Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia

ABSTRACTBackgroundThe pooled burden of HIV treatment failure and its associated factors in Ethiopian context is required to provide evidence towards renewed ambitious future goal.MethodsEthiopian Universities’ (University of Gondar and Addis Ababa University) online repository library, Google scholar, PubMed, Web of Science, and Scopus were used to get the research articles. I-squared statistics was used to see heterogeneity. Publication bias was checked by Egger’s regression test. The DerSimonian-Laird random effects model was employed to estimate the overall prevalence. Subgroup analysis based on geographical location of the study, study population by age, treatment failure type, and study design was conducted to see variation in outcomes. The sensitivity analysis was also employed to see whether the outlier result found in the included studies.ResultsOverall HIV treatment failure found to be 15.9% (95% CI: 11.6%-20.1%). Using immunological definition, HIV treatment failure was 10.2% (6.9%-13.6%); using virological definition of treatment failure (5.6% (95% CI: 2.9%-8.3%) and clinical definition of treatment failure (6.3% (4.6%-8.0%)) were also determined. The pooled effects of WHO clinical stage III/IV (AOR=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (AOR=1.8; 95% CI: 1.2-2.4), and poor HAART adherence (AOR= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure are estimated.ConclusionsHIV treatment failure in Ethiopia found to be high. HIV intervention programs need to address the specified contributing factors of HIV treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain HIV treatment adherence.Protocol RegistrationIt has been registered in the PROSPERO database (CRD42018100254).

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HIV/AIDS treatment failure and associated factors in Ethiopia: Meta-analysis

10.21203/rs.2.16879/v1 ◽

2019 ◽

Author(s):

Aklilu Endalamaw ◽

Mengistu Mekonnen ◽

Demeke Geremw ◽

Fekadu Ambaw ◽

Hiwot Tesera ◽

...

Keyword(s):

Treatment Failure ◽

Associated Factors ◽

Opportunistic Infections ◽

Meta Analysis ◽

Clinical Stage ◽

Treatment Interruption ◽

Hiv Treatment ◽

Contributing Factors ◽

Hiv Intervention ◽

Haart Adherence

Abstract Background: The national burden of HIV treatment failure and associated factors in Ethiopian context is required to provide evidence towards a renewed ambitious future goal.Methods: We accessed Ethiopian Universities’ online repository library, Google Scholar, PubMed, Web of Science, and Scopus to get the research articles. We run I-squared statistics to see heterogeneity. Publication bias was checked by using Egger’s regression test. The pooled prevalence was estimated using DerSimonian-Laird random-effects model. We employed the sensitivity analysis to see the presence of outlier result in the included studies. Results: The overall HIV treatment failure was 15.9% (95% CI: 11.6%-20.1%). Using immunological, virological, and clinical definition, HIV treatment failure was 10.2% (6.9%-13.6%), (5.6% (95% CI: 2.9%-8.3%), and (6.3% (4.6%-8.0%)), respectively. The pooled effects of WHO clinical stage III/IV (AOR=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (AOR=1.8; 95% CI: 1.2-2.4), and poor HAART adherence (AOR= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure were estimated. Conclusions : HIV treatment failure in Ethiopia found to be high. HIV intervention programs need to address the specified contributing factors of HIV treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain HIV treatment adherence. Protocol Registration : It has been registered in the PROSPERO database with a registration number of CRD42018100254.

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HIV/AIDS treatment failure and associated factors in Ethiopia: Meta-analysis

10.21203/rs.2.16879/v2 ◽

2020 ◽

Author(s):

Aklilu Endalamaw ◽

Mengistu Mekonnen ◽

Demeke Geremw ◽

Fekadu Ambaw ◽

Hiwot Tesera ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Confidence Interval ◽

Treatment Failure ◽

Highly Active Antiretroviral Therapy ◽

Opportunistic Infections ◽

Clinical Stage ◽

Contributing Factors ◽

Human Immunodeficiency Virus Treatment ◽

Highly Active ◽

Immunodeficiency Virus

Abstract Background: The national burden of human immunodeficiency virus treatment failure and associated factors in the Ethiopian context is required to provide evidence towards a renewed ambitious future goal. Methods: We accessed Ethiopian Universities’ online repository library, Google Scholar, PubMed, Web of Science, and Scopus to get the research articles. We run I-squared statistics to see heterogeneity. Publication bias was checked by using Egger’s regression test. The pooled prevalence was estimated using the DerSimonian-Laird random-effects model. We employed the sensitivity analysis to see the presence of outlier result in the included studies. Results: The overall human immunodeficiency treatment failure was 15.9% (95% confidence interval: 11.6%-20.1%). Using immunological, virological, and clinical definition, human immunodeficiency treatment failure was 10.2% (95% confidence interval: 6.9%-13.6%), 5.6% (95% confidence interval: 2.9%-8.3%), and 6.3% (95% confidence interval: 4.6%-8.0%), respectively. The pooled effects of World Health Organization clinical stage III/IV (Adjusted Odd Ratio=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (Adjusted Odd Ratio= 1.8; 95% CI: 1.2-2.4), and poor adherence to highly active antiretroviral therapy (Adjusted Odd Ratio= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure were estimated. Conclusions: Human immunodeficiency virus treatment failure in Ethiopia found to be high. Being on advanced clinical stage, presence of opportunistic infections, and poor adherence to highly active antiretroviral therapy were the contributing factors of human immunodeficiency virus treatment failure. Human immunodeficiency virus intervention programs need to address the specified contributing factors of human immunodeficiency virus treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain human immunodeficiency virus treatment adherence. Protocol Registration: It has been registered in the PROSPERO database with a registration number of CRD42018100254.

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Cotrimoxazole Prophylaxis Is Not Associated with a Higher occurrence of Atazanavir Treatment Failure: analysis of Worldwide Pharmacovigilance Data

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666191220112416 ◽

2019 ◽

Vol 20 ◽

Author(s):

Joe Miantezila Basilua ◽

Philippe Pochart

Keyword(s):

Comparative Analysis ◽

Treatment Failure ◽

Odds Ratio ◽

Opportunistic Infections ◽

Safety Data ◽

Individual Case ◽

Hiv Treatment ◽

Reporting Odds Ratio ◽

Cotrimoxazole Prophylaxis ◽

Pharmacovigilance Database

Background: Cotrimoxazole is the main antibiotic used in HIV-infected patients for the prophylaxis of opportunistic infections. This antibiotic is prescribed in patients receiving antiretroviral agents (ART) such as Atazanavir (ATV), a protease inhibitor used with other ART classes. The objective of this study was to compare HIV treatment failure (HIVTF) in HIV-infected patients treated concomitantly with ATV and cotrimoxazole to those of patients treated only with ATV. Materials and Methods: This is a comparative analysis of the safety data of HIVTF available with ATV in the WHO International Pharmacovigilance database "VigiBase®". We used the SMQ (Standardized MedDRA Querie) to identify all the terms corresponding to HIVTF. We presented results as a percentage or an adjusted Reporting Odds Ratio (aROR) with a 95% confidence interval (95% CI). Results: A total of 116 cases of HIVTF (2.2%) were reported with ATV among the 5196 individual case safety reports (ICSR) included in the analysis. The proportion of HIV-infected patients who presented ATV treatment failure (ATVTF) was lower (2.6%, 3/116) when cotrimoxazole was concomitant (aROR was 0.5 with a 95%CI from 0.2 to 1.7). Only 10 of 273 ICSRs (3.7%) were reported from Africa concerning the use of cotrimoxazole prophylaxis concomitantly with ATV. Conclusion: This study did not show a higher occurrence of ATVTF when cotrimoxazole was concomitant. These results reinforce the place of concomitant use of ATV with cotrimoxazole in the management of HIV treatment.

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Assessment of Prevalence of Malnutrition and Its Associated Factors among AIDS Patients from Asella, Oromia, Ethiopia

BioMed Research International ◽

10.1155/2020/7360190 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Teferi Teklu ◽

Nitin Mahendra Chauhan ◽

Firaol Lemessa ◽

Getu Teshome

Keyword(s):

Associated Factors ◽

Opportunistic Infections ◽

Nutritional Assessment ◽

Clinical Stage ◽

Cross Sectional Study ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Cross Sectional ◽

Sub Saharan ◽

The Impact

Sub-Saharan Africa remains to be the most heavily affected region by malnutrition, accounting for 23.8% share of the global burden. Undernutrition weakens the immune system, increases the susceptibility to infections, and may worsen the impact on various kinds of diseases. Our aim was to assess undernutrition and its associated factors among AIDS-infected adult patients from Asella, Oromia Region, Ethiopia. An institutional-based cross-sectional study design was employed from June to July 2018. A total number of 519 patients were selected for the proposed work. Data was entered into EpiData, checked, coded, and analyzed using SPSS version 21 software. Descriptive statistics were used to assess the prevalence of undernutrition among patients. Bivariate and multivariate regressions were used to determine the relationship between undernutrition and its associated factors among the study participants. The results of our study showed that the overall prevalence of undernutrition was 18.3%; out of which 12.7% were mildly and 5.6% were moderately to severely undernourished, respectively. Monthly income (AOR: 3.589, 95% CI (1.469-8.768)), whole grain feeding (AOR: 2.979, 95% CI (1.252-7.088)), opportunistic infections in the last six months (AOR: 3.683, 95% CI (3.075-4.411)), clinical stage (AOR: 2.998, 95% CI (1.269-7.083)), and insufficient quality of food (AOR: 3.149, 95% CI (1.339-7.406)) were found to be significantly associated with undernutrition in this study. Therefore, HIV treatment facility should be supported with nutritional assessment, supplementation, counseling, care, and support to patients that may possibly alleviate this predicament.

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Opportunistic infections among people living with HIV at reference health care centers in Morocco, 2015 (Preprint)

10.2196/preprints.14229 ◽

2019 ◽

Author(s):

Noureddine Sakhri ◽

Fatima Zahra Meski ◽

SOUMIA TRIKI

Keyword(s):

Health Care ◽

Opportunistic Infections ◽

Oral Candidiasis ◽

Clinical Stage ◽

Bivariate Analysis ◽

People Living With Hiv ◽

Cross Sectional Survey ◽

Pneumocystis Jiroveci ◽

Cross Sectional ◽

Health Care Centers

BACKGROUND Morbidity and mortality in HIV disease is due to immune-suppression leading to life-threatening opportunistic infections (OIs) during the natural course of the disease. In 2015, the HIV prevalence is low in general population and concentrated among key populations. OBJECTIVE This study aimed to assess the prevalence and CD4 correlates of OIs among adult HIV-infected patients attending antiretroviral health care in Morocco, during 2015. METHODS We conducted a cross-sectional survey among all adult PLHIV for admitted in the health care centers during 2015, who had acquired infection disease. Patients’ opportunistic infection status was determined through clinical diagnosis and laboratory investigations. CD4 count was determined using flow cytometry technique. The clinical stage of HIV was identified by the classification of Centers for Disease Control and Prevention (CDC). We collected Socio-demographic and clinical data from patients’ medical records. We performed statistical analysis by using Epi-Info 7.2.0.1 software. The appropriate test was applied, bivariate analysis was made and the differences were significant when p<.05. RESULTS 299 HIV-infected cases were included; 53% were males. The most represented age group was 25-34 years (36.1%). The mean age of the cases was 38.7 ± 16.8. The prevalence of OIs was 47.8%. Tuberculosis (65/299, 21.7%), Pneumocystis jiroveci pneumonia (40/299, 13.4%) and Oral candidiasis (22/299, 7.4%) were the most frequently observed OIs. CONCLUSIONS Tuberculosis, pneumocystis and oral candidacies were the leading OIs, encountered by HIV-infected cases. Preventive measures and early diagnosis of HIV associated to OIs are crucial.

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COVID-19-associated rhino-orbital mucormycosis (CAROM)—a case report

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00547-5 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Humsheer Singh Sethi ◽

Kamal Kumar Sen ◽

Sudhansu Sekhar Mohanty ◽

Sangram Panda ◽

Kolluru Radha Krishna ◽

...

Keyword(s):

Case Report ◽

Health Care Professionals ◽

Opportunistic Infections ◽

Fungal Spores ◽

Nasal Discharge ◽

Contributing Factors ◽

Post Discharge ◽

Pulmonary Mucormycosis ◽

The Right

Abstract Background There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM. Case presentation Rhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed. Conclusion Uncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

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Cross-sector pre-registration pharmacist placements in general practice in England: lessons from a national evaluation

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.049 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i40-i41

Author(s):

A Hindi ◽

S Willis ◽

S Jacobs ◽

E Schafheutle

Keyword(s):

General Practice ◽

Wide Spectrum ◽

Geographical Location ◽

Unintended Consequences ◽

Final Report ◽

Contributing Factors ◽

Training Experience ◽

Good Communication ◽

Patient Pathways ◽

Study Sites

Abstract Introduction In 2019/2020, the Pharmacy Integration Fund commissioned delivery of cross-sector pre-registration pharmacist training incorporating 3–6 month placements in general practice (GP). GP placements were managed by Health Education England (HEE) and organised as one (or more) blocks, or as spilt weeks/days across base sector (hospital/community) and GP. Trainees had a pharmacist tutor at base and in GP. Aim to evaluate the implementation of cross-sector pre-registration pharmacy placements in GP in England, and to identify barriers and enablers of a successful placement. Methods A qualitative approach was taken, with case study sites purposively sampled for maximum variation: pharmacy base (hospital/community), number of pre-registration pharmacist trainees in base doing GP placement, length of GP placement, organisation of GP placement and geographical location. With consent, trainees and tutors identified as meeting sampling criteria were emailed invitation letters and participant information sheets. Where the trainee and their tutor(s) agreed to participate, semi-structured telephone interviews were conducted January - July 2020. Questions developed from literature(1, 2) and the HEE handbook were tailored to understanding trainees’ and tutors’ views on the implementation of pre-registration pharmacist placements in GP, including benefits, unintended consequences and impacts. Thematic analysis across sites was undertaken with a focus on exploring inter and intra group themes. Results Thirty-four interviews were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). Trainees and tutors considered GP placements had been successful. Contributing factors were: placement planning (induction, contingency arrangements for cover should GP tutor be unavailable); tutors working together (good communication and collaboration); GP tutor support (regular contact, reflection; identifying learning needs; opportunities for learning); integration of GP placements within training year (specific learning/training activities at base during GP placement); and GP tutors having backing of their organisation to supervise effectively. A lack of these impacted negatively. Trainees completed a wide spectrum of activities and gradually moved from administrative to clinical tasks. They built up confidence to undertake patient-facing activities, with more direct supervision at the beginning moving to indirect supervision using debriefing. Thirteen weeks in GP was considered an appropriate minimum duration by all trainees and tutors; those based in community felt that 26 weeks in GP provided more opportunities for clinical and consultation skills learning. Cross-sector experience facilitated a better understanding of patient pathways and the importance of holistic patient care. All trainees considered working in GP in future but highlighted the lack of a cross-sector GP foundation programme. Base tutors felt the time commitment was comparable to single sector placements. Base and GP tutors felt that a clear set of competencies for GP placements and a broader governance framework would ensure standards and consistency. Conclusion This is the first national evaluation of cross-sector pre-registration pharmacists in general practice placements in England. Sampling as case studies enabled data triangulation and generated a multi-faceted understanding on factors impacting GP placements. A key limitation was the volunteer bias associated with recruitment. Key attributes of a successful pre-registration cross-sector training experience are highlighted and can inform policy reforms including change from pre-registration to foundation year training. References 1. Gray N. Review of Experience of Pre-registration Pharmacist Placements in the General Practice Setting – Final Report. 2019. 2. Jee SD, Schafheutle EI, Noyce PR. Is pharmacist pre-registration training equitable and robust? Higher Education, Skills and Work-Based Learning. 2019;9(3):347–58.

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Analysis of Low-Frequency Mutations Associated with Drug Resistance to Raltegravir before Antiretroviral Treatment

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01492-10 ◽

2010 ◽

Vol 55 (3) ◽

pp. 1114-1119 ◽

Cited By ~ 45

Author(s):

Jia Liu ◽

Michael D. Miller ◽

Robert M. Danovich ◽

Nathan Vandergrift ◽

Fangping Cai ◽

...

Keyword(s):

Drug Resistance ◽

Treatment Failure ◽

Low Frequency ◽

Hiv Treatment ◽

Viral Population ◽

Virologic Suppression ◽

Resistance Mutations ◽

The Difference ◽

Allele Specific Sequencing ◽

Hiv 1

ABSTRACTRaltegravir is highly efficacious in the treatment of HIV-1 infection. The prevalence and impact on virologic outcome of low-frequency resistant mutations among HIV-1-infected patients not previously treated with raltegravir have not been fully established. Samples from HIV treatment-experienced patients entering a clinical trial of raltegravir treatment were analyzed using a parallel allele-specific sequencing (PASS) assay that assessed six primary and six secondary integrase mutations. Patients who achieved and sustained virologic suppression (success patients,n= 36) and those who experienced virologic rebound (failure patients,n= 35) were compared. Patients who experienced treatment failure had twice as many raltegravir-associated resistance mutations prior to initiating treatment as those who achieved sustained virologic success, but the difference was not statistically significant. The frequency of nearly all detected resistance mutations was less than 1% of viral population, and the frequencies of mutations between the success and failure groups were similar. Expansion of pre-existing mutations (one primary and five secondary) was observed in 16 treatment failure patients in whom minority resistant mutations were detected at baseline, suggesting that they might play a role in the development of drug resistance. Two or more mutations were found in 13 patients (18.3%), but multiple mutations were not present in any single viral genome by linkage analysis. Our study demonstrates that low-frequency primary RAL-resistant mutations were uncommon, while minority secondary RAL-resistant mutations were more frequently detected in patients naïve to raltegravir. Additional studies in larger populations are warranted to fully understand the clinical implications of these mutations.

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Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali

Public Health and Preventive Medicine Archive ◽

10.24843/phpma.2017.v05.i01.p01 ◽

2017 ◽

pp. 4

Author(s):

Cok Istri Sri Dharma Astiti ◽

A.A Sagung Sawitri ◽

Tuti Parwati

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Clinical Stage ◽

Hiv And Aids ◽

First Line ◽

Aids Patients ◽

Factors Associated ◽

Art Initiation ◽

Risk Of Treatment ◽

Hiv Aids

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV with (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program with (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.

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