scholarly journals The impact of the 2014 Ebola epidemic on HIV disease burden and outcomes in Liberia West Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257049
Author(s):  
Soka J. Moses ◽  
Ian Wachekwa ◽  
Collin Van Ryn ◽  
Greg Grandits ◽  
Alice Pau ◽  
...  
Keyword(s):  
West Africa ◽  
Hiv Prevalence ◽  
Hiv Positive ◽  
Current State ◽  
National Estimates ◽  
Living With Hiv ◽  
Provision Of Care ◽  
The Impact ◽  
Hiv Negative

Background Detailed longitudinal studies of HIV-positive individuals in West Africa are lacking. Here the HIV prevalence, incidence, all-cause mortality, and the proportion of individuals receiving treatment with cART in two cohorts of participants in Ebola-related studies are described. Setting Individuals of all ages were enrolled and followed at four sites in the area of Monrovia, Liberia. Methods Two cohorts identified in response to the Ebola epidemic are described to provide insights into the current state of the HIV epidemic. HIV testing was performed at baseline for participants in both cohorts and during follow-up in one cohort. Results Prevalence and incidence of HIV (prevalence of 3.1% for women and 1.4% for men and incidence of 3.3 per 1,000) were higher in these cohorts compared to 2018 national estimates (prevalence of 1.3% and incidence of 0.39 per 1,000). Most participants testing positive did not know their status prior to testing. Of those who knew they were HIV positive, 7.9% reported being on antiretroviral treatment. The death rate among those with HIV was 12.3% compared to 1.9% in HIV-negative individuals (adjusted odds ratio of 6.87). While higher levels of d-dimer were associated with increased mortality, this was not specific to those with HIV, however lower hemoglobin levels were associated with increased mortality among those with HIV. Conclusion These findings point to a need to perform further research studies aimed at fulfilling these knowledge gaps and address current shortcomings in the provision of care for those living with HIV in Liberia.

scholarly journals Frailty Is Associated With Mortality and Incident Comorbidity Among Middle-Aged Human Immunodeficiency Virus (HIV)–Positive and HIV-Negative Participants

2020 ◽  
Vol 222 (6) ◽  
pp. 919-928 ◽  
Author(s):  
Eveline Verheij ◽  
Gregory D Kirk ◽  
Ferdinand W Wit ◽  
Rosan A van Zoest ◽  
Sebastiaan O Verboeket ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Strong Predictor ◽  
Hiv Positive ◽  
Geriatric Population ◽  
Mortality And Morbidity ◽  
Immunodeficiency Virus ◽  
The Impact ◽  
Hiv Negative

Abstract Background Frailty is associated with mortality and morbidity in the general geriatric population, but less is known about its impact among the aging but generally younger population with human immunodeficiency virus (HIV). Methods The impact of frailty on all-cause mortality during 6 years of follow-up and incident comorbidity during 4 years of follow-up was assessed among 598 HIV-positive and 550 comparable HIV-negative participants aged ≥ 45 years of the AGEhIV Cohort Study. Frailty encompasses 5 domains; weight loss, low physical activity, exhaustion, decreased grip strength, and slow gait speed. Presence of ≥ 3 denotes frailty, 1–2 prefrailty, and 0 robust. Multivariable Cox and logistic regression models were used to assess the independent relationships of frailty with both outcomes, adjusting for HIV infection and traditional risk factors. Results At baseline, 7.5% (n = 86) of participants were frail. During follow-up, 38 participants died. Mortality rate was significantly higher among frail participants: 25.7/1000 person-years of follow-up (PYFU) (95% confidence interval [CI], 14.2–46.4) compared with prefrail (7.2/1000 PYFU [95% CI, 4.7–11.2]) and robust (2.3/1000 PYFU [95% CI, 1.1–4.9]). In fully adjusted analyses, frailty remained strongly associated with death (hazard ratio, 4.6 [95% CI, 1.7–12.5]) and incident comorbidity (odds ratio, 1.9 [95% CI, 1.1–3.1]). No interactions were observed between frailty and HIV status in all analyses. Conclusions Frailty is a strong predictor of both mortality and incident comorbidity independent from other risk factors. Clinical Trials Registration NCT01466582.

scholarly journals The impact of lookback windows on the prevalence and incidence of chronic diseases among people living with HIV: an exploration in administrative health data in Canada

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ni Gusti Ayu Nanditha ◽  
Xinzhe Dong ◽  
Taylor McLinden ◽  
Paul Sereda ◽  
Jacek Kopec ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Population Based ◽  
Data Driven ◽  
People Living With Hiv ◽  
Administrative Health Data ◽  
Time Period ◽  
Living With Hiv ◽  
The Impact ◽  
Hiv Negative

Abstract Background We described the impact of different lengths of lookback window (LW), a retrospective time period to observe diagnoses in administrative data, on the prevalence and incidence of eight chronic diseases. Methods Our study populations included people living with HIV (N = 5151) and 1:5 age-sex-matched HIV-negative individuals (N = 25,755) in British Columbia, Canada, with complete follow-up between 1996 and 2012. We measured period prevalence and incidence of diseases in 2012 using LWs ranging from 1 to 16 years. Cases were deemed prevalent if identified in 2012 or within a defined LW, and incident if newly identified in 2012 with no previous cases detected within a defined LW. Chronic disease cases were ascertained using published case-finding algorithms applied to population-based provincial administrative health datasets. Results Overall, using cases identified by the full 16-year LW as the reference, LWs ≥8 years and ≥ 4 years reduced the proportion of misclassified prevalent and incidence cases of most diseases to < 20%, respectively. The impact of LWs varied across diseases and populations. Conclusions This study underscored the importance of carefully choosing LWs and demonstrated data-driven approaches that may inform these choices. To improve comparability of prevalence and incidence estimates across different settings, we recommend transparent reporting of the rationale and limitations of chosen LWs.

scholarly journals Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

2022 ◽  
Vol 14 (1) ◽  
pp. 43-55
Author(s):  
Cristina Micali ◽  
Ylenia Russotto ◽  
Grazia Caci ◽  
Manuela Ceccarelli ◽  
Andrea Marino ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cancer Staging ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Liver Cancers ◽  
Significant Difference ◽  
Cancer Specific Mortality ◽  
Living With Hiv ◽  
Hiv Negative

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

scholarly journals Patterns of Immune Activation in HIV and Non HIV Subjects and Its Relation to Cardiovascular Disease Risk

2021 ◽  
Vol 12 ◽  
Author(s):  
Alinda G. Vos ◽  
Caitlin N. Dodd ◽  
Eveline M. Delemarre ◽  
Stefan Nierkens ◽  
Celicia Serenata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Immune Activation ◽  
Hiv Positive ◽  
Inflammation Markers ◽  
Cvd Risk Factors ◽  
Immune Markers ◽  
Cvd Risk ◽  
The Impact ◽  
Hiv Negative

IntroductionInsight into inflammation patterns is needed to understand the pathophysiology of HIV and related cardiovascular disease (CVD). We assessed patterns of inflammation related to HIV infection and CVD risk assessed with carotid intima media thickness (CIMT).MethodsA cross-sectional study was performed in Johannesburg, South Africa, including participants with HIV who were virally suppressed on anti-retroviral therapy (ART) as well as HIV-negative participants who were family members or friends to the HIV-positive participants. Information was collected on CVD risk factors and CIMT. Inflammation was measured with the Olink panel ‘inflammation’, allowing to simultaneously assess 92 inflammation markers. Differences in inflammation patterns between HIV-positive and HIV-negative participants were explored using a principal component analysis (PCA) and ANCOVA. The impact of differentiating immune markers, as identified by ANCOVA, on CIMT was assessed using linear regression while adjusting for classic CVD risk factors.ResultsIn total, 185 HIV-positive and 104 HIV negative participants, 63% females, median age 40.7 years (IQR 35.4 – 47.7) were included. HIV-positive individuals were older (+6 years, p &lt;0.01) and had a higher CIMT (p &lt;0.01). No clear patterns of inflammation were identified by use of PCA. Following ANCOVA, nine immune markers differed significantly between HIV-positive and HIV-negative participants, including PDL1. PDL1 was independently associated with CIMT, but upon stratification this effect remained for HIV-negative individuals only.ConclusionHIV positive patients on stable ART and HIV negative controls had similar immune activation patterns. CVD risk in HIV-positive participants was mediated by inflammation markers included in this study.

scholarly journals Analysis of HIV-related mortality data in a tertiary South African neurology unit, 2006- 2012

2013 ◽  
Vol 14 (3) ◽  
pp. 121-124
Author(s):  
Clara Maria Schutte
Keyword(s):  
South African ◽  
Neurological Complications ◽  
Mortality Data ◽  
Hiv Positive ◽  
Steady Increase ◽  
Number Of Patients ◽  
High Prevalence ◽  
Living With Hiv ◽  
Related Mortality ◽  
Hiv Negative

Background. South Africa (SA) has a high prevalence of HIV infection with almost 11% of the population aged >2 years living with HIV. At the Steve Biko Academic Hospital, Pretoria, the Neurology Department has seen a steady increase in HIV-related neurology patients.Objective. To evaluate the mortality data of this unit as it relates to HIV infection.Methods. The study was a retrospective analysis of records. Patient mortality statistics for 2006, 2008, 2010 and 2012 were analysed regarding cause of death, sex, age and HIV status.Results. During 2006, 85 patients died: 33% were HIV-positive, 13% were HIV-negative and 54% had not tested for HIV. By 2010, these figures were 50%, 22% and 28%, respectively, changing little in 2012 (48%, 28% and 24%, respectively). Causes of death in the HIV-positive group were meningitis in 58% – with tuberculous meningitis the most common aetiology – followed by strokes (14%), space-occupying lesions (8%) and status epilepticus (7%). Among HIV-positive patients aged 20 - 30 years, a larger proportion of young women died than men. In the combined untested and HIV-negative group, strokes accounted for the vast majority of deaths.Conclusion. Neurological complications of HIV remain common in SA and contribute significantly to the overall mortality in our tertiary neurology unit, with TB posing a serious threat. A strong corps of clinical neurologists with training in infective neurology is needed urgently in the coming years to care for this growing number of patients. 

scholarly journals 1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S479-S479
Author(s):  
Jamie Campbell ◽  
Christopher Polk ◽  
Danya Roshdy ◽  
Michael Leonard
Keyword(s):  
Hospice Care ◽  
Intervention Group ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Short Term ◽  
Patient Admissions ◽  
Short Term Mortality ◽  
Living With Hiv ◽  
The Impact

Abstract Background Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes. Methods We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care. Results We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1. Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge. Conclusion Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up. Disclosures All authors: No reported disclosures.

scholarly journals Prevalence, incidence, and distribution of human papillomavirus types in female sex workers in Kenya

2020 ◽  
Vol 31 (2) ◽  
pp. 109-118
Author(s):  
Kristen Sweet ◽  
Claire Bosire ◽  
Busola Sanusi ◽  
Carly J Sherrod ◽  
Jessie Kwatampora ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Female Sex ◽  
Hpv Prevalence ◽  
Hiv Negative

Female sex workers (FSWs) have a notably high risk of acquiring human papillomavirus (HPV) infections. Relatively few studies address the type-specific prevalence and incidence of HPV among FSWs in sub-Saharan Africa. FSWs (n = 348) attending the Korogocho clinic in Nairobi, Kenya participated from August 2009 to March 2011. HPV DNA was detected using the SPF10-LiPA25 PCR assay. Baseline prevalence of HPV infection and cervical dysplasia were calculated, stratified by HIV-serostatus. Incidence rate (IR) of infection was calculated as number of new infections from baseline over person-months among 160 HPV-negative participants with complete 12-month follow-up. Baseline HPV prevalence was 23.6% for any HPV and 20.4% for high-risk HPV (hrHPV) types. Most prevalent types were HPV52 (10.1%), HPV35 (2.3%), and HPV51 (2.3%). A quarter (24%) of participants were HIV-positive. HPV prevalence was higher in HIV-positive (32.1%) than HIV-negative (20.8%) participants. hrHPV prevalence was higher in HIV-positive (27.4%) than HIV-negative (18.2%) women. During follow-up, HPV IR was 31.4 (95% CI: 23.8–41.5) for any HPV and 24.2 (95% CI: 17.9–32.8) for hrHPV types. HPV52 had the highest IR (6.0; 95% CI: 6.5–10.3). Overall HPV and hrHPV prevalence were lower than expected, but both prevalence and incidence were higher in HIV-positive than in HIV-negative women.

HIV testing of pregnant women—what is needed to protect positive women's needs and rights?

Sexual Health ◽  
2005 ◽  
Vol 2 (3) ◽  
pp. 143 ◽  
Author(s):  
Maria de Bruyn ◽  
Susan Paxton
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Perinatal Transmission ◽  
Hiv Positive ◽  
Physical Assault ◽  
People Living With Hiv ◽  
Women's Lives ◽  
Living With Hiv ◽  
Voluntary Counselling And Testing ◽  
The Impact

With increased availability of antiretroviral therapy, there is an escalating global trend to test all pregnant women for HIV in order to stop perinatal transmission. However, insufficient consideration is given to the impact this may have on the lives of these women and their families. Many women feel pressured into HIV testing during pregnancy, do not receive adequate pre-test counselling or do not give truly informed consent. Some women who test positive experience significantly more discrimination from their partners, families and community members than HIV-positive men do. As a consequence, large numbers of women diagnosed during pregnancy do not tell their husband their status because they fear blame, abandonment or abuse, including physical assault. Women who do disclose their HIV status may face dramatic negative repercussions on their own and their children’s wellbeing. Consequently, it is unfair to test women during pregnancy solely or mainly to help prevent perinatal transmission if there are no available support services to protect the women’s rights, enable them to live healthily after an HIV-positive diagnosis and engage them in the policies and programmes that affect women’s lives. We need to create a climate that encourages HIV testing before pregnancy so that women can make informed reproductive choices. Men must be brought into the testing process through couple counselling before pregnancy and scaling up of voluntary counselling and testing programmes outside the antenatal care setting. In addition, people living with HIV have unique expertise and are very effective as peer counsellors. They have been under-utilised in the health care sector to provide support to newly-diagnosed people and to help eliminate AIDS-related shame and stigma.

scholarly journals Impact of the M184V/I Mutation on the Efficacy of Abacavir/Lamivudine/Dolutegravir Therapy in HIV Treatment-Experienced Patients

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Flaminia Olearo ◽  
Huyen Nguyen ◽  
Fabrice Bonnet ◽  
Sabine Yerly ◽  
Gilles Wandeler ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Antiviral Treatment ◽  
Composite Endpoint ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Prior History ◽  
History Of ◽  
The Impact ◽  
Hiv 1

Abstract Objective The impact of the M184V/I mutation on the virological failure (VF) rate in HIV-positive patients with suppressed viremia switching to an abacavir/lamivudine/dolutegravir regimen has been poorly evaluated. Method This is an observational study from 5 European HIV cohorts among treatment-experienced adults with ≤50 copies/mL of HIV-1 RNA who switched to abacavir/lamivudine/dolutegravir. Primary outcome was the time to first VF (2 consecutive HIV-1 RNA &gt;50 copies/mL or single HIV-1 RNA &gt;50 copies/mL accompanied by change in antiretroviral therapy [ART]). We also analyzed a composite outcome considering the presence of VF and/or virological blips. We report also the results of an inverse probability weighting analysis on a restricted population with a prior history of VF on any ART regimen to calculate statistics standardized to the disparate sampling population. Results We included 1626 patients (median follow-up, 288.5 days; interquartile range, 154–441). Patients with a genotypically documented M184V/I mutation (n = 137) had a lower CD4 nadir and a longer history of antiviral treatment. The incidence of VF was 29.8 cases (11.2–79.4) per 1000 person-years in those with a previously documented M184V/I, and 13.6 cases (8.4–21.8) in patients without documented M184V/I. Propensity score weighting in a restricted population (n = 580) showed that M184V/I was not associated with VF or the composite endpoint (hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.35–4.59 and HR 1.66; 95% CI, 0.81–3.43, respectively). Conclusions In ART-experienced patients switching to an abacavir/lamivudine/dolutegravir treatment, we observed few VFs and found no evidence for an impact of previously-acquired M184V/I mutation on this outcome. Additional analyses are required to demonstrate whether these findings will remain robust during a longer follow-up.

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