Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals

2019 ◽  
Author(s):  
A Corma-Gómez ◽  
J Macías ◽  
F Téllez ◽  
C Freyre-Carrillo ◽  
L Morano ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Liver Stiffness ◽  
People Living With Hiv ◽  
Advanced Fibrosis ◽  
Immunodeficiency Virus ◽  
Class B ◽  
Direct Acting ◽  
Living With Hiv ◽  
Liver Complication ◽  
Time Point

Abstract Background Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA). Methods In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR. Results During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant. Conclusions LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.

scholarly journals Clinical Pharmacology of Hyperammonemia by Sodium Valproate and Carbamazepine in People Living with HIV

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 143-143
Author(s):  
Martin J. Mazzoglio y Nabar ◽  
Santiago Muñoz ◽  
Milagros Muñiz ◽  
Alexis Mejías ◽  
Christian Montivero ◽  
...  
Keyword(s):  
Valproic Acid ◽  
People Living With Hiv ◽  
Preventive Control ◽  
Decompensated Liver Disease ◽  
Viral Loads ◽  
Daily Life Activities ◽  
Psychopharmacological Treatment ◽  
Immunodeficiency Virus ◽  
Cirrhotic Patients ◽  
Living With Hiv

AbstractIntroductionHyperammonaemia (HA) is observed in decompensated liver disease. The picture of hyperammonemic encephalopathy in non-cirrhotic patients was reported mostly associated with valproic acid. There are few reports of hyperammonemia in people living with human immunodeficiency virus (PLHIV) and they are associated with other comorbidities and few with antiretrovirals (HAART), but not as adverse drug reactions associated with psychotropic drugs associated with the virus.ObjectiveReport of cases of PLHIV in HARRT with hyperammonemia, its clinical impact and ammonium levels.Materials and MethodsWe report 67 PLHIV in treatment with HAART, negative viral loads, psychopharmacological treatment with valproic acid (n=45) or carbamazepine (n=22). Exclusion criteria were = HCV, HBV and alcohol consumption disorder (current or recent history) and decompensated liver pathology. We apply scales to evaluate side effects (UKU), subjective adherence (DAI), daily life activities (Barthel Index), liver severity (Child-Pugh Classification) and degrees of hepatic encephalopathy (West Haven Scale). The ethical-legal requirements were met. Results: 26.86% presented hyperammonemia, among which 38.88% was symptomatic. The clinical presentation was heterogeneous with a higher prevalence of gastrointestinal and cognitive alterations; the most severe cases presented alterations of the sensorium and 1 case of convulsions. We recorded a greater symptomatic severity with carbamazepine (average ammonia =104.4 pmol/L), but a higher prevalence of non-symptomatic hyperammonemia with valproic acid (62.3 pmol/L). The time of onset of symptoms was lower with carbamazepine, but the time until its decrease was higher with valproic acid.ConclusionsWe observed a higher prevalence of hyperammonemia and associated symptomatology in PLHIV with HAART medicated with carbamazepine. The significant percentage of this adverse drug reaction suggests a biochemical, perhaps preventive, control.

scholarly journals Survival analysis of people living with human immunodeficiency virus: a study in a teaching hospital

2020 ◽  
Vol 7 (9) ◽  
pp. 1339
Author(s):  
S. Bhagyabati Devi ◽  
T. Jeetenkumar Singh ◽  
Kshetrimayum Birendra Singh ◽  
N. Biplab Singh ◽  
Robinson Ningshen ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
People Living With Hiv ◽  
Good Adherence ◽  
National Programme ◽  
Immunodeficiency Virus ◽  
Centre Of Excellence ◽  
High Incidence ◽  
Good Nutrition ◽  
Living With Hiv

Background: Antiretroviral therapy (ART) have changed the outlook of people living with HIV (PLHIV) by transforming the dreaded infection to a chronically manageable disease. However, there is scant of reports which analyses quantitatively the survival benefit of PLHIV under ART. Objectives of this study were to determine the survival time of adult PLHIV who are on ARV. To analyse the factors determining survival outcome of PLHIV on ARV.Methods: This was an observational study in centre of excellence (COE) ART Centre, RIMS, Imphal from April 2004 to December 2009. Details from the data entered in documents of the ART programme were followed up every 3 months for 60 months from the date of initiation of ARV. All PLHIV above 18 years of age and undergoing antiretroviral therapy were included.Results: Survival rate following initiation of ARV was found to be significantly high among PLHIV. Higher CD4 count at the time of ARV initiation had better prognosis. Mortality was high among IDUs and they had high incidence of co-infections with HCV and HBV. The currently available ARV drugs under NACO programme have better suppression of HIV, are less toxic, low pill burden. The combined regimen used in the earlier days were not much inferior to the current ARV drugs if initiated timely with proper prophylaxis of OIs, good adherence, good nutrition and timely management of toxicities and IRIS.Conclusions: Timely treatment with ARV drugs provided under the national programme with good adherence and regular follow-up improves the survival of PLHIV.  

scholarly journals Call For Life, Uganda: Acceptability Of A Mobile Phone Support To Promote Adherence To Anti-Retroviral Therapy For Young Adults In A Randomised Control Trial: A Qualitative Review (Preprint)

2019 ◽  
Author(s):  
Agnes Bwanika Naggirinya
Keyword(s):  
Human Immunodeficiency Virus ◽  
Young Adults ◽  
Mobile Phone ◽  
Interactive Voice Response ◽  
Text Messages ◽  
Randomised Control Trial ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Immunodeficiency Virus ◽  
Living With Hiv

BACKGROUND : Adherence to treatment is critical to obtain successful treatment outcomes. While factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere because of psychosocial issues such as stigma, ART-related side effects as well as lack of access to treatment. Call for Life mHealth tool (C4LU), is a mobile phone- based technology that provides text messages or Interactive Voice Response (IVR) functionalities, through a web-interface and offers four modules including pill reminders, clinic visit reminders, health tips and symptom self-reporting support. Within a randomised control trial, we assessed perspectives and experiences of young adults living with human immunodeficiency virus towards the C4LU- system, with the objective to improve ART adherence among young people living with HIV with help of mHealth tool. OBJECTIVE To improve ART adherence among young people living with HIV through use of mHealth tool. METHODS This was an exploratory qualitative design at two study sites nested within an open label randomized controlled trial (RCT) entitled: “Improving outcomes in human immunodeficiency virus (HIV) patients using mobile phone based interactive software support “Call for Life study A total of 600 participants were randomly assigned 1:1 to either Standard of Care (SoC)- face-to-face counsellor adherence support or SoC plus mHealth call for life system (C4LU). C4LU uses Interactive voice response or text messages delivered via mobile phone. The qualitative study explored perspectives and experiences of young adults (18-24 years) towards the mHealth tool “C4LU”. A purposive sample of twenty-one vulnerable youth, seventeen from the intervention and four from the SoC arm were selected. We used semi-structured interviews to facilitate an in-depth exploration of experiences of young adults regarding C4LU-System. Thirteen in-depth interviews and one focus group discussion were conducted. The young adults were from four categories of population of interest that were targeted to be offered specialised care: young adults on PMTCT, switching to / or on second line ART, positive partners in a discordant relationship and initiating 1st line ART. Data was managed using Nvivo version 11 and analysed thematically. RESULTS C4LU-mHealth tool was perceived as an acceptable intervention for young adults. While on the system, participants reported: improvement in medication adherence, strengthened doctor /clinician -patient relationships, increased health knowledge through educative health tips. Appointment reminders and symptom reporting were singled out as beneficial because the system would address and manage the problems of forgetfulness, and stigma related issues. CONCLUSIONS The system was described as an acceptable and feasible strategy to improve ART adherence and retention among young adults in resource limited settings CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT 02953080

scholarly journals Status Karies Gigi pada Pengidap HIV/AIDS

e-GIGI ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 261
Author(s):  
Michael J. Sundah ◽  
Christy N. Mintjelungan ◽  
Damajanty H. C. Pangemanan
Keyword(s):  
Dental Caries ◽  
Immune Deficiency Syndrome ◽  
Salivary Flow ◽  
Deficiency Syndrome ◽  
People Living With Hiv ◽  
Human Immune System ◽  
Immunodeficiency Virus ◽  
High Prevalence ◽  
Living With Hiv ◽  
Hiv Aids

Abstract: Human immunodeficiency virus (HIV) is a virus that attacks the human immune system, especially white blood cells called CD4 cells. Meanwhile, acquired immune deficiency syndrome (AIDS) is a syndrome that arises due to the decline in the human immune system caused by HIV infection. Several studies showed that people living with HIV/AIDS had a higher risk of developing dental caries compared to those without HIV/AIDS. Maintenance of oral hygiene, consumption of antiretroviral (ARV) drugs, and low salivary flow play a role in increasing the risk of caries in people living with HIV/AIDS. This study was aimed to determine the status of dental caries in people living with HIV/AIDS. This was a literature review using the databases of Google Scholar, PubMed, and Clinical Key. The results obtained five journals that were relevant to the topic of discussion. There was a high prevalence of caries in people with HIV/AIDS (56.78%-78.7%) and a higher average caries status (12.83±9.6, 15.14±6.09, and 11.87±8.08) compared to those without HIV/AIDS. The high prevalence of caries in people with HIV/AIDS was influenced by decreased salivary flow, use of ARVs, consumption of sweet foods, and lack of oral hygiene. In conclusion, the prevalence of caries in people living with HIV/AIDS was high.Keywords: dental caries, HIV/AIDS  Abstrak: Human immunodeficiency virus (HIV) adalah virus yang menyerang sistem kekebalan tubuh manusia kususnya sel darah putih yang disebut sel CD4 sedangkan acquired immune deficiency syndrome (AIDS) merupakan sindrom yang muncul akibat menurunnya sistem kekebalan tubuh manusia yang diakibatkan infeksi HIV. Beberapa penelitian menunjukkan bahwa pengidap HIV/AIDS berisiko lebih tinggi mengalami karies gigi dibandingkan dengan orang tanpa HIV/AIDS. Pemeliharaan kebersihan gigi mulut, konsumsi obat antiretroviral (ARV), dan aliran saliva yang rendah berperan dalam peningkatan risiko karies gigi pada pengidap HIV/AIDS. Penelitian ini bertujuan untuk mengetahui status karies gigi pada pengidap HIV/AIDS. Jenis penelitian ialah suatu literature review. Database yang digunakan untuk pencarian literatur ialah Google Scholar, PubMed, dan Clinical Key. Hasil penelitian mendapatkan prevalensi karies yang tinggi pada pengidap HIV/AIDS (56,78%-78,7%) dan rerata status karies lebih tinggi (12,83±9,6, 15,14±6,09, dan 11,87±8,08) dibandingkan dengan yang tanpa HIV/AIDS. Tingginya prevalensi karies pada pengidap HIV/AIDS dipengaruhi oleh penurunan laju aliran saliva, penggunaan ARV, konsumsi makanan manis, dan kurangnya menjaga kebersihan gigi mulut. Simpulan penelitian ini ialah prevalensi karies pada pengidap HIV/AIDS tergolong tinggi.Kata kunci: karies gigi, HIV/AIDS

scholarly journals A Four-Year Hospital-Based Retrospective Study of the Predictors of Tuberculosis in People Living with HIV and Receiving Care at Bamenda Regional Hospital, Cameroon

2020 ◽  
Vol 9 (2) ◽  
pp. 167-172
Author(s):  
Cho Sabastine Anye ◽  
Claude Ngwayu Nkfusai ◽  
Brenda Mbouamba Yankam ◽  
Frankline Sevidzem Wirsiy ◽  
Joyce Mahlako Tsoka-Gwegweni ◽  
...  
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Descriptive Analysis ◽  
Healthcare Systems ◽  
Regional Hospital ◽  
People Living With Hiv ◽  
Mycobacterium Tuberculosis Infection ◽  
Immunodeficiency Virus ◽  
Latent Tb ◽  
Living With Hiv

Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infections place immense burdens on healthcare systems with particularly diagnostic and therapeutic challenges. TB is high among opportunistic diseases and the most leading cause of death among patients with HIV/AIDS. HIV infection is the most-known risk factor for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation by 20-fold. We present a four-year descriptive analysis of TB in people living with HIV in the Bamenda Regional Hospital (BRH) from 2012-2016. Methods: This was a hospital-based descriptive chart review. We conducted manual reviews of medical records of HIV/TB co-infected patients from June 2017-July 2017 at BRH

Emerging prevalence of fatty liver disease in HIV

2021 ◽  
Vol 16 (1) ◽  
pp. 59-73
Author(s):  
Amreen Dinani ◽  
Ali Khan ◽  
Douglas Dieterich
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Unmet Need ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nonalcoholic Fatty Liver ◽  
Infected People ◽  
Direct Acting ◽  
Living With Hiv

Fatty liver disease is a growing concern in people living with HIV, the main drivers are alcoholic liver disease and nonalcoholic fatty liver disease. It has shown to negatively impact HIV care continuum and result in notable non-HIV related morbidity and mortality. With the advancement in antiretroviral therapy and effective direct acting antivirals, fatty liver disease is surfacing as the next big challenge in this population like that observed in the general population. This review article summarizes the gravity of these two common diseases in HIV-infected people and aims to sheds light on an unmet need to develop effective methods to identify, screen and manage fatty liver disease in this unique population.

scholarly journals 355. Barriers for Hepatitis C Elimination in HIV/HCV Coinfected Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S187-S187
Author(s):  
Joe Espinoza ◽  
Karen J Vigil ◽  
Ben Barnett
Keyword(s):  
Hepatitis C ◽  
Open Access ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Active Intervention ◽  
Key Stakeholders ◽  
Wide Availability ◽  
Direct Acting ◽  
Treatment Use ◽  
Living With Hiv

Abstract Background Approximately 30% of people living with HIV are co-infected with Hepatitis C virus (HCV). HIV/HCV coinfected patients have faster progression to liver fibrosis, cirrhosis, and increased mortality, compared with monoinfected patients. Therefore, treatment in this population is a priority. The objective of this study was to develop an active program to reach HIV/HCV co-infected patients, with the goal to eliminate Hepatitis C in our local HIV clinic. Methods Beginning in December 2016, our clinic received State funds to support open access to treat HIV/HCV patients with direct-acting antivirals (DAA). From December 2016 to May 2018, the process was based on primarily on physician referrals to treat HIV/HCV patients at our clinic, without an active intervention, and 50 patients were treated. Our active intervention during the second part was based on the identification of all untreated HIV/HCV patients and contacting them directly, to link them to care. Results A total of 462 HIV/HCV co-infected patients were identified who qualified for the state-sponsored treatment program. From June 1, 2018 to July 31, 2018, only 7 patients were linked to care and started on DAA. The four main identified reasons for not getting DAA therapy were: no show up to the clinic appointments, poor adherence to their HIV antiretroviral treatment, use of drugs and not able to be reached (figure). Although drug use was listed as one of the main reasons for not receiving DAA therapy, it was not the defining reason for most patients. A majority of the patients had more than one obstacle preventing them from coming in to be treated. Conclusion Wide availability of DAA and open access to treatment is not enough to eliminate HIV/HCV co-infection. Innovative outreach processes with the active participation of key stakeholders are needed in order to eliminate this viral infection. Disclosures All authors: No reported disclosures.

scholarly journals Two diseases, same person: moving toward a combined HIV and tuberculosis continuum of care

2018 ◽  
Vol 29 (9) ◽  
pp. 873-883 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Treatment Success ◽  
World Health ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Tb Treatment ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Living With Hiv

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.

scholarly journals Low hepatitis C virus reinfection rate despite ongoing risk following universal access to direct-acting antiviral therapy among people living with HIV

AIDS ◽  
2020 ◽  
Vol 34 (9) ◽  
pp. 1347-1358
Author(s):  
Samira Hosseini-Hooshyar ◽  
Marianne Martinello ◽  
Jasmine Yee ◽  
Phillip Read ◽  
David Baker ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Universal Access ◽  
People Living With Hiv ◽  
Reinfection Rate ◽  
Direct Acting Antiviral ◽  
Direct Acting ◽  
Living With Hiv

HIV infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected-patients with advanced fibrosis

2020 ◽  
Author(s):  
A Corma-Gómez ◽  
J Macías ◽  
J R Lacalle-Remigio ◽  
F Téllez ◽  
L Morano ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hiv Infection ◽  
Sustained Virological Response ◽  
Virological Response ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Liver Stiffness ◽  
Advanced Fibrosis ◽  
Direct Acting ◽  
The Impact

Abstract Background The aim of this study was to assess the impact of HIV infection on the risk of developing hepatocellular carcinoma (HCC) in HCV-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). Methods Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: 1) SVR with DAA-based combination; 2) Liver stiffness (LS) ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. Results 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1-Q3) follow-up time of 43 (31-49) months, 19 (1.8%) patients developed HCC [11 (3.0%) HCV-monoinfected, 8(1.2%) HIV/HCV-coinfected individuals; p=0.013]. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC [sHR=0.27, 95% IC (0.08-0.90); p=0.034]. Predictors of HCC emergence were: HCV genotype 3 [sHR=7.9 (2.5-24.9); p<0.001], MELD score at SVR>10 [sHR=1.37 (1.01-1.86); p=0.043] and LS value at SVR [sHR=1.03 (1.01-1.06) for 1 kPa increase; p=0.011]. Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC [powered HR=0.33 (0.11-0.85)]. Conclusions Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV-coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.

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