scholarly journals Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chu-Chang Ku ◽  
Peter MacPherson ◽  
McEwen Khundi ◽  
Rebecca H. Nzawa Soko ◽  
Helena R. A. Feasey ◽  
...  
Keyword(s):  
People Living With Hiv ◽  
Case Detection ◽  
Care Seeking ◽  
Age Dependence ◽  
Prevalence Survey ◽  
Living With Hiv ◽  
Stratified Analysis ◽  
Notification Data ◽  
Tuberculosis Disease ◽  
Hiv Negative

Abstract Background Ratios of bacteriologically positive tuberculosis (TB) prevalence to notification rates are used to characterise typical durations of TB disease. However, this ignores the clinical spectrum of tuberculosis disease and potentially long infectious periods with minimal or no symptoms prior to care-seeking. Methods We developed novel statistical models to estimate progression from initial bacteriological positivity including smear conversion, symptom onset and initial care-seeking. Case-detection ratios, TB incidence, durations, and other parameters were estimated by fitting the model to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework using Markov chain Monte Carlo methods. Results Analysis across 11 national datasets found asymptomatic tuberculosis durations in the range 4–8 months for African countries; three countries in Asia (Cambodia, Lao PDR, and Philippines) showed longer durations of > 1 year. For the six countries with relevant data, care-seeking typically began half-way between symptom onset and notification. For Kenya and Blantyre, Malawi, individual-level data were available. The sex-specific durations of asymptomatic bacteriologically-positive tuberculosis were 9.0 months (95% credible interval [CrI]: 7.2–11.2) for men and 8.1 months (95% CrI: 6.2–10.3) for women in Kenya, and 4.9 months (95% CrI: 2.6–7.9) for men and 3.5 months (95% CrI: 1.3–6.2) for women in Blantyre. Age-stratified analysis of data for Kenya showed no strong age-dependence in durations. For Blantyre, HIV-stratified analysis estimated an asymptomatic duration of 1.3 months (95% CrI: 0.3–3.0) for HIV-positive people, shorter than the 8.5 months (95% CrI: 5.0–12.7) for HIV-negative people. Additionally, case-detection ratios were higher for people living with HIV than HIV-negative people (93% vs 71%). Conclusion Asymptomatic TB disease typically lasts around 6 months. We found no evidence of age-dependence, but much shorter durations among people living with HIV, and longer durations in some Asian settings. To eradicate TB transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventions

scholarly journals Estimated durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease

2021 ◽  
Author(s):  
Chu-Chang Ku ◽  
Peter MacPherson ◽  
McEwen Khundi ◽  
Rebecca Nzawa ◽  
Helena R.A. Feasey ◽  
...  
Keyword(s):  
Symptom Onset ◽  
People Living With Hiv ◽  
Case Detection ◽  
Care Seeking ◽  
African Countries ◽  
Prevalence Survey ◽  
Initial Care ◽  
Notification Data ◽  
Tuberculosis Disease ◽  
Tuberculosis Prevalence

Ratios of bacteriologically-positive tuberculosis prevalence to notification rates are used to characterise typical durations of tuberculosis disease, but have not accounted for asymptomatic periods prior to careseeking. We developed novel statistical models to estimate progression from initial bacteriological-positivity including smear conversion, symptom onset and initial care-seeking and fitted them to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework. Asymptomatic tuberculosis duration was in the range 4 – 8 months for African countries; three countries in Asia showed longer durations of > 1 year. Care-seeking typically began half-way between symptom onset and notification. Our method also estimated smear progression rates and case-detection ratios. We found evidence for higher case-detection ratios and much shorter durations of tuberculosis for people living with HIV. To eradicate tuberculosis transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventions.

scholarly journals Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041734
Author(s):  
Ni Gusti Ayu Nanditha ◽  
Adrianna Paiero ◽  
Hiwot M Tafessu ◽  
Martin St-Jean ◽  
Taylor McLinden ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Population Based ◽  
Age At Diagnosis ◽  
Secondary Outcome ◽  
People Living With Hiv ◽  
Prevalence Trends ◽  
Living With Hiv ◽  
Negative Controls ◽  
Hiv Negative

ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

scholarly journals Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

2016 ◽  
Vol 16 (3) ◽  
pp. 239-246 ◽  
Author(s):  
V. Logan Kennedy ◽  
Micaela Collins ◽  
Mark H. Yudin ◽  
Lena Serghides ◽  
Sharon Walmsley ◽  
...  
Keyword(s):  
Logit Model ◽  
Hiv Transmission ◽  
Horizontal Transmission ◽  
People Living With Hiv ◽  
Relative Importance ◽  
Hiv Status ◽  
Ordered Logit Model ◽  
Living With Hiv ◽  
Shed Light ◽  
Hiv Negative

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study’s aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

scholarly journals HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Farina Karim ◽  
Inbal Gazy ◽  
Sandile Cele ◽  
Yenzekile Zungu ◽  
Robert Krause ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Disease Severity ◽  
Immune Cell ◽  
Supplemental Oxygen ◽  
People Living With Hiv ◽  
Cell Counts ◽  
Cell Changes ◽  
Living With Hiv ◽  
Second Wave ◽  
Hiv Negative

There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

scholarly journals Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

2022 ◽  
Vol 14 (1) ◽  
pp. 43-55
Author(s):  
Cristina Micali ◽  
Ylenia Russotto ◽  
Grazia Caci ◽  
Manuela Ceccarelli ◽  
Andrea Marino ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cancer Staging ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Liver Cancers ◽  
Significant Difference ◽  
Cancer Specific Mortality ◽  
Living With Hiv ◽  
Hiv Negative

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

scholarly journals Hodgkin Lymphoma in People Living with HIV

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4366
Author(s):  
Jose-Tomas Navarro ◽  
José Moltó ◽  
Gustavo Tapia ◽  
Josep-Maria Ribera
Keyword(s):  
Hodgkin Lymphoma ◽  
Interdisciplinary Collaboration ◽  
Survival Rates ◽  
People Living With Hiv ◽  
Barr Virus ◽  
Non Hodgkin Lymphoma ◽  
Combined Antiretroviral Therapy ◽  
Epstein Barr ◽  
Living With Hiv ◽  
Hiv Negative

Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein–Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug–drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.

scholarly journals Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245743
Author(s):  
Sorelle Mekachie Sandie ◽  
Irene Ule Ngole Sumbele ◽  
Martin Mih Tasah ◽  
Helen Kuokuo Kimbi
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Intestinal Parasites ◽  
Significant Risk ◽  
People Living With Hiv ◽  
Viral Load Suppression ◽  
Community Based ◽  
Living With Hiv ◽  
Hiv Negative

Background Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. Methods The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson’s Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. Results Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). Conclusion Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

Perpetuated HIV Microaggressions: A Novel Scale to Measure Subtle Discrimination Against People Living With HIV

2021 ◽  
Vol 33 (1) ◽  
pp. 1-15
Author(s):  
Marcie Berman ◽  
Lisa A. Eaton ◽  
Ryan J. Watson ◽  
Jessica L. Maksut ◽  
Katherine B. Rucinski ◽  
...  
Keyword(s):  
Convergent Validity ◽  
Discriminant Validity ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Depressive Symptomology ◽  
Subtle Discrimination ◽  
Conspiracy Beliefs ◽  
Living With Hiv ◽  
Hiv Negative ◽  
Hiv Discrimination

HIV discrimination has served as a barrier to addressing the HIV epidemic and providing effective HIV treatment and care. Measuring HIV discrimination, particularly covert HIV discrimination, has proven to be complex. Adapted from a previous scale, we developed a perpetuated HIV micro-aggressions scale to assess covert forms of discriminatory beliefs among HIV-negative/unknown HIV status individuals. Factor analysis resulted in three subscales, explaining 73.58% of the scale's variance. The new scale demonstrated both convergent validity (HIV prejudice, HIV stereotypes) and discriminant validity (alcohol use, depressive symptomology). Perpetuated HIV microaggressions were significantly associated with HIV conspiracy beliefs, HIV prejudice, and HIV stereotypes. This new scale can serve as an important tool in evaluating perpetuated HIV microaggressions among HIV-negative individuals.

scholarly journals Do people living with HIV experience greater age advancement than their HIV-negative counterparts?

AIDS ◽  
2019 ◽  
Vol 33 (2) ◽  
pp. 259-268 ◽  
Author(s):  
Davide De Francesco ◽  
Ferdinand W. Wit ◽  
Alexander Bürkle ◽  
Sebastian Oehlke ◽  
Neeltje A. Kootstra ◽  
...  
Keyword(s):  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Negative

scholarly journals Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011–2017)

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Nang Thu Thu Kyaw ◽  
Srinath Satyanarayana ◽  
Htun Nyunt Oo ◽  
Ajay M V Kumar ◽  
Anthony D Harries ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Spline Regression ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Need To Evaluate ◽  
Glycemic Targets ◽  
Living With Hiv ◽  
The Relationship ◽  
Tuberculosis Disease

Abstract Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68–310) cell/mm3, the median RBG level (IQR) was 88 (75–106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%–6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1–1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8–1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110–140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2–1.4; restricted spline: aHR, 1.1; 95% CI, 1.0–1.1) compared with those with RBG &lt;110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.

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