1038. Rapid Start: A Changing Algorithm for the Management of HIV Infection

Abstract Background Initiating combination antiretroviral therapy (cART) as early as the day of HIV diagnosis is a strategy of increasing interest to control the HIV epidemic and optimize the health of people living with HIV. Pilot studies have shown that starting cART immediately after diagnosis has led to earlier linkage to care and HIV-1 RNA suppression. However, there is some evidence from observational studies that starting cART on the same day as HIV diagnosis may increase the risk of loss to follow-up. Consequently, there is a need for additional data for immediate cART initiation. Methods A Retrospective cohort study was conducted from 2016 to 2018 to identify clinical characteristics and risk factors in patients that were diagnosed with HIV-1 with a 4th generation assay using electronic medical records. Rapid start was defined as offering cART prior to or on the first clinic visit. Categorical variables were analyzed using chi-sq test and continuous variables were analyzed using t-test. Data analysis was done using SAS 9.4. Results In the study period, 188 patients were identified as HIV-1 positive and cART naïve: 152 males and 34 females. Risk factors included men who have sex with men (N = 86), heterosexual transmission (N = 88), intravenous drug use (N = 18) and multiple partners (N = 15). Of the 188 patients, 40 patients were rapidly started on cART on average within 6 days of diagnosis vs 42 days in the standard of care patients (P > 0.0001), with a shorter duration to clinic follow up over time (P = 0.3103). 50% patients that were rapid started on cART maintained an undetectable viral load vs 77% of the standard of care group (P = 0.3174). 90% of the rapid start patients were retained in care at 12 months vs 78% of the standard of care patients (P = 0.4950). 126 patients were started on single tablet regimens (P = 0.0001) with a trend favoring bictegravir, emtricitabine & tenofovir alafenamide (P = 0.0001). Conclusion Our study adds to the growing data that rapid ART initiation within seven days of HIV diagnosis could reduce loss to follow-up, improve virological suppression rates, and reduce mortality. The percentage of patients with undetectable HIV-1 viral load and retained in care was comparable to that in standard of care, indicating that starting cART immediately after diagnosis was well accepted by patients. Disclosures Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

AIDS Research and Therapy ◽

10.1186/s12981-021-00336-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anita Mesic ◽

Alexander Spina ◽

Htay Thet Mar ◽

Phone Thit ◽

Tom Decroo ◽

...

Keyword(s):

Viral Load ◽

Virological Failure ◽

Antiretroviral Treatment ◽

People Living With Hiv ◽

First Line ◽

Hiv Viral Load ◽

Loss To Follow Up ◽

History Of ◽

Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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Risk factors for loss to follow-up, transfer or death among people living with HIV on their first antiretroviral therapy regimen in Mali

HIV Medicine ◽

10.1111/hiv.12668 ◽

2018 ◽

Vol 20 (1) ◽

pp. 47-53 ◽

Cited By ~ 1

Author(s):

A Baldé ◽

L Lièvre ◽

AI Maiga ◽

F Diallo ◽

IA Maiga ◽

...

Keyword(s):

Risk Factors ◽

Antiretroviral Therapy ◽

People Living With Hiv ◽

Loss To Follow Up ◽

Therapy Regimen ◽

Living With Hiv

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Determinants and Incidence of Chronic Kidney Disease on Tenofovir-Based Antiretroviral Therapy Regimens: A Cohort Study in HIV-Infected Adults in South China

10.21203/rs.3.rs-365588/v1 ◽

2021 ◽

Author(s):

Fang Liu ◽

Hong Liu ◽

Chen Chen ◽

Liang-bin Miao ◽

Zhao-yi Li ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Viral Load ◽

Kidney Disease ◽

Renal Dysfunction ◽

Multiple Imputation ◽

Estimating Equation ◽

Chinese Cohort ◽

Hiv 1

Abstract Background: To evaluate the incidence and risk factors of stage 3 chronic kidney disease (CKD) and rapid kidney function decline (RKFD) among Chinese HIV-1 infected patients starting with tenofovir (TDF)-based regimen.Methods: We enrolled in 797 TDF-initiated HIV-1-infected patients in a Chinese cohort. Kidney dysfunction were defined as stage 3 CKD (eGFR < 60 mL/min/1.73 m2 during follow-up) and RKFD (eGFR decline > 10 mL/min/1.73 m2/year). A linear mixed-effects model was used to quantify the average eGFR change per 48 weeks. A generalized estimating equation regression analysis was conducted to determine the risk factors associated with renal dysfunction. The method of multiple imputation was used to reduce bias caused by missing data.Results: In this retrospective study, 14 (2%) patients experienced stage 3 CKD, and 272 (34%) individuals experienced RKFD during a median of 26 (IQR, 4-78; maximum 325) weeks follow-up period. The mean loss in eGFR per 48 weeks increased consistently over time, from -2.59 mL/min/1.73 m2 before 48 weeks to -17.61 mL/min/1.73 m2 after 288 weeks. For every 10 mL/min/1.73 m2 increase of eGFR, the risk of RKFD increased by 29% (95%CI: 18%, 40%). Each 10 years older and every 10 mL/min/1.73 m2 higher in baseline eGFR, the risk of stage 3 CKD increased to 1.56 (95% CI: 1.00, 2.43) and decreased by 65% (95% CI: 48%, 76%), respectively. Anemia and higher viral load were significantly associated with RKFD. The results were robust across a range of multiple imputation analysis.Conclusions: TDF-associated CKD is rare in HIV-1 infected Chinese adults. Longer TDF-exposed patients are more likely to have renal dysfunction, especially those with older age, anemia, lower baseline eGFR and higher viral load.

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Moderate incidence of lost follow-up and risk factors among adult HIV patients on second-line ART regimens in Amhara region hospitals, Ethiopia

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v9i1-s.2253 ◽

2019 ◽

Vol 9 (1-s) ◽

pp. 52-59

Author(s):

Ahmed Mohammed ◽

Saed Abdi ◽

S Palani ◽

Nisha Mary Joseph

Keyword(s):

Risk Factors ◽

Antiretroviral Therapy ◽

Functional Status ◽

Cumulative Incidence ◽

Categorical Variables ◽

Second Line ◽

Amhara Region ◽

Hiv Patients ◽

Loss To Follow Up

Background and Objectives: Loss to follow-up is a common problem of most patients on antiretroviral therapy in Ethiopia. Second-line antiretroviral therapy is the drug that would be used when the first-line therapy fails. Thus this study intends to determine the incidence and risk factors of time to losses to follow up among Human Immunodeficiency Virus (HIV) patients on second line regimens of Antiretroviral Therapy(ART) in Amhara region Hospitals, Ethiopia. Methods: Institutional based retrospective cohort study was conducted in the Amhara region hospitals from February to March 2016. A total of 1246 patient from eight hospitals in Amhara region were selected using simple random sampling method and data were extracted from patient charts. The log rank test was used to assess presence of significant difference in time to losses to follow among levels of categorical variables. Both bi-variiable and multivariable Cox proportional hazards models were used to identify factors that affect the time to losses to follow up. Results: The cumulative incidence of loss to follow up was 5.41% over the entire (eight) years of follow-up. The cumulative incidence rates of death and transfer out were 10.99%,10.02 %, respectively. In multivariable Cox regression analysis, ambulatory functional status (AHR=0.1967, 95% CI: 0.049- 0 .794), male gender (AHR=2.135, 95% CI: 1.053- 4.330), adherence to ART (AHR=0.442, 95% CI: 0.198- 0.989) were significant predictors of time to losses to follow up. The use of 2a, 2e and 2g types of second line regimen reduced the risk of loss to follow up. Interpretations and Conclusions: The incidence of loss to follow up in Amhara region hospitals was low. Loss to folow up was negatively associated with female gender, ambulatory baseline functional status, adherence, & types of second line regimen types. Further research on the effect of types of drug is recommended by acertaining whether the reduction in loss to follow up for patients who took drug types of 2a, 2e, and 2g is associaed with improved or worsened health outcomes by trafcking lost patients closely.

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Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

10.21203/rs.3.rs-208706/v2 ◽

2021 ◽

Author(s):

Pepukai Bengura

Keyword(s):

Risk Factors ◽

South Africa ◽

Viral Load ◽

Marital Status ◽

Art Adherence ◽

Aids Patients ◽

Loss To Follow Up ◽

Generalized Gamma ◽

Hiv Aids

Abstract Background - Long-term regular follow-up and high retention are the anticipated outcomes for the wellness and longevity of HIV/AIDS patients on antiretroviral treatment. However, these anticipated outcomes are marred by patient loss to follow-up (LTFU) which is currently exacerbated by the Covid-19 pandemic. This study aims to determine the prevalence and potential risk factors to LTFU among HIV/AIDS patients on ART at two rural district hospitals in South Africa.Methods— This is a retrogressive observational study whereby a cohort of HIV/AIDS patients was retrospectively followed from 2010 to 2017 until loss to follow-up occurred or until the end of the observation period at Carolina and Embhuleni hospitals. An institutional based retrospective cohort study was undertaken among children, adolescents and adults living with HIV/AIDS and attending ART clinic between January 1, 2010 and June 30, 2017. Loss to follow up was defined as not taking an ART refill for a period of 90 days or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out’ patient. Patient information was obtained from the routine hospitals’ records, and the data were analysed using Generalized gamma distribution to identify the predictors of loss to follow up among HIV/AIDS patients while Kaplan-Meier model was used to estimate and compare the LTFU survival probabilities of heterogenous groups among the patients.Results— Of the 357 patients, 60.5% were female. The mean (SD) age of the cohort was 36.2 (14.1), 15.4 (3.5), and 5.1 (3.5) years for adults, adolescents, and children, respectively. From 357 HIV/AIDS patients, 93 (26.05%) were lost to follow-up. Empirical results show that the Weibull distribution gives the best fit to the data. The Weibull model determined the Factors associated with significant risk factors to patient loss to follow up as: regimen EFV+D4T+3TC [HR: 2.0 CI;(1.3–3.1)], regimen EFV+AZT+3TC [HR: 2.9 CI;(1.3–6.4)], regimen EFV+3TC+TDF [HR: 10.0 CI;(3.9–25.9)], regimen NVP+3TC+TDF [HR: 10.6 CI;(1.8–62.4)], follow up CD4 [HR: 1.0 CI;(1.0–1.0)], log(follow up viral load) [HR: 0.8 CI;(0.7–0.9)], marital status (married) [HR: 0.4 CI;(0.3–0.8)], marital status (cohabitation) [HR: 0.6 CI;(0.3–0.9)], ART adherence (fair) [HR: 2.4 CI;(1.3–3.4)], ART adherence (good) [HR: 4.6 CI;(2.2–9.5)] and age [HR: 1.02 CI;(1.0–1.04)]. Discussion— Effective control and tracing measures in the at-risk population and in defaulters need to be stepped up especially during this COVID-19 period, to improve retention in hospitals. There is also need for careful adherence counseling and assessment of medication supplies.Conclusion— LTFU is more pronounced among females and is highest among adolescents. Patients with increased risk for LTFU were consistent with ART regimens, viral load, age, CD4 count, adherence and marital status.

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Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

10.21203/rs.3.rs-208706/v1 ◽

2021 ◽

Author(s):

Pepukai Bengura

Keyword(s):

Risk Factors ◽

South Africa ◽

Viral Load ◽

Marital Status ◽

Art Adherence ◽

Aids Patients ◽

Loss To Follow Up ◽

Generalized Gamma ◽

Hiv Aids

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Use of darunavir in HIV-1-infected individuals in routine clinical practice from 2012 to 2016 in France

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz338 ◽

2019 ◽

Vol 74 (11) ◽

pp. 3305-3314 ◽

Cited By ~ 4

Author(s):

Valérie Potard ◽

Ana Canestri ◽

Sebastien Gallien ◽

Dominique Costagliola ◽

S Abgrall ◽

...

Keyword(s):

Cumulative Incidence ◽

Dual Therapy ◽

People Living With Hiv ◽

Subdistribution Hazard ◽

Loss To Follow Up ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Virological Outcomes ◽

Hiv 1

Abstract Objectives We assessed virological outcomes of darunavir use in France from 2012 to 2016, in three groups of people living with HIV (PLHIV): (i) antiretroviral (ARV)-naive PLHIV; (ii) ARV-experienced PLHIV switching to darunavir while failing therapy; and (iii) ARV-experienced PLHIV switching to darunavir while virologically controlled. Methods Virological success (VS) was defined as a plasma HIV-1 viral load (VL) <50 copies/mL and virological failure (VF) as two consecutive VL >50 copies/mL or one VL >50 copies/mL followed by a treatment switch prior to the next VL measurement. The cumulative incidence of VS was assessed considering darunavir discontinuation, loss to follow-up and death as competing risks, while estimates of cumulative incidence of VF accounted for loss to follow-up and death. Results Among the 3235 ARV-naive PLHIV initiating darunavir, the 4 year cumulative incidence of VS was 80.9% and was associated with lower VL and higher CD4 cell counts. Among the 3485 ARV-experienced PLHIV switching to darunavir while failing therapy, the 4 year cumulative incidence of VS was 82.2% and was associated with lower VL. Among the 3005 ARV-experienced PLHIV switching to darunavir while virologically controlled, the 4 year cumulative incidence of VF was 12.6%. The risk of VF was higher with darunavir monotherapy [subdistribution hazard ratio (sHR)=1.67, 95% CI 1.15–2.42] while no difference was observed with dual therapy (sHR = 1.00, 95% CI 0.71–1.42) relative to triple therapy or more. Conclusions Darunavir-containing regimens yielded similarly high rates of viral suppression in PLHIV whether they were ARV naive or ARV experienced switching to darunavir while failing therapy, or of maintaining VS in ARV-experienced PLHIV switching to darunavir while virologically controlled.

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Use of rilpivirine in HIV-1-infected individuals in routine clinical practice from 2012 to 2017 in France

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa449 ◽

2020 ◽

Author(s):

Valérie Potard ◽

Sebastien Gallien ◽

Ana Canestri ◽

Dominique Costagliola ◽

S Abel ◽

...

Keyword(s):

Cumulative Incidence ◽

Viral Suppression ◽

People Living With Hiv ◽

Loss To Follow Up ◽

Virological Success ◽

Virological Outcomes ◽

Treatment Switch ◽

Living With Hiv ◽

Hiv 1

Abstract Objectives We assessed virological outcomes of rilpivirine use in France from 2012 to 2017, in three groups of people living with HIV (PLHIV): (i) antiretroviral (ARV)-naive PLHIV; (ii) ARV-experienced PLHIV switching to rilpivirine while failing therapy; and (iii) ARV-experienced PLHIV switching to rilpivirine while virologically controlled. Methods Virological success (VS) was defined as a plasma HIV-1 viral load (VL) <50 copies/mL and virological failure (VF) as two consecutive VL >50 copies/mL or one VL >50 copies/mL followed by a treatment switch prior to the next VL measurement. The cumulative incidence of VS was assessed considering rilpivirine discontinuation, loss to follow-up and death as competing risks, while estimates of cumulative incidence of VF accounted for loss to follow-up and death. Results Among the 2166 ARV-naive PLHIV initiating rilpivirine, the 4 year cumulative incidence of VS was 91.0% and was associated with baseline VL. Among the 2125 ARV-experienced PLHIV switching to rilpivirine while failing therapy, the 4 year cumulative incidence of VS was 82.5% and was associated with lower VL, higher CD4 and less than three prior ARVs. Among the 11 828 ARV-experienced PLHIV switching to rilpivirine while virologically controlled, the 4 year cumulative incidence of VF was 9.6%. The risk of VF was lower among MSM, for PLHIV with CD4 ≥ 500 cell/mm3, without a prior AIDS event, or with a longer VL suppression at baseline. Conclusions Rilpivirine-containing regimens yielded high rates of viral suppression in most participants, while it was ineffective when used outside the marketing authorization in naive participants.

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947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1133 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S506-S506

Author(s):

Folusakin Ayoade ◽

Dushyantha Jayaweera

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Research ◽

Stroke Risk ◽

Research Network ◽

Categorical Variables ◽

People Living With Hiv ◽

Risk Factor Profile ◽

Stroke Risk Factors ◽

Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

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Maternal age at birth and daughter’s fecundability

Human Reproduction ◽

10.1093/humrep/deab057 ◽

2021 ◽

Author(s):

Olga Basso ◽

Sydney K Willis ◽

Elizabeth E Hatch ◽

Ellen M Mikkelsen ◽

Kenneth J Rothman ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Maternal Age ◽

Limited Information ◽

Loss To Follow Up ◽

Older Mothers ◽

Registration Number ◽

The Usa ◽

Competing Interest

Abstract STUDY QUESTION Do daughters of older mothers have lower fecundability? SUMMARY ANSWER In this cohort study of North American pregnancy planners, there was virtually no association between maternal age ≥35 years and daughters’ fecundability. WHAT IS KNOWN ALREADY Despite suggestive evidence that daughters of older mothers may have lower fertility, only three retrospective studies have examined the association between maternal age and daughter’s fecundability. STUDY DESIGN, SIZE, DURATION Prospective cohort study of 6689 pregnancy planners enrolled between March 2016 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancy Study Online (PRESTO) is an ongoing pre-conception cohort study of pregnancy planners (age, 21-45 years) from the USA and Canada. We estimated fecundability ratios (FR) for maternal age at the participant’s birth using multivariable proportional probabilities regression models. MAIN RESULTS AND THE ROLE OF CHANCE Daughters of mothers ≥30 years were less likely to have previous pregnancies (or pregnancy attempts) or risk factors for infertility, although they were more likely to report that their mother had experienced problems conceiving. The proportion of participants with prior unplanned pregnancies, a birth before age 21, ≥3 cycles of attempt at study entry or no follow-up was greater among daughters of mothers <25 years. Compared with maternal age 25–29 years, FRs (95% CI) for maternal age <20, 20–24, 30–34, and ≥35 were 0.72 (0.61, 0.84), 0.92 (0.85, 1.00), 1.08 (1.00, 1.17), and 1.00 (0.89, 1.12), respectively. LIMITATIONS, REASONS FOR CAUTION Although the examined covariates did not meaningfully affect the associations, we had limited information on the participants’ mother. Differences by maternal age in reproductive history, infertility risk factors and loss to follow-up suggest that selection bias may partly explain our results. WIDER IMPLICATIONS OF THE FINDINGS Our finding that maternal age 35 years or older was not associated with daughter’s fecundability is reassuring, considering the trend towards delayed childbirth. However, having been born to a young mother may be a marker of low fecundability among pregnancy planners. STUDY FUNDING/COMPETING INTEREST(S) PRESTO was funded by NICHD Grants (R21-HD072326 and R01-HD086742) and has received in-kind donations from Swiss Precision Diagnostics, FertilityFriend.com, Kindara.com, and Sandstone Diagnostics. Dr Wise is a fibroid consultant for AbbVie, Inc. TRIAL REGISTRATION NUMBER n/a

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