Racial Adjustment Adversely Affects Glomerular Filtration Estimates in African Americans Living with HIV

2021 ◽  
pp. ASN.2021030311
Author(s):  
Mohamed Atta ◽  
Katie Zook ◽  
Todd Brown ◽  
Dhananjay Vaidya ◽  
Xueting Tao ◽  
...  
Keyword(s):  
Glomerular Filtration ◽  
Cystatin C ◽  
Lean Mass ◽  
Mixed Models ◽  
Estimation Accuracy ◽  
Hiv Positive ◽  
Hiv Status ◽  
Estimate Glomerular Filtration Rate ◽  
Living With Hiv ◽  
Hiv Negative

Background The creatinine-based CKD EPI equation is the most widely used method to estimate glomerular filtration rate (eGFRcr) in clinical practice. Here, we focus on African American (AA) participants to determine whether the race eGFRcr calibration factor contributes to poor accuracy and bias in AAs living with HIV. Methods Annually, we measured GFR by iohexol disappearance from plasma (iGFR) and serum concentrations of creatinine and cystatin C. We calculated eGFRcr and the creatinine-cystatin C combination equation (eGFRcr-cys) with and without race adjustment. We used multilevel mixed models to account for the within-visit linked structure of the multiple GFR measures, further nested within repeated observations for individuals. We examined the association between lean mass, HIV status, and eGFRcr bias in a subset with body composition measures. Results 207 HIV-positive and 107 HIV-negative AA participants contributed 781 and 376 study visits, respectively, with valid measures of iGFR, creatinine, and cystatin C. Among PLWH, omitting the race adjustment (compared with retaining it) changed average eGFRcr bias from 9.1 to -3.9 ml/min/1.73 m2. Moreover, estimation accuracy improved significantly when race adjustment was omitted rather than retained: 86% vs. 78% for eGFRcr (P<0.001) and 91% vs. 88% for eGFRcr-cys (P=0.045). Lean mass was correlated with eGFRcr bias and, in adjusted analyses, lean mass was significantly lower in PLWH compared with HIV-negative AAs compatible with not using the race coefficient. Conclusions We found that the standard, widely used eGFRcr equation overestimate iGFR and has poor accuracy in AAs living with HIV.

scholarly journals Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

2020 ◽  
Author(s):  
Tafadzwa G Dhokotera ◽  
Julia Bohlius ◽  
Matthias Egger ◽  
Adrian Spoerri ◽  
Jabulani Ncayiyana ◽  
...  
Keyword(s):  
South Africa ◽  
Cervical Cancer ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Sectional Study ◽  
Hiv Status ◽  
Cross Sectional ◽  
Cancer Data ◽  
Living With Hiv ◽  
Hiv Negative

Objective: To determine the spectrum of cancers in AYAs living with HIV in South Africa compared to their HIV negative peers. Design: Cross sectional study with cancer data provided by the National Cancer Registry and HIV data from the National Health Laboratory Service. Setting and participants: The NHLS is the largest provider of pathology services in the South African public sector with an estimated coverage of 80%. The NCR is a division of the NHLS. We included AYAs (aged 10-24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8 479). We included 3 672 in the complete case analysis. Primary and secondary outcomes: We used linked NCR and NHLS data to determine the spectrum of cancers by HIV status in AYAs. We also used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex (as appropriate), ethnicity, and calendar period. Due to the large proportion of unknown HIV status we also imputed (post-hoc) the missing HIV status. Results: From 2004-2014, 8 479 AYAs were diagnosed with cancer, HIV status was known for only 45% (n=3812); of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi's sarcoma (adjusted odds ratio (aOR) 218, 95% CI 89.9-530), cervical cancer (aOR 2.18, 95% CI 1.23-3.89), non-Hodgkin's lymphoma (aOR 2.12, 95% CI 1.69-2.66), and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27-5.86). About 44% (n=1 062) of AYAs with HIV related cancers had not been tested for HIV, though they were very likely to have the disease. Conclusions: Cancer burden in AYAs living with HIV in South Africa could be reduced by screening young women for cervical cancer and vaccinating them against human papilloma virus (HPV) infection.

DOES KNOWLEDGE ABOUT ANTIRETROVIRAL THERAPY AND MOTHER-TO-CHILD TRANSMISSION AFFECT THE RELATIONSHIPS BETWEEN HIV STATUS AND FERTILITY PREFERENCES AND CONTRACEPTIVE USE? NEW EVIDENCE FROM NIGERIA AND ZAMBIA

2013 ◽  
Vol 46 (5) ◽  
pp. 580-599 ◽  
Author(s):  
AKINRINOLA BANKOLE ◽  
ANN E. BIDDLECOM ◽  
KUMBUTSO DZEKEDZEKE ◽  
JOSHUA O. AKINYEMI ◽  
OLUTOSIN AWOLUDE ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Contraceptive Use ◽  
Hiv Positive ◽  
Hiv Status ◽  
Child Transmission ◽  
Hiv Positive Women ◽  
Childbearing Desires ◽  
Living With Hiv ◽  
Mother To Child ◽  
Hiv Negative

SummaryThe increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009–2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

scholarly journals 658. Effect of HIV Status on Tuberculosis Load as Detected by Xpert MTB/RIF in Sputum vs. Saliva Samples

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S385-S386
Author(s):  
Zoe C Burger ◽  
Si Thu Aung ◽  
Hlaing Thazin Aung ◽  
Timothy Rodwell ◽  
Marva Seifert
Keyword(s):  
Bacterial Load ◽  
Molecular Diagnostic ◽  
Clinical Samples ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Sample Type ◽  
Hiv Status ◽  
Specimen Type ◽  
Living With Hiv ◽  
Hiv Negative

Abstract Background Tuberculosis (TB) is the most common co-infection among people living with HIV, but HIV positivity is associated with a lower Mycobacterium tuberculosis (MTB) bacillary load in sputum, making TB often difficult to diagnose with current diagnostic solutions. GeneXpert MTB/RIF (Cepheid, USA), a rapid, molecular diagnostic assay, has transformed the TB diagnostic landscape and can be used to diagnose TB and limited drug resistance in HIV patients from direct clinical samples in &lt; 2 hours, but results can be significantly affected by sample bacterial load, which is quantified by the GeneXpert MTB/RIF (Xpert) instrument using Ct values. Our primary objective was to assess how a patient’s HIV status affected their MTB bacterial load in sputum vs. saliva samples submitted for Xpert diagnosis of TB. Methods We completed a retrospective analysis of &gt;4,000 patient records from the Myanmar National TB Program captured as part of a nation-wide electronic reporting system developed with the assistance of FIND (Geneva). De-identified records included HIV status, Xpert testing results, and for a subset of patients, specimen type. With this diagnostic information, we compared the distribution of MTB load (quantified by Xpert Ct values) in sputum and saliva in HIV positive vs. HIV negative patients using STATA. Results Based on mean Ct value comparison independent of HIV status, saliva samples (mean Ct = 22.7) contained a significantly lower bacterial load of MTB as compared to sputum samples (mean Ct=19.2, p &lt; .001).Within saliva samples, a lower bacterial load was also detected in HIV positive patients (mean Ct = 26.9) compared to HIV negative patients (mean Ct = 22.3, p&lt; .05). Similarly, in sputum samples, a lower bacterial load was detected in HIV positive patients (mean Ct = 21.6) compared to HIV negative patients (mean Ct = 19.0, p &lt; .001) (Figure 1). Figure 1. Ct Values by HIV Status and Specimen Type Conclusion Sputum samples have a significantly higher bacterial load on average compared to saliva samples independent of HIV status. Additionally, when looking at both saliva and sputum as sample types, HIV positive patients have significantly lower bacterial load than individuals who are HIV negative. Based on these results, sputum is the optimal sample type for Xpert TB detection, especially in people living with HIV. Disclosures All Authors: No reported disclosures

scholarly journals Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

2016 ◽  
Vol 16 (3) ◽  
pp. 239-246 ◽  
Author(s):  
V. Logan Kennedy ◽  
Micaela Collins ◽  
Mark H. Yudin ◽  
Lena Serghides ◽  
Sharon Walmsley ◽  
...  
Keyword(s):  
Logit Model ◽  
Hiv Transmission ◽  
Horizontal Transmission ◽  
People Living With Hiv ◽  
Relative Importance ◽  
Hiv Status ◽  
Ordered Logit Model ◽  
Living With Hiv ◽  
Shed Light ◽  
Hiv Negative

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study’s aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

Evaluation of microalbumin, cystatin c, creatinine and uric acid levels in HIV patients in Nnamdi Azikiwe University Teaching Hospital, Nnewi

2021 ◽  
Vol 8 (3) ◽  
pp. 132-142
Author(s):  
Ezeugwunne Ifeoma Priscilla ◽  
Amaifeobu Clement ◽  
Meludu Samuel Chukwuemeka ◽  
Analike Rosemary Adamma ◽  
Nnamdi Johnjude Chinonso ◽  
...  
Keyword(s):  
Uric Acid ◽  
Cystatin C ◽  
Teaching Hospital ◽  
University Teaching ◽  
Hiv Positive ◽  
Hiv Patients ◽  
Voluntary Counseling And Testing ◽  
Group B ◽  
And Control ◽  
Hiv Negative

This study evaluated the microalbumin, cystatin C, creatinine and uric acid levels in HIV patients in Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH). A total of one hundred (100) male and female HIV positive and control participants who were aged between 18 and 60 years attending the voluntary counseling and testing unit (VCT) and antiretroviral therapy unit (ART) of NAUTH were randomly recruited for the study and grouped thus: Group A (HIV positive symptomatic participants on long term ART (HPSPLTART) (n= 25); Group B (HIV positive symptomatic participants on short term ART (HPSPSTART) (n= 25); Group C: Asymptomatic HIV positive participants NOT on ART (AHPPNART) (n=25) and Group D: control (n=25).6mls of blood sample and 10mls of freshly voided urine samples were collected from each of the participants for the evaluation of biochemical parameters using standard laboratory methods. Results showed significantly higher BMI and SBP in HPSPSTART than in control (p=0.04; 0.02). SBP was significantly higher in HPSPLTART than in AHPPNART and Control (p=0.00). DBP was significantly higher in HPSPLTART than in HPSPSTART and control respectively (p=0.00). There were significantly higher plasma creatinine and Cys-C levels in both male HIV positives and male HIV positive participants on ART than in both females respectively (p0.00; 0.02). Also, BMI, creatinine, uric acid and Cystatin C levels were significantly higher in male HIV negative participants than in female HIV negative participants (p=0.00; 0.04; 0.02; 0.01). This study has revealed greater risk for renal disease among the HIV participants studied.

scholarly journals Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e043941
Author(s):  
Tafadzwa Dhokotera ◽  
Julia Bohlius ◽  
Matthias Egger ◽  
Adrian Spoerri ◽  
Jabulani Ronnie Ncayiyana ◽  
...  
Keyword(s):  
South Africa ◽  
Young Adults ◽  
Cross Sectional Study ◽  
Adolescents And Young Adults ◽  
Hiv Positive ◽  
Sectional Study ◽  
Hiv Status ◽  
Cross Sectional ◽  
Laboratory Service ◽  
Living With Hiv

ObjectiveTo determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa.DesignCross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS).Setting and participantsThe NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10–24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining.Primary and secondary outcomesWe determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status.Results8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV.ConclusionsTargeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.

scholarly journals THE THORNY ISSUE OF STATUS DISCLOSURE TO CHILDREN LIVING WITH HIV: THE CASE OF HIV POSITIVE CHILDREN LIVING IN A CHILD AND YOUTH CARE FACILITY IN JOHANNESBURG, SOUTH AFRICA

2016 ◽  
Vol 28 (1) ◽  
pp. 53-68
Author(s):  
Nkosiyazi Dube ◽  
Linda Harms Smith
Keyword(s):  
South Africa ◽  
Social Service ◽  
Youth Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Service Workers ◽  
Child And Youth Care ◽  
Living With Hiv ◽  
Status Disclosure ◽  
Hiv Aids

There is a dilemma regarding HIV/AIDS disclosure to children born and living with HIV/AIDS in residential settings. Since the advent and accessibility of Anti-Retroviral Therapy, most children born HIV positive live longer and have healthier lives. Some of these children find themselves in Need of Care due to abandonment, orphanhood and neglect or abuse, and are placed in alternative care such as a Child and Youth Care Centre (CYCC). Social Service Workers are then faced with this dilemma around disclosure of their HIV status, due to the complexities around the consequences of such a disclosure, and the absence of clear policies in this regard. The study explored the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living in a CYCC in Ekurhuleni, South Africa. The findings indicate that HIV status disclosure is a complex but essential process as it reinforces children’s ability to adhere to medication and dispels anxiety and suspicion within themselves around their status. Recommendations relate to community education and awareness programmes, policy and practice changes and makes suggestions for future research.

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 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. 

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