Trends in demographic and clinical characteristics of patients enrolled in HIV care and subsequent Antiretroviral Therapy initiation in the Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) Adult Cohort 2004-2018.

Background The Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) is a prospective study investigating impact, progression and long-term outcomes of HIV/AIDS among people living with HIV (PLWH) in Burundi, Cameroon, Democratic Republic of Congo (DRC), Republic of Congo (ROC) and Rwanda. We described trends in baseline demographic, clinical and immunological characteristics of patients aged >15 years entering into HIV care in the participating CA-IeDEA site and subsequent ART initiation. Materials and Methods Information on socio-demographic characteristics, height, weight, body mass index (BMI), CD4 cell count, WHO staging and ART status at entry into care from 2004 to 2018 were extracted from clinic records of patients aged >15 years enrolling in HIV care at participating clinics in Burundi, Cameroon, DRC, ROC and Rwanda. We assessed trends in patient characteristics at enrollment in HIV care and ART initiation at the participating site and calculated proportions, means and medians (interquartile ranges) for the main variables of interest. Results Among 69,176 participants in the CA-IeDEA cohort, 39% % were from Rwanda, , 24% from ROC, 18% from Cameroon, 14% from Burundi and 5% from DRC. More women (66%) than men were enrolled in care and subsequently initiated ART. Women were also younger (32 years) than men (38 years) (p= <0.001) when they enrolled in care or subsequently initiated ART at the participating site. Trends over time show increases in median CD4 cell count of 190 cells/uL in 2004 to 334 cells/uL in 2018 at enrollment. Among those with complete data on CD4 counts (60%), women had higher median CD4 cell count at care entry in the CA-IeDEA site (299 cells/uL) versus men (249 cells/uL; p= < 0.001).Trends in proportion of patients using ART show an increase from 16% in 2004 to 75% in 2018 among those initiating ART for the first time after entry into care in the participating site. As expected, median CD4 generally increased after ART initiation (p= <0.001). Conclusion Trends from 2004-2018 in the characteristics of patients participating in the CA-IeDEA cohort highlight improvements overtime at entry into care and subsequent ART in all participating sites.

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The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons

International Journal of STD & AIDS ◽

10.1177/0956462419867573 ◽

2019 ◽

Vol 30 (13) ◽

pp. 1257-1264 ◽

Cited By ~ 2

Author(s):

Nima Ghalehkhani ◽

Behnam Farhoudi ◽

Mohammad Mehdi Gouya ◽

Hamid Sharifi ◽

SeyedAhmad SeyedAlinaghi ◽

...

Keyword(s):

Cell Count ◽

Hiv Treatment ◽

Hiv Care ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Treatment Cascade ◽

Cascade Analysis ◽

Hiv Treatment Cascade ◽

Living With Hiv ◽

Cd4 Cell

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

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Risk factors for loss to follow-up prior to ART initiation among patients enrolling in HIV care with CD4+ cell count ≥200 cells/μL in the multi-country MTCT-Plus Initiative

BMC Health Services Research ◽

10.1186/s12913-015-0898-9 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 13

Author(s):

R Charon Gwynn ◽

Ashraf Fawzy ◽

Ida Viho ◽

Yingfeng Wu ◽

Elaine J Abrams ◽

...

Keyword(s):

Risk Factors ◽

Cell Count ◽

Hiv Care ◽

Cd4 Cell Count ◽

Loss To Follow Up ◽

Art Initiation ◽

Cd4 Cell

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769. Mortality Among Inpatients After the Initiation of ‘Treat All’ With Dolutegravir in Botswana

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.959 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S429-S429

Author(s):

Amanda E Klinger ◽

Ryan J Kronen ◽

Tomer Barak ◽

Patricia Mophuthegi ◽

Joseph Makhema ◽

...

Keyword(s):

Cell Count ◽

Opportunistic Infections ◽

Community Acquired Pneumonia ◽

People Living With Hiv ◽

Inpatient Mortality ◽

Cd4 Cell Count ◽

Art Initiation ◽

Treat All ◽

Living With Hiv ◽

Cd4 Cell

Abstract Background Botswana was the first African country to implement a ‘treat all’ dolutegravir (DTG)-based treatment program for all adults. We studied whether this transition made a short-term impact on inpatient mortality among people living with HIV (PLWHIV). Methods From Dec 2015-Nov 2017, data were collected prospectively on all patients admitted to the medical wards of a district hospital in Botswana. Tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) was the first-line recommended antiretroviral treatment (ART) regimen for all ART-naïve adults with CD4 < 350 until May 2016, when it was replaced by TDF/FTC/DTG without CD4 restriction (‘treat all’). Multivariable logistic regression was used to compare mortality by ART regimen. Results Of 1,969 patients admitted, 41.5% were PLWHIV and of these 62.9% were on ART prior to admission. Before ‘treat all’, 160 (58.0%) of 276 PLWHIV were on ART prior to admission, and post-implementation 354 (65.4%) of 541 PLWHIV were on ART prior to admission (p=0.01). Among 315 patients on EFV-based ART and 85 on DTG-based ART prior to admission, demographics were similar (Table 1), except for more recent ART initiation with DTG, and lower median CD4 cell count with DTG (256 vs. 339 cells/mm3). Tuberculosis (TB) and community acquired pneumonia were the leading causes of hospitalization for both regimens. Death occurred in 178 (21.8%) PLWHIV, including 29% not on ART and 19% on any ART (p=0.003). Overall, 38% who initiated ART < 3 months prior to admission died (23.7% DTG, 48.8% EFV), and 36% with CD4 cell count < 50 cells/mm3 died (42.9% DTG, 30.8% EFV). Fewer deaths occurred among those on EFV (18%) compared with those on DTG (27%). However, controlling for CD4 count and timing of ART start, the risk of mortality among those on DTG and EFV was similar (aRR 1.08, 95% CI 0.62, 1.87). TB was the leading cause of death (40.1% off ART, 31.8% on DTG, 22.2% on EFV). Table 1. Demographics, clinical characteristics, and outcomes of people living with HIV (PLWHIV) admitted to Scottish Livingstone Hospital, stratified by ART regimen prior to admission. Conclusion We found no improvement in inpatient mortality among PLWHIV during the shift to ‘treat all’ with DTG-based ART in Botswana. Decreasing high inpatient HIV mortality will require increased testing in the community to detect and treat PLWHIV prior to disease progression, and improved screening for opportunistic infections. Disclosures All Authors: No reported disclosures

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A Systematic Review and Meta-regression of Temporal Trends in Adult CD4+ Cell Count at Presentation to HIV Care, 1992-2011

Clinical Infectious Diseases ◽

10.1093/cid/cit421 ◽

2013 ◽

Vol 57 (7) ◽

pp. 1027-1037 ◽

Cited By ~ 60

Author(s):

C. R. Lesko ◽

S. R. Cole ◽

A. Zinski ◽

C. Poole ◽

M. J. Mugavero

Keyword(s):

Systematic Review ◽

Cell Count ◽

Temporal Trends ◽

Hiv Care ◽

Cd4 Cell Count ◽

Meta Regression ◽

Cd4 Cell

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Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

Research Journal of Health Sciences ◽

10.4314/rejhs.v8i4.8 ◽

2020 ◽

Vol 8 (4) ◽

pp. 283-290

Author(s):

A. Amoko ◽

P.O. Ajiboye ◽

F.A. Olagunju ◽

R.O. Shittu

Keyword(s):

Family Medicine ◽

Cell Count ◽

Teaching Hospital ◽

Cd4 Count ◽

Hiv Positive ◽

P Value ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Prevalence Of Depression ◽

Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

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The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2020v12i6.37682 ◽

2020 ◽

pp. 68-71

Author(s):

NOVIANA JOENPUTRI ◽

KETUT SURYANA

Keyword(s):

Retrospective Study ◽

Marital Status ◽

Cell Count ◽

Associated Factors ◽

Opportunistic Infections ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Highly Active ◽

Living With Hiv ◽

Cd4 Cell

Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali. Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients. Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively. Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.

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CUTANEOUS MANIFESTATIONS OF HIV IN PEOPLE LIVING WITH HIV/AIDS AT TERTIARY CENTRE

10.36106/gjra/8009792 ◽

2021 ◽

pp. 70-72

Author(s):

Anubhav Agrawal ◽

Simmi Dube ◽

Aditya Tejwani

Keyword(s):

Cell Count ◽

Tertiary Care ◽

Skin Lesions ◽

Cd4 Count ◽

People Living With Hiv ◽

Care Centre ◽

Tertiary Care Centre ◽

Cutaneous Manifestations ◽

Cd4 Cell Count ◽

Cd4 Cell

BACKGROUND-The study was conducted to describe systematic clinical manifestations among HIV in PLHA at tertiary care centre. METHODOLOGY- This study was designed as cross sectional study at Department of Medicine, tertiary care centre. A total of 100 HIV infected patients were included detailed enquiry about presence of skin lesions along with CD4 cell count was obtained and entered in pretested questionnaire RESULTS-The mean age of patients with HIV was 43.9±10.2 years and Slight female preponderance was observed with male: 3 female ratio of 0.89:1. Mean CD4 count was 243.2±103.2 cells/mm . Majority of patients had CD4 count in the range of less than 3 200 cells/mm (64%) Staphylococcal skin infections were the most common skin lesions observed in 34% patients. All the patients with cutaneous manifestations presented in present study had low CD4 cell count. However, no statistically signicant association between CD4 count and cutaneous manifestations could be documented (p>0.05). CONCLUSION-Cutaneous manifestations are more prevalent in patients with lower CD4 counts and can also be observed with normal CD4 count levels amongst patients with HIV. Occurrence of cutaneous manifestations was higher in patients with lower CD4 count but the observed difference was not statistically signicant.

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Retention in Care among Patients with Early HIV Disease in Haiti

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957417742670 ◽

2017 ◽

Vol 16 (6) ◽

pp. 523-526 ◽

Cited By ~ 3

Author(s):

Kelly A. Hennessey ◽

Taina Dadaille Leger ◽

Vanessa R. Rivera ◽

Adias Marcelin ◽

Margaret L. McNairy ◽

...

Keyword(s):

Cell Count ◽

Retention In Care ◽

Hiv Treatment ◽

World Health ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Hiv Test ◽

Lost To Follow Up ◽

Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

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