AF9 Relationship Between MEMSTM Adherence Rate, Pill Count and Viral Suppression Among HIV Infected Children on Antiretroviral Therapy in Nigeria

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

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HIV viral suppression in the era of antiretroviral therapy

Postgraduate Medical Journal ◽

10.1136/pmj.79.927.36 ◽

2003 ◽

Vol 79 (927) ◽

pp. 36-42 ◽

Cited By ~ 16

Author(s):

H K Thaker

Keyword(s):

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Viral Suppression

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Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Cells ◽

10.3390/cells10040909 ◽

2021 ◽

Vol 10 (4) ◽

pp. 909

Author(s):

Laura Cheney ◽

John M. Barbaro ◽

Joan W. Berman

Keyword(s):

Quality Control ◽

Antiretroviral Therapy ◽

Side Effects ◽

Viral Suppression ◽

Antiretroviral Drugs ◽

People Living With Hiv ◽

Foreign Material ◽

Complete Understanding ◽

Living With Hiv ◽

Target Effects

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

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Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal

Médecine et Maladies Infectieuses ◽

10.1016/j.medmal.2015.03.009 ◽

2015 ◽

Vol 45 (6) ◽

pp. 199-206 ◽

Cited By ~ 6

Author(s):

G. Batista ◽

A. Buvé ◽

N.F. Ngom Gueye ◽

N.M. Manga ◽

M.N. Diop ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Viral Suppression

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Alternating antiretroviral therapy prolongs viral suppression

Inpharma Weekly ◽

10.2165/00128413-200514760-00043 ◽

2005 ◽

Vol &NA; (1476) ◽

pp. 17

Author(s):

&NA;

Keyword(s):

Antiretroviral Therapy ◽

Viral Suppression

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Abstract 11505: Arterial Inflammation in HIV-Infected Patients Assessed by 18F-Fluorodeoxyglucose Positron Emission Tomography

Circulation ◽

10.1161/circ.130.suppl_2.11505 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Rasmus S Ripa ◽

Andreas Knudsen ◽

Anne Mette F Hag ◽

Annika Loft ◽

Eric von Benzon ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Antiretroviral Therapy ◽

Cardiovascular Risk Factors ◽

Abdominal Aorta ◽

Viral Suppression ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Arterial Inflammation

Introduction: HIV-infected patients are at increased risk of myocardial infarction and arterial inflammation has been suggested as an explanation. Vascular inflammation can be assessed in vivo by 18F-fluorodeoxyglucose (FDG) PET. Hypothesis: Well-treated HIV-infected patients without known cardiovascular disease will have increased uptake of FDG in different arterial regions as compared to healthy controls. Methods: We prospectively included 26 HIV-infected patients on stable antiretroviral therapy and 25 healthy volunteers. All underwent whole-body PET/CT 3 hours after injection of FDG. FDG uptake was assessed (SUV) in the carotid arteries, the ascending, descending, and abdominal aorta. Carotid intima-media thickness was determined by ultrasound. Soluble biomarkers of endothelial dysfunction and inflammation were measured by ELISA. Known cardiovascular risk factors were recorded for all included. Results: The HIV-infected patients were on stable antiretroviral therapy with full viral suppression. The HIV-infected group was older (50 vs 41 yrs; p = 0.01), had higher blood pressure and total cholesterol, and accordingly a higher Framingham risk score. FDG uptake was similar in the two groups quantified as SUVmax (figure) in the carotid region (1.67 ± 0.04 vs. 1.67 ± 0.04, p = 0.98), the ascending aorta (1.84 ± 0.06 vs. 1.97 ± 0.06, p = 0.15), the descending aorta (1.89 ± 0.08 vs. 1.93 ± 0.08, p = 0.70), and the abdominal aorta (1.70 ± 0.06 vs. 1.65 ± 0.06, p = 0.56) even when adjusting for differences in risk profile. No significant correlations between SUV, carotid intima-media thickness, known cardiovascular risk factors and soluble biomarkers were found. Conclusions: We found no evidence of increased arterial inflammation among HIV-infected patients with full viral suppression compared to controls. This may challenge the idea of chronic inflammation as the cause of cardiovascular disease among optimally treated HIV-infected patients.

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Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

10.21203/rs.3.rs-627094/v1 ◽

2021 ◽

Author(s):

Terefe Gone Fuge ◽

George Tsourtos ◽

Emma R Miller

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Viral Suppression ◽

People Living With Hiv ◽

South Ethiopia ◽

Pharmacy Refill ◽

Living With Hiv ◽

Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

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