Circulating microparticles are increased amongst people presenting with HIV and advanced immune suppression in Malawi and correlate closely with arterial stiffness: a nested case control study

Background: We aimed to investigate whether circulating microparticle (CMPs) subsets were raised amongst people presenting with human immunodeficiency virus (HIV) and advanced immune suppression in Malawi, and whether they associated with arterial stiffness. Methods: Antiretroviral therapy (ART)-naïve adults with a new HIV diagnosis and CD4 <100 cells/µL had microparticle characterisation and carotid femoral Pulse Wave Velocity (cfPWV) at 2 weeks post ART initiation. HIV uninfected controls were matched on age, systolic blood pressure (BP) and diastolic BP in a 1:1 ratio. Circulating microparticles were identified from platelet poor plasma and stained for endothelial, leucocyte, monocyte and platelet markers. Results: The median (IQ) total CMP count for 71 participants was 1 log higher in HIV compared to those without (p<0.0001) and was associated with arterial stiffness (spearman rho 0.47, p<0.001). In adjusted analysis, every log increase in circulating particles showed a 20% increase in cfPWV (95% confidence interval [CI] 4 – 40%, p=0.02). In terms of subsets, endothelial and platelet derived microparticles were most strongly associated with HIV. Endothelial derived E-selectin+ CMPs were 1.3log-fold higher and platelet derived CD42a+ CMPs were 1.4log-fold higher (both p<0.0001). Endothelial and platelet derived CMPs also correlated most closely with arterial stiffness (spearman rho: E-selectin+ 0.57 and CD42a 0.56, both p<0.0001). Conclusions: Circulating microparticles associate strongly with arterial stiffness among people living with HIV in Malawi. Endothelial damage and platelet microparticles are the predominant cell origin types and future translational studies could consider prioritising these pathways.

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Circulating Microparticles are increased amongst people presenting with HIV and advanced immune suppression in Malawi and correlate closely with arterial stiffness

10.1101/2020.07.19.20157107 ◽

2020 ◽

Author(s):

Christine Kelly ◽

Rijan Gurung ◽

Willard Tinago ◽

Raphael Kamn'gona ◽

Irene Sheha ◽

...

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Platelet Activation ◽

Immune Suppression ◽

Pulse Wave ◽

Endothelial Damage ◽

Hiv Diagnosis ◽

Art Initiation ◽

Circulating Microparticles ◽

Translational Studies

Objectives We aim to investigate whether circulating microparticle (CMPs) subsets were raised amongst people presenting with HIV and advanced immune suppression in Malawi, and whether they associated with arterial stiffness. Methods ART naive adults with a new HIV diagnosis and CD4 <100 cells/uL had microparticle characterisation and carotid femoral Pulse Wave Velocity (cfPWV) at 2 weeks post ART initiation. HIV uninfected controls were matched on age, systolic BP and diastolic BP in a 1:1 ratio. Circulating microparticles were identified from platelet poor plasma and stained for endothelial, leucocyte, monocyte and platelet markers. Results The median (IQ) total CMP count was 1log higher in participants with HIV compared to those without (p<0.0001) and was associated with arterial stiffness (spearman rho 0.47, p<0.001). In adjusted analysis, every log increase in circulating particles showed a 20% increase in cfPWV (95% CI 4 to 40%, p=0.02). In terms of subsets, endothelial and platelet derived microparticles were most strongly associated with HIV. Endothelial derived Eselectin+ CMPs were 1.3log fold higher and platelet derived CD42a+ CMPs were 1.4log fold higher (both p<0.0001). Endothelial and platelet derived CMPs also correlated most closely with arterial stiffness [spearman rho: Eselectin+ 0.57 and CD42a 0.56, both p<0.0001). Conclusions Circulating microparticles associate strongly with arterial stiffness among PLWH in Malawi. Endothelial damage and platelet activation are of particular importance and future translational studies should consider prioritising this pathway.

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Perceptions dynamics about antiretroviral treatment among HIV patients in Bali

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v10i3.20917 ◽

2021 ◽

Vol 10 (3) ◽

pp. 500

Author(s):

Anak Agung Sagung Sawitri ◽

I Nyoman Sutarsa ◽

Tuti Parwati Merati ◽

Made Bakta ◽

Dewa Nyoman Wirawan

Keyword(s):

Antiretroviral Treatment ◽

Continuous Process ◽

Hiv And Aids ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Chi Square ◽

Art Initiation ◽

Living With Hiv ◽

The Continuum

Perceptions of people living with HIV and AIDS (PLHIV) about antiretroviral treatment (ART) is crucial for improving adherence. This study aims to examine the dynamics of perceptions during the early phase of ART. A longitudinal study involving newly diagnosed PLHIV was conducted. Interviews were carried out at the time of HIV diagnosis and at three months after ART initiation. Data were analyzed by comparing proportion of good perception across the continuum of HIV diagnosis, ART initiation and threemonths follow-up, and were tested using Chi-square. From 170 PLHIV participated in the study, 81.76% had initiated ART and 73.4% remained on ART at three-months of follow-up. Several positive perception items were significantly decreased: ability to take ART at work and ability to continue treatment if experiencing side effects, effectiveness of ART, confidentiality, unwanted disclosure, and level of support from outreach workers. Ability to follow instruction from physician was significantly increased, and negative attitudes toward ART were decreased across the continuum. Adherence to ART is a continuous process, and is influenced by the dynamics perceptions among PLHIV. Understanding these dynamics is crucial to formulate strategies that can promote and maintain positive attitudes toward ART as well as living with HIV more broadly.

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Antiretroviral therapy among patients with HIV in Almaty, Kazakhstan: the implication for HIV-associated tuberculosis control

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11924 ◽

2020 ◽

Vol 14 (11.1) ◽

pp. 128S-132S

Author(s):

Alfiya Denebayeva ◽

Arpine Abrahamyan ◽

Aelita Sargsyan ◽

Karine Kentenyants ◽

Ainur Zhandybayeva ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Treatment Guideline ◽

Hiv Treatment ◽

People Living With Hiv ◽

Preventive Strategy ◽

Hiv Diagnosis ◽

Art Initiation ◽

Living With Hiv ◽

And Control ◽

The Impact

Introduction: Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count. Aim: To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018. Methodology: A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS). Results: The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised. Conclusion: Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.

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Virologic outcomes of people living with human immunodeficiency virus who started antiretroviral treatment on the same-day of diagnosis in Ethiopia: A multicenter observational study

PLoS ONE ◽

10.1371/journal.pone.0257059 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257059

Author(s):

Ismael Ahmed ◽

Meaza Demissie ◽

Alemayehu Worku ◽

Salem Gugsa ◽

Yemane Berhane

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Absolute Difference ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Art Initiation ◽

Universal Test And Treat ◽

Double Robust ◽

Significant Difference ◽

Immunodeficiency Virus

Introduction There have been tremendous achievements in scaling-up antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV), following universal “test and treat” policy implementation in low- and middle-income countries. However, its effects on virologic outcomes is not yet well investigated. We compared low viral load status in people living with HIV between those who were initiated on ART on the same-day and after 7 days of being diagnosed with HIV infection. Methods We conducted a retrospective cohort study of persons age ≥15 years-old who were newly diagnosed and started on ART between October 2016 and July 2018 at 11 public health facilities in northwest Ethiopia. Exposure was initiation of ART on the same-day of HIV diagnosis. The outcome was low viral load at 12-months following ART initiation. We used double-robust estimator using inverse-probability-weighted regression adjustment to compare the groups. Results A total of 398 people who started ART on the same-day of HIV diagnosis and 479 people who started 7 days after the initial diagnosis were included in this study. By 12-months following ART initiation, 73.4% (292) in the same-day group vs 83.7% (401) in the >7 days group achieved low viral load (absolute difference = 10.3% (95% CI: 4.9%, 15.8%)). After adjusting for baseline and follow-up covariates, there was statistically significant difference in low viral load status (adjusted difference = 8.3% (95% CI: 3.5%, 13.0%)) between the same-day group and the >7 days group. Conclusions Achievement of low viral load by 12-months post-initiation of ART was not optimal among participants who started ART on the same-day of HIV diagnosis. Efforts should be made to reinforce treatment adherence while initiating same-day ART.

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ART initiation and predictive factors among men who have sex with men living with HIV after the implementation of new ART strategy in China: an observational cohort study

10.21203/rs.2.19996/v1 ◽

2020 ◽

Author(s):

Weiyi Chen ◽

Zixin Wang ◽

Xiaoyan Fan ◽

Linghua Li ◽

Huifang Xu ◽

...

Keyword(s):

Cohort Study ◽

Social Status ◽

Regression Models ◽

Cox Regression ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Art Initiation ◽

Baseline Information ◽

Sex With Men ◽

Living With Hiv

Abstract BackgroundChina started the new antiretroviral therapy (ART) strategy since 2016, after which free ART could be provided for all people living with HIV. We aimed to understand the prevalence of ART initiation among men who have sex with men (MSM) living with HIV and to explore how ART-related perceptions, psycho-social status etc. predict ART initiation under the new strategy.MethodsA cohort study (maximum follow-up period = 578 days) was conducted in Guangzhou, China. A total of 303 ART-naïve MSM were recruited from community. Baseline information collected demographic characteristics, HIV/AIDS-related health status, ART-related perceptions, weighting of pros versus cons and psycho-social status. The outcome was ART initiation. Cox regression models were fitted for data analyses.ResultsThe prevalence of ART initiation was 83.8% of all participants and 92.6% of MSM diagnosed recently (within 30 days). In multivariate Cox regression models, HIV-positive MSM received HIV diagnosis ≤30 days were less likely to initiate ART (HR = 0.37, 95% CI: 0.28-0.49). In adjusted analyses, belief that immediate ART initiation would have more benefit for themselves associated with increased ART initiation (HRa = 1.44, 95% CI: 1.06-1.96). In the final model, weighting of pros versus cons and time since diagnosis of HIV infection remained significant.ConclusionThe prevalence of ART initiation was high among MSM living with HIV in Guangzhou. To reach the second 90% target, measures should be focused on MSM previously diagnosed. Interventions showing HIV-positives the benefits of ART were also needed.

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Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.48.30417 ◽

2016 ◽

Vol 21 (48) ◽

Cited By ~ 25

Author(s):

Anastasia Pharris ◽

Chantal Quinten ◽

Teymur Noori ◽

Andrew J Amato-Gauci ◽

Ard van Sighem ◽

...

Keyword(s):

European Union ◽

People Living With Hiv ◽

European Economic Area ◽

Hiv Incidence ◽

The European Union ◽

Hiv Diagnosis ◽

European Economic ◽

Economic Area ◽

Immunodeficiency Virus ◽

Living With Hiv

Since 2011, human immunodeficiency virus (HIV) incidence appears unchanged in the European Union/European Economic Area with between 29,000 and 33,000 new cases reported annually up to 2015. Despite evidence that HIV diagnosis is occurring earlier post-infection, the estimated number of people living with HIV (PLHIV) who were unaware of being infected in 2015 was 122,000, or 15% of all PLHIV (n=810,000). This is concerning as such individuals cannot benefit from highly effective treatment and may unknowingly sustain transmission.

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Clinical Pharmacology of Hyperammonemia by Sodium Valproate and Carbamazepine in People Living with HIV

CNS Spectrums ◽

10.1017/s1092852920002266 ◽

2021 ◽

Vol 26 (2) ◽

pp. 143-143

Author(s):

Martin J. Mazzoglio y Nabar ◽

Santiago Muñoz ◽

Milagros Muñiz ◽

Alexis Mejías ◽

Christian Montivero ◽

...

Keyword(s):

Valproic Acid ◽

People Living With Hiv ◽

Preventive Control ◽

Decompensated Liver Disease ◽

Viral Loads ◽

Daily Life Activities ◽

Psychopharmacological Treatment ◽

Immunodeficiency Virus ◽

Cirrhotic Patients ◽

Living With Hiv

AbstractIntroductionHyperammonaemia (HA) is observed in decompensated liver disease. The picture of hyperammonemic encephalopathy in non-cirrhotic patients was reported mostly associated with valproic acid. There are few reports of hyperammonemia in people living with human immunodeficiency virus (PLHIV) and they are associated with other comorbidities and few with antiretrovirals (HAART), but not as adverse drug reactions associated with psychotropic drugs associated with the virus.ObjectiveReport of cases of PLHIV in HARRT with hyperammonemia, its clinical impact and ammonium levels.Materials and MethodsWe report 67 PLHIV in treatment with HAART, negative viral loads, psychopharmacological treatment with valproic acid (n=45) or carbamazepine (n=22). Exclusion criteria were = HCV, HBV and alcohol consumption disorder (current or recent history) and decompensated liver pathology. We apply scales to evaluate side effects (UKU), subjective adherence (DAI), daily life activities (Barthel Index), liver severity (Child-Pugh Classification) and degrees of hepatic encephalopathy (West Haven Scale). The ethical-legal requirements were met. Results: 26.86% presented hyperammonemia, among which 38.88% was symptomatic. The clinical presentation was heterogeneous with a higher prevalence of gastrointestinal and cognitive alterations; the most severe cases presented alterations of the sensorium and 1 case of convulsions. We recorded a greater symptomatic severity with carbamazepine (average ammonia =104.4 pmol/L), but a higher prevalence of non-symptomatic hyperammonemia with valproic acid (62.3 pmol/L). The time of onset of symptoms was lower with carbamazepine, but the time until its decrease was higher with valproic acid.ConclusionsWe observed a higher prevalence of hyperammonemia and associated symptomatology in PLHIV with HAART medicated with carbamazepine. The significant percentage of this adverse drug reaction suggests a biochemical, perhaps preventive, control.

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Serological Responses to Toxoplasma gondii and Matrix Antigen 1 Predict the Risk of Subsequent Toxoplasmic Encephalitis in People Living with HIV

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1917 ◽

2021 ◽

Author(s):

Jianchun Xiao ◽

Fiona Bhondoekhan ◽

Eric C Seaberg ◽

Otto Yang ◽

Valentina Stosor ◽

...

Keyword(s):

Predictive Performance ◽

Toxoplasmic Encephalitis ◽

People Living With Hiv ◽

Serum Samples ◽

Peptide Antigens ◽

Unit Increase ◽

At Risk Populations ◽

Living With Hiv ◽

Nested Case Control ◽

Control Study

Abstract Background Clinically useful predictors for fatal toxoplasmosis are lacking. We investigated the value of serological assays for antibodies to whole Toxoplasma antigens and to peptide antigens of the Toxoplasma cyst protein MAG1, for predicting incident toxoplasmic encephalitis (TE) in people living with HIV (PLWH). Methods We performed a nested case control study, conducted within the Multicenter AIDS Cohort Study (MACS), using serum samples obtained 2 years prior to diagnosis of TE from 28 cases, and 37 HIV disease-matched Toxoplasma seropositive controls at matched time-points. Sera were tested for Toxoplasma antibodies using a commercial assay and for antibodies to MAG1_4.2 and MAG1_5.2 peptides in ELISA. Results Two years prior to clinical diagnosis, 68% of TE cases were MAG1_4.2 seropositive compared with 16% of controls (OR 25.0, 95% CI 3.14-199.18). Corresponding results for MAG1_5.2 seropositivity were 36% and 14% (OR 3.6, 95% CI 0.95-13.42). Higher levels of antibody to MAG1_4.2 (OR 18.5 per doubling of the OD value, 95% CI 1.41-242) and to Toxoplasma (OR 2.91 for each OD unit increase, 95% CI 1.48-5.72) were also associated with the risk of TE. When seropositivity was defined as the presence of MAG1 antibody or relatively high levels of Toxoplasma antibody, the sensitivity was 89% and specificity was 68% for subsequent TE. Conclusions Antibodies to MAG1 showed predictive value on the occurrence of TE in PLWH, and the predictive performance was further improved by adding the levels of Toxoplasma antibody. These measures could be clinically useful for predicting subsequent diseases in multiple at-risk populations.

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Stigma mastery in people living with HIV: gender similarities and theory

Journal of Public Health ◽

10.1007/s10389-021-01480-7 ◽

2021 ◽

Author(s):

Charles Patrick Namisi ◽

John C. Munene ◽

Rhoda K. Wanyenze ◽

Anne R. Katahoire ◽

Rosalinda M. Parkes-Ratanshi ◽

...

Keyword(s):

Older Women ◽

Social Exclusion ◽

Theoretical Framework ◽

People Living With Hiv ◽

Negative Effects ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Age Related ◽

Related Stigma ◽

Living With Hiv

Abstract Aims This study aimed to determine the prevalence of, factors associated with, and to build a theoretical framework for understanding Internalsed HIV-related Stigma Mastery (IHSM). Methods A cross-sectional study nested within a 2014 Stigma Reduction Cohort in Uganda was used. The PLHIV Stigma Index version 2008, was used to collect data from a random sample of 666 people living with HIV (PLHIV) stratified by gender and age. SPSS24 with Amos27 softwares were used to build a sequential-mediation model. Results The majority of participants were women (65%), aged ≥ 40 years (57%). Overall, IHSM was 45.5% among PLHIV, that increased with age. Specifically, higher IHSM correlated with men and older women “masculine identities” self-disclosure of HIV-diagnosis to family, sharing experiences with peers. However, lower IHSM correlated with feminine gender, the experience of social exclusion stress, fear of future rejection, and fear of social intimacy. Thus, IHSM social exclusion with its negative effects and age-related cognition are integrated into a multidimensional IHSM theoretical framework with a good model-to-data fit. Conclusion Internalised HIV-related Stigma Mastery is common among men and older women. Specificially, “masculine identities” self-disclose their own HIV-positive diagnosis to their family, share experiences with peers to create good relationships for actualising or empowerment in stigma mastery. However, social exclusion exacerbates series of negative effects that finally undermine stigma mastery by young feminine identities. Thus, stigma mastery is best explained by an integrated empowerment framework, that has implications for future practice, policy, and stigma-related research that we discuss.

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Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience

International Journal of STD & AIDS ◽

10.1177/0956462420973106 ◽

2021 ◽

Vol 32 (5) ◽

pp. 435-443

Author(s):

Maria Elena Ceballos ◽

Patricio Ross ◽

Martin Lasso ◽

Isabel Dominguez ◽

Marcela Puente ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

General Population ◽

Clinical Characteristics ◽

Cd4 Count ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Hiv Viral Load ◽

Risk Of Death ◽

Living With Hiv

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07–0.31) and younger age (OR 8.68; IC 95% 2.66–28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05–5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

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