scholarly journals Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Jingya Jia ◽  
Qiuying Zhu ◽  
Luojia Deng ◽  
Guanghua Lan ◽  
Andrew Johnson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Hepatitis B ◽  
Drop Out ◽  
Attrition Rate ◽  
People Living With Hiv ◽  
Treatment Attrition ◽  
Cox Proportional Hazard Models ◽  
Hcv Coinfection ◽  
Living With Hiv

Abstract Background Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART. Methods A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010–2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH. Results Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88–3.02] and 5.92 (95% CI 5.82–6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32–1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47–1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87–2.66). Conclusions HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH. Graphical Abstract

scholarly journals Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

2021 ◽  
Author(s):  
Terefe Gone Fuge ◽  
George Tsourtos ◽  
Emma R Miller
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Viral Suppression ◽  
People Living With Hiv ◽  
South Ethiopia ◽  
Pharmacy Refill ◽  
Living With Hiv ◽  
Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

scholarly journals Prevalence of Cryptococcal Antigen and outcomes in people living with HIV in Honduras: A cohort study

2020 ◽  
Author(s):  
Julio C Zuniga-Moya ◽  
Luis Enrique Romero-Reyes ◽  
Emilio Barrueto Saavedra ◽  
Sandra Montoya ◽  
Diana Varela ◽  
...  
Keyword(s):  
Cohort Study ◽  
Central America ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Asymptomatic Patients ◽  
High Incidence ◽  
Cox Proportional Hazard Models ◽  
Living With Hiv

Abstract Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.

scholarly journals Hepatitis B infection in people living with HIV who initiate antiretroviral therapy in Zimbabwe

2020 ◽  
Vol 10 (3) ◽  
pp. 97-103
Author(s):  
T. P. Goverwa-Sibanda ◽  
C. Mupanguri ◽  
C. Timire ◽  
A. D. Harries ◽  
S. Ngwenya ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hepatitis B ◽  
Opportunistic Infections ◽  
Hepatitis B Surface Antigen ◽  
Prevalence Ratio ◽  
Diagnosis And Treatment ◽  
People Living With Hiv ◽  
First Line ◽  
Cross Sectional ◽  
Living With Hiv

Setting: There is little information about the diagnosis and treatment of hepatitis B virus (HBV) infection in people living with HIV (PLHIV) in Zimbabwe despite recommendations that tenofovir (TDF) + lamivudine (3TC) is the most effective nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone of antiretroviral therapy (ART) in those with dual infection.Objective: To determine 1) numbers screened for hepatitis B surface antigen (HBsAg); 2) numbers diagnosed HBsAg-positive along with baseline characteristics; and 3) NRTI backbones used among PLHIV initiating first-line ART at Mpilo Opportunistic Infections Clinic, Bulawayo, Zimbabwe, between October 2017 and April 2019.Design: This was a cross-sectional study using routinely collected data.Results: Of the 422 PLHIV initiating first-line ART (median age 34 years, IQR 25–43), 361 (85%) were screened for HBV, with 10% being HBsAg-positive. HBsAg positivity was significantly associated with anaemia (adjusted prevalence ratio [aPR] 2.3, 95%CI 1.1–4.7) and elevated ala-nine transaminase levels (aPR 2.9, 95%CI 1.5–5.8). Of 38 PLHIV who were diagnosed HBsAg-positive, 30 (79%) were started on ART based on tenofovir (TDF) and lamivudine (3TC), seven were given abacavir (ABC) + 3TC-based ART and one was given zido vudine (ZDV) + 3TC-based ART.Conclusion: In PLHIV, HBV screening worked well, the prevalence of HIV-HBV co-infection was high and most patients received appropriate treatment for both conditions. Recommendations to improve screening, diagnosis and treatment of HIV-HBV co-infection are discussed.

scholarly journals Timely initiation of HIV antiretroviral therapy in Haiti 2004–2018: a retrospective cohort study

2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Nancy Puttkammer ◽  
Canada Parrish ◽  
Yrvel Desir ◽  
Nathaelf Hyppolite ◽  
Nadjy Joseph ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Timely Initiation ◽  
Art Initiation ◽  
Hiv Antiretroviral Therapy ◽  
Living With Hiv

Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 2004–2018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 0–14 years (HR = 0.23, p < 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p < 0.001), and having WHO stage 3 (HR = 0.73, p < 0.001) or stage 4 disease (HR = 0.49, p < 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.

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