Determinants of viral load non-suppression among adolescents in Mbale District, Eastern Rural Uganda

Abstract Background Adolescents are lagging behind in the “third 95” objective of the Joint United Nations Program on HIV/AIDS requiring 95% of individuals on antiretroviral therapy (ART) to have viral load (VL) suppression. This study aimed to describe factors associated with viral non-suppression among adolescents in Mbale district, Uganda. Methods We conducted a retrospective review of routinely collected HIV programme records. Data such as age, education, ART Regimen, ART duration, WHO Clinical stage, comorbidities, etc., were extracted from medical records for the period January 2018 to December 2018. Descriptive analysis was done for continuous variables using means and frequencies to describe study sample characteristics, and to determine the prevalence of outcome variables. We used logistic regression to assess factors associated with VL non-suppression among adolescents. Results The analysis included 567 HIV-infected adolescents, with 300 (52.9%) aged between 13 to 15 years, 335 (59.1%) female, and mean age of 15.6 years (interquartile range [IQR] 13.5–17.8. VL non-suppression was 31.4% (178/567). Male sex (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.01), age 16–19 years (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.05), No formal education (AOR = 3.67, 95% CI 1.48–9.09; p < 0.01), primary education (AOR = 2.23, 95% CI 1.05–2.32; p < 0.01), ART duration of > 12 months to 5 years (AOR = 3.20, 95% CI 1.31–7.82; p < 0.05), ART duration > 5 years (AOR = 3.47, 95% CI 1.39– 8.66; p < 0.01), WHO Clinical Stage II (AOR = 0.48, 95% CI: 0.28, 0.82; p < 0.01), second-line ART regimen (AOR = 2.38, 95% CI 1.53–3.72; p < 0.001) and comorbidities (AOR = 3.28, 95% CI 1.20–9.00; p < 0.05) were significantly associated with viral non-suppression. Conclusions VL non-suppression among adolescents was almost comparable to the national average. VL non-suppression was associated with being male, age 16–19 years, education level, duration on ART therapy, WHO Clinical Staging II, second-line ART regimen, and presence of comorbidities. Adolescent-friendly strategies to improve VL suppression e.g. peer involvement, VL focal persons to identify and actively follow-up non-suppressed adolescents, patient education on VL suppression and demand creation for ART are needed, especially for newly-initiated adolescents and adolescents on ART for protracted periods, to foster attainment of the UNAIDS 95–95–95 targets.

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Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda

PLoS ONE ◽

10.1371/journal.pone.0246140 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0246140

Author(s):

Sarah Nabukeera ◽

Joseph Kagaayi ◽

Fredrick Edward Makumbi ◽

Henry Mugerwa ◽

Joseph K. B. Matovu

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Side Effects ◽

Clinical Research ◽

Clinical Stage ◽

Research Centre ◽

Hiv Positive ◽

Factors Associated ◽

Art Initiation ◽

Stage 4

Background While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. Method This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0–14 years) were randomly selected from existing medical records and data on children’s socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. Results The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5–9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10–14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. Conclusion Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.

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Prevalence of Nonsuppressed Viral Load and Associated Factors Among Adults Receiving Antiretroviral Therapy in Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe (2015-2017): Results from Population-Based Nationally-Representative Surveys

10.1101/2020.07.13.20152553 ◽

2020 ◽

Author(s):

Andreas D Haas ◽

Elizabeth Radin ◽

Avi J Hakim ◽

Andreas Jahn ◽

Neena Philip ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Virologic Failure ◽

Scale Up ◽

Female Gender ◽

Antiretroviral Drugs ◽

People Living With Hiv ◽

Second Line ◽

Viral Load Suppression ◽

Factors Associated

Introduction: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a target of ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) to have viral load suppression (VLS). We examined factors associated with nonsuppressed viral Load (NVL). Methods: We included PLHIV receiving ART aged 15-59 years from Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe. Blood samples from PLHIV were analyzed for HIV RNA and recent exposure to antiretroviral drugs (ARVs). Outcomes were NVL (viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL), and receiving second-line ART. We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART. Results: The prevalence of NVL was 11.2%: 8.2% experienced VF, and 3.0% interrupted ART. Younger age, male gender, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married, and residing in Zimbabwe, Lesotho, or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female gender, shorter ART duration, higher CD4 count, and alcohol use were associated with higher odds for interrupted ART and lower odds for VF. Many people with VF (44.8%) had CD4 counts <200 cells/μL, but few (0.31% per year) switched to second-line ART. Conclusions: Countries are approaching UNAIDS VLS targets for adults. Treatment support for people initiating ART with asymptomatic HIV infection, scale-up of viral load monitoring, and optimized ART regimens may further reduce NVL prevalence.

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Factors associated with HIV-1 virological failure in an outpatient clinic for HIV-infected people in Haiphong, Vietnam

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.010515 ◽

2011 ◽

Vol 22 (11) ◽

pp. 659-664 ◽

Cited By ~ 10

Author(s):

D T M Huong ◽

W Bannister ◽

P T Phong ◽

O Kirk ◽

L Peters

Keyword(s):

Viral Load ◽

Virological Failure ◽

Hiv Transmission ◽

Clinical Stage ◽

World Health ◽

Hiv Viral Load ◽

Heterosexual Intercourse ◽

Infected People ◽

Factors Associated ◽

Hiv 1

The objective of our study was to investigate factors associated with virological failure in 100 consecutive HIV-1 infected Vietnamese adults who initiated antiretroviral therapy (ART) from June 2007 to June 2008. Data were collected from medical records, and a structured questionnaire was used in individual interviews to investigate factors associated with adherence to ART. Plasma HIV viral load was measured at the time of the interview. The median age was 35 years, 35% were women and heterosexual intercourse was the most common mode of HIV transmission (61 %). After a median of 14 months since starting ART, 23% had detectable HIV-1 viral load (≥400 copies/mL). Patients who had developed a World Health Organization (WHO) clinical stage 4 condition at the time of initiation of ART were more likely to experience virological failure than those in stages 1-3, odds ratio (OR): 5.20 (95% confidence interval [CI] 1.34-20.11), P = 0.017. Patients who reported that their health status was evaluated by a physician at each visit were less likely to experience virological failure, OR: 0.02 (95% CI 0.00-0.24), P = 0.002.

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Factors Associated With Viral Suppression and Rebound Among HIV Patients On Treatment: A Retrospective Study in Ghana

10.21203/rs.3.rs-996319/v1 ◽

2021 ◽

Author(s):

Stephen Opoku ◽

Samuel Asamoah Sakyi ◽

Nana Kwame Ayisi-Boateng ◽

Anthony Kwame Enimil ◽

Ebenezer Senu ◽

...

Keyword(s):

Viral Load ◽

Retrospective Study ◽

Viral Suppression ◽

Baseline Viral Load ◽

Clinical Staging ◽

Viral Rebound ◽

Duration Of Treatment ◽

Combination Drug ◽

Hiv Patients ◽

Factors Associated

Abstract Background Viral suppression remains the most desired outcome in the management of patients with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and this can be achieved by an effective combined Antiretroviral Therapy (cART). However, some patients who achieve viral suppression may experience viral rebound with dire consequence. We evaluated viral suppression and rebound and their associated factors among adult patients on cART in Kumasi, Ghana. Methods This hospital-based retrospective study was conducted at the Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records of 720 HIV patients on cART. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism version 8.0. P<0.05 was considered statistically significant. Results Proportions of patients with viral suppression and viral rebound were 76.1% and 21.0% respectively. Being diagnosed at WHO stage I [aOR=4.26, 95%CI (4.20-48.44), p<0.0001], having good adherence to ART [aOR=5.64, 95%CI (2.86-11.13), p<0.0001], taking Nevirapine-based regimen [aOR=4.66, 95%CI (1.20-18.04), p=0.0260] and increasing duration of treatment (p<0.0001) were independently associated with higher odds of viral suppression. However, being diagnosed at WHO stage II (aOR=7.39, 95%CI: 2.67-20.51; p<0.0001) and stage III (aOR=8.62, 95%CI: 3.16-23.50; p<0.0001), having poor adherence (aOR=175.48, 95%CI: 44.30-695.07; p<0.0001), recording baseline suppression value of 20-49 copies/mL (aOR=6.43, 95%CI: 2.72-15.17; p<0.0001) and being treated with Zidovudine/Lamivudine/Efavirenz (aOR=6.49, 95%CI: 1.85-22.79; p=0.004) and Zidovudine/Lamivudine/Nevirapine (aOR=18.68, 95% CI: 1.58-220.90; p=0.02) were independently associated with higher odds of viral rebound. Conclusion Approximately 76% viral suppression rate among HIV patients on cART in Kumasi falls below the WHO 95% target by the year 2030. Choice of ART combination, drug adherence, WHO clinical staging and baseline viral load are factors associated with suppression or rebound. These clinical characteristics of HIV patients must be monitored concurrently with the viral load.

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Primary T-Cell Lymphoma of The Testis Presenting In A Young Adult

Health Sciences ◽

10.15342/hs.2020.214 ◽

2020 ◽

Vol 2020 ◽

Author(s):

MOUNIA BENDARI ◽

Wafaa Matrane ◽

Maryam Qachouh ◽

Asmaa Quessar ◽

Nisrine Khoubila

Keyword(s):

T Cell ◽

Cell Lymphoma ◽

Clinical Stage ◽

T Cell Lymphoma ◽

Second Line ◽

Peripheral T Cell Lymphoma ◽

Not Otherwise Specified ◽

Ann Arbor ◽

Prophylactic Chemotherapy ◽

Line Chemotherapy

We report the case of a 40-year-old male presented with a painless right testicular swelling. Right radical orchidectomy was performed. The pathological diagnosis was peripheral T-Cell lymphoma-not otherwise specified (PTCL-NOS). According to Ann Arbor staging, the initial clinical stage was IEa. Treating him with four courses of the CHOEP protocol and intrathecal prophylactic chemotherapy was unsuccessful; with the appearance of orbital infiltration and a loco-regional extension. Although the patient started a second line chemotherapy, he unfortunately succumbed to death.

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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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Factors Associated with Mental Health Problems among Malaysian Children: A Large Population-Based Study

Children ◽

10.3390/children8020119 ◽

2021 ◽

Vol 8 (2) ◽

pp. 119

Author(s):

Norhafizah Sahril ◽

Noor Ani Ahmad ◽

Idayu Badilla Idris ◽

Rajini Sooryanarayana ◽

Mohamad Aznuddin Abd Razak

Keyword(s):

Mental Health ◽

Formal Education ◽

Mental Health Problems ◽

Large Population ◽

Multiple Logistic Regression Analysis ◽

Population Based ◽

Health Problems ◽

Public Health Issue ◽

Factors Associated ◽

Lower Socioeconomic

Mental health problems are a major public health issue, particularly among children. They impair children’s development, academic achievement, and ability to live a productive life. The present study aimed to determine the prevalence and factors associated with mental health problems among children aged 5 to 15 years old in Malaysia. Data from the National Health and Morbidity Survey (NHMS) 2015 were analyzed. A validated Strengths and Difficulties Questionnaire (SDQ) was used. The overall prevalence of mental health problems among children in Malaysia was 11.1%. Multiple logistic regression analysis revealed that for every year increment in age, mental health problems decreased by 5%. Further analysis found that children who had fathers with a non-formal education and worked in the private sector, had parents who were widowed or divorced, and had either parent with mental health problems were more likely to have mental health problems themselves. Children from the lower socioeconomic group and who had either parent with mental health problems had higher odds of having mental health problems in Malaysia.

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Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali

Public Health and Preventive Medicine Archive ◽

10.24843/phpma.2017.v05.i01.p01 ◽

2017 ◽

pp. 4

Author(s):

Cok Istri Sri Dharma Astiti ◽

A.A Sagung Sawitri ◽

Tuti Parwati

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Clinical Stage ◽

Hiv And Aids ◽

First Line ◽

Aids Patients ◽

Factors Associated ◽

Art Initiation ◽

Risk Of Treatment ◽

Hiv Aids

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV with (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program with (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.

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