Antiretroviral therapy among patients with HIV in Almaty, Kazakhstan: the implication for HIV-associated tuberculosis control

Introduction: Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count. Aim: To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018. Methodology: A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS). Results: The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised. Conclusion: Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.

Download Full-text

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

Viruses ◽

10.3390/v14010122 ◽

2022 ◽

Vol 14 (1) ◽

pp. 122

Author(s):

Mariusz Sapuła ◽

Magdalena Suchacz ◽

Andrzej Załęski ◽

Alicja Wiercińska-Drapało

Keyword(s):

Metabolic Syndrome ◽

Antiretroviral Therapy ◽

Plasma Lipid ◽

Hiv Treatment ◽

New Drugs ◽

People Living With Hiv ◽

The Metabolic Syndrome ◽

Major Interest ◽

Living With Hiv ◽

The Impact

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

Download Full-text

763. Correlates of Antiretroviral Therapy Initiation Among Newly Diagnosed Older People with HIV in Ukraine

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.953 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S427-S427

Author(s):

Amy J Allen ◽

Oleksandr Zeziulin ◽

Julia Rozanova ◽

Taylor Litz ◽

Irina Zaviryukha ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Older People ◽

Opportunistic Infection ◽

Retrospective Chart Review ◽

Hiv Treatment ◽

People Living With Hiv ◽

Newly Diagnosed ◽

Art Initiation ◽

Increased Risk ◽

The Impact

Abstract Background Ukraine has a high burden of HIV, with only 52% of people living with HIV receiving Antiretroviral Therapy (ART) despite test and treat policies and free medications. An underrecognized but significantly increasing proportion of older people with HIV (OPWH) contribute 15% of new HIV diagnoses and demonstrate increased mortality compared to the age-matched general population. To assess the impact of age on HIV treatment outcomes, we examined correlates of ART initiation among newly diagnosed HIV patients in Ukraine. Methods A retrospective chart review was conducted of 400 patients newly diagnosed with HIV between July 1, 2017- Dec 1, 2018 in Odessa, Ukraine. OPWH were defined as those ≥50 years old at the time of diagnosis, while ART initiation was defined as prescription and dispensing of medication. Outcomes were censored 6 months from diagnosis. Demographic, clinical characteristics, and ART outcomes were examined and multivariable logistic regression models were used to estimate correlates of ART initiation with adjusted odds ratios at 95% confidence intervals. Results Of the 400 included patients, 198 (49.5%) were < 50 years old and 202 (50.5%) were ≥ 50 years old at the time of diagnosis. Patients ≥50 years old were more likely to have a lower CD4 count (median 148 (IQR 60-316) vs 295 (IQR 111-478), p=0.001). Correlates of ART initiation included age less than 50 and history of opportunistic infection within 12 months of diagnosis. After controlling for opportunistic infection history, OPWH were 51% less likely to receive ART than those < 50 years old at the time of diagnosis (AOR 0.496, CI 0.301-0.816, p=0.006). Conclusion OPWH exhibit an ART gap associated with advanced disease at presentation compared to younger individuals newly diagnosed with HIV. This is the first clinical data examining OPWH in Ukraine. Interventions to improve linkage to care for OPWH are urgently needed in a population already at increased risk for HIV related mortality. The results of this study emphasize the need for further studies to examine patient and systemic causes of decreased ART initiation among Ukrainian OPWH. Disclosures All Authors: No reported disclosures

Download Full-text

The Impact of Stigma and Discrimination on Adherence to Medication amongst People Living with HIV in Tiv Land, North Central Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i130165 ◽

2019 ◽

pp. 1-9

Author(s):

Godwin Aondohemba Timiun ◽

Timothy J. Scrase

Keyword(s):

People Living With Hiv ◽

Structured Interviews ◽

Hiv Patients ◽

Stigma And Discrimination ◽

Treatment Services ◽

Adherence To Medication ◽

Multi Stage ◽

Living With Hiv ◽

And Control ◽

The Impact

In spite the identification of stigma as a factor impeding public utilisation of HIV counselling, testing, and treatment services in Nigeria, gaps still exist in knowledge on the impact of stigma, and discrimination on adherence to medication amongst people living with HIV (PLWH). This study adopted mixed methods to examine the impact of stigma and discrimination on adherence to medication amongst PLWH in Nigeria. A sample of 1,621 respondents was collected using multi-stage and purposive sampling methods. Structured interviews using questionnaires and in-depth interviews (using a guide) were utilised for data collection. SPSS (version 21) was used for quantitative data analysis while the qualitative data was analysed thematically. There are 46.3% men and 53.7% women respondents. Generally, their income is low, 70.7% are earning less than N25, 000 (approximately $125 USD) per month. Some of the HIV patients are stigmatised. In reaction, they avoid public places, travel long distances away from their immediate community to collect drugs and to avoid been noticed around the centers. They sometimes miss taking drugs regularly as prescribed, suffer depression and die. Stigma and discrimination impede adherence to medication amongst PLHW in Nigeria. More efforts should be made to create awareness to reduce stigma and discrimination of HIV patients, while augmenting their income to meet up with the challenges of adherence to medication. The overall benefits would be enhanced mechanism of HIV prevention, treatment and control in the study area.

Download Full-text

A model to predict adherence to antiretroviral therapy among people living with HIV

Sexually Transmitted Infections ◽

10.1136/sextrans-2021-055222 ◽

2021 ◽

pp. sextrans-2021-055222

Author(s):

Hui Chen ◽

Rusi Long ◽

Tian Hu ◽

Yaqi Chen ◽

Rongxi Wang ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Treatment ◽

Poor Adherence ◽

People Living With Hiv ◽

Art Adherence ◽

Snowball Sampling ◽

Hiv Viral Load ◽

Temporal Validation ◽

Suboptimal Adherence ◽

Living With Hiv

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

Download Full-text

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.

Download Full-text

Psychological distress during the initial COVID-19 pandemic in an Italian cohort of people living with HIV: an online survey

10.21203/rs.3.rs-98904/v2 ◽

2021 ◽

Author(s):

Valentina Delle Donne ◽

Nicoletta Ciccarelli ◽

Valentina Massaroni ◽

Francesca Lombardi ◽

Silvia Lamonica ◽

...

Keyword(s):

Psychological Distress ◽

Online Survey ◽

Psychological Impact ◽

Physical Symptoms ◽

Lower Percentage ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Additional Information ◽

Living With Hiv ◽

The Impact

Abstract Our aim was to explore the psychological impact of the initial 2019 Coronavirus (COVID-19) pandemic in a cohort of people living with HIV (PLWH), a population at increased risk of psychological distress. PLWH, treated at our unit, responded an online survey. Data on demographics, clinical and physical symptoms, contact history, as well as knowledge, concerns, precautionary measures and additional information required with respect to COVID-19 during the first phase of the pandemic in Italy were collected. Additionally, the Impact of Event Scale-Revised (IES-R) (identifying COVID-19 pandemic as specific traumatic life event) and the Depression, Anxiety and Stress Scale (DASS-21) were also administered. Out of 98 participants, 44 (45%) revealed from mild to severe psychological impact distress from COVID-19 according to IES-R. According to DASS-21, a lower percentage of significant levels of depression (14%), anxiety (11%) or stress (6%) were reported. Higher education, unemployment, number of perceived physical COVID-19 symptoms, concerns contracting COVID-19 and the situation regarding the pandemic in Italy, and the need of additional information to prevent COVID-19 infection were positively associated to psychological distress. Moreover, female gender, older age, recent HIV diagnosis and unawareness of own viremia were associated to a higher psychological distress. Almost half of our cohort experienced significant levels of distress related to the COVID-19 pandemic. Women, elderly patients and those with recent HIV diagnosis resulted to be the more psychological fragile subgroup. Our findings could help to identify patients in need of psychological interventions to improve wellbeing of PLWH.

Download Full-text

Depression and its predictors among people living with HIV/AIDS on antiretroviral therapy

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20194528 ◽

2019 ◽

Vol 6 (10) ◽

pp. 4557

Author(s):

Rudramma J. ◽

Jannatbi Iti

Keyword(s):

Mental Illness ◽

Antiretroviral Therapy ◽

Severe Depression ◽

People Living With Hiv ◽

Mild Depression ◽

Clinical Predictors ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Living With Hiv ◽

Hiv Aids

Background: HIV infection is one of the raising public health problems. HIV diagnosis is usually associated with stigma and often results in mental illness among the people infected. Depression is the most common mental illness in HIV patients as found by various studies. Hence the present study aimed to determine the proportion of depression and its socio-demographic and clinical predictors among people living with HIV/AIDS (PLHA).Methods: A hospital based cross sectional study was done among 322 PLHA on Antiretroviral therapy attending ART centre at GIMS Teaching Hospital, Gadag. After taking written informed consent from the patients, a predesigned proforma which included socio-demographic variables, clinical details, and CD-4 count, along with patient health questionnaire (PHQ) 9 was administered to assess depression in PLHA.Results: Out of the 322 people living with HIV/AIDS, 108 (33.5%) had depressed. According to PHQ 9 questionnaire, 19.9% had mild depression, 10.6% moderate depression and 3.1% had moderate severe depression. It was noted that 40.3% of females had depression compared to 24.8% of males. PHLA who were on ART for less than one year had higher proportion of depression (61.1%) compared to those with 5 years duration of ART (28.6%) and it was statistically significant.Conclusions: In the study 33.5% of PHLA had depression. Socio-economic status, gender, duration of ART had significant association with depression whereas age, education, place of residence, CD4 count were not associated with depression. Depression screening among PHLA can be done at regular follows ups at ART centres.

Download Full-text

Physicians’ patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting

BMJ Open ◽

10.1136/bmjopen-2018-023957 ◽

2019 ◽

Vol 9 (3) ◽

pp. e023957

Author(s):

Beverly Allan ◽

Kalysha Closson ◽

Alexandra B Collins ◽

Mia Kibel ◽

Shenyi Pan ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Base Composition ◽

Cox Model ◽

Cox Proportional Hazards ◽

Future Research ◽

People Living With Hiv ◽

All Cause Mortality ◽

Living With Hiv ◽

The Impact

ObjectivesTo assess the impact of physicians’ patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada.DesignObservational cohort study from 1 January 2000 to 31 December 2013.SettingBC Centre for Excellence in HIV/AIDS’ (BC-CfE) Drug Treatment Program, where HAART is available at no cost.ParticipantsPLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study.Outcome measuresAll-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency.Statistical analysisWe examined the relationships between patient characteristics, physicians’ patient base composition, the location of the practice, and physicians’ experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models.ResultsA total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34–49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23–170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004–2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000–2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians’ patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03–1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality.ConclusionsOur findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians’ patient bases and survival.

Download Full-text

Predicting the population impact of increased HIV testing and treatment in Australia

Sexual Health ◽

10.1071/sh13069 ◽

2014 ◽

Vol 11 (2) ◽

pp. 146 ◽

Cited By ~ 16

Author(s):

James Jansson ◽

Cliff C. Kerr ◽

David P. Wilson

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infections ◽

Transmission Risk ◽

Risk Compensation ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Risk Levels ◽

Sex With Men ◽

Living With Hiv ◽

The Impact

Introduction The treatment as prevention strategy has gained popularity as a way to reduce the incidence of HIV by suppressing viral load such that transmission risk is decreased. The effectiveness of the strategy also requires early diagnosis. Methods: Informed by data on the influence of diagnosis and treatment on reducing transmission risk, a model simulated the impact of increasing testing and treatment rates on the expected incidence of HIV in Australia under varying assumptions of treatment efficacy and risk compensation. The model utilises Australia’s National HIV Registry data, and simulates disease progression, testing, treatment, transmission and mortality. Results: Decreasing the average time between infection and diagnosis by 30% is expected to reduce population incidence by 12% (~126 cases per year, 95% confidence interval (CI): 82–198). Treatment of all people living with HIV with CD4 counts <500 cells μL–1 is expected to reduce new infections by 30.9% (95% CI: 15.9–37.6%) at 96% efficacy if no risk compensation occurs. The number of infections could increase up to 12.9% (95% CI: 20.1–7.4%) at 26% efficacy if a return to prediagnosis risk levels occur. Conclusion: Treatment as prevention has the potential to prevent HIV infections but its effectiveness depends on the efficacy outside trial settings among men who have sex with men and the level of risk compensation. If antiretroviral therapy has high efficacy, risk compensation will not greatly change the number of infections. If the efficacy of antiretroviral therapy is low, risk compensation could lead to increased infections.

Download Full-text

How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda—A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0251645 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251645

Author(s):

Jonathan Ross ◽

Charles Ingabire ◽

Francine Umwiza ◽

Josephine Gasana ◽

Athanase Munyaneza ◽

...

Keyword(s):

Treatment Guidelines ◽

Qualitative Interviews ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Status ◽

Hiv Diagnosis ◽

Art Initiation ◽

Treat All

Introduction HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. Methods From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Results Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. Conclusion For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

Download Full-text