scholarly journals Clinical Outcomes and Retention Among HIV-Infected Adolescents and Adults Initiated on Protease Inhibitors Antiretroviral Therapy Regimen in Dar ES Salaam; A Longitudinal Retrospective Descriptive Study

2021 ◽  
Author(s):  
Joan Rugemalila ◽  
Adellah Sariah ◽  
Samuel Mwaikambo ◽  
David Sando ◽  
Samuel Kalluvya
Keyword(s):  
Cell Count ◽  
Clinical Outcomes ◽  
Viral Suppression ◽  
Male Gender ◽  
P Value ◽  
Second Line ◽  
Cd4 Cell Count ◽  
Younger Age ◽  
Adolescents And Adults ◽  
Cd4 Cell

Abstract Background: Globally antiretroviral therapy access has increased and significantly changed HIV morbidity and mortality patterns. In sub-Saharan Africa there are reports of increasing rates of failure to second-line antiretroviral treatment (ART) hence, assessment for clinical outcomes is critical. Objectives: To assess clinical outcomes and retention using programmatic indicators among HIV-infected adolescents and adults receiving second-line ART in Tanzania. Methods: In this longitudinal retrospective cohort study, we enrolled HIV-infected individuals aged 15 years and above who were initiated on second-line ART (Protease Inhibitor based regimen) due to documented failure of first-line ART between July 2012 and September 2015. We evaluated mean change in CD4 cell count, HIV viral load and retention using survival analysis. Results : A total of 1446 participants were enrolled, the mean duration of second-line therapy was 37.0 months± SD 26.50 and the median CD4 cell count at initiation of the second line was 290 cells/mm3. Virologic suppression <50 copies/ml was increasing over time and reached 58% at 36 months. Six months after switching, 80% of patients were retained and thereafter. Predictors of retention were male gender with hazard ratio (HR) 1.04; 95% CI 1.0-1.1 P-value 0.037 and younger age (25 -39 years) with HR 1.1; 95% CI 1.0-1.2 P-value 0.006. Additionally, adherence > 90% increased the likelihood of retention with a strong correlation HR 1.4; 95% CI 1.1-1.7 P-value 0.00. Clinical stage III and IV at switch were less likely to be retained HR 0.6; 95% CI 0.5-0.6 P-value 0.000 and higher CD4 cell count was associated with less retention HR <1; 95 % CI 0.4-0.6 P-value 0.000. Conclusion: There was a low rate of viral suppression (<50copies/ml) 58% 36 months after switch however, more than 87% of participants were retained to care after switch. Predictors of retention were male gender, younger age (25-39 years) and adherence > 90%. Therefore, improving viral suppression after switching to second-line requires further interventions.

scholarly journals Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 283-290
Author(s):  
A. Amoko ◽  
P.O. Ajiboye ◽  
F.A. Olagunju ◽  
R.O. Shittu
Keyword(s):  
Family Medicine ◽  
Cell Count ◽  
Teaching Hospital ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Prevalence Of Depression ◽  
Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with  cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

scholarly journals On the assessment of trend in CD4+ cell count and viral suppression after transition to adult care

AIDS ◽  
2019 ◽  
Vol 33 (9) ◽  
pp. 1536-1537 ◽  
Author(s):  
Cassandra Oliver ◽  
Peter F. Rebeiro ◽  
April C. Pettit
Keyword(s):  
Cell Count ◽  
Viral Suppression ◽  
Transition To Adult Care ◽  
Adult Care ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Immunologic Benefits of Enfuvirtide in Patients Enrolled in a Drug Assistance Program

2008 ◽  
Vol 42 (5) ◽  
pp. 621-626 ◽  
Author(s):  
Parya Saberi ◽  
Nikolai H Caswell ◽  
Cristina I Gruta ◽  
Jason N Tokumoto ◽  
Betty J Dong
Keyword(s):  
Cell Count ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Cell Counts ◽  
Background Regimen ◽  
Cd4 Cell Counts ◽  
Cd4 Cell ◽  
Cell Count Increase

Background: Randomized clinical trials have demonstrated that enfuvirtide plus an optimized background regimen can cause a significant increase in CD4+ cell counts and a reduction in HIV RNA levels. Objective: To describe and anaiyze CD4+ cell count and HIV RNA changes in HIV-infected patients receiving enfuvirtide and a prescribed background regimen (PBR) in a primarily clinical setting. Methods: A retrospective review from September 1998 through August 2005 of CD4+ cell counts and HIV RNA changes from baseline was conducted in patients receiving enfuvirtide. Data were stratified and analyzed according to baseline CD4+ cell count and HIV RNA. Results: A mean CD4+ cell count increase of approximately 102 cells/mm3 was observed, regardless of baseline CD4+ cell count, in 187 patients receiving enfuvirtide during a mean of 19.4 months of follow-up. During 3 years of follow-up, patients initiating enfuvirtide at CD4+ cell counts less than 100 cells/mm3 never achieved absolute CD4+ cell counts comparable to the counts in patients starting enfuvirtide at CD4+ cell counts of 100 cells/mm3 or more. In 38.3% of patients achieving an undetectable HIV RNA level, a mean CD4+ cell count increase of 185 cells/mm3 was observed. An unexpected finding was that a mean CD4+ cell count increase of 76 cells/mm3 occurred in 61.7% of patients not achieving complete viral suppression. Conclusions: Immunologic benefits were observed in subjects continuing enfuvirtide plus a PBR irrespective of baseline CD4+ cell count, complete viral suppression, or antiretroviral susceptibility data. Dala suggest that initiation of enfuvirtide at CD4+ cell counts greater than 100 celis/mm3 may be immunologically advantageous and independent of complete virologic response.

Endothelial Microparticles (EMP) and Their Interactions with Leukocytes in HIV Infected Patients with Optimal Response to Highly Active Antiretroviral Therapy (HAART).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1255-1255
Author(s):  
Jacques Simkins ◽  
Vicente F. Corrales-Medina ◽  
Julio A. Chirinos ◽  
Stephen Symes ◽  
Dushyantha T. Jayaweera ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Pcr Analysis ◽  
P Value ◽  
Hiv Patients ◽  
Endothelial Microparticles ◽  
Cd4 Cell Count ◽  
Optimal Response ◽  
Viral Spread ◽  
Cd4 Cell

Abstract Background: HIV infection has been associated with endothelial dysfunction. Endothelial microparticles (EMP) are informative markers of endothelial cell status and can exert transcellular effects in leukocytes. No previous studies have assessed EMP and their interactions with leukocytes in HIV-infected patients. Methods: We studied 29 patients (mean age = 42.1±7 years) with HIV infection on HAART who demonstrated an optimal viral and immunological response (CD4+ cell count&gt;200 /mm3 and &lt; 50 viral copies/ml by PCR analysis). Patients with diabetes, smoking, thrombotic, cardiovascular or malignant disease were excluded. We used age- and gender-matched healthy controls. Using flow cytometry, we measured free EMP identified by: Expression of CD31 and lack of expression of CD42b (EMP31); E-selectin expression (EMP62E); CD51 expression (EMP51), or; CD54 expression (EMP54). EMP62E- and EMP54-leukocyte conjugates were measured based on the detection of E-selectin or CD54, respectively, coexpressed with CD45 in neutrophils, monocytes and lymphocytes. Results: Results are summarized in Table 1. Levels of free EMP31, EMP51, EMP54 and EMP62E did not differ significantly between the groups. However, a very significant elevation of EMP54-Lymphocyte Conjugates (p=0.001) and a trend towards an elevation of EMP62E-Lymphocyte Conjugates was seen in HIV-infected patients. Furthermore, EMP63E-lymphocyte conjugates significantly correlated with the CD4+ cell count (R=-0.64; p=0.03). Conversely, HIV-infected patients demonstrated significantly lower levels of EMP62E -Monocyte Conjugates (p=0.0005) and a trend toward lower levels of EMP54 -Monocyte Conjugates (p=0.08). Conclusions: HIV infected patients with optimal response to HAART demonstrate an increased number of circulating EMP-lymphocyte conjugates with decreased number of EMP-monocyte conjugates. We speculate that viral EMP-receptor upregulation in lymphocytes and/or downregulation in monocytes could account for this phenomenon. EMP-lymphocyte conjugates inversely correlate with the CD4 count. The role of increased EMP-lymphocyte interactions in viral spread and lymphocyte dysfunction/apoptosis in HIV infected-patients requires further investigation. Levels of endothelial microparticles (EMPs) and EMP-leukocyte conjugates in HIV+ patients compared to controls. HIV+ Patients Control P value MFI=Mean fluorescence intensity EMP31, counts/μL (IQR) 680 (497–1112) 1018 (566-1691) 0.16 EMP51, counts/μL (IQR) 114 (75–141.5) 114 (96–143) 0.59 EMP62E, counts/μL (IQR) 72 (53.5–123.5) 77 (48–113) 0.66 EMP54, counts/μL (IQR) 58 (39.5–78.5) 39 (18–141) 0.42 EMP54-Lymphocyte Conjugates, MFI (IQR) 1.37 (1.26–1.42) 1.2 (1.13–1.26) 0.001 EMP54-Monocyte Conjugates, MFI (IQR) 1.14 (1.05–1.3) 1.22 (1.16–1.64) 0.08 EMP54-Neutrophil Conjugates, MFI (IQR) 1.46 (1.27–2.28) 1.66 (1.28–2.34) 0.74 EMP62E-Lymphocyte Conjugates, MFI (IQR) 1.15 (1.11–1.19) 1.13 (1.07–1.18) 0.13 EMP62E -Monocyte Conjugates, MFI (IQR) 1.17 (1.02–1.19) 1.31 (1.22–1.56) 0.0005 EMP62E -Neutrophil Conjugates, MFI (IQR) 1.47 (1.21–2.01) 1.94 (1.57–2.52) 0.10

Continued CD4 cell count increases in HIV-infected adults experiencing 4 years of viral suppression on antiretroviral therapy

AIDS ◽  
2003 ◽  
Vol 17 (13) ◽  
pp. 1907-1915 ◽  
Author(s):  
Peter W Hunt ◽  
Steven G Deeks ◽  
Benigno Rodriguez ◽  
Hernan Valdez ◽  
Starley B Shade ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Cd4 Cell

scholarly journals Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: A retrospective cohort study

2012 ◽  
Vol 13 (4) ◽  
pp. 168 ◽  
Author(s):  
B P Muzah ◽  
S Takuva ◽  
M Maskew ◽  
S Delany-Moretlwe
Keyword(s):  
Immune Response ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Retrospective Cohort ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Logistic Regression Models ◽  
Art Initiation ◽  
Patients Experience ◽  
Cd4 Cell

Background. The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression. However, some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes. Objective. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation. Methods. Data were analysed from 810 HIV-infected adults initiated on first-line ART at 2 clinics in Johannesburg, between 1 November 2008 and 31 December 2009. Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs) to determine associations between discordant immune response and clinical and demographic factors. Results. At ART initiation, 65% (n=592) of participants were female, with a mean age of 38.5 years. Median baseline CD4 cell count was 155 cells/mm3, 70% (n=645) of patients had a haemoglobin level >11 g/dl and 88% (n=803) were initiated on stavudine-lamivudine-efavirenz/nevirapine (D4T-3TC-EFV/NVP). Six months after ART initiation, 24% (n=220) of patients had a discordant immune response and 7% (n=67) a discordant virological response. On multivariate analysis, baseline CD cell count ≥200 cells/mm3 (AOR 3.02; 95% confidence interval (CI) 2.08 - 4.38; p

scholarly journals Clinical, Immunological and Virological Responses of Zidovudine-Lamivudine-Nevirapine versus Zidovudine-Lamivudine-Efavirenz Antiretroviral Treatment (ART) Among HIV-1 Infected Children: Asella Teaching and Referral Hospital, South-East Ethiopia

2018 ◽  
Vol 12 (1) ◽  
pp. 11-18
Author(s):  
Abebe Sorsa
Keyword(s):  
Cell Count ◽  
Medical Records ◽  
Viral Suppression ◽  
Age Groups ◽  
Cross Sectional ◽  
Cd4 Cell Count ◽  
Virological Outcomes ◽  
The Mean ◽  
Cd4 Cell ◽  
Hiv 1

Background:Antiretroviral Therapy(ART) remarkably reduced HIV-1 infection-related mortality in children. The efficacy and safety of different ART regimen in pediatric age groups remained issues of debates and available evidence were scarce especially among children taking the of one the two prototypes (NVP or EFV) Non-Nucleoside Reverse Transcriptase Inhibitor(NNRTI) as backbone of ART regimen.Therefore, the objective of this study was to compare clinical, immunological and virological responses of zidovudine-lamivudine-nevirapine (AZT+3TC+ NVP)versuszidovudine-lamivudine-efavirenz (AZT+3TC+EFV) ART regimen among HIV-1 infected children.Methods:A retrospective cross-sectional study was done by reviewing medical records of the patients to evaluate clinical, immunological and virological outcomes of NVP+AZT+3TCversusEFV+AZT+3TC ART regimen among HIV-1 infected children. Data were entered into Epi-info version 7.2.2 for clean up and exported to SPSS version 17 for analysis. Paired and Independent t-tests were used to compare the CD4 cell count, weight and virologic level at six months with corresponding baseline value; and the mean weight, CD4 gain and viral suppression across the two ART regimens at six months of ART respectively.Results:Medical records of 122 patients from NVP-based regimen and 61 patients from EFV group were reviewed. After six months of NVP+AZT+3TC treatment, the mean CD4 cell count difference from baseline was 215(95% CI, 175.414-245.613, p<0.001). From EFV+AZT+3TC group, the mean CD4 cell count difference from baseline was 205(95% CI 155.404-235.623, p< 0.001). The mean CD4 count difference between the two regimens was comparable (p 0.145). Similarly, optimal viral suppression was achieved in 82% (100/122) of NVP+AZT+3TC regimen and 83% (44/61) of EFV+AZT+3TC regimen which was still comparable across the two groups.Conclusion:There was no difference in clinical, immunological and virological outcomes among patients taking NVP+AZT+3TC or EFV+AZT+3TC ART regimen.

scholarly journals Advanced HIV Infection in Treatment Naïve Individuals: Effectiveness and Persistence of Recommended Three-Drug Regimens

2022 ◽  
Author(s):  
Karam Mounzer ◽  
Laurence Brunet ◽  
Jennifer S Fusco ◽  
Ian R Mcnicholl ◽  
Helena Diaz Cuervo ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Viral Suppression ◽  
Proportional Hazards ◽  
Drug Regimen ◽  
Cox Proportional Hazards ◽  
Cd4 Cell Count ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Cd4 Cell

Abstract Background Approximately 20% of newly diagnosed people with HIV (PWH) in the U.S. have advanced HIV infection, yet literature on current antiretroviral therapy (ART) options is limited. Discontinuation/modification and effectiveness of common regimens were compared among ART-naïve people with advanced HIV infection (CD4 cell count &lt;200 cells/μL). Methods ART-naïve adults with advanced HIV infection initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen between 1JAN2018 and 31JUL2019 in the OPERA cohort were included. The association between regimen and discontinuation or viral suppression (&lt;50 or &lt;200 copies/mL) was assessed using Cox proportional hazards models with inverse probability of treatment weights. Results Overall, 961 PWH were included (416 B/F/TAF, 106 bDRV, 271 DTG, 168 EVG/c); 70% achieved a CD4 cell count ≥200 cells/μL over a 16 months median follow-up. All regimens were associated with a statistically higher likelihood of discontinuation than B/F/TAF (bDRV aHR: 2.65 [95% CI: 1.75, 4.02], DTG: 2.42 [1.75, 3.35], EVG/c: 3.52 [95% CI: 2.44, 5.07]). Compared to B/F/TAF, bDRV initiators were statistically less likely to suppress to &lt;50 copies/mL (0.72 [0.52, 0.99]) and &lt;200 copies/mL (0.55 [0.43, 0.70]); no statistically significant difference was detected with DTG or EVG/c. Conclusions Among people with advanced HIV infection, those initiating B/F/TAF were less likely to discontinue/modify their regimen than those on any other regimen, and more likely to achieve viral suppression compared to those on bDRV but not compared to those on other integrase inhibitors.

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