scholarly journals Immunologic and Clinical Failure of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus within Two Years of Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Solomon Weldegebreal Asgedom ◽  
Mahlet Maru ◽  
Beletu Berihun ◽  
Kidu Gidey ◽  
Yirga Legesse Niriayo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Treatment Failure ◽  
Antiretroviral Treatment ◽  
Cox Regression ◽  
Statistical Significance ◽  
Cox Regression Analysis ◽  
Immunodeficiency Virus ◽  
Antiretroviral Treatment Failure

Background. Early initiation of highly active antiretroviral therapy (HAART) decreases human immunodeficiency virus- (HIV-) related complications, restores patients’ immunity, decreases viral load, and substantially improves quality of life. However, antiretroviral treatment failure considerably impedes the merits of HAART. Objective. This study is aimed at determining the prevalence of immunologic and clinical antiretroviral treatment failure. Methods. A cross-sectional study design using clinical and immunologic treatment failure definition was used to conduct the study. Sociodemographic characteristics and clinical features of patients were retrieved from patients’ medical registry between the years 2009 and 2015. All patients who fulfilled the inclusion criteria in the study period were studied. Predictors of treatment failure were identified using Kaplan-Meier curves and multivariable Cox regression analysis. Data analysis was done using SPSS version 21 software, and the level of statistical significance was declared at a p value < 0.05. Results. A total of 770 were studied. The prevalence of treatment failure was 4.5%. The AZT-based regimen (AHR=16.95, 95% CI: 3.02-95.1, p=0.001), baseline CD4 count≥301 (AHR=0.199, 95% CI: 0.05-0.76, p=0.018), and bedridden during HAART initiation (AHR=0.131, 95% CI: 0.029-0.596, p=0.009) were the predictors of treatment failure. Conclusion. The prevalence of treatment failure was lower with the risk being higher among patients on the AZT-based regimen. On the other hand, the risk of treatment failure was lower among patients who started HAART at baseline CD4 count≥301 and patients who were bedridden during HAART initiation. We recommend further prospective, multicenter cohort studies to be conducted to precisely detect the prevalence of treatment failure using viral load determination in the whole country.

scholarly journals Detection of Antiretroviral treatment failure among adult HIV-1 patients on anti-retroviral therapy for 12 +/- 3 months attending different Voluntary Counseling Testing and treatment centers in Khartoum state, Sudan

2020 ◽  
Author(s):  
Nafisa Ahmed Ibrahim ◽  
Khalid A Enan ◽  
Mahdi Mustafa Yagoup ◽  
Wafa Ibrahim Elhag
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Treatment Failure ◽  
Antiretroviral Treatment ◽  
Clinical Staging ◽  
Age Group ◽  
First Line ◽  
Voluntary Counseling ◽  
Hiv 1 ◽  
Antiretroviral Treatment Failure

Abstract Objective: Small number of people on antiretroviral therapy and their virological status in Sudan is lacking. This study aimed to determine the viral load for adult HIV-1 patients who were on antiretroviral therapy for 12+/- 3 months attending different Voluntary Counseling Testing and treatment centers (VCT/ART) in Khartoum state, Sudan.Results: out of 112 adult HIV-1 patients included in this study, only 17.9% (20/112) showed unsuppressed viral load (treatment failure). The majority of them from Omdurman VCT/ART center 80% (16/20), followed by Khartoum VCT/ART center 15% (3/20), Bahri VCT/ART center 5% (1/20) and non from Elban Gadeid VCT/ART center. All of them were on the first line of treatment. Most of them 30% (6/20) on 39-48 years old age group, the majority of them 55%(11/20) on stage 3 WHO clinical staging.

scholarly journals Toll-Like Receptor 2 Promoter -196 to -174 Deletion Affects CD4 Levels Along Human Immunodeficiency Virus Infection Progression

2020 ◽  
Vol 222 (12) ◽  
pp. 2007-2011 ◽  
Author(s):  
Marina Laplana ◽  
Maria Jose Bravo ◽  
Marta Fernández-Fuertes ◽  
Celia Ruiz-Garcia ◽  
Emilio Alarcón-Martin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Disease Progression ◽  
Cox Regression ◽  
Toll Like Receptor ◽  
Cox Regression Analysis ◽  
Immunodeficiency Virus ◽  
Toll Like Receptor 2 ◽  
Time Required ◽  
Molecular Patterns ◽  
Hiv 1

Abstract Toll-like receptor 2 (TLR2) plays a key role in innate immune response recognizing molecular patterns expressed by pathogens. rs111200466 is a TLR2 promoter insertion/deletion polymorphism with contradictory data about its role in human immunodeficiency virus type 1 (HIV-1) infection. We analyzed rs111200466 in HIV-1 disease progression and showed a correlation with a faster progression to the CD4+ &lt; 200 cells/μL outcome for deletion allele carriers (Cox regression analysis: hazard ratio, 2.4 [95% confidence interval, 1.4–4]; P = .001). When naive patients with CD4+ &lt; 200 cells/μL started antiretroviral treatment, rs111200466-deletion carriers showed a trend toward a slower, recovery rate (time required to reach CD4+ &gt; 350 cells/μL; Cox P = .36). Our data suggest rs111200466 as a prognosis factor for HIV-1 disease progression.

scholarly journals Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy–Experienced Ugandans With Virologic Failure

2019 ◽  
Vol 71 (7) ◽  
pp. 1726-1731 ◽  
Author(s):  
Edward Mpoza ◽  
Radha Rajasingham ◽  
Lillian Tugume ◽  
Joshua Rhein ◽  
Maria Sarah Nabaggala ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Cryptococcal Meningitis ◽  
Virologic Failure ◽  
Cost Effective ◽  
World Health ◽  
Load Testing ◽  
Viral Loads ◽  
Immunodeficiency Virus

Abstract Background Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus–positive persons with CD4 count &lt;100 cells/μL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown. Methods We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (≥1000 copies/mL) using leftover plasma after viral load testing during September 2017–January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review. Results Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10–84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8–19.8]; P = .001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among those with viral loads &lt;5000 copies/mL. Conclusions In addition to the CD4 threshold of &lt;100 cells/μL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.

scholarly journals Decreased Bone Formative and Enhanced Resorptive Markers in Human Immunodeficiency Virus Infection: Indication of Normalization of the Bone-Remodeling Process during Highly Active Antiretroviral Therapy1

1999 ◽  
Vol 84 (1) ◽  
pp. 145-150 ◽  
Author(s):  
Pål Aukrust ◽  
Charlotte J. Haug ◽  
Thor Ueland ◽  
Egil Lien ◽  
Fredrik Müller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Bone Formation ◽  
Bone Remodeling ◽  
Highly Active Antiretroviral Therapy ◽  
Serum Concentrations ◽  
Marked Rise ◽  
Highly Active ◽  
Immunodeficiency Virus

As cytokines and 1,25-dihydroxyvitamin D [1,25-(OH)2D] appear to have an important role in bone homeostasis, we examined the possibility that human immunodeficiency virus (HIV)-infected patients, characterized by enhanced levels of proinflammatory cytokines and 1,25-(OH)2D deficiency, have disturbed bone metabolism by analyzing serum markers of bone formation (osteocalcin) and bone resorption (C-telopeptide) in 73 HIV-infected patients. HIV-infected patients with advanced clinical and immunological disease and high viral load were characterized by increased C-telopeptide and particularly by markedly depressed osteocalcin levels. HIV-infected patients had enhanced activation of the TNF system. Serum concentrations of p55 and p75-TNF receptors were negatively correlated with osteocalcin, and p75-TNF receptor was positively correlated with C-telopeptide. HIV-infected patients with advanced disease also had decreased serum concentrations of 1,25-(OH)2D, but this parameter was not correlated with osteocalcin or C-telopeptide. During 24 months with highly active antiretroviral therapy there was a marked rise in serum osteolcalcin levels together with a profound fall in viral load and TNF components and a marked rise in CD4+ T cell counts. Also, there was a shift from no correlation to a significant correlation between osteocalcin and C-telopeptide levels during such therapy. The present study suggests disturbed bone formation and resorption during HIV infection. Our findings indicating synchronization of bone remodeling during highly active antiretroviral therapy may represent a previously unrecognized beneficial effect of such therapy and expand our knowledge of the interactions between cytokines and bone in the bone-remodeling process.

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