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

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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Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

Clinical Infectious Diseases ◽

10.1093/cid/ciz1178 ◽

2019 ◽

Vol 71 (8) ◽

pp. e308-e315

Author(s):

McKaylee M Robertson ◽

Sarah L Braunstein ◽

Donald R Hoover ◽

Sheng Li ◽

Denis Nash

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Testing ◽

Mixed Model ◽

Linear Mixed Model ◽

Population Based ◽

Cd4 Count ◽

Hiv Diagnosis ◽

Art Initiation ◽

Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

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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: a nested case control study

Wellcome Open Research ◽

10.12688/wellcomeopenres.17044.1 ◽

2021 ◽

Vol 6 ◽

pp. 264

Author(s):

Christine Kelly ◽

Rijan Gurung ◽

Raphael Kamng'ona ◽

Irene Sheha ◽

Mishek Chammudzi ◽

...

Keyword(s):

Arterial Stiffness ◽

Immune Suppression ◽

Endothelial Damage ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Art Initiation ◽

Immunodeficiency Virus ◽

Circulating Microparticles ◽

Living With Hiv ◽

Nested Case Control

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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Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195045 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4716

Author(s):

Rogers A. Awoh ◽

Halle G. Ekane ◽

Anastase Dzudie ◽

Egbe O. Thomas ◽

Adebola Adedimeji ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Retrospective Chart Review ◽

Hiv Care ◽

Retention Data ◽

Hiv Diagnosis ◽

Chi Square ◽

Test And Treat ◽

Art Initiation ◽

Hiv Test ◽

Immunodeficiency Virus

Background: Success of the human immunodeficiency virus (HIV) test-and-treat (T&T) strategy requires high antiretroviral (ART) uptake and retention. However, low ART uptake and retention continue to be reported in ART programs. This study assessed ART uptake and retention outcomes of the HIV T&T strategy in three HIV clinics in Cameroon.Methods: A retrospective chart review was done for 423 patients who initiated HIV care within a period of three months prior to the implementation of the HIV T&T strategy, and for another 423 patients who initiated HIV care within a three-month period following the HIV T&T strategy implementation. For each group, sociodemographic, ART uptake and retention data were collected. Chi square and Student T tests were used to test for differences proportions and means between the two groups at p <0.05 and 95% confidence interval.Results: The mean ages (years) in the pre-T&T and the T&T groups were 39.73 and 39.72, and the proportion of female were 65.85% and 65.08% respectively. ART uptake proportion was higher amongst those enrolled under the T&T strategy (98.08% vs 95.39%, p=0.02). A greater proportion of the patients in the T&T group initiated ART within 2 weeks following HIV diagnosis (55.84% vs 48.17%, p=0.03). However, ART retention at 24th month was lower in the T&T group (78.83% vs. 85.79%, p=0.01).Conclusions: The findings suggest that the T&T strategy is associated with higher ART uptake, earlier ART initiation, and lower ART retention. This underscores a need for strategies to improve ART retention under the HIV T&T guidelines.

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The Role of Human Immunodeficiency Virus (HIV) Asymptomatic Status When Starting Antiretroviral Therapy on Adherence and Treatment Outcomes and Implications for Test and Treat: The Swiss HIV Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa239 ◽

2020 ◽

Author(s):

Tracy R Glass ◽

Huldrych F Günthard ◽

Alexandra Calmy ◽

Enos Bernasconi ◽

Alexandra U Scherrer ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cohort Study ◽

Viral Load ◽

Antiretroviral Therapy ◽

Clinical Outcomes ◽

Unprotected Sex ◽

Test And Treat ◽

Universal Test And Treat ◽

Immunodeficiency Virus ◽

The Impact

Abstract Background Since the advent of universal test-and-treat , more people living with human immunodeficiency virus (PLHIV) initiating antiretroviral therapy (ART) are asymptomatic with a preserved immune system. We explored the impact of asymptomatic status on adherence and clinical outcomes. Methods PLHIV registered in the Swiss HIV Cohort Study (SHCS) between 2003 and 2018 were included. We defined asymptomatic as Centers for Disease Control and Prevention stage A within 30 days of starting ART, non-adherence as any self-reported missed doses and viral failure as two consecutive viral load>50 copies/mL after >24 weeks on ART. Using logistic regression models, we measured variables associated with asymptomatic status and adherence and Cox proportional hazard models to assess association between symptom status and viral failure. Results Of 7131 PLHIV, 76% started ART when asymptomatic and 1478 (22%) experienced viral failure after a median of 1.9 years (interquartile range, 1.1–4.2). In multivariable models, asymptomatic PLHIV were more likely to be younger, men who have sex with men, better educated, have unprotected sex, have a HIV-positive partner, have a lower viral load, and have started ART more recently. Asymptomatic status was not associated with nonadherence (odds ratio, 1.03 [95% confidence interval {CI}, .93–1.15]). Asymptomatic PLHIV were at a decreased risk of viral failure (adjusted hazard ratio, 0.87 [95% CI, .76–1.00]) and less likely to develop resistance (14% vs 27%, P < .001) than symptomatic PLHIV. Conclusions Despite concerns regarding lack of readiness, our study found no evidence of adherence issues or worse clinical outcomes in asymptomatic PLHIV starting ART.

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Multimorbidity in Elderly Persons According to the Year of Diagnosis of Human Immunodeficiency Virus Infection: A Cross-sectional Dat’AIDS Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz1171 ◽

2019 ◽

Vol 71 (11) ◽

pp. 2880-2888 ◽

Cited By ~ 1

Author(s):

Marie Demontès ◽

Sabrina Eymard Duvernay ◽

Clotilde Allavena ◽

Thomas Jovelin ◽

Jacques Reynes ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Smoking Status ◽

Secondary Analysis ◽

Cd4 Count ◽

Sensitivity Analyses ◽

People Living With Hiv ◽

Elderly Persons ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Immunodeficiency Virus

Abstract Background We assessed prevalence of multimorbidity (MM) according to year of human immunodeficiency virus (HIV) diagnosis in elderly people living with HIV (PLWH). Methods This was a cross-sectional study of MM in PLWH aged ≥70 years from the Dat’AIDS French multicenter cohort. MM was defined as at least 3 coexistent morbidities of high blood pressure, diabetes mellitus, osteoporosis, non-AIDS cancer, chronic renal failure, cardiovascular and cerebrovascular disease, obesity, undernutrition, or hypercholesterolemia. Logistic regression models evaluated the association between MM and calendar periods of HIV diagnosis (1983–1996, 1997–2006, and 2007–2018). The secondary analysis evaluated MM as a continuous outcome, and a sensitivity analysis excluded PLWH with nadir CD4 count <200 cells/μL. Results Between January 2017 and September 2018, 2476 PLWH were included. Median age was 73 years, 75% were men, median CD4 count was 578 cells/μL, and 94% had controlled viremia. MM prevalence was 71%. HBP and hypercholesterolemia were the most prevalent comorbidities. After adjustment for age, gender, smoking status, hepatitis C and hepatitis B virus coinfection, group of exposure, nadir CD4 count, CD4:CD8 ratio, and last CD4 level, calendar period of diagnosis was not associated with MM (P = .169). MM was associated with older age, CD4/CD8 ratio <0.8, and nadir CD4 count <200 cells/μL. Similar results were found with secondary and sensitivity analyses. Conclusions MM prevalence was high and increased with age, low CD4/CD8 ratio, and nadir CD4 count <200 cells/μL but was not associated with calendar periods of HIV diagnosis. Known duration of HIV diagnosis does not seem to be a criterion for selecting elderly PLWH at risk of MM.

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Timeliness of Human Immunodeficiency Virus Diagnosis and Antiretroviral Treatment Initiation in the Era of Universal Testing and Treatment

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz148 ◽

2019 ◽

Vol 220 (4) ◽

pp. 648-656 ◽

Cited By ~ 3

Author(s):

McKaylee M Robertson ◽

Sarah L Braunstein ◽

Donald R Hoover ◽

Sheng Li ◽

Denis Nash

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Antiretroviral Treatment ◽

Proportional Hazards ◽

Treatment Initiation ◽

Hiv Diagnosis ◽

Acute Hiv Infection ◽

Art Initiation ◽

Universal Testing ◽

Immunodeficiency Virus

Abstract Background We describe the timing of human immunodeficiency virus (HIV) diagnosis and antiretroviral treatment (ART) initiation after implementation of universal testing and treatment policies in New York City (NYC). Methods Using NYC population-based HIV registry data for persons with HIV diagnosed from 2012 through 2015 and followed up through June 2017, we examined trends in the proportion with diagnosis soon after HIV infection (ie, with CD4 cell count ≥500/μL or with acute HIV infection) and used Kaplan-Meier plots and proportional hazards regression to examine the timing of ART initiation after diagnosis. Results Among 9987 NYC residents with HIV diagnosed from 2012 to 2015, diagnosis was early in 35%, and 87% started ART by June 2017. The annual proportion of persons with early diagnosis did not increase appreciably (35% in 2012 vs 37% in 2015; P = .08). By 6 months after diagnosis, 62%, 67%, 72% and 77% of persons with HIV diagnosed in 2012, 2013, 2014, or 2015, respectively, had started ART, with median (interquartile range) times to ART initiation of 3.34 (1.34–12.75), 2.62 (1.28–10.13), 2.16 (1.15–7.11), and 2.03 (1.11–5.61) months, respectively. Conclusions Although recommendations for ART initiation on diagnosis are increasingly being implemented, the findings of the current study suggest that immediate treatment initiation is not universal. Continued efforts are needed to expand and better target HIV testing to promote earlier diagnosis.

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Time to viral load suppression and its associated factors in cohort of patients taking antiretroviral treatment in East Shewa zone, Oromiya, Ethiopia, 2018

BMC Infectious Diseases ◽

10.1186/s12879-019-4702-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jemal Hassen Ali ◽

Tewodros Getinet Yirtaw

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Marital Status ◽

Associated Factors ◽

Plasma Viral Load ◽

Antiretroviral Treatment ◽

Baseline Viral Load ◽

People Living With Hiv ◽

Age Group ◽

Immunodeficiency Virus

Abstract Background A key goal of Antiretroviral Treatment (ART) is to achieve and maintain durable viral suppression. Thus, the most important use of viral load measurement is to monitor the effectiveness of therapy after initiation of ART. The main objective of the study was to determine the time for virological suppression and its associated factors among people living with HIV taking antiretroviral treatments in East Shewa Zone, Oromiya, Ethiopia. Methods Patients diagnosed with Human Immunodeficiency Virus presenting to the study health centers between October 3, 2011 and March 1, 2013 were included in the study given the following criteria: age 18 years or greater, eligible to start ART. All patients with baseline viral load measurements were included in the study. Interaction between explanatory variables with the response variable was analyzed by using cross tab features of (Statistical Package for the Social Sciences) SPSS, International Business Machines (IBM) Inc. Significance group comparison was done by Kaplan Meier log-rank test. Cox proportional hazard model was used to select significant factors to the variability between groups. Result Plasma viral load was suppressed below the detection level in 72% of individuals taking a different regimen of ART. The median Human Immunodeficiency virus (HIV)-1 plasma viral load in the cohort was estimated to be log 5.3111 copies/ml. The study observed Survival curve difference in the category of marital status (p-value 0.023) and baseline cluster of differentiation 4 (CD4) value (p-value 0.023). The estimated median time to Plasma Viral Load (PVL) suppression was 181 days (CI: 140.5–221.4) with the age group of 30–39 years having minimum time to achieve suppression with 92 days (CI: 60.1–123.8) and the maximum time required to reach the level was found among the age group between 50 and 59 years. Conclusion The study found that the estimated time to achieve PVL after taking ART to be 181 days. Factors affecting time to suppression level were marital status and baseline CD4.

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Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.3614.3365 ◽

2020 ◽

Vol 28 ◽

Author(s):

Wendel Mombaque dos Santos ◽

Marcelo Ribeiro Primeira ◽

Larissa Garcia de Paiva ◽

Stela Maris de Mello Padoin

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Standard Treatment ◽

Intervention Group ◽

Text Messages ◽

Alternative Strategy ◽

Control Group ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Medical Consultations

Objective: to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus. Method: a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone. Results: 156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs. Conclusion: weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.

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Concentrations of Circulating β-Chemokines Do Not Correlate with Viral Load in Human Immunodeficiency Virus-Infected Individuals

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.5.4.499-502.1998 ◽

1998 ◽

Vol 5 (4) ◽

pp. 499-502 ◽

Cited By ~ 8

Author(s):

Vellalore N. Kakkanaiah ◽

Emmanuel A. Ojo-Amaize ◽

James B. Peter

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Patient Group ◽

Negative Control ◽

Control Group ◽

Hiv Viral Load ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Hiv 1

ABSTRACT The CC or β-chemokines MIP-1α, MIP-1β, and RANTES are the primary components of human immunodeficiency virus type 1 (HIV-1)-suppressive soluble factors in vitro. We studied the relationship between the concentrations of MIP-1α, MIP-1β, and RANTES in plasma and HIV viral load in HIV-infected subjects. The HIV-positive patient group (n = 140) had significantly lower concentrations of all three β-chemokines (MIP-1α,P < 0.0005; MIP-1β, P < 0.005; RANTES, P < 0.0005) than the control group (n = 58 for MIP-1α, n = 27 for MIP-1β, and n = 59 for RANTES). In addition, we divided the patient group into three subgroups (high, moderate, and low) based on the number of HIV-1 RNA copies in the plasma (as measured by quantitative HIV RNA PCR). Again, all three subgroups had significantly lower concentrations of the β-chemokines than the HIV-negative control group. However, there was no significant difference in plasma β-chemokine concentrations among the three subgroups within the patient group (P < 0.3). Although our results demonstrate that HIV-infected individuals had significantly lower concentrations of circulating β-chemokines than healthy uninfected control subjects, we found no correlation between the concentrations of β-chemokines in plasma and HIV-1 viral load in HIV-infected individuals.

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Decreased Time From Human Immunodeficiency Virus Diagnosis to Care, Antiretroviral Therapy Initiation, and Virologic Suppression during the Citywide RAPID Initiative in San Francisco

Clinical Infectious Diseases ◽

10.1093/cid/ciaa620 ◽

2020 ◽

Cited By ~ 2

Author(s):

Oliver Bacon ◽

Jennie Chin ◽

Stephanie E Cohen ◽

Nancy A Hessol ◽

Darpun Sachdev ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

San Francisco ◽

Virologic Suppression ◽

Hiv Diagnosis ◽

Virus Diagnosis ◽

Hiv Surveillance ◽

Art Initiation ◽

Care Visit ◽

Immunodeficiency Virus

Abstract Background Early virologic suppression (VS) after human immunodeficiency virus (HIV) infection improves individual health outcomes and decreases onward transmission. In San Francisco, immediate antiretroviral therapy (ART) at HIV diagnosis was piloted in 2013–2014 and expanded citywide in 2015 in a rapid start initiative to link all new diagnoses to care within 5 days and start ART at the first care visit. Methods HIV providers and linkage navigators were trained on a rapid start protocol with sites caring for vulnerable populations prioritized. Dates of HIV diagnosis, first care visit, ART initiation, and VS were abstracted from the San Francisco Department of Public Health HIV surveillance registry. Results During 2013–2017, among 1354 new HIV diagnoses in San Francisco, median days from diagnosis to first VS decreased from 145 to 76 (48%; P < .0001) and from first care visit to ART initiation decreased from 28 to 1 (96%; P < .0001). By 2017, 28% of new diagnoses had a rapid start, which was independently associated with Latinx ethnicity (AOR, 1.73; 95% CI, 1.15–2.60) and recent year of diagnosis (2017; AOR, 16.84; 95% CI, 8.03–35.33). Persons with a rapid ART start were more likely to be virologically suppressed within 12 months of diagnosis than those with a non-rapid start (RR, 1.17; 95% CI, 1.10–1.24). Conclusions During a multisector initiative to optimize ART initiation, median time from diagnosis to VS decreased by nearly half. Immediate ART at care initiation was achieved across many, but not all, populations, and was associated with improved suppression rates.

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