Direct oral anticoagulants versus warfarin in people living with human immunodeficiency virus

Human immunodeficiency virus (HIV) is associated with increased rates of cardiovascular disease and vascular events, and people living with HIV (PLWH) may often have indications for therapeutic anticoagulation. However, the ideal anticoagulant in PLWH remains unknown. This retrospective cohort evaluated the tolerability and effectiveness of oral anticoagulants in PLWH. The primary outcome was tolerability, defined as a composite of bleeding and/or discontinuation rates. The secondary outcomes included recurrent thromboembolism, bleeding, and discontinuations, independently. There were 92 patients included for analysis, 48 in the direct oral anticoagulant (DOAC) arm and 44 in the warfarin arm. There were 35 (38%) PLWH that did not tolerate oral anticoagulation therapy in the total cohort. Among these, 19 received a DOAC and 16 received warfarin. There were 16 (17%) PLWH that experienced a bleeding event: six in the DOAC arm and 10 in the warfarin arm. There were 15 (16%) PLWH that experienced recurrent thromboembolism, with similar rates between DOAC versus warfarin (10, 21% vs 5, 11%, respectively; p = 0.11). The most commonly prescribed HIV regimens were protease inhibitor and integrase inhibitor-based regimens. Overall, anticoagulation-related outcomes with either a DOAC or warfarin were poor in our cohort of PLWH, with high rates of bleeding, discontinuations, and recurrent thromboembolism. Further studies are necessary to validate and assess reasons for poor tolerability.

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Call For Life, Uganda: Acceptability Of A Mobile Phone Support To Promote Adherence To Anti-Retroviral Therapy For Young Adults In A Randomised Control Trial: A Qualitative Review (Preprint)

10.2196/preprints.17418 ◽

2019 ◽

Author(s):

Agnes Bwanika Naggirinya

Keyword(s):

Human Immunodeficiency Virus ◽

Young Adults ◽

Mobile Phone ◽

Interactive Voice Response ◽

Text Messages ◽

Randomised Control Trial ◽

People Living With Hiv ◽

Art Adherence ◽

Immunodeficiency Virus ◽

Living With Hiv

BACKGROUND : Adherence to treatment is critical to obtain successful treatment outcomes. While factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere because of psychosocial issues such as stigma, ART-related side effects as well as lack of access to treatment. Call for Life mHealth tool (C4LU), is a mobile phone- based technology that provides text messages or Interactive Voice Response (IVR) functionalities, through a web-interface and offers four modules including pill reminders, clinic visit reminders, health tips and symptom self-reporting support. Within a randomised control trial, we assessed perspectives and experiences of young adults living with human immunodeficiency virus towards the C4LU- system, with the objective to improve ART adherence among young people living with HIV with help of mHealth tool. OBJECTIVE To improve ART adherence among young people living with HIV through use of mHealth tool. METHODS This was an exploratory qualitative design at two study sites nested within an open label randomized controlled trial (RCT) entitled: “Improving outcomes in human immunodeficiency virus (HIV) patients using mobile phone based interactive software support “Call for Life study A total of 600 participants were randomly assigned 1:1 to either Standard of Care (SoC)- face-to-face counsellor adherence support or SoC plus mHealth call for life system (C4LU). C4LU uses Interactive voice response or text messages delivered via mobile phone. The qualitative study explored perspectives and experiences of young adults (18-24 years) towards the mHealth tool “C4LU”. A purposive sample of twenty-one vulnerable youth, seventeen from the intervention and four from the SoC arm were selected. We used semi-structured interviews to facilitate an in-depth exploration of experiences of young adults regarding C4LU-System. Thirteen in-depth interviews and one focus group discussion were conducted. The young adults were from four categories of population of interest that were targeted to be offered specialised care: young adults on PMTCT, switching to / or on second line ART, positive partners in a discordant relationship and initiating 1st line ART. Data was managed using Nvivo version 11 and analysed thematically. RESULTS C4LU-mHealth tool was perceived as an acceptable intervention for young adults. While on the system, participants reported: improvement in medication adherence, strengthened doctor /clinician -patient relationships, increased health knowledge through educative health tips. Appointment reminders and symptom reporting were singled out as beneficial because the system would address and manage the problems of forgetfulness, and stigma related issues. CONCLUSIONS The system was described as an acceptable and feasible strategy to improve ART adherence and retention among young adults in resource limited settings CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT 02953080

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Utilization of Direct Oral Anticoagulants in People Living with Human Immunodeficiency Virus: Observational Data from the District of Columbia Cohort

Clinical Infectious Diseases ◽

10.1093/cid/ciaa284 ◽

2020 ◽

Vol 71 (10) ◽

pp. e604-e613

Author(s):

Jomy M George ◽

Safia S Kuriakose ◽

Anne Monroe ◽

Qingjiang Hou ◽

Morgan Byrne ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

International Classification Of Diseases ◽

Bleeding Events ◽

Predominantly Black ◽

Prescribing Trends ◽

Immunodeficiency Virus ◽

Classification Of Diseases

Abstract Background Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people living with human immunodeficiency virus (PWH) are not well described. The coadministration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions. Methods A longitudinal cohort study was conducted using the D.C. Cohort Database in Washington, D.C., from January 2011 to March 2017, to describe oral anticoagulant prescribing among PWH ≥ 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions, and International Classification of Diseases Ninth and Tenth Edition diagnosis codes. Results Among 8315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%) and male (82%), with a mean age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. There were 19 bleeding events recorded among 16 individuals. Despite the Food and Drug Administration label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation. Conclusions DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC/ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH.

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Polypharmacy and Drug–Drug Interactions in People Living With Human Immunodeficiency Virus in the Region of Madrid, Spain: A Population-Based Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz811 ◽

2019 ◽

Vol 71 (2) ◽

pp. 353-362 ◽

Cited By ~ 7

Author(s):

Beatriz López-Centeno ◽

Carlos Badenes-Olmedo ◽

Ángel Mataix-Sanjuan ◽

Katie McAllister ◽

José M Bellón ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Interactions ◽

Age Groups ◽

Population Based ◽

People Living With Hiv ◽

Traffic Light ◽

Population Based Study ◽

Immunodeficiency Virus ◽

Red Flag ◽

Living With Hiv

Abstract Background Drug–drug interactions (DDIs) that involve antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of comorbidity and polypharmacy. Methods A linkage was established between the drug dispensing registry of Madrid and the Liverpool human immunodeficiency virus (HIV) DDI database (January 2017–June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications, and DDIs were classified by a traffic-light ranking for severity. Results A total of 22 945 people living with HIV (PLWH) and 6 613 506 individuals without HIV had received medications. ARV regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was higher in PLWH (32.94%) than individuals without HIV (22.16%; P < .001); this difference was consistently observed across all age strata except for individuals ≥75 years. Polypharmacy was more common in women than men in both PLWH and individuals without HIV. The prevalence of contraindicated combinations involving ARVs was 3.18%. Comedications containing corticosteroids, quetiapine, or antithrombotic agents were associated with the highest risk for red-flag DDI, and the use of raltegravir- or dolutegravir-based antiretroviral therapy was associated with an adjusted odds ratio of 0.72 (95% confidence interval, .60–.88; P = .001) for red-flag DDI. Conclusions Polypharmacy was more frequent among PLWH across all age groups except those aged ≥75 years and was more common in women. The detection of contraindicated medications in PLWH suggests a likely disconnect between hospital and community prescriptions. Switching to alternative unboosted integrase regimens should be considered for patients with risk of harm from DDIs.

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Human immunodeficiency virus infection and inflammatory arthritis: A review of clinical and imaging features

South African Journal of Radiology ◽

10.4102/sajr.v21i2.1261 ◽

2017 ◽

Vol 21 (2) ◽

Author(s):

Farhana E. Suleman ◽

Mahmood M.T.M. Ally

Keyword(s):

Human Immunodeficiency Virus ◽

Pain Syndrome ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Imaging Features ◽

The People ◽

Immunodeficiency Virus ◽

Sub Saharan ◽

Living With Hiv ◽

Articular Pain

The reported prevalence of articular manifestations of human immunodeficiency virus (HIV) varies, but with sub-Saharan Africa accounting for almost 70% of the people living with HIV, this results in a considerable burden of disease in the region. The spectrum of clinical presentation described, includes articular pain syndrome, HIV-associated arthropathy and seronegative spondyloarthropathies, among others. This brief review serves to create awareness of the clinical and imaging presentation of this spectrum of disease as there is significant morbidity associated with these conditions if treatment is delayed.

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Quality of Life People Living with HIV-AIDS (PLWHA) with Antiretroviral therapy in Cendana Clinic Ngudi Waluyo Wlingi Hospital

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v2i1.art.p006-014 ◽

2015 ◽

Vol 2 (1) ◽

pp. 006-014

Author(s):

Erni Setiyorini

Keyword(s):

Quality Of Life ◽

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

People Living With Hiv ◽

Environment Problem ◽

Immunodeficiency Virus ◽

Long Time ◽

Living With Hiv ◽

Hiv Aids

Human Immunodeficiency Virus (HIV)is desease with high mortality and everyone have chancegot HIV. At Blitar HIV/AIDS prevalence increase since 2010. The incubation of HIV need long time tobecome AIDS. At this period PLWHA faced with physic, physichologic, sosial, environment problem andimpact to their quality of life. The purpose of this study was to describe quality of life PLWHA at physic,physichologic, sosial, environment dimension. Method: Research design was descriptive. Population ofthis study is PLWHA who receiving ARV at Cendana Clinic Ngudi Waluyo Wlingi Hospital. Samples 42respondent by using convenient sampling. Data collected at September 1st– 30, 2013 by questionaire.Result of this study in physic dimension much of them at good 16 peoples (38,1%), enough and less, eachof them 13 peoples (31%). Physhicology dimension at good and enough, each of them 20 peoples(47,6%) then at less 2 peoples (4,8%). Sosial dimension enough 25 peoples (59,5%), good 15 peoples(35,7%) and less 2 peoples (4,8%). Environment dimension enough 16 peoples (38,1%), good 15peoples (35,7%) dan kurang 11 orang (26,2%). It is suggested for nurse to implementation nursing careplan to PLWHA suitable with their quality of life dimension and enhance support to their sosial activity.

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ATRIBUSI KOMUNIKASI ORANG DENGAN HIV/AIDS (ODHA) KEPADA KERABAT DEKAT DI YOGYAKARTA

Islamic Communication Journal ◽

10.21580/icj.2020.5.1.4775 ◽

2020 ◽

Vol 5 (1) ◽

pp. 83

Author(s):

Mugiarjo Mugiarjo

Keyword(s):

Human Immunodeficiency Virus ◽

Significant Others ◽

People Living With Hiv ◽

Self Disclosure ◽

Immunodeficiency Virus ◽

The Status ◽

The Stability ◽

Living With Hiv ◽

The Relationship ◽

Hiv Aids

<div>Regarding the response to self-disclosure, a person needs to make an attribution in order to know whether the response is really an intention or just a diversion. This article based on qualitative methods. Data collected by observation, interview, and documentation. The results of this study indicate that People Living With HIV/Aids (PLWHA) carry out quite strict regulations by conducting an assessment first before disclosing their Human Immunodeficiency Virus (HIV) status. The response obtained after they opened the status to the significant others was attributed by. The basis of sincere acceptance and response, the stability of the relationship between PLWHA and significant others after opening the status can be maintained, even stronger. PLWHA rely heavily on the power of spirituality to be able to build themselves better. In addition, the ability to make peace with oneself over their circumstances also influenced by this spirituality. Appreciation of spirituality also indicate that their engagement with God strengthened. This strength is shown by their awareness of the meaning of life.</div>

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FACTORS ASSOCIATED WITH HEPATITIS B AND C CO-INFECTION AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN VIETNAM

Belitung Nursing Journal ◽

10.33546/bnj.813 ◽

2019 ◽

Vol 5 (4) ◽

pp. 147-154

Author(s):

Le Hieu Thuy Anh ◽

Suchada Thaweesit

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis B ◽

Ecological Model ◽

Theoretical Perspective ◽

Hiv Positive ◽

People Living With Hiv ◽

Infected People ◽

Factors Associated ◽

Immunodeficiency Virus ◽

Living With Hiv

Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are the leading causes of death from infectious diseases. Because of sharing same transmission routes, the co-infection of HIV with HBV or HCV is common. And the co-infections make HIV infected persons have higher morbidity and mortality than those who infected only with HIV. This study aims to investigate factors that may have influence on the co-infections of HBV or HCV among HIV positive individuals.Objective: The goals of this study were to identify factors associated with the co-infection of HBV or HCV among people living with HIV. Methods: Quantitative research method was applied in this study to examine factors associated with HBV or HCV co-infection among HIV infected people. A total of 250 HIV infected individuals in Khanh Hoa province, Vietnam were the sample of this study. It employed the Social Ecological Model (SEM) as a theoretical perspective that focused on multiple levels of factors. Descriptive statistic was used to describe the general characteristics of the respondents. And Binary logistic regression was carried out to measure the influence of factors on the co-infection. Results: The multivariate analysis of this study showed that HIV-HBV co-infection was associated significantly with residents of Nha Trang (OR= 7.179). Regarding HIV-HCV co-infection, being men (OR= 7.617), unemployed (OR= 4.013), a resident of Nha Trang (OR=10.894) and an injecting drug user (OR= 16.688) were risk factors of the co-infection.Conclusions: This study recommended that intervention strategies to prevent HIV-positive individuals from co-infection with either HBV or HCV should focuses on altering individuals’ risk behaviors and their socio-economic environments. Also, specific preventing programs should be implemented and focus on unemployed populations, injecting drug users, men in general, as well as people living in particular areas, especially cities having a large number of people living with HIV.

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Dynamics of the Decay of Human Immunodeficiency Virus (HIV) RNA and Distribution of Bictegravir in the Genital Tract and Rectum in Antiretroviral-naive Adults Living With HIV–1 Treated With Bictegravir/Emtricitabine/Tenofovir Alafenamide (Spanish HIV/AIDS Research Network, PreEC/RIS 58)

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1416 ◽

2020 ◽

Author(s):

Arkaitz Imaz ◽

Juan M Tiraboschi ◽

Jordi Niubó ◽

Javier Martinez-Picado ◽

Mackenzie L Cottrell ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Research Network ◽

People Living With Hiv ◽

Limit Of Quantification ◽

Immunodeficiency Virus ◽

Liquid Chromatography Tandem Mass ◽

Half Maximal Effective Concentration ◽

Tenofovir Alafenamide ◽

Living With Hiv ◽

Hiv 1

Abstract Background The pharmacokinetics of bictegravir (BIC) and its association with the decay of human immunodeficiency virus (HIV)–1 RNA in genital fluids and the rectum have not yet been addressed. Methods We conducted a prospective, multicenter study of antiretroviral-naive people living with HIV-1 and initiating BIC/emtricitabine (FTC)/tenofovir alafenamide (TAF). HIV-1 RNA was measured (limit of quantification, 40 copies/mL) in blood plasma (BP), seminal plasma (SP), rectal fluid (RF), and cervicovaginal fluid (CVF) at baseline; Days 3, 7, 14, and 28; and Weeks 12 and 24. Total and protein-unbound BIC concentrations at 24 hours postdose (C24h) were quantified in BP, SP, CVF and rectal tissue (RT) on Day 28 and Week 12 using a validated liquid chromatography-tandem mass spectrometry assay. Results The study population comprised 15 males and 8 females. In SP, RF, and CVF, the baseline HIV-1 RNA was >40 copies/mL in 12/15, 13/15, and 4/8 individuals, respectively, with medians of 3.54 (2.41–3.79), 4.19 (2.98–4.70), and 2.56 (1.61–3.56) log10 copies/mL, respectively. The initial decay slope was significantly lower in SP than in RF and BP. The time to undetectable HIV-1 RNA was significantly shorter in SP and RF than in BP. All women achieved undetectable HIV-1 RNA in CVF at Day 14. The median total BIC concentrations in SP, RT, and CVF were 65.5 (20.1–923) ng/mL, 74.1 (6.0–478.5) ng/g, and 61.6 (14.4–1760.2) ng/mL, respectively, representing 2.7%, 2.6%, and 2.8% of the BP concentration, respectively, while the protein-unbound fractions were 51.1%, 44.6%, and 42.6%, respectively. Conclusions BIC/FTC/TAF led to rapid decay of HIV-1 RNA in genital and rectal fluids. Protein-unbound BIC concentrations in SP, RT, and CVF highly exceeded the half-maximal effective concentration (EC50) value (1.1 ng/mL). Clinical Trials Registration EudraCT 2018-002310-12.

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Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients

Journal of Pharmacy Practice ◽

10.1177/08971900211064189 ◽

2021 ◽

pp. 089719002110641

Author(s):

Thane Feldeisen ◽

Constantina Alexandris-Souphis ◽

Brian Haymart ◽

Xiaowen Kong ◽

Eva Kline-Rogers ◽

...

Keyword(s):

Atrial Fibrillation ◽

Drug Class ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Bleeding Event ◽

Bleeding Events ◽

Anticoagulation Management ◽

Anticoagulation Clinics ◽

The Individual

Background Bleeding events are common complications of oral anticoagulant drugs, including both warfarin and the direct oral anticoagulants (DOACs). Some patients have their anticoagulant changed or discontinued after experiencing a bleeding event, while others continue the same treatment. Differences in anticoagulation management between warfarin- and DOAC-treated patients following a bleeding event are unknown. Methods Patients with non-valvular atrial fibrillation from six anticoagulation clinics taking warfarin or DOAC therapy who experienced an International Society of Thrombosis and Haemostasis (ISTH)-defined major or clinically relevant non-major (CRNM) bleeding event were identified between 2016 and 2020. The primary outcome was management of the anticoagulant following bleeding (discontinuation, change in drug class, and restarting of same drug class). DOAC- and warfarin-treated patients were propensity matched based on the individual elements of the CHA2DS2-VASc and HAS-BLED scores as well as the severity of the bleeding event. Results Of the 509 patients on warfarin therapy and 246 on DOAC therapy who experienced a major or CRNM bleeding event, the majority of patients continued anticoagulation therapy. The majority of warfarin (231, 62.6%) and DOAC patients (201, 81.7%) restarted their previous anticoagulation. Conclusion Following a bleeding event, most patients restarted anticoagulation therapy, most often with the same type of anticoagulant that they previously had been taking.

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