Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living With HIV in Ecuador

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

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CD4/CD8 Ratio Recovery of Children and Adolescents Living With HIV With Virological Suppression: A Prospective Cohort Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa020 ◽

2020 ◽

Author(s):

Win Min Han ◽

Tanakorn Apornpong ◽

Ryan Handoko ◽

Watsamon Jantarabenjakul ◽

Sivaporn Gatechompol ◽

...

Keyword(s):

Children And Adolescents ◽

Viral Suppression ◽

Cd4 Count ◽

Virological Suppression ◽

High Recovery ◽

Hiv Rna ◽

Immunodeficiency Virus ◽

Recovery Group ◽

Living With Hiv

Abstract Background There are limited data on immune restoration of young adults living with virologically suppressed human immunodeficiency virus (HIV). We investigated recovery rates of CD4/CD8 ratio among Thai children and adolescents after they initiated combination antiretroviral therapy (cART). Methods Children and adolescents who started cART at age of ≥ 5 years were eligible in this study if they achieved HIV RNA < 50 copies/mL and had a CD4/CD8 ratio < 0.8 at the time of virological suppression. Normalization of CD4/CD8 ratio was defined as 2 consecutive values ≥ 1. Using group-based trajectory analysis, low- and high-recovery groups were identified in terms of CD4/CD8 ratio recovery. Results One hundred thirty-eight children and adolescents (101 perinatally infected and 37 behaviorally infected) with median age of 10.6 years at cART treatment initiation were included. After 559 person-years of follow-up (PYFU), overall incidence rate of CD4/CD8 ratio normalization was 4.1 (95% confidence interval, 2.7–6.2) per 100 PYFU. The probabilities of normalization at 2, 5, and 10 years after HIV suppression were 5.2%, 22.6%, and 35.6%, respectively. The low-recovery group had lower median pre-cART CD4 count (146 vs 304 cells/μL, P = .01), pre-cART CD4/CD8 ratio (0.15 vs 0.23, P = .03) and at first viral suppression (0.38 vs 0.65, P = .0001), compared to the high-recovery group. Conclusions Less than half of children and adolescents living with HIV on cART with viral suppression had CD4/CD8 ratio normalization. Those with older age at cART initiation, lower pre-cART CD4 count, or CD4/CD8 ratio had slower ratio recovery. Long-term prognoses such as ongoing immune activation and clinical outcomes among children and adolescents on suppressive cART without CD4/CD8 ratio normalization need to be further investigated.

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Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya

African Health Sciences ◽

10.4314/ahs.v21i1.4s ◽

2021 ◽

Vol 21 (1) ◽

pp. 18-24

Author(s):

William N Tanyi ◽

Onesmus Gachuno ◽

Theresa Odero ◽

Carey Farquhar ◽

David Kimosop ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Children And Adolescents ◽

Viral Suppression ◽

County Hospital ◽

Virologic Suppression ◽

Clinic Attendance ◽

Psychosocial Support System ◽

Adherence Counseling ◽

Living With Hiv ◽

Out Of School

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

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Factors Associated with Poor Viral Suppression Among Children and Adolescents Accessing Antiretroviral Therapy in Selected Health Facilities in Lagos, Nigeria

10.21203/rs.3.rs-772837/v1 ◽

2021 ◽

Author(s):

Nneka Egbonrelu ◽

Adeola Awolola ◽

Teniola Lawanson ◽

Olabanjo Ogunsola ◽

Oluwagbemisola Odole-Akinyemi ◽

...

Keyword(s):

Logistic Regression ◽

Viral Load ◽

Antiretroviral Therapy ◽

Children And Adolescents ◽

Viral Suppression ◽

Binary Logistic Regression ◽

Health Facilities ◽

Rural Setting ◽

Factors Associated ◽

Living With Hiv

Abstract IntroductionNigeria has the second largest HIV burden in Sub-Saharan Africa, with high burden amongst children and adolescents. In 2017, it was estimated that 160,000 children (0-9 years) and 230,000 adolescents (10-19 years) are living with HIV globally, with death in 21,000 children and 5400 adolescents resulting from AIDS-related illnesses. The main objective of the study was to determine the factors associated with poor viral suppression in children and adolescents accessing antiretroviral therapy in secondary health facilities in Lagos State.MethodsA descriptive retrospective study of children and adolescents living with HIV accessing care and support in 7 Global Fund supported ART treatment facilities in Lagos between January 2013 and June 2020. Data extraction was done between July 2020 and August 2020. The sociodemographic, clinical and laboratory data were extracted from patients’ folders. Binary logistic regression model was done to identify the determinants of viral non-suppression among children and adolescents age groups. ResultsThe study population consisted of 363 children (age 0-9 years) and 275 adolescents (age 10-19 years). The mean age of children was 5.8±2.2 years and that of adolescent was 13.21±2.8years. About 256(70 %) of children were virally unsuppressed and 118(43 %) had non-suppressed viral load status among adolescents. Binary logistic regression showed that children with WHO stage IV of HIV disease had greater odds (OR=7.984, 95% CI=1.042-61.163) of having suppressed viral load and children who live with their non-biological caregiver had greater odds of having a suppressed viral load compared to the biological caregiver group (OR=2.0421, 95% CI=1.083-10.965). Among adolescents, binary logistic regression showed location of abode and drug pick-up pattern as independent predictors of poor viral suppression. Adolescent patients living in rural setting had greater odds of being virally unsuppressed compared to those living in urban settlement (OR=1.755, 95% CI=1.001-3.083) while patients who have regular drug pick-up pattern from their ART health centres had lesser odds (OR=0.585, 95% CI=0.591-0.912) of viral non-suppression.CONCLUSIONThe findings highlight the need for a renewed focus on developing and strengthening HIV programmes in rural areas where children and adolescents living with HIV are more likely to be virally unsuppressed. More emphasis and resources should be channelled to Public health intervention such as health education, social support group programmes to improve drug pick up and adherence in adolescents living with HIV.

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Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

American Journal of Perinatology ◽

10.1055/s-0040-1721714 ◽

2020 ◽

Author(s):

Ashish Premkumar ◽

Lynn M. Yee ◽

Lia Benes ◽

Emily S. Miller

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Median Time ◽

Social Vulnerability ◽

Viral Suppression ◽

Foreign Born ◽

Women Living With Hiv ◽

Virologic Control ◽

Clinical Records ◽

Living With Hiv

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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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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Towards an AIDS-free generation by 2030: how are South African children, adolescents, caregivers and health care workers coping with HIV?

South African Journal of Psychology ◽

10.1177/0081246321992175 ◽

2021 ◽

pp. 008124632199217

Author(s):

Yogan Pillay

Keyword(s):

Health Care ◽

Children And Adolescents ◽

South African ◽

Health Care Workers ◽

Policy Makers ◽

Number Of Children ◽

Key Stakeholders ◽

Care Workers ◽

Free Generation ◽

Living With Hiv

We are committed to an AIDS free generation by 2030 – nine short years away. This article reflects on the global and South African data on new infections, total number of children and adolescents living with HIV as well as data on vertical transmission. The article includes the voices of key stakeholders in the quest to end HIV in children so that lessons from their experiences can be used by policy makers in strengthening services.

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Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

International Journal of STD & AIDS ◽

10.1177/09564624211024080 ◽

2021 ◽

pp. 095646242110240

Author(s):

Genesis S Huerta-Vera ◽

Manuel A Amarista ◽

Fernando A Mejía ◽

Ana B Graña ◽

Elsa V Gonzalez-Lagos ◽

...

Keyword(s):

Viral Suppression ◽

Clinical Situation ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Sectional Study ◽

Cross Sectional ◽

Epidemiological Trends ◽

Clinical Conditions ◽

Living With Hiv

Due to a huge crisis extensive to health services many Venezuelan people living with HIV (PLWH) had migrated abroad, including Peru where favorable laws were in place until June 2019. We describe the health status and epidemiological trends of PLWH from Venezuela at an HIV program in Lima. We analyzed baseline and follow-up data of all Venezuelan PLWH enrolled in our HIV program from January 2017 to December 2019. A cross-sectional study in a subsample served to describe ARV adherence and context of migration. Between 2017-2019 our HIV Program registered 398 Venezuelan PLWH, representing 20% of the 2018 annual enrollments; numbers decreased since mid-2019. The median age was 30 years (IQR 26;37) and 90.5% were men. Between 2017 and 2019, the proportion with diagnosis in Peru increased from 14.3% to 60.9%; of AIDS stage at entry, from 8.8% to 27.2%. By December 2019, 182/250 (72.8%) were still in care, and 43 (10.8%) had not started ART. Viral suppression evaluated in 195, was achieved in 71.8%. From 2017 to 2019, migrant PLWH arrived in worsened clinical conditions, with increasing diagnosis in Peru; the flow of migrant PLWH entering care diminished with less favorable laws. Viral suppression rates were suboptimal.

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