Determinants of viral load rebound on HIV/AIDS patients receiving antiretroviral therapy: results from South Africa

Background: Highly Active Antiretroviral Therapy (HAART) for persons living with HIV/AIDS (PLWHA) is the gold standard for the management of HIV patients. Purportedly, patients who are not on HAART or defaulted from its use have adverse effects compared to those who adhere to the intake of HAART. Compliant individuals have improved quality of life and show healthy hematological parameters and HIV load as compared to HAART naïve individuals and defaulters. Supplementary and supportive treatment is crucial in HIV/AIDS patients on patients on antiretroviral therapy? Objective: This study was conducted to assess the consistency and default of HAART intake and other supportive treatments and its relationship with viral load on hematological parameters in two different geographical sites. Methods: Ethical clearance was obtained from Navrongo Health Research Centre. Questionnaires were administered to participants for their consent, demographic data, consistency of taking antiretrovirals, and types of antiretrovirals used. Full blood count and HIV load tests were carried out using Urit 5250 and Cobas Taqman / Cobas ampliprep fully automated analysers respectively. Results: Defaulters had a significant (p value=0.003) rise in their viral load (845334.38±409285.62) copies/mL in comparison to adherents in HAART intake 49571.69±30548.89) copies/mL. The hemoglobin level (10.51±0.60 g/dL) of defaulters was significantly (p-value = 0.007) lower than that of adherent (12.04±0.17 g/dL). The default rates in the two study sites were close (9.8% in Sunyani and 9.4% in Tamale). Conclusion: Antiretroviral default does not only lead to an increase in HIV load but also causes a reduction in hemoglobin levels. Hematinics supplementation therapy may help normalize hematological parameters in HIV infection

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Evaluasi Terapi Antiretroviral Pasien HIV/AIDS

Jurnal Farmasetis ◽

10.32583/farmasetis.v8i2.567 ◽

2019 ◽

Vol 8 (2) ◽

pp. 45-54

Author(s):

Ambar Yunita Nugraheni ◽

Rizki Amelia ◽

Inesya Febrianing Rizki

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

General Hospital ◽

Sampling Method ◽

Opportunistic Infections ◽

Aids Patients ◽

Purposive Sampling ◽

Increased Risk ◽

The Right ◽

Hiv Aids

Pengobatan antiretroviral (ARV) bertujuan untuk menurunkan jumlah virus (viral load) serta menghambat perburukan infeksi oportunistik. Ketidakrasionalan terapi ARV akan menyebabkan peningkatan resiko morbiditas dan mortalitas, serta resiko resistensi obat. Tujuan dari penelitian ini untuk mengevaluasi rasionalitas antiretroviral pada pasien HIV/AIDS di rumah sakit umum X Surakarta yang meliputi tepat indikasi, tepat pasien, tepat obat, dan tepat dosis. Penelitian ini merupakan penelitian observasional. Sampel penelitian berjumlah 99 pasien dengan metode purposive sampling. Data diambil melalui rekam medis pasien HIV/AIDS rawat inap di rumah sakit X Surakarta. Data dianalisis secara deskriptif berdasarkan Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 tentang Pedoman Pengobatan Antiretroviral (2014), Pedoman Penerapan Terapi HIV pada Anak (2014), Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada Orang Dewasa (2011). Evaluasi dari 99 pasien yang memenuhi inklusi didapatkan hasil 100% tepat indikasi, 88,89% tepat pasien, 96,97% tepat obat dan 96,97% tepat dosis. Rasionalitas penggunaan terapi ARV pada pasien HIV/AIDS di rumah sakit umum X Surakarta sebesar 85,86%. Katakunci: antiretroviral, HIV/AIDS, rasionalitas EVALUATION OF ANTIRETROVIRAL THERAPY IN HIV/AIDS PATIENTS ABSTRACT Antiretroviral (ARV) treatment aims to reduce the amount of virus (viral load) and inhibit opportunistic infections. The irrationality of ARV therapy will cause an increased risk of morbidity and mortality, as well as the risk of drug resistance. The purpose of this study was to evaluate the rationality of antiretroviral in HIV/AIDS patients at general hospital X Surakarta which includes the right indication, the right patient, the right drug, and the right dose. This study was an observational study. The research sample was 99 patients with purposive sampling method. Data was collected from medical records of inpatient HIV / AIDS patients at general hospital X Surakarta. Data were analyzed descriptively based on Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 tentang Pedoman Pengobatan Antiretroviral (2014), Pedoman Penerapan Terapi HIV pada Anak (2014), Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada Orang Dewasa (2011). An evaluation of 99 patients showed 100% correct indications, 88,89% right patients, 96,97% right drugs and 96,97% right doses. The rationality of antiretroviral therapy in HIV/AIDS patients at general hospital X Surakarta was 85,86%. Keywords: antiretroviral, HIV/AIDS, rasionality

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Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

10.21203/rs.3.rs-208706/v2 ◽

2021 ◽

Author(s):

Pepukai Bengura

Keyword(s):

Risk Factors ◽

South Africa ◽

Viral Load ◽

Marital Status ◽

Art Adherence ◽

Aids Patients ◽

Loss To Follow Up ◽

Generalized Gamma ◽

Hiv Aids

Abstract Background - Long-term regular follow-up and high retention are the anticipated outcomes for the wellness and longevity of HIV/AIDS patients on antiretroviral treatment. However, these anticipated outcomes are marred by patient loss to follow-up (LTFU) which is currently exacerbated by the Covid-19 pandemic. This study aims to determine the prevalence and potential risk factors to LTFU among HIV/AIDS patients on ART at two rural district hospitals in South Africa.Methods— This is a retrogressive observational study whereby a cohort of HIV/AIDS patients was retrospectively followed from 2010 to 2017 until loss to follow-up occurred or until the end of the observation period at Carolina and Embhuleni hospitals. An institutional based retrospective cohort study was undertaken among children, adolescents and adults living with HIV/AIDS and attending ART clinic between January 1, 2010 and June 30, 2017. Loss to follow up was defined as not taking an ART refill for a period of 90 days or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out’ patient. Patient information was obtained from the routine hospitals’ records, and the data were analysed using Generalized gamma distribution to identify the predictors of loss to follow up among HIV/AIDS patients while Kaplan-Meier model was used to estimate and compare the LTFU survival probabilities of heterogenous groups among the patients.Results— Of the 357 patients, 60.5% were female. The mean (SD) age of the cohort was 36.2 (14.1), 15.4 (3.5), and 5.1 (3.5) years for adults, adolescents, and children, respectively. From 357 HIV/AIDS patients, 93 (26.05%) were lost to follow-up. Empirical results show that the Weibull distribution gives the best fit to the data. The Weibull model determined the Factors associated with significant risk factors to patient loss to follow up as: regimen EFV+D4T+3TC [HR: 2.0 CI;(1.3–3.1)], regimen EFV+AZT+3TC [HR: 2.9 CI;(1.3–6.4)], regimen EFV+3TC+TDF [HR: 10.0 CI;(3.9–25.9)], regimen NVP+3TC+TDF [HR: 10.6 CI;(1.8–62.4)], follow up CD4 [HR: 1.0 CI;(1.0–1.0)], log(follow up viral load) [HR: 0.8 CI;(0.7–0.9)], marital status (married) [HR: 0.4 CI;(0.3–0.8)], marital status (cohabitation) [HR: 0.6 CI;(0.3–0.9)], ART adherence (fair) [HR: 2.4 CI;(1.3–3.4)], ART adherence (good) [HR: 4.6 CI;(2.2–9.5)] and age [HR: 1.02 CI;(1.0–1.04)]. Discussion— Effective control and tracing measures in the at-risk population and in defaulters need to be stepped up especially during this COVID-19 period, to improve retention in hospitals. There is also need for careful adherence counseling and assessment of medication supplies.Conclusion— LTFU is more pronounced among females and is highest among adolescents. Patients with increased risk for LTFU were consistent with ART regimens, viral load, age, CD4 count, adherence and marital status.

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Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

10.21203/rs.3.rs-208706/v1 ◽

2021 ◽

Author(s):

Pepukai Bengura

Keyword(s):

Risk Factors ◽

South Africa ◽

Viral Load ◽

Marital Status ◽

Art Adherence ◽

Aids Patients ◽

Loss To Follow Up ◽

Generalized Gamma ◽

Hiv Aids

Abstract Background - Long-term regular follow-up and high retention are the anticipated outcomes for the wellness and longevity of HIV/AIDS patients on antiretroviral treatment. However, these anticipated outcomes are marred by patient loss to follow-up (LTFU) which is currently exacerbated by the Covid-19 pandemic. This study aims to determine the prevalence and potential risk factors to LTFU among HIV/AIDS patients on ART at two rural district hospitals in South Africa.Methods— This is a retrogressive observational study whereby a cohort of HIV/AIDS patients was retrospectively followed from 2010 to 2017 until loss to follow-up occurred or until the end of the observation period at Carolina and Embhuleni hospitals. An institutional based retrospective cohort study was undertaken among children, adolescents and adults living with HIV/AIDS and attending ART clinic between January 1, 2010 and June 30, 2017. Loss to follow up was defined as not taking an ART refill for a period of 90 days or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out’ patient. Patient information was obtained from the routine hospitals’ records, and the data were analysed using Generalized gamma distribution to identify the predictors of loss to follow up among HIV/AIDS patients while Kaplan-Meier model was used to estimate and compare the LTFU survival probabilities of heterogenous groups among the patients.Results— Of the 357 patients, 60.5% were female. The mean (SD) age of the cohort was 36.2 (14.1), 15.4 (3.5), and 5.1 (3.5) years for adults, adolescents, and children, respectively. From 357 HIV/AIDS patients, 93 (26.05%) were lost to follow-up. Empirical results show that the Weibull distribution gives the best fit to the data. The Weibull model determined the Factors associated with significant risk factors to patient loss to follow up as: regimen EFV+D4T+3TC [HR: 2.0 CI;(1.3–3.1)], regimen EFV+AZT+3TC [HR: 2.9 CI;(1.3–6.4)], regimen EFV+3TC+TDF [HR: 10.0 CI;(3.9–25.9)], regimen NVP+3TC+TDF [HR: 10.6 CI;(1.8–62.4)], follow up CD4 [HR: 1.0 CI;(1.0–1.0)], log(follow up viral load) [HR: 0.8 CI;(0.7–0.9)], marital status (married) [HR: 0.4 CI;(0.3–0.8)], marital status (cohabitation) [HR: 0.6 CI;(0.3–0.9)], ART adherence (fair) [HR: 2.4 CI;(1.3–3.4)], ART adherence (good) [HR: 4.6 CI;(2.2–9.5)] and age [HR: 1.02 CI;(1.0–1.04)]. Discussion— Effective control and tracing measures in the at-risk population and in defaulters need to be stepped up especially during this COVID-19 period, to improve retention in hospitals. There is also need for careful adherence counseling and assessment of medication supplies.Conclusion— LTFU is more pronounced among females and is highest among adolescents. Patients with increased risk for LTFU were consistent with ART regimens, viral load, age, CD4 count, adherence and marital status.

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Development and Validation of a Prognostic Nomogram for HIV/AIDS Patients Who Underwent Antiretroviral Therapy: Data from a China Population-Based Cohort

SSRN Electronic Journal ◽

10.2139/ssrn.3444387 ◽

2019 ◽

Author(s):

Xiang Qing Hou ◽

Dayong Wang ◽

Jingjing Zuo ◽

Jushuang Li ◽

Tao Wang ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Population Based ◽

Aids Patients ◽

Development And Validation ◽

Hiv Aids

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Factors associated with prognostic or treatment outcomes in HIV/AIDS patients with and without hypertension in Eswatini

Scientific Reports ◽

10.1038/s41598-021-92185-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sabelo Bonginkosi Dlamini ◽

Hans-Uwe Dahms ◽

Ming-Tsang Wu

Keyword(s):

Viral Load ◽

P Value ◽

Aids Patients ◽

Large Hospital ◽

Hypertensive Patients ◽

Factors Associated ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell ◽

Hiv Aids

AbstractNon-communicable diseases are increasing faster in HIV/AIDS patients than in the general population. We studied the association between hypertension and other possible confounding factors on viral load and CD4-cell counts in hypertensive and non-hypertensive HIV/AIDS patients receiving antiretroviral therapy (ART) at a large hospital in Eswatini over a 4-year period. We performed a retrospective longitudinal review of the medical records of 560 ART patients divided into non-hypertension and hypertension groups (n = 325 and n = 235) from July 27 to September 8, 2018. Generalized Estimated Equation was used to analyze the longitudinal data. Hypertensive patients were more likely to have improved CD4-cell counts than non-hypertensive patients (OR = 1.83, [1.37–2.44]). ART patients with hypertension were more likely to have detectable viral loads, though not significant (OR = 1.37 [0.77–2.43]). In non-hypertensive patients, second line ART was significantly associated with viral load (OR = 8.61 [2.93–25.34]) and adverse side effects (OR = 3.50 [1.06–11.54]), while isoniazid preventive therapy was significantly associated with CD4-cell counts (OR = 1.68 [1.16–2.45]). In hypertensive patients, factors associated with viral load were WHO HIV stage (OR = 2.84 [1.03–7.85]) and adherence (OR = 8.08 [1.33–49.04]). In both groups, CD4-cell counts significantly and steadily increased over time (p-value < 0.001). Results show a significant association between hypertension and CD4 cell counts but not viral load. In ART patients with and without hypertension, the factors associated with prognostic markers were different. More attention may need to be paid to ART patients with well controlled HIV status to monitoring and controlling of hypertension status.

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