. However readers will probably want to know what statistical adjustments were made to the model. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non–AIDS-defining cancers. Results Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non–AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001–2005 to 313.6 per 100 000 person-years during 2011–2015, while the PAF increased from 12.6% to 17.1%; the PAF for non–AIDS-defining cancers increased from 7.2% to 11.8% during 2011–2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non–AIDS-defining cancers. Conclusions Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non–AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality.

scholarly journals Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012–2017

2020 ◽  
Author(s):  
Ya-Lin A Huang ◽  
Guoyu Tao ◽  
Dawn K Smith ◽  
Karen W Hoover
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Female Sex ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. Methods We analyzed data from the IBM MarketScan Research Database to identify persons aged 18–64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence. Results We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [CI], 13.3–14.1), compared to 6.8 months (95% CI, 6.1–7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [HR], 1.81 [95% CI, 1.56–2.11]) and younger age (18–24 years: HR, 2.38 [95% CI, 2.11–2.69]) predicted nonpersistence. Conclusions More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.

HIV Testing of Infants Born to Infected Mothers

1993 ◽  
Vol 14 (1) ◽  
pp. 38-39
Keyword(s):  
Human Immunodeficiency Virus ◽  
Early Identification ◽  
Pneumocystis Carinii ◽  
Perinatal Transmission ◽  
The United States ◽  
Intravenous Drug Use ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Heterosexual Contact ◽  
Immunodeficiency Virus

The human immunodeficiency virus (HIV) increasingly is being spread through intravenous drug use and heterosexual contact, leading to higher rates of infection among women of childbearing age. As a result, perinatal transmission of the virus now accounts for more than 90% of HIV infection among preadolescent children in the United States. Current estimates suggest that 15% to 35% of infants born to HIV-infected women are themselves infected, either in utero or intrapartum. With the advent of treatment against HIV directly as well as against Pneumocystis carinii pneumonia prophylactically, early identification of those newborns who actually have been infected perinatally has become an issue of real consequence.

scholarly journals Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

2019 ◽  
Author(s):  
◽  
Elizabeth Chappell ◽  
Andrew Riordan ◽  
Gonzague Jourdain ◽  
Antoni Soriano-Arandes ◽  
...  
Keyword(s):  
Immune Response ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Multivariable Analysis ◽  
World Health ◽  
Severe Immunosuppression ◽  
Art Initiation ◽  
Cell Counts ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background In human immunodeficiency virus (HIV)–positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART. Methods Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status. Results Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001). Conclusions One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.

scholarly journals A Single Quantifiable Viral Load Is Predictive of Virological Failure in Human Immunodeficiency Virus (HIV)-Infected Patients on Combination Antiretroviral Therapy: The Austrian HIV Cohort Study

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Gisela Leierer ◽  
Katharina Grabmeier-Pfistershammer ◽  
Andrea Steuer ◽  
Mario Sarcletti ◽  
Maria Geit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Combination Antiretroviral Therapy ◽  
Limit Of Quantification ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background.  Viral loads (VLs) detectable at low levels are not uncommon in patients on combination antiretroviral therapy (cART). We investigated whether a single quantifiable VL predicted virological failure (VF). Methods.  We analyzed patients receiving standard regimens with at least 1 VL measurement below the limit of quantification (BLQ) in their treatment history. The first VL measurement after 6 months of unmodified cART served as baseline VL for the subsequent analyses of the time to reach single VL levels of ≥200, ≥400, and ≥1000 copies/mL. Roche TaqMan 2.0 was used to quantify human immunodeficiency virus-1 ribonucleic acid. Factors associated with VF were determined by Cox proportional hazards models. Results.  Of 1614 patients included in the study, 68, 44, and 34 experienced VF ≥200, ≥400, and ≥1000 copies/mL, respectively. In multivariable analyses, compared with patients who were BLQ, a detectable VL ≤ 50 and VL 51–199 copies/mL predicted VF ≥ 200 copies/mL (hazards ratio [HR] = 2.19, 95% confidence interval [CI] = 1.06–4.55 and HR = 4.21, 95% CI = 2.15–8.22, respectively). In those with VL 51–199 copies/mL, a trend for an increased risk of VF ≥400 and VF ≥1000 copies/mL could be found (HR = 2.13, 95% CI = 0.84–5.39 and HR = 2.52, 95% CI = 0.96–6.60, respectively). Conclusions.  These findings support closer monitoring and adherence counseling for patients with a single measurement of quantifiable VL &lt;200 copies/mL.

scholarly journals Gambaran Tingkat Pengetahuan Wanita Usia Subur Tentang HIV/AIDS di Wilayah Kerja Puskesmas Gurah Kabupaten Kediri

2021 ◽  
Vol 1 (1) ◽  
pp. 12-27
Author(s):  
Ratna Frenty Nurkhalim
Keyword(s):  
Human Immunodeficiency Virus ◽  
Health Workers ◽  
Signs And Symptoms ◽  
Total Sample ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Cross Sectional ◽  
Immunodeficiency Virus ◽  
Level Of Knowledge ◽  
Hiv Aids

HIV / AIDS is an infectious disease caused by infection with the Human Immunodeficiency Virus (HIV) which attacks the immune system. (RI Ministry of Health, 2017). The high case of HIV / AIDS in women is feared to have an impact on the increase in cases of HIV / AIDS in children who get from perinatal transmission or transmission of infections that occur during pregnancy or childbirth. Another contributing factor is the lack of knowledge and awareness about HIV / AIDS that has threatened ordinary people including women of childbearing age. This study aims to determine the level of knowledge of women of childbearing age about HIV / AIDS in the Gurah Health Center area of ​​Kediri Regency. The method used was cross-sectional by distributing questionnaires to a group of women of childbearing age with a total sample of 98 respondents. With variables including the characteristics of respondents and knowledge of HIV / AIDS. Based on the research results obtained for the most age at the end of adulthood (35.7%), the most education was high school / vocational school (62.2%), IRT work (65.3%), electronic media information sources (41.8%). While knowledge of HIV / AIDS was sufficient as much as 43.9%, knowledge about transmission is low (49.9%), knowledge of prevention about limiting sexual relations (70.4%), condom use (55.1%), knowledge of signs and symptoms of people appear healthy (73.5%) , knowledge of characteristics affected by HIV / AIDS (59.2%), knowledge of prevention of HIV / AIDS testing (54.1%), and place of testing services (53.1%). The conclusion that can be taken was the level of knowledge of women of childbearing age about HIV / AIDS was in the sufficient category and was expected to be further improved so that it becomes a high level by conducting counseling by health workers in the Puskesmas and other agencies.   HIV/AIDS merupakan penyakit menular yang disebabkan oleh infeksi Human Immunodeficiency Virus (HIV) yang menyerang sistem kekebalan tubuh. (Kemenkes RI, 2017). Tingginya kasus HIV/AIDS pada perempuan dikhawatirkan akan ikut berdampak pada peningkatan kasus HIV/AIDS pada anak-anak yang didapat dari penularan melalui perinatal atau penularan infeksi yang terjadi pada saat kehamilan atau persalinan. Faktor penyebab lainnya adalah kurangnya pengetahuan dan kesadaran tentang HIV/AIDS yang telah mengancam kalangan orang biasa termasuk wanita usia subur. Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan wanita usia subur tentang HIV/AIDS di wilayah Puskesmas Gurah Kabupaten Kediri. Metode yang digunakan adalah cross-sectional dengan menyebarkan kuesioner ke kelompok wanita usia subur dengan jumlah sampel sebanyak 98 responden. Dengan variabel meliputi karakteristik responden dan pengetahuan HIV/AIDS. Berdasarkan penelitian diperoleh hasil untuk usia terbanyak pada dewasa akhir (35.7%), pendidikan terbanyak yaitu SMA/SMK (62.2%), pekerjaan IRT (65.3%), sumber informasi media elektronik ( 41.8%). Sedangkan pengetahuan HIV/AIDS yaitu cukup sebanyak 43.9%, pengetahuan mengenai penularan yaitu rendah (49.9%), pengetahuan pencegahan tentang membatasi hubungan seksual (70.4%), pemakaian kondom (55.1%), pengetahuan tanda dan gejala orang tampak sehat (73.5%), pengetahuan ciri terkena HIV/AIDS (59.2%), pengetahuan penanggulangan adanya tes HIV/AIDS (54.1%), dan tempat pelayanan tes (53.1%). Simpulan yang dapat diambil adalah tingkat pengetahuan wanita usia subur tentang HIV/AIDS berada pada kategori cukup dan diharapkan dapat lebih ditingkatkan sehingga menjadi tingkatan yang tinggi dengan dilakukan penyuluhan oleh tenaga kesehatan yang ada di Puskesmas maupun instansi lainnya.

Cancer in human immunodeficiency virus-infected children: a case series from the Children's Cancer Group and the National Cancer Institute.

1998 ◽  
Vol 16 (5) ◽  
pp. 1729-1735 ◽  
Author(s):  
M O Granovsky ◽  
B U Mueller ◽  
H S Nicholson ◽  
P S Rosenberg ◽  
C S Rabkin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Cancer Diagnosis ◽  
National Cancer Institute ◽  
Death Rate ◽  
Proportional Hazards ◽  
Case Series ◽  
Cox Proportional Hazards ◽  
Cancer Group ◽  
Immunodeficiency Virus

PURPOSE To describe the spectrum of malignancies in human immunodeficiency virus (HIV)-infected children and the clinical outcome of patients with these tumors. METHODS We retrospectively surveyed the Children's Cancer Group (CCG) and the National Cancer Institute (NCI) for cases of cancer that occurred between July 1982 and February 1997 in children who were HIV seropositive before or at the time of cancer diagnosis. We used Kaplan-Meier survivorship curves, hazard function estimates, and Cox proportional hazards models to evaluate survival. RESULTS Sixty-four children (39 boys, 25 girls) with 65 tumors were reported. Thirty-seven children (58%) acquired HIV infection vertically (median age at cancer diagnosis, 4.3 years); 22 children (34%) acquired HIV through transfusion of blood or blood products (median age at cancer diagnosis, 13.4 years). Forty-two children (65%) had non-Hodgkin's lymphoma (NHL). Eleven children (17%) had leiomyosarcomas (or leiomyomas), which are otherwise exceptionally rare in children. Other malignancies included acute leukemia (five children), Kaposi's sarcoma (KS; three children), Hodgkin's disease (two children), vaginal carcinoma in situ (one child), and tracheal neuroendocrine carcinoma (one child). Median survival after NHL diagnosis was 6 months (range, 1 day to 89 months) and after leiomyosarcoma was 12 months (range, 10 days to 19 months). The average monthly death rate after NHL diagnosis was 12% in the first 6 months, which decreased to about 2% thereafter. In contrast, the monthly death rate after leiomyosarcoma diagnosis increased from 5% in the first 6 months to about 20% thereafter. CONCLUSION After NHL, leiomyosarcoma is the second leading cancer in children with HIV infection. Both cancers have high mortality rates; improved outcome for NHL, in particular, may depend on earlier diagnosis and therapy.

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