Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

Abstract Background SARS-CoV-2 binding receptor ACE2 and the spike protein priming protease TMPRSS2 are co-expressed in human placentae. It is unknown whether their expression is altered in the context of HIV infection and antiretroviral therapy (ART). Methods We compared mRNA levels of SARS-CoV-2 cell-entry mediators ACE2, TMPRSS2 and L-SIGN (an alternative entry receptor) by qPCR in 105 placentae: 45 from pregnant women with HIV (WHIV) exposed to protease inhibitor (PI)-based ART, 17 from WHIV on non-PI-based ART, and 43 from HIV-uninfected women. Results ACE2 levels were lower, while L-SIGN levels were higher in placentae from WHIV on PI-based ART as compared to those on non-PI-based ART and to HIV-uninfected women. TMPRSS2 levels were similar between groups. Black race was significantly associated with lower expression of ACE2 and higher expression of L-SIGN. ACE2 levels were significantly higher in placentae of female fetuses. Discussion We have identified pregnant women of Black race and WHIV who are on PI-based ART to have relatively lower expression of placental ACE2 than those of White race and HIV-uninfected women. This effect may potentially contribute to altered susceptibility to COVID-19 in these women, either favorably; by reduced viral entry, or detrimentally; by loss of ACE2 protection against hyperinflammation.

Download Full-text

Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda

PLoS ONE ◽

10.1371/journal.pone.0246140 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0246140

Author(s):

Sarah Nabukeera ◽

Joseph Kagaayi ◽

Fredrick Edward Makumbi ◽

Henry Mugerwa ◽

Joseph K. B. Matovu

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Side Effects ◽

Clinical Research ◽

Clinical Stage ◽

Research Centre ◽

Hiv Positive ◽

Factors Associated ◽

Art Initiation ◽

Stage 4

Background While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. Method This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0–14 years) were randomly selected from existing medical records and data on children’s socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. Results The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5–9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10–14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. Conclusion Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.

Download Full-text

Prenatal screening of HIV positive pregnant women under HAART (highly active antiretroviral therapy)

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.189 ◽

2019 ◽

Vol 234 ◽

pp. e18

Author(s):

Mircea Onofriescu ◽

Dragos Nemescu ◽

Adina Tanase ◽

Anca Berescu ◽

Mirabela Petica ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Highly Active Antiretroviral Therapy ◽

Prenatal Screening ◽

Hiv Positive ◽

Highly Active

Download Full-text

All-cause mortality after antiretroviral therapy initiation in HIV-positive women from Europe, Sub-Saharan Africa and the Americas

AIDS ◽

10.1097/qad.0000000000002399 ◽

2020 ◽

Vol 34 (2) ◽

pp. 277-289

Author(s):

Keyword(s):

Antiretroviral Therapy ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Therapy Initiation ◽

Hiv Positive Women ◽

All Cause Mortality ◽

Sub Saharan

Download Full-text

Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda

AIDS Research and Treatment ◽

10.1155/2017/3527563 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Rachel Musomba ◽

Frank Mubiru ◽

Shadia Nakalema ◽

Hope Mackline ◽

Ivan Kalule ◽

...

Keyword(s):

Pregnant Women ◽

Older Women ◽

First Trimester ◽

Hiv Positive ◽

Urban Centre ◽

Factors Associated ◽

Point Of Entry ◽

Art Initiation ◽

Hiv Positive Women

Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64–1.0, and P=0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34–0.98, and P=0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.

Download Full-text