scholarly journals The MANGUA Project: A Population-Based HIV Cohort in Guatemala

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Juan Ignacio García ◽  
Blanca Samayoa ◽  
Meritxell Sabidó ◽  
Luis Alberto Prieto ◽  
Mikhail Nikiforov ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Population Based ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Multicenter Observational Study ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Hiv Positive Adults ◽  
Living With Hiv ◽  
Cd4 Cell

Introduction.The MANGUA cohort is an ongoing multicenter, observational study of people living with HIV/AIDS in Guatemala. The cohort is based on the MANGUA application which is an electronic database to capture essential data from the medical records of HIV patients in care.Methods.The cohort enrolls HIV-positive adults ≥16 years of age. A predefined set of sociodemographic, behavioral, clinical, and laboratory data are registered at entry to the cohort study.Results.As of October 1st, 2012, 21 697 patients had been included in the MANGUA cohort (median age: 33 years, 40.3% female). At enrollment 74.1% had signs of advanced HIV infection and only 56.3% had baseline CD4 cell counts. In the first 12 months after starting antiretroviral treatment 26.9% (n=3938) of the patients were lost to the program.Conclusions.The implementation of a cohort of HIV-positive patients in care in Guatemala is feasible and has provided national HIV indicators to monitor and evaluate the HIV epidemic. The identified percentages of late presenters and high rates of LTFU will help the Ministry to target their current efforts in improving access to diagnosis and care.

Causes and outcomes of hospitalizations among people living with HIV in Georgia’s referral institution, 2012–2017

2021 ◽  
Vol 32 (7) ◽  
pp. 662-670
Author(s):  
Nino Rukhadze ◽  
Ole Kirk ◽  
Nikoloz Chkhartishvili ◽  
Natalia Bolokadze ◽  
Lali Sharvadze ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Immunology ◽  
Fatal Outcome ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Lethal Outcome ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

We assessed trends in causes and outcomes of hospitalization among people living with HIV (PLWH) admitted to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) in Tbilisi, Georgia. Retrospective analysis included adult PLWH admitted to IDACIRC for at least 24 h. Internationally validated categorization was used to split AIDS admissions into mild, moderate, and severe AIDS. A total of 2085 hospitalizations among 1123 PLWH were registered over 2012–2017 with 65.1% (731/1123) of patients presenting with CD4 count <200. Of 2085 hospitalizations, 931 (44.7%) were due to AIDS-defining illnesses. In 2012, AIDS conditions accounted for 50.3% of admissions compared to 41.6% in 2017 ( p = 0.16). Overall, 167 hospitalizations (8.0%) resulted in lethal outcome. AIDS admissions had higher mortality than non-AIDS admissions (11.5% vs 5.2%, p < 0.0001). Among 167 deceased patients, 137 (82.0%) had CD4 count <200 at admission. In multivariate analysis, factors significantly associated with mortality included severe AIDS versus non-AIDS admission (OR 2.81, 95% CI: 1.10–7.15), CD4 cell counts <50 (OR 4.34, 95% CI: 2.52–7.47), and 50–100 (OR 2.37, 95% CI: 1.27–4.42) versus >200. Active AIDS disease remains a significant cause of hospitalization and fatal outcome in Georgia. Earlier diagnosis of HIV is critical for decreasing AIDS hospitalizations and mortality.

scholarly journals Virologic Outcomes among People Living with HIV with High Pre-Therapy Viral Load Burden Initiating on Common Core Agents

2021 ◽  
Author(s):  
Anthony M Mills ◽  
Kathy L Schulman ◽  
Jennifer S Fusco ◽  
Michael B Wohlfeiler ◽  
Julie L Priest ◽  
...  
Keyword(s):  
Common Core ◽  
Virologic Failure ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Viral Loads ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Background People living with HIV (PLWH) initiating antiretroviral therapy (ART) with viral loads (VL) ≥100,000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes. Methods ART-naïve PLWH with VLs ≥100,000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL) or darunavir (DRV) between 12Aug2013 and 31July2017 were identified from the OPERA Database. Virologic failure was defined as (i) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART, or (ii) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks, or (iii) 2 consecutive VL ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks, or (iv) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modelling estimated the association between regimen and virologic failure. Results There were 2,038 ART-naïve patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%) or RAL (2%). Median follow-up was 18.1 months (IQR:12.4-28.9). EVG and DTG initiators were similar at baseline but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% CI) was 1.46 (1.05, 2.03) for EVG, 2.24 (1.50, 3.34) for DRV, and 4.13 (1.85, 9.24) for RAL. Conclusion ART-naïve PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL and DRV initiators.

scholarly journals Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort)

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027325
Author(s):  
Juan Liu ◽  
James Wilton ◽  
Ashleigh Sullivan ◽  
Alex Marchand-Austin ◽  
Beth Rachlis ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Retrospective Cohort ◽  
Laboratory Data ◽  
Population Based ◽  
Hiv Care ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Laboratory Test Results ◽  
Living With Hiv

PurposePopulation-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada.ParticipantsA datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985–2015) or VL test (1996–2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration.Findings to dateAs of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort—contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015.Future plansWe plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities.

scholarly journals HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Matthew S. Freiberg ◽  
Meredith S. Duncan ◽  
Charles Alcorn ◽  
Chung‐Chou H. Chang ◽  
Suman Kundu ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
World Health ◽  
People Living With Hiv ◽  
Hiv Viral Load ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Health Organization ◽  
Living With Hiv ◽  
Cd4 Cell

Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow‐up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04–1.25), adjusting for possible confounders. In analyses with time‐varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm 3 (HR, 1.57; 95% CI, 1.28–1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46–1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm 3 (HR, 1.03; 95% CI, 0.90–1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87–1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO‐defined SCD among those with elevated HIV viral load or low CD4 cell counts.

scholarly journals Immunodeficiency and cancer in 3.7 million people living with HIV: the South African HIV Cancer Match Study

2020 ◽  
Author(s):  
Yann Ruffieux ◽  
Mazvita Muchengeti ◽  
Matthias Egger ◽  
Orestis Efthimiou ◽  
Lina Bartels ◽  
...  
Keyword(s):  
Cell Count ◽  
Kaposi Sarcoma ◽  
Incidence Rates ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Non Hodgkin Lymphoma ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

Background: The mechanisms linking the human immunodeficiency virus (HIV) to cancer are not fully understood. We analysed associations between immunodeficiency and the incidence of various infection-related and infection-unrelated cancers in a large cohort of people living with HIV (PLWH).Methods: We used data from the South African HIV Cancer Match (SAM) study which is the result of probabilistic record linkage between HIV laboratory measurements provided by the National Health Laboratory Services and cancer records from the National Cancer Registry in South Africa. We classified cancers based on type and related infections. For each of these cancer groups, we calculated crude incidence rates and evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported the associations using adjusted hazard ratios (aHR) over a grid of CD4 values for a reference value of 200 cells/µl, and by estimating the aHR per decrease of 100 CD4 cells/µl after assuming a linear relationship between the log hazard and CD4 cell counts. Results: We analysed 3,695,723 PLWH, of which 16,274 developed cancer, for an overall crude cancer incidence rate of 169 per 100,000 person-years (py). The most common cancers were cervical cancer (4,151 cases in women, rate of 59 per 100,000 py), Kaposi Sarcoma (2,311 cases, rate of 24 per 100,000 py), and non-Hodgkin lymphoma (1,101 cases, rate of 11 per 100,000 py). There were 6,482 PLWH diagnosed with cancer not related to infection (rate of 67 per 100,000 py). The association between low CD4 cell count and higher rates of cancer was strongest in conjunctival cancer (aHR per decrease of 100 CD4 cells/µl: 1.47, 95% confidence interval [CI] 1.39-1.55), followed by Kaposi Sarcoma (aHR 1.23, 95% CI 1.20-1.26) and non-Hodgkin lymphoma (aHR 1.16, 95% CI 1.12-1.19). Among the infection-unrelated cancers, we found low CD4 cell count to be associated with higher rates of squamous cell carcinoma of the skin (aHR 1.06, 95% CI 1.02-1.11) and cancer of the oesophagus (aHR 1.06, 95 CI 1.00-1.11). We found no association between CD4 cell count and both breast and prostate cancer incidence.Conclusions: Low time-updated CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer prevention strategy among PLWH in South Africa, a region heavily burdened by cancers attributable to infections.

scholarly journals The correlation of tuberculosis smear results and immuno-suppression with CD4+ counts as a surrogate marker among HIV infected patients.

2021 ◽  
Author(s):  
Kingsley Kamvuma ◽  
Yusuf ademola ◽  
Warren Chanda ◽  
Christopher Newton Phiri ◽  
Sam Bezza Phiri ◽  
...  
Keyword(s):  
Cell Count ◽  
Surrogate Marker ◽  
Hiv Positive ◽  
Sputum Smear ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Study Participants ◽  
Cd4 Cell

Abstract Background: Human immunodeficiency virus (HIV) and M.tuberculosis are two intracellular pathogens that interact at the cellular, clinical and population levels. Since the recognition of AIDS in 1981, the number of reported cases of TB in the has increased substantially, especially in regions with high incidence of AIDS. The main aim of this study was to establish weather there is a relationship between sputum smear positives and low CD4 cell counts among HIV infected patients.Materials and methods: This was a retrospective study involving 473 participants. The patients recruited in this study were those who tested HIV positive and smear positive for TB. Their HIV status was determined by performing an HIV blood test, if they were HIV positive their CD4 cell count were then made.Results: This study examined the relation between smear positivity and low CD4 (below 200cells/µl) together with CD8 and CD3 markers as a measure of immune function among patients infected with HIV. The study participants’ constituted males 67% and females 33%. The overall mean age was 33.2 (SD 6.9) with the youngest and oldest participants being 18 and 60 respectively. It was found that smear positive results negatively (r=-0.13; p=0.021) correlated with CD4+ below 200 cells/µl. No correlation was observed between smear positives and CD8+ or CD3+ since the calculated correlation coefficient was not significant 0.007 (p=0.9) and 0.03 (p=0.6) respectively. There are more 3+ smear results below 200 cells/µl than the others while above 200 cells/µl 1+ was the most commonly reported smear result. The scanty smear positives were the least commonly reported result in the low and high CD4 counts. Conclusion: The smear positive result negatively correlated with a low CD4+ (r=-0.13; p=0.021) but no correlation with low CD+8 and CD+3 results was observed. The long held theory that low bacillary counts in patients with low CD4+ counts needs to be revisited. The reduction of CD4+ cell count parallels' that of the total lymphocyte count and is more marked in patients with high bacillary counts. Further, studies are required to confirm these findings

scholarly journals Prevalence and viral loads of polyomaviruses BKPyV, JCPyV, MCPyV, TSPyV and NJPyV and hepatitis viruses HBV, HCV and HEV in HIV-infected patients in China

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xianfeng Zhou ◽  
Kenji Nakashima ◽  
Masahiko Ito ◽  
Xiaoling Zhang ◽  
Satoshi Sakai ◽  
...  
Keyword(s):  
Hiv Positive ◽  
Hepatitis Viruses ◽  
Positive Group ◽  
Viral Loads ◽  
Hiv Rna ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Significant Difference ◽  
Potential Risk Factors ◽  
Cd4 Cell

Abstract Human polyomaviruses (PyVs) and hepatitis viruses are often more prevalent or persistent in human immunodeficiency virus (HIV)-infected persons and the associated diseases are more abundant than in immunocompetent individuals. Here, we evaluated seroreactivities and viral loads of human PyVs and hepatitis viruses in HIV/AIDS patients and the general population in China in the combination antiretroviral therapy (cART) era. A total of 810 HIV-1-infected patients and age- and sex-matched HIV-negative individuals were enrolled to assess seroprevalence of PyVs BKPyV, JCPyV, MCPyV, TSPyV, and NJPyV and hepatitis viruses HBV, HCV, and HEV. 583 (72%) patients received cART, and among them, 31.2% had undetectable HIV RNA. While no significant difference was observed in prevalence of anti-PyV antibodies between HIV-positive and -negative groups, serum DNA positivity and DNA copy level of MCPyV were higher in the HIV-positive group. Among HIV-infected patients, BKPyV DNA positivity was significantly higher in patients with CD4 + cell counts < 200 cells/mm3 compared to those with CD4 + cell counts > 500 cells/mm3, suggesting possible reactivation caused by HIV-induced immune suppression. Higher HBV and HCV seropositivities but not HEV seropositivity were also observed in the HIV-positive group. Further correlation analyses demonstrated that HBV and HEV are potential risk factors for increased prevalence of PyV infection.

scholarly journals TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Anne Marie W. Efsen ◽  
Alexander M. Panteleev ◽  
Daniel Grint ◽  
Daria N. Podlekareva ◽  
Anna Vassilenko ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Rank Test ◽  
Hiv Positive ◽  
Cumulative Probability ◽  
Factors Associated ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Kaplan Meier ◽  
Adjusted Incidence Rate ◽  
Cd4 Cell

Objectives.The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters with those of extrapulmonary TB (TBEP) and pulmonary TB (TBP).Methods.Kaplan-Meier estimation and Poisson regression models were used to assess the mortality following TB diagnosis and to evaluate potential prognostic factors for the 3 groups of TB patients separately.Results.A total of 100 patients with TBM, 601 with TBEP, and 371 TBP were included. Patients with TBM had lower CD4 cell counts and only 17.0% received antiretroviral therapy (ART) at TB diagnosis. The cumulative probability of death at 12 months following TB was 51.2% for TBM (95% CI 41.4–61.6%), 12.3% for TBP (8.9–15.7%), and 19.4% for TBEP (16.1–22.6) (P<0.0001; log-rank test). For TBM, factors associated with a poorer prognosis were not being on ART (adjusted incidence rate ratio (aIRR) 4.00 (1.72–9.09), a prior AIDS diagnosis (aIRR=4.82(2.61–8.92)), and receiving care in Eastern Europe (aIRR=5.41(2.58–11.34))).Conclusions.TBM among HIV-positive patients was associated with a high mortality rate, especially for patients from Eastern Europe and patients with advanced HIV-infection, which urgently calls for public health interventions to improve both TB and HIV aspects of patient management.

“What shots do I need?”

HIV ◽  
2020 ◽  
pp. 253-258
Author(s):  
Giorgos Hadjivassiliou ◽  
Edgar T. Overton
Keyword(s):  
Varicella Vaccine ◽  
The United States ◽  
Human Papilloma Virus Vaccine ◽  
Vaccine Preventable Diseases ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Persons Living With Hiv ◽  
Control And Prevention ◽  
Living With Hiv ◽  
Cd4 Cell

This chapter reviews the current recommendations for adult persons living with HIV (PLWH) in the United States regarding vaccine-preventable diseases. In clinical practice, PLWH should be offered annual influenza vaccine; a combination of tetanus, diphtheria, and pertussis vaccine; depending on previous vaccination, pneumococcal vaccine, meningococcal conjugate vaccine, and hepatitis A and hepatitis B vaccines. Human papilloma virus vaccine can be given in PLWH up until the age of 26. Live vaccines, including the measles-mumps-rubella vaccine and varicella vaccine, can be given in those individuals who have CD4 cell counts of greater than 200 cells/mm3 and did not receive these vaccines during childhood. Some expert panels endorse recombinant zoster vaccination in PLWH at least 50 years old, although there is no current official recommendation from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. The chapter covers routine vaccinations for PLWH.

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