Viral and immunological markers of HIV-associated Kaposi sarcoma recurrence

Kaposi sarcoma (KS) is an AIDS-defining angio-proliferative malignancy highly prevalent in Sub-Saharan Africa. The main objective of this study was to determine the factors associated with recurrence of HIV-associated KS. We recruited a cohort of individuals on antiretroviral therapy who were in remission for HIV-associated KS after undergoing cytotoxic cancer chemotherapy. Collected variables included sociodemographic and clinical parameters, cytokines and chemokines, HIV viral loads, and CD4 counts. Compared to individuals who had KS recurrence, IL-5 was significantly higher at time of follow-up in individuals who had sustained remission (22.7pg/ml vs. 2.4pg/ml; p = 0.02); IL-6 was significantly higher at baseline and time of follow-up in individuals who had sustained remission, (18.4pg/ml vs. 0pg/ml; p = 0.01) and (18.0pg/ml vs. 0.18pg/ml; p = 0.03) respectively; IP-10 was significantly lower at baseline and at time of follow-up in individuals who had sustained remission, (534pg/ml vs. 920pg/ml; p = 0.04) and (446pg/ml vs.1098pg/ml; p = 0.01) respectively; while HIV viral load was significantly lower at baseline and at time of follow-up in individuals who had sustained remission, (0copies/ml vs. 113copies/ml; p = 0.004) and (0copies/ml vs. 152copies/ml; p = 0.025) respectively. Plasma levels of IL-5, IL-6, and IP-10 are associated with recurrence of HIV-associated KS, while persistently detectable HIV viral loads increase the risk of KS recurrence.

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HIV and Malaria co-infection and the impact of viral load and HAART usage on the development of Plasmodium falciparum Artemisinin and Lumefantrine resistant genes in Nnewi, Anambra State, Nigeria

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2021.12.3.0710 ◽

2021 ◽

Vol 12 (3) ◽

pp. 505-516

Author(s):

Peace Amaka Onwuzurike ◽

Ifeoma Bessie Enweani ◽

Ifeoma Mercy Ekejindu

Keyword(s):

Viral Load ◽

Sub Saharan Africa ◽

Hiv Viral Load ◽

Anambra State ◽

Viral Loads ◽

Highly Active ◽

Resistant Genes ◽

Sub Saharan ◽

Socio Demographic Factors ◽

The Impact

Background: Human Immunodeficiency virus (HIV) and malaria co-infection poses a serious health threat in sub-Saharan Africa and other endemic countries. Highly active anti-retroviral therapy (HAART) is currently used to suppress viral loads. Methods: Blood samples collected from 400 participants comprising 200 HIV sero-positive and 200 sero-negative individuals was added to EDTA sample containers. Malaria parasitemia was evaluated using standard parasitological techniques followed by PCR techniques using the Quick Load One Taq One Step Polymerase Chain Reaction (PCR) for characterization of species of Plasmodium and resistant studies using specific primers. HIV viral load estimation was done using COBAS® TaqMan® Analyzer. Results: Malaria has prevalent rate of 22.75% in the study population, while the prevalence of malaria infection among the HIV sero-positive and sero-negative is 77.0% and 23% respectively. Socio-demographic factors had no significant association with the development of resistant genes. HAART exposed individuals had prevalence of PfK13 (6.9%) and Pfmdr-1 (20.8%). Viral load was significantly related with the development of resistant genes (100%) and (86.1%) for PfK13 and Pfmdr-1 respectively. Conclusion: Unsuppressed viral load in HIV sero-positive individuals heightens the prevalence of malaria parasitaemia and increases the chances of possible emergence and spread of PfK13 and Pfmdr-1 genes.

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Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds1755 ◽

2017 ◽

Vol 20 (5) ◽

pp. 423-431 ◽

Cited By ~ 8

Author(s):

Maria M. Santos ◽

Derick K. Rubagumya ◽

Imani Dominic ◽

Amos Brighton ◽

Soledad Colombe ◽

...

Keyword(s):

Risk Factors ◽

Head Circumference ◽

Surgical Complications ◽

Surgical Procedure ◽

Postoperative Mortality ◽

Endoscopic Procedure ◽

Sub Saharan Africa ◽

Factors Associated ◽

Sub Saharan

OBJECTIVEInfant hydrocephalus is estimated to affect more than 100,000 new infants each year in sub-Saharan Africa (SSA). Bugando Medical Centre (BMC), a government-funded and patient cost-shared referral center, serves over 13 million people in the Lake and Western regions of Tanzania. The goals of this study were to characterize the infant population affected by hydrocephalus who presented to BMC and were treated with a ventriculoperitoneal shunt (VPS) to determine the rate of early complications associated with this surgical procedure and to assess its potential risk factors.METHODSData were prospectively collected from all patients less than 1 year of age who, over a period of 7 months, were diagnosed with hydrocephalus and admitted to BMC for insertion of a primary VPS. Demographic data, maternal history, preoperative studies, surgical procedure, and surgical complications developing by the time of the first follow-up visit were analyzed. Risk factors associated with the surgical complications were determined.RESULTSDuring the 7-month study period, 125 infants eligible for the study were included in the analysis. Overall, 75% were younger than 6 months of age, and 56% were males. Only 7% of mothers had a gestational ultrasound, 98% did not receive preconception folic acid, and 25% delivered their child at home. In most patients with hydrocephalus the etiology was uncertain (56%), and other patients had postinfectious (22.4%) or myelomeningocele-associated (16%) hydrocephalus. Patients’ mean head circumference on admission was 51.4 ± 6.3 cm. Their median age at shunt surgery was 137 days, and 22.4% of the patients were operated on without having undergone radiological assessment. The majority of shunts were placed in a right parietooccipital location. Thirteen patients had undergone a previous intraventricular endoscopic procedure. Overall, at least one surgical complication was found in 33.6% of patients up to the first follow-up assessment (median follow-up time of 70 days); shunt infection was the most common complication. The postoperative mortality rate was 9%. The risk factors associated with early surgical complications were tumor-related etiology, larger head circumference, and postoperative hospital stays of greater duration.CONCLUSIONSIn a region of the continent where most infant hydrocephalus cases had an uncertain etiology, most patients presented to the hospital in a late stage, with no prenatal diagnosis and with large head circumferences. Standard preoperative investigations were not uniformly performed, and the surgical complications, led by VPS infection, were disturbingly high. Younger patient age, previous endoscopic procedure, surgeon involved, and cranial location of the VPS had no statistical relation to the surgical complications.This study shows that the positive results previously reported by SSA mission hospitals, subspecialized in pediatric neurosurgery, are still not generalizable to every hospital in East Africa. To improve maternal and neonatal care in the Lake region of Tanzania, the development of a fluxogram to determine hydrocephalus etiology, a strict perioperative protocol for VPS insertion, and an increase in the number of endoscopic procedures are recommended to BMC.

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Updating vital status by tracking in the community among patients with epidemic Kaposi sarcoma who are lost to follow-up in sub-Saharan Africa

BMC Cancer ◽

10.1186/s12885-017-3549-1 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Aggrey Semeere ◽

Esther Freeman ◽

Megan Wenger ◽

David Glidden ◽

Mwebesa Bwana ◽

...

Keyword(s):

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Vital Status ◽

Sub Saharan ◽

Lost To Follow Up

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Faculty Opinions recommendation of Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726698717.793523215 ◽

2016 ◽

Author(s):

Simon Portsmouth

Keyword(s):

Antiretroviral Therapy ◽

Children And Adolescents ◽

Kaposi Sarcoma ◽

Sub Saharan Africa ◽

Combination Antiretroviral Therapy ◽

Sub Saharan

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003773 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003773

Author(s):

Edward Kwabena Ameyaw ◽

Yusuf Olushola Kareem ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Sanni Yaya

Keyword(s):

Decomposition Analysis ◽

Household Wealth ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Childhood Immunisation ◽

Urban Settings ◽

Factors Associated ◽

Rural And Urban ◽

Full Immunisation ◽

Sub Saharan

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

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A Low Level of Darunavir Resistance–Associated Mutation Emergence in Patients With Virological Failure During Long-term Use of Darunavir in People With HIV. The ANRS CO3 Aquitaine Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa567 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Hélène Chaussade ◽

Camille Tumiotto ◽

Fabien Le Marec ◽

Olivier Leleux ◽

Lucile Lefèvre ◽

...

Keyword(s):

Protease Inhibitor ◽

Virological Failure ◽

Resistance Test ◽

Resistance Testing ◽

Factors Associated ◽

Viral Loads ◽

Hiv Resistance ◽

Baseline Characteristics

Abstract Background Ritonavir-boosted darunavir (DRV/r) is a protease inhibitor (PI) indicated for the treatment of naïve and pretreated HIV-infected patients since 2007. Our study aims to describe DRV/r-treated patients experiencing virological failure (VF) documented with HIV resistance testing. Methods Data from patients belonging to the ANRS CO3 Aquitaine Cohort treated with a regimen including DRV/r between February 2007 and December 2015 were analyzed. Baseline characteristics of patients experiencing VF (defined by 2 consecutive plasma viral loads >50 copies/mL) were compared with those without VF. We then described factors associated with VF as emergence of IAS DRV resistance–associated mutations (RAMs). Results Among the 1458 patients treated at least once with a DRV/r-based regimen, 270 (18.5%) patients experienced VF during follow-up, including 240 with at least 1 genotype resistance test (GRT). DRV RAMs were detected in 29 patients (12%). Among them, 25/29 patients had ≥2 DRV RAMs before DRV/r initiation, all of whom had experienced VF during previous PI treatments. For 18/29, DRV/r was maintained after VF, and controlled viremia was restored after modification of DRV-associated antiretroviral molecules or increased DRV dose. Finally, only 6/29 patients selected new DRV RAMs after DRV/r initiation. All of these experienced previous VFs while on other PIs. Conclusions These results highlight the efficacy and robustness of DRV/r, as the emergence of DRV RAMs appeared in <0.4% of patients receiving a DRV/r-based regimen in our large cohort.

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Persistence of mRNA indicative of Plasmodium falciparum ring-stage parasites 42 days after artemisinin and non-artemisinin combination therapy in naturally infected Malians

Malaria Journal ◽

10.1186/s12936-020-03576-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Almahamoudou Mahamar ◽

Kjerstin Lanke ◽

Wouter Graumans ◽

Halimatou Diawara ◽

Koualy Sanogo ◽

...

Keyword(s):

Combination Therapy ◽

Artemisinin Combination Therapy ◽

Parasite Prevalence ◽

Sub Saharan Africa ◽

Ring Stage ◽

Qrt Pcr ◽

Sub Saharan ◽

Stage Parasite ◽

Ring Stage Parasite

Abstract Background Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasite mRNA, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), was previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitaemia following ACT and non-ACT treatment was examined. Methods Samples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin–piperaquine (DP) or sulfadoxine–pyrimethamine (SP–AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results At baseline, 89% (64/73) of participants had measurable ring-stage parasite mRNA. Following treatment, the proportion of ring-stage parasite-positive individuals and estimated densities declined for all four treatment groups. Ring-stage parasite prevalence and density was generally lower in arms that received DP compared to SP–AQ. This finding was most apparent days 1, 2, and 42 of follow-up (p < 0.01). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite density estimates on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitaemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14 = 0.011 and pday 28 = 0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions The current findings of lower ring-stage persistence after ACT without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage mRNA after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitaemia.

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