scholarly journals Advanced HIV Infection in Treatment Naïve Individuals: Effectiveness and Persistence of Recommended Three-Drug Regimens

2022 ◽  
Author(s):  
Karam Mounzer ◽  
Laurence Brunet ◽  
Jennifer S Fusco ◽  
Ian R Mcnicholl ◽  
Helena Diaz Cuervo ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Viral Suppression ◽  
Proportional Hazards ◽  
Drug Regimen ◽  
Cox Proportional Hazards ◽  
Cd4 Cell Count ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Cd4 Cell

Abstract Background Approximately 20% of newly diagnosed people with HIV (PWH) in the U.S. have advanced HIV infection, yet literature on current antiretroviral therapy (ART) options is limited. Discontinuation/modification and effectiveness of common regimens were compared among ART-naïve people with advanced HIV infection (CD4 cell count <200 cells/μL). Methods ART-naïve adults with advanced HIV infection initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen between 1JAN2018 and 31JUL2019 in the OPERA cohort were included. The association between regimen and discontinuation or viral suppression (<50 or <200 copies/mL) was assessed using Cox proportional hazards models with inverse probability of treatment weights. Results Overall, 961 PWH were included (416 B/F/TAF, 106 bDRV, 271 DTG, 168 EVG/c); 70% achieved a CD4 cell count ≥200 cells/μL over a 16 months median follow-up. All regimens were associated with a statistically higher likelihood of discontinuation than B/F/TAF (bDRV aHR: 2.65 [95% CI: 1.75, 4.02], DTG: 2.42 [1.75, 3.35], EVG/c: 3.52 [95% CI: 2.44, 5.07]). Compared to B/F/TAF, bDRV initiators were statistically less likely to suppress to <50 copies/mL (0.72 [0.52, 0.99]) and <200 copies/mL (0.55 [0.43, 0.70]); no statistically significant difference was detected with DTG or EVG/c. Conclusions Among people with advanced HIV infection, those initiating B/F/TAF were less likely to discontinue/modify their regimen than those on any other regimen, and more likely to achieve viral suppression compared to those on bDRV but not compared to those on other integrase inhibitors.

scholarly journals 328. Kaposi Sarcoma in High Population ART Utilization Setting: An Observational Study in Botswana

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S174-S175
Author(s):  
Kristen Hysell ◽  
Zola Musimar ◽  
Shekinah N C Elmore ◽  
Mukendi K A Kayembe ◽  
Gita Suneja ◽  
...  
Keyword(s):  
Cell Count ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Kaposi Sarcoma ◽  
Cox Proportional Hazards ◽  
Recent Measurement ◽  
Surveillance Period ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Abstract Background Despite population antiretroviral treatment (ART) utilization exceeding UNAIDS 90-90-90 targets, Kaposi sarcoma (KS) remains one of the most prevalent malignancies in Botswana. We sought to examine the characteristics and outcomes of KS in the context of high ART utilization. Methods Consenting patients at one of four oncology centers for KS treatment were enrolled prospectively (October 2010 to March 2019) and followed quarterly for 5 years. Survival was estimated using Kaplan–Meier estimator and predictors assessed with Cox proportional hazards modeling. Results A total of 408 KS patients were enrolled and of those, 396 (97%) were HIV-positive and included in analyses. Median age at diagnosis was 40 years (IQR: 34.1, 46.7) and 247 patients (62%) were male. The median CD4 cell count at the time of KS diagnosis was 253 cells/mL (IQR: 134, 364) and 279 (73%) were receiving ART at the time of KS diagnosis. Among those on ART, the median duration of ART prior to KS diagnosis was 11.9 months (IQR: 2.7, 46.7). The proportion receiving ART prior to KS increased during the surveillance period from 58% to 80% (P < 0.001). Of the 248 (62.6%) patients with recent measurement, 91% had HIV-1 RNA < 1000 copies/mL. Five-year overall survival was 73% (95% CI 68–78%). In multivariable analysis, Female sex and higher income were associated with improved survival, but not age or CD4 cell count. The duration of ART was significantly associated with survival (P = 0.02), with improved survival for individuals on ART < 6 months compared with longer ART (HR 0.54; 95% CI 0.29–0.98). The incidence of KS cases declined by nearly 50%, but has remained relatively stable since 2015. Conclusion Survival rates in this cohort were comparable to other KS cohorts. While KS treatment initially declined with ART expansion, KS remains a significant disease burden in Botswana with 80% of cases occurring among individuals receiving ART. Disclosures All authors: No reported disclosures.

scholarly journals Effect of CD4+ cell count and viral suppression on risk of ischemic stroke in HIV infection

AIDS ◽  
2014 ◽  
Vol 28 (17) ◽  
pp. 2573-2577 ◽  
Author(s):  
Felicia C. Chow ◽  
Peter Bacchetti ◽  
Anthony S. Kim ◽  
Richard W. Price ◽  
Priscilla Y. Hsue
Keyword(s):  
Ischemic Stroke ◽  
Hiv Infection ◽  
Cell Count ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Amount of lymphatic tissue fibrosis in HIV infection predicts magnitude of HAART-associated change in peripheral CD4 cell count

AIDS ◽  
2005 ◽  
Vol 19 (18) ◽  
pp. 2169-2171 ◽  
Author(s):  
Timothy W Schacker ◽  
Cavan Reilly ◽  
Gregory J Beilman ◽  
Jodie Taylor ◽  
David Skarda ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Lymphatic Tissue ◽  
Tissue Fibrosis ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Sustained Cognitive Decline in HIV Infection: Relationship to CD4+ Cell Count, Plasma Viremia and p24 Antigenemia

1998 ◽  
Vol 4 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Gerald J Dal Pan ◽  
Homayoon Farzadegan ◽  
Ola Seines ◽  
Donald R Hoover ◽  
Eric N Miller ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cognitive Decline ◽  
Cell Count ◽  
Plasma Viremia ◽  
Cd4 Cell Count ◽  
Cd4 Cell

scholarly journals HIV Infection, Antiretroviral Therapy, and CD4+Cell Count Distributions in African Populations

2006 ◽  
Vol 194 (10) ◽  
pp. 1450-1458 ◽  
Author(s):  
Brian G. Williams ◽  
Eline L. Korenromp ◽  
Eleanor Gouws ◽  
George P. Schmid ◽  
Bertran Auvert ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Cell Count ◽  
Cd4 Cell Count ◽  
African Populations ◽  
Cd4 Cell

scholarly journals Clinical Outcomes and Retention Among HIV-Infected Adolescents and Adults Initiated on Protease Inhibitors Antiretroviral Therapy Regimen in Dar ES Salaam; A Longitudinal Retrospective Descriptive Study

2021 ◽  
Author(s):  
Joan Rugemalila ◽  
Adellah Sariah ◽  
Samuel Mwaikambo ◽  
David Sando ◽  
Samuel Kalluvya
Keyword(s):  
Cell Count ◽  
Clinical Outcomes ◽  
Viral Suppression ◽  
Male Gender ◽  
P Value ◽  
Second Line ◽  
Cd4 Cell Count ◽  
Younger Age ◽  
Adolescents And Adults ◽  
Cd4 Cell

Abstract Background: Globally antiretroviral therapy access has increased and significantly changed HIV morbidity and mortality patterns. In sub-Saharan Africa there are reports of increasing rates of failure to second-line antiretroviral treatment (ART) hence, assessment for clinical outcomes is critical. Objectives: To assess clinical outcomes and retention using programmatic indicators among HIV-infected adolescents and adults receiving second-line ART in Tanzania. Methods: In this longitudinal retrospective cohort study, we enrolled HIV-infected individuals aged 15 years and above who were initiated on second-line ART (Protease Inhibitor based regimen) due to documented failure of first-line ART between July 2012 and September 2015. We evaluated mean change in CD4 cell count, HIV viral load and retention using survival analysis. Results : A total of 1446 participants were enrolled, the mean duration of second-line therapy was 37.0 months± SD 26.50 and the median CD4 cell count at initiation of the second line was 290 cells/mm3. Virologic suppression <50 copies/ml was increasing over time and reached 58% at 36 months. Six months after switching, 80% of patients were retained and thereafter. Predictors of retention were male gender with hazard ratio (HR) 1.04; 95% CI 1.0-1.1 P-value 0.037 and younger age (25 -39 years) with HR 1.1; 95% CI 1.0-1.2 P-value 0.006. Additionally, adherence > 90% increased the likelihood of retention with a strong correlation HR 1.4; 95% CI 1.1-1.7 P-value 0.00. Clinical stage III and IV at switch were less likely to be retained HR 0.6; 95% CI 0.5-0.6 P-value 0.000 and higher CD4 cell count was associated with less retention HR <1; 95 % CI 0.4-0.6 P-value 0.000. Conclusion: There was a low rate of viral suppression (<50copies/ml) 58% 36 months after switch however, more than 87% of participants were retained to care after switch. Predictors of retention were male gender, younger age (25-39 years) and adherence > 90%. Therefore, improving viral suppression after switching to second-line requires further interventions.

scholarly journals A clinico epidemiological study of pediatric dermatoses of HIV infected children in a tertiary care hospital of North Bengal

2021 ◽  
Vol 8 (11) ◽  
pp. 1837
Author(s):  
Mrinmoy Bairagi ◽  
Tanushree Mandal ◽  
Balai Chandra Karmakar
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Epidemiological Study ◽  
Skin Lesions ◽  
Pediatric Hiv ◽  
Hiv Positive ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Cd4 Cell

Background: Pediatric Human immunodeficiency virus (HIV) infection and its dermatological manifestation has emerged a serious burden globally including India. Dermatological manifestations are unique in pediatric HIV infection and related to CD4 cell count and its percentage. The study was carried out to assess the cutaneous manifestation of HIV positive pediatric patients and its correlation with CD4 cell count in eastern part of India below 12 years of age.Methods: This analytic epidemiological study with prospective observational design was carried among 30 HIV positive children below 12 years of age in our institution over a period of one year.Results: Total 30 HIV infected children were studied among male 23 (76.67%)) and female 7 (23.33%). Age ranged from birth to 12 years with mean was 6.39±2.48 years. The skin lesions are highest in 3-6 yrs age group 12 (40%) and 33.33% of them had CD4 counts between 500-750 while 3.33% had CD4 counts above 1500. 27 patients (90%) were received ART and 3 (10%) patients were without ART. Nine distinct patterns of lesions: abscess (3), furuncles (1), maculopapular rash (2), papular (7), pruritic (10), plaque (3), soreness of tongue (2), pustules (1) and red scaly (1) were detected. 46.67% pain (14), 40.0% itching (12) and 13.33% burning sensation (4) were the main symptoms and 20.0% face (6), 16.7% oral cavity (5), 20.0% hands (6), 10.0% abdomen (3) and 33.3% legs (10) were principal site of involvement. 13 different skin lesions: fungal infection (3), furuncles (1), urticaria (4), scabies (5), prurigo (5), measles (1), molluscum contagiosum (1), abscess (3), venous leg (1), pyoderma (1), atopic dermatitis (1), chicken pox (2) and glossitis (2) were diagnosed.Conclusions: Various dermatological manifestations are common with pediatric HIV infection and sometime are the first clinical presentation that is well correlated with CD4 cell count and its percentage.  

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