Response to ???CD4 Cell Count Natural History and Informative Censoring in Sub-Saharan Africa???

2007 ◽  
Vol 44 (4) ◽  
pp. 491
Author(s):  
Charles B Holmes ◽  
Robin Wood ◽  
Gary Maartens ◽  
Kenneth A Freedberg ◽  
Elena Losina
Keyword(s):  
Natural History ◽  
Cell Count ◽  
Informative Censoring ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
Cd4 Cell

scholarly journals Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

2019 ◽  
Vol 30 (5) ◽  
pp. 479-485
Author(s):  
James Muchira ◽  
Eileen Stuart-Shor ◽  
Jen Manne-Goehler ◽  
Janet Lo ◽  
Alexander C Tsai ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Fasting Blood Glucose ◽  
High Specificity ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
And Gender ◽  
Living With Hiv ◽  
Cd4 Cell

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26–67%) but high specificity (98%, 95% CI 96–99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA.

scholarly journals Program-level and contextual-level determinants of low-median CD4+ cell count in cohorts of persons initiating ART in eight sub-Saharan African countries

AIDS ◽  
2011 ◽  
Vol 25 (12) ◽  
pp. 1523-1533 ◽  
Author(s):  
Denis Nash ◽  
Yingfeng Wu ◽  
Batya Elul ◽  
David Hoos ◽  
Wafaa El Sadr
Keyword(s):  
Cell Count ◽  
African Countries ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
Cd4 Cell

scholarly journals Multilevel model on longitudinal data analysis in determinants of cd4 cell count among antiretroviral therapy attendant of hiv infected adults follow up in gondar teaching referral hospital, Gonder, Ethiopia.

2020 ◽  
Author(s):  
Kindu Kebede
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Multilevel Model ◽  
Immune Cell ◽  
Hemoglobin Level ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Abstract Background: Human immunodeficiency virus attacked an immune cell and the CD4 cell which is responsible for the body’s immune to infectious agents. Acquired immunodeficiency syndrome is one of the major public health problems in Sub-Saharan Africa including Ethiopia. The main objective of this study to identify the determinants of CD4 cell count among antiretroviral therapy attendants of infected adults follow up in Gonder teaching referral hospital, Gonder, Ethiopia implemented by SAS version 94. Methods: A retrospective cohort study was conducted on 216 regular follow up patients whose age greater than 14 years from December 1, 2012, to December 30, 2017. A multilevel model was used to identify the factors of CD4 cell count of patients and it considered variability between and within patients. Results: The mean with a standard deviation of weight, and a hemoglobin level of patients were 55.48(10.21), and 18.25(33.028) respectively. This study concluded that the variation for CD4 cell count existed between patients was 63 % and the remaining 37 % of variation existing within patients. In this study, the random coefficient time-varying covariate model was well fitted which shows weight and hemoglobin level were statistically significant predictors at a 5% level of significance for the log of CD4 cell count of patients. Conclusion: This study shows the hemoglobin level and weight of patients were statistically significant for the log of CD4 cell count of patients follow up in Gonder teaching referral hospital, Gonder, Ethiopia. Moreover, the result of the study shows that the log of CD4 count of patients increased when hemoglobin level and weight of patients increased. Hence, intervention should be given the ways to increase weight and hemoglobin levels of patients during follow up antiretroviral therapy.

scholarly journals Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary Hospital in Kenya

2021 ◽  
Vol 21 (1) ◽  
pp. 1-7
Author(s):  
Patrick Mburugu ◽  
Peter Muiruri ◽  
Nelly Opiyo ◽  
Justus Simba ◽  
Jane Adunda ◽  
...  
Keyword(s):  
Young Adults ◽  
Viral Load ◽  
Cell Count ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Adolescents And Young Adults ◽  
Virologic Suppression ◽  
Late Adolescents ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Background: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. Objective: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. Methodology: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. Results: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ ml p<0.012. Conclusion: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years). Keywords: Adolescents; HIV; Kenya; virologic suppression; young adults.

scholarly journals The Impact of Human Pegivirus on CD4 Cell Count in HIV-Positive Persons in Botswana

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Kombo F N’Guessan ◽  
Motswedi Anderson ◽  
Bonolo Phinius ◽  
Sikhulile Moyo ◽  
Alyyah Malick ◽  
...  
Keyword(s):  
Cell Count ◽  
Disease Progression ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Disease ◽  
Genotype 1 ◽  
Cd4 Cell Count ◽  
Resource Limited ◽  
Genotype 5 ◽  
Cd4 Cell

Abstract Background Human pegiviruses (HPgV)—formerly known as hepatitis G virus or GB virus C (GBV-C)—are common single-stranded RNA viruses that may have a beneficial impact on slowing HIV disease progression. The data on HPgV in resource-limited regions such as Sub-Saharan Africa are scarce. Thus, we conducted the first study of HPgV in Botswana as part of a natural history study of HIV subtype C disease progression. Methods Plasma samples from 133 HIV-positive adults were evaluated for HPgV RNA, and the 5’UTR was sequenced to determine the HPgV genotype. Results HPgV RNA was detected in 41 (30.8%) individuals. While the presence of HPgV RNA had no impact on baseline HIV viral load, a significant difference in baseline CD4 cell count was observed. HPgV genotypes were determined for 27 individuals and included 5 individuals (18.5%) with genotype 1 and 22 (81.5%) with genotype 5. Baseline CD4 cell counts were significantly higher for persons infected with HPgV genotype 5 compared with genotype 1. Conclusions These data suggest that HPgV infection is common among HIV-positive individuals in Botswana and has a significant impact on CD4 cell count. This difference in CD4 cell count based on HPgV genotype suggests that HPgV genotype should be evaluated as a possible predictor of HIV disease progression and highlights the need for additional studies of this virus in resource-limited settings.

scholarly journals Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary Hospital in Kenya

2021 ◽  
Vol 21 ◽  
pp. 1-7
Author(s):  
Patrick Mburugu ◽  
Peter Muiruri ◽  
Nelly Opiyo ◽  
Justus Simba ◽  
Jane Adunda ◽  
...  
Keyword(s):  
Young Adults ◽  
Viral Load ◽  
Cell Count ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Adolescents And Young Adults ◽  
Virologic Suppression ◽  
Late Adolescents ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Background: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. Objective: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. Methodology: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. Results: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ ml p<0.012. Conclusion: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years). Keywords: Adolescents; HIV; Kenya; virologic suppression; young adults.

scholarly journals Which clinical parameters predict a positive CSF diagnosis of meningitis in a population with high HIV prevalence?

2014 ◽  
Vol 15 (2) ◽  
pp. 50-54 ◽  
Author(s):  
Will Loughborough ◽  
Louisa Jones ◽  
Michael Abouyannis ◽  
Sharadh Garach
Keyword(s):  
South African ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Clinical Predictors ◽  
Cd4 Cell Count ◽  
Presenting Symptoms ◽  
Resource Limited ◽  
High Incidence ◽  
Sub Saharan ◽  
Cd4 Cell

Background. The HIV epidemic has changed the aetiology of meningitis in sub-Saharan Africa, and frontline clinicians are faced with a variety of meningitic presentations. Doctors working in resource-limited settings have the challenge of appropriately selecting patients for lumbar puncture (LP), a potentially risky procedure that requires laboratory analysis. Methods. In a rural South African hospital, the practice of performing LPs was audited against local guidelines. Data were collected retrospectively between February and June 2013. Symptoms and signs of meningitis, HIV status, investigations performed prior to LP and cerebrospinal fluid (CSF) results were recorded. With the aim of determining statistically significant clinical predictors of meningitis, parameters were explored using univariate and multivariate logistic regression analyses.Results. A total of 107 patients were included, of whom 43% had an abnormal CSF result. The majority (76%) of patients were HIV-positive (CD4+ cell count <200 cells/µl in 46%). Cryptococcal meningitis (CCM) was the most prevalent microbiological diagnosis, confirmed in 10 out of 12 patients. Of the non-microbiological diagnoses, lymphocytic predominance was the most common abnormality, present in 17 out of 33 patients. Confusion (p=0.011) was the most statistically significant predictor of an abnormal CSF result. Headache (p=0.355), fever (p=0.660) and photophobia (p=0.634) were not statistically predictive.Conclusion. The high incidence of CCM correlates with previous data from sub-Saharan Africa. In populations with high HIV prevalence, the classic meningitic symptoms of headache, fever and photophobia, while common presenting symptoms, are significantly less predictive of a meningitis diagnosis than confusion.

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