Immunologic and Virologic Outcomes of Obese and Nonobese Incarcerated Adults on Antiretroviral Therapy for HIV Infection

Background: Obesity is common among patients with HIV. The objective of this study was to characterize response to antiretroviral therapy (ART) in a cohort of obese incarcerated adults compared to a nonobese cohort. Methods: A retrospective matched cohort study was conducted in an HIV telemedicine clinic. Patients with body mass index (BMI) >30 kg/m2 who received the same ART with >95% adherence for at least 6 months were matched to nonobese patients by age, gender, ART, CD4 count, and viral load at baseline. Results: Twenty pairs were included, with an average BMI of 24 kg/m2 in the nonobese cohort and 35 kg/m2 in the obese cohort. No difference was observed in the proportion of patients who achieved virologic suppression or the change in CD4 count from baseline to 6 to 12 months. Conclusion: This study revealed no differences in immunologic recovery or virologic suppression between obese and nonobese patients in an adult correctional population.

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Body mass index increases CD4+ count in HIV/AIDS patients on first-line therapy

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2020.v39.121-127 ◽

2020 ◽

Vol 39 (2) ◽

pp. 121

Author(s):

Mirna Widiyanti ◽

Moch Irfan Hadi ◽

Mei Lina Fitri Kumalasari ◽

Evi Iriani Natalia ◽

Dedi Ananta Purba ◽

...

Keyword(s):

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Influencing Factor ◽

Clinical Stage ◽

Cd4 Count ◽

First Line ◽

Aids Patients ◽

Cd4 Counts ◽

Hiv Aids

Background The body mass index (BMI) may contribute somewhat to drug metabolism, thus affecting the efficacy of antiretroviral therapy (ART). CD4+ counts in people infected with HIV are essential in determining the stage of the disease, initiation of antiretroviral therapy, opportunistic infections and evaluating treatment outcomes. The aim of this study was to determine the association of BMI and clinical stage with CD4+ counts in HIV patients seeking treatment using first-line antiretroviral therapy (ART). Methods An analytic study with a cross-sectional approach was conducted involving 251 HIV/AIDS patients who had received first-line antiretrovirals over six months. BMI, clinical staging according to WHO and CD4 + were collected. Multiple linear regression was used to evaluate the relationship between BMI, clinical stage and CD4+. Results Among the enrolled patients, the median age was 36 years, 135 (55%) of the patients was female, 102 (40.6%) was overweight/obese, 161 (64.1%) was in stage 3 of the disease, and the median CD4+ count was 389 cells/mm3. Multiple linear regression test showed two variables with a significant effect on CD4+ count, namely BMI (B=69.247; 95 % CI : 42.886-95.608) and clinical stage (B=61.590; 28.910-94.270). BMI was the most influencing factor for CD4+ count (β=0.307) compared to clinical stage (β=0.216). Conclusions Body mass index was the most influencing factor for CD4 + counts of HIV/AIDS patients. Regular ART can increase CD4+ counts and maintain the health of HIV/AIDS patients.

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Bone health in symptomatic carriers of haemophilia A: a protocol for a multicentre prospective matched-cohort study

BMJ Open ◽

10.1136/bmjopen-2019-032891 ◽

2019 ◽

Vol 9 (12) ◽

pp. e032891 ◽

Cited By ~ 1

Author(s):

Grace H Tang ◽

Erin Norris ◽

Jessica Petrucci ◽

Paula D James ◽

Adrienne Lee ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

General Hospital ◽

Body Mass ◽

Bone Health ◽

Medical Centre ◽

Haemophilia A ◽

Matched Cohort ◽

Matched Cohort Study ◽

Kingston General Hospital

IntroductionHaemophilia A is an X linked inherited bleeding disorder, caused by a decrease in coagulation factor VIII. Persons with haemophilia experience repeated musculoskeletal bleeding, which can lead to decreased range of motion, irreversible joint damage, low bone mineral density (BMD), and are at greater risk for osteoporosis. Women heterozygous for this mutation, also known as haemophilia A carriers, can have bleeding symptoms and even experience joint bleeding evidenced by radiological soft tissue and osteochondral changes. The prevalence of low BMD as a risk factor for osteoporosis has never been evaluated in carriers of haemophilia, and given the recent findings which suggest subclinical musculoskeletal bleeding in carrier women, we hypothesise that they too are at risk of impaired bone health.Methods and analysisThis is a national multicentre prospective matched-cohort study to compare BMD T-scores among symptomatic haemophilia A carriers, 50 years of age or older, with age-matched and body mass index-matched non-carriers (1:1). A total of 40 symptomatic carriers and 40 matched non-carriers will be recruited from St. Michael’s Hospital, Kingston General Hospital in Ontario, Canada and Foothills Medical Centre in Alberta, Canada. Multivariable linear regression models will be used to estimate the effect of haemophilia carriership on BMD T-scores, adjusting for age, body mass index and other relevant covariates.Ethics and disseminationThe protocol was designed and will be conducted in compliance with applicable laws, rules and regulations. Research ethics approval was obtained from St. Michael’s Hospital, Foothills Medical Centre, and Kingston General Hospital. Findings will be presented at international venues such as the American Society of Haematology and the World Federation of Haemophilia World Congress. The authors of this study will seek publication in journals such as Blood, Journal of Thrombosis and Haemostasis, American Journal ofHematology and British Journal ofHaematology.

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Zidovudine- versus Tenofovir-Based Antiretroviral Therapy for the Initial Treatment of HIV Infection in the Ethnic Minority Region of Liangshan Prefecture, Sichuan Province, China

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

10.1177/2325957416686190 ◽

2017 ◽

Vol 16 (2) ◽

pp. 189-193 ◽

Cited By ~ 3

Author(s):

Cedric P. Cheung ◽

Wen Hong Lai ◽

Jonathan Shuter

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Odds Ratio ◽

Initial Treatment ◽

Multivariate Logistic Regression Analysis ◽

Sichuan Province ◽

World Health ◽

Virologic Suppression ◽

Hiv Viral Load

Background: Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World Health Organization guidelines for HIV-naive patients, has been limited in resource-constrained settings. The aim of this study was to evaluate the effectiveness of zidovudine-(ZDV) versus TDF-based HAART in the Yi minority region of Sichuan Province, China at a single HIV treatment center. Methods: The primary end point was the attainment of an HIV viral load <50 copies/mL. Secondary end points included change in CD4 level, adverse reactions, mortality, and sustained virologic suppression. Results: Of the 361 total participants, recipients of TDF-based HAART were more likely to achieve viral load <50 copies/mL (60% versus 46%, odds ratio [OR] = 1.7, P = .016) as well as sustained virologic suppression (61% versus 28%, OR = 3.4, P = .001). Tenofovir (adjusted odds ratio [ORadj] = 1.71, P = .025) and female sex (ORadj = 1.93, P = .003) were identified as independent predictors of achieving HIV viral load <50 copies/mL in the multivariate logistic regression analysis. Conclusion: Among Chinese Yi minority HIV-infected participants, TDF-based HAART was superior to ZDV-based HAART for initial treatment of HIV infection, suggesting TDF-based HAART should be the regimen of choice in China.

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MONITORING OF IMMUNE RESPONSE IN VIROLOGIC SUCCESSFULLY TREATED HIV-INFECTED PATIENTS IN SOUTHEASTERN SERBIA

Facta Universitatis Series Medicine and Biology ◽

10.22190/fumb170529007v ◽

2018 ◽

pp. 51

Author(s):

Miodrag Vrbic ◽

Maja Jovanovic ◽

Lidija Popovic-Dragonjic ◽

Aleksandar Rankovic ◽

Marina Djordjevic-Spasic

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Cd4 Count ◽

Response To Treatment ◽

Individual Risk ◽

Virologic Suppression ◽

Individual Response ◽

Duration Of Treatment ◽

Infection Age ◽

Southeastern Serbia

The number of CD4 lymphocytes defines the evolutional stage of HIV-infection and is the most important for a reliable estimation of the individual risk of developing AIDS. However, it is difficult to predict the degree of immune reconstitution during antiretroviral therapy, as it varies significantly from one person to another. Further investigations to better understand the limitations of immunological success are necessary to improve the response to treatment and regimen durability. The current study includes HIV-infected patients in Southeastern Serbia with achieved virologic suppression of HIV infection. The CD4 count was determined by flow cytometry, and was correlated with the duration of treatment, initial number of CD4 cells, type of antiretroviral therapy, mode of transmission of infection, age and gender of examinees. The resulting arithmetic mean and standard deviation of CD4 number was 473±259 cells/µl (range, 1130 cells/µl). There was no statistically significant correlation between the values of CD4 count and length of treatment, stage of the infection at which the therapy was started, treatment profile, method of infection, age or gender. The obtained results are comparable with the existing studies that follow immunological response to antiretroviral therapy and primarily point out the issue of substantial individual response variability, which has not yet been fully elucidated.

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Effect of pregravid preparation of HIV-infected couples on perinatal outcomes

Perm Medical Journal ◽

10.17816/pmj3856-14 ◽

2021 ◽

Vol 38 (5) ◽

pp. 6-14

Author(s):

A. O. Ovchinnikova ◽

S. V. Mikhalchenko ◽

M. A. Kaganova ◽

O. E. Chernova

Keyword(s):

Cohort Study ◽

Viral Load ◽

Correlation Analysis ◽

Hiv Infection ◽

Body Mass ◽

Preterm Labor ◽

Immune Status ◽

Perinatal Outcomes ◽

Reproductive Age ◽

Women Of Reproductive Age

Objective. To assess the levels of viral load, immune status as well as labor outcome depending on the absence or presence of pregravid preparation with the partner and without the latter. Materials and methods. This cohort study included 90 women of reproductive age with stages 3 and 4A HIV infection. To compare the groups, Kruskal Wallis, Mann Whitney tests and correlation analysis were applied. Results. The pregravid preparation of HIV-infected women without a partner was detected to three-fold decrease a viral load in the I trimester of pregnancy (p = 0.001), two-fold in the II trimester (p = 0.02) and three-fold in the III trimester (p = 0.002); with a partner a two-fold decrease in the I trimester (p = 0.0018). The pregravid preparation of HIV-infected women reduces the probability of giving birth to a child with low body mass (p = 0.023); with a partner it decreases the risk for the preterm labor (p = 0.02). Conclusions. Thus, the presence of pregravid preparation in HIV-infected women, with a partner as well, decreases the probability of giving birth to a child with low body mass and preterm labor.

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Assessment of Antiretroviral therapy Initiation among pregnant Women under Option B+ Approach; Viral Load and CD4 Count Outcomes in selected Hospitals of West Zone Oromia, Ethiopia: Quantitative Prospective Cohort Study Design

10.21203/rs.2.9662/v1 ◽

2019 ◽

Author(s):

Dereje Bayissa Demissie ◽

Gizachew Abdissa Bulto ◽

Wagi Tosisa Mekuria ◽

Fikru Negassa Dufera

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Pregnant Women ◽

Treatment Outcomes ◽

Prospective Cohort ◽

Cd4 Count ◽

Hiv Positive ◽

Virologic Suppression ◽

Art Initiation ◽

Study Results

Abstract Abstract Background: Antiretroviral therapy (ART) is effective for elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) infection, reducing infant mortality and ensuring maternal virologic suppression. While pregnant women require lifelong ART immediately they test HIV positive (“test and treat”) under Option B+ programs, eMTCT programs face challenges and information on the relationship between the time to ART initiation following HIV testing and treatment outcomes is limited in Ethiopia Methods: A quantitative prospective cohort design was employed to conduct the study. Five randomly selected Hospitals providing Option B+ services with routine viral load assessment by Oromia regional Laboratory (ORL) from January 2016 to January 2017 was randomly selected. Bivariate and multivariable analyses were conducted to determine factors affecting the time to ART initiation following an HIV test and logistic regression used to determine the correlation between time and treatment outcomes. Results: The study results produced and evidence of a mean VL (copies/ml) of 197.27 copies/ml. Respondents that were on ART for a shorter period ≤37 months had the least proportion of women 31% were suppressed with VL<1000 copies/ml compared to those on ART for >38 months (58.7%) were suppressed. The median (IQR) CD4 count change or difference among women that had initial and last CD4 was 581 cells/μl and mean of current CD4 count 629.17ceels/ml3 and more than 85.3% had increase CD4 count. Therefore, in this study identified that factors associated with viral load response were poor /fair adherence missing doses in the past month, missing appointments, baseline CD4 and maternal months on ART were statistically significant among HIV positive pregnant women that initiated lifelong ART on option B+ in Ethiopia. Conclusion: The study results demonstrated that HIV positive pregnant women Study results indicate that majority of the respondents 89.7% were suppressed of which 80.3% were undetectable (VL= 0 copies /ml3 and 85.3% had increased CD4 count and 10.3% were not suppressed (VL >1000 copies/ml). Therefore, strategies aimed at improving adherence among women on option B+ are to ensure that these women achieve adequate immunological outcomes. Keywords: ART Initiation Pregnant Women Option B +, Viral Load, CD4 Count

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Type 2 Diabetes, Body Mass Index and Cancer Mortality: A Population-Based Matched Cohort Study of 1.0 Million Adults in England

SSRN Electronic Journal ◽

10.2139/ssrn.3335073 ◽

2019 ◽

Author(s):

Nasra N. Alam ◽

Alison K. Wright ◽

Martin K. Rutter ◽

Iain Buchan ◽

Darren M. Ashcroft ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Cohort Study ◽

Body Mass ◽

Cancer Mortality ◽

Population Based ◽

Matched Cohort ◽

Matched Cohort Study

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Trends in the Incidence of HIV-Related Hematologic Malignancies in the Era of Combination Antiretroviral Therapy and Predictors of HIV-Related Non-Hodgkin's Lymphoma Development and Survival.

Blood ◽

10.1182/blood.v114.22.1916.1916 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1916-1916

Author(s):

Linda R Taggart ◽

Pierre K Isogai ◽

Nancy Risebrough ◽

Nicole Mittmann ◽

Anita R Rachlis ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Median Survival ◽

Hematologic Malignancies ◽

Incidence Rates ◽

Cd4 Count ◽

Hodgkin's Lymphoma ◽

P Value ◽

Combination Antiretroviral Therapy

Abstract Abstract 1916 Poster Board I-939 Introduction: Since the introduction of combination antiretroviral therapy (cART), the incidence rates of non-Hodgkin's lymphoma (NHL) and primary central nervous system lymphoma (PCNSL) have declined; however, less is known about the rates of other hematologic malignancies such as Hodgkin lymphoma (HL) and multiple myeloma (MM). We aimed to study changes in the incidence and outcomes of hematologic malignancies (HMs) in the pre- and post-cART eras. Methods: A retrospective analysis of The Ontario HIV Treatment Network Cohort Study (OCS) was performed. The OCS is an ongoing prospective study of HIV-infected adults from 11 sites throughout Ontario, Canada. Incidence rates of HMs were calculated for the pre- (<1997) and post-cART (≥ 1997) eras and compared using Poisson regression analysis. Median survival for each HM was calculated using Kaplan Meier techniques and compared using the logrank test. Predictors of NHL and death from NHL including age, sex, CD4 count, viral load, previous AIDS-defining illness, cART era and duration of HIV infection were evaluated using Cox proportional hazard models. All variables except sex were considered time dependent variables. Results: The OCS database included 4118 individuals with 41978 person-years of follow up over 28 years (1980-2008). There was no significant difference in the incidence of HM in the pre- and post-cART eras (3.6 versus 4.1 cases per 1000 person-years, p-value=0.49) although incidence of PCNSL trended downward (0.8 versus 0.4 cases per 1000 person-years, p-value=0.13) and incidence of HL trended upward (0.1 versus 0.4 cases per 1000 person-years, p-value=0.08). Those with HL had the longest median survival, followed by NHL and PCNSL (63, 39 and 4 months respectively). Predictors of NHL development included low CD4 count, high viral load and pre-cART era. Predictors of death following NHL diagnosis were low CD4 count, previous AIDS-defining illness and longer duration of HIV infection. Conclusion: Since the introduction of cART, the overall incidence of HM has not significantly changed in this cohort. However, as fewer individuals in the cART era develop low CD4 counts, high viral loads and AIDS-defining illnesses, reduced incidence of NHL in this cohort and improved survival following NHL may become apparent. Disclosures: No relevant conflicts of interest to declare.

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Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

AIDS Research and Therapy ◽

10.1186/s12981-020-00323-x ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Emmanuel Bahemana ◽

◽

Allahna Esber ◽

Nicole Dear ◽

Kavitha Ganesan ◽

...

Keyword(s):

Cohort Study ◽

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Cd4 Count ◽

Age Group ◽

Art Initiation ◽

Living With Hiv ◽

Over Time

Abstract Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130–547 vs. 277cells/mm3, IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

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