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Sample records for hiv cohort study

  1. Cohort profile update: the Danish HIV Cohort Study (DHCS).

    Science.gov (United States)

    Omland, Lars Haukali; Ahlström, Magnus Glindvad; Obel, Niels

    2014-12-01

    The DHCS is a cohort of all HIV-infected individuals seen in one of the eight Danish HIV centres after 31 December 1994. Here we update the 2009 cohort profile emphasizing the development of the cohort. Every 12-24 months, DHCS is linked with the Danish Civil Registration System (CRS) in order to extract an age- and sex-matched comparison cohort from the general population, as well as cohorts of family members of the HIV-infected patients and of the comparison cohort. The combined cohort is linked with CRS, the Danish Cancer Registry, the Danish National Hospital Registry, the Danish Registry of Causes of Death, the Danish National Prescription Registry, the Attainment Register and the Integrated Database for Labour Market Research to get information on vital status, migration, cancer, hospital contacts, causes of death, dispensed prescriptions, education and employment. Using this design, rates of a range of outcomes have been compared between HIV-infected patients and the comparison cohort, as well as between families of these two cohorts in order to disaggregate the effects of HIV infection and familial/environmental factors. Data can be shared with foreign institutions following approval from the Danish Data Protection Agency. Potential collaborators can contact the study director, Niels Obel (e-mail: niels.obel@regionh.dk). © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  2. Speech audiometry findings from HIV+ and HIV- adults in the MACS and WIHS longitudinal cohort studies.

    Science.gov (United States)

    Torre, Peter; Hoffman, Howard J; Springer, Gayle; Cox, Christopher; Young, Mary A; Margolick, Joseph B; Plankey, Michael

    The purpose of this study was to compare various speech audiometry measures between HIV+ and HIV- adults and to further evaluate the association between speech audiometry and HIV disease variables in HIV+ adults only. Three hundred ninety-six adults from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) completed speech audiometry testing. There were 262 men, of whom 117 (44.7%) were HIV+, and 134 women, of whom 105 (78.4%) were HIV+. Speech audiometry was conducted as part of the standard clinical audiological evaluation that included otoscopy, tympanometry, and pure-tone air- and bone-conduction thresholds. Specific speech audiometry measures included speech recognition thresholds (SRT) and word recognition scores in quiet presented at 40dB sensation level (SL) in reference to the SRT. SRT data were categorized in 5-dB steps from 0 to 25dB hearing level (HL) with one category as ≥30dB HL while word recognition scores were categorized as <90%, 90-99%, and 100%. A generalized estimating equations model was used to evaluate the association between HIV status and both ordinal outcomes. The SRT distributions across HIV+ and HIV- adults were similar. HIV+ and HIV- adults had a similar percentages of word recognition scores <90%, a lower percentage of HIV- adults had 90-99%, but HIV- adults had a higher percentage of 100%. After adjusting for covariables, HIV+ adults were borderline significantly more likely to have a higher SRT than HIV- adults (odds ratio [OR]=1.45, p=0.06). Among HIV+ adults, HIV-related variables (i.e., CD4+ T-cell counts, HIV viral load, and ever history of clinical AIDS) were not significantly associated with either SRT or word recognition score data. There was, however, a ceiling effect for word recognition scores, probably the result of obtaining this measure in quiet with a relatively high presentation level. A more complex listening task, such as speech-in-noise testing, may be a more clinically informative

  3. Unique features of HLA-mediated HIV evolution in a Mexican cohort: a comparative study

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    Brumme Zabrina L

    2009-08-01

    Full Text Available Abstract Background Mounting evidence indicates that HLA-mediated HIV evolution follows highly stereotypic pathways that result in HLA-associated footprints in HIV at the population level. However, it is not known whether characteristic HLA frequency distributions in different populations have resulted in additional unique footprints. Methods The phylogenetic dependency network model was applied to assess HLA-mediated evolution in datasets of HIV pol sequences from free plasma viruses and peripheral blood mononuclear cell (PBMC-integrated proviruses in an immunogenetically unique cohort of Mexican individuals. Our data were compared with data from the IHAC cohort, a large multi-center cohort of individuals from Canada, Australia and the USA. Results Forty three different HLA-HIV codon associations representing 30 HLA-HIV codon pairs were observed in the Mexican cohort (q Conclusion Our data support universal HLA-mediated HIV evolution at the population level, resulting in detectable HLA-associated footprints in the circulating virus. However, it also strongly suggests that unique genetic backgrounds in different HIV-infected populations may influence HIV evolution in a particular direction as particular HLA-HIV codon associations are determined by specific HLA frequency distributions. Our analysis also suggests a dynamic HLA-associated evolution in HIV with fewer HLA-HIV codon associations observed in the proviral compartment, which is likely enriched in early archived HIV sequences, compared to the plasma virus compartment. These results highlight the importance of comparative HIV evolutionary studies in immunologically different populations worldwide.

  4. Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study

    OpenAIRE

    Morgan, D.; Mahe, C.; Mayanja, B; Whitworth, JA

    2002-01-01

    OBJECTIVES: To estimate the rate of progression from seroconversion to symptomatic disease in adults infected with HIV-1, and to establish whether the background level of signs and symptoms commonly associated with HIV-1 in uninfected controls are likely to affect progression rates. DESIGN: Longitudinal, prospective cohort study of people infected with HIV-1 and randomly selected subjects negative for HIV-1 antibodies identified during population studies. SETTING: Study clinic with basic medi...

  5. Participation, characteristics and retention rates of HIV-positive immigrants in the Swiss HIV Cohort Study.

    Science.gov (United States)

    Thierfelder, C; Weber, R; Elzi, L; Furrer, H; Cavassini, M; Calmy, A; Bernasconi, E; Gutmann, C; Ledergerber, B

    2012-02-01

    Data from observational cohorts may be influenced by population structure and loss to follow-up (LTFU). Quality of care may be associated with participation in cohort networks. We aimed to study the participation, characteristics and retention rates of immigrants in the Swiss HIV Cohort Study (SHCS). We compared enrolment over time (1996-1999, 2000-2003 and 2004-2008) and LTFU between individuals from different geographical regions. In 2008, we performed a cross-sectional survey to investigate the proportion of individuals not participating in the SHCS but who were in care at SHCS institutions. Predictors for LTFU were analysed using Cox proportional hazard models, and those for nonparticipation using logistic regression. A total of 7840 individuals entered the SHCS during the observation period. The proportion of immigrants increased over time, especially the proportion of women from sub-Saharan Africa, which increased from 21 to 48% during the observation period. Overall LTFU was 3.76 [95% confidence interval (CI) 3.58-3.95]/100, with the highest hazard ratio in men from sub-Saharan Africa (2.82/100 patient-years; 95% CI 2.30-3.46/100), compared with men from northwestern countries. Other predictors for LTFU were age education, injecting drug use, and higher baseline CD4 cell counts. Participants taking antiretroviral therapy had reduced LTFU. The survey showed that 84% of HIV-infected patients in care at SHCS institutions were enrolled in the cohort. Nonparticipation was more likely among men from non-European regions (odds ratio 2.73; 95% CI 2.29-3.24), women from sub-Saharan Africa (odds ratio 3.01; 95% CI 2.40-3.77) and women from Latin America/Caribbean (odds ratio 2.10; 95% CI 1.30-3.39). Numbers of HIV-infected immigrants are increasing but they are underrepresented in the SHCS, and immigrants are more likely to be lost to follow-up. © 2011 British HIV Association.

  6. Methadone maintenance treatment modalities in relation to incidence of HIV: results of the Amsterdam cohort study

    NARCIS (Netherlands)

    Langendam, M. W.; van Brussel, G. H.; Coutinho, R. A.; van Ameijden, E. J.

    1999-01-01

    To evaluate methadone maintenance treatment modalities, prescribed within the concept of harm reduction, in relation to incidence of HIV infection among drug users with a history of methadone treatment in Amsterdam, The Netherlands. Prospective observational cohort study among 582 HIV-negative drug

  7. Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study.

    Science.gov (United States)

    Durand, Madeleine; Sheehy, Odile; Baril, Jean-Guy; LeLorier, Jacques; Tremblay, Cécile L

    2013-10-01

    We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage. We performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression. There were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage. The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. HIV infection, malaria, and pregnancy: a prospective cohort study in Kigali, Rwanda.

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    Ladner, Joël; Leroy, Valériane; Simonon, Arlette; Karita, Etienne; Bogaerts, Joseph; De Clercq, André; Van De Perre, Philippe; Dabis, François

    2002-01-01

    In order to study the relation between human immunodeficiency virus (HIV) infection and malaria in women, during and after pregnancy, a prospective cohort study was initiated at the Centre Hospitalier de Kigali in Rwanda through routine voluntary and confidential HIV screening in antenatal clinics. At inclusion in the cohort of all HIV-positive and an equivalent number of HIV-negative pregnant women, between 21 and 28 weeks of gestation, sociodemographic characteristics and medical history during the current pregnancy were collected; screening for malaria (tick blood smear) and anemia and a CD4 lymphocyte count were systematically performed. Each woman enrolled had a monthly follow-up until 6 months after delivery. A clinic was implemented that was accessible and free of charge to every woman during the study period between scheduled visits. Malaria infection was systematically screened in case of fever or other compatible symptoms. The cohort included 228 HIV-positive and 229 HIV-negative women. At inclusion, malaria prevalence was 8.0% in HIV-positive women and 3.5% in HIV-negative women (P taking account in the same multivariate model (including HIV infection, primiparity, CD4 lymphocytes, anemia, and education level), positive HIV serostatus remained the only factor significantly associated with malaria infection (RR = 1.4, CI = 1.1-1.6; P = 0.016). Our study prospectively documents the association between malaria and maternal HIV infection and highlights the increased risk of malaria occurrence in all HIV-infected women. Strategies to reduce the malaria morbidity during pregnancy should be reinforced in areas of high HIV seroprevalence.

  9. Caffeine and Insomnia in People Living With HIV From the Miami Adult Studies on HIV (MASH) Cohort.

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    Ramamoorthy, Venkataraghavan; Campa, Adriana; Rubens, Muni; Martinez, Sabrina S; Fleetwood, Christina; Stewart, Tiffanie; Liuzzi, Juan P; George, Florence; Khan, Hafiz; Li, Yinghui; Baum, Marianna K

    We explored the relationship between caffeine consumption, insomnia, and HIV disease progression (CD4+ T cell counts and HIV viral loads). Caffeine intake and insomnia levels were measured using the Modified Caffeine Consumption Questionnaire and the Pittsburgh Insomnia Rating Scale (PIRS) in 130 clinically stable participants who were living with HIV, taking antiretroviral therapy, and recruited from the Miami Adult Studies on HIV cohort. Linear regressions showed that caffeine consumption was significantly and adversely associated with distress score, quality-of-life score, and global PIRS score. Linear regression analyses also showed that global PIRS score was significantly associated with lower CD4+ T cell counts and higher HIV viral loads. Caffeine could have precipitated insomnia in susceptible people living with HIV, which could be detrimental to their disease progression states. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  10. A cohort pilot study on HIV-associated neuropsychological impairments in haemophilia patients

    Directory of Open Access Journals (Sweden)

    Silvia eRiva

    2015-06-01

    Full Text Available Despite advances in the management of HIV infection with the introduction of combination antiretroviral therapy (cART, it is well known that HIV can directly infect the central nervous system (CNS and, as a result of such infection, neuropsychological impairments can be manifested. In this study we tried to determine whether seropositivity was associated with a poor neuropsychological performance in patients with hemophilia and HIV. Such a cohort of patients is very often underrepresented and understudied in the HIV literature. To amend such a gap, we carried out an extensive neuropsychological evaluation on these patients, and compared their performance with that of a group of seronegative hemophilia patients. The results revealed that HIV infection in HIV seropositive (HIV+ hemophilia patients was associated with deficits in attention, short-term memory, abstraction and visual recognition. Such results are still preliminary and explorative due to the small cohort of patients enrolled. However, the results do seem to have some important implications for day-to-day functioning, as the level of impairment detected may cause difficulties in completing common everyday tasks such as maintaining adherence to complex medication regimens, or maintaining social life activities. Continued research into the mechanisms related to HIV and neurocognitive dysfunction may provide targets for interventions that could have meaningful consequences in the real world for HIV hemophilia patients.

  11. HIV shedding from male circumcision wounds in HIV-infected men: a prospective cohort study.

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    Tobian, Aaron A R; Kigozi, Godfrey; Manucci, Jordyn; Grabowski, Mary K; Serwadda, David; Musoke, Richard; Redd, Andrew D; Nalugoda, Fred; Reynolds, Steven J; Kighoma, Nehemiah; Laeyendecker, Oliver; Lessler, Justin; Gray, Ronald H; Quinn, Thomas C; Wawer, Maria J

    2015-04-01

    A randomized trial of voluntary medical male circumcision (MC) of HIV-infected men reported increased HIV transmission to female partners among men who resumed sexual intercourse prior to wound healing. We conducted a prospective observational study to assess penile HIV shedding after MC. HIV shedding was evaluated among 223 HIV-infected men (183 self-reported not receiving antiretroviral therapy [ART], 11 self-reported receiving ART and had a detectable plasma viral load [VL], and 29 self-reported receiving ART and had an undetectable plasma VL [HIV shedding and VL using a real-time quantitative PCR assay. Unadjusted prevalence risk ratios (PRRs) and adjusted PRRs (adjPRRs) of HIV shedding were estimated using modified Poisson regression with robust variance. HIV shedding was detected in 9.3% (17/183) of men not on ART prior to surgery and 39.3% (72/183) of these men during the entire study. Relative to baseline, the proportion shedding was significantly increased after MC at 1 wk (PRR = 1.87, 95% CI = 1.12-3.14, p = 0.012), 2 wk (PRR = 3.16, 95% CI = 1.94-5.13, p HIV shedding was decreased by 6 wk after MC (PRR = 0.27, 95% CI = 0.09-0.83, p = 0.023) and remained suppressed at 12 wk after MC (PRR = 0.19, 95% CI = 0.06-0.64, p = 0.008). Detectable HIV shedding from MC wounds occurred in more study visits among men with an HIV plasma VL > 50,000 copies/ml than among those with an HIV plasma VL HIV shedding was less common in visits from men with healed MC wounds compared to visits from men without healed wounds (adjPRR = 0.12, 95% CI = 0.07-0.23, p HIV shedding, the median log10 HIV copies/milliliter of lavage fluid was significantly lower in men with ART-induced undetectable plasma VL (1.93, interquartile range [IQR] = 1.83-2.14) than in men not on ART (2.63, IQR = 2.28-3.22, p HIV shedding is significantly reduced after healing of MC wounds. Lower plasma VL is associated with decreased frequency and quantity of HIV shedding from MC wounds. Starting ART prior to MC

  12. HIV-1 variation before seroconversion in men who have sex with men: analysis of acute/early HIV infection in the multicenter AIDS cohort study

    NARCIS (Netherlands)

    Gottlieb, Geoffrey S.; Heath, Laura; Nickle, David C.; Wong, Kim G.; Leach, Stephanie E.; Jacobs, Benjamin; Gezahegne, Surafel; van 't Wout, Angélique B.; Jacobson, Lisa P.; Margolick, Joseph B.; Mullins, James I.

    2008-01-01

    Understanding the characteristics of human immunodeficiency virus (HIV) necessary for infection in a new host is a critical goal for acquired immunodeficiency syndrome (AIDS) research. We studied the characteristics of HIV-1 envelope genes in 38 men in the Multicenter AIDS Cohort Study cohort before

  13. Comorbidity Acquired before HIV Diagnosis and Mortality in HIV-infected and Uninfected Persons: A Danish population-based cohort study

    DEFF Research Database (Denmark)

    Lohse, Nicolai; Gerstoft, Jan; Kronborg, Gitte

    2011-01-01

    BACKGROUND:: We aimed to estimate the impact of comorbidity acquired before HIV diagnosis on mortality in HIV-infected individuals METHODS:: This cohort study compared two different cohorts. The prospective population-based nationwide observational Danish HIV Cohort Study was used to compare all...... adults diagnosed with HIV in Denmark from 1997 with a matched general population cohort. Comorbidity history was ascertained from the Danish National Patient Registry and vital statistics obtained from Denmark's Civil Registration System. Cox regression was used to estimate impact of Charlson Comorbidity...... Index (CCI) and hepatitis C virus coinfection (HCV) on mortality, and Population Attributable Risk to assess the proportional impact of comorbidity on mortality. RESULTS:: CCI comorbidity was present before HIV diagnosis in 11.3% of 1,638 persons with HIV, and in 8.0% of 156,506 persons in the general...

  14. Pregnancy outcomes in HIV-positive women: a retrospective cohort study.

    Science.gov (United States)

    Arab, Kholoud; Spence, Andrea R; Czuzoj-Shulman, Nicholas; Abenhaim, Haim A

    2017-03-01

    In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women. A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes. Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14-1.60) and urinary tract infections (OR 3.02, 95% CI 2.40-3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79-3.36), postpartum sepsis (OR 8.05, 95% CI 5.44-11.90), venous thromboembolism (OR 2.21, 95% CI 1.46-3.33), blood transfusions (OR 3.67, 95% CI 3.01-4.49), postpartum infection (OR 3.00, 95% CI 2.37-3.80), and maternal mortality (OR 21.52, 95% CI 12.96-35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction. Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.

  15. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study.

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    Choi, Stephanie K Y; Boyle, Eleanor; Cairney, John; Gardner, Sandra; Collins, Evan J; Bacon, Jean; Rourke, Sean B

    2016-01-01

    Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes. Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines. Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression's impact on their lives.

  16. The Canadian HIV and aging cohort study - determinants of increased risk of cardio-vascular diseases in HIV-infected individuals: rationale and study protocol.

    Science.gov (United States)

    Durand, Madeleine; Chartrand-Lefebvre, Carl; Baril, Jean-Guy; Trottier, Sylvie; Trottier, Benoit; Harris, Marianne; Walmsley, Sharon; Conway, Brian; Wong, Alexander; Routy, Jean-Pierre; Kovacs, Colin; MacPherson, Paul A; Monteith, Kenneth Marc; Mansour, Samer; Thanassoulis, George; Abrahamowicz, Michal; Zhu, Zhitong; Tsoukas, Christos; Ancuta, Petronela; Bernard, Nicole; Tremblay, Cécile L

    2017-09-11

    With potent antiretroviral drugs, HIV infection is becoming a chronic disease. Emergence of comorbidities, particularly cardiovascular disease (CVD) has become a leading concern for patients living with the infection. We hypothesized that the chronic and persistent inflammation and immune activation associated with HIV disease leads to accelerated aging, characterized by CVD. This will translate into higher incidence rates of CVD in HIV infected participants, when compared to HIV negative participants, after adjustment for traditional CVD risk factors. When characterized further using cardiovascular imaging, biomarkers, immunological and genetic profiles, CVD associated with HIV will show different characteristics compared to CVD in HIV-negative individuals. The Canadian HIV and Aging cohort is a prospective, controlled cohort study funded by the Canadian Institutes of Health Research. It will recruit patients living with HIV who are aged 40 years or older or have lived with HIV for 15 years or more. A control population, frequency matched for age, sex, and smoking status, will be recruited from the general population. Patients will attend study visits at baseline, year 1, 2, 5 and 8. At each study visit, data on complete medical and pharmaceutical history will be captured, along with anthropometric measures, a complete physical examination, routine blood tests and electrocardiogram. Consenting participants will also contribute blood samples to a research biobank. The primary outcome is incidence of a composite of: myocardial infarction, coronary revascularization, stroke, hospitalization for angina or congestive heart failure, revascularization or amputation for peripheral artery disease, or cardiovascular death. Preplanned secondary outcomes are all-cause mortality, incidence of the metabolic syndrome, incidence of type 2 diabetes, incidence of renal failure, incidence of abnormal bone mineral density and body fat distribution. Patients participating to the

  17. Determinants of Human Immunodeficiency Virus (HIV prevalence in homosexual and bisexual men screened for admission to a cohort study of HIV negatives in Belo Horizonte, Brazil: Project Horizonte

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    Carneiro Mariângela

    2003-01-01

    Full Text Available Project Horizonte, an open cohort of homosexual and bisexual human immunodeficiency virus (HIV-1 negative men, is a component of the AIDS Vaccine Program, in Belo Horizonte, Minas Gerais, Brazil. The objective of this study was to compare volunteers testing HIV positive at cohort entry with a sample of those who tested HIV negative in order to identify risk factors for prevalent HIV infection, in a population being screened for enrollment at Project Horizonte. A nested case-control study was conducted. HIV positive volunteers at entry (cases were matched by age and admission date to three HIV negative controls each. Selected variables used for the current analysis included demographic factors, sexual behavior and other risk factors for HIV infection. During the study period (1994-2001, among the 621 volunteers screened, 61 tested positive for HIV. Cases were matched to 183 HIV negative control subjects. After adjustments, the main risk factors associated with HIV infection were unprotected sex with an occasional partners, OR = 3.7 (CI 95% 1.3-10.6, receptive anal intercourse with an occasional partner, OR = 2.8 (95% CI 0.9-8.9 and belonging to the negro racial group, OR = 3.4 (CI 95% 1.1-11.9. These variables were associated with an increase in the risk of HIV infection among men who have sex with men at the screening for admission to an open HIV negative cohort.

  18. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study

    DEFF Research Database (Denmark)

    Obel, Niels; Thomsen, Henrik F; Kronborg, Gitte

    2007-01-01

    BACKGROUND: There are concerns about highly active antiretroviral therapy (HAART) causing a progressive increase in the risk of ischemic heart disease. We examined this issue in a nationwide cohort study of patients with human immunodeficiency virus (HIV) infection and a population-based control...... group. METHODS: We determined the rate of first hospitalization for ischemic heart disease in all Danish patients with HIV infection (3953 patients) from 1 January 1995 through 31 December 2004 and compared this rate with that for 373,856 subjects in a population-based control group. Data on first...... was not statistically significant, patients with HIV infection who had not initiated HAART were slightly more likely to be hospitalized for the first time with ischemic heart disease than were control subjects (adjusted relative risk, 1.39; 95% confidence interval, 0.81-2.33). After HAART initiation, the risk increase...

  19. Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study.

    Science.gov (United States)

    Silverberg, Michael J; Lau, Bryan; Achenbach, Chad J; Jing, Yuezhou; Althoff, Keri N; D'Souza, Gypsyamber; Engels, Eric A; Hessol, Nancy A; Brooks, John T; Burchell, Ann N; Gill, M John; Goedert, James J; Hogg, Robert; Horberg, Michael A; Kirk, Gregory D; Kitahata, Mari M; Korthuis, Philip T; Mathews, William C; Mayor, Angel; Modur, Sharada P; Napravnik, Sonia; Novak, Richard M; Patel, Pragna; Rachlis, Anita R; Sterling, Timothy R; Willig, James H; Justice, Amy C; Moore, Richard D; Dubrow, Robert

    2015-10-06

    Cancer is increasingly common among persons with HIV. To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. Cohort study. North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009. 86 620 persons with HIV and 196 987 uninfected adults. Cancer type-specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status. Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (-9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate. Secular trends in screening, smoking, and viral co-infections were not evaluated. Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.

  20. Four years of natural history of HIV-1 infection in African women : a prospective cohort study in Kigali (Rwanda), 1988-1993

    OpenAIRE

    Leroy, V.; Msellati, Philippe; Lepage, P.; Batungwanayo, J.; Hitimana, D.G.; Taelman, H.; Bogaerts, J.; Boineau, F.; Van de Perre, P.; Simonon, A.; Salamon, R.; Dabis, F.

    1995-01-01

    Clinical features and mortality due to human immunodeficiency virus type-1 (HIV-1) infection in women are described as part of a prospective 4-year cohort study on perinatal transmission of HIV in Kigali, Rwanda. Two hundred fifteen HIV-positive (HIV+) and 216 HIV-negative (HIV-) pregnant women were enrolled at delivery between November 1988 and June 1989. Clinical information collected during systematic quarterly examinations was compared. HIV antibody tests were performed at delivery and CD...

  1. Serum HIV-1 RNA levels and time to development of AIDS in the multicenter hemophilia cohort study

    NARCIS (Netherlands)

    OBrien, TR; Blattner, WA; Waters, D; Eyster, ME; Hilgartner, MW; Cohen, AR; Luban, N; Hatzakis, A; Aledort, LM; Rosenberg, PS; Miley, WJ; Kroner, BL; Goedert, JJ

    1996-01-01

    Objective.-To determine if the long-term incidence of the acquired immunodeficiency syndrome (AIDS) is related to human immunodeficiency virus type 1 (HIV-1) RNA levels measured early in HIV-1 infection. Design.-Epidemiologic cohort study. Setting.-Five hemophilia treatment centers in the United

  2. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study

    DEFF Research Database (Denmark)

    Obel, Niels; Thomsen, Henrik F; Kronborg, Gitte

    2007-01-01

    BACKGROUND: There are concerns about highly active antiretroviral therapy (HAART) causing a progressive increase in the risk of ischemic heart disease. We examined this issue in a nationwide cohort study of patients with human immunodeficiency virus (HIV) infection and a population-based control...... hospitalization for ischemic heart disease and comorbidity were obtained from the Danish National Hospital Registry for all study participants. We used Cox's regression to compute the hospitalization rate ratio as an estimate of relative risk, adjusting for comorbidity. RESULTS: Although the difference...

  3. The HIV-Brazil cohort study: design, methods and participant characteristics.

    Directory of Open Access Journals (Sweden)

    Alexandre Grangeiro

    Full Text Available BACKGROUND: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART and the impact of this treatment on morbidity, quality of life (QOL and mortality. The study design, patients' profiles and characteristics of cART initiation between 2003 and 2010 were described. METHODOLOGY/PRINCIPAL FINDINGS: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2-5.9 years with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7∶1, with a mean age of 36.9 years (SD 9.9 years; 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4% initiated cART with a CD4+ T-cell count ≤200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7% and lopinavir/ritonavir (18.2%. The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1-78.6. Nearly half (45.4% of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. CONCLUSIONS/SIGNIFICANCE: Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient

  4. The HIV-Brazil cohort study: design, methods and participant characteristics.

    Science.gov (United States)

    Grangeiro, Alexandre; Escuder, Maria Mercedes; Cassenote, Alex Jones Flores; Cassanote, Alex Jones Flores; Souza, Rosa Alencar; Kalichman, Artur O; Veloso, Valdiléa G; Veloso, Valdiléa; Ikeda, Maria Letícia Rodrigues; Barcellos, Nêmora Tregnago; Brites, Carlos; Tupinanbás, Unai; Lucena, Noaldo O; da Silva, Carlos Lima; Lacerda, Heloisa Ramos; Grinsztejn, Beatriz; Castilho, Euclides Ayres

    2014-01-01

    The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients' profiles and characteristics of cART initiation between 2003 and 2010 were described. Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2-5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7∶1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count ≤200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1-78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country.

  5. Lipodystrophy induced by combination antiretroviral therapy in HIV/AIDS patients: a Belgrade cohort study.

    Science.gov (United States)

    Dragović, Gordana; Danilović, Dragana; Dimić, Aleksandra; Jevtović, Djordje

    2014-08-01

    Highly active antiretroviral therapy (HAART) has led to dramatic reductions in mortality and morbidity of HIV/AIDS-patients. Lipodystrophy, a syndrome including peripheral fat wasting and central obesity, is well-documented side effect of HAART. The aim of this study was to evaluate the incidence of lipodystrophy, and to determine its risk ratios in a HIV/AIDS-cohort. This cross-sectional study included all the antiretroviral-naive HIV/AIDS patients commencing HAART from October 1, 2001 to October 1, 2010, at the HIV/AIDS Center, Institute of Infectious and Tropical Diseases, Belgrade, Serbia. Univariate and stepwise multivariate logistic regression analyses were used to determine the odds ratios (OR) with the confidence interval (CI) of 95%, in order to establish the relative risk for lipodystrophy. The Kaplan-Meier-method was used to determine the probability of development lipodystrophy over time. All statistical analyses were performed using SPSS software version using 0.05 as a p-treshold for the significance. This study included 840 HIV/AIDS patients, 608 women and 232 men, followed for 5.6 +/- 2.8 years. The prevalence of lipodystrophy was 69.2%. Univariate and stepwise multivariate regression analysis identified that the female gender, hepatitis C coinfection, AIDS diagnosis prior to HAART initiation, nucleoside-reverse-transcriptase-inhibitors and protease-inhibitors based regimens had a high risk for developing lipodystrophy in HIV/AIDS-patients (OR = 1.6, 95% CI = 1.1-3.49, p = 0.04; OR = 3.31, 95% CI = 1.3-6.8, p lipodystrophy, as side effect of HAART, is particularly important.

  6. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies

    NARCIS (Netherlands)

    Sterne, Jonathan A. C.; May, Margaret; Costagliola, Dominique; de Wolf, Frank; Phillips, Andrew N.; Harris, Ross; Funk, Michele Jönsson; Geskus, Ronald B.; Gill, John; Dabis, François; Miró, Jose M.; Justice, Amy C.; Ledergerber, Bruno; Fätkenheuer, Gerd; Hogg, Robert S.; D'Arminio Monforte, Antonella; Saag, Michael; Smith, Colette; Staszewski, Schlomo; Egger, Matthias; Cole, Stephen R.; Brodt, Hans Reinhard; Casabona, Jordi; Chêne, Geneviève; Costagliola, Dominque; del Amo, Julia; Guest, Jodie; Hogg, Robert; Justice, Amy; Kitahata, Mari; Lampe, Fiona; Mocroft, Amanda; Reiss, Peter

    2009-01-01

    BACKGROUND: The CD4 cell count at which combination antiretroviral therapy should be started is a central, unresolved issue in the care of HIV-1-infected patients. In the absence of randomised trials, we examined this question in prospective cohort studies. METHODS: We analysed data from 18 cohort

  7. Mortality in migrants living with HIV in western Europe (1997-2013): a collaborative cohort study.

    Science.gov (United States)

    2015-12-01

    Many migrants face adverse socioeconomic conditions and barriers to health services that can impair timely HIV diagnosis and access to life-saving treatments. We aimed to assess the differences in overall mortality by geographical origin in HIV-positive men and women using data from COHERE, a large European collaboration of HIV cohorts from 1997 to 2013. In this observational cohort study, we included HIV-positive, antiretroviral-naive people accessing care in western Europe from COHERE. Individuals were eligible if enrolled in a cohort that collected information on geographical origin or ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had available information about sex, they were not infected perinatally or after the receipt of clotting factor concentrates, and were naive to combination antiretroviral therapy at cohort entry. Migrants' origins were grouped into seven regions: western Europe and similar countries (Australia, Canada, New Zealand, and the USA); eastern Europe; North Africa and the Middle East; sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of Oceania (excluding Australia and New Zealand). Crude and adjusted mortality rate ratios were calculated by use of Poisson regression stratified by sex, comparing each group with the native population. Multiple imputation with chained equations was used to account for missing values. Between Oct 25, 1979, and March 19, 2013, we recruited 279 659 individuals to the COHERE collaboration in EuroCoord. Of these 123 344 men and 45 877 women met the inclusion criteria. Our data suggested effect modification by transmission route (pinteraction=0·12 for men; pinteraction=0·002 for women). No significant difference in mortality was identified by geographical origin in men who have sex with men. In heterosexual populations, most migrant men had mortality lower than or equal to that of native men, whereas no group of migrant women had mortality lower than that in

  8. Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study

    OpenAIRE

    Shoptaw, Steven; Stall, Ron; Bordon, Jose; Kao, Uyen; Cox, Christopher; Li, Xiuhong; Ostrow, David G.; Plankey, Michael W.

    2012-01-01

    We examined associations between stimulant use (methamphetamine and cocaine) and other substances (nicotine, marijuana, alcohol, inhaled nitrites) with immune function biomarkers among HIV-seropositive (HIV+) men using highly active antiretroviral therapy (ART) and -seronegative (HIV−) men in the Multicenter AIDS Cohort Study (MACS). Among HIV+ men, cumulative adherence to ART (4.07, 95% CI: 3.52, 4.71, per 10 years of adherent HAART use), and recent cohort enrollment (1.38; 95% CI: 1.24, 1.5...

  9. Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

    Directory of Open Access Journals (Sweden)

    Alberto Novaes Ramos Jr.

    2013-07-01

    Full Text Available This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002 of Brazilian children with AIDS (N = 1,758 through mother-to-child-transmission. Late-stage diagnosis (CDC category C was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6% of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009 and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001. Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004. Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.

  10. Testing initiatives increase rates of HIV diagnosis in primary care and community settings: an observational single-centre cohort study.

    Directory of Open Access Journals (Sweden)

    Prini Mahendran

    Full Text Available The primary objective was to examine trends in new HIV diagnoses in a UK area of high HIV prevalence between 2000 and 2012 with respect to site of diagnosis and stage of HIV infection.Single-centre observational cohort study.An outpatient HIV department in a secondary care UK hospital.1359 HIV-infected adults.Demographic information (age, gender, ethnicity, and sexual orientation, site of initial HIV diagnosis (Routine settings such as HIV/GUM clinics versus Non-Routine settings such as primary care and community venues, stage of HIV infection, CD4 count and seroconversion symptoms were collated for each participant.There was a significant increase in the proportion of new HIV diagnoses made in Non-Routine settings (from 27.0% in 2000 to 58.8% in 2012; p<0.001. Overall there was a decrease in the rate of late diagnosis from 50.7% to 32.9% (p=0.001. Diagnosis of recent infection increased from 23.0% to 47.1% (p=0.001. Of those with recent infection, significantly more patients were likely to report symptoms consistent with a seroconversion illness over the 13 years (17.6% to 65.0%; p<0.001.This is the first study, we believe, to demonstrate significant improvements in HIV diagnosis and a shift in diagnosis of HIV from HIV/GUM settings to primary practice and community settings due to multiple initiatives.

  11. A comparison of HAART outcomes between the US military HIV Natural History Study (NHS and HIV Atlanta Veterans Affairs Cohort Study (HAVACS.

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    Jodie L Guest

    Full Text Available INTRODUCTION: The Department of Defense (DoD and the Department of Veterans Affairs (VA provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. METHODS: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS and 1199 patients from the US Military HIV Natural History Study (NHS. Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. RESULTS: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only and 26.8% to 4.1% (combined mortality or AIDS when controlling for clinical and demographic variables. CONCLUSION: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

  12. Effect of HIV-1 subtypes on disease progression in rural Uganda: a prospective clinical cohort study.

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    Deogratius Ssemwanga

    Full Text Available We examined the association of HIV-1 subtypes with disease progression based on three viral gene regions.A prospective HIV-1 clinical cohort study in rural Uganda.Partial gag, env and pol genes were sequenced. Cox proportional hazard regression modelling was used to estimate adjusted hazard ratios (aHRs of progression to: CD4≤250, AIDS onset and death, adjusted for sex, age and CD4 count at enrolment.Between 1990 and 2010, 292 incident cases were subtyped: 25% had subtype A, 45% had D, 26% had A/D recombinants, 1% had C and 4% were other recombinant forms. Of the 278 incident cases included in the disease progression analysis, 62% progressed to CD4≤250, 32% to AIDS, and 34% died with a higher proportion being among subtype D cases. The proportions of individuals progressing to the three endpoints were significantly higher among individuals infected with subtype D. Throughout the study period, individuals infected with subtype D progressed faster to CD4≤250, adjusted HR (aHR, (95% CI = 1.72 (1.16-2.54, but this was mainly due to events in the period before antiretroviral therapy (ART introduction, when individuals infected with subtype D significantly progressed faster to CD4≤250 than subtype A cases; aHR (95% CI = 1.78 (1.01-3.14.In this population, HIV-1 subtype D was the most prevalent and was associated with faster HIV-1 disease progression than subtype A. Further studies are needed to examine the effect of HIV-1 subtypes on disease progression in the ART period and their effect on the virological and immunological ART outcomes.

  13. Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study.

    Science.gov (United States)

    Obel, Niels; Omland, Lars Haukali; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Pedersen, Gitte; Sørensen, Henrik Toft; Gerstoft, Jan

    2011-01-01

    We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population. In a Danish nationwide, population-based cohort study, we used population based registries to identify (1) all Danish HIV-infected patients who started HAART in the period 1 January 1998-1 July 2009, and (2) a comparison cohort of individuals matched on date of birth and gender (N = 2,267 and 9,068, respectively). Study inclusion began 1 year after start of HAART. Patients were categorised hierarchically in four groups according to the three risk factors, which were identified before study inclusion. The main outcome measure was probability of survival from age 25 to 65 years. The probability of survival from age 25 to age 65 was substantially lower in HIV patients [0.48 (95% confidence interval (CI) 0.42-0.55)] compared to the comparison cohort [0.88 (0.86 to 0.90)]. However, in HIV patients with no risk factors (N = 871) the probability of survival was equivalent to that of the general population [0.86 (95% CI 0.77-0.92)]. In contrast, the probability of survival was 0.58 in patients with HIV risk factors (N = 704), 0.30 in patients with comorbidities (N = 479), and 0.03 in patients with drug or alcohol abuse (N = 313). The increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment. Mortality in patients without risk factors on a successful HAART is almost identical to that of the non-HIV-infected population.

  14. Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study.

    Science.gov (United States)

    Rodríguez-Arbolí, Eduardo; Mwamelo, Kim; Kalinjuma, Aneth Vedastus; Furrer, Hansjakob; Hatz, Christoph; Tanner, Marcel; Battegay, Manuel; Letang, Emilio

    2017-01-01

    Scarce data are available on the epidemiology of hypertension among HIV patients in rural sub-Saharan Africa. We explored the prevalence, incidence and risk factors for incident hypertension among patients who were enrolled in a rural HIV cohort in Tanzania. Prospective longitudinal study including HIV patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2013 and 2015. Non-ART naïve subjects at baseline and pregnant women during follow-up were excluded from the analysis. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of baseline characteristics and incident hypertension. Among 955 ART-naïve, eligible subjects, 111 (11.6%) were hypertensive at recruitment. Ten women were excluded due to pregnancy. The remaining 834 individuals contributed 7967 person-months to follow-up (median 231 days, IQR 119-421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days from time of enrolment into the cohort [incidence rate 120.0 cases/1000 person-years, 95% confidence interval (CI) 97.2-150.0]. ART was started in 630 (75.5%) patients, with a median follow-up on ART of 7 months (IQR 4-14). Cox regression models identified age [adjusted hazard ratio (aHR) 1.34 per 10 years increase, 95% CI 1.07-1.68, p = 0.010], body mass index (aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and estimated glomerular filtration rate (aHR risk factors for hypertension development. The prevalence and incidence of hypertension were high in our cohort. Traditional cardiovascular risk factors predicted incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and integrated management into HIV programmes in rural sub-Saharan Africa.

  15. Lipodystrophy induced by combination antiretroviral therapy in HIV/AIDS patients: A Belgrade cohort study

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    Dragović Gordana

    2014-01-01

    Full Text Available Background/Aim. Highly active antiretroviral therapy (HAART has led to dramatic reductions in mortality and morbidity of HIV/AIDS-patients. Lipodystrophy, a syndrome including peripheral fat wasting and central obesity, is well-documented side effect of HAART. The aim of this study was to evaluate the incidence of lipodystrophy, and to determine its risk ratios in a HIV/AIDS cohort. Methods. This cross-sectional study included all antiretroviral-naive HIV/AIDS patients commencing HAART from October 1, 2001 to October 1, 2010, in the HIV/AIDS Center, Institute of Infectious and Tropical Diseases, Belgrade, Serbia. Univariate and stepwise multivariate logistic regression analyses were used to determine the odds ratios (OR with the confidence interval (CI of 95%, in order to establish the relative risk for lipodystrophy. The Kaplan-Meier-method was used to determine the probability of development lipodystrophy over time. All statistical analyses were performed using SPSS software version using 0.05 as a p-treshold for the significance. Results. This study included 840 HIV/AIDS patients, 608 women and 232 men, followed for 5.6 ± 2.8 years. The prevalence of lipodystrophy was 69.2%. Univariate and stepwise multivariate regression analysis identified that the female gender, hepatitis C coinfection, AIDS diagnosis prior to HAART initiation, nucleoside-reverse-transcriptase-inhibitors and proteaseinhibitors based regimens had a high risk for developing lipodystrophy in HIV/AIDS-patients (OR = 1.6, 95% CI = 1.1-3.49, p = 0.04; OR = 3.31, 95% CI = 1.4 - 3.8, p < 0.01; OR = 3.7, 95% CI = 1.7 - 6.1, p < 0.01; OR = 2.1, 95% CI = 1.7 - 3.3, p < 0.01; OR = 6.1, 95% CI = 4.1 - 9.7, p < 0.01, respectively. Conclusion. Despite much greater life expectancy of HIV/AIDSpatients, treatment-related toxicities still remain a major concern. Monitoring of lipodystrophy, as side effect of HAART, is particularly important. [Projekat Ministarstva nauke Republike Srbije, br

  16. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study.

    Science.gov (United States)

    Weber, R; Ruppik, M; Rickenbach, M; Spoerri, A; Furrer, H; Battegay, M; Cavassini, M; Calmy, A; Bernasconi, E; Schmid, P; Flepp, M; Kowalska, J; Ledergerber, B

    2013-04-01

    Mortality among HIV-infected persons is decreasing, and causes of death are changing. Classification of deaths is hampered because of low autopsy rates, frequent deaths outside of hospitals, and shortcomings of International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding. We studied mortality among Swiss HIV Cohort Study (SHCS) participants (1988-2010) and causes of death using the Coding Causes of Death in HIV (CoDe) protocol (2005-2009). Furthermore, we linked the SHCS data to the Swiss National Cohort (SNC) cause of death registry. AIDS-related mortality peaked in 1992 [11.0/100 person-years (PY)] and decreased to 0.144/100 PY (2006); non-AIDS-related mortality ranged between 1.74 (1993) and 0.776/100 PY (2006); mortality of unknown cause ranged between 2.33 and 0.206/100 PY. From 2005 to 2009, 459 of 9053 participants (5.1%) died. Underlying causes of deaths were: non-AIDS malignancies [total, 85 (19%) of 446 deceased persons with known hepatitis C virus (HCV) status; HCV-negative persons, 59 (24%); HCV-coinfected persons, 26 (13%)]; AIDS [73 (16%); 50 (21%); 23 (11%)]; liver failure [67 (15%); 12 (5%); 55 (27%)]; non-AIDS infections [42 (9%); 13 (5%); 29 (14%)]; substance use [31 (7%); 9 (4%); 22 (11%)]; suicide [28 (6%); 17 (7%), 11 (6%)]; myocardial infarction [28 (6%); 24 (10%), 4 (2%)]. Characteristics of deceased persons differed in 2005 vs. 2009: median age (45 vs. 49 years, respectively); median CD4 count (257 vs. 321 cells/μL, respectively); the percentage of individuals who were antiretroviral therapy-naïve (13 vs. 5%, respectively); the percentage of deaths that were AIDS-related (23 vs. 9%, respectively); and the percentage of deaths from non-AIDS-related malignancies (13 vs. 24%, respectively). Concordance in the classification of deaths was 72% between CoDe and ICD-10 coding in the SHCS; and 60% between the SHCS and the SNC registry. Mortality in HIV-positive persons decreased to 1.33/100 PY in 2010. Hepatitis

  17. Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

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    Didier K Ekouevi

    Full Text Available HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA.We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female, including 1,021 HIV-2 infected patients (551 on ART and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART. At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7 and 42.4 years, IQR (37.0-47.3 for dually seropositive patients (p = 0.048. Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C. The median CD4 count at the ART initiation is 166 cells/mm(3, IQR (83-247 among HIV-2 infected patients and 146 cells/mm(3, IQR (55-249 among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3 after 24 months on ART for HIV-2 patients and 169 cells/mm(3 for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3.This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.

  18. Statin Therapy and Mortality in HIV-Infected Individuals; A Danish Nationwide Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Rasmussen, Line; Kronborg, Gitte; Larsen, Carsten

    2013-01-01

    Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nationwide cohort of HIV......-infected individuals to estimate the impact of statin use on mortality before and after a diagnosis of cardiovascular disease, chronic kidney disease or diabetes....

  19. Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study.

    Science.gov (United States)

    Velásquez, Gustavo E; Cegielski, J Peter; Murray, Megan B; Yagui, Martin J A; Asencios, Luis L; Bayona, Jaime N; Bonilla, César A; Jave, Hector O; Yale, Gloria; Suárez, Carmen Z; Sanchez, Eduardo; Rojas, Christian; Atwood, Sidney S; Contreras, Carmen C; Santa Cruz, Janeth; Shin, Sonya S

    2016-02-01

    Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Of 1701 participants treated for tuberculosis, 136 (8.0%) died during tuberculosis treatment. HIV-positive patients constituted 11.0% of the cohort and contributed to 34.6% of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9%, P Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.

  20. Time to complete wound healing in HIV-positive and HIV-negative men following medical male circumcision in Kisumu, Kenya: a prospective cohort study.

    Science.gov (United States)

    Rogers, John H; Odoyo-June, Elijah; Jaoko, Walter; Bailey, Robert C

    2013-01-01

    While voluntary medical male circumcision (VMMC) has been shown to be protective against HIV-acquisition, the procedure may place men and their partners at risk of HIV infection in the period following circumcision if sex is resumed before the wound is healed. This prospective cohort study evaluates post-circumcision wound healing to determine whether the 42-day post-circumcision abstinence period, recommended by the World Health Organization and adopted by VMMC programs, is optimal. Men were circumcised by forceps-guided method and their post-circumcision wounds examined weekly for seven weeks and at 12 weeks. Time to complete healing was recorded in completed weeks since circumcision, and its associations with baseline covariates were assessed by Kaplan-Meier methods and Cox Proportional Hazard Models. A total of 215 HIV-negative and 108 HIV-positive men aged 18-35 years (median 26, IQR 23-30) were enrolled. 97.1% of scheduled follow-up visits were completed. At week 4, 59.3% of HIV-positive men and 70.4% of age-matched HIV-negative men were healed. At week 6, these percentages rose to 93.4% in HIV-positive men and 92.6% in age-matched HIV-negative men. There was no difference in the hazard of healing between 108 HIV-positive and 108 age-matched HIV-negative men (HR 0.91 95% CI 0.70-1.20). Early post-operative infection was associated with delayed healing in both HIV-positive and HIV-negative men (HR 0.48 95% CI 0.23-1.00). Our results indicate that the WHO recommendation for 42-days post-circumcision sexual abstinence should be maintained for both HIV-positive and HIV-negative men. It is important to stress condom use upon resumption of sex in all men undergoing circumcision.

  1. Time to complete wound healing in HIV-positive and HIV-negative men following medical male circumcision in Kisumu, Kenya: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    John H Rogers

    Full Text Available While voluntary medical male circumcision (VMMC has been shown to be protective against HIV-acquisition, the procedure may place men and their partners at risk of HIV infection in the period following circumcision if sex is resumed before the wound is healed. This prospective cohort study evaluates post-circumcision wound healing to determine whether the 42-day post-circumcision abstinence period, recommended by the World Health Organization and adopted by VMMC programs, is optimal.Men were circumcised by forceps-guided method and their post-circumcision wounds examined weekly for seven weeks and at 12 weeks. Time to complete healing was recorded in completed weeks since circumcision, and its associations with baseline covariates were assessed by Kaplan-Meier methods and Cox Proportional Hazard Models. A total of 215 HIV-negative and 108 HIV-positive men aged 18-35 years (median 26, IQR 23-30 were enrolled. 97.1% of scheduled follow-up visits were completed. At week 4, 59.3% of HIV-positive men and 70.4% of age-matched HIV-negative men were healed. At week 6, these percentages rose to 93.4% in HIV-positive men and 92.6% in age-matched HIV-negative men. There was no difference in the hazard of healing between 108 HIV-positive and 108 age-matched HIV-negative men (HR 0.91 95% CI 0.70-1.20. Early post-operative infection was associated with delayed healing in both HIV-positive and HIV-negative men (HR 0.48 95% CI 0.23-1.00.Our results indicate that the WHO recommendation for 42-days post-circumcision sexual abstinence should be maintained for both HIV-positive and HIV-negative men. It is important to stress condom use upon resumption of sex in all men undergoing circumcision.

  2. Cohort study of human immunodeficiency virus (HIV) antibody testing among patients receiving long-term dialysis at a university hospital.

    Science.gov (United States)

    Johnston, B L; Poole, C L; Zito, D R; Normansell, D E; Westervelt, F B; Farr, B M

    1988-12-01

    In a longitudinal study to determine the seroprevalence of antibody to the human immunodeficiency virus (HIV) and the natural history of a positive enzyme immunoassay (EIA) result we followed a cohort of 98 patients receiving long-term dialysis. Eight patients (8.2%) in the cohort had a positive EIA and a negative Western blot test result. The EIA-positive results of all patients seroconverted to negative during follow-up. No illness suggestive of HIV infection developed in any of the patients. Significantly associated with a false positive EIA were prior renal transplantation, transfusions during the months just before the positive EIA result, and a greater number of lifetime transfusions before the positive test result. We confirm that routine HIV screening of patients receiving long-term dialysis is associated with a high rate of false positive EIA results and conclude that such testing is unnecessary in the absence of established risk factors for HIV infection.

  3. Predictors of Delayed Entry into Medical Care of Children Diagnosed with HIV Infection: Data from an HIV Cohort Study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2013-01-01

    Full Text Available Data about the attrition before entry into care of children diagnosed with HIV in low- or middle-income countries are scarce. The aim of this study is to describe the attrition before engagement in HIV medical care in 523 children who were diagnosed with HIV from 2007 to 2012 in a cohort study in India. The cumulative incidence of children who entered into care was 87.2% at one year, but most children who did not enter into care within one year were lost to followup. The mortality before entry into care was low (1.3% at one year and concentrated during the first three months after HIV diagnosis. Factors associated with delayed entry into care were being diagnosed after mother’s HIV diagnosis, belonging to scheduled castes, age 90 minutes from the HIV centre. Children whose parents were alive and were living in a rented house were at a higher risk of delayed entry into care than those who were living in an owned house. The results of this study can be used to improve the linkage between HIV testing and HIV care of children diagnosed with HIV in India.

  4. Weighted likelihood method for grouped survival data in case-cohort studies with application to HIV vaccine trials.

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    Li, Zhiguo; Gilbert, Peter; Nan, Bin

    2008-12-01

    Grouped failure time data arise often in HIV studies. In a recent preventive HIV vaccine efficacy trial, immune responses generated by the vaccine were measured from a case-cohort sample of vaccine recipients, who were subsequently evaluated for the study endpoint of HIV infection at prespecified follow-up visits. Gilbert et al. (2005, Journal of Infectious Diseases 191, 666-677) and Forthal et al. (2007, Journal of Immunology 178, 6596-6603) analyzed the association between the immune responses and HIV incidence with a Cox proportional hazards model, treating the HIV infection diagnosis time as a right-censored random variable. The data, however, are of the form of grouped failure time data with case-cohort covariate sampling, and we propose an inverse selection probability-weighted likelihood method for fitting the Cox model to these data. The method allows covariates to be time dependent, and uses multiple imputation to accommodate covariate data that are missing at random. We establish asymptotic properties of the proposed estimators, and present simulation results showing their good finite sample performance. We apply the method to the HIV vaccine trial data, showing that higher antibody levels are associated with a lower hazard of HIV infection.

  5. HIV and cancer: a comparative retrospective study of Brazilian and U.S. clinical cohorts.

    Science.gov (United States)

    Castilho, Jessica L; Luz, Paula M; Shepherd, Bryan E; Turner, Megan; Ribeiro, Sayonara R; Bebawy, Sally S; Netto, Juliana S; McGowan, Catherine C; Veloso, Valdiléa G; Engels, Eric A; Sterling, Timothy R; Grinsztejn, Beatriz

    2015-01-01

    With successful antiretroviral therapy, non-communicable diseases, including malignancies, are increasingly contributing to morbidity and mortality among HIV-infected persons. The epidemiology of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in HIV-infected populations in Brazil has not been well described. It is not known if cancer trends in HIV-infected populations in Brazil are similar to those of other countries where antiretroviral therapy is also widely available. We performed a retrospective analysis of clinical cohorts at Instituto Nacional de Infectologia Evandro Chagas (INI) in Rio de Janeiro and Vanderbilt Comprehensive Care Clinic (VCCC) in Nashville from 1998 to 2010. We used Poisson regression and standardized incidence ratios (SIRs) to examine incidence trends. Clinical and demographic predictors of ADCs and NADCs were examined using Cox proportional hazards models. This study included 2,925 patients at INI and 3,927 patients at VCCC. There were 57 ADCs at INI (65% Kaposi sarcoma), 47 at VCCC (40% Kaposi sarcoma), 45 NADCs at INI, and 82 at VCCC. From 1998 to 2004, incidence of ADCs remained statistically unchanged at both sites. From 2005 to 2010, ADC incidence decreased in both cohorts (INI incidence rate ratio per year = 0.74, p < 0.01; VCCC = 0.75, p < 0.01). Overall Kaposi sarcoma incidence was greater at INI than VCCC (3.0 vs. 1.2 cases per 1,000 person-years, p < 0.01). Incidence of NADCs remained constant throughout the study period (overall INI incidence 3.6 per 1,000 person-years and VCCC incidence 5.3 per 1,000 person-years). Compared to general populations, overall risk of NADCs was increased at both sites (INI SIR = 1.4 [95% CI 1.1-1.9] and VCCC SIR = 1.3 [1.0-1.7]). After non-melanoma skin cancers, the most frequent NADCs were anal cancer at INI (n = 7) and lung cancer at VCCC (n = 11). In multivariate models, risk of ADC was associated with male sex and immunosuppression. Risk of

  6. Preventive health care among HIV positive women in a Utah HIV/AIDS clinic: a retrospective cohort study

    Science.gov (United States)

    2014-01-01

    Background Despite evidence that HIV positive women may suffer higher rates of heart disease, diabetes, human papillomavirus infection, and some types of cancer, the provision of preventive health services to HIV positive women is unknown. Preventive health services recommended for such women include breast, colorectal and cervical cancer screening, sexually transmitted infection (STI) testing, vaccinations, and patient counseling on a number of issues including sexual behaviors. Methods This retrospective cohort study utilized medical record reviews of 192 HIV positive women who were patients at the University of Utah Infectious Diseases Clinic in 2009. Medical records were reviewed for all encounters during 2009 using a standardized data collection form; data were collected on patient demographics and a variety of preventive health services. Chi squared tests were used to assess receipt of preventive health services by demographic factors, and multivariable logistic regression was used to determine predictors of receiving select services. Results The most commonly recorded preventive services included blood pressure screening, screening for Hepatitis A and B, Tetanus-Diphtheria-Pertussis vaccination, Pneumococcal pneumonia vaccination, substance abuse screening, and mental health screening. STI testing and safe sex counseling were documented in the medical records of only 37% and 33.9% of women, respectively. Documentation of cancer screening was also low, with cervical cancer screening documented for 56.8% of women, mammography for 65% (N = 26/40) of women, and colorectal cancer screening for 10% (N = 4/40) of women, where indicated. In multivariable models, women with private health insurance were less likely to have documented STI testing (OR 0.20; 95% CI 0.08 - 0.52), and, Hispanic women were less likely to have documented safe-sex counseling (OR 0.26; 95% CI 0.07 - 0.94). Conclusions HIV/AIDS providers should focus on the needs of all women for

  7. Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort

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    Philip, Susan S.; Yu, Xuesong; Donnell, Deborah; Vittinghoff, Eric; Buchbinder, Susan

    2010-01-01

    Background Seroadaptation strategies such as serosorting and seropositioning originated within communities of men who have sex with men (MSM), but there are limited data about their effectiveness in preventing HIV transmission when utilized by HIV-negative men. Methodology/Principal Findings Data from the EXPLORE cohort of HIV-negative MSM who reported both seroconcordant and serodiscordant partners were used to evaluate serosorting and seropositioning. The association of serosorting and seropositioning with HIV seroconversion was evaluated in this cohort of high risk MSM from six U.S. cities. Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR = 0.88; 95%CI, 0.81–0.95), even among participants reporting ≥10 partners. Those who more consistently practiced serosorting were more likely to be white (p = 0.01), have completed college (p = <0.0002) and to have had 10 or more partners in the six months before the baseline visit (p = 0.01) but did not differ in age, reporting HIV-infected partners, or drug use. There was no evidence of a seroconversion effect with seropositioning (OR 1.02, 95%CI, 0.92–1.14). Significance In high risk HIV uninfected MSM who report unprotected anal intercourse with both seroconcordant and serodiscordant partners, serosorting was associated with a modest decreased risk of HIV infection. To maximize any potential benefit, it will be important to increase accurate knowledge of HIV status, through increased testing frequency, improved test technology, and continued development of strategies to increase disclosure. PMID:20844744

  8. Health and economic impact of HIV/AIDS on South African households: a cohort study

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    Booysen Frederick LR

    2003-04-01

    Full Text Available Abstract Background South African households are severely affected by human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS but health and economic impacts have not been quantified in controlled cohort studies. Methods We compared households with an HIV-infected member, and unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa. Interviews were conducted with one key informant in each household, at baseline and six months later. We studied 1913 members of 404 households, with 94% and 96% follow up, respectively. Household and individual level analyses were done. Results Members of affected households, compared to members of unaffected households, were independently more likely to be continuously ill (adjusted odds ratio (OR 2.1, 95% CI 1.3–3.4 at follow up, and to die (adjusted OR 3.4, 95% CI 1.0–11, mainly due to infectious diseases. Government clinics and hospitals were the main sources of health care. Affected households were poorer than unaffected households at baseline (relative income per person 0.61, 95% CI 0.49–0.76. Over six months expenditure and income decreased more rapidly in affected than in unaffected households (baseline-adjusted relative expenditure 0.86, 95% CI 0.75–0.99 and income 0.89, 95% CI 0.75–1.05. Baseline morbidity was independently associated with lower income and expenditure at baseline but not with changes over six months. Conclusions HIV/AIDS affects the health and wealth of households as well as infected individuals, aggravating pre-existing poverty.

  9. Immune reconstitution inflammatory syndrome associated with toxoplasmic encephalitis in hiv-infected patients : a multicenter cohort study

    NARCIS (Netherlands)

    van Bilsen, Ward P H; van den Berg, Charlotte H S B; Rijnders, Bart J A; Brinkman, Kees; Mulder, Jan W.; Gelinck, Luc B S; Hoepelman, Andy I M|info:eu-repo/dai/nl/074382160; Wit, Ferdinand W N M; van de Beek, Diederik; Prins, Jan M.

    OBJECTIVES:: To investigate the incidence and risk factors of immune reconstitution inflammatory syndrome (IRIS) associated with toxoplasmic encephalitis (TE) in patients starting cART. DESIGN:: A historical multicenter cohort study. METHODS:: We included all HIV-infected patients diagnosed with TE

  10. Linking women who test HIV-positive in pregnancy-related services to HIV care and treatment services in Kenya: a mixed methods prospective cohort study.

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    Laura Ferguson

    Full Text Available There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV.This prospective cohort study of 100 HIV-positive women recruited within pregnancy-related services in a district hospital in Kenya employed quantitative methods to assess attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services. Qualitative methods were used to explore barriers and facilitators to navigating these services. Structured questionnaires were administered to cohort participants at enrolment and 90+ days later. Participants' medical records were monitored prospectively. Semi-structured qualitative interviews were carried out with a sub-set of 19 participants.Only 53/100 (53% women registered at an HIV clinic within 90 days of HIV diagnosis, of whom 27/53 (51% had a CD4 count result in their file. 11/27 (41% women were eligible for immediate antiretroviral therapy (ART; only 6/11 (55% started ART during study follow-up. In multivariable logistic regression analysis, factors associated with registration at the HIV clinic within 90 days of HIV diagnosis were: having cared for someone with HIV (aOR:3.67(95%CI:1.22, 11.09, not having to pay for transport to the hospital (aOR:2.73(95%CI:1.09, 6.84, and having received enough information to decide to have an HIV test (aOR:3.61(95%CI:0.83, 15.71. Qualitative data revealed multiple factors underlying high patient drop-out related to women's social support networks (e.g. partner's attitude to HIV status, interactions with health workers (e.g. being given unclear/incorrect HIV-related information and health services characteristics (e.g. restricted opening hours, long waiting times.HIV testing within pregnancy-related services is an important entry point to HIV care and treatment services, but few women successfully completed the steps needed for assessment of their treatment needs within three months of diagnosis

  11. Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study.

    Science.gov (United States)

    Peck, Robert N; Wang, Richard J; Mtui, Graham; Smart, Luke; Yango, Missana; Elchaki, Rim; Wajanga, Bahati; Downs, Jennifer A; Mteta, Kien; Fitzgerald, Daniel W

    2016-12-15

    Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, posthospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality. In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at 1, 3, 6, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital. We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in hospital vs. 104/494 (21.1%) of the HIV-uninfected adults. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Posthospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected adults (adjusted P = 0.006). The 66/105 (62.9%) HIV-infected adults who attended clinic within 1 month after discharge had significantly lower mortality than the other HIV-infected adults [adjusted hazards ratio = 0.17 (0.07-0.39), P Adults admitted to a nearby government hospital had similar high rates of posthospital mortality. Posthospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The posthospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing posthospital linkage to primary HIV care.

  12. Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study.

    Science.gov (United States)

    Dehon, Patricia M; Hagensee, Michael E; Sutton, Kimberly J; Oddo, Hope E; Nelson, Nia; McGowin, Chris L

    2016-06-01

    Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in inflammatory syndromes of the female reproductive tract. The objective of this study was to investigate human immunodeficiency virus (HIV)-infected women for an association between M. genitalium and cervicitis, a putative mechanism for enhanced HIV transmission efficiency to an uninfected partner. Using a longitudinal cohort of antiretroviral therapy-adherent New Orleans women, we retrospectively screened for M. genitalium and quantitatively characterized several markers of cervical inflammation, including secreted cytokines and cytological and histological signs of leukocyte infiltration. We observed a high prevalence of M. genitalium (7.4%) among HIV-infected New Orleans women. Chronic M. genitalium infection was associated with increased secretion of proinflammatory cytokines, including interleukin 1β, interleukin 6, and interleukin 8, and marked inflammatory cervical infiltrates in the cervix with enrichment of HIV target cells. Cure of M. genitalium infection resulted in ablation of all signs of inflammation. These findings implicate M. genitalium as an etiologic agent of cervicitis in HIV-infected women, providing a potential mechanism for enhanced HIV transmission to an uninfected partner. Screening and treatment of M. genitalium among HIV-infected individuals may be warranted to further understand this coinfection scenario, improve cervical health, and reduce the spread of HIV. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  13. Frequency of and Risk Factors for Depression among Participants in the Swiss HIV Cohort Study (SHCS.

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    Alexia Anagnostopoulos

    Full Text Available We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study.Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression.Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI 3.5-4.3. Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7% participants. Incidence and cumulative prevalence were higher in injection drug users (IDU and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83-1.11 based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78-3.09, female IDU (2.33, 1.59-3.39 and white heterosexual men (1.32, 0.94-1.84 compared to white heterosexual women and homosexual men (0.53, 0.29-0.95; and 0.71, 0.55-0.92. Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94-1.45 vs. 0.86, 0.71-1.03, P = 0.033. Suicides (n = 18 did not differ between HIV transmission groups (P = 0.50, but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10-0.31; vs. 0.04, 0.02-0.10; P = 0.003.Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.

  14. Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984-2013.

    Science.gov (United States)

    Okafor, Chukwuemeka N; Cook, Robert L; Chen, Xinguang; Surkan, Pamela J; Becker, James T; Shoptaw, Steve; Martin, Eileen; Plankey, Michael W

    2017-04-01

    To construct longitudinal trajectories of marijuana use in a sample of men who have sex with men living with or at-risk for HIV infection. We determined factors associated with distinct trajectories of use as well as those that serve to modify the course of the trajectory. Data were from 3658 [1439 HIV-seropositive (HIV+) and 2219 HIV-seronegative (HIV-)] participants of the Multicenter AIDS Cohort Study. Frequency of marijuana use was obtained semiannually over a 29-year period (1984-2013). Group-based trajectory models were used to identify the trajectories and to determine predictors and modifiers of the trajectories over time. Four distinct trajectories of marijuana use were identified: abstainer/infrequent (65 %), decreaser (13 %), increaser (12 %) and chronic high (10 %) use groups. HIV+ status was significantly associated with increased odds of membership in the decreaser, increaser and chronic high use groups. Alcohol, smoking, stimulant and other recreational drug use were associated with increasing marijuana use across all four trajectory groups. Antiretroviral therapy use over time was associated with decreasing marijuana use in the abstainer/infrequent and increaser trajectory groups. Having a detectable HIV viral load was associated with increasing marijuana use in the increaser group only. Future investigations are needed to determine whether long-term patterns of use are associated with adverse consequences especially among HIV+ persons.

  15. Inflammation in HIV-infected patients: impact of HIV, lifestyle, body composition, and demography - a cross sectional cohort study.

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    Anne Langkilde

    Full Text Available To examine mechanisms underlying the increased inflammatory state of HIV-infected patients, by investigating the association of HIV-related factors, demography, lifestyle, and body composition with the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR.suPAR was measured in EDTA-plasma and associated with HIV-related factors (HIV-duration, combination antiretroviral treatment (cART, nadir CD4+ cell count, CD4+ cell count, and HIV RNA; demography; lifestyle; and body composition determined by Dual energy X-ray Absorptiometry (DXA scan, in multiple linear regression analyses adjusted for biological relevant covariates, in a cross-sectional study of 1142 HIV-infected patients.Increased suPAR levels were significantly associated with age, female sex, daily smoking, metabolic syndrome and waist circumference. cART was associated with 17% lower suPAR levels. In cART-treated patients 10-fold higher HIV RNA was associated with 15% higher suPAR, whereas there was no association in untreated patients. Patients with CD4+ cell count <350 cells/µL had higher suPAR levels than patients with CD4+ cell count ≥350 cells/µL , though not significantly. We found no association with nadir CD4+ cell count or with duration of HIV-infection [corrected]. Finally, suPAR was not associated with adipose tissue distribution, but strongly associated with low leg muscle mass [corrected].In patients infected through intravenous drug use (IDU, CD4+ cell counts ≥350 cells/µL were associated with 27% lower suPAR (p = 0.03, andsuPAR was 4% lower pr. year during treatment (p = 0.05; however, there was no association with HIV RNA, duration of HIV-infection, nor cART [corrected].We found elevated suPAR levels in untreated patients compared to patients on cART. Moreover, we observed a significant positive association between suPAR and HIV RNA levels in cART-treated patients. Age, HIV-transmission through IDU, metabolic syndrome, smoking, and low leg

  16. The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV.

    Science.gov (United States)

    Lucero, Robert James; Frimpong, Jemima A; Fehlberg, Elizabeth A; Bjarnadottir, Ragnhildur I; Weaver, Michael T; Cook, Christa; Modave, Francois; Rathore, Mobeen H; Morano, Jamie P; Ibanez, Gladys; Cook, Robert L

    2017-07-27

    The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.

  17. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study.

    Science.gov (United States)

    Ndlovu, Kwazi C Z; Sibanda, Wilbert; Assounga, Alain

    2017-02-03

    Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. HIV infection in end-stage renal disease patients managed by CAPD was associated with

  18. Neuropsychological profile in a specific cohort of HIV patients infected postnatally : a cross-sectional study

    OpenAIRE

    Riva, Silvia; Pravettoni, Gabriella; Cutica, Ilaria

    2015-01-01

    Silvia Riva,1,2 Ilaria Cutica,1 Gabriella Pravettoni1,3 1Department of Health Sciences, University of Milan, 2Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", 3European Institute of Oncology, Milan, Italy Abstract: HIV-associated neurocognitive disorders (HANDs) are one of the most important complications of HIV infection reported in the current literature. Although HANDs have been closely studied in vertically infected HIV populations o...

  19. Pericardial effusion of HIV-infected patients - results of a prospective multicenter cohort study in the era of antiretroviral therapy

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    Lind A

    2011-11-01

    Full Text Available Abstract Background Patients with human immunodeficiency virus (HIV infection have an increased risk of cardiovascular diseases. Previous publications described pericardial effusion as one of the most common HlV-associated cardiac affiliations. The aim of the current study was to investigate if pericardial effusion still has a relevant meaning of HIV-infected patients in the era of antiretroviral therapy. Methods The HIV-HEART (HIV-infection and HEART disease study is a cardiology driven, prospective and multicenter cohort study. Outpatients with a known HIV-infection were recruited during a 20 month period in a consecutive manner from September 2004 to May 2006. The study comprehends classic parameters of HIV-infection, comprising CD4-cell count (cluster of differentiation and virus load, as well as non-invasive tests of cardiac diseases, including a thorough transthoracic echocardiography. Results 802 HIV-infected patients (female: 16.6% with a mean age of 44.2 ± 10.3 years, were included. Duration of HIV-infection since initial diagnosis was 7.6 ± 5.8 years. Of all participants, 85.2% received antiretroviral therapy. Virus load was detectable in 34.4% and CD4 - cell count was in 12.4% less than 200 cells/μL. Pericardial effusions were present in only two patients of the analysed population. None of the participants had signs of a relevant cardiovascular impairment by pericardial effusion. Conclusions Our results demonstrate that the era of antiretroviral therapy goes along with low rates of pericardial effusions in HIV-infected outpatients. Our findings are in contrast to the results of publications, performed before the common use of antiretroviral therapy.

  20. The immunological response to syphilis differs by HIV status; a prospective observational cohort study.

    Science.gov (United States)

    Kenyon, Chris; Osbak, Kara Krista; Crucitti, Tania; Kestens, Luc

    2017-01-31

    It is not known if there is a difference in the immune response to syphilis between HIV-infected and uninfected individuals. We prospectively recruited all patients with a new diagnosis of syphilis and tested their plasma for IFNα, IFNγ, IL-1β, IL-12p40, IL-12p70, IP-10, MCP-1, MIP-1α, MIP-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10 and IL-17A at baseline pre-treatment and 6 months following therapy. A total of 79 HIV-infected [44 primary/secondary syphilis (PSS) and 35 latent syphilis (LS)] and 12 HIV-uninfected (10 PSS and 2 LS) cases of syphilis and 30 HIV-infected controls were included in the study. At the baseline visit, compared to the control group, concentrations of IL-10 were significantly elevated in the HIV-infected and uninfected groups. The level of IL-10 was significantly higher in the HIV-infected compared to the HIV-uninfected PSS group (25.3 pg/mL (IQR, 4.56-41.76) vs 2.73 pg/mL (IQR, 1.55-9.02), P = 0.0192). In the HIV-infected PSS group (but not the HIV-infected LS or HIV-uninfected PSS groups) the IP-10, MIP-1b, IL-6 and IL-8 were raised compared to the controls. IL-10 levels decreased but did not return to control baseline values by 6 months in HIV infected PSS and LS and HIV uninfected PSS. PSS and LS in HIV-infected individuals is characterized by an increase in inflammatory and anti-inflammatory cytokines such as IL-10. The increase of IL-10 is greater in HIV-infected than uninfected individuals. Further work is required to ascertain if this is part of an immunological profile that correlates with adverse outcomes such as serofast syphilis and neurosyphilis, in HIV-infected individuals.

  1. Acute HIV-1 infection in the Southeastern United States: a cohort study.

    Science.gov (United States)

    McKellar, Mehri S; Cope, Anna B; Gay, Cynthia L; McGee, Kara S; Kuruc, Joann D; Kerkau, Melissa G; Hurt, Christopher B; Fiscus, Susan A; Ferrari, Guido; Margolis, David M; Eron, Joseph J; Hicks, Charles B

    2013-01-01

    In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ≥18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years (IQR 22-38). Most (n=138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm(3) (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,585-3,565,728). The emergency department was the most frequent site of initial presentation (n=55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics.

  2. The Relationship Between Caffeine Intake and Immunological and Virological Markers of HIV Disease Progression in Miami Adult Studies on HIV Cohort.

    Science.gov (United States)

    Ramamoorthy, Venkataraghavan; Campa, Adriana; Rubens, Muni; Martinez, Sabrina S; Fleetwood, Christina; Stewart, Tiffanie; Liuzzi, Juan P; George, Florence; Khan, Hafiz; Li, Yinghui; Baum, Marianna K

    2017-05-01

    Although there are many studies on adverse health effects of substance use and HIV disease progression, similar studies about caffeine consumption are few. In this study, we investigated the effects of caffeine on immunological and virological markers of HIV disease progression. A convenience sample of 130 clinically stable people living with HIV/AIDS on antiretroviral therapy (65 consuming ≤250 mg/day and 65 consuming >250 mg/day of caffeine) were recruited from the Miami Adult Studies on HIV (MASH) cohort. This study included a baseline and 3-month follow-up visit. Demographics, body composition measures, substance use, Modified Caffeine Consumption Questionnaire (MCCQ), and CD4 count and HIV viral load were obtained for all participants. Multivariable linear regression and Linear Mixed Models (LMMs) were used to understand the effect of caffeine consumption on CD4 count and HIV viral load. The mean age of the cohort was 47.9 ± 6.4 years, 60.8% were men and 75.4% were African Americans. All participants were on ART during both the visits. Mean caffeine intake at baseline was 337.6 ± 305.0 mg/day and did not change significantly at the 3-month follow-up visit. Multivariable linear regressions after adjustment for covariates showed significant association between caffeine consumption and higher CD4 count (β = 1.532, p = 0.049) and lower HIV viral load (β = -1.067, p = 0.048). LMM after adjustment for covariates showed that the relationship between caffeine and CD4 count (β = 1.720, p = 0.042) and HIV viral load (β = -1.389, p = 0.033) continued over time in a dose-response manner. Higher caffeine consumption was associated with higher CD4 cell counts and lower HIV viral loads indicating beneficial effects on HIV disease progression. Further studies examining biochemical effects of caffeine on CD4 cell counts and viral replication need to be done in the future.

  3. Associations between HIV and schizophrenia and their effect on HIV treatment outcomes: a nationwide population-based cohort study in Denmark.

    Science.gov (United States)

    Helleberg, Marie; Pedersen, Marianne G; Pedersen, Carsten B; Mortensen, Preben B; Obel, Niels

    2015-08-01

    Associations between HIV and schizophrenia in people with and without substance use disorders and the effect on timeliness of HIV diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly understood. We aimed to assess the association between HIV and schizophrenia and the effect on HIV treatment outcomes in people with and without substance use disorders. We did a population-based cohort study with data from nationwide registries in Denmark to investigate the risk of schizophrenia after a diagnosis of HIV and the risk of HIV after a diagnosis of schizophrenia, accounting for substance misuse, timeliness of HIV diagnosis, and treatment success in relation to schizophrenia. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 1995, who we followed up from their 16th birthday or Jan 1, 1995 (whichever occurred last) until their death, emigration from Denmark, onset of schizophrenia, or Dec 31, 2011 (whichever came first). We estimated incidence rate ratios (IRRs) with Poisson and Cox regression, with adjustment for calendar period, and age and its interaction with sex. We identified 2,786,286 individuals, of whom we included 2,646,154 people in analyses of risk of schizophrenia diagnosis and 2,658,662 people in analyses of risk of HIV diagnosis. In 35,353,633 person-years of follow up, HIV was associated with an increased risk of schizophrenia (IRR 4·09, 95% CI 2·73-5·83) and acute psychosis (7·15, 4·45-10·8); the IRR was highest within the first year of HIV diagnosis for both disorders (8·24, 2·95-17·7 and 12·7, 3·15-32·9, respectively). Schizophrenia was not associated with an increased risk of HIV in individuals without substance misuse disorders (IRR 1·42, 95% CI 0·81-2·27). The risk of schizophrenia in individuals with HIV decreased after ART (IRR 0·53, 0·32-0·87). The risk of acute psychosis did not differ between HIV-infected individuals receiving antiretroviral regimens with and without

  4. Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study.

    Science.gov (United States)

    De Socio, Giuseppe Vittorio; Ricci, Elena; Maggi, Paolo; Parruti, Giustino; Celesia, Benedetto Maurizio; Orofino, Giancarlo; Madeddu, Giordano; Martinelli, Canio; Menzaghi, Barbara; Taramasso, Lucia; Bonfanti, Paolo; Pucci, Giacomo; Schillaci, Giuseppe

    2017-02-01

    Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension. Multicenter prospective cohort study, sampling 961 consecutive HIV patients (71% men, mean age 46 ± 9 years, 30% hypertensive) examined in 2010-2014 and after a median follow-up of 3.4 years. Among hypertensive patients, hypertension awareness (63% at baseline and 92% at follow-up), treatment (54 vs. 79%), and control (35 vs. 59%) all improved during follow-up. The incidence of new-onset hypertension was 50.1/1000 person-years (95% confidence interval, 41.2-60.3). Multivariable-adjusted predictors of hypertension were age, BMI, estimated cardiovascular risk, blood pressure, and advanced HIV clinical stage.In total, 35 new cardiovascular events were reported during follow-up (11.1/1000 person-years). In a multivariate model, baseline cardiovascular risk and hypertensive status predicted incident cardiovascular events, whereas a higher CD4 cell count had a protective role. In treated hypertensive patients, the use of integrase strand transfer inhibitors at follow-up was associated with a lower SBP (average yearly change, -3.8 ± 1.6 vs. -0.9 ± 0.5 mmHg in integrase strand transfer inhibitor users vs. nonusers, respectively, P = 0.02). Hypertension awareness, treatment, and control rates all improved in adult Italian HIV patients over the last few years, although hypertension remains highly prevalent (41%) in middle-aged HIV patients, and significantly impacts cardiovascular morbidity. Traditional risk factors and advanced HIV disease predict new-onset hypertension, whereas CD4 cell count favorably affects future cardiovascular events.

  5. Risk of Cataract Surgery in HIV-Infected Individuals: A Danish Nationwide Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Kessel, Line; Molander, Laleh D

    2011-01-01

    analogue reverse-transcriptase inhibitors (NNRTIs) were estimated by Poisson regression analyses and adjusted for age, sex, and calendar year. Results. HIV-infected individuals had a higher risk of cataract surgery than the comparison cohort (adjusted IRR, 1.87; 95% confidence interval (CI): 1...... assessed the risk of cataract surgery in HIV-infected individuals compared with the general population. Methods. We identified 5315 HIV-infected individuals from a Danish national cohort of HIV-infected individuals and a population-based age- and sex-matched comparison cohort of 53¿150 individuals. Data...

  6. Risk of Cataract Surgery in HIV-Infected Individuals: A Danish Nationwide Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Kessel, Line; Molander, Laleh D

    2011-01-01

    analogue reverse-transcriptase inhibitors (NNRTIs) were estimated by Poisson regression analyses and adjusted for age, sex, and calendar year.Results. HIV-infected individuals had a higher risk of cataract surgery than the comparison cohort (adjusted IRR, 1.87; 95% confidence interval (CI): 1...... assessed the risk of cataract surgery in HIV-infected individuals compared with the general population.Methods. We identified 5315 HIV-infected individuals from a Danish national cohort of HIV-infected individuals and a population-based age- and sex-matched comparison cohort of 53 150 individuals. Data...

  7. Observed versus predicted cardiovascular events and all-cause death in HIV infection: a longitudinal cohort study.

    Science.gov (United States)

    De Socio, Giuseppe Vittorio; Pucci, Giacomo; Baldelli, Franco; Schillaci, Giuseppe

    2017-06-12

    The aim of the study was to assess the applicability of an algorithm predicting 10-year cardiovascular disease (CVD) generated in the setting of the Framingham Heart Study to a real-life, contemporary Italian cohort of HIV-positive subjects. The study was an observational longitudinal cohort study. The probability for 10-year CVD events according to the Framingham algorithm was assessed in 369 consecutive HIV-positive participants free from overt CVD enrolled in 2004, who were followed for a median of 10.0 years (interquartile range, 9.1-10.1). Cardiovascular events included myocardial infarction, hospitalized heart failure, revascularized angina, sudden cardiac death, stroke, peripheral arterial disease. Over 3097 person-years of observation, we observed a total of 34 CVD events, whereas Framingham algorithm predicted the occurrence of 34.3 CVD events. CVD event rate was 11.0/1000 person-years of follow-up. In a receiver operating characteristics curve analysis, Framingham risk equation showed an excellent predictive value for incident CVD events (c-statistics, 0.83; 95% confidence interval, 0.76-0.90). In a multivariable Cox analysis, age, smoking and diabetes were independent predictors of CVD events. All-cause death rate was 20.0/1000 person-years of follow-up (n = 62 deaths). Causes of death included liver diseases (18), malignancies (14), AIDS-related (11); cardiovascular (9) and others (10). In a Cox analysis, age, AIDS diagnosis and chronic hepatitis were independent predictors of death. Observed CVD events in HIV-infected patients were well predicted by Framingham algorithm. Established major CVD risk factors are the strongest determinants of CVD morbidity in an Italian contemporary cohort of HIV-positive subjects. Interventions to modify traditional risk factors are urgently needed in HIV people.

  8. COBA-Cohort: a prospective cohort of HIV-negative men who have sex with men, attending community-based HIV testing services in five European countries (a study protocol).

    Science.gov (United States)

    Lorente, Nicolas; Fernàndez-López, Laura; Fuertes, Ricardo; Rojas Castro, Daniela; Pichon, François; Cigan, Bojan; Chanos, Sophocles; Meireles, Paula; Lucas, Raquel; Morel, Stéphane; Slaaen Kaye, Per; Agustí, Cristina; Klavs, Irena; Platteau, Tom; Casabona, Jordi

    2016-07-13

    Community-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries. (1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour. All MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country. The study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences. Published by the BMJ Publishing Group Limited

  9. Cerebral toxoplasmosis mimicking subacute meningitis in HIV-infected patients; a cohort study from Indonesia.

    Directory of Open Access Journals (Sweden)

    A Rizal Ganiem

    Full Text Available BACKGROUND: HIV-associated subacute meningitis is mostly caused by tuberculosis or cryptococcosis, but often no etiology can be established. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the differential diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: We performed cerebrospinal fluid real time PCR and serological testing for Toxoplasma gondii in archived samples from a well-characterized cohort of 64 HIV-infected patients presenting with subacute meningitis in a referral hospital in Indonesia. Neuroradiology was only available for 6 patients. At time of presentation, patients mostly had newly diagnosed and advanced HIV infection (median CD4 count 22 cells/mL, with only 17.2% taking ART, and 9.4% PJP-prophylaxis. CSF PCR for T. Gondii was positive in 21 patients (32.8%. Circulating toxoplasma IgG was present in 77.2% of patients tested, including all in whom the PCR of CSF was positive for T. Gondii. Clinically, in the absence of neuroradiology, toxoplasmosis was difficult to distinguish from tuberculosis or cryptococcal meningitis, although CSF abnormalities were less pronounced. Mortality among patients with a positive CSF T. Gondii PCR was 81%, 2.16-fold higher (95% CI 1.04-4.47 compared to those with a negative PCR. CONCLUSIONS/SIGNIFICANCE: Toxoplasmosis should be considered in HIV-infected patients with clinically suspected subacute meningitis in settings where neuroradiology is not available.

  10. Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study.

    Science.gov (United States)

    Moges, Nurilign Abebe; Kassa, Getachew Mullu; Boneya, Dube Jara

    2017-07-06

    In 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia. Retrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association. Three hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%-7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn't get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096). There is significant progress on the reduction of the rate of HIV transmission from mother to

  11. Highly active antiretroviral therapy (HAART) among HIV-infected drug users: a prospective cohort study of sexual risk and injecting behaviour

    NARCIS (Netherlands)

    Smit, Colette; Lindenburg, Karen; Geskus, Ronald B.; Brinkman, Kees; Coutinho, Roel A.; Prins, Maria

    2006-01-01

    AIMS: To study sexual risk and injecting behaviour among HIV-infected drug users (DU) receiving highly active antiretroviral therapy (HAART). DESIGN AND SETTING: As part of an ongoing prospective cohort study, HIV-infected DU who commenced HAART (n=67) were matched with those not starting HAART

  12. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection.

    Science.gov (United States)

    Lama, Javier R; Karuna, Shelly T; Grant, Shannon P; Swann, Edith M; Ganoza, Carmela; Segura, Patricia; Montano, Silvia M; Lacherre, Martin; De Rosa, Stephen C; Buchbinder, Susan; Sanchez, Jorge; McElrath, M Juliana; Lemos, Maria P

    2016-01-01

    Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. ClinicalTrials.gov NCT02630082.

  13. Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study.

    Science.gov (United States)

    Sigel, Keith; Wisnivesky, Juan; Crothers, Kristina; Gordon, Kirsha; Brown, Sheldon T; Rimland, David; Rodriguez-Barradas, Maria C; Gibert, Cynthia; Goetz, Matthew Bidwell; Bedimo, Roger; Park, Lesley S; Dubrow, Robert

    2017-02-01

    HIV infection is independently associated with risk of lung cancer, but few data exist for the relation between longitudinal measurements of immune function and lung-cancer risk in people living with HIV. We followed up participants with HIV from the Veterans Aging Cohort Study for a minimum of 3 years between Jan 1, 1998, and Dec 31, 2012, and used cancer registry data to identify incident cases of lung cancer. The index date for each patient was the later of the date HIV care began or Jan 1, 1998. We excluded patients with less than 3 years' follow-up, prevalent diagnoses of lung cancer, or incomplete laboratory data. We used Cox regression models to investigate the relation between different time-updated lagged and cumulative exposures (CD4 cell count, CD8 cell count, CD4/CD8 ratio, HIV RNA, and bacterial pneumonia) and risk of lung cancer. Models were adjusted for age, race or ethnicity, smoking, hepatitis C virus infection, alcohol use disorders, drug use disorders, and history of chronic obstructive pulmonary disease and occupational lung disease. We identified 277 cases of incident lung cancer in 21 666 participants with HIV. In separate models for each time-updated 12 month lagged, 24 month simple moving average cumulative exposure, increased risk of lung cancer was associated with low CD4 cell count (p trend=0·001), low CD4/CD8 ratio (p trend=0·0001), high HIV RNA concentration (p=0·004), and more cumulative bacterial pneumonia episodes (12 month lag only; p trend=0·0004). In a mutually adjusted model including these factors, CD4/CD8 ratio and cumulative bacterial pneumonia episodes remained significant (p trends 0·003 and 0·004, respectively). In our large HIV cohort in the antiretroviral therapy era, we found evidence that dysfunctional immune activation and chronic inflammation contribute to the development of lung cancer in the setting of HIV infection. These findings could be used to target lung-cancer prevention measures to high-risk groups

  14. HIV-infection and psychiatric illnesses - A double edged sword that threatens the vision of a contained epidemic: The Greater Stockholm HIV Cohort Study.

    Science.gov (United States)

    Jallow, Amadou; Ljunggren, Gunnar; Wändell, Per; Wahlström, Lars; Carlsson, Axel C

    2017-01-01

    The Greater Stockholm HIV Cohort Study is an initiative to provide longitudinal information regarding the health of people living with HIV. Our aim was to explore the prevalence of HIV and its association with psychiatric co-morbidities. All patients with a recorded diagnosis of HIV (any position of the ICD-10 codes B20-B24) were identified during the period 2007-2014 and related to the total population in Stockholm by January 1, 2015, N = 2.21 million. The age at diagnosis, gender, and first occurrence of an HIV diagnosis was recorded. Analyses were done by age and gender. Prevalence of psychiatric co-morbidities amongst HIV patients were recorded. Age-adjusted odds ratios with 95% confidence intervals were calculated with logistic regression for prevalent psychiatric co-morbidities in HIV infected individuals compared to the prevalence in the general population. The total prevalence of HIV was 0.16%; females 0.10% (n = 1134) and males 0.21% (n = 2448). HIV-infected people were more frequently diagnosed with psychiatric illnesses and drug abuse. In females and males with HIV-diagnosis respectively, drug dependence disorder was 7.5 (7.76% vs 1.04%) and 5.1 (10.17% vs 1.98%) times higher, psychotic disorders were 6.3 (2.65% vs 0.42%) and 2.9 (1.43% vs 0.49%) times higher, bipolar disorder was 2.5 (1.41% vs 0.57%) and 3 (1.02% vs 0.34%) times higher, depression diagnosis was 1.5 (8.47% vs 5.82%) and 3.4 (10.17% vs 2.97%) higher, trauma-related disorder was 1.5 (6.00% vs 4.10%) respectively 2.9 (4.45% vs 1.56%) times higher, anxiety disorder was 1.2 (6.88% vs 5.72%) and 2.2 (6.54% vs 2.93%) times higher than in their non-infected peers. Despite effective ART, many individuals with HIV have an impaired mental health and a history of drug abuse that may threaten the vision of a contained epidemic. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  15. Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Florian Vogt

    Full Text Available CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas.To compare CD4 testing among rural and urban HIV patients during the first year of treatment.Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients.While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9, 9.2 (95% CI 5.5-15.3, and 7.6 (95% 3.7-17.1 comparing rural versus urban patients at treatment initiation, six and 12 months, respectively.CD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing.

  16. Risk factors for pre-treatment mortality among HIV-infected children in rural Zambia: a cohort study.

    Directory of Open Access Journals (Sweden)

    Catherine G Sutcliffe

    Full Text Available Many HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation.A prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated.351 children were included in the study, of whom 210 (59.8% were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74. Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18 was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83. In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment.These results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented.

  17. Risk factors for pre-treatment mortality among HIV-infected children in rural Zambia: a cohort study.

    Science.gov (United States)

    Sutcliffe, Catherine G; van Dijk, Janneke H; Munsanje, Bornface; Hamangaba, Francis; Siniwymaanzi, Pamela; Thuma, Philip E; Moss, William J

    2011-01-01

    Many HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART) can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation. A prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated. 351 children were included in the study, of whom 210 (59.8%) were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74). Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18) was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83). In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment. These results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented. © 2011 Sutcliffe et al.

  18. Group B streptococcus colonization and HIV in pregnancy: A cohort study in Nigeria.

    Science.gov (United States)

    Biobaku Oluwafunmilola, R; Olaleye Atinuke, O; Adefusi Olorunwa, F; Adeyemi Babalola, A; Onipede Anthony, O; Loto Olabisi, M; Imaralu John, O

    2017-01-01

    Group B streptococcus (GBS) is a leading cause of maternal and neonatal infectious morbidity. HIV is prevalent among pregnant women in Nigeria. To determine the rates of anogenital GBS colonization in our institution and compare GBS colonization rates between HIV positive and negative pregnant women. A cross-sectional comparative study was conducted over 6 months. Patients were separated according to their HIV status: positive and negative. GBS colonization was assessed by vaginal and anal swabs collected at 35-37 weeks of gestation and cultured in Todd-Hewitt broth, followed by a confirmatory test. Socio-demographic characteristics and CD4 count were extracted from patient medical records. Secondary outcomes were identification of risk factors for GBS colonization, antibiotic sensitivity, and any association between CD4 count and GBS colonization. Appropriate statistical analysis was done. A total of 200 patients attended the clinic; 67 HIV positive and 133 negative. Analyzed samples were 198; the overall prevalence of GBS was 18.2%. No significant difference in GBS colonization was noted between HIV positive (19.4% [13]) and negative patients (17.6% [23/131]). Most GBS isolates were susceptible to ampicillin (87%) and penicillin (81%). A high body mass index (BMI) was independently associated with GBS colonization (OR = 1.25, 95% CI: 1.04-1.51). No association was observed between CD4 counts and GBS colonization. A high prevalence of GBS colonization was observed in our institution. Colonization rates were independent of the HIV status but associated with a high BMI in HIV positive women.

  19. Cancer incidence and mortality for all causes in HIV-infected patients over a quarter century: a multicentre cohort study.

    Science.gov (United States)

    Raffetti, Elena; Albini, Laura; Gotti, Daria; Segala, Daniela; Maggiolo, Franco; di Filippo, Elisa; Saracino, Annalisa; Ladisa, Nicoletta; Lapadula, Giuseppe; Fornabaio, Chiara; Castelnuovo, Filippo; Casari, Salvatore; Fabbiani, Massimiliano; Pierotti, Piera; Donato, Francesco; Quiros-Roldan, Eugenia

    2015-03-12

    We aimed to assess cancer incidence and mortality for all-causes and factors related to risk of death in an Italian cohort of HIV infected unselected patients as compared to the general population. We conducted a retrospective (1986-2012) cohort study on 16 268 HIV infected patients enrolled in the MASTER cohort. The standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were computed using cancer incidence rates of Italian Cancer Registries and official national data for overall mortality. The risk factors for death from all causes were assessed using Poisson regression models. 1,195 cancer cases were diagnosed from 1986 to 2012: 700 AIDS-defining-cancers (ADCs) and 495 non-AIDS-defining-cancers (NADCs). ADC incidence was much higher than the Italian population (SIR = 30.8, 95% confidence interval 27.9-34.0) whereas NADC incidence was similar to the general population (SIR = 0.9, 95% CI 0.8-1.1). The SMR for all causes was 11.6 (11.1-12.0) in the period, and it decreased over time, mainly after 1996, up to 3.53 (2.5-4.8) in 2012. Male gender, year of enrolment before 1993, older age at enrolment, intravenous drug use, low CD4 cell count, AIDS event, cancer occurrence and the absence of antiretroviral therapy were all associated independently with risk of death. In HIV infected patients, ADC but not NADC incidence rates were higher than the general population. Although overall mortality in HIV infected subjects decreased over time, it is about three-fold higher than the general population at present.

  20. Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study.

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    Stephanie K Y Choi

    Full Text Available Current studies of depression among people living with HIV focus on describing its point prevalence. Given the fluctuating nature of depression and its profound impacts on clinical and quality-of-life outcomes, this study aimed to examine the prevalence, recurrence and incidence of current depressive symptoms and its underlying catalysts longitudinally and systematically among these individuals.We conducted a prospective cohort study between October 1, 2007 and December 31, 2012 using longitudinal linked data sources. Current depressive symptoms was identified using the Centre for Epidemiologic Studies Depression Scale or the Kessler Psychological Distress Scale, first at baseline and again during follow-up interviews. Multivariable regressions were used to characterize the three outcomes.Of the 3,816 HIV-positive participants, the point prevalence of depressive symptoms was estimated at 28%. Of the 957 participants who were identified with depressive symptoms at baseline and who had at least two years of follow-up, 43% had a recurrent episode. The cumulative incidence among 1,745 previously depressive symptoms free participants (at or prior to baseline was 14%. During the five-year follow-up, our multivariable models showed that participants with greater risk of recurrent cases were more likely to feel worried about their housing situation. Participants at risk of developing incident cases were also likely to be younger, gay or bisexual, and unable to afford housing-related expenses.Depressive symptoms are prevalent and likely to recur among people living with HIV. Our results support the direction of Ontario's HIV/AIDS Strategy to 2026, which addresses medical concerns associated with HIV (such as depression and the social drivers of health in order to enhance the overall well-being of people living with or at risk of HIV. Our findings reinforce the importance of providing effective mental health care and demonstrate the need for long

  1. Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia

    Directory of Open Access Journals (Sweden)

    Soeung Seithabot

    2009-08-01

    Full Text Available Abstract Background Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. Methods Retrospective cohort study on 1168 HIV-positive children Results Over half (53% of children were 5 years or above and only 69(6% were Conclusion HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.

  2. Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study

    Science.gov (United States)

    Shoptaw, Steven; Stall, Ron; Bordon, Jose; Kao, Uyen; Cox, Christopher; Li, Xiuhong; Ostrow, David G.; Plankey, Michael W.

    2013-01-01

    SUMMARY We examined associations between stimulant use (methamphetamine and cocaine) and other substances (nicotine, marijuana, alcohol, inhaled nitrites) with immune function biomarkers among HIV-seropositive (HIV+) men using highly active antiretroviral therapy (ART) and -seronegative (HIV−) men in the Multicenter AIDS Cohort Study (MACS). Among HIV+ men, cumulative adherence to ART (4.07, 95% CI: 3.52, 4.71, per 10 years of adherent HAART use), and recent cohort enrollment (1.38; 95% CI: 1.24, 1.55) were multiplicatively associated with increases in CD4+/CD8+ ratios. Cumulative use of methamphetamine (0.93; 95% CI: 0.88, 0.98, per 10 use years), cocaine (0.93; 95% CI: 0.89, 0.96, per 10 use years), and cumulative medical visits (0.99; 95% CI: 0.98, 0.99, per 10 visit years), each showed small negative associations with CD4+/CD8+ ratios. Among HIV- men, cumulative medical visits (0.996; 95% CI: 0.993, 0.999), cumulative number of male sexual partners (0.999; 95% CI: 0.998, 0.9998, per 10 partner years) and cigarette pack years (1.10; 95% CI: 1.02, 1.18, per 10 pack years) were associated with CD4+/CD8+ ratios over the same period. ART adherence is associated with a positive immune function independent of stimulant use, underscoring the influence of ART on immune health for HIV+ men who engage in stimulant use. PMID:22930295

  3. Traditional and HIV-specific risk factors for cardiovascular morbidity and mortality among HIV-infected adults in Brazil: a retrospective cohort study.

    Science.gov (United States)

    Diaz, Chanelle M; Segura, Eddy R; Luz, Paula M; Clark, Jesse L; Ribeiro, Sayonara R; De Boni, Raquel; Eksterman, Leonardo; Moreira, Rodrigo; Currier, Judith S; Veloso, Valdiléa G; Grinsztejn, Beatriz; Lake, Jordan E

    2016-08-08

    Antiretroviral therapy (ART) agents potentially associated with adverse metabolic profiles are commonly used in low- and middle-income countries. We assessed risk factors for cardiovascular disease (CVD)-related morbidity and mortality in a cohort of HIV-infected, ART-treated adults in Rio de Janeiro, Brazil. Hospital records and mortality data between 2000-2010 were examined for incident CVD-related ICD-10 and Coding of Death in HIV diagnoses among adults ≥18 years old on ART, enrolled in an observational cohort. Poisson regression models assessed associations between demographic and clinical characteristics and ART agent or class on CVD event risk. Of 2960 eligible persons, 109 had a CVD event (89 hospitalizations, 20 deaths). Participants were 65 % male, 54 % white, and had median age of 37 and 4.6 years on ART. The median nadir CD4(+) T lymphocyte count was 149 cells/mm(3). The virologic suppression rate at the end of study follow-up was 60 %. In multivariable models, detectable HIV-1 RNA prior to the event, prior CVD, less time on ART, age ≥40 at study baseline, nadir CD4(+) T lymphocyte count ≤50 cells/mm(3), non-white race, male gender, and a history of hypertension were significantly associated with CVD event incidence (p ART on CVD risk and the need for metabolically-neutral first- and second-line ART in resource-limited settings.

  4. Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study.

    Science.gov (United States)

    Mirkuzie, Alemnesh H; Sisay, Mitike M; Moland, Karen Marie; Astrøm, Anne N

    2011-08-18

    To facilitate access to the prevention of mother-to-child HIV transmission (PMTCT) services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB) to explain intended- and actual HIV testing. A sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing. The TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due to the large proportion of low intenders that ended up being tested

  5. Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study

    Directory of Open Access Journals (Sweden)

    Mirkuzie Alemnesh H

    2011-08-01

    Full Text Available Abstract Background To facilitate access to the prevention of mother-to-child HIV transmission (PMTCT services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB to explain intended- and actual HIV testing. Methods A sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values Results The TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing. Conclusion The TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due

  6. Diagnostic and Prognostic Value of Serum Albumin for Tuberculosis in HIV Infected Patients Eligible for Antiretroviral Therapy: Data from an HIV Cohort Study in India

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    Gerardo Alvarez-Uria

    2013-09-01

    Full Text Available Introduction: Tuberculosis is difficult to diagnose and it is the leading cause of death in HIV infected individuals in developing countries. There is an urgent need of low-cost diagnostic markers for resource-limited settings. Methods: The study involved 1571 patients from an HIV cohort study in India with known serum albumin concentrations at the time of becoming eligible for antiretroviral therapy (ART. We investigated the diagnostic accuracy of serum albumin to predict tuberculosis within six months of ART eligibility and the prognostic value in patients who experienced tuberculosis. Results: The diagnostic accuracy of serum albumin, measured by the area under the receiver operating characteristic curve, to predict tuberculosis was 0.81 (95% confidence interval 0.78-0.83. Serum albumin concentrations 90%, even in settings with high tuberculosis prevalence. Hypoalbuminemia was associated with an increased risk of mortality in patients with tuberculosis. Conclusion: Serum albumin can be a useful low-cost diagnostic marker for tuberculosis in HIV infected patients eligible for ART. However, we failed to find thresholds to rule out or rule in tuberculosis. If these results are confirmed by other studies, serum albumin could be used to improve the diagnostic accuracy of intensive case finding algorithms for HIV-related tuberculosis. In patients who experience tuberculosis, hypoalbuminemia is associated with poor prognosis.

  7. Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

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    Lennox Jeffrey L

    2010-02-01

    Full Text Available Abstract Background HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. Methods A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Results Participants were mostly Moslem (99%, male (53.5%, with no formal education (55%. Baseline HIV knowledge was low ( Conclusions Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities.

  8. Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study.

    Science.gov (United States)

    Ofotokun, Ighovwerha; Binongo, Jose Nilo G; Rosenberg, Eli S; Kane, Michael; Ifland, Rick; Lennox, Jeffrey L; Easley, Kirk A

    2010-02-02

    HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Participants were mostly Moslem (99%), male (53.5%), with no formal education (55%). Baseline HIV knowledge was low (technology-facilitated (n = 511) compared with the seminar-based (n = 474) program. Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities.

  9. HIV cohort collaborations: proposal for harmonization of data exchange

    DEFF Research Database (Denmark)

    Kjær, Jesper; Ledergerber, Bruno

    2004-01-01

    is freely available at http://www.cphiv.dk/HICDEP.pdf. Once individual cohorts have set up a means of transfering data into this format, as and when required, this should greatly facilitate data merging for future joint analyses. The HICDEP incorporates data from HIV drug resistance tests, which have been......HIV cohort studies have provided useful information on the natural history of HIV infection and the effects of antiretroviral therapy. It has become increasingly common to combine data from several cohorts into one dataset in order to address certain specific questions with more statistical power...... than can be achieved with the individual studies. This requires each cohort to map data into a standard format before merging. Until recently, this standard format has differed for each such collaborative analysis. We have therefore developed the HIV Cohort Data Exchange Protocol (HICDEP), which...

  10. Inverse relationship of serum hepcidin levels with CD4 cell counts in HIV-infected patients selected from an Indonesian prospective cohort study.

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    Rudi Wisaksana

    Full Text Available BACKGROUND: Distortion of iron homeostasis may contribute to the pathogenesis of human immunodeficiency virus (HIV infection and tuberculosis (TB. We studied the association of the central iron-regulatory hormone hepcidin with the severity of HIV and the association between hepcidin and other markers of iron homeostasis with development of TB. METHODS: Three groups of patients were selected from a prospective cohort of HIV-infected subjects in Bandung, Indonesia. The first group consisted of HIV-infected patients who started TB treatment more than 30 days after cohort enrollment (cases. The second group consisted of HIV-infected patients who were matched for age, gender and CD4 cell count to the cases group (matched controls. The third group consisted of HIV-infected patients with CD4 cell counts above 200 cells/mm(3 (unmatched controls. Iron parameters including hepcidin were compared using samples collected at cohort enrollment, and compared with recently published reference values for serum hepcidin. RESULTS: A total of 127 HIV-infected patients were included, 42 cases together with 42 matched controls and 43 unmatched controls. Patients with advanced HIV infection had elevated serum hepcidin and ferritin levels. Hepcidin levels correlated inversely with CD4 cells and hemoglobin. Cases had significantly higher hepcidin and ferritin concentrations at cohort enrollment compared to matched controls, but these differences were fully accounted for by the cases who started TB treatment between day 31 and 60 after enrollment. Hepcidin levels were not different in those with or without hepatitis C infection. CONCLUSION: Iron metabolism is distorted in advanced HIV infection with CD4 cell counts correlating inversely with serum hepcidin levels. High serum hepcidin levels and hyperferritinemia were found in patients starting TB treatment shortly after cohort enrollment, suggesting that these parameters have a predictive value for development of

  11. Changes in HIV incidence among people who inject drugs in Taiwan following introduction of a harm reduction program: a study of two cohorts.

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    Yen-Fang Huang

    2014-04-01

    Full Text Available Harm reduction strategies for combating HIV epidemics among people who inject drugs (PWID have been implemented in several countries. However, large-scale studies using sensitive measurements of HIV incidence and intervention exposures in defined cohorts are rare. The aim of this study was to determine the association between harm reduction programs and HIV incidence among PWID.The study included two populations. For 3,851 PWID who entered prison between 2004 and 2010 and tested HIV positive upon incarceration, we tested their sera using a BED HIV-1 capture enzyme immunoassay to estimate HIV incidence. Also, we enrolled in a prospective study a cohort of 4,357 individuals who were released from prison via an amnesty on July 16, 2007. We followed them with interviews at intervals of 6-12 mo and by linking several databases. A total of 2,473 participants who were HIV negative in January 2006 had interviews between then and 2010 to evaluate the association between use of harm reduction programs and HIV incidence. We used survival methods with attendance at methadone clinics as a time-varying covariate to measure the association with HIV incidence. We used a Poisson regression model and calculated the HIV incidence rate to evaluate the association between needle/syringe program use and HIV incidence. Among the population of PWID who were imprisoned, the implementation of comprehensive harm reduction programs and a lower mean community HIV viral load were associated with a reduced HIV incidence among PWID. The HIV incidence in this population of PWID decreased from 18.2% in 2005 to 0.3% in 2010. In an individual-level analysis of the amnesty cohort, attendance at methadone clinics was associated with a significantly lower HIV incidence (adjusted hazard ratio: 0.20, 95% CI: 0.06-0.67, and frequent users of needle/syringe program services had lower HIV incidence (0% in high NSP users, 0.5% in non NSP users. In addition, no HIV seroconversions were

  12. Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C: an observational cohort study.

    Science.gov (United States)

    Warren-Gash, Charlotte; Childs, Kate; Thornton, Alicia; Bhagani, Sanjay; Demma, Shirin; Srivastava, Ankur; Leen, Clifford; Agarwal, Kosh; Rodger, Alison J; Sabin, Caroline A

    2017-04-01

    This study assessed the likelihood of referral for liver transplantation assessment in a prospective cohort of patients co-infected with HIV and hepatitis B or C with complications of cirrhosis. There were 141 co-infected patients from 11 UK centres with at least one complication of cirrhosis recorded (either decompensation or hepatocellular carcinoma) out of 772 identified with cirrhosis and/or HCC. Only 23 of these 141 (16.3%) were referred for liver transplantation assessment, even though referral is recommended for co-infected patients after the first decompensation episode.

  13. Prospective cohort study of HIV incidence and molecular characteristics of HIV among men who have sex with men(MSM) in Yunnan Province, China.

    Science.gov (United States)

    Xu, Junjie; An, Minghui; Han, Xiaoxu; Jia, Manhong; Ma, Yanling; Zhang, Min; Hu, Qinghai; Chu, Zhenxing; Zhang, Jing; Jiang, Yongjun; Geng, Wenqing; Lu, Lin; Shang, Hong

    2013-01-04

    Yunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces, the reported prevalence of HIV among Yunnan men who have sex with men (MSM) passed 10%, while HIV incidence epidemic and molecular characteristics of new infected Yunnan MSM were not evaluated before. An 18 months prospective followed up with a frequency of 3 month per visit were conducted among HIV seronegative MSM in Kunming cityduring 2009-2011. Interviewer-administrated questionnaires were carried out. Blood specimens were obtained to test for syphilis and HIV, in which HIV were evaluated by standard HIV enzyme immunoassay (EIA) and HIV nucleic acid amplification testing (NAAT). Near full-length regions of the HIV-1 were evaluated for subtyping, primary drug resistance mutations. During the follow-up 70.1% of the recruited 378 MSM retained in the cohort. Eleven MSM seroconverted to HIV and fifteen MSM seroconverted to syphilis. The HIV incidence and syphilis incidence was 3.5 (95% CI 1.8-6.2) cases /100 person year(PY) and 5.3 (95% CI 3.0-8.7) cases/100 PY, respectively. Multivariate analysis showed that baseline syphilis infection (aHR, 17.7), occupation (students vs. others [aHR, 5.7], retirees vs. others [aHR, 4.1]), bleeding experience after receptive anal intercourse (aHR,7.6), and minority ethnic(vs. Han) [aHR, 5.7] were independent risk factors for HIV seroconversion(each PHIV transmission pairs were detected among seroconverted minority ethnic MSM. HIV incidence was moderately high among Yunnan MSM. Yunnan province need to strengthen both HIV and syphilis screening among MSM population. Some subpopulations of MSM, such as students, retirees and minority ethnic groups require more HIV epidemic surveillance and strengthened behavior interventions. HIV subtypes and primary drug resistance should be continually monitored to track cross-group transmission of HIV strains.

  14. A Clinical Algorithm to Identify HIV Patients at High Risk for Incident Active Tuberculosis: A Prospective 5-Year Cohort Study.

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    Susan Shin-Jung Lee

    Full Text Available Predicting the risk of tuberculosis (TB in people living with HIV (PLHIV using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL, and interferon-gamma release assay (IGRA, to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART is routinely provided.A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count < = 350/μL. Cox regression was used to identify the predictors of active TB and to construct the algorithm. The validation cohorts included 1455 HIV-infected individuals from previous published studies. Area under the receiver operating characteristic (ROC curve was calculated.Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ≥ 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49-15.90, P = 0.009. A positive baseline IGRA predicted TB in patients with baseline CD4 ≥ 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52-24.40, P = 0.01. Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5% to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6% from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587-0.798 for the study cohort and 0.792 (95% CI: 0.776-0.808 and 0.766 in the 2 validation cohorts.A validated algorithm incorporating the baseline CD4 cell count, HIV viral load, and IGRA status can be used to guide targeted TB preventive treatment in PLHIV in low-to-moderate TB burden settings where HAART is routinely provided to all PLHIV. The implementation of this algorithm will avoid unnecessary

  15. A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV-infected patients.

    Science.gov (United States)

    Rodríguez Arrondo, Francisco; von Wichmann, Miguel Ángel; Camino, Xabier; Goenaga, Miguel Ángel; Ibarguren, Maialen; Azcune, Harkaitz; Bustinduy, María Jesús; Ferrero, Oscar; Muñoz, Josefa; Ibarra, Sofía; Aguirrebengoa, Koldo; Goicoetxea, Josune; Bereciartua, Elena; Montejo, Miguel; García, M Asunción; Martínez, Eduardo; Portu, Joseba; Metola, Luis; Silvariño, Rafael; Sarasqueta, Cristina; Arrizabalaga, Julio; Iribarren, Jose Antonio

    2017-05-18

    We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  16. Liver retransplantation in HIV-infected patients: a prospective cohort study

    NARCIS (Netherlands)

    Gastaca, M.; Aguero, F.; Rimola, A.; Montejo, M.; Miralles, P.; Lozano, R.; Castells, L.; Abradelo, M.; Mata Mde, L.; San Juan Rodriguez, F.; Cordero, E.; Campo, S.; Manzardo, C.; Urbina, J.O. de; Perez, I.; Rosa Gde, L.; Miro, J.M.; Barrera, P.

    2012-01-01

    Information regarding liver retransplantation in HIV-infected patients is scant. Data from 14 HIV-infected patients retransplanted between 2002 and 2011 in Spain (6% retransplantation rate) were analyzed and compared with those from 157 matched HIV-negative retransplanted patients. In HIV-infected

  17. Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

    Science.gov (United States)

    Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J.; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

    2013-01-01

    Objective To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Design Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. Methods HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Results Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. Conclusions This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control. PMID:23555035

  18. Predictive factors of plasma HIV suppression during pregnancy: a prospective cohort study in Benin.

    Science.gov (United States)

    Denoeud-Ndam, Lise; Fourcade, Camille; Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

    2013-01-01

    To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

  19. Immune recovery of middle-aged HIV patients following antiretroviral therapy: An observational cohort study.

    Science.gov (United States)

    Wong, Ngai Sze; Chan, Kenny Chi Wai; Cheung, Edward Ka Hin; Wong, Ka Hing; Lee, Shui Shan

    2017-07-01

    In HIV-infected persons, age is negatively associated with optimal CD4 recovery following antiretroviral therapy. Our understanding of the situation in older adults, especially the middle-aged is, however, limited. We undertook to examine the latter's pattern of CD4/CD8 recovery following antiretroviral therapy.Retrospective clinical cohort data of HIV patients diagnosed between 1985 and 2014 in Hong Kong were collected. They were categorized by age at treatment initiation, viz., young adults (age 18-49), middle-aged (age 50-64), and elderly (≥65 years' old). Predictors of immune recovery (CD4 count, CD8 count, CD4/CD8 ratio) over time were examined using multivariable linear generalized estimating equations.A total of 2754 patients (aged ≥18) have been on antiretroviral therapy, with baseline characteristics similar between middle-aged and the elderly. Late diagnosis, defined as progression to AIDS within 3 months of HIV diagnosis, was less common in middle-aged (odds ratio = 0.58, 95% confidence interval = 0.37-0.91). Among Chinese patients who have been on treatment for ≥4 years (n = 913), 80.6%, 14.6%, and 4.8% were young adults, middle-aged, and elderly respectively. Late treatment initiation, defined as AIDS diagnosis or CD4 count ≤100 cells/μL before treatment, was common in middle-aged and elderly, the former however had faster CD4 recovery (3.95 vs. 3.36 cells/μL/month), but slower CD8 decline (-1.76 vs. -4.34 cells/μL/month) and CD4/CD8 normalization (0.009 vs. 0.0101/month).As a transitional age group, the immune recovery of middle-aged patients lagged behind young adults largely because of late treatment initiation. Following adoption of early and non-CD4-guided treatment initiation, their long-term clinical outcome is expected to improve.

  20. Outcome and prognostic factors in HIV-1-infected patients on dialysis in the cART era: a GESIDA/SEN cohort study.

    Science.gov (United States)

    Trullàs, Joan-Carles; Cofan, Federico; Barril, Guillermina; Martínez-Castelao, Alberto; Jofre, Rosa; Rivera, Maite; Martínez-Ara, Jorge; Ros, Silvia; Perez, Iñaki; Moreno, Asunción; Miró, Jose M

    2011-08-01

    Prognosis of HIV-infected patients on dialysis has improved. Few studies have compared survival between HIV-infected and HIV-negative patients on dialysis in the combined antiretroviral therapy (cART) era. We compared the outcome of HIV-infected patients on dialysis with a matched HIV-negative cohort. National, multicenter, retrospective cohort study of HIV-infected patients starting dialysis in Spain (1999-2006). Matching criteria for HIV-negative patients were dialysis center, year of starting dialysis, age, sex, and race. The study population comprised 122 patients, 66 HIV-infected, and 66 HIV-negative patients. Median age was 41 years, and all but 4 HIV-infected patients were white. HIV-associated nephropathy was only present in 4 cases. HIV-infected patients were less frequently included on the kidney transplantation waiting list (17% vs 62%, P < 0.001). They also had more hepatitis C virus coinfection (76% vs 11%, P < 0.001), fewer cardiovascular events (62% vs 88%, P = 0.001), fewer kidney transplants (4.5% vs 38%, P < 0.001), and higher mortality (32% vs 1.5%, P < 0.001). Survival rates [95% confidence interval (CI)] at 1, 3, and 5 years for HIV-infected patients were 95.2% (89.9%-100%), 71.7% (59.7%-83.7%), and 62.7% (46.6%-78.8%). Five-year survival for HIV-negative patients was 94.4% (83.8%-100%) (P < 0.001). Multivariate analysis revealed the following variables to be associated with death in HIV-infected patients: peritoneal dialysis vs hemodialysis [hazard ratio; (95% CI): 2.88 (1.16-7.17)] and being on effective cART [hazard ratio (95% CI): 0.39 (0.16-0.97)]. Medium-term survival of HIV-infected patients on dialysis was lower than that of matched HIV-negative patients. Fewer HIV-infected patients had access to kidney transplantation. Being on effective cART improves survival. Further studies are needed to determine whether peritoneal dialysis increases mortality.

  1. Nutritional status and complementary feeding among HIV-exposed infants: a prospective cohort study.

    Science.gov (United States)

    Kamenju, Pili; Liu, Enju; Hertzmark, Ellen; Spiegelman, Donna; Kisenge, Rodrick; Kupka, Roland; Aboud, Said; Manji, Karim P; Duggan, Christopher; Fawzi, Wafaie W

    2017-07-01

    Complementary feeding is crucial for improving child survival and promoting growth and development, particularly among HIV-exposed children who have higher risk of morbidity and mortality than their un-exposed peers. This prospective study employed an infant and child feeding index (ICFI) to measure complementary feeding and determine its association with nutritional status among 2092 HIV-exposed infants followed from 6 to 24 months of age in Dar es Salaam, Tanzania. The ICFI measured both quality and quantity of complementary feeding, including current breastfeeding status, food consistency, dietary diversity scores (DDS), food group frequency score, and meal frequency. The ICFI score ranged from 0 to 9; the median score was 6 (Inter-Quartile Range, IQR= 4-7). After adjusting for potential confounders, high ICFI scores were associated with reduced risk of stunting (high vs. low tertile hazard ratio, HR: 0.72; 95% confidence interval, CI: 0.57, 0.91; Pnutrition programs in low-income countries to emphasize educating HIV-exposed children's caregivers on the importance of dietary diversity and optimal complementary feeding to improve nutritional status in this important subpopulation. © 2016 John Wiley & Sons Ltd.

  2. Causes of Death Among Patients Infected with HIV at a Tertiary Care Hospital in China: An Observational Cohort Study.

    Science.gov (United States)

    Xiao, Jiang; Du, Shuxu; Tian, Yunfei; Su, Wenjing; Yang, Di; Zhao, Hongxin

    2016-08-01

    The objective of this study was to elucidate the causes of death and mortality in a cohort of inpatients infected with HIV. The causes of death and mortality were evaluated by using the clinical data of 1,076 patients admitted to the Center for Infectious Diseases, Beijing Ditan Hospital, between January 1, 2009, and November 30, 2012, and who were followed for 6 months after discharge. During the 4-year study period, 216 patients had died by the 6-month follow-up (mortality rate, 20.1%). Opportunistic infections were the most common causes of death (42.0%), followed by malignancies (23.1%), unexplained central nervous system infections and occupying lesions (18.1%), infectious shock (10.2%), severe hepatitis and decompensated cirrhosis (3.2%), sudden death (1.4%), lactic acidosis (0.9%), and uremia (0.9%). The strong risk factors for mortality were cost constraints and unaffordable further diagnosis and treatment (adjusted hazard ratio [AHR] = 134.394, 95% confidence interval [CI] = 25.748-701.481, p HIV/AIDS patients in China. AIDS-related infections and malignancies were the most common causes of death in patients infected with HIV, and improvement of the etiological diagnosis would help physicians provide appropriate treatment and reduce mortality rates.

  3. To use or not to use a condom: A prospective cohort study comparing contraceptive practices among HIV-infected and HIV-negative youth in Uganda

    Directory of Open Access Journals (Sweden)

    Neema Stella

    2011-05-01

    Full Text Available Abstract Background Unwanted pregnancy and HIV infection are issues of significant concern to young people. Limited data exists on contraceptive decision-making and practices among HIV-infected and HIV-negative young people in low resource settings with generalized HIV epidemics. Methods From July 2007 until April 2009, we recruited, and followed up over a one year period, a cohort of 501 HIV-negative and 276 HIV-infected young women and men aged 15-24 years residing in Kampala and Wakiso districts. We compared contraceptive use among HIV-infected and HIV-negative young people and assessed factors associated with contraceptive decision-making and use, using multivariate logistic regression modelling to estimate odds ratios (OR and 95% confidence intervals (CI. Results Contraceptive use among sexually active HIV-infected young people was 34% while it was 59% among the HIV-negative group. The condom was the most frequently used method of contraception. Only 24% of the HIV-infected used condoms consistently compared to 38% among the negative group OR 0.56 (95% CI 0.38, 0.82. HIV-infected young people were more likely to discuss safe sex behaviour with health workers OR 1.70 (95% CI 1.13, 2.57, though its effect on fertility decision-making was not significant. Throughout the year's follow-up, only 24% among the HIV-negative and 18% among the HIV-infected continued to use contraception while 12% and 28% among the HIV-negative and infected respectively did not use contraception at all. At multivariate analysis, the HIV-infected young people were less likely to maintain contraceptive use. Other factors independently associated with sustained contraceptive use were age of the respondent, marital status and being a male. Conversely, HIV-infected young people were less likely to initiate use of contraception. Being married or in a relationship was associated with higher odds of initiating contraceptive use. Conclusion Compared to the HIV-negative group

  4. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study

    Science.gov (United States)

    Gompels, Mark; Delpech, Valerie; Porter, Kholoud; Post, Frank; Johnson, Margaret; Dunn, David; Palfreeman, Adrian; Gilson, Richard; Gazzard, Brian; Hill, Teresa; Walsh, John; Fisher, Martin; Orkin, Chloe; Ainsworth, Jonathan; Bansi, Loveleen; Phillips, Andrew; Leen, Clifford; Nelson, Mark; Anderson, Jane; Sabin, Caroline

    2011-01-01

    Objectives To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm3 at start of antiretroviral therapy. Design Cohort study. Setting Outpatient HIV clinics throughout the United Kingdom. Population Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤350 cells/mm3 at start of antiretroviral therapy in 1996-2008. Main outcome measures Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period. Results 1248 of 17 661 eligible patients died during 91 203 person years’ follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996-2006). Starting antiretroviral therapy later than guidelines suggest resulted in up to 15 years’ loss of life: at age 20, life expectancy was 37.9 (1.3), 41.0 (2.2), and 53.4 (1.2) years in those starting antiretroviral therapy with CD4 count <100, 100-199, and 200-350 cells/mm3, respectively. Conclusions Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy. PMID:21990260

  5. Anaemia and Iron Homeostasis in a Cohort of HIV-Infected Patients: A Cross-Sectional Study in Ghana

    Directory of Open Access Journals (Sweden)

    Christian Obirikorang

    2016-01-01

    Full Text Available Aim. We determined the prevalence of anaemia and evaluated markers of iron homeostasis in a cohort of HIV patients. Methods. A comparative cross-sectional study on 319 participants was carried out at the Tamale Teaching Hospital from July 2013 to December 2013, 219 patients on HAART (designated On-HAART and 100 HAART-naive patients. Data gathered include sociodemography, clinical history, and selected laboratory assays. Results. Prevalence of anaemia was 23.8%. On-HAART participants had higher CD4/CD3 lymphocyte counts, Hb, HCT/PCV, MCV, MCH, iron, ferritin, and TSAT (P<0.05. Hb, iron, ferritin, and TSAT decreased from grade 1 to grade 3 anaemia and CD4/CD3 lymphocyte count was lowest in grade 3 anaemia (P<0.05. Iron (P=0.0072 decreased with disease severity whilst transferrin (P=0.0143 and TIBC (P=0.0143 increased with disease severity. Seventy-six (23.8% participants fulfilled the criteria for anaemia, 86 (26.9% for iron deficiency, 41 (12.8% for iron deficiency anaemia, and 17 (5.3% for iron overload. The frequency of anaemia was higher amongst participants not on HAART (OR 2.6 for grade 1 anaemia; OR 3.0 for grade 3 anaemia. Conclusion. In this study population, HIV-associated anaemia is common and is related to HAART status and disease progression. HIV itself is the most important cause of anaemia and treatment of HIV should be a priority compared to iron supplementation.

  6. A Retrospective Cohort Study of Lesion Distribution of HIV-1 Infection Patients With Cryptococcal Meningoencephalitis on MRI

    Science.gov (United States)

    Xia, Shuang; Li, Xueqin; Shi, Yanbin; Liu, Jinxin; Zhang, Mengjie; Gu, Tenghui; Pan, Shinong; Song, Liucun; Xu, Jinsheng; Sun, Yan; Zhao, Qingxia; Lu, Zhiyan; Lu, Puxuan; Li, Hongjun

    2016-01-01

    Abstract The objective of this paper is to correlate the MRI distribution of cryptococcal meningoencephalitis in HIV-1 infection patients with CD4 T cell count and immune reconstitution effect. A large retrospective cohort study of HIV patients from multi-HIV centers in China was studied to demonstrate the MRI distribution of cryptococcal meningoencephalitis and its correlation with the different immune status. The consecutive clinical and neuroimaging data of 55 HIV-1-infected patients with cryptococcal meningoencephalitis collected at multi-HIV centers in China during the years of 2011 to 2014 was retrospectively analyzed. The enrolled patients were divided into 2 groups based on the distribution of lesions. One group of patients had their lesions at the central brain (group 1, n = 34) and the other group of patients had their lesions at the superficial brain (group 2, n = 21). We explored their MRI characterization of brain. In addition, we also compared their CD4 T cell counts and immune reconstitution effects between the 2 groups based on the imaging findings. No statistical difference was found in terms of age and gender between the 2 groups. The medians of CD4 T cell counts were 11.67 cells/mm3 (3.00–52.00 cells/mm3) in group 1 and 42.00 cells/mm3 (10.00–252.00 cells/mm3) in group 2. Statistical difference of CD4 T cell count was found between the 2 groups (P = 0.023). Thirteen patients in group 1 (13/34) and 12 patients in group 2 (12/21) received highly active antiretroviral treatment (HAART). Patients of group 2 received HAART therapy more frequently than patients of group 1 (P = 0.021). Central and superficial brain lesions detected by MR imaging in HIV-1-infected patients with cryptococcal meningoencephalitis are in correlation with the host immunity and HAART therapy. PMID:26871791

  7. Systemic inflammation-based scores and mortality for all causes in HIV-infected patients: a MASTER cohort study.

    Science.gov (United States)

    Raffetti, Elena; Donato, Francesco; Casari, Salvatore; Castelnuovo, Filippo; Sighinolfi, Laura; Bandera, Alessandra; Maggiolo, Franco; Ladisa, Nicoletta; di Pietro, Massimo; Fornabaio, Chiara; Digiambenedetto, Simona; Quiros-Roldan, Eugenia

    2017-03-07

    Two biomarkers, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), have been shown to be indicative of systemic inflammation and predictive of mortality in general population. We aimed to assess the association of NLR and PLR, with risk of death in HIV-infected subjects when also taking account of HIV-related factors. We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment. The associations of NLR and PLR with all-cause mortality were tested by univariate and multivariate analyses using both time independent and dependent Cox proportional hazard models. We also fitted models with a cubic-spline for PLR and NLR to evaluate the possible non-linear relationship between biomarkers values and risk of death. Eight-thousand and two hundred thirty patients (73.1% males) with a mean age of 38.4 years (SD 10.1) were enrolled. During a median follow-up of 3.9 years, 539 patients died. PLR death at both univariate and multivariate analyses. Using multivariate models with restricted cubic-splines, we found a linear relationship of increasing risk of death with increasing values for NRL over 1.1, and an U-shape curve for PLR, with higher mortality risk for values higher or lower than 120. Our data suggest that NLR and PLR can reflect the severity of the underlying systemic disturbance of the inflammatory process and coagulation leading to augmented mortality in HIV positive subjects.

  8. Prevalence, incidence and correlates of HSV-2 infection in an HIV incidence adolescent and adult cohort study in western Kenya.

    Directory of Open Access Journals (Sweden)

    Brenda Akinyi

    Full Text Available Herpes simplex virus type 2 (HSV-2 infections are associated with increased risk of HIV transmission. We determined HSV-2 prevalence, incidence and associated risk factors, incidence among persons with indeterminate results, and prevalence of HSV-2/HIV co-infection among young adults (18-34 years and adolescents (16-17 years enrolled in an HIV incidence cohort study in western Kenya.Participants (n = 1106; 846 adults were screened and those HIV-1 negative were enrolled and followed-up quarterly for one year. HSV-2 was assessed using the Kalon enzyme immunoassay. HSV-2 incidence was calculated separately among HSV-2 seronegative participants and those indeterminate at baseline. Logistic regression was used to estimate the odds of HSV-2 infection and Poisson regression was used to assess HSV-2 incidence and associated factors.Overall, HSV-2 prevalence was 26.6% [95% confidence interval (CI: 23.9-29.4] and was higher in adults (31.5% [95% CI: 28.3-34.9] than adolescents (10.7% [95% CI: 7.1-15.3]. Factors associated with prevalent HSV-2 included female gender, increasing age, HIV infection, history of sexually transmitted infection, low level of education, multiple sexual partners, and being married, divorced, separated or widowed. Overall HSV-2 incidence was 4.0 per 100 person-years (/100PY 95% CI: 2.7-6.1 and was higher in adults (4.5/100PY and females (5.1/100PY. In multivariable analysis only marital status was associated with HSV-2 incidence. Among 45 participants with indeterminate HSV-2 results at baseline, 22 seroconverted, resulting in an incidence rate of 53.2 /100PY [95% CI: 35.1-80.9]. Inclusion of indeterminate results almost doubled the overall incidence rate to 7.8 /100 PY [95% CI: 5.9-10.5]. Prevalence of HIV/HSV-2 co-infection was higher in female adults than female adolescents (17.1 [95% CI: 13.6-21.0] versus 3.4 [95% CI: 1.1-7.8].The high incidence rate among persons with indeterminate results underscores the public health

  9. Impact of hepatitis C virus coinfection on response to highly active antiretroviral therapy and outcome in HIV-infected individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    Weis, Nina Margrethe; Lindhardt, Bjarne Ø.; Kronborg, Gitte

    2006-01-01

    BACKGROUND: Coinfection with hepatitis C virus (HCV) in human immunodeficiency virus (HIV) type 1-infected patients may decrease the effectiveness of highly active antiretroviral therapy. We determined the impact of HCV infection on response to highly active antiretroviral therapy and outcome among...... Danish patients with HIV-1 infection. METHODS: This prospective cohort study included all adult Danish HIV-1-infected patients who started highly active antiretroviral therapy from 1 January 1995 to 1 January 2004. Patients were classified as HCV positive (positive HCV serological test and/or HCV PCR...

  10. The incidence rate of HIV type-1 drug resistance in patients on antiretroviral therapy: a nationwide population-based Danish cohort study 1999-2005

    DEFF Research Database (Denmark)

    Audelin, A.M.; Lohse, N.; Obel, N.

    2009-01-01

    failure (HIV RNA>1,000 copies/ml). We estimated annual IRs of new resistance mutations towards nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs) and protease inhibitors (PI), and of new specific resistance mutations. RESULTS: A total of 1,829 individuals were observed for 7......BACKGROUND: Newer antiretroviral treatment regimens for HIV carry a lower risk of inducing drug resistance mutations. We estimated changes in incidence rates (IRs) of new mutations in HIV-infected individuals receiving highly active antiretroviral therapy (HAART). METHODS: Population-based data...... were obtained from the Danish HIV Cohort Study and the Danish HIV Sequence Database. We included treatment-naive patients initiating HAART after December 1997 and computed time to first drug resistance mutation, identified as new mutations detected within 1 year after a 60-day period of treatment...

  11. Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa.

    Science.gov (United States)

    Carlos, Silvia; Nzakimuena, Francis; Reina, Gabriel; Lopez-Del Burgo, Cristina; Burgueño, Eduardo; Ndarabu, Adolphe; Osorio, Alfonso; de Irala, Jokin

    2016-07-20

    Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo). Prospective cohort study from December 2014 until March 2016. People 15-60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up. This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

  12. Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004–12: a prospective cohort study

    Science.gov (United States)

    Vandormael, Alain; Newell, Marie-Louise; Bärnighausen, Till; Tanser, Frank

    2014-01-01

    Summary Background Studies of HIV-serodiscordant couples in stable sexual relationships have provided convincing evidence that antiretroviral therapy can prevent the transmission of HIV. We aimed to quantify the preventive effect of a public-sector HIV treatment and care programme based in a community with poor knowledge and disclosure of HIV status, frequent migration, late marriage, and multiple partnerships. Specifically, we assessed whether an individual's hazard of HIV acquisition was associated with antiretroviral therapy coverage among household members of the opposite sex. Methods In this prospective cohort study, we linked patients' records from a public-sector HIV treatment programme in rural KwaZulu-Natal, South Africa, with population-based HIV surveillance data collected between 2004 and 2012. We used information about coresidence to construct estimates of HIV prevalence and antiretroviral therapy coverage for each household. We then regressed the time to HIV seroconversion for 14 505 individuals, who were HIV-uninfected at baseline and individually followed up over time regarding their HIV status, on opposite-sex household antiretroviral therapy coverage, controlling for household HIV prevalence and a range of other potential confounders. Findings 2037 individual HIV seroconversions were recorded during 54 845 person-years of follow-up. For each increase of ten percentage points in opposite-sex household antiretroviral therapy coverage, the HIV acquisition hazard was reduced by 6% (95% CI 2–9), after controlling for other factors. This effect size translates into large reductions in HIV acquisition hazards when household antiretroviral therapy coverage is substantially increased. For example, an increase of 50 percentage points in household antiretroviral therapy coverage (eg, from 20% to 70%) reduced the hazard of HIV acquisition by 26% (95% CI 9–39). Interpretation Our findings provide further evidence that antiretroviral therapy

  13. Tuberculosis treatment survival of HIV positive TB patients on directly observed treatment short-course in Southern Ethiopia: a retrospective cohort study.

    Science.gov (United States)

    Shaweno, Debebe; Worku, Alemayehu

    2012-12-12

    Tuberculosis (TB) and HIV co-infection remains a major public health problem. In spite of different initiatives implemented to tackle the disease, many countries have not reached TB control targets. One of the major attributing reasons for this failure is infection with HIV. This study aims to determine the effect of HIV infection on the survival of TB patients. A retrospective cohort study was employed to compare the survival between HIV positive and HIV negative TB patients (370 each) during an eight month directly observed treatment short-course (DOTS) period. TB patient's HIV status was considered as an exposure and follow up time until death was taken as an outcome. All patients with TB treatment outcomes other than death were censored, and death was considered as failure. Cox proportional hazard regression model was used to determine the hazard ratio (HR) of death for each main baseline predictor. TB/HIV co-infected patients were more likely to die; adjusted Hazard Rate (AHR) =1.6, 95%CI (1.01, 2.6) during the DOTS period. This risk was statistically higher among HIV patients during the continuation phase (p=0.0003), as a result HIV positive TB patients had shorter survival (Log rank test= 6.90, df= 2, p= 0.008). The adjusted survival probability was lower in HIV positive TB patients ( 85%) at the end of the DOTS period (8th month). TB treatment survival was substantially lower in HIV infected TB patients, especially during the continuation phase. Targeted and comprehensive management of TB/HIV with a strict follow up should be considered through the entire TB treatment period.

  14. Tuberculosis treatment survival of HIV positive TB patients on directly observed treatment short-course in Southern Ethiopia: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Shaweno Debebe

    2012-12-01

    Full Text Available Abstract Background Tuberculosis (TB and HIV co-infection remains a major public health problem. In spite of different initiatives implemented to tackle the disease, many countries have not reached TB control targets. One of the major attributing reasons for this failure is infection with HIV. This study aims to determine the effect of HIV infection on the survival of TB patients. Findings A retrospective cohort study was employed to compare the survival between HIV positive and HIV negative TB patients (370 each during an eight month directly observed treatment short-course (DOTS period. TB patient’s HIV status was considered as an exposure and follow up time until death was taken as an outcome. All patients with TB treatment outcomes other than death were censored, and death was considered as failure. Cox proportional hazard regression model was used to determine the hazard ratio (HR of death for each main baseline predictor. TB/HIV co-infected patients were more likely to die; adjusted Hazard Rate (AHR =1.6, 95%CI (1.01, 2.6 during the DOTS period. This risk was statistically higher among HIV patients during the continuation phase (p=0.0003, as a result HIV positive TB patients had shorter survival (Log rank test= 6.90, df= 2, p= 0.008. The adjusted survival probability was lower in HIV positive TB patients ( 85% at the end of the DOTS period (8th month. Conclusion TB treatment survival was substantially lower in HIV infected TB patients, especially during the continuation phase. Targeted and comprehensive management of TB/HIV with a strict follow up should be considered through the entire TB treatment period.

  15. Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study.

    Science.gov (United States)

    Podlekareva, Daria N; Efsen, Anne Marie W; Schultze, Anna; Post, Frank A; Skrahina, Alena M; Panteleev, Alexander; Furrer, Hansjakob; Miller, Robert F; Losso, Marcelo H; Toibaro, Javier; Miro, Jose M; Vassilenko, Anna; Girardi, Enrico; Bruyand, Mathias; Obel, Niels; Lundgren, Jens D; Mocroft, Amanda; Kirk, Ole

    2016-03-01

    Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (pdeath were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (pdeath: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at

  16. Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania.

    Science.gov (United States)

    Reddy, Elizabeth A; Agala, Chris Bernard; Maro, Venance P; Ostermann, Jan; Pence, Brian W; Itemba, Dafrosa K; Safley, Donna; Yao, Jia; Thielman, Nathan M; Whetten, Kathryn

    2016-09-20

    Linkage to HIV care is crucial to the success of antiretroviral therapy (ART) programs worldwide, loss to follow up at all stages of the care continuum is frequent, and long-term prospective studies of care linkage are currently lacking. Consecutive clients who tested HIV-positive were enrolled from four HIV testing centers (1 health facility and 3 community-based centers) in the Kilimanjaro region of Tanzania as part of the larger Coping with HIV/AIDS in Tanzania (CHAT) prospective observational study. Biannual interviews were conducted over 3.5 years, assessing care linkage, retention, and mental health. Bivariable and multivariate logistic regression analyses were conducted to determine associations with early death (prior to the second follow up interview) and delayed (>6 months post-test) or failed care linkage. A total of 263 participants were enrolled between November, 2008 and August, 2009 and 240 participants not already linked to care were retained in the final dataset. By 6 months after enrollment, 169 (70.4 %) of 240 participants had presented to an HIV care and treatment facility; 41 (17.1 %) delayed more than 6 months, 15 (6.3 %) died, and 15 (6.3 %) were lost to follow up. Twenty-six patients died before their second follow up visit and were analyzed in the early death group (10.8 %). Just 15 (9.6 %) of those linked to care had started ART within 6 months, but 123 (89.1 %) of patients documented to be ART eligible by local guidelines had started ART by the end of 3.5 years. On multivariate analysis, male gender (OR 1.72; 95 % CI 1.08, 2.75), testing due to illness (OR 1.63; 95 % CI 1.01, 2.63), and higher mean depression scale scores (4 % increased risk per increase in depression score; 95 % CI 1 %, 8 %) were associated with early death. Testing at a community versus a hospital-based site (OR 2.89; 95 % CI 1.79, 4.66) was strongly associated with delaying or never entering care. Nearly 30 % of the cohort did not have timely care

  17. Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study.

    Science.gov (United States)

    Ogunmola, Olarinde Jeffrey; Oladosu, Olatunji Yusuf; Olamoyegun, Adeyemi Michael

    2014-01-01

    There are few studies from Nigeria and Africa regarding the contribution of obesity and hypertension to cardiovascular risk in HIV-infected patients. This study investigates the prevalence of hypertension and obesity and their association with HIV infection and antiretroviral treatment (ART). We conducted a cross-sectional cohort study in a rural tertiary health center in Nigeria. The data collected included demographic variables, blood pressure, body mass index (BMI), monthly income, educational attainment, HIV status and ART treatment, duration of treatment, and CD4 T-lymphocyte count. A total of 403 participants met the inclusion criteria. There were 153 (38.0%) HIV-negative subjects (42.5% male, 57.5% female; mean age: 35.5 ± 7.6 years), 120 (29.8%) HIV-positive drug-naïve subjects (42.5% male, 57.5% female; mean age: 36.5 ± 9.1 years), and 130 (32.2%) HIV-positive subjects taking antiretroviral drugs (33.1% male, 66.9% female; mean age: 38.6 ± 8.0 years). The prevalence of hypertension was 13.7% in HIV-negative subjects, 19.0% in HIV-positive drug-naïve subjects, and 12.3% in HIV-positive ART subjects. The prevalence of obesity was 15.9% in the HIV-negative group, 3% in the HIV-positive drug-naïve group, and 8% in the HIV-positive ART group. Multivariate regression analysis showed no relationship between hypertension and HIV status (P=0.293) or ART status (P=0.587). In contrast, BMI showed a strong relationship with HIV status (odds ratio: 0.281; 95% confidence interval: 0.089-0.884; P=0.030) but not with ART status (P=0.593). BMI was a significant predictor of hypertension. HIV or ART status was not associated with hypertension. HIV infection was associated with a lower BMI, and a lower prevalence of obesity compared with HIV-negative subjects.

  18. Associations between Tobacco, Alcohol, and Drug Use with Coronary Artery Plaque among HIV-Infected and Uninfected Men in the Multicenter AIDS Cohort Study.

    Directory of Open Access Journals (Sweden)

    Sean G Kelly

    Full Text Available We characterized associations between smoking, alcohol, and recreational drug use and coronary plaque by HIV serostatus within the Multicenter AIDS Cohort Study (MACS.MACS participants (N = 1005, 621 HIV+ and 384 HIV- underwent non-contrast CT scanning to measure coronary artery calcium; 764 underwent coronary CT angiograms to evaluate plaque type and extent. Self-reported use of alcohol, tobacco, smoked/inhaled cocaine, methamphetamine, ecstasy, marijuana, inhaled nitrites, and erectile dysfunction drugs was obtained at semi-annual visits beginning 10 years prior to CT scanning. Multivariable logistic and linear regression models were performed, stratified by HIV serostatus.Among HIV+ men, current smoking, former smoking, and cumulative pack years of smoking were positively associated with multiple coronary plaque measures (coronary artery calcium presence and extent, total plaque presence and extent, calcified plaque presence, and stenosis >50%. Smoking was significantly associated with fewer plaque measures of comparable effect size among HIV- men; current smoking and calcified plaque extent was the only such association. Heavy alcohol use (>14 drinks/week was associated with stenosis >50% among HIV+ men. Among HIV- men, low/moderate (1-14 drinks/week and heavy alcohol use were inversely associated with coronary artery calcium and calcified plaque extent. Few significant associations between other recreational drug use and plaque measures were observed.Smoking is strongly associated with coronary plaque among HIV+ men, underscoring the value of smoking cessation for HIV+ persons. Alcohol use may protect against coronary artery calcium and calcified plaque progression in HIV- (but not HIV+ men. Few positive associations were observed between recreational drug use and coronary plaque measures.

  19. Incidence of low- and high-energy fractures in persons with and without HIV-infection: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit E; Gerstoft, Jan; Kronborg, Gitte

    2012-01-01

    OBJECTIVE:: To compare fracture risk in persons with and without HIV-infection and to examine the influence of HAART initiation on risk of fracture. DESIGN:: Population-based nationwide cohort study using Danish registries. METHODS:: Outcome measures were time to first fracture at any site, time...

  20. Risk of triple-class virological failure in children with HIV: a retrospective cohort study

    DEFF Research Database (Denmark)

    Castro, Hannah; Judd, Ali; Gibb, Diana M

    2011-01-01

    In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological...

  1. Substantially Higher and Earlier Occurrence of Anti-Tuberculosis Drug-Related Adverse Reactions in HIV Coinfected Tuberculosis Patients: A Matched-Cohort Study.

    Science.gov (United States)

    Matono, Takashi; Nishijima, Takeshi; Teruya, Katsuji; Morino, Eriko; Takasaki, Jin; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Kaku, Mitsuo; Oka, Shinichi

    2017-11-01

    Little information exists on the frequency, severity, and timing of first-line anti-tuberculosis drug-related adverse events (TB-AEs) in HIV-tuberculosis coinfected (HIV-TB) patients in the antiretroviral therapy (ART) era. This matched-cohort study included HIV-TB patients as cases and HIV-uninfected tuberculosis (non-HIV-TB) patients as controls. Tuberculosis was culture-confirmed in both groups. Cases were matched to controls in a 1:4 ratio on age, sex, and year of diagnosis. TB-AEs were defined as Grade 2 or higher requiring drug discontinuation/regimen change. From 2003 to 2015, 94 cases and 376 controls were analyzed (95% men, 98% Asians). Standard four-drug combination therapy was initiated in 91% of cases and 89% of controls (p = 0.45). Cases had a higher frequency of TB-AE [51% (48/94) vs. 10% (39/376), p tuberculosis treatment. HIV infection was an independent risk factor for TB-AEs in the multivariate Cox analysis [adjusted HR (aHR): 6.96; 95% confidence interval: 3.93-12.3]. TB-AEs occurred more frequently in HIV-TB than in non-HIV-TB patients, and were more severe. The majority of TB-AEs occurred within 4 weeks of initiating anti-tuberculosis treatment. Because TB-AEs may delay ART initiation, careful monitoring during this period is warranted in coinfected patients.

  2. Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study

    Science.gov (United States)

    Mutabazi-Mwesigire, Doris

    2015-01-01

    Introduction With the availability of antiretroviral therapy (ART) and primary general care for people living with HIV (PLHIV) in resource limited settings, PLHIV are living longer, and HIV has been transformed into a chronic illness. People are diagnosed and started on treatment when they are relatively well. Although ART results in clinical improvement, the ultimate goal of treatment is full physical functioning and general well-being, with a focus on quality of life rather than clinical outcomes. However, there has been little research on the relationship of specific factors to quality of life in PLHIV. The objective of this study was to investigate factors associated with quality of life among PLHIV in Uganda receiving basic care and those on ART. Methods We enrolled 1274 patients attending an HIV outpatient clinic into a prospective cohort study. Of these, 640 received ART. All were followed up at 3 and 6 months. Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index (GPGI). Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary (PHS) score, Mental Health Summary (MHS) score, and GPGI. Results Among PLHIV receiving basic care, PHS was associated with: sex (p=0.045) - females had lower PHS; age in years at enrollment (p=0.0001) - older patients had lower PHS; and depression (pART, PHS was associated with: study visit (p=0.01), with increase in time there was better PHS, and this also improved with increase in education level (p=0.002). Patients with WHO disease stage 3&4 had a lower PHS compared to patients at stage 1&2 (p=0.006), and depressed patients had lower PHS (pART. Regardless of treatment status, PLHIV with depression or low education level and female gender were at risk of having a poor quality of life. Clinicians and policy makers should be aware of

  3. Ribavirin Concentrations Do Not Predict Sustained Virological Response in HIV/HCV-Coinfected Patients Treated with Ribavirin and Pegylated Interferon in the Swiss HIV Cohort Study.

    Directory of Open Access Journals (Sweden)

    Helen Kovari

    Full Text Available Ribavirin (RBV is an essential component of most current hepatitis C (HCV treatment regimens and still standard of care in the combination with pegylated interferon (pegIFN to treat chronic HCV in resource limited settings. Study results in HIV/HCV-coinfected patients are contradicting as to whether RBV concentration correlates with sustained virological response (SVR.We included 262 HCV treatment naïve HIV/HCV-coinfected Swiss HIV Cohort Study (SHCS participants treated with RBV and pegIFN between 01.01.2001-01.01.2010, 134 with HCV genotype (GT 1/4, and 128 with GT 2/3 infections. RBV levels were measured retrospectively in stored plasma samples obtained between HCV treatment week 4 and end of therapy. Uni- and multivariable logistic regression analyses were used to evaluate the association between RBV concentration and SVR in GT 1/4 and GT 2/3 infections. The analyses were repeated stratified by treatment phase (week 4-12, 13-24, >24 and IL28B genotype (CC versus CT/TT.SVR rates were 35.1% in GT 1/4 and 70.3% in GT 2/3 infections. Overall, median RBV concentration was 2.0 mg/L in GT 1/4, and 1.9 mg/L in GT 2/3, and did not change significantly across treatment phases. Patients with SVR had similar RBV concentrations compared to patients without SVR in both HCV genotype groups. SVR was not associated with RBV levels ≥2.0 mg/L (GT 1/4, OR 1.19 [0.5-2.86]; GT 2/3, 1.94 [0.78-4.80] and ≥2.5 mg/L (GT 1/4, 1.56 [0.64-3.84]; GT 2/3 2.72 [0.85-8.73], regardless of treatment phase, and IL28B genotype.In HIV/HCV-coinfected patients treated with pegIFN/RBV, therapeutic drug monitoring of RBV concentrations does not enhance the chance of HCV cure, regardless of HCV genotype, treatment phase and IL28B genotype.

  4. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau - a retrospective cohort study.

    Science.gov (United States)

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Erikstrup, Christian; Østergaard, Lars; Wejse, Christian

    2015-01-01

    With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9-107.8), 7.6 (95% CI: 1.6-35.5) and 3.1 (95% CI: 1.5-6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7-11.8). We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased risk of resistance development and excess

  5. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau – a retrospective cohort study

    Science.gov (United States)

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Erikstrup, Christian; Østergaard, Lars; Wejse, Christian

    2015-01-01

    Introduction With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. Methods In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. Results We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9–107.8), 7.6 (95% CI: 1.6–35.5) and 3.1 (95% CI: 1.5–6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7–11.8). Conclusions We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased

  6. Differences in the causes of death of HIV-positive patients in a cohort study by data sources and coding algorithms.

    Science.gov (United States)

    Hernando, Victoria; Sobrino-Vegas, Paz; Burriel, M Carmen; Berenguer, Juan; Navarro, Gemma; Santos, Ignacio; Reparaz, Jesús; Martínez, M Angeles; Antela, Antonio; Gutiérrez, Félix; del Amo, Julia

    2012-09-10

    To compare causes of death (CoDs) from two independent sources: National Basic Death File (NBDF) and deaths reported to the Spanish HIV Research cohort [Cohort de adultos con infección por VIH de la Red de Investigación en SIDA CoRIS)] and compare the two coding algorithms: International Classification of Diseases, 10th revision (ICD-10) and revised version of Coding Causes of Death in HIV (revised CoDe). Between 2004 and 2008, CoDs were obtained from the cohort records (free text, multiple causes) and also from NBDF (ICD-10). CoDs from CoRIS were coded according to ICD-10 and revised CoDe by a panel. Deaths were compared by 13 disease groups: HIV/AIDS, liver diseases, malignancies, infections, cardiovascular, blood disorders, pulmonary, central nervous system, drug use, external, suicide, other causes and ill defined. There were 160 deaths. Concordance for the 13 groups was observed in 111 (69%) cases for the two sources and in 115 (72%) cases for the two coding algorithms. According to revised CoDe, the commonest CoDs were HIV/AIDS (53%), non-AIDS malignancies (11%) and liver related (9%), these percentages were similar, 57, 10 and 8%, respectively, for NBDF (coded as ICD-10). When using ICD-10 to code deaths in CoRIS, wherein HIV infection was known in everyone, the proportion of non-AIDS malignancies was 13%, liver-related accounted for 3%, while HIV/AIDS reached 70% due to liver-related, infections and ill-defined causes being coded as HIV/AIDS. There is substantial variation in CoDs in HIV-infected persons according to sources and algorithms. ICD-10 in patients known to be HIV-positive overestimates HIV/AIDS-related deaths at the expense of underestimating liver-related diseases, infections and ill defined causes. CoDe seems as the best option for cohort studies.

  7. Predictors of unsafe sex among HIV patients in Denmark: A population-based cohort study

    DEFF Research Database (Denmark)

    Qvist, Tavs; Engsig, Frederik; Kronborg, Gitte

    2011-01-01

    Abstract Background: Sexual transmission continues to be the primary mode of human immunodeficiency virus (HIV) infection in Western Europe. We aimed to describe predictors of unsafe sex and reasons given for such behaviour. Methods: We performed a survey examining sexual risk behaviours...... are primarily linked to negotiation issues concerning condom use, including assumptions about the sexual partner's intent....

  8. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study

    DEFF Research Database (Denmark)

    Weber, R; Ruppik, M; Rickenbach, M

    2013-01-01

    Mortality among HIV-infected persons is decreasing, and causes of death are changing. Classification of deaths is hampered because of low autopsy rates, frequent deaths outside of hospitals, and shortcomings of International Statistical Classification of Diseases and Related Health Problems (ICD-10...

  9. Point-of-Care Ultrasound for Extrapulmonary Tuberculosis in India: A Prospective Cohort Study in HIV-Positive and HIV-Negative Presumptive Tuberculosis Patients.

    Science.gov (United States)

    Weber, Stefan F; Saravu, Kavitha; Heller, Tom; Kadavigere, Rajagopal; Vishwanath, Shashidhar; Gehring, Stephan; Bélard, Sabine; And Pocus Eti Study Group

    2017-10-16

    Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Point-of-care ultrasound (POCUS) for human immunodeficiency virus (HIV)-associated EPTB is applied in sub-Saharan Africa. This study aimed at evaluating the applicability of POCUS for diagnosing EPTB in HIV-positive and HIV-negative presumptive tuberculosis (TB) patients in India, a country of moderate relative TB and HIV burden. Presumptive TB patients at Kasturba Hospital, Manipal, India, prospectively underwent POCUS evaluating for pericardial, pleural and ascitic effusion, abdominal lymphadenopathy, and hepatic and splenic microabscesses. Findings were correlated with TB category (confirmed TB, clinical TB, unlikely TB), HIV status, and discharge diagnoses. A total of 425 patients underwent POCUS; 81 (20%) were HIV-positive. POCUS findings were more common in HIV/TB coinfected patients than in HIV-positive patients with unlikely TB (24/40 (60%) versus 9/41 (22%), P EPTB. In HIV-negative patients, POCUS detected features associated with EPTB but also of malignancy and other infectious diseases.

  10. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study.

    Science.gov (United States)

    Rasmussen, Line D; May, Margaret T; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Gerstoft, Jan; Obel, Niels

    2015-07-01

    Whether the reported high risk of age-related diseases in HIV-infected people is caused by biological ageing or HIV-associated risk factors such as chronic immune activation and low-grade inflammation is unknown. We assessed time trends in age-standardised and relative risks of nine serious age-related diseases in a nationwide cohort study of HIV-infected individuals and population controls. We identified all HIV-infected individuals in the Danish HIV Cohort Study who had received HIV care in Denmark between Jan 1, 1995, and June 1, 2014. Population controls were identified from the Danish Civil Registration System and individually matched in a ratio of nine to one to the HIV-infected individuals for year of birth, sex, and date of study inclusion. Individuals were included in the study if they had a Danish personal identification number, were aged 16 years or older, and were living in Denmark at the time of study inclusion. Data for study outcomes were obtained from the Danish National Hospital Registry and the Danish National Registry of Causes of Death and were cardiovascular diseases (myocardial infarction and stroke), cancers (virus associated, smoking related, and other), severe neurocognitive disease, chronic kidney disease, chronic liver disease, and osteoporotic fractures. We calculated excess and age-standardised incidence rates and adjusted incidence rate ratios of outcomes for time after HIV diagnosis, highly active antiretroviral therapy (ART) initiation, and calendar time. The regression analyses were adjusted for age, sex, calendar time, and origin. We identified 5897 HIV-infected individuals and 53,073 population controls; median age was 36·8 years (IQR 30·6-44·4), and 76% were men in both cohorts. Dependent on disease, the HIV cohort had 55,050-57,631 person-years of follow-up and the population controls had 638,204-659,237 person-years of follow-up. Compared with the population controls, people with HIV had high excess and relative risk of all

  11. Predictors of adverse pregnancy outcomes in women infected with HIV in Latin America and the Caribbean: a cohort study.

    Science.gov (United States)

    Kreitchmann, R; Li, S X; Melo, V H; Fernandes Coelho, D; Watts, D H; Joao, E; Coutinho, C M; Alarcon, J O; Siberry, G K

    2014-11-01

    To examine maternal characteristics associated with adverse pregnancy outcomes among women infected with HIV. Prospective cohort study. Multiple sites in Latin America and the Caribbean. Women infected with HIV enrolled in the Perinatal (2002-2007) and the Longitudinal Study in Latin American Countries (LILAC; 2008-2012) studies of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Frequencies of adverse pregnancy outcomes assessed among pregnancies. Risk factors investigated by logistic regression analysis. Adverse pregnancy outcomes, including preterm delivery (PT), low birthweight (LBW), small for gestational age (SGA), stillbirth (SB), and neonatal death. Among 1512 women, 1.9% (95% confidence interval, 95% CI, 1.3-2.7) of singleton pregnancies resulted in a stillbirth and 32.9% (95% CI 30.6-35.4) had at least one adverse pregnancy outcome. Of 1483 singleton live births, 19.8% (95% CI 17.8-21.9) were PT, 14.2% (95% CI 12.5-16.1) were LBW, 12.6% (95% CI 10.9-14.4) were SGA, and 0.4% (95% CI 0.2-0.9) of infants died within 28 days of birth. Multivariable logistic regression modelling indicated that the following risk factors increased the probability of having one or more adverse pregnancy outcomes: lower maternal body mass index at delivery (odds ratio, OR, 2.2; 95% CI 1.4-3.5), hospitalisation during pregnancy (OR 3.3; 95% CI 2.0-5.3), hypertension during pregnancy (OR 2.7; 95% CI 1.5-4.8), antiretroviral use at conception (OR 1.4; 95% CI 1.0-1.9), and tobacco use during pregnancy (OR 1.7; 95% CI 1.3-2.2). The results of fitting multivariable logistic regression models for PT, LBW, SGA, and SB are also reported. Women infected with HIV had a relatively high occurrence of adverse pregnancy outcomes, and some maternal risk factors were associated with these adverse pregnancy outcomes. Interventions targeting modifiable risk factors should be evaluated further. © 2014

  12. Predictors of Adverse Pregnancy Outcomes in HIV infected Women in Latin America and the Caribbean: a Cohort Study

    Science.gov (United States)

    Kreitchmann, Regis; Li, Su X.; Melo, Victor Hugo; Coelho, Debora Fernandes; Watts, D. Heather; Joao, Esau; Coutinho, Conrado Milani; Alarcon, Jorge O.; Siberry, George K.

    2014-01-01

    Objectives To examine maternal characteristics associated with adverse pregnancy outcomes (APOs) among HIV-infected women. Design Prospective cohort study Setting Multiple sites in Latin America and the Caribbean Population First on-study pregnancy among HIV-1-infected women enrolled in NISDI (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative) Perinatal (2002–2007) and LILAC (2008–2012) studies. Methods Frequencies of APOs assessed among pregnancies. Risk factors investigated by logistic regression analysis. Main Outcome measures APOs including preterm delivery (PT), low birth weight (LBW), small for gestational age (SGA), stillbirth (SB) and neonatal death. Results Among 1512 women, 1.9% (95% confidence interval [CI] 1.3–2.7%) of singleton pregnancies resulted in a stillbirth and 32.9% (30.6–35.4%) had at least one APO. Of 1483 singleton live births, 19.8% (17.8–21.9%) were PT, 14.2% (12.5–16.1%) were LBW, 12.6% (10.9–14.4%) were SGA, and 0.4% (0.2–0.9%) of infants died within 28 days after birth. Multivariable logistic regression modeling indicated that the following risk factors increased the probability of having one or more APOs: lower maternal body mass index (odds ratio [OR]=2.2; 95% CI: 1.4–3.5) at delivery, hospitalization during pregnancy (OR=3.3; 95% CI: 2.0–5.3), hypertension during pregnancy (OR=2.7; 95% CI: 1.5–4.8), antiretroviral use at conception (OR=1.4; 95% CI: 1.0–1.9) and tobacco use during pregnancy (OR=1.7; 95% CI: 1.3–2.2). Results of fitting multivariable logistic regression models for PT, LBW, SGA and SB are also reported. Conclusions HIV-infected women had relatively high occurrence of APOs and some maternal risk factors were associated with these APOs. Interventions targeting modifiable risk factors should be evaluated further. PMID:24602102

  13. Histological Evidence of Chronic Mycoplasma genitalium���Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study

    OpenAIRE

    Dehon, Patricia M.; Hagensee, Michael E; Sutton, Kimberly J.; Oddo, Hope E.; Nelson, Nia; McGowin, Chris L.

    2016-01-01

    Background.���Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in inflammatory syndromes of the female reproductive tract. The objective of this study was to investigate human immunodeficiency virus (HIV)���infected women for an association between M. genitalium and cervicitis, a putative mechanism for enhanced HIV transmission efficiency to an uninfected partner.

  14. Characteristics and outcomes of older HIV-infected patients receiving antiretroviral therapy in Malawi: A retrospective observation cohort study.

    Directory of Open Access Journals (Sweden)

    Hannock Tweya

    Full Text Available To estimate patients enrolling on antiretroviral therapy (ART over time; describe trends in baseline characteristics; and compare immunological response, loss to follow-up (LTFU, and mortality by three age groups (25-39, 40-49 and ≥50 years.A retrospective observation cohort study.This study used routine ART data from two public clinics in Lilongwe, Malawi. All HIV-infected individuals, except pregnant or breastfeeding women, aged ≥ 25 years at ART initiation between 2006 and 2015 were included. Poisson regression models estimated risk of mortality, stratified by age groups.Of 37,378 ART patients, 3,406 were ≥ 50 years old. Patients aged ≥ 50 years initiated ART with more advanced WHO clinical stage and lower CD4 cell count than their younger counterparts. Older patients had a significantly slower immunological response to ART in the first 18 months on ART compared to patients aged 25-39 years (p = 0.04. Overall mortality rates were 2.3 (95% confidence Interval (CI 2.2-2.4, 2.9 (95% CI 2.7-3.2 and 4.6 (95% CI 4.2-5.1 per 100 person-years in patients aged 25-39 years, 40-49 years and 50 years and older, respectively. Overall LTFU rates were 6.3 (95% CI 6.1-6.5, 4.5 (95% CI 4.2-4.7, and 5.6 (95% CI 5.1-6.1 per 100 person years among increasing age cohorts. The proportion of patients aged ≥ 50 years and newly enrolling into ART care remained stable at 9% while the proportion of active ART patients aged ≥50 years increased from 10% in 2006 to 15% in 2015.Older people had slower immunological response and higher mortality. Malawi appears to be undergoing a demographic shift in people living with HIV. Increased consideration of long-term ART-related problems, drug-drug interactions and age-related non-communicable diseases is warranted.

  15. Efficacy and safety of rilpivirine-based regimens in treatment-experienced HIV-1 infected patients: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Sandrine Gazaignes

    2014-11-01

    Full Text Available Introduction: Rilpivirine (RPV is a new once-daily, non-nucleoside, reverse transcriptase inhibitor (NNRTI. In treatment-naïve patients, RPV has shown non-inferior antiviral activity to efavirenz but data in treatment-experienced patients are more limited. We assessed the efficacy and safety of RPV in treatment-experienced patients switching to a RPV-based regimen. Methods: Between September 2012 and June 2013, all antiretroviral therapy (ART experienced HIV-1 infected patients with a plasma HIV-RNA level <50 cp/mL, and switching to a RPV-based regimen, were enrolled in this prospective monocentric cohort study. Clinical and laboratory data were collected every 3 months to assess safety and efficacy. The primary endpoint was the proportion of patients with virologic success (HIV-RNA load <50 cp/mL at 12 months using the FDA snapshot algorithm. Results: A total of 281 patients (76% male, median age: 47 years, 56% MSM were enrolled in this study. Median lymphocyte CD4 count at baseline was 640/mm3. Patients have received ART for a median of 7 years and viral replication was fully suppressed for a median of 3 years. Before the switch, 39% patients were treated with NNRTI, 52% with protease inhibitor and 7% with integrase inhibitor-based regimens. Reasons for switch were simplification (176 cases, adverse events (AEs (93 cases and others (12 cases. At month 12 (database frozen on June 2014 in the snapshot analysis, 56% of patients met virologic success, 5% experienced virologic failure (n=14 and 39% had no data in the window period. In the LOCF analysis (using data from the previous available visit before month 12, 89% patients were suppressed, 5% had virologic failure and 6% had no data. Genotypic resistance analysis was performed in 7/14 patients at the time of virologic failure (3 of whom had previous NRTI/NNRTI resistance-associated mutations (RAMs, and new NNRTI and NRTI RAMs emerged in 4 patients. RPV-based regimen was generally well

  16. Efficacy and safety of rilpivirine-based regimens in treatment-experienced HIV-1 infected patients: a prospective cohort study

    Science.gov (United States)

    Gazaignes, Sandrine; Resche-Rigon, Matthieu; Yang, Chloe; Gatey, Caroline; Munier, Anne-Lise; Desseaux, Kristell; Rozenbaum, Willy; Molina, Jean-Michel

    2014-01-01

    Introduction Rilpivirine (RPV) is a new once-daily, non-nucleoside, reverse transcriptase inhibitor (NNRTI). In treatment-naïve patients, RPV has shown non-inferior antiviral activity to efavirenz but data in treatment-experienced patients are more limited. We assessed the efficacy and safety of RPV in treatment-experienced patients switching to a RPV-based regimen. Methods Between September 2012 and June 2013, all antiretroviral therapy (ART) experienced HIV-1 infected patients with a plasma HIV-RNA level <50 cp/mL, and switching to a RPV-based regimen, were enrolled in this prospective monocentric cohort study. Clinical and laboratory data were collected every 3 months to assess safety and efficacy. The primary endpoint was the proportion of patients with virologic success (HIV-RNA load <50 cp/mL) at 12 months using the FDA snapshot algorithm. Results A total of 281 patients (76% male, median age: 47 years, 56% MSM) were enrolled in this study. Median lymphocyte CD4 count at baseline was 640/mm3. Patients have received ART for a median of 7 years and viral replication was fully suppressed for a median of 3 years. Before the switch, 39% patients were treated with NNRTI, 52% with protease inhibitor and 7% with integrase inhibitor-based regimens. Reasons for switch were simplification (176 cases), adverse events (AEs) (93 cases) and others (12 cases). At month 12 (database frozen on June 2014) in the snapshot analysis, 56% of patients met virologic success, 5% experienced virologic failure (n=14) and 39% had no data in the window period. In the LOCF analysis (using data from the previous available visit before month 12), 89% patients were suppressed, 5% had virologic failure and 6% had no data. Genotypic resistance analysis was performed in 7/14 patients at the time of virologic failure (3 of whom had previous NRTI/NNRTI resistance-associated mutations (RAMs)), and new NNRTI and NRTI RAMs emerged in 4 patients. RPV-based regimen was generally well tolerated and

  17. Nutritional status and its effect on treatment outcome among HIV infected clients receiving HAART in Ethiopia: a cohort study.

    Science.gov (United States)

    Hussen, Sadikalmahdi; Belachew, Tefera; Hussien, Nezif

    The aim of this study was to determine the effects of nutritional status at the start of highly active anti-retroviral therapy on treatment outcomes among HIV/AIDS patients taking HAART at Jimma University Specialized Hospital. We performed a retrospective cohort study involving 340 adults who started highly active anti-retroviral therapy. The patients have been clinically followed for 2 years. Data were extracted from paper based medical charts by trained data collectors from January 30 to February 28, 2014 using data collection format. We entered data into Epi data version 3.1 and then exported to SPSS for windows version 21. Predictors of CD4 change were identified using multivariable linear regression model. Time to an event (death) was estimated by Kaplan-Meier and predictors of mortality were identified by Cox proportional hazard model. Out of 340 patients, 42 patients died during the follow-up. Twenty-five (59.5 %) deaths were from malnourished group. Age, baseline CD4, sex, baseline HAART and marital status were significant predictors of immunologic recovery at different time points. Malnutrition was associated with lower CD4 recovery and greater hazard of death. Malnutrition tends to decrease CD4 recovery and predisposes patient to early death.

  18. Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study.

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    Doris Mutabazi-Mwesigire

    Full Text Available With the availability of antiretroviral therapy (ART and primary general care for people living with HIV (PLHIV in resource limited settings, PLHIV are living longer, and HIV has been transformed into a chronic illness. People are diagnosed and started on treatment when they are relatively well. Although ART results in clinical improvement, the ultimate goal of treatment is full physical functioning and general well-being, with a focus on quality of life rather than clinical outcomes. However, there has been little research on the relationship of specific factors to quality of life in PLHIV. The objective of this study was to investigate factors associated with quality of life among PLHIV in Uganda receiving basic care and those on ART.We enrolled 1274 patients attending an HIV outpatient clinic into a prospective cohort study. Of these, 640 received ART. All were followed up at 3 and 6 months. Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index (GPGI. Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary (PHS score, Mental Health Summary (MHS score, and GPGI.Among PLHIV receiving basic care, PHS was associated with: sex (p=0.045 - females had lower PHS; age in years at enrollment (p=0.0001 - older patients had lower PHS; and depression (p<0.001 - depressed patients had lower PHS. MHS was only associated with opportunistic infection (p=0.01 - presence of an opportunistic infection was associated with lower MHS. For the GPG the associated variables were age (p=0.03 - older patients had lower GPGI; education (p=0.01 - higher education associated with higher GPGI; and depression - patients with depression had a lower GPGI (p<0.001. Among patients on ART, PHS was associated with: study visit (p=0.01, with increase in time there was better PHS

  19. Risk factors associated with HIV infection among male homosexuals and bisexuals followed in an open cohort study: Project Horizonte, Brazil (1994-2010.

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    Ana Paula Silva

    Full Text Available There has recently been an increase in HIV infection rates among men who have sex with men (MSM. This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort-Project Horizonte, Belo Horizonte, Minas Gerais, Brazil.This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994-2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case was compared with three randomly selected HIV negative controls, matched by admission date and age (±3 years. During follow-up, 93 volunteers seroconverted and were compared with 279 controls.The risk factors associated with HIV seroconversion were: contact with partner's blood during sexual relations (OR 3.7; 95% CI 1.2-11.6, attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3-5.4, occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3-5.1, inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1-5.4, little interest to look up information about AIDS (OR 2.6; 95% CI 1.0-6.7 particularly in newspapers (OR 3.4; 95% CI 1.4-8.1.This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic's development and the specificities of this particular population are needed.

  20. Hodgkin lymphoma is as common as non-Hodgkin lymphoma in HIV-positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study.

    Science.gov (United States)

    Hoffmann, C; Hentrich, M; Gillor, D; Behrens, G; Jensen, B; Stoehr, A; Esser, S; van Lunzen, J; Krznaric, I; Müller, M; Oette, M; Hensel, M; Thoden, J; Fätkenheuer, G; Wyen, C

    2015-04-01

    The incidence of HIV-related non-Hodgkin lymphoma (NHL) but not that of Hodgkin lymphoma (HL) has been declining. The aim of the study was to compare HIV-infected patients with NHL and HL with respect to antiretroviral therapy (ART) exposure at the time of lymphoma diagnosis. HIV-infected patients with NHL and HL included in a prospective multicentre cohort study since January 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. As of 31 December 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P  12 months and a CD4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD4 count of < 350 cells/μL. This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL, the majority of patients with HL were on effective ART, suggesting that ART provides insufficient protection from developing HL. The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART. © 2014 British HIV Association.

  1. Impact of Hepatitis C Virus Coinfection on Response to Highly Active Antiretroviral Therapy and Outcome in HIV-Infected Individuals: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Weis, Nina Margrethe; Lindhardt, Bjarne Ø.; Kronborg, Gitte

    2006-01-01

    BACKGROUND: Coinfection with hepatitis C virus (HCV) in human immunodeficiency virus (HIV) type 1-infected patients may decrease the effectiveness of highly active antiretroviral therapy. We determined the impact of HCV infection on response to highly active antiretroviral therapy and outcome among...... Danish patients with HIV-1 infection. METHODS: This prospective cohort study included all adult Danish HIV-1-infected patients who started highly active antiretroviral therapy from 1 January 1995 to 1 January 2004. Patients were classified as HCV positive (positive HCV serological test and/or HCV PCR...... was significantly higher in the HCV-positive group (mortality rate ratio, 2.4; 95% confidence interval [CI], 1.9-3.0), as was liver disease-related mortality (mortality rate ratio, 16; 95% CI, 7.2-33). Furthermore, patients in the HCV-positive group had a higher risk of dying with a prothrombin time

  2. Incident Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Men Who Have Sex With Men From Pre-HAART to HAART Periods: A Cohort Study.

    Science.gov (United States)

    Falade-Nwulia, Oluwaseun; Seaberg, Eric C; Snider, Anna E; Rinaldo, Charles R; Phair, John; Witt, Mallory D; Thio, Chloe L

    2015-11-03

    Men who have sex with men (MSM) are at high risk for hepatitis B virus (HBV) infection. Data on the effect of highly active antiretroviral therapy (HAART) on incident HBV infection in HIV-infected and HIV-uninfected MSM are limited. To determine predictors of incident HBV infection in MSM during pre-HAART and HAART periods. Observational cohort study. Cohort of MSM who have, or are at risk for, HIV infection. 2375 HBV-uninfected MSM in the Multicenter AIDS Cohort Study. Poisson regression was used to compare incidence rates of HBV infection in the pre-HAART and HAART eras and to identify factors associated with incidence of HBV infection. In 25,322 person-years of follow-up, 244 incident HBV infections occurred. The unadjusted incidence rate was higher in HIV-infected MSM than in HIV-uninfected MSM (incidence rate ratio [IRR], 1.9 [95% CI, 1.5 to 2.4]) and was significantly lower in the HAART era than in the pre-HAART era among HIV-infected (IRR, 0.2 [CI, 0.1 to 0.4]) and HIV-uninfected (IRR, 0.3 [CI, 0.2 to 0.4]) MSM. Age younger than 40 years (IRR, 2.3 [CI, 1.7 to 3.0]), more than 1 recent sexual partner (IRR, 3.1 [CI, 2.3 to 4.2]), and HIV infection (IRR, 2.4 [CI, 1.8 to 3.1]) were independently associated with higher incidence of HBV infection, whereas HBV vaccination was protective (IRR, 0.3 [CI, 0.2 to 0.4]). Highly active antiretroviral therapy with HIV RNA levels less than 400 copies/mL was associated with protection (IRR, 0.2 [CI, 0.1 to 0.5]), but HAART in those with HIV RNA levels of 400 copies/mL or greater was not. The observational nature limits inferences about causality. Effective HAART is associated with lower incidence of HBV infection; however, even in the HAART era, incidence of HBV infection remains high among MSM. National Institute of Allergy and Infectious Diseases.

  3. Pregnancy outcomes in HIV-positive women in Ukraine, 2000-12 (European Collaborative Study in EuroCoord): an observational cohort study.

    Science.gov (United States)

    Bagkeris, Emmanouil; Malyuta, Ruslan; Volokha, Alla; Cortina-Borja, Mario; Bailey, Heather; Townsend, Claire L; Thorne, Claire

    2015-09-01

    Women living with HIV are potentially at increased risk of adverse pregnancy outcomes, due to a range of factors, including immunosuppression, use of combination antiretroviral therapy (ART), and injecting drug use. Rates of mother-to-child transmission of HIV in Ukraine have declined to around 2-4%, but little is known about other pregnancy outcomes in this setting. We used data from an observational prospective cohort study to assess pregnancy outcomes among HIV-positive women in Ukraine. The European Collaborative Study (ECS) in EuroCoord is a continuing cohort study, established in Ukraine in 2000. Eligible women are those with a diagnosis of HIV infection before or during pregnancy (including intrapartum) who deliver liveborn babies at seven sites. Maternal sociodemographic, HIV-related, and delivery (mother and infant) data were collected with study-specific questionnaires. We used Poisson regression models to identify factors associated with preterm delivery (before 37 weeks' gestation) and small weight for gestational age (less than the tenth percentile of weight for gestational age), based on complete cases. Between January, 2000, and July, 2012, data were collected on 8884 HIV-positive mother and liveborn infant pairs. Median maternal age was 26·5 years (IQR 23·1-30·3). 832 (11%) women had WHO stage 3 or 4 HIV and 1474 (17%) had a history of injecting drug use. 7348 (83%) had received antenatal ART. Among 7435 for whom ART type was available, 4396 (50%) had received zidovudine monotherapy and 2949 (33%) combination ART. Preterm delivery was seen in 780 (9%, 95% CI 8-9) of 8860 births overall and in 77 (9%, 7-11) of 889 babies with small size for gestational age. Factors associated with preterm delivery were history of injecting drug use (adjusted risk ratio 1·64, 95% CI 1·38-1·95), no ART (2·94, 2·43-3·57 vs zidovudine monotherapy), antenatal combination ART (1·40, 1·14-1·73 vs zidovudine monotherapy), WHO stage 4 HIV (2·42, 1·71-3·41 vs

  4. Association Between Educational Level and Risk of Cancer in HIV-infected Individuals and the Background Population: Population-based Cohort Study 1995-2011.

    Science.gov (United States)

    Legarth, Rebecca; Omland, Lars H; Dalton, Susanne O; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Pedersen, Gitte; Gerstoft, Jan; Obel, Niels

    2015-11-15

    Human immunodeficiency virus (HIV)-infected individuals have increased risk of cancer. To our knowledge, no previous study has examined the impact of socioeconomic position on risk and prognosis of cancer in HIV infection. Population-based cohort-study, including HIV-infected individuals diagnosed (without intravenous drug abuse or hepatitis C infection) (n = 3205), and a background population cohort matched by age, gender, and country of birth (n = 22 435) were analyzed. Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, incidence rate ratios (IRRs), and survival using Kaplan-Meier methods were estimated. Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to population controls: all (adjusted-IRRs: 1.4 [95% confidence interval {CI}, 1.1-1.7] vs 1.1 [95% CI, .9-1.2]), tobacco- and alcohol-related (2.1 [95% CI, 1.3-3.4] vs 1.3 [95% CI, 1.1-1.6]), and other (1.7 [95% CI, 1.1-2.8] vs 0.9 [95% CI, .7-1.0]). Educational level was not associated with infection-related or ill-defined cancers. One-year-survival was not associated with educational level, but HIV-infected individuals with low educational level had lower 5-year-survival following infection-related and ill-defined cancers. Education is associated with risk and prognosis of some cancers in HIV infection, and diverges from what is observed in the background population. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. HIV-associated idiopathic non-cirrhotic portal hypertension is an underdiagnosed disorder: results of a large cohort study

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    T Koëter

    2012-11-01

    Full Text Available Purpose of the study Idiopathic non-cirrhotic portal hypertension (INCPH has been reported increasingly in patients with chronic HIV infection. However, several aspects of this disorder remain to be elucidated. The aim of our study was to evaluate the prevalence and risk factors of HIV associated INCPH. Methods All adult HIV patients attending the outpatient clinic between February and September 2011 underwent sonographical spleen size determination and assessment of portosystemic collaterals. Patients with splenomegaly underwent an extensive ultrasound examination. Gastroscopy was performed when additional signs of portal hypertension or collaterals were observed. All children with HIV infection underwent extensive ultrasound examination. INCPH was diagnosed according to the general definition. Differences between INCPH cases (group 1 and HIV patients treated with didanosine (ddI without portal hypertension (group 2 were assessed at HIV diagnosis, start of ddI and INCPH diagnosis. Summary of results Four out of 1010 screened adult HIV patients were diagnosed with INCPH (prevalence of 4‰. Hundred of the 1010 screened patients were treated with ddI. All INCPH patients were treated with ddI, representing an INCPH prevalence of 4% in patients exposed to ddI. In The Netherlands, 7000 patients were treated with ddI and only 17 are diagnosed with INCPH, suggesting underdiagnosis in 260 patients. No differences in clinical characteristics predictive for the development of INCPH could be demonstrated between group 1 and group 2 at HIV infection or start of ddI treatment. INCPH patients were treated longer with ddI [86 vs. 51 months, p<0.01] and concomitant treatment with ddI and stavudine [21 vs. 4 months, p<0.01]. Corrected for age and duration of follow-up of HIV, active protein c [0.64 vs. 1.13, p<0.01] and active protein s [0.67 vs. 1.01, p<0.01] levels were lower in the INCPH group. None of the 38 children with HIV infection were diagnosed with

  6. Long-term efficacy of first line antiretroviral therapy in Indian HIV-1 infected patients: a longitudinal cohort study.

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    Ujjwal Neogi

    Full Text Available Short term efficacy of combination antiretroviral therapy (cART in resource-constrained settings is comparable to that found in western studies. However, long term data are limited. India has the third largest HIV infected population in the world but the long-term outcome of first line therapy according to the national guidelines has not been evaluated yet. Therefore, we conducted a long-term longitudinal analysis of the efficacy of the national first-line therapy in India from an observational cohort of Indian patients in two different clinical settings.A total 323 patients who had been on ART for a median of 23 months and achieved virological suppression 2000 copies/mL. Adherence and treatment interruptions (>48 h were assessed via self-report. In the studied patients, the median duration of viral suppression was 44 months; 15.8% of patients showed viral rebound, and 2.8% viral failure. Viral rebound or failure was significantly negatively related to perfect adherence (100% adherence and no treatment interruption >48 hrs. Virological re-suppression in the subsequent visit was observed in three patients without any change in therapy despite the presence of key mutations.Our study reports for the first time, a good long-term response to the first line therapy for a median of nearly four years although a less than perfect adherence increases the risk for treatment failure and subsequent drug resistance development. The empirical findings in this study also indicate the overall success of the Indian ART program in two different settings which likely are representative of other clinics that operate under the national guidelines.

  7. Relatively low HIV infection rates in rural Uganda, but with high potential for a rise: a cohort study in Kayunga District, Uganda.

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    David Guwatudde

    Full Text Available BACKGROUND: Few studies have been conducted in Uganda to identify and quantify the determinants of HIV-1 infection. We report results from a community-based cohort study, whose primary objectives were to determine HIV-1 prevalence, incidence, and determinants of these infections, among other objectives. METHODOLOGY: Consenting volunteers from the rural district of Kayunga in Uganda aged 15-49 years were enrolled between March and July 2006. Participants were evaluated every six months. A questionnaire that collected information on behavioral and other HIV-1 risk factors was administered, and a blood sample obtained for laboratory analysis at each study visit. PRINCIPAL FINDINGS: HIV-1 prevalence among the 2025 participants was 9.9% (95% CI = 8.6%-11.2%. By the end of 12 months of follow-up, 1689.7 person-years had been accumulated, with a median follow-up time of 11.97 months. Thirteen HIV-1 incident cases were detected giving an annual HIV-1 incidence of 0.77% (95% CI = 0.35-1.19. Prevalence of HSV-2 infection was 57% and was strongly associated with prevalent HIV-1 infection (adjusted Odds Ratio = 3.9, 95% CI = 2.50-6.17; as well as incident HIV-1 infection (adjusted Rate Ratio (RR = 8.7, 95% CI = 1.11-67.2. The single most important behavioral characteristic associated with incident HIV infection was the number of times in the past 6 months, a participant had sex with person(s they suspected/knew were having sex with others; attaining statistical significance at 10 times and higher (adjusted RR = 6.3, 95% CI = 1.73-23.1. By the end of 12 months of follow-up, 259 participants (13% were lost to follow-up, 13 (0.6% had died, and 2 (0.1% had withdrawn consent. CONCLUSIONS: Despite relatively low HIV-1 incidence observed in this community, prevalence remains relatively high. In the presence of high prevalence of HSV-2 infection and the behavioral characteristic of having sex with more than one partner, there is potential for increase in HIV-1

  8. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.

    Science.gov (United States)

    Jewkes, Rachel K; Dunkle, Kristin; Nduna, Mzikazi; Shai, Nwabisa

    2010-07-03

    Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women. We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions. 128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3) for intimate partner violence. Relationship power inequity and intimate partner violence

  9. Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study.

    Science.gov (United States)

    Bowman, Alex S; Lerebours, Leonel; Amesty, Silvia; de la Rosa, Milagros; Gil, Elizabeth; Halpern, Mina; Nicholas, Stephen; Lamb, Matthew R

    2016-04-01

    The Caribbean has the highest adult HIV prevalence in the world after sub-Saharan Africa (2011). One sub-population in the Dominican Republic is the migratory Batey community primarily comprised of Haitian immigrants with limited access to healthcare and HIV prevalence rates of between 3.0% and 9.0%, compared to 0.7% nationally. This retrospective cohort study describes the cumulative retention from diagnosis to virological suppression for newly-diagnosed HIV-infected adults presenting to the Clínica de Familia and its Batey programme in La Romana, during 2011. Of the patients diagnosed with HIV, 65% entered into care, 59% completed immunologic testing, 53% were eligible for antiretroviral therapy (ART) initiation, 36% initiated ART within three months of eligibility and 27% were retained in care. Seventeen per cent of those retained on ART with a 12-month viral load measure had undetectable viral load. Attrition primarily occurred before ART initiation. The Batey programme had a first step lost-to-follow-up of 88% compared to 20% at the clinic (p < 0.001). This retrospective study details the continuum of care and indicates where structural changes must occur to increase continuity between steps. The manuscript results are important to help implement programmes to enhance engagement and retention in HIV primary care. © The Author(s) 2015.

  10. CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care-a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999-2013.

    Science.gov (United States)

    Zeitlmann, Nadine; Gunsenheimer-Bartmeyer, Barbara; Santos-Hövener, Claudia; Kollan, Christian; An der Heiden, Matthias

    2016-12-07

    Although early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care. We used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-naïve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group. In total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)SSA: 1.44, 95%-confidence interval (95%-CI):1.12-1.84) and SEA-migrants (ORSEA:2.16, 95%-CI:1.43-3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18-4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA. SSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV

  11. Medicinal and recreational marijuana use among HIV-infected women in the Women's Interagency HIV Study (WIHS) cohort, 1994-2010.

    Science.gov (United States)

    Dʼsouza, Gypsyamber; Matson, Pamela A; Grady, Cynthia D; Nahvi, Shadi; Merenstein, Dan; Weber, Kathleen M; Greenblatt, Ruth; Burian, Pam; Wilson, Tracey E

    2012-12-15

    Despite the major benefits of effective antiretroviral therapy on HIV-related survival, there is an ongoing need to help alleviate medication side effects related to antiretroviral therapy use. Initial studies suggest that marijuana use may reduce HIV-related symptoms, but medical marijuana use among HIV-infected individuals has not been well described. The authors evaluated trends in marijuana use and reported motivations for use among 2776 HIV-infected women in the Women's Interagency HIV Study between October 1994 and March 2010. Predictors of any and daily marijuana use were explored in multivariate logistic regression models clustered by person using generalized estimating equation. In 2009, participants were asked if their marijuana use was medical, "meaning prescribed by a doctor," or recreational, or both. Over the 16 years of this study, the prevalence of current marijuana use decreased significantly from 21% to 14%. In contrast, daily marijuana use almost doubled from 3.3% to 6.1% of all women and from 18% to 51% of current marijuana users. Relaxation, appetite improvement, reduction of HIV-related symptoms, and social use were reported as common reasons for marijuana use. In 2009, most marijuana users reported either purely medicinal use (26%) or both medicinal and recreational usage (29%). Daily marijuana use was associated with higher CD4 cell count, quality of life, and older age. Demographic characteristics and risk behaviors were associated with current marijuana use overall but were not predictors of daily use. This study suggests that both recreational and medicinal marijuana use are relatively common among HIV-infected women in the United States.

  12. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study

    Directory of Open Access Journals (Sweden)

    Ivers Louise C

    2010-08-01

    Full Text Available Abstract Background Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection. We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospective observational cohort study. Methods Adults with HIV infection were eligible for monthly food rations if they had any one of: tuberculosis, body mass index (BMI 2, CD4 cell count 3 (in the prior 3 months or severe socio-economic conditions. A total of 600 individuals (300 eligible and 300 ineligible for food assistance were interviewed before rations were distributed, at 6 months and at 12 months. Data collected included demographics, BMI and food insecurity score (range 0 - 20. Results At 6- and 12-month time-points, 488 and 340 subjects were eligible for analysis. Multivariable analysis demonstrated that at 6 months, food security significantly improved in those who received food assistance versus who did not (-3.55 vs -0.16; P Conclusions Food assistance was associated with improved food security, increased BMI, and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be part of routine care where HIV and food insecurity overlap.

  13. Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study.

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    Ahamad, Keith; Hayashi, Kanna; Nguyen, Paul; Dobrer, Sabina; Kerr, Thomas; Schütz, Christian G; Montaner, Julio S; Wood, Evan

    2015-10-01

    HIV infection in people who inject drugs (PWID) is an international public health concern. We aimed to assess the effect of methadone maintenance therapy on HIV incidence in PWID in Vancouver, BC, Canada, where methadone is widely available through family physicians' offices and dispensed by community pharmacies. Data were derived from the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of PWID in Vancouver. Individuals were eligible to enrol in VIDUS if they had injected illicit drugs at least once in the previous month and lived in the Greater Vancouver region. Participants responded to an interviewer-administered questionnaire and provided blood samples at enrolment and follow-up visits every 6 months. We estimated time to HIV seroconversion with Kaplan-Meier methods and used Cox proportional hazards methods to assess associations between methadone use and time to seroconversion. 1639 HIV-negative individuals were recruited between May 1, 1996, and May 31, 2013. Of these individuals, 138 had HIV seroconversion during a median of 75·5 months (IQR 33·4-115·3) of follow-up. In multivariate Cox regression analyses, methadone maintenance therapy remained independently associated with a reduced hazard of HIV infection after adjustment for sociodemographic characteristics and drug use patterns (adjusted relative hazard 0·64, 95% CI 0·41-0·98). Methadone maintenance therapy for PWID made available through primary care physicians and community pharmacies can help to achieve public health goals such as reducing the spread of HIV. US National Institutes of Health, Canada Research Chair, Canadian Institutes of Health Research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. A psycho-educational HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: results from a non-randomized cohort pilot study.

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    Carmen H Logie

    Full Text Available BACKGROUND: Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo (Women Taking Action For Their Health study examined the effectiveness of a peer health worker (PHW delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti. METHOD: This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829. RESULTS: Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88% completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (β = 4.81; 95% CI 4.36-5.26, STI knowledge (β = 0.84; 95% CI 0.70-0.99, condom use (AOR = 4.05, 95% CI 1.86-8.83, and depression (β = -0.63, 95% CI -0.88--0.39 scores showed statistically significant change post-intervention (p<0.05. CONCLUSIONS: This pilot study evaluated a PHW psycho-educational HIV/STI prevention intervention among internally displaced women in post-earthquake Haiti. Pilot studies are an important

  15. Community-associated Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis among HIV Patients: A cohort study

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    Stine Oscar C

    2011-10-01

    Full Text Available Abstract Background HIV patients are at increased risk of development of infections and infection-associated poor health outcomes. We aimed to 1 assess the prevalence of USA300 community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA among HIV-infected patients with S. aureus bloodstream infections and. 2 determine risk factors for infective endocarditis and in-hospital mortality among patients in this population. Methods All adult HIV-infected patients with documented S. aureus bacteremia admitted to the University of Maryland Medical Center between January 1, 2003 and December 31, 2005 were included. CA-MRSA was defined as a USA300 MRSA isolate with the MBQBLO spa-type motif and positive for both the arginine catabolic mobile element and Panton-Valentin Leukocidin. Risk factors for S. aureus-associated infective endocarditis and mortality were determined using logistic regression to calculate odds ratios (OR and 95% confidence intervals (CI. Potential risk factors included demographic variables, comorbid illnesses, and intravenous drug use. Results Among 131 episodes of S. aureus bacteremia, 85 (66% were MRSA of which 47 (54% were CA-MRSA. Sixty-three patients (48% developed endocarditis and 10 patients (8% died in the hospital on the index admission Patients with CA-MRSA were significantly more likely to develop endocarditis (OR = 2.73, 95% CI = 1.30, 5.71. No other variables including comorbid conditions, current receipt of antiretroviral therapy, pre-culture severity of illness, or CD4 count were significantly associated with endocarditis and none were associated with in-hospital mortality. Conclusions CA-MRSA was significantly associated with an increased incidence of endocarditis in this cohort of HIV patients with MRSA bacteremia. In populations such as these, in which the prevalence of intravenous drug use and probability of endocarditis are both high, efforts must be made for early detection, which may improve

  16. High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

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    Caroline De Schacht

    2014-03-01

    Full Text Available Introduction: Acute infection with HIV in the postpartum period results in a high risk of vertical transmission through breastfeeding. A study was done to determine the HIV incidence rate and associated risk factors among postpartum women in Southern Mozambique, where HIV prevalence among pregnant women is 21%. Methods: A prospective cohort study was conducted in six rural health facilities in Gaza and Maputo provinces from March 2008 to July 2011. A total of 1221 women who were HIV-negative on testing at delivery or within two months postpartum were recruited and followed until 18 months postpartum. HIV testing, collection of dried blood spot samples and administration of a structured questionnaire to women were performed every three months. Infant testing by DNA-PCR was done as soon as possible after identification of a new infection in women. HIV incidence was estimated, and potential risk factors at baseline were compared using Poisson regression. Results: Data from 957 women were analyzed with follow-up after the enrolment visit, with a median follow-up of 18.2 months. The HIV incidence in postpartum women is estimated at 3.20/100 women-years (95% CI: 2.30–4.46, with the highest rate among 18- to 19-year-olds (4.92 per 100 women-years; 95% CI: 2.65–9.15. Of the new infections, 14 (34% were identified during the first six months postpartum, 11 (27% between 6 and 12 months and 16 (39% between 12 and 18 months postpartum. Risk factors for incident HIV infection include young age, low number of children, higher education level of the woman's partner and having had sex with someone other than one's partner. The vertical transmission was 21% (95% CI: 5–36 among newly infected women. Conclusions: Incidence of HIV is high among breastfeeding women in Southern Mozambique, contributing to increasing numbers of HIV-infected infants. Comprehensive primary prevention strategies targeting women of reproductive age, particularly pregnant and

  17. Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study.

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    Loeliger, Kelsey B; Altice, Frederick L; Desai, Mayur M; Ciarleglio, Maria M; Gallagher, Colleen; Meyer, Jaimie P

    2017-11-27

    Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services. To create a retrospective cohort of all adults with HIV released from jails and prisons in Connecticut, USA (2007-14), we linked administrative custody and pharmacy databases with mandatory HIV/AIDS surveillance monitoring and case management data. We examined time to LTC (defined as first viral load measurement after release) and viral suppression at LTC. We used generalised estimating equations to show predictors of LTC within 14 days and 30 days of release. Among 3302 incarceration periods for 1350 individuals between 2007 and 2014, 672 (21%) of 3181 periods had LTC within 14 days of release, 1042 (34%) of 3064 had LTC within 30 days of release, and 301 (29%) of 1042 had detectable viral loads at LTC. Factors positively associated with LTC within 14 days of release are intermediate (31-364 days) incarceration duration (adjusted odds ratio 1·52; 95% CI 1·19-1·95), and transitional case management (1·65; 1·36-1·99), receipt of antiretroviral therapy during incarceration (1·39; 1·11-1·74), and two or more medical comorbidities (1·86; 1·48-2·36). Reincarceration (0·70; 0·56-0·88) and conditional release (0·62; 0·50-0·78) were negatively associated with LTC within 14 days. Hispanic ethnicity, bonded release, and psychiatric comorbidity were also associated with LTC within 30 days but reincarceration was not. LTC after release is suboptimal but improves when inmates' medical, psychiatric, and case management needs are identified and addressed before release. People who are rapidly cycling through jail facilities are particularly vulnerable to missed linkage opportunities. The use of integrated programmes to align justice and health-care goals has great potential to improve long-term HIV treatment outcomes. US

  18. HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study.

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    Bailey, Heather; Nizova, Nataliya; Martsynovska, Violeta; Volokha, Alla; Malyuta, Ruslan; Cortina-Borja, Mario; Thorne, Claire

    2016-12-12

    Ukraine's injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV/HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women. Characteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase (AST) to platelet ratio (APRI) and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis (APRI >1.5) among 762 women with an APRI score available. Of 2050 HIV-positive women (median age 27.7 years, IQR 24.6-31.3), 33% were HCV co-infected (79% of those with a history of injecting drug use vs 23% without) and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV/HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U/L and 34% an elevated AST (53% and 61% among HIV/HCV co-infected). Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV/HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV/HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection (AOR 2.53 95%CI 1.03-6.23), history of injecting drug use (AOR 3.51 95%CI 1.39-8.89), WHO stage 3-4 HIV disease (AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease) and not being on combination antiretroviral therapy (AOR 3.08 95%CI 1.23-7.74), adjusted additionally for HBV co-infection, smoking and age. Most HIV/HCV co-infected women had elevated liver

  19. Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study.

    Science.gov (United States)

    Montalto, Gregg Joseph; Sawe, Fredrick K; Miruka, Argwings; Maswai, Jonah; Kiptoo, Ignatius; Aoko, Appolonia; Oreyo, Chrispine; Obiero, Eunice; Korir, Sheila; Bii, Stephen K; Song, Katherine X; Kunz, Anjali N

    2017-01-01

    Emphasis on adolescent HIV has increased worldwide as antiretroviral treatment has greatly extended life expectancies of HIV-positive children. Few evidence-based guidelines exist on the optimal time to disclose to an adolescent living with HIV (ALHIV); little is known about the medical effects of disclosure. This study looked to determine whether disclosure is associated with improved medical outcomes in ALHIV. Prior work has tended to be qualitative, cross-sectional, and with an emphasis on psychosocial outcomes. This paper addresses the adolescent cohort retrospectively (longitudinally), building upon what is already known about disclosure. Retrospective, longitudinal clinical record reviews of ALHIV seen at Kericho District Hospital between April 2004 and November 2012 were performed. Patient demographics and clinical outcomes were systematically extracted. The student's t-test was used to calculate changes in mean CD4 count, antiretroviral therapy (ART), and cotrimoxazole adherence pre- vs. post-disclosure. Linear regression modelling assessed for trends in those clinical outcomes associated with age of disclosure. Ninety-six ALHIV (54 female, 42 male) were included; most (73%) entered care through the outpatient department. Nearly half were cared for by parents, and 20% experienced a change in their primary caregiver. The mean time in the study was 2.47 years; mean number of visits 10.97 per patient over the mean time in the study. Mean disclosure age was 12.34 years. An increase in mean ART adherence percentage was found with disclosure (0.802 vs. 0.917; p = 0.0015). Younger disclosure age was associated with significantly higher mean CD4 counts over the course of the study (p = 0.001), and a nonsignificant trend toward a higher mean ART adherence percentage (p = 0.055). ART adherence and improved immunologic status are both associated with disclosure of HIV infection to adolescent patients. Disclosure of an HIV diagnosis to an adolescent is an important

  20. Very high incidence of syphilis in HIV-infected men who have sex with men in Buenos Aires city: a retrospective cohort study.

    Science.gov (United States)

    Bissio, E; Cisneros, V; Lopardo, G D; Cassetti, L I

    2017-08-01

    The incidence of sexually transmitted infections (STIs), particularly syphilis, is high and continues to rise among some populations, especially among men who have sex with men (MSM). Furthermore, a higher incidence of STIs has been reported in HIV-positive than in HIV-negative MSM. To determine the incidence of syphilis in a cohort of men with HIV in Buenos Aires city. Retrospective cohort study. We examined the records and visits made by men with HIV aged >18 years in our institution during a 1-year period. Venereal Disease Reference Laboratory (VDRL) results for all the men in our cohort during the study period were analysed. We considered a case of syphilis as incident if a person had a VDRL result of ≥16 DILS, provided that this was increased at least fourfold compared with a previous determination. All VDRL results ≤8 were investigated, and analysed together with the medical records, to determine if they were new cases. We analysed the VDRL results and the clinical records of 1150 men followed up in our centre during the study period. Mean age was 40.9 years. According to the definition used, we registered 171 new cases of syphilis-that is, an incidence of 14.9/100 patients/year (95% CI 12.9 to 17.0). No significant differences in incidence according to age group were found, but there was a trend towards a lower incidence in older men. Ten men had two new episodes during the study. The incidence of syphilis in this cohort of men with HIV (predominantly MSM) was very high. In addition to maintaining high surveillance for early diagnosis and treatment, it is necessary to implement newer and more effective measures to prevent syphilis and other STIs in this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Exclusive breastfeeding, diarrhoeal morbidity and all-cause mortality in infants of HIV-infected and HIV uninfected mothers: an intervention cohort study in KwaZulu Natal, South Africa.

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    Nigel C Rollins

    Full Text Available INTRODUCTION: Antiretroviral drug interventions significantly reduce the risk of HIV transmission to infants through breastfeeding. We report diarrhoea prevalence and all-cause mortality at 12 months of age according to infant feeding practices, among infants born to HIV-infected and uninfected mothers in South Africa. METHODS: A non-randomised intervention cohort study that followed both HIV-infected and HIV-uninfected mothers and their infants until 18 months of age. Mothers were supported in their infant feeding choice. Detailed morbidity and vital status data were collected over the first year. At the time, only single dose nevirapine was available to prevent mother-to-child transmission of HIV. RESULTS: Among 2,589 infants, detailed feeding data and vital status were available for 1,082 HIV-exposed infants and 1,155 HIV non-exposed infants. Among exclusively breastfed (EBF infants there were 9.4 diarrhoeal days per 1,000 child days (95%CI. 9.12-9.82 while among infants who were never breastfed there were 15.6 diarrhoeal days per 1,000 child days (95%CI. 14.62-16.59. Exclusive breastfeeding was associated with fewer acute, persistent and total diarrhoeal events than mixed or no breastfeeding in both HIV-exposed infants and also infants of HIV uninfected mothers. In an adjusted cox regression analysis, the risk of death among all infants by 12 months of age was significantly greater in those who were never breastfed (aHR 3.5, p<0.001 or mixed fed (aHR 2.65, p<0.001 compared with those who were EBF. In separate multivariable analyses, infants who were EBF for shorter durations had an increased risk of death compared to those EBF for 5-6 months [aHR 2.18 (95% CI, 1.56-3.01; p<0.001]. DISCUSSION: In the context of antiretroviral drugs being scaled-up to eliminate new HIV infections among children, there is strong justification for financial and human resource investment to promote and support exclusive breastfeeding to improve HIV-free survival

  2. A Retrospective Cohort Study of Lesion Distribution of HIV-1 Infection Patients With Cryptococcal Meningoencephalitis on MRI: Correlation With Immunity and Immune Reconstitution.

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    Xia, Shuang; Li, Xueqin; Shi, Yanbin; Liu, Jinxin; Zhang, Mengjie; Gu, Tenghui; Pan, Shinong; Song, Liucun; Xu, Jinsheng; Sun, Yan; Zhao, Qingxia; Lu, Zhiyan; Lu, Puxuan; Li, Hongjun

    2016-02-01

    The objective of this paper is to correlate the MRI distribution of cryptococcal meningoencephalitis in HIV-1 infection patients with CD4 T cell count and immune reconstitution effect.A large retrospective cohort study of HIV patients from multi-HIV centers in China was studied to demonstrate the MRI distribution of cryptococcal meningoencephalitis and its correlation with the different immune status.The consecutive clinical and neuroimaging data of 55 HIV-1-infected patients with cryptococcal meningoencephalitis collected at multi-HIV centers in China during the years of 2011 to 2014 was retrospectively analyzed. The enrolled patients were divided into 2 groups based on the distribution of lesions. One group of patients had their lesions at the central brain (group 1, n = 34) and the other group of patients had their lesions at the superficial brain (group 2, n = 21). We explored their MRI characterization of brain. In addition, we also compared their CD4 T cell counts and immune reconstitution effects between the 2 groups based on the imaging findings.No statistical difference was found in terms of age and gender between the 2 groups. The medians of CD4 T cell counts were 11.67 cells/mm (3.00-52.00 cells/mm) in group 1 and 42.00 cells/mm (10.00-252.00 cells/mm) in group 2. Statistical difference of CD4 T cell count was found between the 2 groups (P = 0.023). Thirteen patients in group 1 (13/34) and 12 patients in group 2 (12/21) received highly active antiretroviral treatment (HAART). Patients of group 2 received HAART therapy more frequently than patients of group 1 (P = 0.021).Central and superficial brain lesions detected by MR imaging in HIV-1-infected patients with cryptococcal meningoencephalitis are in correlation with the host immunity and HAART therapy.

  3. Mortality and its predictors among highly active antiretroviral therapy naive hiv-infected individuals: data from prospective cohort study in Ukraine.

    Science.gov (United States)

    Zhyvytsia, D

    2014-01-01

    There is little information from Ukraine about the effect of Highly active antiretroviral therapy (HAART) on survival of HIV-infected patients. Our objective was to identify predictors of mortality in HIV-infected patients initiating HAART at the Zaporizhzhya AIDS Center, Ukraine. Prospective cohort study of HIV-infected patients from January 2005 to December 2008 in a Zaporizhzhya AIDS Center, and were tracked for 60 months after start HAART. Unvaried and multivariate analysis and constructed Kaplan-Meier curves to assess predictors. To identify predictors of mortality were used to build a regression Cox proportional hazards model.Two hundred and seventy two patients were studied (mean age 34 years, 42% female, median CD4 count 120 cell/μL). In 60 months of HAART 36 patients died. The probability of survival was 87%. In the univariate analysis, mortality was strongly associated with male gender (HR 6,28; 95% CI 2,22-17,78), IDU route of HIV transmission (HR 2,90; 95% CI 1,32-6,36), WHO clinical stage 4 (HR 3,45 95% CI 1,7-7,0). Mortality was also strongly associated with anemia (HR 2,24 95% CI 1,02-4,92) and HBsAg seropositivity (HR 6,26 95% CI 3,01-13,02). In the multivariate analysis independent factors associated with mortality were WHO clinical stage 4 (HR 2,66 95% CI 1,26-5,58) and HBsAg seropositivity (HR 4,35 95% CI 2,05-9,23). HAART significantly increased probability of survival and reduced the risk of death for HIV-infected patients in Ukraine. Simple clinical and laboratory data independently predict mortality and allow for risk stratification in HIV-infected patients in Ukraine.

  4. Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study.

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    Parchure, Ritu S; Kulkarni, Vinay V; Darak, Trupti S; Mhaskar, Rahul; Miladinovic, Branko; Emmanuel, Patricia J

    2015-06-01

    To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis. During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ. The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.

  5. Impact of hepatitis B virus co-infection on response to highly active antiretroviral treatment and outcome in HIV-infected individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    Omland, L.H.; Weis, Nina; Skinhoj, P.

    2008-01-01

    BACKGROUND: The impact of chronic hepatitis B virus (HBV) infection on viral suppression, immune recovery and mortality in HIV-1 infected patients on highly active antiretroviral treatment (HAART) is a matter of debate. The impact of HBeAg status is unknown. METHODS: This prospective cohort study...... included all adult Danish HIV-1 infected patients who started HAART between 1 January 1995 and 1 December 2006 (3180 patients). Patients were classified as chronic HBV-infected (6%), HBV-negative (87%) or HBV-unknown (7%). HBV-positive patients were divided into HBeAg-positive or -negative (3.0 vs. 2.......6%). Study endpoints were viral load, CD4 cell count and mortality. RESULTS: HBV co-infection had no impact on response to HAART regarding viral suppression or immune recovery. HBV co-infection was associated with several outcomes: overall mortality [mortality rate ratio (MRR) 1.5; 95% confidence interval...

  6. Frequency of Viremic Episodes in HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy: A Cohort Study.

    Science.gov (United States)

    Myer, Landon; Dunning, Lorna; Lesosky, Maia; Hsiao, Nei-Yuan; Phillips, Tamsin; Petro, Greg; Zerbe, Allison; McIntyre, James A; Abrams, Elaine J

    2017-02-15

    The numbers of human immunodeficiency virus (HIV)-infected women initiating antiretroviral therapy (ART) in pregnancy are increasing rapidly with global policy changes. There are widespread concerns about ART adherence during pregnancy and postpartum but few data on viral suppression (VS) over time in these populations. We followed a cohort of 523 women in Cape Town, South Africa, initiating ART in pregnancy (once-daily tenofovir 300 mg, emtricitabine 200 mg, and efavirenz 600 mg) and achieving VS (1000 copies/mL) and minor (50-1000 copies/mL) viremic episodes (VEs) and factors associated with major VEs. In the cohort (median age, 28 years; median pre-ART VL, 3.99 copies/mL; 3% previously defaulted ART; 24% with previous exposure to short-course antiretrovirals), the median time of follow-up from VS was 322 days. Overall, 70% maintained VS throughout follow-up, 8% experienced minor VEs only, and at least 1 major VE was documented in 22% of women. In women with VEs, peak viremia (median, 3.79 log10 copies/mL) was linearly related to pre-ART VL. The incidence of major VEs after initial VS was independently associated with younger age, ART initiation during the third trimester, previous defaulting on ART, and postpartum follow-up. Viremia appears to occur frequently, particularly postpartum, among HIV-infected women after initial VS in this setting. More intensive VL monitoring is warranted in this population; the immediate causes and long-term implications of VE require investigation.

  7. Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study.

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    Raffaella Bucciardini

    Full Text Available Although Ethiopia has been scaling up the antiretroviral therapy (ART services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia.We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation.The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5% and transfers to other HF (6.6 were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77-3.23. Active TB (HR 1.72, 95% CI: 1.23-2.41 and gender (HR 1.64, 95% CI: 1.10-2.56 were also significantly associated with attrition.Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of

  8. Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study.

    Science.gov (United States)

    Bucciardini, Raffaella; Fragola, Vincenzo; Abegaz, Teshome; Lucattini, Stefano; Halifom, Atakilt; Tadesse, Eskedar; Berhe, Micheal; Pugliese, Katherina; Binelli, Andrea; De Castro, Paola; Terlizzi, Roberta; Fucili, Luca; Di Gregorio, Massimiliano; Mirra, Marco; Olivieri, Erika; Teklu, Tsigemariam; Zegeye, Teame; Haile, Amanuel; Vella, Stefano; Abraham, Loko; Godefay, Hagos

    2015-01-01

    Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77-3.23). Active TB (HR 1.72, 95% CI: 1.23-2.41) and gender (HR 1.64, 95% CI: 1.10-2.56) were also significantly associated with attrition. Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex

  9. A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes

    Science.gov (United States)

    Strathdee, Steffanie A; Arredondo, Jaime; Rocha, Teresita; Abramovitz, Daniela; Rolon, Maria Luisa; Patiño Mandujano, Efrain; Rangel, Maria Gudelia; Olivarria, Horcasitas Omar; Gaines, Tommi; Patterson, Thomas L; Beletsky, Leo

    2015-01-01

    Introduction Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre–post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. Objectives Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). Methods/analysis ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N=∼1200), we will administer one 3 h PEP course to groups of 20–50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. Ethics/dissemination Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. Trial registration number NCT02444403. PMID:26260350

  10. Insulin resistance and adipokines serum levels in a caucasian cohort of hiv-positive patients undergoing antiretroviral therapy: a cross sectional study.

    Science.gov (United States)

    Arama, Victoria; Tiliscan, Catalin; Streinu-Cercel, Adrian; Ion, Daniela; Mihailescu, Raluca; Munteanu, Daniela; Hristea, Adriana; Arama, Stefan Sorin

    2013-01-26

    Insulin resistance is frequent in human immunodeficiency virus (HIV) infection and may be related to antiretroviral therapy. Cytokines secreted by adipose tissue (adipokines) are linked to insulin sensitivity. The present study is aimed to assess the prevalence of insulin resistance (IR) and its association with several adipokines, in a non-diabetic Romanian cohort of men and women with HIV-1 infection, undergoing combination antiretroviral therapy (cART). A cross-sectional study was conducted in an unselected sample of 89 HIV-1-positive, non-diabetic patients undergoing stable cART for at least 6 months. Metabolic parameters were measured, including fasting plasma insulin, and circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) levels. Insulin resistance was estimated by measuring the Quantitative Insulin Sensitivity Check Index (QUICKI), using a cut-off value of 0.33. A linear regression model was fitted to QUICKI to test the association of IR and adipokines levels. A total of 89 patients (aged 18-65, median: 28 years) including 51 men (57.3%) and 38 women (42.7%) were included in the study. Fifty nine patients (66.3%) were diagnosed with IR based on QUICKI values lower than the cut-off point. IR prevalence was 72.5% in men and 57.6% in women. The presence of the IR was not influenced by either the time of the HIV diagnosis or by the duration of cART. Decreased adiponectin and increased serum triglycerides were associated with increased IR in men (R=0.43, p=0.007). Hyperleptinemia in women was demonstrated to be associated with the presence of IR (R=0.33, p=0.03). Given the significant prevalence of the IR in our young non-diabetic cohort with HIV infection undergoing antiretroviral therapy reported in our study and the consecutive risk of diabetes and cardiovascular events, we suggest that the IR management should be a central component of HIV-infection therapeutic strategy. As adipokines play major

  11. Insulin resistance and adipokines serum levels in a caucasian cohort of hiv-positive patients undergoing antiretroviral therapy: a cross sectional study

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    Arama Victoria

    2013-01-01

    Full Text Available Abstract Background Insulin resistance is frequent in human immunodeficiency virus (HIV infection and may be related to antiretroviral therapy. Cytokines secreted by adipose tissue (adipokines are linked to insulin sensitivity. The present study is aimed to assess the prevalence of insulin resistance (IR and its association with several adipokines, in a non-diabetic Romanian cohort of men and women with HIV-1 infection, undergoing combination antiretroviral therapy (cART. Methods A cross-sectional study was conducted in an unselected sample of 89 HIV-1-positive, non-diabetic patients undergoing stable cART for at least 6 months. Metabolic parameters were measured, including fasting plasma insulin, and circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha and interleukin-6 (IL-6 levels. Insulin resistance was estimated by measuring the Quantitative Insulin Sensitivity Check Index (QUICKI, using a cut-off value of 0.33. A linear regression model was fitted to QUICKI to test the association of IR and adipokines levels. Results A total of 89 patients (aged 18–65, median: 28 years including 51 men (57.3% and 38 women (42.7% were included in the study. Fifty nine patients (66.3% were diagnosed with IR based on QUICKI values lower than the cut-off point. IR prevalence was 72.5% in men and 57.6% in women. The presence of the IR was not influenced by either the time of the HIV diagnosis or by the duration of cART. Decreased adiponectin and increased serum triglycerides were associated with increased IR in men (R=0.43, p=0.007. Hyperleptinemia in women was demonstrated to be associated with the presence of IR (R=0.33, p=0.03. Conclusions Given the significant prevalence of the IR in our young non-diabetic cohort with HIV infection undergoing antiretroviral therapy reported in our study and the consecutive risk of diabetes and cardiovascular events, we suggest that the IR management should be a central component of HIV

  12. A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

    Science.gov (United States)

    2013-05-01

    significant barrier for patients attempting to remain adherent with care. The same risk factors associated with HIV transmission such as poverty ...as non-AIDS-related comorbid- ities such as diabetes mellitus (DM), cardiovascular disease (CVD), and pulmonary disease. Though these data were not...Wanke C, Terrin N, Skinner S, Knox T (2011) Poverty , hunger, education, and residential status impact survival in HIV. AIDS and Behavior 15: 1503

  13. Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort.

    Science.gov (United States)

    Reitter, A; Stücker, A U; Linde, R; Königs, C; Knecht, G; Herrmann, E; Schlößer, R; Louwen, F; Haberl, A

    2014-10-01

    The aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. There were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. In our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P HIV Association.

  14. Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study.

    Science.gov (United States)

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L; De Boni, Raquel; Quintana, Marcel S B; Campos, Dayse P; Ribeiro, Sayonara R; Pacheco, Antonio G; Veloso, Valdilea G; Luz, Paula M

    2016-10-01

    Mortality in HIV-infected individuals might differ by sex and mode of HIV acquisition. We aimed to study mortality in HIV-infected women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. In this observational cohort study, we included HIV-infected women, heterosexual men, and MSM (aged ≥18 years) from the Instituto Nacional de Infectologia Evandro Chagas database who were enrolled between Jan 1, 2000, and Oct 30, 2011, and who had at least 60 days of follow-up. Causes of deaths, defined with the Coding of Death in HIV protocol, were documented. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS-related and non-AIDS-related deaths. We had 10 142 person-years of follow-up from 2224 individuals: 817 (37%) women, 554 (25%) heterosexual men, and 853 (38%) MSM. Of 103 deaths occurred, 64 were AIDS related, 31 were non-AIDS related, and eight were of unknown causes. In unadjusted analyses, compared with women, the hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% CI 1·30-9·08; p=0·009) and for MSM (2·30, 0·89-5·94; p=0·084). After adjustment for age, CD4 cell counts, last HIV viral load, antiretroviral therapy use, and AIDS-defining infection, AIDS-defining malignant disease, and hospital admission during follow-up, the excess risk of AIDS-related death decreased for heterosexual men (adjusted HR 1·99, 0·75-5·25; p=0·163) but was unchanged for MSM (2·24, 0·82-6·11; p=0·114). Non-AIDS-related mortality did not differ by group. Compared with women, increased risk of AIDS-related death in heterosexual men was partly mitigated by risk factors for AIDS mortality, whereas the excess risk in MSM was unchanged. Further study of reasons for disparity in AIDS-related mortality by mode of transmission is needed. US National Institutes of Health, Brazilian National Council of Technological and Scientific Development (CNPq

  15. Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study

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    Bagenda Danstan

    2010-08-01

    Full Text Available Abstract Background Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes. Methods A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ, weight and height-for-age z scores (WAZ & HAZ were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS, virological failure and immunological success (VF/IS. virological success and immunological failure (VS/IF and both virological and immunological failure (VF/IF. Results From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR was 5.0 years (2.1 - 7.0 and 49% (61/124 were female. The median [95% confidence interval (CI] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2, -1.2 (-2.1, -0.5 and -2.06 (-2.9, -1.2 respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0 and 5.6 (5.2-5.8 copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from - 0.98 (SD 1.7 to + 1.22 (SD 1.2 and from -1.99 (1.7 to + 0.76 (2.4 respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3 to - 0.41 (1.2 and -2.25 (1.2 to -1.16 (1.3 respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 -18.6], age [OR 4.6 95% CI (1.14 -19.1] and WHO clinical stage [OR 3.5 95%CI (1.05 -12.7] were associated with successful treatment outcome. Conclusions HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to

  16. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.

    Science.gov (United States)

    Grant, Robert M; Anderson, Peter L; McMahan, Vanessa; Liu, Albert; Amico, K Rivet; Mehrotra, Megha; Hosek, Sybil; Mosquera, Carlos; Casapia, Martin; Montoya, Orlando; Buchbinder, Susan; Veloso, Valdilea G; Mayer, Kenneth; Chariyalertsak, Suwat; Bekker, Linda-Gail; Kallas, Esper G; Schechter, Mauro; Guanira, Juan; Bushman, Lane; Burns, David N; Rooney, James F; Glidden, David V

    2014-09-01

    The effect of HIV pre-exposure prophylaxis (PrEP) depends on uptake, adherence, and sexual practices. We aimed to assess these factors in a cohort of HIV-negative people at risk of infection. In our cohort study, men and transgender women who have sex with men previously enrolled in PrEP trials (ATN 082, iPrEx, and US Safety Study) were enrolled in a 72 week open-label extension. We measured drug concentrations in plasma and dried blood spots in seroconverters and a random sample of seronegative participants. We assessed PrEP uptake, adherence, sexual practices, and HIV incidence. Statistical methods included Poisson models, comparison of proportions, and generalised estimating equations. We enrolled 1603 HIV-negative people, of whom 1225 (76%) received PrEP. Uptake was higher among those reporting condomless receptive anal intercourse (416/519 [81%] vs 809/1084 [75%], p=0·003) and having serological evidence of herpes (612/791 [77%] vs 613/812 [75%] p=0·03). Of those receiving PrEP, HIV incidence was 1·8 infections per 100 person-years, compared with 2·6 infections per 100 person-years in those who concurrently did not choose PrEP (HR 0·51, 95% CI 0·26-1·01, adjusted for sexual behaviours), and 3·9 infections per 100 person-years in the placebo group of the previous randomised phase (HR 0·49, 95% CI 0·31-0·77). Among those receiving PrEP, HIV incidence was 4·7 infections per 100 person-years if drug was not detected in dried blood spots, 2·3 infections per 100 person-years if drug concentrations suggested use of fewer than two tablets per week, 0·6 per 100 person-years for use of two to three tablets per week, and 0·0 per 100 person-years for use of four or more tablets per week (phistory of syphilis or herpes. PrEP uptake was high when made available free of charge by experienced providers. The effect of PrEP is increased by greater uptake and adherence during periods of higher risk. Drug concentrations in dried blood spots are strongly correlated

  17. Current status of medication adherence and infant follow up in the prevention of mother to child HIV transmission programme in Addis Ababa: a cohort study

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    Mirkuzie Alemnesh H

    2011-10-01

    Full Text Available Abstract Background Prevention of mother to child HIV transmission (PMTCT programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme. Methods A prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done. Results Of 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86% initiated medication during pregnancy, 154 (64% initiated combined zidovudine (ZDV prophylaxis regimen while 78 (33% were initiated lifelong antiretroviral treatment (ART. In total, 171 (60%, 95% CI 55-66% mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins, 191 (87%, 95% CI 81-90% ingested ZDV and single-dose nevirapine (sdNVP at birth. Of the 219 live births (twin births were counted once, 148 (68%, 95% CI 61-73% mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65 to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90% infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58% for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39% had documented HIV test results and six (8.4% were HIV positive. Conclusions We found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually

  18. Transmission route and reasons for HIV testing among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

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    Basak Dokuzoguz

    2014-11-01

    Full Text Available Introduction: Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Methods: Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. Results: The study included 693 patients (561 male, 132 female from 24 sites. Reason for HIV testing was available in 640 patients (92%. The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7% and sex among men who have sex with men (MSM (22.6%. At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm3 (3–1433/mm3. Primary HIV infection was determined in 42/693 (6% patients and 9/693 (% 1, 2 cases were considered “probable primary HIV infection.” The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2% patients delayed their presentation for more than 3 months. The longest delay was 11 months. Conclusions: The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions.

  19. Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study

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    Myer Landon

    2012-09-01

    Full Text Available Abstract Background Antiretroviral therapy (ART initiation in eligible HIV-infected pregnant women is an important intervention to promote maternal and child health. Increasing the duration of ART received before delivery plays a major role in preventing vertical HIV transmission, but pregnant women across Africa experience significant delays in starting ART, partly due the perceived need to deliver ART counseling and patient education before ART initiation. We examined whether delaying ART to provide pre-ART counseling was associated with improved outcomes among HIV-infected women in Cape Town, South Africa. Methods We undertook a retrospective cohort study of 490 HIV-infected pregnant women referred to initiate treatment at an urban ART clinic. At this clinic all patients including pregnant women are screened by a clinician and then undergo three sessions of counseling and patient education prior to starting treatment, commonly introducing delays of 2–4 weeks before ART initiation. Data on viral suppression and retention in care after ART initiation were taken from routine clinic records. Results A total of 382 women initiated ART before delivery (78%; ART initiation before delivery was associated with earlier gestational age at presentation to the ART service (p  Conclusions A substantial proportion of eligible pregnant women referred for ART do not begin treatment before delivery in this setting. Among women who do initiate ART, delaying initiation for patient preparation is not associated with improved maternal outcomes. Given the need to maximize the duration of ART before delivery for prevention of mother-to-child HIV transmission, there is an urgent need for new strategies to help expedite ART initiation in eligible pregnant women.

  20. Impact on adherence of a telephone follow up strategy in HIV-naïve patients who start antiretroviral therapy: cohort study

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    M Bullo

    2012-11-01

    Full Text Available Antiretroviral therapy changed the prognosis of people living with HIV/AIDS. However, lack of adherence jeopardizes the success of antiretroviral therapy and enhances the development of treatment-resistant strains, treatment failure, and therefore it stands as a public health problem. The main goal of this study was to measure the impact on treatment discontinuations and lost to follow up, of a telephone follow-up strategy in naïve patients who start antiretroviral therapy. We conducted a single-site, cohort study during a 12-month period (May 2011–May 2012. A prospective cohort of naïve patients received the standard of care plus a specific telephone follow-up strategy. Results were compared with a retrospective cohort of naïve patients followed up at the same site, who started antiretroviral therapy receiving only the standard of care during a similar period (January–December 2009. We used descriptive statistics and Fisher exact test for the comparisons of variables. We enrolled 41 patients in the prospective cohort and 50 in the retrospective one. Both cohorts had similar general characteristics. We found a lower number of patients who were lost to follow up in the prospective cohort (intervention consistent with lower rates of treatment abandonment, suspensions and a similar tendency for events, including death, even when none of these findings was statistically significant. Baseline characteristics and main results are shown in the table below. Further randomized studies should be conducted applying a telephone follow-up strategy to confirm these findings.

  1. Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study.

    Science.gov (United States)

    Lodi, Sara; Phillips, Andrew; Logan, Roger; Olson, Ashley; Costagliola, Dominique; Abgrall, Sophie; van Sighem, Ard; Reiss, Peter; Miró, José M; Ferrer, Elena; Justice, Amy; Gandhi, Neel; Bucher, Heiner C; Furrer, Hansjakob; Moreno, Santiago; Monge, Susana; Touloumi, Giota; Pantazis, Nikos; Sterne, Jonathan; Young, Jessica G; Meyer, Laurence; Seng, Rémonie; Dabis, Francois; Vandehende, Marie-Anne; Pérez-Hoyos, Santiago; Jarrín, Inma; Jose, Sophie; Sabin, Caroline; Hernán, Miguel A

    2015-08-01

    Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL. We used data from the HIV-CAUSAL Collaboration of cohort studies in Europe and the USA. We included 55,826 individuals aged 18 years or older who were diagnosed with HIV-1 infection between January, 2000, and September, 2013, had not started ART, did not have AIDS, and had CD4 count and HIV-RNA viral load measurements within 6 months of HIV diagnosis. We estimated relative risks of death and of death or AIDS-defining illness, mean survival time, the proportion of individuals in need of ART, and the proportion of individuals with HIV-RNA viral load less than 50 copies per mL, as would have been recorded under each ART initiation strategy after 7 years of HIV diagnosis. We used the parametric g-formula to adjust for baseline and time-varying confounders. Median CD4 count at diagnosis of HIV infection was 376 cells per μL (IQR 222-551). Compared with immediate initiation, the estimated relative risk of death was 1·02 (95% CI 1·01-1·02) when ART was started at a CD4 count less than 500 cells per μL, and 1·06 (1·04-1·08) with initiation at a CD4 count less than 350 cells per μL. Corresponding estimates for death or AIDS-defining illness were 1·06 (1·06-1·07) and 1·20 (1·17-1·23), respectively. Compared with immediate initiation, the mean survival time at 7 years with a strategy of initiation at a CD4 count less than 500 cells per μL was 2 days shorter (95% CI 1-2) and at a CD4 count less than 350 cells per μL was 5 days shorter (4-6). 7 years after diagnosis of HIV, 100%, 98·7% (95% CI 98·6-98·7), and 92·6% (92·2-92·9) of individuals would have

  2. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies.

    Science.gov (United States)

    2010-05-15

    We examined specific causes of mortality in human immunodeficiency virus type 1 (HIV-1)-infected patients who initiated antiretroviral therapy (ART) in Europe and North America from 1996 through 2006, and we quantified associations of prognostic factors with cause-specific mortality. We retrospectively classified all deaths among 39,272 patients enrolled in 13 HIV-1 cohorts (154,667 person years of follow-up) into the categories specified in the Cause of Death (CoDe) project protocol. In 1597 (85%) of 1876 deaths, a definitive cause of death could be assigned. Among these, 792 deaths (49.5%) were AIDS related, followed by non-AIDS malignancies (189; 11.8%), non-AIDS infections (131; 8.2%), violence- and/or drug-related causes (124; 7.7%), liver disease (113; 7.0%), and cardiovascular disease (103; 6.5%). Rates of AIDS-related death (hazard ratio [HR] per 100 cell decrease, 1.43; 95% confidence interval [CI], 1.34-1.53) and death from renal failure (HR, 1.73; 95% CI, 1.18-2.55) were strongly inversely related to CD4 count at initiation of ART, whereas rates of death attributable to AIDS (HR for viral load >5 vs 5 log copies/mL, 1.31; 95% CI, 1.12-1.53), infection (HR, 1.85; 95% CI, 1.25-2.73), cardiovascular (HR, 1.54; 95% CI, 1.05-2.27), and respiratory causes (HR, 3.62; 95% CI, 1.30-10.09) were higher in patients with baseline viral load >5 log copies/mL than in other patients. Rates of each cause of death were higher in patients with presumed transmission via injection drug use than in other patients, with marked increases in rates of liver-related (HR for injection drug use vs non-injection drug use, 6.06; 95% CI, 4.03-9.09) and respiratory tract-related (HR, 4.94; 95% CI, 1.96-12.45) mortality. The proportion of deaths classified as AIDS related decreased with increasing duration of ART. Important contributors to non-AIDS mortality in treated HIV-1-infected individuals must be addressed if decreases in mortality rates are to continue.

  3. Trends and Correlates of Cigarette Smoking and Its Impacts on Health-Related Quality of Life Among People Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study, 2008-2014.

    Science.gov (United States)

    Bekele, Tsegaye; Rueda, Sergio; Gardner, Sandra; Raboud, Janet; Smieja, Marek; Kennedy, Richard; Fletcher, David; Burchell, Ann N; Bacon, Jean; Rourke, Sean B

    2017-02-01

    We sought to examine the trends of cigarette smoking, identify correlates of smoking, and examine the impacts of smoking on health-related quality of life (HRQOL) among people living with HIV in Ontario, Canada. Study sample included 4473 individuals receiving care and enrolled in the Ontario HIV Treatment Network Cohort Study. Self-report data on cigarette smoking, HRQOL, and demographic and sociobehavioral variables were collected between 2008 and 2014 through annual face-to-face interviews. Clinical data were abstracted from participants' medical records and enhanced through linkage with a provincial public health laboratory database. Analyses included descriptive statistics, generalized logit regression, and linear mixed-effects modeling. At first interview, 1760 participants (39.3%) were current cigarette smokers. Smoking prevalence declined annually by 1.6% between 2008 and 2014, but remained much higher than the prevalence in the general population. Current cigarette smokers were more likely to be younger, male, white or indigenous, Canadian-born, single, unemployed with lower education, heavy drinkers, nonmedicinal drug users, and to have current depression than former cigarette smokers or those who never smoked. Current cigarette smokers also had significantly (p smoked after adjusting for demographic, socioeconomic, and HIV-related clinical variables. To reduce the burden of cigarette smoking, cessation interventions that take into account the complex social, economic, and medical needs of people living with HIV are needed urgently.

  4. Examining HIV Viral Load in a Matched Cohort of HIV Positive Individuals With and Without Psoriasis.

    Science.gov (United States)

    Wu, Jashin J; Gilbert, Kathleen E; Batech, Michael; Manalo, Iviensan F; Towner, William J; Raposo, Rui André Saraiva; Nixon, Douglas F; Liao, Wilson

    2017-04-01

    BACKGROUND: HIV-associated psoriasis is well-documented. Genetic, cellular, and cytokine profiles have been used as evidence to suggest psoriasis activates antiviral pathways. There has been a lack of epidemiologic evidence investigating whether psoriasis patients have lower HIV viral counts compared to non-psoriasis patients. OBJECTIVE: Compare the viral load set point of HIV positive patients with and without psoriasis. METHODS: A retrospective matched cohort study of HIV positive patients with and without psoriasis using the Kaiser Permanente Southern California Health Plan database. RESULTS: We identified 101 HIV-positive psoriasis cases; 19 met inclusion criteria and were matched with 3-5 control patients; 94 total patients were analyzed. The mean age was 41.4 (12.07) years and 83% were male. Overall, the median log of the viral load of cases was slightly higher than controls (4.3 vs 4.2; P less than 0.01). CONCLUSIONS: The serum viral load set point of patients with HIV and psoriasis was slightly higher than the viral load set point of HIV patients without psoriasis. J Drugs Dermatol. 2017;16(4):372-377..

  5. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: a cohort study.

    Science.gov (United States)

    Sutcliffe, Catherine G; van Dijk, Janneke H; Munsanje, Bornface; Hamangaba, Francis; Sinywimaanzi, Pamela; Thuma, Philip E; Moss, William J

    2011-03-01

    Deficits in growth observed in HIV-infected children in resource-poor settings can be reversed with antiretroviral treatment (ART). However, many of the studies have been conducted in urban areas with older pediatric populations. This study was undertaken to evaluate growth patterns after ART initiation in a young pediatric population in rural Zambia with a high prevalence of undernutrition. Between 2007 and 2009, 193 HIV-infected children were enrolled in a cohort study in Macha, Zambia. Children were evaluated every 3 months, at which time a questionnaire was administered, height and weight were measured, and blood specimens were collected. Weight- and height-for-age z-scores were constructed from WHO growth standards. All children receiving ART at enrollment or initiating ART during the study were included in this analysis. Linear mixed effects models were used to model trajectories of weight and height-for-age z-scores. A high proportion of study children were underweight (59%) and stunted (72%) at treatment initiation. Improvements in both weight- and height-for-age z-scores were observed, with weight-for-age z-scores increasing during the first 6 months of treatment and then stabilizing, and height-for-age z-scores increasing consistently over time. Trajectories of weight-for-age z-scores differed by underweight status at treatment initiation, with children who were underweight experiencing greater increases in z-scores in the first 6 months of treatment. Trajectories of height-for-age z-scores differed by age, with children older than 5 years of age experiencing smaller increases over time. Some of the effects of HIV on growth were reversed with ART initiation, although a high proportion of children remained underweight and stunted after two years of treatment. Partnerships between treatment and nutrition programs should be explored so that HIV-infected children can receive optimal nutritional support.

  6. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: a cohort study

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    Sinywimaanzi Pamela

    2011-03-01

    Full Text Available Abstract Background Deficits in growth observed in HIV-infected children in resource-poor settings can be reversed with antiretroviral treatment (ART. However, many of the studies have been conducted in urban areas with older pediatric populations. This study was undertaken to evaluate growth patterns after ART initiation in a young pediatric population in rural Zambia with a high prevalence of undernutrition. Methods Between 2007 and 2009, 193 HIV-infected children were enrolled in a cohort study in Macha, Zambia. Children were evaluated every 3 months, at which time a questionnaire was administered, height and weight were measured, and blood specimens were collected. Weight- and height-for-age z-scores were constructed from WHO growth standards. All children receiving ART at enrollment or initiating ART during the study were included in this analysis. Linear mixed effects models were used to model trajectories of weight and height-for-age z-scores. Results A high proportion of study children were underweight (59% and stunted (72% at treatment initiation. Improvements in both weight- and height-for-age z-scores were observed, with weight-for-age z-scores increasing during the first 6 months of treatment and then stabilizing, and height-for-age z-scores increasing consistently over time. Trajectories of weight-for-age z-scores differed by underweight status at treatment initiation, with children who were underweight experiencing greater increases in z-scores in the first 6 months of treatment. Trajectories of height-for-age z-scores differed by age, with children older than 5 years of age experiencing smaller increases over time. Conclusions Some of the effects of HIV on growth were reversed with ART initiation, although a high proportion of children remained underweight and stunted after two years of treatment. Partnerships between treatment and nutrition programs should be explored so that HIV-infected children can receive optimal nutritional

  7. 18-month occurrence of severe events among early diagnosed HIV-infected children before antiretroviral therapy in Abidjan, Côte d'Ivoire: A cohort study

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    Dabis François

    2008-05-01

    Full Text Available Abstract Objective To assess the 18-month field effectiveness on severe events of a pediatric package combining early HIV-diagnosis and targeted cotrimoxazole prophylaxis in HIV-infected children from age six-week before the antiretroviral era, in Abidjan, Côte d'Ivoire. Methods Data from two consecutive prevention of HIV mother-to-child transmission programs were compared: the ANRS 1201/1202 Ditrame-Plus cohort (2001–2005 and the pooled data of the ANRS 049a Ditrame randomized trial and its following open-labeled cohort (1995–2000, used as a reference group. HIV-infected pregnant women ≥ 32–36 weeks of gestation were offered a short-course peri-partum antiretroviral prophylaxis (ZDV in Ditrame, and ZDV ± 3TC+single-dose (sd NVP in Ditrame-Plus. Neonatal prophylaxis was provided in Ditrame-Plus only: 7-day ZDV and sdNVP 48–72 h after birth. A 6-week pediatric HIV-RNA diagnosis was provided on-line in the Ditrame-Plus while it was only oriented on clinical symptoms in Ditrame. Six-week HIV-infected children received a daily cotrimoxazole prophylaxis in Ditrame-Plus while no prophylaxis was provided in Ditrame. The determinants of severe events (death or hospitalization > 1 day were assessed in a Cox regression model. Results Between 1995 and 2003, 98 out of the 1121 live-births were diagnosed as HIV-infected in peri-partum: 45 from Ditrame-Plus and 53 from Ditrame. The 18-month Kaplan-Meier cumulative probability of presenting a severe event was 66% in Ditrame-Plus (95% confidence interval [95%CI]: 50%–81% and 77% in Ditrame (95%CI: 65%–89%, Log Rank test: p = 0.47. After adjustment on maternal WHO clinical stage, maternal death, 6-week pediatric viral load, birth-weight, and breastfeeding exposure, the 18-month risk of severe event was lower in Ditrame-Plus than in Ditrame (adjusted Hazard Ratio (aHR: 0.55, 95%CI: 0.3–1.1, although the difference was not statistically significant; p = 0.07. Maternal death was the only variable

  8. The EVVA Cohort Study: Anal and Cervical Type-Specific Human Papillomavirus Prevalence, Persistence, and Cytologic Findings in Women Living With HIV.

    Science.gov (United States)

    de Pokomandy, Alexandra; Kaufman, Elaina; de Castro, Christina; Mayrand, Marie-Hélène; Burchell, Ann N; Klein, Marina; Charest, Louise; Auger, Manon; Rodrigues-Coutlée, Sophie; Coutlée, François

    2017-08-15

    The risk of anal cancer due to high-risk human papillomavirus (HR-HPV) is higher in women living with human immunodeficiency virus (HIV) than in the general population. We present findings of cervical and anal HPV and cytologic tests at baseline in the EVVA cohort study and HPV persistence data 6 months after baseline. Semiannual visits included questionnaires, chart reviews, cervical/anal cytologic and cervical/anal HPV testing for 2 years. Genotyping for 36 HPV genotypes was performed using the Roche Linear Array HPV genotyping test. A total of 151 women living with HIV were recruited. At baseline, 75% had anal HPV, 51% had anal HR-HPV, 50% had cervical HPV, and 29% had cervical HR-HPV. Anal HPV-16 and HPV-51 were more frequent in women born in Canada (31% and 29%, respectively, compared with ≤16% for other women). Most anal HR-HPV types detected at 6 months (57%-93%) were persistent from baseline. Findings of anal cytologic tests were abnormal for 37% of women. Anal HPV is highly prevalent in women living with HIV, and type distribution varies by place of birth. High-resolution anoscopy was indicated in more than one third of results. As anal cancer is potentially preventable, these important findings need to be considered when selecting the best approach for anal cancer screening programs.

  9. Association of Cytomegalovirus End-Organ Disease with Stroke in People Living with HIV/AIDS: A Nationwide Population-Based Cohort Study.

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    Yung-Feng Yen

    Full Text Available Cytomegalovirus (CMV infection might increase the risk of cardiovascular event. However, data on the link between incident stroke and co-infections of CMV and human immunodeficiency virus (HIV are limited and inconsistent. This nationwide population-based cohort study analyzed the association of CMV end-organ disease and stroke among people living with HIV/AIDS (PLWHA.From January 1, 1998, this study identified adult HIV individuals with and without CMV end-organ disease in the Taiwan National Health Insurance Research Database. All patients were observed for incident stroke and were followed until December 31, 2012. Time-dependent analysis was used to evaluate associations of CMV end-organ disease with stroke.Of the 22,581 PLWHA identified (439 with CMV end-organ disease and 22,142 without CMV end-organ disease, 228 (1.01% had all-cause stroke during a mean follow-up period of 4.85 years, including 169 (0.75% with ischemic stroke and 59 (0.26% with hemorrhagic stroke. After adjusting for age, sex, comorbidities, opportunistic infections after HIV diagnosis, and antiretroviral treatment, CMV end-organ disease was found to be an independent risk factor for incident all-cause stroke (adjusted hazard ratio [AHR], 3.07; 95% confidence interval [CI], 1.70 to 5.55. When stroke type was considered, CMV end-organ disease was significantly positively associated with the risk of ischemic stroke (AHR, 3.14; 95% CI, 1.49 to 6.62 but not hemorrhagic stroke (AHR, 2.52; 95% CI, 0.64 to 9.91.This study suggested that CMV end-organ disease was an independent predictor of ischemic stroke among PLWHA.

  10. A large French prospective cohort of HIV-infected patients: the Nadis Cohort.

    Science.gov (United States)

    Pugliese, Pascal; Cuzin, Lise; Cabié, André; Poizot-Martin, Isabelle; Allavena, Clotilde; Duvivier, Claudine; El Guedj, Myriam; de la Tribonnière, Xavier; Valantin, M A; Dellamonica, P

    2009-09-01

    The aim of this article is to describe the development of a dynamic French cohort of HIV-infected patients, the methodological issues and decisions made, and the characteristics of the patients currently enrolled. Data are collected during medical encounters. Data quality is ensured by automated checks during data capture, by regular controls, by annual assessments, and by ad hoc processes before any scientific analysis is performed. In September 2007, 10,458 patients representing 59,383 patient-years of follow-up were followed in our centres, including 446 with a first HIV diagnosis in the past year. Among these recently diagnosed patients, 25.6% presented with late diagnosis. Our cohort included 3017 women (28.8%). The women were less likely to be receiving highly active antiretroviral therapy (HAART) than men, and when treated were less likely to be receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Our network includes medical centres in overseas territories (1105 patients living overseas). In this particular population, women represented 38.5% of the patients, and the probable route of infection was heterosexual in 75.7% of the patients. Despite epidemiological and social disparities, more patients had nondetectable viral loads when receiving HAART in overseas departments than in metropolitan France. The Nadis Cohort represents a collaboration of major French HIV treatment centres. In September 2007, the cohort database contained up-to-date information on more than 10,000 patients, of whom a significant proportion were women. As a consequence of the choices made when building the cohort and the efforts made to ensure the quality of the database, scientific studies are regularly performed using this cohort.

  11. Gender Differences in Virologic Response after Antiretroviral Therapy in Treatment-naïve HIV-infected Individuals: Results from the 550 Clinic HIV Cohort Study.

    Science.gov (United States)

    Vega, Andrea Reyes; Loban, Alejandra; Srinivasan, Kavitha; Furmanek, Stephen; English, Connor; Bishop, Mary; Spencer, Cathy; Truelove, Daniel; Ramirez, Julio; Raghuram, Anupama; Peyrani, Paula

    2017-01-01

    Abstract Background Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results A total of 70 women and 90 men were included in the study. Median age was 41 years (19) for women and 34 years (19) for men (P < 0.001). Virologic suppression was documented in 76% of women and 64% of men (p 0.166). Immune recovery was documented in 60% of women and 68% of men (p 0.323). Multivariate analysis of virologic success is shown in Figure 1 and immunologic recovery is shown in Figure 2. Conclusion In our study, gender was not found to be associated with differences in response to ART. As expected, drug abuse continues to be an independent variable associated with lack of virologic suppression. If one of the goals of treatment is to achieve a rapid immunologic response, our study may indicate

  12. Establishing the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS): Operationalizing Community-based Research in a Large National Quantitative Study.

    Science.gov (United States)

    Loutfy, Mona; Greene, Saara; Kennedy, V Logan; Lewis, Johanna; Thomas-Pavanel, Jamie; Conway, Tracey; de Pokomandy, Alexandra; O'Brien, Nadia; Carter, Allison; Tharao, Wangari; Nicholson, Valerie; Beaver, Kerrigan; Dubuc, Danièle; Gahagan, Jacqueline; Proulx-Boucher, Karène; Hogg, Robert S; Kaida, Angela

    2016-08-19

    Community-based research has gained increasing recognition in health research over the last two decades. Such participatory research approaches are lauded for their ability to anchor research in lived experiences, ensuring cultural appropriateness, accessing local knowledge, reaching marginalized communities, building capacity, and facilitating research-to-action. While having these positive attributes, the community-based health research literature is predominantly composed of small projects, using qualitative methods, and set within geographically limited communities. Its use in larger health studies, including clinical trials and cohorts, is limited. We present the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a large-scale, multi-site, national, longitudinal quantitative study that has operationalized community-based research in all steps of the research process. Successes, challenges and further considerations are offered. Through the integration of community-based research principles, we have been successful in: facilitating a two-year long formative phase for this study; developing a novel survey instrument with national involvement; training 39 Peer Research Associates (PRAs); offering ongoing comprehensive support to PRAs; and engaging in an ongoing iterative community-based research process. Our community-based research approach within CHIWOS demanded that we be cognizant of challenges managing a large national team, inherent power imbalances and challenges with communication, compensation and volunteering considerations, and extensive delays in institutional processes. It is important to consider the iterative nature of community-based research and to work through tensions that emerge given the diverse perspectives of numerous team members. Community-based research, as an approach to large-scale quantitative health research projects, is an increasingly viable methodological option. Community-based research has several

  13. Establishing the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS: Operationalizing Community-based Research in a Large National Quantitative Study

    Directory of Open Access Journals (Sweden)

    Mona Loutfy

    2016-08-01

    Full Text Available Abstract Background Community-based research has gained increasing recognition in health research over the last two decades. Such participatory research approaches are lauded for their ability to anchor research in lived experiences, ensuring cultural appropriateness, accessing local knowledge, reaching marginalized communities, building capacity, and facilitating research-to-action. While having these positive attributes, the community-based health research literature is predominantly composed of small projects, using qualitative methods, and set within geographically limited communities. Its use in larger health studies, including clinical trials and cohorts, is limited. We present the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS, a large-scale, multi-site, national, longitudinal quantitative study that has operationalized community-based research in all steps of the research process. Successes, challenges and further considerations are offered. Discussion Through the integration of community-based research principles, we have been successful in: facilitating a two-year long formative phase for this study; developing a novel survey instrument with national involvement; training 39 Peer Research Associates (PRAs; offering ongoing comprehensive support to PRAs; and engaging in an ongoing iterative community-based research process. Our community-based research approach within CHIWOS demanded that we be cognizant of challenges managing a large national team, inherent power imbalances and challenges with communication, compensation and volunteering considerations, and extensive delays in institutional processes. It is important to consider the iterative nature of community-based research and to work through tensions that emerge given the diverse perspectives of numerous team members. Conclusions Community-based research, as an approach to large-scale quantitative health research projects, is an increasingly viable

  14. The MANGUA Project: A Population-Based HIV Cohort in Guatemala

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    Juan Ignacio García

    2015-01-01

    Full Text Available Introduction. The MANGUA cohort is an ongoing multicenter, observational study of people living with HIV/AIDS in Guatemala. The cohort is based on the MANGUA application which is an electronic database to capture essential data from the medical records of HIV patients in care. Methods. The cohort enrolls HIV-positive adults ≥16 years of age. A predefined set of sociodemographic, behavioral, clinical, and laboratory data are registered at entry to the cohort study. Results. As of October 1st, 2012, 21 697 patients had been included in the MANGUA cohort (median age: 33 years, 40.3% female. At enrollment 74.1% had signs of advanced HIV infection and only 56.3% had baseline CD4 cell counts. In the first 12 months after starting antiretroviral treatment 26.9% (n=3938 of the patients were lost to the program. Conclusions. The implementation of a cohort of HIV-positive patients in care in Guatemala is feasible and has provided national HIV indicators to monitor and evaluate the HIV epidemic. The identified percentages of late presenters and high rates of LTFU will help the Ministry to target their current efforts in improving access to diagnosis and care.

  15. The MANGUA Project: A Population-Based HIV Cohort in Guatemala

    Science.gov (United States)

    García, Juan Ignacio; Samayoa, Blanca; Sabidó, Meritxell; Prieto, Luis Alberto; Nikiforov, Mikhail; Pinzón, Rodolfo; Santa Marina de León, Luis Roberto; Ortiz, José Fernando; Ponce, Ernesto; Mejía, Carlos Rodolfo; Arathoon, Eduardo; Casabona, Jordi; Study Group, The Mangua Cohort

    2015-01-01

    Introduction. The MANGUA cohort is an ongoing multicenter, observational study of people living with HIV/AIDS in Guatemala. The cohort is based on the MANGUA application which is an electronic database to capture essential data from the medical records of HIV patients in care. Methods. The cohort enrolls HIV-positive adults ≥16 years of age. A predefined set of sociodemographic, behavioral, clinical, and laboratory data are registered at entry to the cohort study. Results. As of October 1st, 2012, 21 697 patients had been included in the MANGUA cohort (median age: 33 years, 40.3% female). At enrollment 74.1% had signs of advanced HIV infection and only 56.3% had baseline CD4 cell counts. In the first 12 months after starting antiretroviral treatment 26.9% (n = 3938) of the patients were lost to the program. Conclusions. The implementation of a cohort of HIV-positive patients in care in Guatemala is feasible and has provided national HIV indicators to monitor and evaluate the HIV epidemic. The identified percentages of late presenters and high rates of LTFU will help the Ministry to target their current efforts in improving access to diagnosis and care. PMID:26425365

  16. Methodology Series Module 1: Cohort Studies.

    Science.gov (United States)

    Setia, Maninder Singh

    2016-01-01

    Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be prospective, retrospective, or a combination of both of these types. Since at the time of entry into the cohort study, the individuals do not have outcome, the temporality between exposure and outcome is well defined in a cohort design. If the exposure is rare, then a cohort design is an efficient method to study the relation between exposure and outcomes. A retrospective cohort study can be completed fast and is relatively inexpensive compared with a prospective cohort study. Follow-up of the study participants is very important in a cohort study, and losses are an important source of bias in these types of studies. These studies are used to estimate the cumulative incidence and incidence rate. One of the main strengths of a cohort study is the longitudinal nature of the data. Some of the variables in the data will be time-varying and some may be time independent. Thus, advanced modeling techniques (such as fixed and random effects models) are useful in analysis of these studies.

  17. Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert™ MTB/RIF era: a cohort study.

    Science.gov (United States)

    Hermans, Sabine M; Babirye, Juliet A; Mbabazi, Olive; Kakooza, Francis; Colebunders, Robert; Castelnuovo, Barbara; Sekaggya-Wiltshire, Christine; Parkes-Ratanshi, Rosalind; Manabe, Yukari C

    2017-06-16

    The Xpert™ MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to testing clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment was decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and all-cause mortality in the first year. Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did not differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%] versus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP results did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not associated with higher mortality compared to no or microbiologically confirmed treatment. XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive patients led experienced clinicians to use XP as a "rule-in" rather than "rule-out" test, with the majority of patients still treated empirically.

  18. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

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    Amanda Mocroft

    2015-03-01

    Full Text Available Chronic kidney disease (CKD is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D study with ≥3 estimated glomerular filtration rate (eGFR values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y. Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2. There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events, rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events and high risk groups (risk score ≥ 5, 505

  19. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

    Science.gov (United States)

    Mocroft, Amanda; Lundgren, Jens D; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A; Ryom, Lene

    2015-03-01

    Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events

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

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    B P Muzah

    2012-11-01

    Full Text Available 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<0.001 and moderate anaemia (8.0 - 9.4 g/dl at baseline (AOR 2.30; 95% CI 1.25 - 4.59; p=0.007 were independently associated with the development of discordant immune response, after adjustment for education level, World Health Organization (WHO clinical stage and ART regimen. Conclusions. Discordant immune response following ART initiation was common and associated with baseline anaemia and CD4 cell count in our cohort. Intensive monitoring of at-risk individuals may improve clinical outcomes.

  1. Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study.

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    Ingrid T Katz

    2017-11-01

    Full Text Available South Africa has undergone multiple expansions in antiretroviral therapy (ART eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years, almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl. Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4, or comorbidity (active tuberculosis; and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001, 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001, and pre-ART mortality of 34.2% versus 16.7% (p

  2. Changes in depression in a cohort of Danish HIV-positive individuals: time for routine screening

    DEFF Research Database (Denmark)

    Rodkjaer, Lotte; Laursen, Tinne; Christensen, Nils B

    2011-01-01

    Background: The aim of this study was to follow a cohort of HIV-positive individuals for 3 years in order to assess changes in depression, adherence, unsafe sex and emotional strains from living with HIV. Methods: Participants were assessed for depression, adherence, emotional strain and unsafe s...

  3. Risk of myocardial infarction in parents of HIV-infected individuals: a population-based cohort study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court

    2010-01-01

    associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk.......42; 95% CI: 1.01-2.00). CONCLUSION: Mothers of HIV-infected patients have an increased risk of MI. We presume that this stems from family related life style risk factors, some of which may also influence the risk of MI in HIV-infected patients....

  4. Risk of myocardial infarction in parents of HIV-infected Individuals: a population-based Cohort Study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court

    2010-01-01

    with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents...

  5. Prevalence and incidence of HIV in a rural community-based HIV vaccine preparedness cohort in Masaka, Uganda.

    Directory of Open Access Journals (Sweden)

    Eugene Ruzagira

    Full Text Available BACKGROUND: Local HIV epidemiology data are critical in determining the suitability of a population for HIV vaccine efficacy trials. The objective of this study was to estimate the prevalence and incidence of, and determine risk factors for HIV transmission in a rural community-based HIV vaccine preparedness cohort in Masaka, Uganda. METHODS: Between February and July 2004, we conducted a house-to-house HIV sero-prevalence survey among consenting individuals aged 18-60 years. Participants were interviewed, counseled and asked to provide blood for HIV testing. We then enrolled the HIV uninfected participants in a 2-year HIV sero-incidence study. Medical evaluations, HIV counseling and testing, and sample collection for laboratory analysis were done quarterly. Sexual risk behaviour data was collected every 6 months. RESULTS: The HIV point prevalence was 11.2%, and was higher among women than men (12.9% vs. 8.6%, P = 0.007. Risk factors associated with prevalent HIV infection for men were age <25 years (aOR = 0.05, 95% CI 0.01-0.35 and reported genital ulcer disease in the past year (aOR = 2.17, 95% CI 1.23-3.83. Among women, being unmarried (aOR = 2.59, 95% CI 1.75-3.83 and reported genital ulcer disease in the past year (aOR = 2.40, 95% CI 1.64-3.51 were associated with prevalent HIV infection. Twenty-one seroconversions were recorded over 2025.8 person-years, an annual HIV incidence of 1.04% (95% CI: 0.68-1.59. The only significant risk factor for incident HIV infection was being unmarried (aRR = 3.44, 95% CI 1.43-8.28. Cohort retention after 2 years was 87%. CONCLUSIONS: We found a high prevalence but low incidence of HIV in this cohort. HIV vaccine efficacy trials in this population may not be feasible due to the large sample sizes that would be required. HIV vaccine preparatory efforts in this setting should include identification of higher risk populations.

  6. Correlates of prevalent HIV infection among adults and adolescents in the Kisumu incidence cohort study, Kisumu, Kenya.

    Science.gov (United States)

    Gumbe, Anne; McLellan-Lemal, Eleanor; Gust, Deborah A; Pals, Sherri L; Gray, Kristen Mahle; Ndivo, Richard; Chen, Robert T; Mills, Lisa A; Thomas, Timothy K

    2015-11-01

    We estimated HIV prevalence and identified correlates of HIV infection among 1106 men and women aged 16-34 years residing in Kisumu, Kenya. Demographic, sexual, and other behavioural data were collected using audio computer-assisted self-interview in conjunction with a medical examination, real-time parallel rapid HIV testing, and laboratory testing for pregnancy, gonorrhoea, chlamydia, syphilis, and herpes simplex virus type 2. Multivariate logistic regression was used to identify variables associated with prevalent HIV infection by gender. Overall HIV prevalence was 12.1%. HIV prevalence among women (17.1%) was approximately two-and-one-half times the prevalence among men (6.6%). Odds of HIV infection in men increased with age (aOR associated with one-year increase in age = 1.21, CI = 1.07-1.35) and were greater among those who were uncircumcised (aOR = 4.42, CI = 1.41-13.89) and those who had an herpes simplex virus type 2-positive (aOR = 3.13, CI = 1.12-8.73) test result. Odds of prevalent HIV infection among women also increased with age (aOR associated with one-year increase in age = 1.16, CI = 1.04-1.29). Women who tested herpes simplex virus type 2 positive had more than three times the odds (aOR = 3.85, CI = 1.38-10.46) of prevalent HIV infection compared with those who tested herpes simplex virus type 2 negative. Tailored sexual health interventions and programs may help mitigate HIV age and gender disparities. © The Author(s) 2015.

  7. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study.

    Science.gov (United States)

    Molina, Jean-Michel; Charreau, Isabelle; Spire, Bruno; Cotte, Laurent; Chas, Julie; Capitant, Catherine; Tremblay, Cecile; Rojas-Castro, Daniela; Cua, Eric; Pasquet, Armelle; Bernaud, Camille; Pintado, Claire; Delaugerre, Constance; Sagaon-Teyssier, Luis; Mestre, Soizic Le; Chidiac, Christian; Pialoux, Gilles; Ponscarme, Diane; Fonsart, Julien; Thompson, David; Wainberg, Mark A; Doré, Veronique; Meyer, Laurence

    2017-09-01

    Data for on-demand pre-exposure prophylaxis (PrEP) are scarce. We implemented a cohort study to assess its efficacy, safety, and effect on sexual behaviour. We invited men and transgender women who have sex with men, previously enrolled in the randomised placebo-controlled ANRS IPERGAY trial at seven sites (six in France and one in Canada), to participate in an open-label extension with on-demand tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) to be taken before and after sexual intercourse. We assessed the incidence of HIV and other sexually transmitted infections (STIs), PrEP adherence, safety, and sexual behaviour. Statistical analyses included comparisons of proportions and incidence between the randomised phase of the ANRS IPERGAY trial and the open-label phase, and all participants were included in safety analyses. ANRS IPERGAY is registered with ClinicalTrials.gov, number NCT01473472. Between Nov 4, 2014, and Jan 27, 2015, we enrolled 361 participants. Median follow-up was 18·4 months (IQR 17·7-19·1). One participant who discontinued PrEP acquired HIV infection. HIV incidence was 0·19 per 100 person-years (95% CI 0·01-1·08), compared with 6·60 per 100 person-years (3·60-11·05) in the placebo group of the randomised study, indicating a relative reduction of 97% (95% CI 81-100) in the incidence of HIV with on-demand PrEP. Participants used a median of 18 pills of study drugs per month (IQR 11-25), and at the 6 month visit 240 (71%) of 336 participants had tenofovir detected in plasma. Drug-related gastrointestinal events were reported in 49 participants (14%) but were self-limited. Only four participants (1%) discontinued PrEP, three because of an increase in plasma creatinine. The proportion of participants reporting condomless sex at their last receptive anal intercourse significantly increased from 77% (136 of 176 participants) at baseline to 86% (66 of 77 participants) at 18 months' follow-up (p for trend=0·0004). The incidence

  8. Mortality among HIV-infected women, heterosexual men, and men who have sex with men: insights from an observational cohort study

    Science.gov (United States)

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L.; De Boni, Raquel; Quintana, Marcel S. B.; Campos, Dayse P.; Ribeiro, Sayonara R.; Pacheco, Antonio G.; Veloso, Valdilea G.; Luz, Paula M.

    2016-01-01

    Background Mortality among HIV-infected individuals may differ by sex and mode of HIV acquisition. We studied mortality among women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. Methods HIV-infected adults followed at Instituto Nacional de Infectologia Evandro Chagas from 2000–2011 were included. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS and non-AIDS related deaths. Findings 2224 individuals were included (36·7%[817/2224] women, 24·9%[554/2224] heterosexual men, and 38·4%[853/2224] MSM). Throughout the study period, 103 deaths occurred: 64 due to AIDS-related causes, 31 due to non-AIDS related causes and 8 of unknown causes. In unadjusted analyses, compared to women, hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% confidence interval [95%CI] 1·30–9·08) and for MSM (HR 2·30, 95%CI 0·89–5·94). After adjusting for confounders, excess risk of AIDS-related death observed for heterosexual men was attenuated (aHR 1·99, 95%CI 0·75–5·25, p-value=0.163), but unchanged for MSM (aHR 2·24, 95%CI 0·82–6·11, p-value=0.114). Non-AIDS related mortality did not differ by group. Interpretation Compared to women, increased risk of AIDS-related death among heterosexual men was partially mitigated by risk factors for AIDS mortality while excess risk observed among MSM was unchanged. Further study of reasons for AIDS-related mortality disparity by mode of transmission is needed. PMID:27658875

  9. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens D; Ross, Michael

    2015-01-01

    AND FINDINGS: A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004......; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two...... the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria...

  10. Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study.

    Science.gov (United States)

    Jao, J; Yu, W; Patel, K; Miller, T L; Karalius, B; Geffner, M E; DiMeglio, L A; Mirza, A; Chen, J S; Silio, M; McFarland, E J; Van Dyke, R B; Jacobson, D

    2017-11-21

    Dyslipidaemia is common in perinatally HIV-infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs. We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TC:HDL-C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)- or darunavir/ritonavir (DRV/r)-based antiretroviral therapy (ART) from an older PI-based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r- or DRV/r-based ART with the rate of change in lipids, adjusted for potential confounders. From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL-C. (β = -0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL-C, LDL-C, or TG change. A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL-C ratio in PHIV youth, potentially impacting long-term cardiovascular disease risk. © 2017 British HIV Association.

  11. Prevalence, incidence, and associated risk factors of tuberculosis in children with HIV living in the UK and Ireland (CHIPS): a cohort study.

    Science.gov (United States)

    Turkova, Anna; Chappell, Elizabeth; Judd, Ali; Goodall, Ruth L; Welch, Steven B; Foster, Caroline; Riordan, Andrew; Shingadia, Delane; Shackley, Fiona; Doerholt, Katja; Gibb, Diana M; Collins, Intira J

    2015-12-01

    Tuberculosis is the most common serious co-infection in people living with HIV worldwide, but little is known about its incidence in HIV-infected children living in high-resource settings with low tuberculosis prevalence. We aimed to assess the incidence and prevalence of tuberculosis in children with HIV living in the UK and Ireland to understand rates, risk factors, and outcomes of the disease in this group. We did an analysis of children enrolled in CHIPS, an observational multicentre cohort of children receiving HIV care in the UK and Ireland. We assessed characteristics and prevalence of tuberculosis at baseline, measured incidence of disease through the follow-up period using the CHIPS database, and calculated associated risk factors in these children with multivariable logistic and Cox regression models. Between Jan 1, 1996, to Sept 18, 2014, data for 1848 children with 14 761 years of follow-up were reported to CHIPS. 57 (3%) children were diagnosed with tuberculosis: 29 children had tuberculosis at presentation (prevalent tuberculosis) and 29 had the disease diagnosed during follow-up (incident tuberculosis), including one child with recurrent tuberculosis events. Median age at diagnosis was 9 years (IQR 5-12). 25 (43%) children had pulmonary tuberculosis, 24 (41%) had extrapulmonary tuberculosis with or without pulmonary involvement, and the remainder (n=9; 16%) had unspecified-site tuberculosis. The overall incidence rate for the follow-up period was 196 cases per 100 000 person-years (95% CI 137-283). In our multivariable model, tuberculosis at presentation was associated with more severe WHO immunological stage at baseline (odds ratio 0·25, 95% CI 0·08-0·74; p=0·0331; for none vs severe) and being born abroad (odds ratio 0·28, 0·10-0·73; p=0·0036; for UK and Ireland vs abroad). Incident tuberculosis was associated with time-updated more severe WHO immunological stage (hazard ratio 0·15, 95% CI 0·06-0·41; p=0·0056; for none vs severe

  12. Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study.

    Science.gov (United States)

    Katz, Ingrid T; Kaplan, Richard; Fitzmaurice, Garrett; Leone, Dominick; Bangsberg, David R; Bekker, Linda-Gail; Orrell, Catherine

    2017-11-01

    South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl. We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a

  13. Psychological predictors for attendance of post-HIV test counselling and linkage to care: the Umeed cohort study in Goa, India.

    Science.gov (United States)

    Mayston, Rosie; Patel, Vikram; Abas, Melanie; Korgaonkar, Priya; Paranjape, Ramesh; Rodrigues, Savio; Prince, Martin

    2014-06-30

    Successful linkage to care is increasingly recognised as a potentially important factor in determining the success of Antiretroviral Therapy treatment programmes. However, the role of psychological factors during the early part of the continuum of care has so far been under-investigated. The objective of the Umeed study was to evaluate the impact of Common Mental Disorder (CMD), hazardous alcohol use and low cognitive functioning upon attendance for post-test counselling and linkage to care among people attending for HIV-testing in Goa, India. The study was a prospective cohort design. Participants were recruited at the time of attending for testing and were asked to complete a baseline interview covering sociodemographic characteristics and mental health exposures. HIV status, post-test counselling (PTC) and Antiretroviral Treatment (ART) Centre data were extracted from clinical records. Among 1934 participants, CMD predicted non-attendance for PTC (adjusted OR = 0.51, 0.21-0.82). There was tentative evidence of an association between hazardous alcohol use and non-attendance for PTC (adjusted OR = 0.69, 0.45-1.02). There was no evidence of an association between CMD caseness and attendance for ART. However, post-hoc analyses showed an association between increasing symptoms of CMD and non-attendance. Although participation rates were high (86%), non-participation was a possible source of bias. Cognitive tests had not been previously validated in a young population in Goa. The context in which cognitive testing took place may have contributed to the high prevalence of low scores. Findings suggest the need to move towards a broader conceptualisation of the interrelationship between mental health and HIV. It may be important to consider the impact of symptoms of depression and anxiety at every stage of the continuum of care, including immediately after diagnosis and when initiating contact with treatment services.

  14. Antiretroviral Regimens and CD4/CD8 Ratio Normalization in HIV-Infected Patients during the Initial Year of Treatment: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    F De Salvador-Guillouët

    Full Text Available As CD4/CD8 ratio inversion has been associated with non-AIDS morbidity and mortality, predictors of ratio normalization after cART need to be studied. Here, we aimed to investigate the association of antiretroviral regimens with CD4/CD8 ratio normalization within an observational cohort.We selected, from a French cohort at the Nice University Hospital, HIV-1 positive treatment-naive patients who initiated cART between 2000 and 2011 with a CD4/CD8 ratio 1 in the first year was assessed using multivariate logistic regression models. Specific association with INSTI-containing regimens was examined.567 patients were included in the analyses; the median CD4/CD8 ratio was 0.36. Respectively, 52.9%, 29.6% and 10.4% initiated a PI-based, NNRTI-based or NRTI-based cART regimens. About 8% of the population started an INSTI-containing regimen. 62 (10.9% patients achieved a CD4/CD8 ratio ≥1 (N group. cART regimen was not associated with normalization when coded as PI-, NNRTI- or NRTI-based regimen. However, when considering INSTI-containing regimens alone, there was a strong association with normalization [OR, 7.67 (2.54-23.2].Our findings suggest an association between initiation of an INSTI-containing regimen and CD4/CD8 ratio normalization at one year in naïve patients. Should it be confirmed in a larger population, it would be another argument for their use as first-line regimen as it is recommended in the recent update of the "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents".

  15. Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2013-09-01

    Full Text Available Background: Studies from sub-Saharan Africa have shown high incidence of attrition due to mortality or loss to follow-up (LTFU after initiating antiretroviral therapy (ART. India is the third largest country in the world in terms of HIV infected people, but predictors of attrition after ART initiation are not well known. Design: We describe factors associated with attrition, mortality, and LTFU in 3,159 HIV infected patients who initiated ART between 1 January 2007 and 4 November 2011 in an HIV cohort study in India. The study included 6,852 person-years with a mean follow-up of 2.17 years. Results: After 5 years of follow-up, the estimated cumulative incidence of attrition was 37.7%. There was no significant difference between attrition due to mortality and attrition due to LTFU. Having CD4 counts <100 cells/µl and being homeless [adjusted hazard ratio (aHR 3.1, 95% confidence interval (CI 2.6–3.8] were associated with a higher risk of attrition, and female gender (aHR 0.64, 95% CI 0.6–0.8 was associated with a reduced risk of attrition. Living near a town (aHR 0.82, 95% CI 0.7–0.999 was associated with a reduced risk of mortality. Being single (aHR 1.6, 95% CI 1.2–2.3, illiteracy (aHR 1.3, 95% CI 1.1–1.6, and age <25 years (aHR 1.3, 95% CI 1–1.8 were associated with an increased risk of LTFU. Although the cumulative incidence of attrition in patients diagnosed with tuberculosis after ART initiation was 47.4%, patients who started anti-tuberculous treatment before ART had similar attrition to patients without tuberculosis (36 vs. 35.2%, P=0.19 after four years of follow-up. Conclusions: In this cohort study, the attrition was similar to the one found in sub-Saharan Africa. Earlier initiation of ART, improving the diagnosis of tuberculosis before initiating ART, and giving more support to those patients at higher risk of attrition could potentially reduce the mortality and LTFU after ART initiation.

  16. Prevalence and incidence of HIV-1 and HIV-2 before, during and after a civil war in an occupational cohort in Guinea-Bissau, West Africa.

    Science.gov (United States)

    Månsson, Fredrik; Biague, Antonio; da Silva, Zacarias José; Dias, Francisco; Nilsson, L A Fredrik; Andersson, Sören; Fenyö, Eva Maria; Norrgren, Hans

    2009-07-31

    To study prevalence and incidence of HIV-1 and HIV-2 between 1990 and 2007 and to examine impact of the civil war in 1998-1999. We also wanted to investigate possible interaction between HIV-1 and HIV-2. Open prospective cohort study of 4592 police officers in Guinea-Bissau, West Africa. Analysis of HIV-1 and HIV-2 prevalence and incidence divided in 2-3 years time strata. HIV-1 prevalence (including HIV-1/HIV-2 dual reactivity) increased gradually from 0.6 to 3.6% before the war and was 9.5% in the first serosurvey after the war. HIV-1 incidence more than doubled during and shortly after the war, from 0.50 to 1.22 per 100 person-years. Both prevalence and incidence of HIV-1 decreased in the following periods after the war. HIV-2 prevalence decreased from 13.4 to 6.2% during the entire study period and HIV-2 incidence decreased from 1.38 to 0.18 per 100 person-years. Adjusted incidence rate ratios of HIV-1 incidence in HIV-2-positive participants compared with HIV-negative participants ranged from 1.02 to 1.18 (not significant) depending on the confounding variables included. HIV-1 has increased, whereas HIV-2 has decreased and the risk of acquiring HIV-1 is now more than four times higher as compared with HIV-2. The civil war in 1998-1999 appears to have induced a temporary increase in HIV-1 transmission, but now a stabilization of HIV-1 incidence and prevalence seems to have taken place. There was no evidence of a protective effect of HIV-2 against HIV-1 infection.

  17. Hospitalization for pneumonia among individuals with and without HIV infection, 1995-2007: a Danish population-based, nationwide cohort study

    DEFF Research Database (Denmark)

    Sogaard, O.S.; Lohse, N.; Gerstoft, J.

    2008-01-01

    BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals with high CD4(+) cell counts may have increased susceptibility to other infections. We compared incidence rates of pneumonia among individuals with and without HIV infection and explored risk factors for pneumonia in the HIV...... diagnoses from 1977 onward were obtained from nationwide administrative databases. Individuals without previous hospitalization for pneumonia were observed from the date of HIV diagnosis until the first hospitalization to treat pneumonia (excluding pneumonia attributable to Pneumocystis jiroveci). Risk...... factors were assessed by Poisson regression. RESULTS: The study included 3516 persons with HIV infection and 328,738 persons without HIV infection, which provided 23,677 person-years and 2,944,760 person-years of observation, respectively. Incidence rates of pneumonia in HIV-infected individuals decreased...

  18. Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV : a retrospective cohort study

    NARCIS (Netherlands)

    Ayele, Henok Tadesse; van Mourik, Maaike S M; Bonten, Marc J M|info:eu-repo/dai/nl/123144337

    2015-01-01

    Background: Isoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we

  19. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study.

    Science.gov (United States)

    Thirumurthy, Harsha; Masters, Samuel H; Mavedzenge, Sue Napierala; Maman, Suzanne; Omanga, Eunice; Agot, Kawango

    2016-06-01

    Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing. Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53

  20. Cervical screening within HIV care: findings from an HIV-positive cohort in Ukraine.

    Directory of Open Access Journals (Sweden)

    Heather Bailey

    Full Text Available HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions among women who had been screened was estimated, and associated factors explored.Overall, 30% (337/1120 of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum, a third (115/334 of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR 0.62, 95% CI 0.51-0.75 p<0.01 for 1(st/2(nd trimester diagnosis and APR 0.42, 95% CI 0.28-0.63 p<0.01 for 3(rd trimester/intrapartum diagnosis. Among those with a cervical screening result reported at any time (including follow-up, 21% (68/325 had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07-3.11 and APR 3.49 95% CI 2.11-5.76 respectively.In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis

  1. Cervical Screening within HIV Care: Findings from an HIV-Positive Cohort in Ukraine

    Science.gov (United States)

    Bailey, Heather; Thorne, Claire; Semenenko, Igor; Malyuta, Ruslan; Tereschenko, Rostislav; Adeyanova, Irina; Kulakovskaya, Elena; Ostrovskaya, Lyudmila; Kvasha, Liliana; Cortina-Borja, Mario; Townsend, Claire L.

    2012-01-01

    Introduction HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe. Methods Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored. Results Overall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51–0.75 p<0.01 for 1st/2nd trimester diagnosis and APR 0.42, 95% CI 0.28–0.63 p<0.01 for 3rd trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07–3.11 and APR 3.49 95% CI 2.11–5.76 respectively). Conclusions In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV

  2. Determinants of progression to AIDS and death following HIV diagnosis: a retrospective cohort study in Wuhan, China.

    Science.gov (United States)

    Jiang, Hongbo; Xie, Nianhua; Cao, Beibei; Tan, Li; Fan, Yunzhou; Zhang, Fan; Yao, Zhongzhao; Liu, Li; Nie, Shaofa

    2013-01-01

    To identify determinants associated with disease progression and death following human immunodeficiency virus (HIV) diagnosis. Disease progression data from the diagnosis of HIV infection or acquiring immunodeficiency syndrome (AIDS) to February 29, 2012 were retrospectively collected from the national surveillance system databases and the national treatment database in Wuhan, China. Kaplan-Meier method, Logistic regression and Cox proportional hazards model were applied to identify the related factors of progression to AIDS or death following HIV diagnosis. By the end of February 2012, 181 of 691 HIV infectors developed to AIDS, and 129 of 470 AIDS patients died among whom 289 cases received concurrent HIV/AIDS diagnosis. Compared with men infected through homosexual behavior, injection drug users possessed sharply decreased hazard ratio (HR) for progression to AIDS following HIV diagnosis [HR = 0.31, 95% confidence interval (CI), 0.18-0.54, P = 4.01×10(-5)]. HIV infectors at least 60 years presented 1.15-fold (HR = 2.15, 95% CI, 1.15-4.03, P = 0.017) increased risk to develop AIDS when compared with those aged 17-29 years. Similarly, AIDS patients with diagnosis ages between 50 and 59 years were at a 1.60-fold higher risk of death (HR = 2.60, 95% CI, 1.18-5.72, P = 0.017) compared to those aged 19-29 years. AIDS patients with more CD4(+) T-cells within 6 months at diagnosis (cell/µL) presented lower risk of death (HR = 0.29 for 50- vs HIV diagnosis (HR = 0.15, 95% CI, 0.07-0.34, P = 6.46×10(-6)) and reduced the risk of death after AIDS diagnosis (HR = 0.02, 95% CI, 0.01-0.04, P = 7.25×10(-25)). Progression to AIDS and death following HIV diagnosis differed in age at diagnosis, transmission categories, CD4(+) T-cell counts and HAART. Effective interventions should target those at higher risk for morbidity or mortality, ensuring early diagnosis and timely treatment to slow down the disease progression.

  3. The effect of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected clients under pre-ART care, Jimma, Ethiopia: a retrospective cohort study.

    Science.gov (United States)

    Assebe, Lelisa Fekadu; Reda, Hailemariam Lemma; Wubeneh, Alem Desta; Lerebo, Wondwossen Terefe; Lambert, Saba Maria

    2015-04-10

    Tuberculosis (TB) is a major public health problem that accounts for almost half a million human immunodeficiency virus (HIV) associated deaths. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB in HIV infected individuals. However, in Ethiopia, the coverage and implementation of IPT is limited. The objective of this study is to compare the incidence rate of TB, TB-free survival time and identify factors associated with development TB among HIV-infected individuals on pre-ART follow up. A retrospective cohort study was conducted from January, 2008 to February 31, 2012 in Jimma hospital. Kaplan-Meier survival plots were used to calculate the crude effect in both groups on TB-free survival probabilities and compared using the log rank test. A Cox proportional hazard model was used to identify predictors of TB. A total of 588 patients on pre-ART care (294 IPT and 294 non-IPT group) were followed retrospectively for a median duration of 24.1 months. The median CD4 (+) cell count was 422 cells/μl (IQR 344-589). During the follow up period, 49 individuals were diagnosed with tuberculosis, giving an overall incidence of 3.78 cases per 100 person year (PY). The incidence rate of TB was 5.06 per 100 PY in non-IPT group and 2.22 per 100 PY in IPT user group. Predictors of higher TB risk were: being on clinical WHO stage III/IV (adjusted hazard ratio (AHR = 3.05, 95% confidence interval (CI): 1.61, 5.81); non-IPT user (AHR = 2.02, 95% CI: 1.04, 3.92); having CD4 (+) cell count less than 350 cells/μl (AHR = 3.16, 95% CI: 1.04, 3.92) and between 350-499 cells/μl, (AHR = 2.87; 95% CI: 1.37-6.03) and having episode of opportunistic infection (OI) in the past (AHR = 2.41, 95% CI: 1.33-4.34). IPT use was associated with fifty percent reduction in new cases of tuberculosis and probability of developing TB was higher in non-IPT group. Implementing the widespread use of IPT has the potential to

  4. The effects of household wealth on HIV prevalence in Manicaland, Zimbabwe – a prospective household census and population-based open cohort study

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    Nadine Schur

    2015-11-01

    Full Text Available Introduction: Intensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe. Objectives: To assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population-based open cohort. Methods: Household wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011. Temporal trends in summed asset ownership indices for sellable, non-sellable and all assets combined were compared for households in four socio-economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas. Multivariate logistic random-effects models were used to measure differences in individual-level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation. Results: Household mean asset scores remained similar at around 0.37 (on a scale of 0 to 1 up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non-sellable assets continued increasing until 2008. Small-town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better-off locations (small towns but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011, men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men. Conclusions: The economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio-economic locations and sub-groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.

  5. Declining Mortality Rates in HIV-Infected People Who Inject Drugs During a Seek-and-Treat Initiative in Vancouver, Canada, 1996-2014: A Prospective Cohort Study.

    Science.gov (United States)

    Hayashi, Kanna; Dong, Huiru; Kerr, Thomas; Dobrer, Sabina; Guillemi, Silvia; Barrios, Rolando; Montaner, Julio S G; Wood, Evan; Milloy, M-J

    2017-12-27

    We estimated rates and predictors of death among a community-recruited prospective cohort of 961 human immunodeficiency virus (HIV)-infected people who inject drugs in Vancouver, Canada, between 1996 and 2014. The results demonstrated significant declines in age-adjusted all-cause and HIV-related mortality rates since 2010, coincident with the scale-up of a community-wide "seek-and-treat" campaign. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  6. Macrolide use and the risk of vascular disease in HIV-infected men in the Multicenter AIDS Cohort Study

    DEFF Research Database (Denmark)

    Woolley, Ian J; Li, Xiuhong; Jacobson, Lisa P

    2007-01-01

    scale with time varying cofactors obtained at each semi-annual visit were used to assess the independent effect of macrolide use. RESULTS: Controlling for other significant effects including race and smoking, HIV-infection was not independently associated with vascular events. Increased risk...... was observed among those who used HAART (relative hazard 1.09, 95% confidence intervals 1.00-1.19 in multivariate model), antihypertensive treatment (1.81 [1.26-2.60]), lipid-lowering medication (1.65 [1.12-2.42]), and antibiotics (1.72 [1.25-2.36]). The protective association of macrolide use for a vascular...... event in the HAART era was also significant (0.10 [0.01-0.75]). CONCLUSIONS: Traditional risk factors are important in the pathogenesis of vascular events in HIV-infected individuals. Macrolide antibiotics may have a protective effect in the HIV-infected individuals in the HAART era. Udgivelsesdato...

  7. The Cedar Project: resilience in the face of HIV vulnerability within a cohort study involving young Indigenous people who use drugs in three Canadian cities.

    Science.gov (United States)

    Pearce, Margo E; Jongbloed, Kate A; Richardson, Chris G; Henderson, Earl W; Pooyak, Sherri D; Oviedo-Joekes, Eugenia; Christian, Wunuxtsin M; Schechter, Martin T; Spittal, Patricia M

    2015-10-29

    Indigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs. This study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012. Among 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection.

  8. Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study.

    Science.gov (United States)

    Patel, Rena C; Onono, Maricianah; Gandhi, Monica; Blat, Cinthia; Hagey, Jill; Shade, Starley B; Vittinghoff, Eric; Bukusi, Elizabeth A; Newmann, Sara J; Cohen, Craig R

    2015-11-01

    Concerns have been raised about efavirenz reducing the effectiveness of contraceptive implants. We aimed to establish whether pregnancy rates differ between HIV-positive women who use various contraceptive methods and either efavirenz-based or nevirapine-based antiretroviral therapy (ART) regimens. We did this retrospective cohort study of HIV-positive women aged 15-45 years enrolled in 19 HIV care facilities supported by Family AIDS Care and Education Services in western Kenya between Jan 1, 2011, and Dec 31, 2013. Our primary outcome was incident pregnancy diagnosed clinically. The primary exposure was a combination of contraceptive method and efavirenz-based or nevirapine-based ART regimen. We used Poisson models, adjusting for repeated measures, and demographic, behavioural, and clinical factors, to compare pregnancy rates among women receiving different contraceptive and ART combinations. 24,560 women contributed 37,635 years of follow-up with 3337 incident pregnancies. In women using implants, adjusted pregnancy incidence was 1.1 per 100 person-years (95% CI 0.72-1.5) for nevirapine-based ART users and 3.3 per 100 person-years (1.8-4.8) for efavirenz-based ART users (adjusted incidence rate ratio [IRR] 3.0, 95% CI 1.3-4.6). In women using depot medroxyprogesterone acetate, adjusted pregnancy incidence was 4.5 per 100 person-years (95% CI 3.7-5.2) for nevirapine-based ART users and 5.4 per 100 person-years (4.0-6.8) for efavirenz-based ART users (adjusted IRR 1.2, 95% CI 0.91-1.5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, had 3.1-4.1 higher rates of pregnancy than did those using implants, with 1.6-2.8 higher rates in women using efavirenz-based ART. Although HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other

  9. Detection of HIV drug resistance during antiretroviral treatment and clinical progression in a large European cohort study

    DEFF Research Database (Denmark)

    Cozzi-Lepri, Alessandro; Phillips, Andrew N; Clotet, Bonaventura

    2008-01-01

    OBJECTIVE(S): To investigate the relationship between detection of HIV drug resistance by 2 years from starting antiretroviral therapy and the subsequent risk of progression to AIDS and death. DESIGN: Virological failure was defined as experiencing two consecutive viral loads of more than 400...

  10. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2010-01-01

    We examined specific causes of mortality in human immunodeficiency virus type 1 (HIV-1)-infected patients who initiated antiretroviral therapy (ART) in Europe and North America from 1996 through 2006, and we quantified associations of prognostic factors with cause-specific mortality....

  11. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies

    NARCIS (Netherlands)

    Gill, John; May, Margaret; Lewden, Charlotte; Saag, Mike; Mugavero, Michael; Reiss, Peter; Ledergerber, Bruno; Mocroft, Amanda; Harris, Ross; Fux, Christoph A.; Justice, Amy; Costagliola, Dominique; Casabona, Jordi; Hogg, Robert S.; Khaykin, Pavel; Lampe, Fiona; Vehreschild, Janne; Sterne, Jonathan A. C.; Egger, Matthias; Brodt, Hans-Reinhard; Chene, Genevieve; Dabis, Francois; D'Arminio Monforte, Antonella; de Wolf, Frank; Fatkenheuer, Gerd; Guest, Jodie; Kirk, Ole; Kitahata, Mari; Saag, Michael; Sterling, Tim; Sterne, Jonathan

    2010-01-01

    BACKGROUND: We examined specific causes of mortality in human immunodeficiency virus type 1 (HIV-1)-infected patients who initiated antiretroviral therapy (ART) in Europe and North America from 1996 through 2006, and we quantified associations of prognostic factors with cause-specific mortality.

  12. Design, implementation, and evaluation at entry of a prospective cohort study of homosexual and bisexual HIV-1-negative men in Belo Horizonte, Brazil: Project Horizonte.

    Science.gov (United States)

    Carneiro, M; de Figueiredo Antunes, C M; Greco, M; Oliveira, E; Andrade, J; Lignani, L; Greco, D B

    2000-10-01

    Project Horizonte, an open cohort of homosexual and bisexual HIV-1-negative men, is a component of the Minas Gerais AIDS Vaccine Program of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Its objectives included the evaluation of seroincidence of HIV, to ascertain the role of counseling on behavior modification and to assess their willingness to participate in future HIV vaccine trials. Various means of recruitment were used, including pamphlets, notices in community newspapers, radio, and television, at anonymous testing centers, and by word of mouth. From October 1994 to May 1999, 470 volunteers were enrolled. Their mean age was 26 years and over 70% of them had high school or college education. During the follow-up, they were seen every 6 months, when they received counseling and condoms, and when HIV testing was done. Eighteen seroconversions were observed, and the incidence rates estimates were 1.75 per 100 and 1.99 per 100 person-years, for 36 and 48 months of follow-up, respectively. During the entire period, 139 volunteers were lost to follow-up. Among them, 59 (42.4%) never returned after the initial visit and 51 (36.7) came only once after their initial visit. No losses were observed for those observed during follow-up for more than 3 years. At enrollment, 50% of participants said they would participate in a vaccine trial, and 30% said they might participate. The results obtained up to this moment confirm the feasibility of following this type of cohort for an extended period, estimating HIV incidence rate, and evaluating counseling for safe sexual practices in preparation for clinical trials with candidate HIV vaccines in Brazil.

  13. Association between elevated coffee consumption and daily chocolate intake with normal liver enzymes in HIV-HCV infected individuals: results from the ANRS CO13 HEPAVIH cohort study.

    Science.gov (United States)

    Carrieri, M Patrizia; Lions, Caroline; Sogni, Philippe; Winnock, Maria; Roux, Perrine; Mora, Marion; Bonnard, Philippe; Salmon, Dominique; Dabis, François; Spire, Bruno

    2014-01-01

    We used longitudinal data from the ANRS CO13 HEPAVIH cohort study of HIV-HCV co-infected individuals to investigate whether polyphenol rich food intake through coffee and/or daily chocolate consumption could play a role in reducing liver enzymes levels. Longitudinal data collection included self-administered questionnaires and medical data (aspartate aminotransferase (AST) and alanine aminotransferase (ALT) liver enzymes). Two analyses were performed to assess the association between coffee (≥3 cups a day) and daily chocolate intake and abnormal values of AST and ALT (AST or ALT >2.5 × upper normal limit (UNL)) (N=990) over time, after adjustment for known correlates. Logistic regression models based on generalized estimating equations were used to take into account the correlations between repeated measures and estimate adjusted odds ratio. After adjustment, patients reporting elevated coffee consumption and daily chocolate intake were less likely to present abnormal ALT (OR=0.65; p=0.04 and OR=0.57; p=0.04, for coffee and chocolate respectively), while only patients reporting elevated coffee consumption were less likely to have abnormal AST values (p=0.05). Nevertheless, the combined indicator of coffee and chocolate intake was most significantly associated with approximately 40% reduced risk of abnormal liver enzymes (p=0.003 for AST; p=0.002 for ALT). Elevated coffee consumption and daily chocolate intake appear to be associated with reduced levels of liver enzymes in HIV-HCV co-infected patients. Further experimental and observational research is needed to better understand the role that polyphenol intake or supplementation can play on liver disease and liver injury. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  14. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands.

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    Marleen A van Amsterdam

    Full Text Available Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease.Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART, or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART < 24 weeks, pregnancy, and transgenderism.215 patients (72% had positive findings: lipodystrophy (30%, lymphadenopathy (16% and hypertension (8.4% were the most common. Two-thirds of all findings were not new or were based on complaints indicating a physical examination even if not routinely scheduled. For 24 patients (8.0% the routine physical examination led to the finding of a new diagnosis: six-all men who have sex with men (MSM-had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding.Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM.

  15. Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014: Data from the ICONA Foundation Study cohort.

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    Silvia Nozza

    Full Text Available In Italy the prevalence of recent HIV infection (RHI isn't currently monitored. Early diagnosis is crucial to allow introduction of antiretroviral therapy (cART in the recent phase of infection. We aimed to estimate the proportion and the determinants of RHI among patients enrolled in the ICONA cohort; we explored differences in the median time from HIV diagnosis to cART initiation and in the viro-immunological response between RHI and Less Recent HIV infections (NRHI. We included antiretroviral-naïve HIV-positive patients enrolled in the cohort with documented dates of HIV-negative and positive antibodies tests, grouped in RHI (estimated date of seroconversion within 12 months of enrolment and NRHI. Proportion of RHI and the trend of this proportion by calendar period (1996-2014 were investigated (Chi-square test. Logistic regression analysis was employed to identify factors associated with RHI. The time from seroconversion to cART initiation was compared in RHI and NRHI overall and after stratification by calendar period (survival analysis. We finally explored the time from starting cART to HIV-RNA <50 copies/mL and to CD4+ gain ≥200 cells/mmc by Cox regression. HIV seroconversion could be estimated for 2608/12,616 patients: 981/2608 (37.6% were RHI. Proportion of RHI increased in recent calendar periods and was associated with younger age, baseline higher HIV-RNA and CD4+ count. There wasn't difference in the 2-year estimates of cART start between RHI and NRHI, regardless of calendar period. Rates and hazards of virological response were similar in RHI versus NRHI. RHI showed a 1.5-fold higher probability of CD4+ gain, also following adjustment for calendar period and cART regimen, and for age, HCV and smoking; the difference in probability was however attenuated after further controlling for baseline HIV-RNA and CD4+ T-cells. The increased proportion of RHI over time suggests that in recent years in Italy HIV infections are more likely to

  16. Maternal characteristics during pregnancy and risk factors for positive HIV RNA at delivery: a single-cohort observational study (Brescia, Northern Italy

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    Magoni Michele

    2011-02-01

    Full Text Available Abstract Background Detectable HIV RNA in mothers at delivery is an important risk factor for HIV transmission to newborns. Our hypothesis was that, in migrant women, the risk of detectable HIV RNA at delivery is greater owing to late HIV diagnosis. Therefore, we examined pregnant women by regional provenance and measured variables that could be associated with detectable HIV RNA at delivery. Methods A observational retrospective study was conducted from January 1999 to May 2008. Univariate and multivariable regression analyses (generalized linear models were used, with detectable HIV RNA at delivery as dependent variable. Results The overall population comprised 154 women (46.8% migrants. Presentation was later in migrant women than Italians, as assessed by CD4-T-cell count at first contact (mean 417/mm3 versus 545/mm3, respectively; p = 0.003. Likewise, HIV diagnosis was made before pregnancy and HAART was already prescribed at the time of pregnancy in more Italians (91% and 75%, respectively than migrants (61% and 42.8%, respectively. A subgroup of women with available HIV RNA close to term (i.e., ≤30 days before labour was studied for risk factors of detectable HIV RNA (≥50 copies/ml at delivery. Among 93 women, 25 (26.9% had detectable HIV RNA. A trend toward an association between non-Italian nationality and detectable HIV RNA at delivery was demonstrated by univariate analysis (relative risk, RR = 1.86; p = 0.099. However, by multivariable regression analysis, the following factors appeared to be more important: lack of stable (i.e., ≥14 days antiretroviral therapy at the time of HIV RNA testing (RR = 4.3; p 3, RR = 0.94; p = 0.038. Conclusions These results reinforce the importance of extensive screening for HIV infection, earlier initiation of antiretroviral therapy and stricter monitoring of pregnant women to reduce the risk of detectable HIV RNA at delivery. Public health interventions should be particularly targeted to migrant

  17. A Description of Mortality Associated with IPT plus ART Compared to ART Alone among HIV-Infected Individuals in Addis Ababa, Ethiopia: A Cohort Study.

    Science.gov (United States)

    Edessa, Dumessa; Likisa, Jimma

    2015-01-01

    Tuberculosis (TB) is the most common human immunodeficiency virus (HIV) associated opportunistic infection. It is the leading cause of death in HIV-infected individuals in sub-Saharan Africa. Anti-retroviral therapy (ART) and isoniazid preventive therapy (IPT) are the two useful TB preventative strategies available to reduce TB among people living with HIV (PLHIV). Therefore, the aim of this study is to compare mortality associated with IPT taken together with ART, as well as ART alone, among PLHIV. A retrospective cohort study was undertaken at Tikur Anbessa Specialized Hospital (TASH) and Zewditu Memorial Hospital (ZMH) on 185 patients receiving IPT (6 months) plus ART and 557 patients receiving ART alone. Mortality rates (MR) per 100 person-years (PYs) were used to compare mortality rates amongst the groups. Time-to-death and survival probabilities of the patients were determined using the Kaplan Meier Method. The Cox Proportional Hazard Model was employed to estimate the effect of IPT plus ART on survival of PLHIV. The mortality cases noted in patients treated by IPT plus ART versus ART alone were 18 (4.5 cases/100 PYs) and 116 (10 cases/100 PYs), respectively. In reference to the ART alone, the IPT plus ART reduced the likelihood of death significantly (aHR 0.48; 95% CI 0.38-0.69) and median time to death was about 26 months (IQR 19-34). Moreover, WHO stage IV (aHR 2.42: 95% CI 1.42-4.11), CD4 values ≥350 cells/mm3 (aHR 0.52; 95% CI 0.28-0.94), adherence to ART (aHR 0.12; 95% CI 0.08-0.20), primary levels of education (aHR 2.20; 95% CI 1.07-4.52); and alcohol consumption (aHR 1.71; 95% CI 1.04-2.81) were factors strongly associated with mortality. We found that PLHIV treated by the IPT plus ART had a lower likelihood of mortality and delayed time-to-death when compared to patients treated by ART alone.

  18. 1970 British Cohort Study

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    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London.  BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of BCS70 survey data can be accessed by bona fide researchers through the UK Data Service at the University of Essex.

  19. Cohort profile: the Right to Care Clinical HIV Cohort, South Africa.

    Science.gov (United States)

    Fox, Matthew P; Maskew, Mhairi; Brennan, Alana T; Evans, Denise; Onoya, Dorina; Malete, Given; MacPhail, Patrick; Bassett, Jean; Ebrahim, Osman; Mabotja, Dikeledi; Mashamaite, Sello; Long, Lawrence; Sanne, Ian

    2017-06-10

    The research objectives of the Right to Care Clinical HIV Cohort analyses are to: (1) monitor treatment outcomes (including death, loss to follow-up, viral suppression and CD4 count gain among others) for patients on antiretroviral therapy (ART); (2) evaluate the impact of changes in the national treatment guidelines around when to initiate ART on HIV treatment outcomes; (3) evaluate the impact of changes in the national treatment guidelines around what ART regimens to initiate on drug switches; (4) evaluate the cost and cost-effectiveness of HIV treatment delivery models; (5) evaluate the need for and outcomes on second-line and third-line ART; (6) evaluate the impact of comorbidity with non-communicable diseases on HIV treatment outcomes and (7) evaluate the impact of the switch to initiating all patients onto ART regardless of CD4 count. The Right to Care Clinical HIV Cohort is an open cohort of data from 10 clinics in two provinces within South Africa. All clinics include data from 2004 onwards. The cohort currently has data on over 115 000 patients initiated on HIV treatment and patients are followed up every 3-6 months for clinical and laboratory monitoring. Cohort data includes information on demographics, clinical visit, laboratory data, medication history and clinical diagnoses. The data have been used to identify rates and predictors of first-line failure, to identify predictors of mortality for patients on second-line (eg, low CD4 counts) and to show that adolescents and young adults are at increased risk of unsuppressed viral loads compared with adults. Future analyses will inform national models of HIV care and treatment to improve HIV care policy in South Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Cost-Effectiveness of isoniazid preventive therapy among HIV-infected patients clinicaly screened for latent tuberculosis infection in Dar es Salaam, Tanzania: A prospective Cohort study

    Directory of Open Access Journals (Sweden)

    Grace A. Shayo

    2017-07-01

    Full Text Available Abstract Background One of the reasons why Isoniazid preventive therapy (IPT for Tuberculosis (TB is not widely used in low income countries is concerns on cost of excluding active TB. We analyzed the cost-effectiveness of IPT provision in Tanzania having ruled out active TB by a symptom-based screening tool. Methods Data on IPT cost-effectiveness was prospectively collected from an observational cohort study of 1283 HIV-infected patients on IPT and 1281 controls; followed up for 24 months. The time horizon for the analysis was 2 years. Number of TB cases prevented and deaths averted were used for effectiveness. A micro costing approach was used from a provider perspective. Cost was estimated on the basis of clinical records, market price or interviews with medical staff. We annualized the cost at a discount of 3%. A univariate sensitivity analysis was done. Results are presented in US$ at an average annual exchange rate for the year 2012 which was Tanzania shillings 1562.4 for 1 US $. Results The number of TB cases prevented was 420/100,000 persons receiving IPT. The number of deaths averted was 979/100,000 persons receiving IPT. Incremental cost due to IPT provision was US$ 170,490. The incremental cost effective ratio was US $ 405.93 per TB case prevented and US $ 174.15 per death averted. These costs were less than 3 times the 768 US $ Gross Domestic Product (GDP per capita for Tanzania in the year 2014, making IPT provision after ruling out active TB by the symptom-based screening tool cost-effective. The results were robust to changes in laboratory and radiological tests but not to changes in recurrent, personnel, medication and utility costs. Conclusion IPT should be given to HIV-infected patients who screen negative to symptom-based TB screening questionnaire. Its cost-effectiveness supports government policy to integrate IPT to HIV/AIDS care and treatment in the country, given the availability of budget and the capacity of health

  1. Cost-Effectiveness of isoniazid preventive therapy among HIV-infected patients clinicaly screened for latent tuberculosis infection in Dar es Salaam, Tanzania: A prospective Cohort study.

    Science.gov (United States)

    Shayo, Grace A; Chitama, Dereck; Moshiro, Candida; Aboud, Said; Bakari, Muhammad; Mugusi, Ferdinand

    2017-07-19

    One of the reasons why Isoniazid preventive therapy (IPT) for Tuberculosis (TB) is not widely used in low income countries is concerns on cost of excluding active TB. We analyzed the cost-effectiveness of IPT provision in Tanzania having ruled out active TB by a symptom-based screening tool. Data on IPT cost-effectiveness was prospectively collected from an observational cohort study of 1283 HIV-infected patients on IPT and 1281 controls; followed up for 24 months. The time horizon for the analysis was 2 years. Number of TB cases prevented and deaths averted were used for effectiveness. A micro costing approach was used from a provider perspective. Cost was estimated on the basis of clinical records, market price or interviews with medical staff. We annualized the cost at a discount of 3%. A univariate sensitivity analysis was done. Results are presented in US$ at an average annual exchange rate for the year 2012 which was Tanzania shillings 1562.4 for 1 US $. The number of TB cases prevented was 420/100,000 persons receiving IPT. The number of deaths averted was 979/100,000 persons receiving IPT. Incremental cost due to IPT provision was US$ 170,490. The incremental cost effective ratio was US $ 405.93 per TB case prevented and US $ 174.15 per death averted. These costs were less than 3 times the 768 US $ Gross Domestic Product (GDP) per capita for Tanzania in the year 2014, making IPT provision after ruling out active TB by the symptom-based screening tool cost-effective. The results were robust to changes in laboratory and radiological tests but not to changes in recurrent, personnel, medication and utility costs. IPT should be given to HIV-infected patients who screen negative to symptom-based TB screening questionnaire. Its cost-effectiveness supports government policy to integrate IPT to HIV/AIDS care and treatment in the country, given the availability of budget and the capacity of health facilities.

  2. Morbidity in HIV-1-infected individuals before and after the introduction of antiretroviral therapy: a longitudinal study of a population-based cohort in Uganda.

    Science.gov (United States)

    Iwuji, C C; Mayanja, B N; Weiss, H A; Atuhumuza, E; Hughes, P; Maher, D; Grosskurth, H

    2011-10-01

    We compared morbidities in HIV-1-infected patients before and after the introduction of antiretroviral therapy (ART) in a rural Ugandan cohort followed from 1990 to 2008. ART was introduced in 2004. Random-effects Poisson regression models were used to estimate incidence rates of World Health Organization (WHO) stage-defining diseases in HIV-infected individuals aged 13 years or older with known seroconversion dates, and in an age-stratified sample of HIV-negative individuals. The most common morbid event was bacterial pneumonia, with an incidence of 7.4/100 person-years (pyr) among 309 HIV seroconverters and 1.3/100 pyr among 348 HIV-negative participants [hazard ratio (HR) 5.64; 95% confidence interval (CI) 3.6-8.8]. Among seroconverters, the incidence of the acquisition of any WHO stage-defining disease rose from 14.4/100 pyr (95% CI 11.1-18.6) in 1990-1998 to 46.0/100 pyr (95% CI 37.7-56.0) in 1999-2003. Following the introduction of ART, the incidence among seroconverters declined to 36.4/100 pyr (95% CI 27.1-48.9) in 2004-2005 and to 28.3/100 pyr (95% CI 21.2-37.8) in 2006-2008. At the individual level, a higher rate of acquiring any WHO stage-defining disease was independently associated with lower CD4 cell count, longer duration of HIV infection and older age. In addition, individuals who had been on ART for longer than 12 months had a substantially lower rate of any WHO stage disease than those not yet on ART (adjusted HR 0.35; 95% CI 0.2-0.6). Morbidity in HIV-positive participants decreased following the introduction of ART, and this decline was more marked with increasing duration on ART. The benefits of decreased HIV-related morbidity from ART lend support to urgent efforts to ensure universal access to early diagnosis of HIV infection and to ART, especially in rural Africa. © 2011 British HIV Association.

  3. Decreasing rate of multiple treatment modifications among individuals who initiated antiretroviral therapy in 1997-2009 in the Danish HIV cohort study

    DEFF Research Database (Denmark)

    Helleberg, Marie; Kronborg, Gitte; Larsen, Carsten S.

    2013-01-01

    BACKGROUND: We hypothesized that rates and reasons for treatment modifications have changed since the implementation of combination antiretroviral therapy (cART) due to improvements in therapy. METHODS: From a nationwide population-based cohort study we identified all HIV-1 infected adults who...... initiated cART in Denmark 1997-2009 and were followed (3)1 year. Incidence rate ratios (IRR) and reasons for treatment modifications were estimated and compared between patients, who initiated treatment in 1997-1999, 2000-2004 and 2005-2009. Rates of discontinuation of individual antiretroviral drugs (ARVs......) were evaluated. RESULTS: 3,107 patients were followed median 7.3 years (IQR 3.8-10.8). Rates of first treatment modification ≤1 year after cART initiation did not change (IRR 0.88 (95% CI 0.78-1.01) and 1.03 (95% CI 0.90-1.18) in 2000-2004 and 2005-2009 compared to 1997-1999). Rates of multiple...

  4. Decreasing rate of multiple treatment modifications among individuals who initiated antiretroviral therapy in 1997-2009 in the Danish HIV Cohort Study

    DEFF Research Database (Denmark)

    Helleberg, Marie; Kronborg, Gitte; Larsen, Carsten S

    2012-01-01

    ) were evaluated. RESULTS: 3,107 patients were followed median 7.3 years (IQR 3.8-10.8). Rates of first treatment modification ≤1 year after cART initiation did not change (IRR 0.88 (95% CI 0.78-1.01) and 1.03 (95% CI 0.90-1.18) in 2000-2004 and 2005-2009 compared to 1997-1999). Rates of multiple......-2009 compared to 1997-1999), while the rate of modifications with the aim of simplification increased (IRR 1.85 (95% CI 1.52-2.25)). CONCLUSIONS: Rates of first treatment modification ≤1 year after cART initiation have not changed since the early cART era, while the risk of multiple modifications has decreased......BACKGROUND: We hypothesized that rates and reasons for treatment modifications have changed since the implementation of combination antiretroviral therapy (cART) due to improvements in therapy. METHODS: From a nationwide population-based cohort study we identified all HIV-1 infected adults who...

  5. cryptococcus meningitis in a cohort of hiv positive kenyan patients

    African Journals Online (AJOL)

    East African Medical Journal Vol. 90 No. 12 (Supplement) December 2013. CRYPTOCOCCUS MENINGITIS IN A COHORT OF HIV POSITIVE KENYAN PATIENTS : OUTCOME AFTER TWO. WEEKS OF THERAPY. A. E. O. Otedo, MBChB, MMed (Int.Med.); Cert. Gastroenterology, Consultant Physician/ Gastroenterologist, ...

  6. HIV prevalence in the Israeli tuberculosis cohort, 1999-2011.

    Science.gov (United States)

    Zohar, Mor; Moshe, Lidji; Daniel, Chemtob; Noa, Cedar; Itamar, Grotto

    2014-10-21

    Tuberculosis (TB) patients who are co-infected with HIV are at greater risk of mortality. Nevertheless, not all countries achieved sustainable and TB and HIV collaboration to describe the burden of both diseases at a national scale. This study aims to describe HIV prevalence among TB-patients in Israel and identify variable associated with TB/HIV co-infection. This retrospective study was conducted by cross-matching the National HIV and TB Registries to describe TB/HIV epidemiology during the last 13-years and define variables predicting TB/HIV co-infection. Between 1999 and 2011, 5,502 TB-patients were reported: 779 (14.2%) were Israeli-born and 4,723 (85.8%) non-Israeli born. Of all TB patients, 254 (4.6%) were HIV-infected. The trend of HIV/TB co-infection among non-Israeli born has generally decreased since 2003 (trend analysis p tuberculosis patient. In a multivariate analysis, short time after arrival in Israel, older age, being born in Ethiopia, having positive sputum, positive culture and multi-drug resistant TB predicted TB/HIV co-infection.TB/HIV co-infected patients with extra-pulmonary TB had a higher proportion of infection in lymphatic, miliary and abdominal sites than those with extra-pulmonary TB who were HIV-negative. Most TB/HIV co-infected patients were migrants originating in high-burden countries. Despite the moderate 4.6% TB/HIV co-infection rate in Israel, these patients had worse treatment outcomes and higher mortality rates. This study illustrates the importance of integrating TB with HIV in surveillance and treatment components, which should be employed in other countries, as it has a positive impact on disease control.

  7. HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study.

    Science.gov (United States)

    Marzel, Alex; Shilaih, Mohaned; Yang, Wan-Lin; Böni, Jürg; Yerly, Sabine; Klimkait, Thomas; Aubert, Vincent; Braun, Dominique L; Calmy, Alexandra; Furrer, Hansjakob; Cavassini, Matthias; Battegay, Manuel; Vernazza, Pietro L; Bernasconi, Enos; Günthard, Huldrych F; Kouyos, Roger D; Aubert, V; Battegay, M; Bernasconi, E; Böni, J; Bucher, H C; Burton-Jeangros, C; Calmy, A; Cavassini, M; Dollenmaier, G; Egger, M; Elzi, L; Fehr, J; Fellay, J; Furrer, H; Fux, C A; Gorgievski, M; Günthard, H F; Haerry, D; Hasse, B; Hirsch, H H; Hoffmann, M; Hösli, I; Kahlert, C; Kaiser, L; Keiser, O; Klimkait, T; Kouyos, R D; Kovari, H; Ledergerber, B; Martinetti, G; de Tejada, B Martinez; Metzner, K; Müller, N; Nadal, D; Nicca, D; Pantaleo, G; Rauch, A; Regenass, S; Rickenbach, M; Rudin, C; Schöni-Affolter, F; Schmid, P; Schüpbach, J; Speck, R; Tarr, P; Trkola, A; Vernazza, P L; Weber, R; Yerly, S

    2016-01-01

    Reducing the fraction of transmissions during recent human immunodeficiency virus (HIV) infection is essential for the population-level success of "treatment as prevention". A phylogenetic tree was constructed with 19 604 Swiss sequences and 90 994 non-Swiss background sequences. Swiss transmission pairs were identified using 104 combinations of genetic distance (1%-2.5%) and bootstrap (50%-100%) thresholds, to examine the effect of those criteria. Monophyletic pairs were classified as recent or chronic transmission based on the time interval between estimated seroconversion dates. Logistic regression with adjustment for clinical and demographic characteristics was used to identify risk factors associated with transmission during recent or chronic infection. Seroconversion dates were estimated for 4079 patients on the phylogeny, and comprised between 71 (distance, 1%; bootstrap, 100%) to 378 transmission pairs (distance, 2.5%; bootstrap, 50%). We found that 43.7% (range, 41%-56%) of the transmissions occurred during the first year of infection. Stricter phylogenetic definition of transmission pairs was associated with higher recent-phase transmission fraction. Chronic-phase viral load area under the curve (adjusted odds ratio, 3; 95% confidence interval, 1.64-5.48) and time to antiretroviral therapy (ART) start (adjusted odds ratio 1.4/y; 1.11-1.77) were associated with chronic-phase transmission as opposed to recent transmission. Importantly, at least 14% of the chronic-phase transmission events occurred after the transmitter had interrupted ART. We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For

  8. Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study

    Science.gov (United States)

    Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clin...

  9. Epidemiology of meningitis in an HIV-infected Ugandan cohort.

    Science.gov (United States)

    Rajasingham, Radha; Rhein, Joshua; Klammer, Kate; Musubire, Abdu; Nabeta, Henry; Akampurira, Andrew; Mossel, Eric C; Williams, Darlisha A; Boxrud, Dave J; Crabtree, Mary B; Miller, Barry R; Rolfes, Melissa A; Tengsupakul, Supatida; Andama, Alfred O; Meya, David B; Boulware, David R

    2015-02-01

    There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains needed, and implementation of cryptococcal diagnostics is critical. © The American Society of Tropical Medicine and Hygiene.

  10. Detection and treatment of Fiebig stage I HIV-1 infection in young at-risk women in South Africa: a prospective cohort study.

    Science.gov (United States)

    Dong, Krista L; Moodley, Amber; Kwon, Douglas S; Ghebremichael, Musie S; Dong, Mary; Ismail, Nasreen; Ndhlovu, Zaza M; Mabuka, Jenniffer M; Muema, Daniel M; Pretorius, Karyn; Lin, Nina; Walker, Bruce D; Ndung'u, Thumbi

    2018-01-01

    HIV incidence among young women in sub-Saharan Africa remains high and their inclusion in vaccine and cure efforts is crucial. We aimed to establish a cohort of young women detected during Fiebig stage I acute HIV infection in whom treatment was initiated immediately after diagnosis to advance research in this high-risk group. 945 women aged 18-23 years in KwaZulu-Natal, South Africa, who were HIV uninfected and sexually active consented to HIV-1 RNA testing twice a week and biological sampling and risk assessment every 3 months during participation in a 48-96 week life-skills and job-readiness programme. We analysed the effect of immediate combination antiretroviral therapy (ART) on viraemia and immune responses, sexual risk behaviour, and the effect of the socioeconomic intervention. 42 women were diagnosed with acute HIV infection between Dec 1, 2012, and June 30, 2016, (incidence 8·2 per 100 person-years, 95% CI 5·9-11·1), of whom 36 (86%) were diagnosed in Fiebig stage I infection with a median initial viral load of 2·97 log10 copies per mL (IQR 2·42-3·85). 23 of these 36 women started ART at a median of 1 day (1-1) after detection, which limited the median peak viral load to 4·22 log10 copies per mL (3·27-4·83) and the CD4 nadir to 685 cells per μL (561-802). ART also suppressed viral load (to women, prevented seroconversion, as shown with western blotting. 385 women completed the 48 week socioeconomic intervention, of whom 231 were followed up for 1 year. 202 (87%) of these 231 women were placed in jobs, returned to school, or started a business. Frequent HIV screening combined with a socioeconomic intervention facilitated sampling and risk assessment before and after infection. In addition to detection of acute infection and immediate treatment, we established a cohort optimised for prevention and cure research. Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases, International AIDS Vaccine Initiative, Wellcome

  11. Genetic diversity of EBV-encoded LMP1 in the Swiss HIV Cohort Study and implication for NF-Κb activation.

    Directory of Open Access Journals (Sweden)

    Emilie Zuercher

    Full Text Available Epstein-Barr virus (EBV is associated with several types of cancers including Hodgkin's lymphoma (HL and nasopharyngeal carcinoma (NPC. EBV-encoded latent membrane protein 1 (LMP1, a multifunctional oncoprotein, is a powerful activator of the transcription factor NF-κB, a property that is essential for EBV-transformed lymphoblastoid cell survival. Previous studies reported LMP1 sequence variations and induction of higher NF-κB activation levels compared to the prototype B95-8 LMP1 by some variants. Here we used biopsies of EBV-associated cancers and blood of individuals included in the Swiss HIV Cohort Study (SHCS to analyze LMP1 genetic diversity and impact of sequence variations on LMP1-mediated NF-κB activation potential. We found that a number of variants mediate higher NF-κB activation levels when compared to B95-8 LMP1 and mapped three single polymorphisms responsible for this phenotype: F106Y, I124V and F144I. F106Y was present in all LMP1 isolated in this study and its effect was variant dependent, suggesting that it was modulated by other polymorphisms. The two polymorphisms I124V and F144I were present in distinct phylogenetic groups and were linked with other specific polymorphisms nearby, I152L and D150A/L151I, respectively. The two sets of polymorphisms, I124V/I152L and F144I/D150A/L151I, which were markers of increased NF-κB activation in vitro, were not associated with EBV-associated HL in the SHCS. Taken together these results highlighted the importance of single polymorphisms for the modulation of LMP1 signaling activity and demonstrated that several groups of LMP1 variants, through distinct mutational paths, mediated enhanced NF-κB activation levels compared to B95-8 LMP1.

  12. Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.

    Science.gov (United States)

    Koubar, Sahar H; Estrella, Michelle M; Warrier, Rugmini; Moore, Richard D; Lucas, Gregory M; Atta, Mohamed G; Fine, Derek M

    2017-07-17

    The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014. A retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI. Three hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5-10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40-2.99]), infection (OR 5.48 [95% CI 2.65-11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03-1.45]). Rhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.

  13. The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV.

    Science.gov (United States)

    Powell, Anna M; DeVita, Julia M; Ogburu-Ogbonnaya, Amartha; Peterson, Andrea; Lazenby, Gweneth B

    2017-08-01

    Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.

  14. Performance of routine syphilis serology in the Ethiopian cohort on HIV/AIDS

    NARCIS (Netherlands)

    Dorigo-Zetsma, J. W.; Belewu, D.; Meless, H.; Sanders, E.; Coutinho, R. A.; Schaap, A.; Wolday, D.

    2004-01-01

    OBJECTIVES: To assess the performance of routine syphilis screening during 5 year follow up of Ethiopian factory workers, participating in a cohort study on HIV/AIDS. METHODS: Syphilis serology test results of factory workers, who each donated at least six blood samples were evaluated. Screening in

  15. Low level viremia and high CD4% predict normal survival in a cohort of HIV type-2-infected villagers

    NARCIS (Netherlands)

    Berry, Neil; Jaffar, Shabbar; Schim van der Loeff, Maarten; Ariyoshi, Koya; Harding, Elizabeth; N'Gom, Pa Tamba; Dias, Francisco; Wilkins, Andrew; Ricard, Dominic; Aaby, Peter; Tedder, Richard; Whittle, Hilton

    2002-01-01

    A community-based study of human immunodeficiency virus type 2 (HIV-2) infection was conducted in a rural village in northern Guinea Bissau, West Africa to assess the relationship between plasma HIV-2 RNA levels, CD4 lymphocyte percentage, and survival over an 8-year period. The cohort of 133

  16. Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study.

    Science.gov (United States)

    Mee, Paul; Wagner, Ryan G; Gómez-Olivé, Francesc Xavier; Kabudula, Chodziwadziwa; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Byass, Peter; Tollman, Stephen M

    2014-12-17

    In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. There were large decreases in reported traditional healthcare use and increases in

  17. Differential effects of sex in a West African cohort of HIV-1, HIV-2 and HIV-1/2 dually infected patients: men are worse off.

    Science.gov (United States)

    Jespersen, Sanne; Hønge, Bo Langhoff; Esbjörnsson, Joakim; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Østergaard, Lars; Andersen, Andreas; Aaby, Peter; Erikstrup, Christian; Wejse, Christian

    2016-02-01

    Several studies have reported conflicting effects of sex on HIV-1 infection. We describe differences in baseline characteristics and assess the impact of sex on HIV progression among patients at a clinic with many HIV-2 and HIV-1/2 dually infected patients. This study utilised a retrospective cohort of treatment-naïve adults at the largest HIV clinic in Guinea-Bissau from 6 June 2005 to 1 December 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow-up, or 1 June 2014. We estimated the time from the first clinic visit until initiation of ART, death or loss to follow-up using Cox proportional hazard models. A total of 5694 patients were included in the study, 3702 women (65%) and 1992 men (35%). Women were more likely than men to be infected with HIV-2 (19% vs. 15%, P < 0.01) or dually infected with HIV-1/2 (11% vs. 9%, P = 0.02). For all HIV types, women were younger (median 35 vs. 40 years), less likely to have schooling (55% vs. 77%) or to be married (46% vs. 67%), and had higher baseline CD4 cell counts (median 214 vs. 178 cells/μl). Men had a higher age-adjusted mortality rate (hazard rate ratio (HRR) 1.29, 95% confidence interval (CI) 1.09-1.52) and were more often lost to follow-up (HRR 1.27, 95% CI 1.17-1.39). Significant differences exist between HIV-infected men and women regardless of HIV type. Men seek treatment at a later stage and, despite better socio-economic status, have higher mortality and loss to follow-up than women. © 2015 John Wiley & Sons Ltd.

  18. Antiretroviral Drug Use in a Cohort of HIV-Uninfected Women in the United States: HIV Prevention Trials Network 064.

    Directory of Open Access Journals (Sweden)

    Iris Chen

    Full Text Available Antiretroviral (ARV drug use was analyzed in HIV-uninfected women in an observational cohort study conducted in 10 urban and periurban communities in the United States with high rates of poverty and HIV infection. Plasma samples collected in 2009-2010 were tested for the presence of 16 ARV drugs. ARV drugs were detected in samples from 39 (2% of 1,806 participants: 27/181 (15% in Baltimore, MD and 12/179 (7% in Bronx, NY. The ARV drugs detected included different combinations of non-nucleoside reverse transcriptase inhibitors and protease inhibitors (1-4 drugs/sample. These data were analyzed in the context of self-reported data on ARV drug use. None of the 39 women who had ARV drugs detected reported ARV drug use at any study visit. Further research is needed to evaluate ARV drug use by HIV-uninfected individuals.

  19. Subcortical shape and volume abnormalities in an elderly HIV+ cohort

    Science.gov (United States)

    Wade, Benjamin S. C.; Valcour, Victor; Busovaca, Edgar; Esmaeili-Firidouni, Pardis; Joshi, Shantanu H.; Wang, Yalin; Thompson, Paul M.

    2015-03-01

    Over 50% of HIV+ individuals show significant impairment in psychomotor functioning, processing speed, working memory and attention [1, 2]. Patients receiving combination antiretroviral therapy may still have subcortical atrophy, but the profile of HIV-associated brain changes is poorly understood. With parametric surface-based shape analyses, we mapped the 3D profile of subcortical morphometry in 63 elderly HIV+ subjects (4 female; age=65.35 ± 2.21) and 31 uninfected elderly controls (2 female; age=64.68 ± 4.57) scanned with MRI as part of a San Francisco Bay Area study of elderly people with HIV. We also investigated whether morphometry was associated with nadir CD4+ (T-cell) counts, viral load and illness duration among HIV+ participants. FreeSurfer was used to segment the thalamus, caudate, putamen, pallidum, hippocampus, amygdala, accumbens, brainstem, callosum and ventricles from brain MRI scans. To study subcortical shape, we analyzed: (1) the Jacobian determinant (JD) indexed over structures' surface coordinates and (2) radial distances (RD) of structure surfaces from a medial curve. A JD less than 1 reflects regional tissue atrophy and greater than 1 reflects expansion. The volumes of several subcortical regions were found to be associated with HIV status. No regional volumes showed detectable associations with CD4 counts, viral load or illness duration. The shapes of numerous subcortical regions were significantly linked to HIV status, detectability of viral RNA and illness duration. Our results show subcortical brain differences in HIV+ subjects in both shape and volumetric domains.

  20. Low frequency of genotypic resistance in HIV-1-infected patients failing an atazanavir-containing regimen: a clinical cohort study

    Science.gov (United States)

    Dolling, David I.; Dunn, David T.; Sutherland, Katherine A.; Pillay, Deenan; Mbisa, Jean L.; Parry, Chris M.; Post, Frank A.; Sabin, Caroline A.; Cane, Patricia A.; Aitken, Celia; Asboe, David; Webster, Daniel; Cane, Patricia; Castro, Hannah; Dunn, David; Dolling, David; Chadwick, David; Churchill, Duncan; Clark, Duncan; Collins, Simon; Delpech, Valerie; Geretti, Anna Maria; Goldberg, David; Hale, Antony; Hué, Stéphane; Kaye, Steve; Kellam, Paul; Lazarus, Linda; Leigh-Brown, Andrew; Mackie, Nicola; Orkin, Chloe; Rice, Philip; Pillay, Deenan; Phillips, Andrew; Sabin, Caroline; Smit, Erasmus; Templeton, Kate; Tilston, Peter; Tong, William; Williams, Ian; Zhang, Hongyi; Zuckerman, Mark; Greatorex, Jane; Wildfire, Adrian; O'Shea, Siobhan; Mullen, Jane; Mbisa, Tamyo; Cox, Alison; Tandy, Richard; Hale, Tony; Fawcett, Tracy; Hopkins, Mark; Ashton, Lynn; Booth, Claire; Garcia-Diaz, Ana; Shepherd, Jill; Schmid, Matthias L.; Payne, Brendan; Hay, Phillip; Rice, Phillip; Paynter, Mary; Bibby, David; Kirk, Stuart; MacLean, Alasdair; Gunson, Rory; Coughlin, Kate; Fearnhill, Esther; Fradette, Lorraine; Porter, Kholoud; Ainsworth, Jonathan; Anderson, Jane; Babiker, Abdel; Fisher, Martin; Gazzard, Brian; Gilson, Richard; Gompels, Mark; Hill, Teresa; Johnson, Margaret; Kegg, Stephen; Leen, Clifford; Nelson, Mark; Palfreeman, Adrian; Post, Frank; Sachikonye, Memory; Schwenk, Achim; Walsh, John; Huntington, Susie; Jose, Sophie; Thornton, Alicia; Glabay, Adam; Orkin, C.; Garrett, N.; Lynch, J.; Hand, J.; de Souza, C.; Fisher, M.; Perry, N.; Tilbury, S.; Gazzard, B.; Nelson, M.; Waxman, M.; Asboe, D.; Mandalia, S.; Delpech, V.; Anderson, J.; Munshi, S.; Korat, H.; Welch, J.; Poulton, M.; MacDonald, C.; Gleisner, Z.; Campbell, L.; Gilson, R.; Brima, N.; Williams, I.; Schwenk, A.; Ainsworth, J.; Wood, C.; Miller, S.; Johnson, M.; Youle, M.; Lampe, F.; Smith, C.; Grabowska, H.; Chaloner, C.; Puradiredja, D.; Walsh, J.; Weber, J.; Ramzan, F.; Mackie, N.; Winston, A.; Leen, C.; Wilson, A.; Allan, S.; Palfreeman, A.; Moore, A.; Wakeman, K.

    2013-01-01

    Objectives To determine protease mutations that develop at viral failure for protease inhibitor (PI)-naive patients on a regimen containing the PI atazanavir. Methods Resistance tests on patients failing atazanavir, conducted as part of routine clinical care in a multicentre observational study, were randomly matched by subtype to resistance tests from PI-naive controls to account for natural polymorphisms. Mutations from the consensus B sequence across the protease region were analysed for association and defined using the IAS-USA 2011 classification list. Results Four hundred and five of 2528 (16%) patients failed therapy containing atazanavir as a first PI over a median (IQR) follow-up of 1.76 (0.84–3.15) years and 322 resistance tests were available for analysis. Recognized major atazanavir mutations were found in six atazanavir-experienced patients (P < 0.001), including I50L and N88S. The minor mutations most strongly associated with atazanavir experience were M36I, M46I, F53L, A71V, V82T and I85V (P < 0.05). Multiple novel mutations, I15S, L19T, K43T, L63P/V, K70Q, V77I and L89I/T/V, were also associated with atazanavir experience. Conclusions Viral failure on atazanavir-containing regimens was not common and major resistance mutations were rare, suggesting that adherence may be a major contributor to viral failure. Novel mutations were described that have not been previously documented. PMID:23711895

  1. Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

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    Thamkhantho Manopchai

    2011-01-01

    Full Text Available Abstract Background Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition. Methods To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+ among this group of patients. Results The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times, and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count P = 0.043. There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level. Conclusion There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.

  2. Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

    Science.gov (United States)

    2011-01-01

    Background Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition. Methods To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+) among this group of patients. Results The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times), and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count ASCUS+ (P = 0.043). There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level. Conclusion There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening. PMID:21211065

  3. High resolution human leukocyte antigen class I allele frequencies and HIV-1 infection associations in Chinese Han and Uyghur cohorts.

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    Yanhou Liu

    Full Text Available Host immunogenetic factors such as HLA class I polymorphism are important to HIV-1 infection risk and AIDS progression. Previous studies using high-resolution HLA class I profile data of Chinese populations appeared insufficient to provide information for HIV-1 vaccine development and clinical trial design. Here we reported HLA class I association with HIV-1 susceptibility in a Chinese Han and a Chinese Uyghur cohort.Our cohort included 327 Han and 161 Uyghur ethnic individuals. Each cohort included HIV-1 seropositive and HIV-1 seronegative subjects. Four-digit HLA class I typing was performed by sequencing-based typing and high-resolution PCR-sequence specific primer. We compared the HLA class I allele and inferred haplotype frequencies between HIV-1 seropositive and seronegative groups. A neighbor-joining tree between our cohorts and other populations was constructed based on allele frequencies of HLA-A and HLA-B loci. We identified 58 HLA-A, 75 HLA-B, and 32 HLA-Cw distinct alleles from our cohort and no novel alleles. The frequency of HLA-B*5201 and A*0301 was significantly higher in the Han HIV-1 negative group. The frequency of HLA-B*5101 was significantly higher in the Uyghur HIV-1 negative group. We observed statistically significant increases in expectation-maximization (EM algorithm predicted haplotype frequencies of HLA-A*0201-B*5101 in the Uyghur HIV-1 negative group, and of Cw*0304-B*4001 in the Han HIV-1 negative group. The B62s supertype frequency was found to be significantly higher in the Han HIV-1 negative group than in the Han HIV-1 positive group.At the four-digit level, several HLA class I alleles and haplotypes were associated with lower HIV-1 susceptibility. Homogeneity of HLA class I and Bw4/Bw6 heterozygosity were not associated with HIV-1 susceptibility in our cohort. These observations contribute to the Chinese HLA database and could prove useful in the development of HIV-1 vaccine candidates.

  4. HIV Infection and Carotid Artery Intima-media Thickness: Pooled Analyses Across 5 Cohorts of the NHLBI HIV-CVD Collaborative.

    Science.gov (United States)

    Hanna, David B; Guo, Mengye; Bůžková, Petra; Miller, Tracie L; Post, Wendy S; Stein, James H; Currier, Judith S; Kronmal, Richard A; Freiberg, Matthew S; Bennett, Siiri N; Shikuma, Cecilia M; Anastos, Kathryn; Li, Yanjie; Tracy, Russell P; Hodis, Howard N; Delaney, Joseph A; Kaplan, Robert C

    2016-07-15

    Age and human immunodeficiency virus (HIV) treatment may affect the association of HIV infection with atherosclerosis. We used identical carotid artery B-mode ultrasonographic methods in 5 cohorts participating in the National Heart, Lung, and Blood Institute HIV-CVD Collaborative to measure intima-media thickness of the right far wall of the common carotid artery (CCA-IMT) and carotid artery bifurcation (BIF-IMT) between 2010 and 2013. Participants aged 6-75 years were either HIV infected or uninfected. Linear regression assessed associations of CCA-IMT and BIF-IMT with HIV infection and cardiovascular disease risk factors, within age and HIV treatment groups. Adjustment variables included sex, race/ethnicity, smoking, height, weight, and use of antihypertensive and lipid-lowering drugs. We studied 867 HIV-infected and 338 HIV-uninfected male and 696 HIV-infected and 246 HIV-uninfected female participants. Among both middle-aged (30-49 years) and older adults (50-75 years), HIV-infected participants had CCA-IMT and BIF-IMT values that were similar to or lower than those in HIV-uninfected participants. In contrast, among those aged 6-29 years, HIV infection was associated with higher CCA-IMT and BIF-IMT values. Among HIV-infected participants, associations of higher systolic blood pressure and lower high-density lipoprotein cholesterol with Carotid artery intima-media thickness strengthened with age. The effects of HIV on carotid artery structure may differ across the lifespan, with traditional determinants of cardiovascular disease burden playing a larger role and HIV playing a lesser role in older adults than in young adults and children. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  5. Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital: a 30-year retrospective study.

    Science.gov (United States)

    Grignolo, S; Agnello, R; Gerbaldo, D; Gotta, C; Alicino, C; Del Puente, F; Taramasso, L; Bruzzone, B; Gustavino, C; Trasino, S; DE Maria, A; Icardi, G; Viscoli, C; DI Biagio, A

    2017-06-01

    The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38·6%) in 2005-2014), and a decrease in intravenous drug use (75·2% (91/121) in 1985-1994 vs. 12·9% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92·2% (59/64) in 2005-2014) and in HIV-RNA pregnancies were associated with preterm delivery (odds ratio (OR) 2·7; 95% confidence intervals (CI) 1-7·8 and OR 2·6; 95% CI 1·1-6·7, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3·1; 95% CI 1·4-6·8). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA.

  6. Superior Effects of Antiretroviral Treatment among Men Who have Sex with Men Compared to Other HIV At-Risk Populations in a Large Cohort Study in Hunan, China

    Directory of Open Access Journals (Sweden)

    Shu Su

    2016-03-01

    Full Text Available This study assesses association between CD4 level at initiation of antiretroviral treatment (ART on subsequent treatment outcomes and mortality among people infected with HIV via various routes in Hunan province, China. Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5% MSM, 5484 (74.8% heterosexuals, 1164 (15.9% injection drug users (IDU and 132 (1.8% former plasma donors (FPD, were recruited. MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167–298 than other populations (Heterosexuals: 144 IQR 40–242, IDU: 134 IQR 38–224, FPD: 86 IQR 36–181. During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm3 (IQR 43–246 to 265 cells/mm3 (IQR 162–380, whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm3. Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤200 cells/mm3 (AHR = 3.14; CI, 2.43–4.06 significantly contributed to HIV-related mortality during treatment. Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.

  7. T20QoL: an observational multicenter cohort study to evaluate the quality of life in HIV-patients treated with enfuvirtide (ENF, T-20 in combination with an optimized background therapy

    Directory of Open Access Journals (Sweden)

    R Bucciardini

    2008-09-01

    Full Text Available R Bucciardini1, M Massella1, A Corpolongo2, P Narciso2, V Fragola1, M Mirra1, S Donnini1, O Viganò3, S Costarelli4, V Tozzi21Istituto Superiore di Sanità, Rome, Italy; 2IRCCS L. Spallanzani, Rome, Italy; 3Ospedale L. Sacco, Milan, Italy; 4Spedali Civili di Brescia, Brescia, ItalyAim: To evaluate the impact of health-related quality of life (HRQoL enfuvirtide-based (ENF-based salvage regimens of treatment-experienced HIV patients, in an observational multicenter cohort study.Methods: HRQoL was measured in a cohort of 16 patients over a 6-month follow-up using 2 instruments: the ISSQoL (Istituto Superiore di Sanità Quality of Life, a recently validated HIV-specific questionnaire; the EQ-5D (EuroQol, a generic widely used instrument. ENF was given at standard dosage along with an optimized background regimen.Results: Most of HRQoL dimensions showed improvement in ENF-treated patients at the post-baseline time points. Social functioning was the only dimension showing a negative effect. Monthly care costs of antiretroviral drugs for HIV patients taking ENF plus an optimized background regimen were approximately €2,348 per patient-month (range €382– €2,940.Conclusion: Our results show that the addition of ENF to an optimized background salvage-HAART may positively affect HRQoL not only in clinical trials but also in a sample population of patients used in a routine clinical practice.Keywords: enfuvirtide, HRQoL, HIV

  8. Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico.

    Science.gov (United States)

    Tossas-Milligan, Katherine Y; Hunter-Mellado, Robert F; Mayor, Angel M; Fernández-Santos, Diana M; Dworkin, Mark S

    2015-09-01

    Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.

  9. Survival of people living with HIV who defaulted from tuberculosis treatment in a cohort, Recife, Brazil.

    Science.gov (United States)

    Cunha, R; Maruza, M; Montarroyos, U R; Coimbra, I; de B Miranda-Filho, D; Albuquerque, M de F; Lacerda, H R; Ximenes, Raa

    2017-02-10

    Tuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment. This was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz - HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations. From a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.

  10. Impact on adherence of a telephone follow up strategy in HIV-naïve patients who start antiretroviral therapy: cohort study

    OpenAIRE

    M. Bullo; Toibaro, J.; Losso, M.

    2012-01-01

    Antiretroviral therapy changed the prognosis of people living with HIV/AIDS. However, lack of adherence jeopardizes the success of antiretroviral therapy and enhances the development of treatment-resistant strains, treatment failure, and therefore it stands as a public health problem. The main goal of this study was to measure the impact on treatment discontinuations and lost to follow up, of a telephone follow-up strategy in naïve patients who start antiretroviral therapy. We conducte...

  11. Liver transplant outcomes in HIV-infected patients: a systematic review and meta-analysis with synthetic cohort.

    Science.gov (United States)

    Cooper, Curtis; Kanters, Steve; Klein, Marina; Chaudhury, Prosanto; Marotta, Paul; Wong, Phil; Kneteman, Norman; Mills, Edward J

    2011-03-27

    The relative success of liver transplantation in those with HIV compared to HIV-uninfected individuals remains a point of intense debate. We aimed to evaluate the effectiveness of liver transplantation in HIV-hepatitis co-infected patients using a meta-analysis and individual patient data meta-analysis as a synthetic cohort. We searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE (inception to 2010), AMED, CINAHL, TOXNET, Development and Reproductive Toxicology, Hazardous Substances Databank, Psych-info and relevant conferences. We included cohort studies and individual case-reports evaluating survival of co-infected transplant patients. We abstracted data on cohort and case demographics and outcomes. We pooled cohorts using a random-effects analysis and created a synthetic cohort of cases using individual patient data. We confirmed this with the pooled cohort analysis. We included 15 cohort studies and 49 case series with individual patient data. At 12 months, 84.4% [95% confidence interval (CI) 81.1-87.8%] of patients had survived. Within the HIV-infected population evaluated, HIV-hepatitis B virus (HBV) co-infection was associated with optimal survival. In an adjusted model, individuals positive for HBV were 8.28 (95% CI 2.26-30.33) times more likely to survive when compared to those without HBV. Further, individuals with an undetectable HIV viral load at the time of transplantation were 2.89 (95% CI 1.41-5.91) times more likely to survive when compared to those with detectable HIV viremia. Hepatitis C virus was not a predictor of patient survival when adjusted for by other key predictors [0.54 (95% CI 0.17-1.80)].

  12. Causes of death in HIV-infected patients from the Cologne-Bonn cohort.

    Science.gov (United States)

    Ehren, K; Hertenstein, C; Kümmerle, T; Vehreschild, J J; Fischer, J; Gillor, D; Wyen, C; Lehmann, C; Cornely, O A; Jung, N; Gravemann, S; Platten, M; Wasmuth, J C; Rockstroh, J K; Boesecke, C; Schwarze-Zander, C; Fätkenheuer, G

    2014-02-01

    Causes of death in human immunodeficiency virus (HIV)-infected subjects have changed in countries with high resources over the last several years. Acquired immunodeficiency syndrome (AIDS)-related diseases have become less prevalent, whereas deaths due to non-AIDS causes are increasing. The aim of the present study was to analyse causes of death in the Cologne-Bonn cohort. Causes of death from the Cologne-Bonn cohort between 2004 and 2010 were systematically recorded using the CoDe algorithm (The Coding Causes of Death in HIV Project). In 3,165 patients followed from 2004 to 2010, 182 deaths occurred (5.7 %, 153 males, 29 females). The median age at the time of death was 47 years (range 24-85 years). The most frequent causes of death were AIDS-defining events (n = 60, 33 %), with non-Hodgkin lymphoma (NHL) (n = 29, 16 %) and infections (n = 20, 11 %) being the leading entities in this category. Non-AIDS malignancies accounted for 16 % (n = 29), non-HIV-related infections for 10 % (n = 18), cardiovascular diseases for 7 % (n = 14), suicide or accident for 4 % (n = 7) and liver diseases for 3 % (n = 5) of deaths (unknown n = 47, 26 %). Although the majority of patients (92.5 %) was on antiretroviral therapy (ART), only 50 % were virologically suppressed (HIV-RNA death. One-third of the causes of death in our cohort between 2004 and 2010 was AIDS-related. Since most of these deaths occur with severe immune suppression, they can possibly be prevented by the early diagnosis and treatment of HIV infection. Care providers must be aware of an increased risk for a broad range of diseases in HIV-infected patients and should apply appropriate preventive measures.

  13. Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study

    Science.gov (United States)

    Walter, Jan; Kuhn, Louise; Kankasa, Chipepo; Semrau, Katherine; Sinkala, Moses; Thea, Donald M; Aldrovandi, Grace M

    2008-01-01

    Background Single-dose nevirapine (SDNVP) for the prevention of mother-to-child HIV transmission (PMTCT) results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood. Methods We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders. Results Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0). Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19%) at both the first (unexposed) and second (exposed) delivery. The results were unchanged, if infant death was included as an outcome. Conclusion These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies. PMID:19116004

  14. Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study

    Directory of Open Access Journals (Sweden)

    Sinkala Moses

    2008-12-01

    Full Text Available Abstract Background Single-dose nevirapine (SDNVP for the prevention of mother-to-child HIV transmission (PMTCT results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood. Methods We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed and those that had not (unexposed and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders. Results Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0. Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19% at both the first (unexposed and second (exposed delivery. The results were unchanged, if infant death was included as an outcome. Conclusion These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.

  15. Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study.

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    Simon Muhumuza

    Full Text Available In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART regardless of CD4 count. We describe retention in care and factors associated with loss to follow-up (LTFU among women initiated on Option B+ as part of an evaluation of the effectiveness of the national program.We conducted a retrospective cohort analysis of data abstracted from records of 2,169 women enrolled on Option B+ between January and March 2013 from a representative sample of 145 health facilities in all 24 districts of the Central region of Uganda. We defined retention as "being alive and receiving ART at the last clinic visit". We used Kaplan-Meier analysis to estimate retention in care and compared differences between women retained in care and those LTFU using the chi-squared test for dichotomized or categorical variables.The median follow-up time was 20.2 months (IQR 4.2-22.5. The proportion of women retained in HIV care at 6, 12 and 18 months post-ART initiation was 74.2%, 66.7% and 62.0%, respectively. Retention at 18 months varied significantly by level of health facility and ranged from 70.0% among those seen at hospitals to 56.6% among those seen at lower level health facilities. LTFU was higher among women aged less than 25 years, 59.3% compared to those aged 25 years and above, 40.7% (p = 0.02; among those attending care at lower level facilities, 44.0% compared to those attending care at hospitals, 34.1% (p = 0.01, and among those who were not tested for CD4 cell count at ART initiation, 69.4% compared to those who were tested, 30.9% (p = 0.002.Retention of women who were initiated on Option B+ during the early phases of roll-out was only moderate, and could undermine the effectiveness of the program. Identifying reasons why women drop out and designing targeted interventions for improved retention

  16. HBV or HCV coinfections and risk of myocardial infarction in HIV-infected individuals: the D:A:D Cohort Study

    DEFF Research Database (Denmark)

    Weber, Rainer; Sabin, Caroline; Reiss, Peter

    2010-01-01

    Data on a link between HCV or HBV infection and the development of cardiovascular disease among HIV-negative and HIV-positive individuals are conflicting. We sought to investigate the association between HBV or HCV infection and myocardial infarction in HIV-infected individuals.......Data on a link between HCV or HBV infection and the development of cardiovascular disease among HIV-negative and HIV-positive individuals are conflicting. We sought to investigate the association between HBV or HCV infection and myocardial infarction in HIV-infected individuals....

  17. Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study.

    Science.gov (United States)

    Gunda, Daniel Wilfred; Nkandala, Igembe; Kilonzo, Semvua Bukheti; Kilangi, Boniface Bartholomew; Mpondo, Bonaventura Cornel

    2017-01-01

    HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in northwestern rural Tanzania. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen, and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. In total, 740 patients were studied. The median age was 35 (27-42) years with female predominance of 465 (62.8%). Of the participants, 261 (35.3%) had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%), had baseline CD4 counts ART in northwestern rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up of at-risk patients within the first year of ART could reduce the mortality of this subgroup of patients.

  18. AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000–2008: hospital-based cohort studies

    Science.gov (United States)

    2014-01-01

    Background In high-income settings, the spectrum of morbidity and mortality experienced by Human Immunodeficiency Virus (HIV)-infected individuals receiving combination antiretroviral therapy (cART) has switched from predominantly AIDS-related to non-AIDS-related conditions. In the context of universal access to care, we evaluated whether that shift would apply in Brazil, a middle-income country with universal access to treatment, as compared to France. Methods Two hospital-based cohorts of HIV-infected individuals were used for this analysis: the ANRS CO3 Aquitaine Cohort in South Western France and the Evandro Chagas Research Institute (IPEC) Cohort of the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Severe morbid events (AIDS- and non-AIDS-related) were defined as all clinical diagnoses associated with a hospitalization of ≥48 hours. Trends in the incidence rate of events and their determinants were estimated while adjusting for within-subject correlation using generalized estimating equations models with an auto-regressive correlation structure and robust standard errors. Result Between January 2000 and December 2008, 7812 adult patients were followed for a total of 41,668 person-years (PY) of follow-up. Throughout the study period, 90% of the patients were treated with cART. The annual incidence rate of AIDS and non-AIDS events, and of deaths significantly decreased over the years, from 6.2, 21.1, and 1.9 AIDS, non-AIDS events, and deaths per 100 PY in 2000 to 4.3, 14.9, and 1.5/100 PY in 2008. The annual incidence rates of non-AIDS events surpassed that of AIDS-events during the entire study period. High CD4 cell counts were associated with a lower incidence rate of AIDS and non-AIDS events as well as with lower rates of specific non-AIDS events, such as bacterial, hepatic, viral, neurological, and cardiovascular conditions. Adjusted analysis showed that severe morbidity was associated with lower CD4 counts and higher plasma HIV RNAs but not with

  19. Epidemiology of autoimmune and inflammatory diseases in a French nationwide HIV cohort.

    Science.gov (United States)

    Lebrun, Delphine; Hentzien, Maxime; Cuzin, Lise; Rey, David; Joly, Véronique; Cotte, Laurent; Allavena, Clotilde; Dellamonica, Pierre; Servettaz, Amélie; Bani-Sadr, Firouzé

    2017-09-24

    HIV infection and inflammatory and autoimmune diseases (IADs) are both related to immune dysfunction. Epidemiological data on IAD in patients living with HIV (PLHIV) are scarce. The aim of this study was thus to estimate the prevalence of 26 IAD among PLHIV followed in a large French multicenter cohort in the combination antiretroviral therapy (cART) era (from January 2000 to July 2013), and to describe their occurrence according to cART onset, the immuno-virological status of patients and hepatitis C virus (HCV) and/or hepatitis B virus coinfection. During the study period, 33 403 PLHIV were included in the Dat'AIDS cohort; 1381 patients with an IAD were identified. The most prevalent IADs were psoriasis, sarcoidosis, rheumatoid arthritis, ankylosing spondyloarthritis, Grave's disease, autoimmune hemolytic anemia, immune thrombocytopenia and chronic inflammatory bowel disease. In contrast, the prevalence of systemic lupus erythematosus and multiple sclerosis were low. Most patients (59%) developed IAD after HIV infection with a mean delay of 10.6 ± 6.4 years. Compared with the entire cohort, HCV coinfection was significantly more frequent in patients with psoriasis, Grave's disease and immune thrombocytopenia, and chronic hepatitis B in patients was more frequent in those with immune thrombocytopenia and autoimmune hemolytic anemia. Among patients developing IAD after the diagnosis of HIV infection, 572 (70%) were on antiretroviral therapy and 419 of them (73%) had undetectable HIV viral load. Our study showed that some IAD are not rare among PLHIV and occur mostly in patients with immuno-virological control under cART. The higher frequency of HCV or hepatitis B virus coinfection for some IAD is also confirmed.

  20. Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study

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    Daniel Wilfred Gunda

    2017-01-01

    Full Text Available Introduction. HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in northwestern rural Tanzania. Methods. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen, and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. Results. In total, 740 patients were studied. The median age was 35 (27–42 years with female predominance of 465 (62.8%. Of the participants, 261 (35.3% had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%, had baseline CD4 counts <200 cells/μl. Deaths occurred in 86 (11.6% patients which were independently associated with male gender (16.0% versus 9.0%, p=0.015, being divorced (OR = 2.7, p<0.001, WHO stages 3 and 4 (OR = 2.3, p=0.05, CD4 <200 cells/μl (OR = 3.4, p<0.001, and severe anemia (OR = 6.6, p<0.001. Conclusions. The mortality is high among HIV patients receiving ART in northwestern rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up of at-risk patients within the first year of ART could reduce the mortality of this subgroup of patients.

  1. Copenhagen comorbidity in HIV infection (COCOMO) study

    DEFF Research Database (Denmark)

    Ronit, Andreas; Haissman, Judith Melchior; Kirkegaard-Klitbo, Ditte Marie

    2016-01-01

    BACKGROUND: Modern combination antiretroviral therapy (cART) has improved survival for people living with HIV (PLWHIV). Non-AIDS comorbidities have replaced opportunistic infections as leading causes of mortality and morbidity, and are becoming a key health concern as this population continues....../DESIGN: The Copenhagen comorbidity in HIV-infection (COCOMO) study is an observational, longitudinal cohort study. The study was initiated in 2015 and recruitment is ongoing with the aim of including 1500 PLWHIV from the Copenhagen area. Follow-up examinations after 2 and 10 years are planned. Uninfected controls...... (PBMC), urine, and stool samples are collected in a biobank for future studies. Data will be updated through periodical linking to national databases. DISCUSSION: As life expectancy for PLWHIV improves, it is essential to study long-term impact of HIV and cART. We anticipate that findings from...

  2. Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV

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    Mehta Shruti H

    2010-05-01

    Full Text Available Abstract Background Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV infection and with obstructive lung diseases (OLD. Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs. Methods Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea. Results Of 974 participants, 835 (86% were current smokers and 288 (29.6% were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70 was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively. COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively. Conclusions While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

  3. Cohort Profile: French hospital database on HIV (FHDH-ANRS CO4).

    Science.gov (United States)

    Mary-Krause, Murielle; Grabar, Sophie; Lièvre, Laurence; Abgrall, Sophie; Billaud, Eric; Boué, François; Boyer, Laurence; Cabié, André; Cotte, Laurent; De Truchis, Pierre; Duval, Xavier; Duvivier, Claudine; Enel, Patricia; Gasnault, Jacques; Gaud, Catherine; Gilquin, Jacques; Guiguet, Marguerite; Katlama, Christine; Khuong-Josses, Marie-Aude; Lacombe, Jean-Marc; Lang, Sylvie; Lascaux, Anne-Sophie; Launay, Odile; Mahamat, Aba; Matheron, Sophie; Meynard, Jean-Luc; Pavie, Juliette; Pilorgé, Fabrice; Piroth, Lionel; Poizot-Martin, Isabelle; Potard, Valérie; Pradier, Christian; Reynes, Jacques; Rouveix, Elisabeth; Selinger-Leneman, Hana; Simon, Anne; Tattevin, Pierre; Tissot-Dupont, Hervé; Viard, Jean-Paul; Viget, Nathalie; Costagliola, Dominique

    2014-10-01

    The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989. The research objectives focus mainly on mid- and long-term clinical outcomes and therapeutic strategies, as well as severe AIDS and non-AIDS morbidities, and public health issues relative to HIV infection. FHDH also serves to describe HIV-infected patients receiving hospital care in France. FHDH includes data on more than 120,000 HIV-infected patients from 70 French general or university hospitals distributed throughout France. Patients are eligible for inclusion if they are infected by HIV-1 or HIV-2 and give their written informed consent. Standardized variables are collected at each outpatient visit or hospital admission during which a new clinical manifestation is diagnosed, a new treatment is prescribed or a change in biological markers is noted, and/or at least every 6 months. Since its inception, variables collected in FHDH include demographic characteristics, HIV-related biological markers, the date and type of AIDS and non AIDS-defining events, antiretroviral treatments and the date and causes of death, as reported in the medical records. Since 2005, data have also been collected on: co-infection with hepatitis B or C virus; alcohol and tobacco use; and non HIV-related biomarkers. Anyone can submit a research project by completing a standardized form available on the FHDH website (http://www.ccde.fr/_fold/fl-1385734776-429.pdf) or from the corresponding author, describing the context and objectives of the study. All projects are reviewed by the scientific committee. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  4. Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients.

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    Takeshi Nishijima

    Full Text Available BACKGROUND: Treatment with tenofovir is sometimes associated with renal dysfunction. Limited information is available on this side effect in patients with small body weight, although the use of tenofovir will spread rapidly in Asia and Africa, where patients are likely to be of smaller body weight. METHODS: In a single-center cohort, Japanese patients with HIV infection who started tenofovir-containing antiretroviral therapy were retrospectively analyzed. The incidence of tenofovir-associated renal dysfunction, defined as more than 25% decrement of estimated glomerular filtration rate (eGFR from the baseline, was determined. The effects of small body weight and body mass index (BMI on tenofovir-associated renal dysfunction, respectively, were estimated in univariate and multivariate Cox hazards models as the primary exposure. Other possible risk factors were evaluated by univariate analysis and those found significant were entered into the multivariate analysis. RESULTS: The median weight of 495 patients was 63 kg. Tenofovir-related renal dysfunction occurred in 97 (19.6% patients (incidence: 10.5 per 100 person-years. Univariate analysis showed that the incidence of tenofovir-related renal dysfunction was significantly associated with smaller body weight and BMI, respectively (per 5 kg decrement, HR = 1.23; 95% CI, 1.10-1.37; p<0.001(per 1 kg/m(2 decrement, HR = 1.14; 95% CI, 1.05-1.23; p = 0.001. Old age, high baseline eGFR, low serum creatinine, low CD4 count, high HIV viral load, concurrent nephrotoxic drugs, hepatitis C infection, and current smoking were also associated with tenofovir-related renal dysfunction. Multivariate analysis identified small body weight as a significant risk (adjusted HR = 1.13; 95% CI, 1.01-1.27; p = 0.039, while small BMI had marginal significance (adjusted HR = 1.07; 95% CI 1.00-1.16; p = 0.058. CONCLUSION: The incidence of tenofovir-associated renal dysfunction in Japanese patients

  5. Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil.

    Science.gov (United States)

    Cardoso, Sandra W; Luz, Paula M; Velasque, Luciane; Torres, Thiago S; Tavares, Isabel C; Ribeiro, Sayonara R; Moreira, Ronaldo I; Veloso, Valdilea G; Moore, Richard D; Grinsztejn, Beatriz

    2014-12-19

    World-wide, the notable expansion of HIV/AIDS treatment programs in resource-limited settings has lead to an increasing number of patients in need of second-line cART. To adequately address and prepare for this scenario, critical assessments of the outcomes of second-line cART are particularly relevant in settings where monitoring strategies may be inadequate. We evaluated virologic outcomes of second-line combination antiretroviral therapy (cART) among HIV-infected individuals from Brazil. This study was conducted at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, at Rio de Janeiro, Brazio. For this study we included all patients who started first-line and second-line cART between 2000 and 2013. Second-line cART required a switch in the anchor drug of first-line cART. We evaluated time from second-line start to virologic failure and factors associated with increased risk of failure using multivariable Cox proportional hazards regression models. Among the 1,311 patients who started first-line cART a total of 386 patients (29.5%) initiated second-line cART, out of which 35.0% and 60.6% switched from their first-line to their second-line cART when their HIV RNA was undetectable and after documented virologic failure, respectively. At second line cART initiation, median age was 38 years [interquartile range (IQR): 31-45years]. Median CD4 count was significantly different for patients starting second-line cART undetectable [412 cells/mm3 (IQR: 240-617)] compared to those starting second-line cART after documented virologic failure [230 cells/mm3 (IQR: 118-322.5)] (p < 0.01). Median time from second-line cART initiation to failure was also significantly different for patients starting second-line cART undetectable compared to those who with documented virologic failure (log-rank test p < 0.01). Multivariable Cox models showed that younger age, lower education, and HIV RNA level were independently associated with an increased

  6. Early Mortality during Initial Treatment of Tuberculosis in Patients Co-Infected with HIV at the Yaounde Central Hospital, Cameroon: An 8-Year Retrospective Cohort Study (2006-2013.

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    Jean Joel R Bigna

    Full Text Available Understanding contributors to mortality during the initial phase of tuberculosis (TB treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases and 3 months (retreatment cases of TB treatment and to assess correlates of mortality in HIV co-infected patients.We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (aOR with 95% confidence interval. A p value < 0.05 was considered statistically significant.The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9 years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO. Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (aOR 2.47, 95%CI 1.22-5.02, p = 0.012, having extra-pulmonary TB (aOR 1.89, 95%CI 1.05-3.43, p = 0.035, and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49 were independently associated with death during the intensive phase of TB treatment.Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and

  7. The Majority of the Pre-Antiretroviral Population Who Were Lost to Follow-Up Stopped Their Care in Freetown, Sierra Leone: A 12-Month Prospective Cohort Study Starting with HIV Diagnosis.

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    J Daniel Kelly

    Full Text Available The heterogeneity of the pre-antiretroviral (pre-ART population calls for more granular depictions of the cascade of HIV care.We studied a prospective cohort of persons newly diagnosed with HIV infection from a single center in Freetown, Sierra Leone, over a 12-month period and then traced those persons who were lost to follow-up (LTFU during pre-ART care (before ART initiation. ART eligibility was based on a CD4 cell count result of ≤ 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an appointment in the final three months were considered to be retained in care. Adherence to ART was measured using pharmacy refill dates. "Effective HIV care" was defined as completion of the cascade of care at 12-months regardless of whether patients are on ART. Tracing outcomes were obtained for those who were LTFU during pre-ART care.408 persons newly diagnosed with HIV infection were screened, 338 were enrolled, and 255 persons were staged for ART. ART-ineligible persons had higher retention rates than ART-eligible persons (59.6% vs 41.8%, p = 0.03. 77 (22.8% of 338 persons received effective HIV care. Most attrition (61.9% occurred with persons during pre-ART care. 123 of 138 persons (89.1% who were LTFU prior to ART initiation were found, and 91 of those 123 (74.0% were alive. Of the 74 persons who were alive and described their engagement in care, 40 (54.1% stopped care. Nearly half (42.5% of those 40 stopped after assessment of ART-eligibility but before ART initiation. The main limitation of this study was the lack of tracing outcomes for those lost during ART care.The majority of the pre-ART LTFU population stopped their care, particularly after ART-eligibility but before ART initiation. Interventions to hasten ART initiation and retain this at-risk group may have significant downstream impact on effective HIV care.

  8. The Majority of the Pre-Antiretroviral Population Who Were Lost to Follow-Up Stopped Their Care in Freetown, Sierra Leone: A 12-Month Prospective Cohort Study Starting with HIV Diagnosis

    Science.gov (United States)

    Kelly, J. Daniel; Schlough, Gabriel Warren; Conteh, Sulaiman; Barrie, M. Bailor; Kargbo, Brima; Giordano, Thomas P.

    2016-01-01

    Background The heterogeneity of the pre-antiretroviral (pre-ART) population calls for more granular depictions of the cascade of HIV care. Methods We studied a prospective cohort of persons newly diagnosed with HIV infection from a single center in Freetown, Sierra Leone, over a 12-month period and then traced those persons who were lost to follow-up (LTFU) during pre-ART care (before ART initiation). ART eligibility was based on a CD4 cell count result of ≤ 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an appointment in the final three months were considered to be retained in care. Adherence to ART was measured using pharmacy refill dates. “Effective HIV care” was defined as completion of the cascade of care at 12-months regardless of whether patients are on ART. Tracing outcomes were obtained for those who were LTFU during pre-ART care. Results 408 persons newly diagnosed with HIV infection were screened, 338 were enrolled, and 255 persons were staged for ART. ART-ineligible persons had higher retention rates than ART-eligible persons (59.6% vs 41.8%, p = 0.03). 77 (22.8%) of 338 persons received effective HIV care. Most attrition (61.9%) occurred with persons during pre-ART care. 123 of 138 persons (89.1%) who were LTFU prior to ART initiation were found, and 91 of those 123 (74.0%) were alive. Of the 74 persons who were alive and described their engagement in care, 40 (54.1%) stopped care. Nearly half (42.5%) of those 40 stopped after assessment of ART-eligibility but before ART initiation. The main limitation of this study was the lack of tracing outcomes for those lost during ART care. Conclusions The majority of the pre-ART LTFU population stopped their care, particularly after ART-eligibility but before ART initiation. Interventions to hasten ART initiation and retain this at-risk group may have significant downstream impact on effective HIV care. PMID:26901765

  9. Diabetes and cognitive decline in a French cohort of patients infected with HIV-1.

    Science.gov (United States)

    Dufouil, Carole; Richert, Laura; Thiébaut, Rodolphe; Bruyand, Mathias; Amieva, Hélène; Dauchy, Frédéric-Antoine; Dartigues, Jean-François; Neau, Didier; Morlat, Philippe; Dehail, Patrick; Dabis, François; Bonnet, Fabrice; Chêne, Geneviève

    2015-09-22

    We investigated the relationship of diabetes and prediabetes with cognitive performances, assessed through raw test and z scores and according to neurocognitive impairment (NCI) classification in a cohort of individuals infected with HIV. The ANRS CO3 Aquitaine cohort is a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in 6 public hospitals in southwestern France. Between 2007 and 2009, an ancillary study consisted of a neuropsychological battery of 10 tests at baseline and 2-year follow-up. The severity of NCI (normal, asymptomatic, mild, HIV dementia) was assessed according to international guidelines. At baseline (400 patients, 33 with prediabetes, 39 with diabetes), in cross-sectional multivariable analyses, patients with diabetes performed significantly worse on 9 neuropsychological tests that assessed memory, executive functions, attention, psychomotor speed, language, and manual dexterity. Participants with prediabetes had worse performances compared with those who had normal glycemia in 5 tests. The longitudinal analysis of the association between glycemia status at baseline and change in cognitive performances over 2-year follow-up (n = 283) suggested that patients with diabetes also showed a slightly higher decline on 5 of the 10 tests, those involving executive functions and memory functioning. Glycemia status at baseline was not significantly associated with NCI severity in cross-sectional (p = 0.44) and longitudinal (p = 0.64) analyses. In this hospital-based cohort of people living with HIV, diabetes, but not the other cardiovascular risk factors, is associated with worse cognitive performances in several cognitive domains and with larger decline in fewer domains over the short term. © 2015 American Academy of Neurology.

  10. Mortality and health outcomes of HIV-exposed and unexposed children in a PMTCT cohort in Malawi.

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    Megan Landes

    Full Text Available BACKGROUND: Mortality and morbidity among HIV-exposed children are thought to be high in Malawi. We sought to determine mortality and health outcomes of HIV-exposed and unexposed infants within a PMTCT program. METHOD: Data were collected as part of a retrospective cohort study in Zomba District, Malawi. HIV-infected mothers were identified via antenatal, delivery and postpartum records with a delivery date 18-20 months prior; the next registered HIV-uninfected mother was identified as a control. By interview and health record review, data on socio-demographic characteristics, service uptake, and health outcomes were collected. HIV-testing was offered to all exposed children. RESULTS: 173 HIV-infected and 214 uninfected mothers were included. 4 stillbirths (1.0% occurred; among the 383 livebirths, 41 (10.7% children died by 20 months (32 (18.7% HIV-exposed and 9 unexposed children (4.3%; p<0.0001. Risk factors for child death included: HIV-exposure [adjOR2.9(95%CI 1.1-7.2], low birthweight [adjOR2.5(1.0-6.3], previous child death (adjOR25.1(6.5-97.5] and maternal death [adjOR5.3(11.4-20.5]. At 20 months, HIV-infected children had significantly poorer health outcomes than HIV-unexposed children and HIV-exposed but uninfected children (HIV-EU, including: hospital admissions, delayed development, undernutrition and restrictions in function (Lansky scale; no significant differences were seen between HIV-EU and HIV-unexposed children. Overall, no difference was seen at 20 months among HIV-infected, HIV-EU and HIV-unexposed groups in Z-scores (%<-2.0 for weight, height and BMI. Risk factors for poor functional health status at 20 months included: HIV-infection [adjOR8.9(2.4-32.6], maternal illness [adjOR2.8(1.5-5.0] and low birthweight [adjOR2.0(1.0-4.1]. CONCLUSION: Child mortality remains high within this context and could be reduced through more effective PMTCT including prioritizing the treatment of maternal HIV infection to address the effect of

  11. Risk of virological failure in HIV-1-infected patients experiencing low-level viraemia under active antiretroviral therapy (ANRS C03 cohort study).

    Science.gov (United States)

    Vandenhende, Marie-Anne; Perrier, Adélaïde; Bonnet, Fabrice; Lazaro, Estibaliz; Cazanave, Charles; Reigadas, Sandrine; Chêne, Geneviève; Morlat, Philippe

    2015-01-01

    We assessed the association of persistent low-level viraemia between 50-199 copies/ml (LLV) with the risk of virological failure (VF) among HIV-1-infected patients receiving combination antiretroviral therapy (ART). ART-naive and ART-experienced patients followed up in the ANRS-CO3 Aquitaine Cohort were included if they started two nucleoside reverse transcriptase inhibitors (NRTIs) with either one non-nucleoside reverse transcriptase inhibitor (NNRTI) or one protease inhibitor boosted with ritonavir (PI/r) between 2000 and 2011 and achieved viral load (VL)<200 copies/ml 4-8 months after initiating ART. VF was defined as either two consecutive VL≥200 copies/ml or one VL≥200 followed by a modification of ART. LLV was defined as at least two consecutive VLs between 50-199 copies/ml for at least one month. We used Cox models to estimate the association of LLV with VF. Among 2,374 patients with a median follow-up of 3 years, 205 (8.6%) experienced LLV. LLV was strongly associated with further VF (adjusted hazard ratio [aHR] 2.30, 95% CI 1.65, 3.20). LLV was associated with VF in ART-experienced patients (aHR 3.02, 95% CI 2.10, 4.33) but not in ART-naive patients. Neither type of ART regimen (PI/r- versus NNRTI-based regimen) nor cumulative duration of LLV was associated with VF. Persistent LLV between 50-199 copies/ml was associated with VF among ART-experienced patients under ART. LLV between 50-199 copies/ml in ART-experienced patients should lead, after assessing patient's adherence and checking for drug interactions, to a closer monitoring and to consider ART optimization.

  12. Imputation of the Date of HIV Seroconversion in a Cohort of Seroprevalent Subjects: Implications for Analysis of Late HIV Diagnosis

    NARCIS (Netherlands)

    Sobrino-Vegas, Paz; Pérez-Hoyos, Santiago; Geskus, Ronald; Padilla, Belén; Segura, Ferrán; Rubio, Rafael; del Romero, Jorge; Santos, Jesus; Moreno, Santiago; del Amo, Julia

    2012-01-01

    Objectives. Since subjects may have been diagnosed before cohort entry, analysis of late HIV diagnosis (LD) is usually restricted to the newly diagnosed. We estimate the magnitude and risk factors of LD in a cohort of seroprevalent individuals by imputing seroconversion dates. Methods. Multicenter

  13. Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study

    DEFF Research Database (Denmark)

    Larsen, Mette V; Omland, Lars Haukali Hvass; Gerstoft, Jan

    2010-01-01

    To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era.......To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era....

  14. Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study

    NARCIS (Netherlands)

    Gregson, John; Tang, Michele; Ndembi, Nicaise; Hamers, Raph L.; Rhee, Soo-Yon; Marconi, Vincent C.; Diero, Lameck; Brooks, Katherine; Theys, Kristof; de Wit, Tobias F. Rinke; Arruda, Monica; Garcia, Frederico; Monge, Susana; Gunthard, Huldrych F.; Hoffmann, Christopher J.; Kanki, Phyllis J.; Kumarasamy, Nagalingeshwaran; Kerschberger, Bernard; Mor, Orna; Charpentier, Charlotte; Todesco, Eva; Rokx, Casper; Gras, Luuk; Halvas, Elias K.; Sunpath, Henry; Di Carlo, Domenico; Antinori, Antonio; Andreoni, Massimo; Latini, Alessandra; Mussini, Cristina; Aghokeng, Avelin; Sonnerborg, Anders; Neogi, Ujjwal; Fessel, William J.; Agolory, Simon; Yang, Chunfu; Blanco, Jose L.; Juma, James M.; Smit, Erasmus; Schmidt, Daniel; Watera, Christine; Asio, Juliet; Kirungi, Wilford; Tostevin, Anna; El-Hay, Tal; Clumeck, Nathan; Goedhals, Dominique; van Vuuren, Cloete; Bester, Philip Armand; Sabin, Caroline; Mukui, Irene; Santoro, Maria M.; Perno, Carlo F.; Hunt, Gillian; Morris, Lynn; Camacho, Ricardo; de Oliveira, Tulio; Pillay, Deenan; Schulter, Eugene; Murakami-Ogasawara, Akio; Reyes-Teran, Gustavo; Romero, Karla; Avila-Rios, Santiago; Sirivichayakul, Sunee; Ruxrungtham, Kiat; Mekprasan, Suwanna; Dunn, David; Kaleebu, Pontiano; Raizes, Elliot; Kantor, Rami; Shafer, Robert W.; Gupta, Ravindra K.

    2016-01-01

    Background Antiretroviral therapy (ART) is crucial for controlling HIV-1 infection through wide-scale treatment as prevention and pre-exposure prophylaxis (PrEP). Potent tenofovir disoproxil fumarate-containing regimens are increasingly used to treat and prevent HIV, although few data exist for

  15. Incidence and impact on mortality of severe neurocognitive disorders in persons with and without HIV infection: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Lescure, François-Xavier; Omland, Lars Haukali Hvass; Engsig, Frederik Neess

    2011-01-01

    The risk of neurocognitive disorders in human immunodeficiency virus (HIV)-infected patients in the era of highly active antiretroviral therapy (HAART) is controversial. We aimed to compare the incidence and impact on mortality of severe neurocognitive disorders (SNCDs) in HIV-infected patients w...

  16. Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada.

    Science.gov (United States)

    Benoit, Anita C; Younger, Jaime; Beaver, Kerrigan; Jackson, Randy; Loutfy, Mona; Masching, Renée; Nobis, Tony; Nowgesic, Earl; O'Brien-Teengs, Doe; Whitebird, Wanda; Zoccole, Art; Hull, Mark; Jaworsky, Denise; Benson, Elizabeth; Rachlis, Anita; Rourke, Sean B; Burchell, Ann N; Cooper, Curtis; Hogg, Robert S; Klein, Marina B; Machouf, Nima; Montaner, Julio S G; Tsoukas, Chris; Raboud, Janet

    2017-06-16

    Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort. The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naïve persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication. The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Québec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) (p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001). The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.

  17. Factors associated with the use of irreversible contraception and continuous use of reversible contraception in a cohort of HIV-positive women

    NARCIS (Netherlands)

    Kancheva Landolt, Nadia; Ramautarsing, Reshmie Ashmanie; Phanuphak, Nittaya; Teeratakulpisarn, Nipat; Pinyakorn, Suteeraporn; Rodbamrung, Piyanee; Chaithongwongwatthana, Surasith; Ananworanich, Jintanat

    2013-01-01

    Effective contraception can be lifesaving by reducing maternal mortality linked to childbirth and unsafe abortion and by reducing vertical and horizontal transmission of HIV, in the case of an HIV-positive woman. This study is a secondary analysis of a prospective cohort study. We assessed factors

  18. Vitamin D deficiency in a cohort of HIV-infected patients: clinical analysis

    Directory of Open Access Journals (Sweden)

    B Vandercam

    2012-11-01

    Full Text Available Purpose of the study: Observational studies have noted very high rates of low serum 25-hydroxyvitamin D [25(OHD3] levels in both general and HIV-infected populations. In HIV-infected patients, low 25(OHD3 levels are secondary to a combination of usual risk factors and HIV-specific risk factors, like antiretroviral therapy [1]. The objective of our study is to analyse the magnitude of vitamin D deficiency or insufficiency and the role of various factors such as age, sex, ethnicity, season, and antiretroviral medications in our cohort of HIV-infected patients. Methods: We prospectively collected data on 25-hydroxyvitamin D levels sampled between January 2009 and June 2011 from our cohort of 930 HIV-infected patients. Vitamin D dosage was performed using immunoassay (‘Diasorin’ - Saluggia, Italy. We divided vitamin D levels into 3 categories: 25-hydroxyvitamin D levels <20 mg/nl were considered deficient, insufficient between 20 and 29 ng/ml. Levels ≥30 ng/ml were defined as normal [2]. Data on demographic features (age, ethnicity, season, heterosexuality vs homosexuality, clinical features and laboratory findings (CD4 cell count, viral load, HAART, BMI were collected from patients’ medical records using our institutional database ‘Medical explorer v3r9, 2009’. Summary of results: Overall, 848 patients were included in our study (Table 1. Low levels of serum 25(OHD3 were seen in 89.3% of the study population, from which 69.5% were deficient and 19.8% were insufficient. On univariate analysis, female sex, high BMI, black African, heterosexuality, undetectable viral load and antiretroviral treatment were all predictors of vitamin D deficiency and insufficiency. Treatment with efavirenz and tenofovir were the most associated with low vitamin D levels. On multivariate analysis (multiple linear regression model only female sex (OR=1.14; 95% CI 0.84–0.96; p<0.001, dosage during winter months (OR=1.14; 95% CI 1–1.15; p<0.05 and HAART (OR=1

  19. Natural History and Factors Associated with Early and Delayed Mortality in HIV-Infected Patients Treated of Tuberculosis under Directly Observed Treatment Short-Course Strategy: A Prospective Cohort Study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2012-01-01

    Full Text Available Despite the impressive global results of DOTS in India, the effectiveness of DOTS for the treatment of tuberculosis in HIV-infected patients is not well known. This is an observational prospective cohort study performed in Anantapur District, Andhra Pradesh, India. The study included 1000 DOTS antituberculosis treatment (ATT episodes and 840 person-years. CD4 lymphocyte count was below 200 cells/mm3 in 77% of the cases, and 21% were retreatments. Two thirds were presented with extrapulmonary tuberculosis, and the most common form of extrapulmonary tuberculosis was tuberculous meningitis followed by pleuritis, abdominal tuberculosis, and lymphadenitis. Cumulative incidence of mortality was 16%, 26%, 39%, and 46% at 1, 3, 12, and 24 months, respectively. Factors associated with three-month (early mortality were being homeless, having low CD4+ lymphocyte count, having tuberculous meningitis, belonging to a socially disadvantaged community, having more than 35 years, and being on an antiretroviral therapy at the moment of initiating the ATT. Factors associated with delayed mortality were having low CD4+ lymphocyte count, belonging to a socially disadvantaged community, receiving a category II ATT because of a previous episode of ATT and having acid fast bacilli in sputum before the ATT initiation. These findings indicate that there is an urgent need to improve the treatment of tuberculosis in HIV-infected patients in India.

  20. Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: A retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Alyssa Bilinski

    Full Text Available HIV/AIDS remains the second most common cause of death in low and middle-income countries (LMICs, and only 34% of eligible patients in Africa received antiretroviral therapy (ART in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program from August 1, 2006, when ART first became available, through December 31, 2013. We used GPS data to calculate patient-level distance to care, and examined number of annual ART visits and one-year lost to follow-up (LTFU in HIV care. The number of ART patients in Neno increased from 48 to 3,949 over the decentralization period. Mean travel distance decreased from 7.3 km when ART was only available at the district hospital to 4.7 km when ART was decentralized to 12 primary health facilities. For patients who transferred from centralized care to nearer health facilities, mean travel distance decreased from 9.5 km to 4.7 km. Following a transfer, the proportion of patients achieving the clinic's recommended ≥4 annual visits increased from 89% to 99%. In Cox proportional hazards regression, patients living ≥8 km from a health facility had a greater hazard of being LTFU compared to patients <8 km from a facility (adjusted HR: 1.7; 95% CI: 1.5-1.9. ART decentralization in Neno District was associated with increased ART enrollment, decreased travel distance, and increased retention in care. Increasing access to ART by reducing travel distance is one strategy to achieve the ART coverage and viral suppression objectives of the 90-90-90 UNAIDS targets in rural impoverished areas.

  1. Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV-infected individuals from 1995 to 2007: a nationwide cohort study(*)

    DEFF Research Database (Denmark)

    Larsen, Mv; Harboe, Zb; Ladelund, S

    2012-01-01

    OBJECTIVES: Incidence rates (IRs) of Staphylococcus aureus bacteraemia (SAB) are known to be higher in HIV-infected individuals than in the general population, but have not been assessed in the era of highly active antiretroviral therapy. METHODS: From 1 January 1995 to 31 December 2007, all Dani...... and the smallest decline in IR, while men who have sex with men (MSM) had the largest decline over time. Among HIV-infected individuals, a latest CD4 count MSM). Low CD4 cell count and IDU were strong predictors of SAB among HIV-infected individuals....

  2. Menopause and HIV infection: age at onset and associated factors, ANRS CO3 Aquitaine cohort.

    Science.gov (United States)

    de Pommerol, M; Hessamfar, M; Lawson-Ayayi, S; Neau, D; Geffard, S; Farbos, S; Uwamaliya, B; Vandenhende, M-A; Pellegrin, J-L; Blancpain, S; Dabis, F; Morlat, P

    2011-02-01

    The aim of the paper is to describe the characteristics of postmenopausal HIV-infected women and to investigate the factors associated with an earlier onset of menopause in a hospital-based cohort. Information was collected using a self-administered questionnaire. A Cox model was used to determine factors associated with menopause. Among the 404 women who completed the questionnaire, 69 were naturally postmenopausal at the time of the study (median age at onset: 49 years, premature menopause <40 years: 12%). The onset of menopause was studied among the 41 women still menstruating at the enrollment in the cohort, and who experienced menopause during follow-up. African origin (hazard ratio [HR] = 8.16; 95% confidence interval [CI] = 2.23-29.89) and history of injecting drug use (IDU) (HR = 2.46; 95% CI = 1.03-5.85) were associated with an increased risk of earlier menopause. Women with a CD4 cell count <200 cells/mm(3) tended to reach menopause earlier (HR = 2.25; 95% CI = 0.94-5.39). Earlier occurrence of menopause seems to be associated with factors already reported in HIV-negative women (IDU, ethnicity) and with HIV-related immunodeficiency.

  3. Risk factors related to hypertension among patients in a cohort living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Evanizio Roque de Arruda Junior

    Full Text Available INTRODUCTION: Studies disagree as to whether there is a greater prevalence of hypertension among HIV/AIDS patients and the role of antiretroviral therapy. OBJECTIVE: Evaluate the prevalence of hypertension and risk factors in a cohort of HIV-infected patients, with emphasis on antiretroviral therapy. METHOD: Case-control study conducted at baseline of a cohort, between June/2007 and December/2008 in Pernambuco/Brazil. Blood pressure was classified as normal, prehypertension, and hypertension. RESULTS: Of 958 patients, 245 (25.6% had hypertension (cases, 325 (33.9% had prehypertension, and 388 (40.5% were normotensive (controls. Comparison between hypertensive and normotensive patients showed that traditional factors, such as age > 40 (OR = 3.06, CI = 1.91-4.97, male gender (OR = 1.85, CI = 1.15-3.01, BMI > 25 (OR = 5.51, CI = 3.36-9.17, and triglycerides > 150 mg/dL (OR = 1.69, CI = 1.05-2.71, were independently associated with hypertension. Duration of antiretroviral therapy and CD4 > 200 cells/mm³ were associated with hypertension in univariate analysis, but did not remain in final model. Type of antiretroviral schema and lipodystrophy showed no association with hypertension. CONCLUSION: Hypertension in HIV/AIDS patients is partially linked to invariable factors, such as age and sex. Efforts should be directed toward controlling reversible factors, particularly excessive weight gain and unsuitable diet.

  4. Imputation of the Date of HIV Seroconversion in a Cohort of Seroprevalent Subjects: Implications for Analysis of Late HIV Diagnosis

    Directory of Open Access Journals (Sweden)

    Paz Sobrino-Vegas

    2012-01-01

    Full Text Available Objectives. Since subjects may have been diagnosed before cohort entry, analysis of late HIV diagnosis (LD is usually restricted to the newly diagnosed. We estimate the magnitude and risk factors of LD in a cohort of seroprevalent individuals by imputing seroconversion dates. Methods. Multicenter cohort of HIV-positive subjects who were treatment naive at entry, in Spain, 2004–2008. Multiple-imputation techniques were used. Subjects with times to HIV diagnosis longer than 4.19 years were considered LD. Results. Median time to HIV diagnosis was 2.8 years in the whole cohort of 3,667 subjects. Factors significantly associated with LD were: male sex; Sub-Saharan African, Latin-American origin compared to Spaniards; and older age. In 2,928 newly diagnosed subjects, median time to diagnosis was 3.3 years, and LD was more common in injecting drug users. Conclusions. Estimates of the magnitude and risk factors of LD for the whole cohort differ from those obtained for new HIV diagnoses.

  5. Feasibility of Identifying a Female Sex Worker Cohort at High Risk of HIV Infection in the Caribbean for HIV Vaccine Efficacy Trials: Longitudinal Results of HVTN 907.

    Science.gov (United States)

    Deschamps, Marie M; Metch, Barbara; Morgan, Cecilia A; Zorilla, Carmen D; Donastorg, Yeycy; Swann, Edith; Taina, Dadaille; Patrice, Joseph; Pape, William J

    2016-01-01

    Identifying cohorts of Caribbean women with HIV infection rates sufficient for inclusion in HIV vaccine efficacy trials has been challenging. HVTN 907 determined the feasibility of identifying and retaining a cohort of women at high risk for HIV acquisition by focusing recruitment on female sex workers (FSWs). HIV uninfected FSWs, residing in Haiti, Dominican Republic, and Puerto Rico, who reported unprotected sex and met previously described more stringent site-specific eligibility criteria, were eligible. Behavioral risk assessment, HIV counseling and testing, and pregnancy testing were performed at baseline, 6, 12, and 18 months. Among 799 FSWs (264 from Dominican Republic, 334 from Haiti, and 201 from Puerto Rico), the median age was 26 years, with 54% having less than a high school education and 45% having a monthly household income of less than $US 100. Median number of male partners 6 months before screening was 200. Retention at 18 months was 93%. Twelve women became HIV infected, 9 from Haiti. The annualized HIV incidence was 1.07% (95% confidence interval: 0.55% to 1.87%). Pregnancy incidence was 22.5% (95% confidence interval: 21.9% to 29.5%). Statistically significant declines in risk behaviors occurred between screening and the 18-month visit assessment. The HVTN 907 study identified a high-risk cohort of women with excellent retention for all 3 sites, despite major challenges especially in Haiti. These results show that a bridging study of a vaccine shown to be efficacious in other clade settings would be possible among FSWs in the region, particularly in Haiti.

  6. Feasibility of Identifying a Female Sex Worker Cohort at High Risk of HIV Infection in the Caribbean for HIV Vaccine Efficacy Trials: Longitudinal Results of HVTN 907

    Science.gov (United States)

    Deschamps, Marie Marcelle; Metch, Barbara; Morgan, Cecilia A; Zorrilla, Carmen D; Donastorg, Yeycy; Swann, Edith; Taina, Dadaille; Patrice, Joseph; JW, Pape

    2015-01-01

    Background Identifying cohorts of Caribbean women with HIV infection rates sufficient for inclusion in HIV vaccine efficacy trials has been challenging. HVTN 907 determined the feasibility of identifying and retaining a cohort of women at high risk for HIV acquisition by focusing recruitment on female sex workers (FSW). Methods HIV uninfected FSWs, residing in Haiti, Dominican Republic (DR) and Puerto Rico (PR), who reported unprotected sex and met previously described more stringent site-specific eligibility criteria14, were eligible. Behavioral risk assessment, HIV counseling and testing and pregnancy testing were done at baseline, 6, 12, and 18 months. Results Among 799 FSWs (264 from DR, 334 from Haiti, 201 from PR), the median age was 26 years, with 54% having less than a high school education and 45% having a monthly household income of less than $US100. Median number of male partners six months prior to screening was 200. Retention at 18 months was 93%. Twelve women became HIV infected, nine from Haiti. The annualized HIV incidence was 1.07 % (95% CI 0.55%, 1.87%). Pregnancy incidence was 22.5% (95% CI 21.9, 29.5%). Statistically significant declines in risk behaviors occurred between screening and the 18 month visit assessment. Discussion The HVTN 907 study identified a high risk cohort of women with excellent retention for all 3 sites, despite major challenges especially in Haiti. These results show that a bridging study of a vaccine shown to be efficacious in other clade settings would be possible among FSW in the region, particularly in Haiti. PMID:26761272

  7. Can you hear me now? Limited use of technology among an urban HIV-infected cohort.

    Science.gov (United States)

    Shacham, E; Stamm, K; Overton, E T

    2009-08-01

    Recent studies support technology-based behavioral interventions for individuals with HIV. This study focused on the use of cell phone and internet technologies among a cohort of 515 HIV-infected individuals. Socio-demographic and clinic data were collected among individuals presenting at an urban Midwestern university HIV clinic in 2007. Regular internet usage occurred more often with males, Caucasians, those who were employed, had higher income, and were more educated. Higher levels of education and income >$10,000 predicted regular usage when controlling for race, employment, and gender. Cell phone ownership was associated with being Caucasian, employed, more educated, and salary >$10,000. Employment was the only predictor of owning a cell phone when controlling for income, race, and education. Individuals who were <40 years of age, employed, and more educated were more likely to know how to text message. Employment and post-high school education predicted knowledge of text messaging, when controlling for age. Disparities among internet, cell phone, and text messaging usage exist among HIV-infected individuals.

  8. Cholangiopathy in a Co-Hort of HIV Positive Kenyan Patients ...

    African Journals Online (AJOL)

    It is an uncommon manifestation of advanced HIV/AIDS that was associated with poor prognosis prior to the anti-retroviral therapy era. ... Objective: To describe AIDS-related cholangiopathy and the associated ultrasound features, immunological and biochemical markers in a cohort of HIV positive patients. Design: ...

  9. Mortality in a cohort of children born to HIV-1 infected women from ...

    African Journals Online (AJOL)

    Objectives. To describe mortality in a cohort ofinfants withvertically transmitted HIV-1 infection. Patients and methods. Children of HIV-1 infected. women were' followed up from birth and a record was made at each visit of growth, development and all illnesses. Details surrounding death were obtained from hospital records.

  10. Thirty-day Readmission Rates in an HIV-infected Cohort From Rio de Janeiro, Brazil.

    Science.gov (United States)

    Coelho, Lara E; Ribeiro, Sayonara R; Japiassu, Andre M; Moreira, Ronaldo I; Lara, Priscila C; Veloso, Valdilea G; Grinsztejn, Beatriz; Luz, Paula M

    2017-08-01

    The 30-day readmission rate is an indicator of the quality of hospital care and transition to the outpatient setting. Recent studies suggest HIV infection might increase the risk of readmission although estimates of 30-day readmission rates are unavailable among HIV-infected individuals living in middle/low-income settings. Additionally, factors that may increase readmission risk in HIV-infected populations are poorly understood. Thirty-day readmission rates were estimated for HIV-infected adults from the Instituto Nacional de Infectologia Evandro Chagas/Fiocruz cohort in Rio de Janeiro, Brazil, from January 2007 to December 2013. Cox regression models were used to evaluate factors associated with the risk of 30-day readmission. Between January 2007 and December 2013, 3991 patients were followed and 1861 hospitalizations were observed. The estimated 30-day readmission rate was 14% (95% confidence interval: 12.3 to 15.9). Attending a medical visit within 30 days after discharge (adjusted hazard ratio [aHR] = 0.73, P = 0.048) and being hospitalized in more recent calendar years (aHR = 0.89, P = 0.002) reduced the risk of 30-day readmission. In contrast, low CD4 counts (51-200 cells/mm³: aHR = 1.70, P = 0.024 and ≤ 50 cells/mm³: aHR = 2.05, P = 0.003), time since HIV infection diagnosis ≥10 years (aHR = 1.58, P = 0.058), and leaving hospital against medical advice (aHR = 2.67, P = 0.004) increased the risk of 30-day readmission. Patients with advanced HIV/AIDS are most at risk of readmission and should be targeted with prevention strategies to reduce this risk. Efforts to reduce discharge against medical advice and to promote early postdischarge medical visit would likely reduce 30-day readmission rates in our population.

  11. HIV incidence and risk factors for acquisition in HIV discordant couples in Masaka, Uganda: an HIV vaccine preparedness study.

    Directory of Open Access Journals (Sweden)

    Eugene Ruzagira

    Full Text Available To determine the incidence of and risk factors for HIV acquisition in a cohort of HIV-uninfected partners from HIV discordant couples in Masaka, Uganda, and to establish its suitability for HIV vaccine trials.HIV-uninfected adults living in HIV discordant couple relationships were enrolled and followed for 2 years. Interviews, medical investigations, HIV counseling and testing, syphilis and urine pregnancy (women tests were performed at quarterly visits. Sexual risk behaviour data were collected every 6 months.495 participants were enrolled, of whom 34 seroconverted during 786.6 person-years of observation (PYO. The overall HIV incidence rate [95% confidence interval (CI] was 4.3 [3.1-6]; and 4.3 [2.8-6.4] and 4.4 [2.5-8] per 100 PYO in men and women respectively. Independent baseline predictors for HIV acquisition were young age [18-24 (aRR = 4.1, 95% CI 1.6-10.8 and 25-34 (aRR = 2.7, 95% CI 1.2-5.8 years]; alcohol use (aRR = 2.6, 95% CI 1.1-6; and reported genital discharge (aRR = 3.4, 95% CI 1.6-7.2 in the past year. Condom use frequency in the year preceding enrolment was predictive of a reduced risk of HIV acquisition [sometimes (aRR = 0.4, 95% CI 0.2-0.8; always (aRR = 0.1, 95% CI 0.02-0.9]. In the follow-up risk analysis, young age [18-24 (aRR = 6.2, 95% CI 2.2-17.3 and 25-34 (aRR = 2.3, 95% CI 1.1-5.0 years], reported genital discharge (aRR = 2.5, 95% CI 1.1-5.5, serological syphilis (aRR 3.2, 95% CI 1.3-7.7 and the partner being ART naïve (aRR = 4.8, 95% CI 1.4-16.0 were independently associated with HIV acquisition. There were no seroconversions among participants who reported consistent condom use during the study.The study has identified important risk factors for HIV acquisition among HIV discordant couples. HIV-uninfected partners in discordant couples may be a suitable population for HIV vaccine efficacy trials. However, recent confirmation that ART reduces heterosexual HIV transmission may

  12. Treatment discontinuation in HIV-1-infected individuals starting their first-line HAART after 2008: data from the ICONA Foundation Study Cohort

    Directory of Open Access Journals (Sweden)

    Antonio Di Biagio

    2014-11-01

    Full Text Available Introduction: The aim of this study was to analyze the likelihood and the predictors of discontinuation of first-line regimen in the late HAART era. Methodology: An observational multi-center analysis of HIV-positive patients enrolled in ICONA. Patients eligible were those starting a first-line HAART after 1 January 2008. Discontinuation was defined as stop and/or switch of at least one drug of the regimen. All causes of discontinuation, as reported by the treating physician, were evaluated and cumulative risk of stopping was investigated according to age, gender, co-morbidity, years since starting HAART, immuno-virological status, third drug and backbone of the first regimen. Kaplan Meier (KM analysis and Cox proportional hazards model were used for the outcome discontinuation of ≥1 drug regardless of the reason. For the KM estimates a competing risk approach was used to estimate the contribution of each of the reasons over time to the cumulative risk of stopping over time. Results: Data of 1759 patients who started first HAART and had at least one month of clinical follow-up were analyzed. The overall discontinuation risk was 33% over a median follow-up of 12 months. The likelihood of discontinuation by KM was 27% by one year (95% CI 25–29 and 41% by two years (95% CI 38–44. Main reason for stopping at least one drug in regimen was simplification (10%, followed by intolerance (7%, toxicity (5%, failure (2% and other causes (8%. Estimates of the cumulative risk of discontinuation of ≥1 drug over time and according to reason are shown in Figure 1. In a multivariable Cox model independent predictors of discontinuation regardless of the reason were: longer time from HIV diagnosis to date of starting HAART (hazard ratio [HR] 0.96; 95% CI 0.93–1.00; p=0.039, regimens containing ZDV/3TC (HR 2.86; 95% CI 1.42–5.76; p=0.003 vs TDF/FTC and an NNRTI-based regimen (HR 2.47; 95% CI 0.91–6.72; p=0.07 vs regimens not NNRTI-based. Conclusions

  13. Serum neutralizing activities from a Beijing homosexual male cohort infected with different subtypes of HIV-1 in China.

    Directory of Open Access Journals (Sweden)

    Mingshun Zhang

    Full Text Available Protective antibodies play a critical role in an effective HIV vaccine; however, eliciting antibodies to block infection by viruses from diverse genetic subtypes remains a major challenge. As the world's most populous country, China has been under the threat of at least three major subtypes of circulating HIV-1 viruses. Understanding the cross reactivity and specificities of serum antibody responses that mediate broad neutralization of the virus in HIV-1 infected Chinese patients will provide valuable information for the design of vaccines to prevent HIV-1 transmission in China. Sera from a cohort of homosexual men, who have been managed by a major HIV clinical center in Beijing, China, were analyzed for cross-sectional neutralizing activities against pseudotyped viruses expressing Env antigens of the major subtype viruses (AE, BC and B subtypes circulating in China. Neutralizing activities in infected patients' blood were most capable of neutralizing viruses in the homologous subtype; however, a subset of blood samples was able to achieve broad neutralizing activities across different subtypes. Such cross neutralizing activity took 1-2 years to develop and CD4 binding site antibodies were critical components in these blood samples. Our study confirmed the presence of broadly neutralizing sera in China's HIV-1 patient population. Understanding the specificity and breadth of these neutralizing activities can guide efforts for the development of HIV vaccines against major HIV-1 viruses in China.

  14. The impact of HIV-1 co-infection on long-term mortality in patients with hepatitis C: a population-based cohort study

    DEFF Research Database (Denmark)

    Omland, L H; Jepsen, P; Skinhøj, P

    2009-01-01

    OBJECTIVE: To investigate the impact of HIV co-infection on mortality in patients infected with hepatitis C virus (HCV). METHODS: From a nationwide Danish database of HCV-infected patients, we identified individuals diagnosed with HCV subsequent to an HIV diagnosis. For each co-infected patient...... (MRRs), controlling for comorbidity. RESULTS: We identified 483 HCV-HIV co-infected and 1932 HCV mono-infected patients, yielding 2192 and 9894 person-years of observation with 129 and 271 deaths, respectively. The 5-year probability of survival was 0.74 [95% confidence interval (CI) 0.69-0.80] for HCV......-HIV co-infected patients and 0.87 (95% CI 0.85-0.89) for HCV mono-infected patients. Co-infection was associated with substantially increased mortality (MRR 2.1, 95% CI 1.7-2.6). However, prior to the first observed decrease in CD4 counts to below 300 cells/muL, HIV infection did not increase mortality...

  15. Neurosyphilis in a clinical cohort of HIV-1-infected patients

    Science.gov (United States)

    Ghanem, Khalil G.; Moore, Richard D.; Rompalo, Anne M.; Erbelding, Emily J.; Zenilman, Jonathan M.; Gebo, Kelly A.

    2008-01-01

    Objectives To describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis. Methods Comprehensive demographic, clinical, and therapeutic data were collected prospectively on all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells >10/μl; protein >50 mg/dl; reactive venereal diseases research laboratory], (b) an otherwise unexplained neurological finding. Results Of 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria (median age 38.6 years, 79.1% male). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18–7.02), a rapid plasma regain titer >1:128 (2.83; 1.11–7.26), and male sex (2.46; 1.06–5.70). Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14–0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P =0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis. Conclusion Early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis. PMID:18525260

  16. Cohort Studies: Prospective versus Retrospective

    NARCIS (Netherlands)

    Euser, Anne M.; Zoccali, Carmine; Jager, Kitty J.; Dekker, Friedo W.

    2009-01-01

    Cohort studies form a suitable study design to assess associations between multiple exposures on the one hand and multiple outcomes on the other hand. They are especially appropriate to study rare exposures or exposures for which randomization is not possible for practical or ethical reasons.

  17. HIV is associated with airway obstruction: a matched controlled study.

    Science.gov (United States)

    Makinson, Alain; Hayot, Maurice; Eymard-Duvernay, Sabrina; Ribet, Céline; Raffi, François; Pialoux, Gilles; Zucman, David; Poizot-Martin, Isabelle; Bonnet, Fabrice; Abgrall, Sophie; Tattevin, Pierre; Cheret, Antoine; Ferry, Tristan; Mauboussin, Jean-Marc; Marchand, Lucie; Rouzaud, Claire; Reynes, Jacques; Zins, Marie; Le Moing, Vincent

    2018-01-14

    To explore whether airway obstruction is associated with HIV in a cohort of HIV-infected and uninfected smokers. People living with HIV (PLWHIV) participated in the ANRS EP48 HIV CHEST study, an early lung cancer diagnosis study with low-dose chest tomography. HIV-uninfected study participants were from the CONSTANCES cohort. Inclusion criteria were an age greater than 40 years, a smoking history of at least 20 pack-years, and for PLWHIV, a CD4 T-lymphocyte nadir less than 350/μl and last CD4 cell count more than 100 cells/μl. Two randomly selected HIV-uninfected study participants were matched by age and sex with one PLWHIV. Prebronchodilatator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio was the primary outcome, and association of FEV1/FVC ratio less than 0.70 and FEV1 less than 80% of the theoretical value, as a proxy of chronic obstructive pulmonary disease, the secondary outcome. In total, 351 PLWHIV and 702 HIV-uninfected study participants were included. Median age was 50 years, and 17% of study participants were women. Plasma HIV RNA was less than 50 copies/ml in 89% of PLWHIV, with a median CD4 cell count of 573 cells/μl. HIV (β -2.19), age (per 10 years increase; β -2.81), tobacco use (per 5 pack-years increase; β -0.34), and hepatitis C virus serology (β-2.50) were negatively associated with FEV1/FVC. HIV [odds ratio (OR: 1.72)], age (per 10 years increase; OR 1.77), and tobacco use (per 5 pack-years increase; OR 1.11) were significantly associated with the secondary outcome. Our study found a significant association of airway obstruction with HIV status in smokers aged more than 40 years with previous immunodeficiency.

  18. Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

    NARCIS (Netherlands)

    May, Margaret T.; Hogg, Robert S.; Justice, Amy C.; Shepherd, Bryan E.; Costagliola, Dominique; Ledergerber, Bruno; Thiébaut, Rodolphe; Gill, M. John; Kirk, Ole; van Sighem, Ard; Saag, Michael S.; Navarro, Gemma; Sobrino-Vegas, Paz; Lampe, Fiona; Ingle, Suzanne; Guest, Jodie L.; Crane, Heidi M.; D'Arminio Monforte, Antonella; Vehreschild, Jörg J.; Sterne, Jonathan A. C.; Gras, L. A.; van Sighem, A. I.; Smit, C.; de Wolf, F.; Prins, J. M.; Bos, J. C.; Eeftinck-Schattenkerk, J. K. M.; Geerlings, S. E.; Godfried, M. H.; Lange, J. M. A.; van der Meer, J. T. M.; Nellen, F. J. B.; Olszyna, D. P.; van der Poll, T.; Reiss, P.; Sankatsing, S. U. C.; van der Valk, M.; Vermeulen, J. N.; Vrouenraets, S. M. E.; van Vugt, M.; Wit, F. W. M. N.; Schreij, G.; van der Geest, S.; Oude Lashof, A.; Lowe, S.; Verbon, A.; Bravenboer, B.; Pronk, M. J. H.; Kuijpers, T. W.; Pajkrt, D.; Scherpbier, H. J.; van der Ende, M. E.; Bax, H.; van der Feltz, M.; Gelinck, L. B. S.; de Melo, Mendoca; Nouwen, J. L.; Rijnders, B. J. A.; de Ruiter, E. D.; Slobbe, L.; Schurink, C. A. M.; de Vries, T. E. M. S.; Driessen, G.; van der Flier, M.; Hartwig, N. G.; Branger, J.; Kauffmann, R. H.; Schippers, E. F.; Groeneveld, P. H. P.; Alleman, M. A.; Kroon, F. P.; Arend, S. M.; de Boer, M. G. J.; van den Broek, P. J.; van Dissel, J. T.; van Nieuwkoop, C.; den Hollander, J. G.; Bronsveld, W.; Pogány, K.; Haag, Den; Vriesendorp, R.; Jeurissen, F. J. F.; Leyten, E. M. S.; van Houte, D.; Polée, M. B.; van Vonderen, M.; ten Napel, C. H. H.; Kootstra, G. J.; Brinkman, K.; van den Berk, G. E. L.; Blok, W. L.; Frissen, P. H. J.; Schouten, W. E. M.; van Eeden, A.; Verhagen, D. W. M.; Mulder, J. W.; van Gorp, E. C. M.; Steingrover, A. T. A.; Wagenaar, J.; Juttmann, J. R.; van Kasteren, M. E. E.; Veenstra, J.; Vasmel, W. L. E.; Lettinga, K. D.; Koopmans, P. P.; Brouwer, A. M.; Dofferhoff, A. S. M.; de Groot, R.; ter Hofstede, H. J. M.; Keuter, M.; van der Ven, A. J. A. M.; Sprenger, H. G.; van Assen, S.; Stek, C. J.; Doedens, R.; Scholvinck, E. H.; Hoepelman, I. M.; Schneider, M. M. E.; Bonten, M. J. M.; Ellerbroek, P. M.; Jaspers, C. A. J. J.; Maarschalk-Ellerbroek, L. J.; Oosterheert, J. J.; Peters, E. J. G.; Mudrikova, T.; Wassenberg, M. W. M.; Weijer, S.; Hoogenwerf, M. H.; Arends, J. E.; Hoornenborg, E.; Geelen, S. P. M.; Wolfs, T. F. W.; Danner, S. A.; van Agtmael, M. A.; Bierman, W. F. W.; Claessen, F. A. P.; Hillebrand, M. E.; de Jong, E. V.; Kortmann, W.; Perenboom, R. M.; de Vaate, E. A.; Richter, C.; van der Berg, J.; Gisolf, E. H.; Tanis, A. A.; Duits, A. J.; Winkel, K.; Back, N. K. T.; Bakker, M. E. G.; Zaaijer, H. L.; Berkhout, B.; Jurriaans, S.; Cuijpers, Th; Rietra, P. J. G. M.; Roozendaal, K. J.; Pauw, W.; Smits, P. H. M.; van Zanten, A. P.; von Blomberg, B. M. E.; Pettersson, A.; Savelkoul, P.; Swanink, C. M. A.; Franck, P. F. H.; Lampe, A. S.; Jansen, C. L.; Hendriks, R.; Benne, C. A.; Schirm, J.; Veenendaal, D.; Storm, H.; Weel, J.; van Zeijl, J. H.; Claas, H. C. J.; Kroes, A. C. M.; Bruggeman, C. A. M. V. A.; Goossens, V. J.; Galama, J. M. D.; Melchers, W. J. G.; van Doornum, G. J. J.; Niesters, H. G. M.; Osterhaus, A. D. M. E.; Schutten, M.; Buiting, A. G. M.; Boucher, C. A. B.; Boel, E.; Schuurman, R.; Jansz, A. F.; Wulf, M.; Veldkamp, A.; Beijnen, J. H.; Huitema, A. D. R.; Burger, D. M.; van Kan, H. J. M.; Bruyand, M.; Chêne, G.; Dabis, F.; Lawson-Ayayi, S.; Thiébaut, R.; Bonarek, M.; Bonnal, F.; Bonnet, F.; Bernard, N.; Caubet, O.; Caunègre, L.; Cazanave, C.; Ceccaldi, J.; Dauchy, F. A.; de La Taille, C.; de Witte, S.; Dupon, M.; Duffau, P.; Dutronc, H.; Farbos, S.; Greib, C.; Lacoste, D.; Lafarie, S.; Loste, P.; Malvy, D.; Mercié, P.; Morlat, P.; Neau, D.; Ochoa, A.; Pellegrin, J. L.; Ragnaud, J. M.; Tchamgoué, S.; Viallard, J. F.; Blanco, P.; Moreau, J. F.; Fleury, H.; Lafon, M. E.; Masquelier, B.; Pellegrin, I.; Breilh, D.; Miremont-Salamé, G.; Blaizeau, M. J.; Decoin, M.; Delveaux, S.; Hannapier, C.; Labarrère, S.; Lavignolle-Aurillac, V.; Uwamaliya-Nziyumvira, B.; Geffard, S.; Palmer, G.; Touchard, D.; Longy-Boursier, M.; Fätkenheuer, Gerd; Rockstroh, Jürgen; Hertenstein, Caro; Vehreschild, Janne; Wasmuth, Jan-Christian; Berenguer, Juan; del Amo, Julia; García, Federico; Gutiérrez, Félix; Labarga, Pablo; Moreno, Santiago; Muñoz, María Ángeles; Sobrino, Paz; Hernando, Victoria; Alejos, Belén; Álvarez, Débora; Monge, Susana; Jarrín, Inmaculada; Martínez, Isabel García Pilar; Sirvent, Juan Luis Gómez; Fortúnez, Patricia Rodríguez; Valls, María Remedios Alemán; del Mar Alonso Socas, María; Lirola, Ana María López; Hernández, María Inmaculada Hernández; Díaz-Flores, Felicitas; Soriano, Vicente; Barreiro, Pablo; Castañares, Carol; Rivas, Pablo; Ruiz, Andrés; Blanco, Francisco; García, Pilar; Rubio, Rafael; Pulido, Federico; Fiorante, Silvana; Llenas, Jara; Rodríguez, Violeta; Matarranz, Mariano; Iribarren, José Antonio; Arrizabalaga, Julio; Aramburu, María José; Camino, Xabier; Rodríguez-Arrondo, Francisco; von Wichmann, Miguel Ángel; Tomé, Lidia Pascual; Goenaga, Miguel Ángel; Bustinduy, Jesús; Masiá, Mar; Ramos, José Manuel; Padilla, Sergio; Navarro, Andrés; Montolio, Fernando; Peral, Yolanda; Bernaldo, Juan Carlos López; Miralles, Pilar; Ochaíta, Jaime Cosín; Conde, Matilde Sánchez; Cuellar, Isabel Gutiérrez; Schacke, Margarita Ramírez; Ortega, Belén Padilla; Vidaurreta, Paloma Gijón; Marañón, Gregorio; Vidal, Francesc; Peraire, Joaquín; Viladés, Consuelo; Veloso, Sergio; Vargas, Montserrat; López-Dupla, Miguel; Olona, Montserrat; Aguilar, Alba; Sirvent, Joan Joseph; Soriano, Antoni; Rodríguez, Johana; Aparicio, Ana Salas; Sarriá, Cristina; Oteo, José Antonio; Blanco, José Ramón; Ibarra, Valvanera; Metola, Luis; Sanz, Mercedes; Boneta, Julio Sola; Uriz, Javier; Castiello, Jesús; Reparaz, Jesús; Arraiza, María Jesús; Irigoyen, Carmen; Mozas, David; Casado, José Luis; Dronda, Fernando; Moreno, Ana; Elías, María Jesús Pérez; López, Dolores; Gutiérrez, Carolina; Hernández, Beatriz; Pumares, María; García, Federico García; Quero, José Hernández; Monje, Alejandro Peña; Medina, Leopoldo Muñoz; Losso, M.; Kundro, M.; Mejia, J.; Vetter, N.; Zangerle, R.; Karpov, I.; Vassilenko, A.; Mitsura, V. M.; Suetnov, O.; Clumeck, N.; Delforge, M.; Colebunders, R.; Vandekerckhove, L.; Hadziosmanovic, V.; Kostov, K.; Begovac, J.; Machala, L.; Jilich, D.; Sedlacek, D.; Nielsen, J.; Kronborg, G.; Benfield, T.; Larsen, M.; Gerstoft, J.; Katzenstein, T.; Hansen, A.-B. E.; Skinhøj, P.; Pedersen, C.; Ostergaard, L.; Zilmer, K.; Ristola, M.; Katlama, C.; Viard, J.-P.; Girard, P.-M.; Livrozet, J. M.; Vanhems, P.; Pradier, C.; Rockstroh, J.; Schmidt, R.; van Lunzen, J.; Degen, O.; Stellbrink, H. J.; Staszewski, S.; Goethe, J. W.; Bogner, J.; Fätkenheuer, G.; Kosmidis, J.; Gargalianos, P.; Xylomenos, G.; Perdios, J.; Panos, G.; Filandras, A.; Karabatsaki, E.; Sambatakou, H.; Banhegyi, D.; Mulcahy, F.; Yust, I.; Turner, D.; Burke, M.; Pollack, S.; Hassoun, G.; Maayan, S.; Vella, S.; Esposito, R.; Mazeu, I.; Mussini, C.; Arici, C.; Pristera, R.; Mazzotta, F.; Gabbuti, A.; Vullo, V.; Lichtner, M.; Chirianni, A.; Montesarchio, E.; Gargiulo, M.; Antonucci, G.; Testa, A.; Offizi, G. D.; Vlassi, C.; Zaccarelli, M.; Antorini, A.; Lazzarin, A.; Castagna, A.; Gianotti, N.; Galli, M.; Ridolfo, A.; Sacco, L.; d'Arminio Monforte, A.; Rozentale, B.; Zeltina, I.; Chaplinskas, S.; Staub, T.; Hemmer, R.; Ormaasen, V.; Maeland, A.; Bruun, J.; Knysz, B.; Gasiorowski, J.; Horban, A.; Bakowska, E.; Grzeszczuk, A.; Flisiak, R.; Boron-Kaczmarska, A.; Pynka, M.; Parczewski, M.; Beniowski, M.; Mularska, E.; Trocha, H.; Jablonowska, E.; Malolepsza, E.; Wojcik, K.; Antunes, F.; Doroana, M.; Caldeira, L.; Mansinho, K.; Maltez, F.; Duiculescu, D.; Babes, Victor; Rakhmanova, A.; Zakharova, N.; Buzunova, S.; Jevtovic, D.; Mokráš, M.; Staneková, D.; Tomazic, J.; González-Lahoz, J.; Soriano, V.; Labarga, P.; Medrano, J.; Moreno, S.; Rodriguez, J. M.; Clotet, B.; Jou, A.; Paredes, R.; Tural, C.; Puig, J.; Bravo, I.; Gatell, J. M.; Miró, J. M.; Domingo, P.; Gutierrez, M.; Mateo, G.; Sambeat, M. A.; Blaxhult, A.; Flamholc, L.; Ledergerber, B.; Weber, R.; Francioli, P.; Cavassini, M.; Hirschel, B.; Boffi, E.; Furrer, H.; Battegay, M.; Elzi, L.; Kravchenko, E.; Chentsova, N.; Frolov, V.; Kutsyna, G.; Servitskiy, S.; Krasnov, M.; Barton, S.; Johnson, A. M.; Mercey, D.; Phillips, A.; Johnson, M. A.; Mocroft, A.; Murphy, M.; Weber, J.; Scullard, G.; Fisher, M.; Leen, C.; Gatell, J.; Gazzard, B.; d'Arminio, A.; de Wit, S.; Lundgren, J.; Kirk, O.; Cozzi-Lepri, A.; Grint, D.; Sabin, M.; Podlekareva, D.; Kjær, J.; Peters, L.; Tverland, J.; Fischer, A. H.; Grarup, J.; Thiebaut, R.; Burger, D.; Abgrall, S.; Barin, F.; Bentata, M.; Billaud, E.; Boué, F.; Burty, C.; Cabié, A.; Costagliola, D.; Cotte, L.; de Truchis, P.; Duval, X.; Duvivier, C.; Enel, P.; Fredouille-Heripret, L.; Gasnault, J.; Gaud, C.; Gilquin, J.; Grabar, S.; Khuong, M. A.; Lang, J. M.; Lascaux, A. S.; Launay, O.; Mahamat, A.; Mary-Krause, M.; Matheron, S.; Meynard, J. L.; Pavie, J.; Pialoux, G.; Pilorgé, F.; Poizot-Martin, I.; Reynes, J.; Rouveix, E.; Simon, A.; Tattevin, P.; Tissot-Dupont, H.; Viard, J. P.; Viget, N.; Jacquemet, N.; Guiguet, M.; Lanoy, E.; Lièvre, L.; Selinger-Leneman, H.; Lacombe, J. M.; Potard, V.; Pitié, G. H.; Bricaire, F.; Herson, S.; Desplanque, N.; Girard, P. M.; Meyohas, M. C.; Picard, O.; Cadranel, J.; Mayaud, C.; Clauvel, J. P.; Decazes, J. M.; Gerard, L.; Molina, J. M.; Lariboisière-Fernand, G. H.; Diemer, M.; Sellier, P.; Honoré, P.; Jeantils, V.; Tassi, S.; Mechali, D.; Taverne, B.; Bouvet, E.; Crickx, B.; Ecobichon, J. L.; Picard-Dahan, C.; Yeni, P.; Berthé, H.; Dupont, C.; Chandemerle, C.; Mortier, E.; Tisne-Dessus, D.; Weiss, L.; Tarnier-Cochin, G. H.; Salmon, D.; Auperin, I.; Roudière, L.; Fior, R.; Delfraissy, J. F.; Goujard, C.; Jung, C.; Vittecoq, D.; Fraisse, P.; Rey, D.; Beck-Wirth, G.; Stahl, J. P.; Lecercq, P.; Gourdon, F.; Laurichesse, H.; Fresard, A.; Lucht, F.; Bazin, C.; Verdon, R.; Chavanet, P.; Arvieux, C.; Michelet, C.; Choutet, P.; Goudeau, A.; Maître, M. F.; Hoen, B.; Eglinger, P.; Faller, J. P.; Borsa-Lebas, F.; Caron, F.; Daures, J. P.; May, T.; Rabaud, C.; Berger, J. L.; Rémy, G.; Arlet-Suau, E.; Cuzin, L.; Massip, P.; Legrand, M.; Pontonnier, G.; Yasdanpanah, Y.; Dellamonica, P.; Pugliese, P.; Aleksandrowicz, K.; Quinsat, D.; Ravaux, I.; Delmont, J. P.; Moreau, J.; Gastaut, J. A.; Retornaz, F.; Soubeyrand, J.; Galinier, A.; Ruiz, J. M.; Allegre, T.; Blanc, P. A.; Bonnet-Montchardon, D.; Lepeu, G.; Granet-Brunello, P.; Esterni, J. P.; Pelissier, L.; Cohen-Valensi, R.; Nezri, M.; Chadapaud, S.; Laffeuillade, A.; Raffi, F.; Boibieux, A.; Peyramond, D.; Touraine, J. L.; Trepo, C.; Strobel, M.; Saint-Martin, C. H.; Bissuel, F.; Pradinaud, R.; Sobesky, M.; Contant, M.; Moroni, M.; Angarano, G.; Antinori, A.; Castelli, F.; Cauda, R.; Di Perri, G.; Iardino, R.; Ippolito, G.; Perno, C. F.; Armignacco, O.; Viale, P. L.; Von Schlosser, F.; Ammassari, A.; Andreoni, M.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, M. R.; Ceccherini-Silberstein, F.; Cinque, P.; de Luca, A.; Gervasoni, C.; Girardi, E.; Gori, A.; Guaraldi, G.; Caputo, S. Lo; Madeddu, G.; Maggiolo, F.; Marchetti, G.; Marcotullio, S.; Monno, L.; Murri, R.; Puoti, M.; Torti, C.; Cicconi, P.; Fanti, I.; Formenti, T.; Galli, L.; Lorenzini, P.; Giacometti, A.; Costantini, A.; Riva, A.; Carrisa, C.; Lazzari, G.; Verucchi, G.; Minardi, C.; Quirino, T.; Abeli, C.; Manconi, P. E.; Piano, P.; Vecchiet, J.; Falasca, K.; Sighinolfi, L.; Segala, D.; Cassola, G.; Viscoli, G.; Alessandrini, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Chiodera, A.; Castelli, P.; Rizzardini, G.; Ridolfo, A. L.; Piolini, R.; Salpietro, S.; Galli, A.; Bigoloni, A.; Spagnuolo, V.; Carenzi, L.; Zucchi, P.; Moioli, M. C.; Rossotti, R.; Bisio, L.; Lapadula, G.; Abrescia, N.; Guida, M. G.; Baldelli, F.; Belfiori, B.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; Tozzi, V.; d'Avino, A.; Gallo, L.; Nicastro, E.; Acinapura, R.; Capozzi, M.; Libertone, R.; Tebano, G.; Mura, M. S.; Caramello, P.; Orofino, G. C.; Sciandra, M.; Pellizzer, G.; Manfrin, V.; Casabona, J.; Esteve, A.; Alquézar, A.; Podzamczer, D.; Murillas, J.; Romero, A.; Agustí, C.; Agüero, F.; Ferrer, E.; Riera, M.; Navarro, F.; Force, L.; Vilaró, J.; Masabeu, A.; García, I.; Guadarrama, M.; Montoliu, A.; Ortega, N.; Lazzari, E.; Puchol, E.; Sanchez, M.; Blanco, J. L.; Garcia-Alcaide, F.; Martinez, E.; López-Dieguez, J.; García-Goez, J. F.; Sirera, G.; Romeu, J.; Negredo, E.; Miranda, C.; Capitan, M. C.; Olmo, M.; Barragan, P.; Saumoy, M.; Bolao, F.; Cabellos, C.; Peña, C.; Sala, M.; Cervantes, M.; Jose Amengual, M.; Navarro, M.; Penelo, E.; Barrufet, P.; Bhagani, S.; Carroll, A.; Cropley, I.; Cuthbertson, Z.; Drinkwater, T.; Dunleavy, A.; Fernandez, T.; Geretti, A. M.; Marshall, N.; Murphy, G.; Nair, D.; Ivens, D.; Johnson, M.; Kinloch-de Loes, S.; Lipman, M.; Madge, S.; Mahungu, T.; Prinz, B.; Swaden, L.; Rodger, A.; Tyrer, M.; Youle, M.; Chaloner, C.; Holloway, J.; Puradiredja, J.; Scott, S.; Tsintas, R.; Cambiano, V.; Harris, E.; Lampe, F.; Lodwick, R.; Smith, C.; Amoah, E.; Booth, C.; Clewley, G.; Garcia Diaz, A.; Gregory, B.; Labbett, W.; Libaste, J.; Tahami, F.; Thomas, M.; Zhong, Y.; Aubert, V.; Barth, J.; Bernasconi, E.; Böni, J.; Bucher, H. C.; Burton-Jeangros, C.; Calmy, A.; Egger, M.; Fehr, J.; Fellay, J.; Fux, C. A.; Gorgievski, M.; Günthard, H.; Haerry, D.; Hasse, B.; Hirsch, H. H.; Hösli, I.; Kahlert, C.; Kaiser, L.; Keiser, O.; Kind, C.; Klimkait, T.; Kovari, H.; Martinetti, G.; Martinez de Tejada, B.; Metzner, K.; Müller, N.; Nadal, D.; Pantaleo, G.; Rauch, A.; Regenass, S.; Rickenbach, M.; Rudin, C.; Schmid, P.; Schultze, D.; Affolter, F.; Schüpbach, J.; Speck, R.; Taffé, P.; Tarr, P.; Telenti, A.; Trkola, A.; Vernazza, P.; Yerly, S.; Gill, John; Read, Ron; Beckthold, Brenda; Akagi, Linda; Brandson, Eirikka; Druyts, Eric; Fernandes, Kim; Gataric, Nada; Harrigan, P. Richard; Harris, Marrianne; Hogg, Robert; Lima, Viviane; Montaner, Julio; Moore, David; Palmer, Ali; Wood, Evan; Yip, Benita; Zhang, Wen; Rimland, David; Moanna, Abeer; Hidron, Alicia; DeSilva, Kathryn E.; Moorfield, Michelle; Dorsey, Martha; Mindley, Rondeen; Wirtz, Susan Schlueter; Brown, Patrick; Dozier, Rene; Robinson, Yvette; Mugavero, Michael J.; Willig, James H.; Raper, James L.; Allison, Jeroan J.; Kempf, Mirjam-Colette; Schumacher, Joseph E.; Westfall, Andrew O.; Lin, Hui-Yi; Pisu, Maria; Moneyham, Linda; Vance, David; Bachmann, Laura; Davies, Susan L.; Berner, Eta; Acosta, Edward; King, Jennifer; Kaslow, Richard A.; Savage, Karen; Nevin, Christa; Walton, Frances B.; Marler, Malcolm L.; Lawrence, Sarah; Files-Kennedy, Barbara; Batey, D. Scott; Patil, Manoj A.; Patil, Ujavala; Varshney, Mohit; Gibson, Eugene; Guzman, Alfredo; Rinehart, Dustin; Brandt, Cynthia; Crothers, Kristina; Dubrow, Robert; Fiellin, David; Freiberg, Matthew; Gandhi, Neel; Goulet, Joseph; Justice, Amy; Lim, Joseph; LoRe, Vincent; McGinnis, Kathleen; Ohl, Michael; Parikh, Chirag; Skanderson, Melissa; Tate, Janet; Womack, Julie; Brown, Sheldon; Butt, Adeel; Gibert, Cynthia; Goetz, Matthew; Oursler, Kris Ann; Rodriguez-Barradas, Maria; Simberkoff, Michael; Sterling, Timothy R.; Shepherd, Bryan; Hulgan, Todd; McGowan, Catherine; Wester, William; Melekhin, Vlada; Koethe, John; Qian, Han-Zhu; Kipp, Aaron; Raffanti, Stephen; Haas, David; D'Aquila, Richard; Stinnette, Samuel; Bebawy, Sally; Turner, Megan; Rasbach, Daniel; Tillman, Ashley; Heaton, Henry; Jenkins, Cathy; Kitahata, Mari; Crane, Heidi; van Rompaey, Stephen; Harrington, Robert; Lober, Bill; Collier, Ann; Simoni, Jane; Tarczy-Hornoch, Peter; Scott, John; McCormick, Wayne; Mallolas, M.; Segura, G.; Thiercelin, F.; Ramos, M.; Mairuhu, R.

    2012-01-01

    HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. We obtained data on adult HIV-positive

  19. Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study.

    Science.gov (United States)

    Sania, Ayesha; Brittain, Kirsty; Phillips, Tamsin K; Zerbe, Allison; Ronan, Agnes; Myer, Landon; Abrams, Elaine J

    2017-03-20

    Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women. Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight psychological distress and 15% reported experiencing physical or psychological IPV. 14% of infants were born preterm and 12% were SGA. Infants born to women reporting hazardous drinking were twice (adjusted RR 2.00 (95% CI 1.13 to 3.54)) as likely to be SGA compared with women reporting low alcohol intake. Alcohol consumption did not have a significant effect on the incidence of preterm birth. Depressive symptoms, non-specific psychological distress, physical and psychological IPV did not increase the risk of SGA or preterm birth significantly. The observed elevated risk of SGA births associated with periconception alcohol consumption underscores the urgent need to reduce alcohol consumption among women of childbearing age. Interventions targeting modifiable risk factors of adverse birth outcomes need to be integrated into HIV prevention and maternal child health programmes to improve the long-term health of HIV-exposed children. NCT01933477; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  20. Predictors of longitudinal change in bone mineral density in a cohort of HIV-positive and negative patients.

    Science.gov (United States)

    Tinago, Willard; Cotter, Aoife G; Sabin, Caroline A; Macken, Alan; Kavanagh, Eoin; Brady, Jennifer J; McCarthy, Geraldine; Compston, Juliet; Mallon, Patrick W G

    2017-03-13

    Although low bone mineral density (BMD) is prevalent in HIV, changes in BMD over time remain unclear. We aimed to compare rates of, and factors associated with, BMD change between HIV-positive and HIV-negative patients. In a prospective, 3-year cohort, HIV-positive and HIV-negative patients provided annual demographic and clinical data, fasting bloods, and dual x-ray absorptiometry. Using longitudinal mixed models we compared and determined predictors of rate of change in BMD. Of 384 study participants (45.8% HIV positive), 120 contributed two and 264 contributed three BMD measurements. Those with HIV were younger [median interquartile range 39 (34-46) vs. 43 (35-50) years; P = 0.04], more often men (61 vs. 46%; P = 0.003), and less likely Caucasian (61 vs. 82%; P < 0.001). Although BMD was lower in those with HIV, BMD declined in both groups, with nonsignificant between-group difference in rate of BMD change over time. Within the HIV group, starting antiretroviral therapy (ART) within 3 months of enrolment was associated with greater BMD decline at all anatomical sites (all P < 0.001). Age more than 30 years, Caucasian ethnicity, and not being on ART during follow-up were associated with greater decline and higher parathyroid hormone associated with a smaller decline in BMD at the femoral neck. We found no association between BMD change and exposure to tenofovir disoproxil fumarate or protease inhibitors. We observed no difference in rate of BMD decline regardless of HIV status and in HIV-positive patient, having started ART within the previous 3 months was the only factor associated with greater BMD decline at all three sites.

  1. Extrapulmonary mycobacterial infections in a cohort of HIV-positive patients: ultrasound experience from Vicenza, Italy.

    Science.gov (United States)

    Giordani, Maria Teresa; Brunetti, Enrico; Binazzi, Raffaella; Benedetti, Paolo; Stecca, Clara; Goblirsch, Sam; Heller, Tom

    2013-04-01

    Extrapulmonary tuberculosis (EPTB) is frequently seen in human immunodeficiency virus (HIV)-infected individuals in Sub-Saharan Africa and recent work has shown point-of-care (POC) ultrasound to be a diagnostic aid in the resource-limited, highly endemic setting. Its role in industrialized countries, however, has rarely been studied. With international migration, EPTB is increasingly seen in European hospitals. This study reports ultrasound findings and discusses the diagnostic relevance of EPTB in an industrialized country setting. In this retrospective study, we describe a cohort of 27 patients with a predominantly immigrant background diagnosed with HIV and EPTB in Northern Italy and evaluate the role of ultrasound in their clinical management. All inpatient files of HIV-positive individuals admitted to our hospital with culture-proven diagnosis of EPTB were reviewed, along with chest X-rays and ultrasound studies. The outcome and results of long-term follow-up were extracted. A total of 243 HIV-positive inpatients were identified between January 2005 and November 2011. Twenty-seven of the patients [11.1 %, 95 % confidence interval (CI) 7.4-15.7] were diagnosed with EPTB. Ultrasound showed a typical pattern of enlarged abdominal lymph nodes and focal lesions in the spleen and liver in 22 patients (81.5 %, 95 % CI 7.4-15.7) and, thus, helped to raise the suspicion of mycobacterial infection. As disseminated mycobacterial infections in HIV-positive patients can be treated effectively if diagnosed early, and typical sonographic findings are seen in the majority of these patients, we suggest that POC ultrasound should be integrated in diagnostic and screening algorithms for EPTB in developed countries.

  2. Anemia in a cohort of HIV-infected Hispanics: prevalence, associated factors and impact on one-year mortality.

    Science.gov (United States)

    Santiago-Rodríguez, Eduardo J; Mayor, Angel M; Fernández-Santos, Diana M; Ruiz-Candelaria, Yelitza; Hunter-Mellado, Robert F

    2014-07-08

    Anemia occurs frequently in HIV-infected patients and has been associated with an increased risk of death in this population. For Hispanic subjects, information describing this blood disorder during HIV is scarce. Therefore, the present study examined data from a cohort of HIV-positive Hispanics to determine the prevalence of anemia, identify its associated factors, and evaluate its relationship with one-year mortality. This study included 1,486 patients who enrolled between January, 2000 and December, 2010 in an HIV-cohort in Bayamón, Puerto Rico. Data were collected through personal interviews and medical record abstractions. To determine the factors independently associated with anemia, a multivariable logistic regression model was used. Kaplan-Meier and Cox proportional hazards models were also performed to estimate survival time and to predict death risk. The prevalence of anemia at enrollment was 41.5%. Factors independently associated with increased odds of anemia were: unemployment (OR = 2.02; 95% CI 1.45-2.79), CD4 count anemia. Survival differed significantly by anemia status (log-rank test: p anemia, respectively. Having anemia at baseline was independently associated with an increased one-year mortality risk (severe anemia: HR = 9.06; 95% CI: 4.16-19.72; moderate anemia: HR = 6.51; 95% CI: 3.25-13.06; mild anemia: HR = 2.53; 95% CI: 1.35-4.74). A high prevalence of anemia at enrollment was observed in this cohort of HIV-infected Hispanics. Unemployment and several adverse prognostic features of HIV infection were independently associated with this blood disorder. Anemia resulted to be the strongest predictor of one-year mortality, evidencing a dose-response effect. Further investigations are needed to evaluate whether recovering from anemia is associated with longer survival, and to identify the types of anemia affecting this particular group of HIV patients.

  3. Adverse events and adherence to HIV post-exposure prophylaxis : a cohort study at the Korle-Bu Teaching Hospital in Accra, Ghana

    NARCIS (Netherlands)

    Tetteh, Raymond A; Nartey, Edmund T; Lartey, Margaret; Mantel-Teeuwisse, Aukje K; Leufkens, Hubert G M; Nortey, Priscilla A; Dodoo, Alexander N O

    2015-01-01

    BACKGROUND: There is strong evidence that post-exposure prophylaxis (PEP) with antiretroviral drugs in the timely management of occupational exposures sustained by healthcare workers decreases the risk of HIV infection and PEP is now widely used. Antiretroviral drugs have well documented toxicities

  4. Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study

    NARCIS (Netherlands)

    Lodi, Sara; Phillips, Andrew; Logan, Roger; Olson, Ashley; Costagliola, Dominique; Abgrall, Sophie; van Sighem, Ard; Reiss, Peter; Miró, José M.; Ferrer, Elena; Justice, Amy; Gandhi, Neel; Bucher, Heiner C.; Furrer, Hansjakob; Moreno, Santiago; Monge, Susana; Touloumi, Giota; Pantazis, Nikos; Sterne, Jonathan; Young, Jessica G.; Meyer, Laurence; Seng, Rémonie; Dabis, Francois; Vandehende, Marie-Anne; Pérez-Hoyos, Santiago; Jarrín, Inma; Jose, Sophie; Sabin, Caroline; Hernán, Miguel A.; Ainsworth, J.; Anderson, J.; Babiker, A.; Delpech, V.; Dunn, D.; Easterbrook, P.; Fisher, M.; Gazzard, B.; Gilson, R.; Gompels, M.; Hill, T.; Johnson, M.; Leen, C.; Orkin, C.; Phillips, A.; Pillay, D.; Porter, K.; Sabin, C.; Walsh, J.; Glabay, A.; Thomas, R.; Jones, K.; Perry, N.; Pullin, A.; Churchill, D.; Bulbeck, S.; Mandalia, S.; Clarke, J.; Munshi, S.; Post, F.; Khan, Y.; Patel, P.; Karim, F.; Duffell, S.; Williams, I.; Dooley, D.; Schwenk, A.; Youle, M.; Lampe, F.; Chaloner, C.; Puradiredja, D. Ismajani; Bansi, L.; Weber, J.; Kemble, C.; Mackie, N.; Winston, A.; Wilson, A.; Bezemer, D. O.; Kesselring, A. M.; van Sighem, A. I.; Smit, C.; Zaheri, S.; Kortmann, W.; Prins, J. M.; Kuijpers, T. W.; Godfried, M. H.; Pajkrt, D.; Bos, J. C.; van der Valk, M.; Grijsen, M. L.; Wiersinga, W. J.; Vrouwe, Lieve; Brinkman, K.; Blok, W. L.; Ziekenhuis, Andreas; Veenstra, J.; Lettinga, K. D.; Mulder, J. W.; Lauw, F. N.; van Agtmael, M. A.; Perenboom, R. M.; Bomers, M.; Richter, C.; van der Berg, J. P.; Gisolf, E. H.; Schippers, E. F.; van Elzakker, E. P.; Bravenboer, B.; Kootstra, G. J.; Sprenger, H. G.; Doedens, R.; van Assen, S.; Gasthuis, Kennemer; Soetekouw, R.; Kroon, F. P.; van Dissel, J. T.; Arend, S. M.; Jolink, H.; Bauer, M. P.; Weijer, S.; Lowe, S.; Lashof, A. Oude; Posthouwer, D.; Koopmans, P. P.; Warris, A.; van Crevel, R.; Nouwen, J. L.; Nispen, M. H.; Verbon, A.; Hassing, R. J.; Hartwig, N. G.; Ziekenhuis, Maasstad; Pogany, K.; Ziekenhuis, Sint Elisabeth; Juttmann, J. R.; van Kasteren, M. E. E.; Mudrikova, T.; Ellerbroek, P. M.; Oosterheert, J. J.; Barth, R. E.; Kinderziekenhuis, Wilhelmina; Bont, L. J.; de Ruyter Ziekenhuis, Admiraal; Stegeman, A.; Alleman, M. A.; Bouwhuis, J. W.; Abgrall, S.; Barin, F.; Bentata, M.; Billaud, E.; Boué, F.; Burty, C.; Cabié, A.; de Truchis, P.; Duval, X.; Duvivier, C.; Enel, P.; Fredouille-Heripret, L.; Gasnault, J.; Gaud, C.; Katlama, C.; Khuong, M. A.; Lang, J. M.; Lascaux, A. S.; Launay, O.; Mahamat, A.; Mary-Krause, M.; Meynard, J. L.; Pavie, J.; Pialoux, G.; Pilorgé, F.; Poizot-Martin, I.; Pradier, C.; Reynes, J.; Rouveix, E.; Simon, A.; Tissot-Dupont, H.; Viard, J. P.; Viget, N.; Jacquemet, N.; Costagliola, D.; Grabar, S.; Guiguet, M.; Lanoy, E.; Lièvre, L.; Lacombe, J. M.; Potard, V.; Pitié, G. H.; Bricaire, F.; Herson, S.; Desplanque, N.; Meyohas, M. C.; Picard, O.; Cadranel, J.; Mayaud, C.; Clauvel, J. P.; Decazes, J. M.; Gerard, L.; Molina, J. M.; Lariboisière-Fernand, G. H.; Honoré, P.; Jeantils, V.; Tassi, S.; Mechali, D.; Taverne, B.; Bouvet, E.; Ecobichon, J. L.; Matheron, S.; Picard-Dahan, C.; Yeni, P.; Dupont, C.; Chandemerle, C.; Mortier, E.; Tisne-Dessus, D.; Weiss, L.; Tarnier-Cochin, G. H.; Auperin, I.; Gilquin, J.; Roudière, L.; Fior, R.; Delfraissy, J. F.; Goujard, C.; Jung, C.; Vittecoq, D.; Fraisse, P.; Beck-Wirth, G.; Stahl, J. P.; Lecercq, P.; Gourdon, F.; Laurichesse, H.; Fresard, A.; Basse-Normandie, Corevih; Bazin, C.; Verdon, R.; Bourgogne, Corevih; Bretagne, Corevih; Arvieux, C.; Michelet, C.; Goudeau, A.; Maître, M. F.; Hoen, B.; Faller, J. P.; Haute-Normandie, Corevih; Borsa-Lebas, F.; Caron, F.; Daures, J. P.; Lorraine, Corevih; May, T.; Rabaud, C.; Berger, J. L.; Rémy, G.; Arlet-Suau, E.; Cuzin, L.; Massip, P.; Legrand, M. F. Thiercelin; Pontonnier, G.; de Calais, Corevih Nord-Pas; Yasdanpanah, Y.; Dellamonica, P.; Pugliese, P.; Quinsat, D.; Ravaux, I.; Tissot, H.; Delmont, J. P.; Moreau, J.; Gastaut, J. A.; Retornaz, F.; Soubeyrand, J.; Galinier, A.; Ruiz, J. M.; Allegre, T.; Blanc, P. A.; Bonnet, D.; Lepeu, G.; Granet-Brunello, P.; Esterni, J. P.; Cohen-Valensi, R.; Nezri, M.; Chadapaud, S.; Laffeuillade, A.; Raffi, F.; Boibieux, A.; Peyramond, D.; Livrozet, J. M.; Touraine, J. L.; Strobel, M.; Saint-Martin, C. H.; Bissuel, F.; Pradinaud, R.; Sobesky, M.; Martinique, Corevih; Guyon, Félix; Contant, M.; HC, Bucher; CA, Fux; HH, Hirsch; de Tejada B, Martinez; Casabona, J.; Miró, Jose M.; de Barcelona-Idibaps, Clínic; Gallois, A.; Esteve, A.; Podzamczer, D.; Murillas, J.; Gatell, J. M.; Manzardo, C.; Tural, C.; Clotet, B.; Ferrer, E.; Riera, M.; Segura, F.; Navarro, G.; Vilaró, J.; Masabeu, A.; García, I.; Guadarrama, M.; Cifuentes, C.; Dalmau, D.; Agustí, C.; Montoliu, A.; Pérez, I.; Gargoulas, Freyra; Blanco, J. L.; Garcia-Alcaide, F.; Martínez, E.; García-Goez, J. F.; Sirera, G.; Negredo, E.; Miranda, C.; Capitan, M. C.; Saumoy, M.; Imaz, A.; Tiraboschi, J. M.; Murillo, O.; Bolao, F.; Peña, C.; Cabellos, C.; Vila, A.; Sala, M.; Cervantes, M.; Amengual, Jose; Navarro, M.; Barrufet, P.; Molina, J.; Alvaro, M.; Mercadal, J.; Fernández, Juanse; Ospina, Jesús E.; Berenguer, J.; García, F.; Gutiérrez, F.; Labarga, P.; Moreno, S.; Caro-Murillo, A. M.; Sobrino, P.; Jarrín, I.; Sirvent, J. L. Gómez; Rodríguez, P.; Alemán, M. R.; Alonso, M. M.; López, A. M.; Hernández, M. I.; Soriano, V.; Barreiro, P.; Medrano, J.; Rivas, P.; Herrero, D.; Blanco, F.; Vispo, M. E.; Martín, L.; Ramírez, G.; Rubio, R.; Pulido, F.; Moreno, V.; Cepeda, C.; Iribarren, J. A.; Camino, X.; Rodríguez-Arrondo, F.; von Wichmann, M. A.; Pascual, L.; Goenaga, M. A.; Masiá, M.; Ramos, J. M.; Padilla, S.; Sánchez-Hellín, V.; Bernal, E.; Montolio, F.; Peral, Y.; Marañón, Gregorio; López, J. C.; Miralles, P.; Cosín, J.; Sánchez, M.; Gutiérrez, I.; Ramírez, M.; Padilla, B.; Vidal, F.; Veloso, S.; Viladés, C.; López-Dupla, M.; Olona, M.; Vargas, M.; Lacruz, J.; Salavert, M.; Montero, M.; Cuéllar, S.; Sanz, J.; Oteo, J. A.; Blanco, J. R.; Ibarra, V.; Metola, L.; Sanz, M.; Pérez-Martínez, L.; Sola, J.; Uriz, J.; Castiello, J.; Reparaz, J.; Arriaza, M. J.; Irigoyen, C.; Antela, A.; Casado, J. L.; Dronda, F.; Moreno, A.; Pérez, M. J.; López, D.; Gutiérrez, C.; Martí, P.; García, L.; Page, C.; Hernández, J.; Peña, A.; Muñoz, L.; Parra, J.; Viciana, P.; Leal, M.; López-Cortés, L. F.; Mata, R.; Justice, A. C.; Rimland, D.; Jones-Taylor, C.; Oursler, K. A.; Brown, S.; Garrison, S.; Rodriguez-Barradas, M.; Masozera, N.; Goetz, M.; Leaf, D.; Simberkoff, M.; Blumenthal, D.; Leung, J.; Peck, R.; Mattocks, K.; Braithwaite, S.; Cook, R.; Conigliaro, J.; Crothers, K.; Chang, J.; Crystal, S.; Day, N.; Erdos, J.; Freiberg, M.; Kozal, M.; Gerschenson, M.; Good, B.; Gordon, A.; Goulet, J. L.; Hernán, M. A.; Kraemer, K.; Lim, J.; Maisto, S.; O'Connor, P.; Papas, R.; Robins, J. M.; Rinaldo, C.; Roberts, M.; Samet, J.; Tierney, B.; Whittle, J.; Brettle, R.; Fidler, S.; Goldberg, D.; Hawkins, D.; Jaffe, H.; Johnson, A.; McLean, K.; Porter, Kholoud; Ewings, Fiona; Fairbrother, Keith; Gnatiuc, Louisa; Murphy, Brendan; Douglas, G.; Kennedy, N.; Pritchard, J.; Andrady, U.; Gwynedd, Ysbyty; Rajda, N.; Maw, R.; McKernan, S.; Drake, S.; Gilleran, G.; White, D.; Ross, J.; Toomer, S.; Hewart, R.; Wilding, H.; Woodward, R.; Dean, G.; Heald, L.; Horner, P.; Glover, S.; Bansaal, D.; Carne, C.; Browing, M.; Stanley, B.; O'Mahony, C.; Fraser, P.; Hayman, B.; Joshi, U.; Ralph, S.; Wade, A.; Mette, R.; Lalik, J.; Summerfield, H.; El-Dalil, A.; France, A. J.; White, C.; Robertson, R.; Gordon, S.; Lean, C.; Morris, S.; Vithayathil, K.; McLean, L.; Winter, A.; Gale, D.; Jacobs, S.; Tayal, S.; Short, L.; Williams, G.; Minton, J.; Dhar, J.; Nye, F.; DeSouza, C. B.; Isaksen, A.; McDonald, L.; Franca, A.; William, L.; Peters, B.; El, S.; Easterbrook, P. J.; Mazhude, C.; Johnstone, R.; Fakoya, A.; Mchale, J.; Waters, A.; Kegg, S.; Mitchell, S.; Byrne, P.; Rice, P.; Mullaney, S. A.; McCormack, S.; David, D.; Melville, R.; Phillip, K.; Balachandran, T.; Mabey, S.; Sukthankar, A.; Murphy, C.; Wilkins, E.; Ahmad, S.; Cook, James; Haynes, J.; Keynes, Milton; Evans, E.; Ong, E.; Das, R.; Grey, R.; Meaden, J.; Bignell, C.; Loay, D.; Peacock, K.; Eliot, George; Girgis, M. R.; Morgan, B.; Palfreeman, A.; Wilcox, J.; Tobin, J.; Tucker, L.; Saeed, A. M.; Williams, O.; Clwyd, Glan; Lacey, H.; Herman, S.; Kinghorn, D.; Devendra, S. V.; Wither, J.; Dawson, S.; Rowen, D.; Harvey, J.; Chauhan, M.; Kellock, D.; Young, S.; Dannino, S.; Kathir, Y.; Rooney, G.; Currie, J.; Fitzgerald, M.; Devendra, S.; Keane, F.; Booth, G.; Arumainayyagam, J.; Chandramani, S.; Robinson, T.; Curless, E.; Gokhale, R.; Tariq, A.; Luzzi, G.; Fairley, I.; Wallis, F.; Smit, E.; Ward, F.; Loze, B.; Morlat, P.; Bonarek, M.; Bonnet, F.; Nouts, C.; Louis, I.; Reliquet, V.; Sauser, F.; Biron, C.; Mounoury, O.; Hue, H.; Brosseau, D.; Ghosn, J.; Rannou, M. T.; Bergmann, J. F.; Badsi, E.; Rami, A.; Girard, P. M.; Samanon-Bollens, D.; Campa, P.; Tourneur, M.; Desplanques, N.; Jeanblanc, F.; Chiarello, P.; Makhloufi, D.; Herriot, E.; Blanc, A. P.; Allègre, T.; Baillat, V.; Lemoing, V.; de Boever, C. Merle; Tramoni, C.; Sobesky, G.; Abel, S.; Beaujolais, V.; Slama, L.; Fournier, I.; Gerbe, J.; Trepo, C.; Koffi, K.; Miailhes, P.; Thoirain, V.; Brochier, C.; Souala, F.; Ratajczak, M.; Beytoux, J.; Jacomet, C.; Montpied, G.; Olivier, C.; Paré, A.; Lortholary, O.; Dupont, B.; Maignan, A.; Raymond, I.; Leport, C.; Jadand, C.; Jestin, C.; Longuet, P.; Boucherit, S.; Sereni, D.; Lascoux, C.; Prevoteau, F.; Sobel, A.; Levy, Y.; Lelièvre, J. D.; Mondor, H.; Aumaître, H.; Delmas, B.; Saada, M.; Medus, M.; Salmon, D.; Tahi, T.; Yazdanpanah, Y.; Pavel, S.; Marien, M. C.; Dron, C. H.; Beck, C.; Benomar, M.; Muller, E.; Tubiana, R.; Mohand, H. Ait; Touam, F.; Folzer, A.; Obadia, M.; Prudhomme, L.; Bonnet, E.; Balzarin, F.; Pichard, E.; Chennebault, J. M.; Fialaire, P.; Loison, J.; Galanaud, P.; Bornarel, D.; Six, M.; Ferret, P.; Batisse, D.; Devidas, A.; Chevojon, P.; Turpault, I.; Philip, G.; Morel, P.; Timsit, J.; Amirat, N.; Cabane, J.; Tredup, J.; Chavanet, C.; Buisson, M.; Treuvetot, S.; Choutet, P.; Bastides, F.; Boyer, L.; Wassoumbou, S.; Oksenhendeler, E.; Gérard, L.; Bernard, L.; Berthé, H.; Poincaré, R.; Domart, Y.; Merrien, D.; Belan, A. Greder; Mignot, A.; Gayraud, M.; Bodard, L.; Meudec, A.; Pape, E.; Vinceneux, P.; Simonpoli, A. M.; Zeng, A.; Mourier, L.; Fournier, L.; Jacquet, M.; Fuzibet, J. G.; Sohn, C.; Rosenthal, E.; Quaranta, M.; Sabah, M.; Audhuy, B.; Schieber, A.; Pasteur, L.; Moreau, P.; Vaillant, O.; Huchon, G.; Compagnucci, A.; de Lacroix Szmania, I.; Lamaury, I.; Saint-Dizier, F.; Garipuy, D.; Drogoul, M. P.; Martin, I. Poizot; Fabre, G.; Lambert, G.; Lagarde, P.; David, F.; Roche-Sicot, J.; Saraux, J. L.; Leprêtre, A.; Veil, S.; Fampin, B.; Uludag, A.; Morin, A. S.; Bletry, O.; Zucman, D.; Regnier, A.; Girard, J. J.; Quinsat, D. T.; Heripret, L.; Grihon, F.; Houlbert, D.; Ruel, M.; Chemlal, K.; Debab, Y.; Nicolle, C.; Perronne, V.; Quesnay, F.; Slama, B.; Duffaut, H.; Perré, P.; Miodovski, C.; Guermonprez, G.; Dulioust, A.; Ballanger, R.; Patey, O.; Semaille, C.; Deville, J.; Beclere, Antoine; Boue, F.; Chambrin, V.; Pignon, C.; Estocq, G. A.; Levy, A.; Bicetre, Le Kremlin; Duracinsky, M.; Bras, P. Le; Ngussan, M. S.; Lambert, T.; Segeral, O.; Lezeau, P.; Laurian, Y.; Piketty, C.; Karmochkine, M.; Eliaszewitch, M.; Jayle, D.; Tisne, D.; Colasante, U.; Vilde, J. L.; Bollens, D.; Binet, D.; Diallo, B.; Lagneau, J. L.; Pietrie, M. P.; Sicard, D.; Stieltjes, N.; Michot, J.; Bourdillon, F.; Obenga, G.; Escaut, L.; Bolliot, C.; Schneider, L.; Iguertsira, M.; Stein, A.; Tomei, C.; Dhiver, C.; Gallais, J.; Gallais, H.; Durant, J.; Mondain, V.; Perbost, I.; Cassuto, J. P.; Karsenti, J. M.; Ceppi, C.; Krivitsky, J. A.; Honore, P.; Delgado, J.; Rouzioux, C.; Burgard, M.; Boufassa, L.; Peynet, J.; Pérez-Hoyos, S.; Schiaffino, A.; Monge, D. Alvarez S.; Pujol, I.; Muga, R.; Sanvisens, A.; Tor, J.; Rivas, I.; Vallecillo, G.; del Romero, J.; Raposo, P.; Rodríguez, C.; Vera, M.; Alastrue, E. Fernandez I.; Tasa, C. Santos T.; Juan, A.; Trullen, J.; de Olalla, P. Garcia; Cayla, J.; Sambeat, M. A.; Guerrero, R.; Rivera, E.; Marco, A.; Quintana, M.; Gonzalez, C.; Castilla, J.; Guevara, M.; de Mendoza, C.; Zahonero, N.; Ortíz, M.; G, Daikos; T, Kordossis; G, Panos; H, Sambatakou; M, Chini; Nelson, M.; Asboe, D.; Man, S.-L.; Smith, C.; Grabowska, H.; Gras, L. A. J.; Branger, J.; Scherpbier, H. J.; van der Meer, J. T. M.; Wit, F. W. M. N.; van der Poll, T.; Nellen, F. J. B.; Lange, J. M. A.; Geerlings, S. E.; van Vugt, M.; Frissen, P. H. J.; Schouten, W. E. M.; van den Berk, G. E. L.; Vrouenraets, S. M. E.; van Eeden, A.; Verhagen, D. W. M.; Claessen, F. A. P.; Peters, E. J. G.; van Nieuwkoop, C.; Leyten, E. M. S.; Gelinck, L. B. S.; Ziekenhuis, Catharina; Pronk, M. J. H.; Delsing, C. E.; Scholvinck, E. H.; Bierman, W. F. W.; ten Kate, R. W.; de Boer, M. G. J.; ter Vollaard, H. J. M.; Zuiderzee, M. C.; Schreij, G.; Keuter, M.; van der Ven, A. J. A. M.; ter Hofstede, H. J. M.; Dofferhoff, A. S. M.; van der Ende, M. E.; de Vries-Sluijs, T. E. M. S.; Schurink, C. A. M.; Rijnders, B. J. A.; van Gorp, E. C. M.; Smeulders, A. W. M.; den Hollander, J. G.; Hoepelman, A. I. M.; Schneider, M. M. E.; Jaspers, C. A. J. J.; Arends, J. E.; Wassenberg, M. W. M.; Geelen, S. P. M.; Wolfs, T. F. W.; Cotte, L.; Tattevin, P.; Selinger-Leneman, H.; Diemer, M.; Sellier, P.; Crickx, B.; Lesprit, Ph; Rey, D.; Lucht, F.; Chavanet, P.; Eglinger, P.; Aleksandrowicz, K.; Pelissier, L.; Aubert, V.; Barth, J.; Battegay, M.; Bernasconi, E.; Böni, J.; Burton-Jeangros, C.; Calmy, A.; Cavassini, M.; Egger, M.; Elzi, L.; Fehr, J.; Fellay, J.; Furrer, H.; Gorgievski, M.; Günthard, H.; Hasse, B.; Hösli, I.; Kahlert, C.; Kaiser, L.; Keiser, O.; Klimkait, T.; Kovari, H.; Ledergerber, B.; Martinetti, G.; Metzner, K.; Müller, N.; Nadal, D.; Pantaleo, G.; Rauch, A.; Regenass, S.; Rickenbach, M.; Rudin, C.; Schmid, P.; Schultze, D.; Schöni-Affolter, F.; Schüpbach, J.; Speck, R.; Taffé, P.; Tarr, P.; Telenti, A.; Trkola, A.; Vernazza, P.; Weber, R.; Yerly, S.; Force, L.; Mallolas, J.; López-Dieguez, M.; Romeu, J.; Jou, A.; Masó, M.; Bejarano, G.; del Amo, J.; Muñoz, M. A.; Arrizabalaga, A. J.; Aramburu, M. J.; Escolano, C.; Sanjuan, M.; Peraire, J.; Aldeguer, J. L.; Blanes, M.; de los Santos, I.; Hernández, B.; Pumares, M.; Trastoy, M.; Fiellin, D. A.; Titanji, R.; Butt, A.; Brandt, C.; Bryant, K.; Gandhi, N.; Gaziano, M.; Miller, P.; Mole, L.; Darbyshire, J.; Cursley, Adam; Eduards, S.; Estreich, S.; Magdy, A.; Jebakumar, S. P. R.; McMillan, S.; Green, S.; Sivakumar, K.; Monteiro, E.; Jendrulek, I.; Deheragada, A.; Rajamanoharan, S.; Parrinello, M.; Chakvetadze, C.; Berrebi, V.; Augustin-Normand, C.; Morelon, S.; Ragnaud, J. M.; Dominguez, S.; Dumont, C.; Drenou, B.; Drobacheff, C.; Gonzales-Canali, A.; Cheret, A.; Brancion, C.; Ravault, I.; Nau, P.; Beuscart, C.; Daniel, C.; Chaillou, S.; Niault, M.; Richier, L.; Abraham, B.; Perino, C.; Tremollieres, F.; Boudon, P.; Malbec, D.; Remy, G.; Béguinot, I.; Peretti, D.; Medintzeff, N.; Kazatchkine, M.; Fonquernie, L.; Lelievre, J. D.; Tissot Dupont, H.; Vallon, A.; Venti, H.; Bouchaud, O.; Hurtado, I.; Belda, J.; Gargalianos-Kakolyris, P.; Katsarou, O.; Lazanas, M.; Paparizos, V.; Paraskevis, D.; Skoutelis, A.; Touloumi, G.; Pantazis, N.; Bakoyannis, G.; Gioukari, V.; Antoniadou, A.; Papadopoulos, A.; Petrikkos, G.; Daikos, G.; Psichogiou, M.; Xylomenos, G.; Kouramba, A.; Ioannidou, P.; Kordossis, T.; Kontos, A.; Tsogas, N.; Leuow, K.; Kourkounti, S.; Sambatakou, H.; Mariolis, I.; Papastamopoulos, V.; Baraboutis, I.

    2015-01-01

    Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation,

  5. Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert™ MTB/RIF era: a cohort study

    NARCIS (Netherlands)

    Hermans, Sabine M.; Babirye, Juliet A.; Mbabazi, Olive; Kakooza, Francis; Colebunders, Robert; Castelnuovo, Barbara; Sekaggya-Wiltshire, Christine; Parkes-Ratanshi, Rosalind; Manabe, Yukari C.

    2017-01-01

    The Xpert™ MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a

  6. Scaling-up access to antiretroviral therapy for children: A cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia

    NARCIS (Netherlands)

    J.H. van Dijk (Janneke); W.J. Moss (William); F. Hamangaba (Francis); B. Munsanje (Bornface); C.G. Sutcliffe (Catherine)

    2014-01-01

    textabstractBackground: Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving

  7. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    NARCIS (Netherlands)

    Mocroft, Amanda; Lundgren, Jens D.; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A.; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A.; Ryom, Lene; Lundgren, J. D.; Powderly, B.; Shortman, N.; Moecklinghoff, C.; Reilly, G.; Franquet, X.; Sabin, C. A.; Phillips, A.; Kirk, O.; Weber, R.; Pradier, C.; Law, M.; d'Arminio Monforte, A.; Dabis, F.; El-Sadr, W. M.; de Wit, S.; Ryom, L.; Kamara, D.; Smith, C.; Mocroft, A.; Tverland, J.; Mansfeld, M.; Nielsen, J.; Raben, D.; Salbøl Brandt, R.; Rickenbach, M.; Fanti, I.; Krum, E.; Hillebregt, M.; Geffard, S.; Sundström, A.; Delforge, M.; Fontas, E.; Torres, F.; McManus, H.; Wright, S.; Kjær, J.; Sjøl, A.; Meidahl, P.; Helweg-Larsen, J.; Schmidt Iversen, J.; Ross, M.; Fux, C. A.; Morlat, P.; Moranne, O.; Kesselring, A. M.; Kamara, D. A.; Friis-Møller, N.; Kowalska, J.; Sabin, C.; Bruyand, M.; Bower, M.; Fätkenheuer, G.; Donald, A.; Grulich, A.; Prins, J. M.; Kuijpers, T. W.; Scherpbier, H. J.; van der Meer, J. T. M.; Wit, F. W. M. N.; Godfried, M. H.; van der Poll, T.; Nellen, F. J. B.; Geerlings, S. E.; van Vugt, M.; Pajkrt, D.; Bos, J. C.; Wiersinga, W. J.; van der Valk, M.; Goorhuis, A.; Hovius, J. W.; van Eden, J.; Henderiks, A.; van Hes, A. M. H.; Mutschelknauss, M.; Nobel, H. E.; Pijnappel, F. J. J.; Westerman, A. M.; Jurriaans, S.; Back, N. K. T.; Zaaijer, H. L.; Berkhout, B.; Cornelissen, M. T. E.; Schinkel, C. J.; Thomas, X. V.; de Ruyter Ziekenhuis, Admiraal; van den Berge, M.; Stegeman, A.; Baas, S.; Hage de Looff, L.; Versteeg, D.; Pronk, M. J. H.; Ammerlaan, H. S. M.; Korsten-Vorstermans, E. M. H. M.; de Munnik, E. S.; Jansz, A. R.; Tjhie, J.; Wegdam, M. C. A.; Deiman, B.; Scharnhorst, V.; van der Plas, A.; Weijsenfeld, A. M.; van der Ende, M. E.; de Vries-Sluijs, T. E. M. S.; van Gorp, E. C. M.; Schurink, C. A. M.; Nouwen, J. L.; Verbon, A.; Rijnders, B. J. A.; Bax, H. I.; Hassing, R. J.; van der Feltz, M.; Bassant, N.; van Beek, J. E. A.; Vriesde, M.; van Zonneveld, L. M.; de Oude-Lubbers, A.; van den Berg-Cameron, H. J.; Bruinsma-Broekman, F. B.; de Groot, J.; de Zeeuw-de Man, M.; Broekhoven-Kruijne, M. J.; Schutten, M.; Osterhaus, A. D. M. E.; Boucher, C. A. B.; Driessen, G. J. A.; van Rossum, A. M. C.; van der Knaap, L. C.; Visser, E.; Branger, J.; Duijf-van de Ven, C. J. H. M.; Schippers, E. F.; van Nieuwkoop, C.; Brimicombe, R. W.; van Ijperen, J. M.; van der Hut, G.; Franck, P. F. H.; van Eeden, A.; Brokking, W.; Groot, M.; Damen, M.; Kwa, I. S.; Groeneveld, P. H. P.; Bouwhuis, J. W.; van den Berg, J. F.; van Hulzen, A. G. W.; van der Bliek, G. L.; Bor, P. C. J.; Bloembergen, P.; Wolfhagen, M. J. H. M.; Ruijs, G. J. H. M.; Gasthuis, Kennemer; van Lelyveld, S. F. L.; Soetekouw, R.; Hulshoff, N.; van der Prijt, L. M. M.; Schoemaker, M.; Bermon, N.; van der Reijden, W. A.; Jansen, R.; Herpers, B. L.; Veenendaal, D.; Kroon, F. P.; Arend, S. M.; de Boer, M. G. J.; Bauer, M. P.; Jolink, H.; Vollaard, A. M.; Dorama, W.; Moons, C.; Claas, E. C. J.; Kroes, A. C. M.; den Hollander, J. G.; Pogany, K.; Kastelijns, M.; Smit, J. V.; Smit, E.; Bezemer, M.; van Niekerk, T.; Pontesilli, O.; Lowe, S. H.; Oude Lashof, A.; Posthouwer, D.; Ackens, R. P.; Schippers, J.; Vergoossen, R.; Weijenberg Maes, B.; Savelkoul, P. H. M.; Loo, I. H.; Weijer, S.; el Moussaoui, R.; Heitmuller, M.; Kortmann, W.; van Twillert, G.; Cohen Stuart, J. W. T.; Diederen, B. M. W.; Pronk, D.; van Truijen-Oud, F. A.; Leyten, E. M. S.; Gelinck, L. B. S.; van Hartingsveld, A.; Meerkerk, C.; Wildenbeest, G. S.; Mutsaers, J. A. E. M.; Jansen, C. L.; van Vonderen, M. G. A.; van Houte, D. P. F.; Dijkstra, K.; Faber, S.; Weel, J.; Kootstra, G. J.; Delsing, C. E.; van der Burg-van de Plas, M.; Heins, H.; Lucas, E.; Brinkman, K.; Frissen, P. H. J.; Blok, W. L.; Schouten, W. E. M.; Bosma, A. S.; Brouwer, C. J.; Geerders, G. F.; Hoeksema, K.; Kleene, M. J.; van der Meché, I. B.; Toonen, A. J. M.; Wijnands, S.; van Ogtrop, M. L.; Koopmans, P. P.; Keuter, M.; van der Ven, A. J. A. M.; ter Hofstede, H. J. M.; Dofferhoff, A. S. M.; van Crevel, R.; Albers, M.; Bosch, M. E. W.; Grintjes-Huisman, K. J. T.; Zomer, B. J.; Stelma, F. F.; Burger, D.; Richter, C.; van der Berg, J. P.; Gisolf, E. H.; ter Beest, G.; van Bentum, P. H. M.; Langebeek, N.; Tiemessen, R.; Swanink, C. M. A.; Veenstra, J.; Lettinga, K. D.; Spelbrink, M.; Sulman, H.; Witte, E.; Peerbooms, P. G. H.; Mulder, J. W.; Vrouenraets, S. M. E.; Lauw, F. N.; van Broekhuizen, M. C.; Paap, H.; Vlasblom, D. J.; Oudmaijer Sanders, E.; Smits, P. H. M.; Rosingh, A. W.; Verhagen, D. W. M.; Geilings, J.; van Kasteren, M. E. E.; Brouwer, A. E.; de Kruijf-van de Wiel, B. A. F. M.; Kuipers, M.; Santegoets, R. M. W. J.; van der Ven, B.; Marcelis, J. H.; Buiting, A. G. M.; Kabel, P. J.; Bierman, W. F. W.; Sprenger, H. G.; Scholvinck, E. H.; van Assen, S.; Wilting, K. R.; Stienstra, Y.; de Groot-de Jonge, H.; van der Meulen, P. A.; de Weerd, D. A.; Niesters, H. G. M.; Riezebos-Brilman, A.; van Leer-Buter, C. C.; Hoepelman, A. I. M.; Schneider, M. M. E.; Mudrikova, T.; Ellerbroek, P. M.; Oosterheert, J. J.; Arends, J. E.; Barth, R. E.; Wassenberg, M. W. M.; van Elst-Laurijssen, D. H. M.; Laan, L. M.; van Oers-Hazelzet, E. E. B.; Patist, J.; Vervoort, S.; Nieuwenhuis, H. E.; Frauenfelder, R.; Schuurman, R.; Verduyn-Lunel, F.; Wensing, A. M. J.; Peters, E. J. G.; van Agtmael, M. A.; Perenboom, R. M.; Bomers, M.; de Vocht, J.; Elsenburg, L. J. M.; Pettersson, A. M.; Vandenbroucke-Grauls, C. M. J. E.; Ang, C. W.; Geelen, S. P. M.; Wolfs, T. F. W.; Bont, L. J.; Nauta, N.; Bezemer, D. O.; Gras, L.; van Sighem, A. I.; Smit, C.; Zaheri, S.; Kimmel, V.; Tong, Y.; Lascaris, B.; van den Boogaard, R.; Hoekstra, P.; de Lang, A.; Berkhout, M.; Grivell, S.; Jansen, A.; de Groot, L.; van den Akker, M.; Bergsma, D.; Lodewijk, C.; Meijering, R.; Peeck, B.; Raethke, M.; Ree, C.; Regtop, R.; Ruijs, Y.; Schoorl, M.; Tuijn, E.; Veenenberg, L.; Woudstra, T.; Bakker, Y.; de Jong, A.; Broekhoven, M.; Claessen, E.; Rademaker, M. J.; Munjishvili, L.; Kruijne, E.; Tuk, B.; Bonnet, F.; Dupon, M.; Chêne, G.; Breilh, D.; Fleury, H.; Malvy, D.; Mercié, P.; Pellegrin, I.; Neau, D.; Pellegrin, J. L.; Bouchet, S.; Gaborieau, V.; Lacoste, D.; Tchamgoué, S.; Thiébaut, R.; Lawson-Ayayi, S.; Wittkop, L.; Bernard, N.; Hessamfar, M.; Vandenhende, M. A.; Dauchy, F. A.; Dutronc, H.; Longy-Boursier, M.; Duffau, P.; Schmeltz, J. Roger; Pistone, T.; Receveur, M. C.; Cazanave, C.; Ochoa, A.; Vareil, M. O.; Viallard, J. F.; Greib, C.; Lazaro, E.; Lafon, M. E.; Reigadas, S.; Trimoulet, P.; Molimard, M.; Titier, K.; Moreau, J. F.; Haramburu, F.; Miremont-Salamé, G.; Dupont, A.; Gerard, Y.; André, K.; Bonnal, F.; Farbos, S.; Gemain, M. C.; Ceccaldi, J.; de Witte, S.; Courtault, C.; Monlun, E.; Lataste, P.; Meraud, J. P.; Chossat, I.; Blaizeau, M. J.; Conte, V.; Decoin, M.; Delaune, J.; Delveaux, S.; Diarra, F.; D'Ivernois, C.; Frosch, A.; Hannapier, C.; Lenaud, E.; Leleux, O.; Le Marec, F.; Leray, J.; Louis, I.; Palmer, G.; Pougetoux, A.; Sicard, X.; Uwamaliya-Nziyumvira, D. Touchard B.; Petoumenos, K.; Bendall, C.; Moore, R.; Edwards, S.; Hoy, J.; Watson, K.; Roth, N.; Nicholson, J.; Bloch, M.; Franic, T.; Baker, D.; Vale, R.; Carr, A.; Cooper, D.; Chuah, J.; Ngieng, M.; Nolan, D.; Skett, J.; Calvo, G.; Mateu, S.; Domingo, P.; Sambeat, M. A.; Gatell, J.; del Cacho, E.; Cadafalch, J.; Fuster, M.; Codina, C.; Sirera, G.; Vaqué, A.; Clumeck, N.; Necsoi, C.; Gennotte, A. F.; Gerard, M.; Kabeya, K.; Konopnicki, D.; Libois, A.; Martin, C.; Payen, M. C.; Semaille, P.; van Laethem, Y.; Neaton, J.; Bartsch, G.; Thompson, G.; Wentworth, D.; Luskin-Hawk, R.; Telzak, E.; Abrams, D. I.; Cohn, D.; Markowitz, N.; Arduino, R.; Mushatt, D.; Friedland, G.; Perez, G.; Tedaldi, E.; Fisher, E.; Gordin, F.; Crane, L. R.; Sampson, J.; Baxter, J.; Lundgren, J.; Cozzi-Lepri, A.; Grint, D.; Podlekareva, D.; Peters, L.; Reekie, J.; Fischer, A. H.; Losso, M.; Elias, C.; Vetter, N.; Zangerle, R.; Karpov, I.; Vassilenko, A.; Mitsura, V. M.; Suetnov, O.; Colebunders, R.; Vandekerckhove, L.; Hadziosmanovic, V.; Kostov, K.; Begovac, J.; Machala, L.; Jilich, D.; Sedlacek, D.; Kronborg, G.; Benfield, T.; Larsen, M.; Gerstoft, J.; Katzenstein, T.; Hansen, E.; Skinhøj, P.; Pedersen, C.; Ostergaard, L.; Zilmer, K.; Smidt, J.; Ristola, M.; Katlama, C.; Viard, J. P.; Girard, P.-M.; Livrozet, J. M.; Vanhems, P.; Rockstroh, J.; Schmidt, R.; van Lunzen, J.; Degen, O.; Stellbrink, H. J.; Staszewski, S.; Bickel, M.; Kosmidis, J.; Gargalianos, P.; Xylomenos, G.; Perdios, J.; Panos, G.; Filandras, A.; Karabatsaki, E.; Sambatakou, H.; Banhegyi, D.; Mulcahy, F.; Yust, I.; Turner, D.; Burke, M.; Pollack, S.; Hassoun, G.; Maayan, S.; Vella, S.; Esposito, R.; Mazeu, I.; Mussini, C.; Arici, C.; Pristera, R.; Mazzotta, F.; Gabbuti, A.; Vullo, V.; Lichtner, M.; Chirianni, A.; Montesarchio, E.; Gargiulo, M.; Antonucci, G.; Testa, A.; Narciso, P.; Vlassi, C.; Zaccarelli, M.; Lazzarin, A.; Castagna, A.; Gianotti, N.; Galli, M.; Ridolfo, A.; Rozentale, B.; Zeltina, I.; Chaplinskas, S.; Hemmer, R.; Staub, T.; Ormaasen, V.; Maeland, A.; Bruun, J.; Knysz, B.; Gasiorowski, J.; Horban, A.; Bakowska, E.; Grzeszczuk, A.; Flisiak, R.; Boron-Kaczmarska, A.; Pynka, M.; Parczewski, M.; Beniowski, M.; Mularska, E.; Trocha, H.; Jablonowska, E.; Malolepsza, E.; Wojcik, K.; Antunes, F.; Doroana, M.; Caldeira, L.; Mansinho, K.; Maltez, F.; Duiculescu, D.; Rakhmanova, A.; Zakharova, N.; Petersburg, Saint; Buzunova, S.; Jevtovic, D.; Mokráš, M.; Staneková, D.; Tomazic, J.; González-Lahoz, J.; Soriano, V.; Labarga, P.; Medrano, J.; Moreno, S.; Rodriguez, J. M.; Clotet, B.; Jou, A.; Paredes, R.; Tural, C.; Puig, J.; Bravo, I.; Gatell, J. M.; Miró, J. M.; Gutierrez, M.; Mateo, G.; Karlsson, A.; Flamholc, L.; Ledergerber, B.; Francioli, P.; Cavassini, M.; Hirschel, B.; Boffi, E.; Furrer, H.; Battegay, M.; Elzi, L.; Kravchenko, E.; Chentsova, N.; Frolov, V.; Kutsyna, G.; Servitskiy, S.; Krasnov, M.; Barton, S.; Johnson, A. M.; Mercey, D.; Johnson, M. A.; Murphy, M.; Weber, J.; Scullard, G.; Fisher, M.; Leen, C.; Morfeldt, L.; Thulin, G.; Åkerlund, B.; Koppel, K.; Håkangård, C.; Moroni, M.; Angarano, G.; Antinori, A.; Armignacco, O.; Castelli, F.; Cauda, R.; Di Perri, G.; Iardino, R.; Ippolito, G.; Perno, C. F.; von Schloesser, F.; Viale, P.; Ceccherini-Silberstein, F.; Girardi, E.; Lo Caputo, S.; Puoti, M.; Andreoni, M.; Ammassari, A.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, R.; Cingolani, A.; Cinque, P.; de Luca, A.; Di Biagio, A.; Gori, A.; Guaraldi, G.; Lapadula, G.; Madeddu, G.; Maggiolo, F.; Marchetti, G.; Marcotullio, S.; Monno, L.; Quiros Roldan, E.; Rusconi, S.; Cicconi, P.; Formenti, T.; Galli, L.; Lorenzini, P.; Giacometti, A.; Costantini, A.; Santoro, C.; Suardi, C.; Vanino, E.; Verucchi, G.; Minardi, C.; Quirino, T.; Abeli, C.; Manconi, P. E.; Piano, P.; Vecchiet, J.; Falasca, K.; Sighinolfi, L.; Segala, D.; Cassola, G.; Viscoli, G.; Alessandrini, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Castelli, A. P.; Rizzardini, G.; Ridolfo, A. L.; Piolini, R.; Salpietro, S.; Carenzi, L.; Moioli, M. C.; Puzzolante, C.; Abrescia, N.; Guida, M. G.; Onofrio, M.; Baldelli, F.; Francisci, D.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; d'Avino, A.; Gallo, L.; Nicastri, E.; Acinapura, R.; Capozzi, M.; Libertone, R.; Tebano, G.; Cattelan, A.; Mura, M. S.; Caramello, P.; Orofino, G. C.; Sciandra, M.; Pellizzer, G.; Manfrin, V.; Dollet, K.; Caissotti, C.; Dellamonica, P.; Roger, P. M.; Bernard, E.; Cua, E.; de Salvador-Guillouet, F.; Durant, J.; Ferrando, S.; Dunais, B.; Mondain-Miton, V.; Perbost, I.; Prouvost-Keller, B.; Pugliese, P.; Naqvi, A.; Pillet, S.; Risso, K.; Aubert, V.; Barth, J.; Bernasconi, E.; Böni, J.; Bucher, H. C.; Burton-Jeangros, C.; Calmy, A.; Egger, M.; Fehr, J.; Fellay, J.; Gorgievski, M.; Günthard, H.; Haerry, D.; Hasse, B.; Hirsch, H. H.; Hösli, I.; Kahlert, C.; Kaiser, L.; Keiser, O.; Klimkait, T.; Kovari, H.; Martinetti, G.; Martinez de Tejada, B.; Metzner, K.; Müller, N.; Nadal, D.; Pantaleo, G.; Rauch, A.; Regenass, A.; Rudin, C.; Schmid, P.; Schultze, D.; Schöni-Affolter, F.; Schüpbach, J.; Speck, R.; Taffé, P.; Tarr, P.; Telenti, A.; Trkola, A.; Vernazza, P.; Yerly, S.; Bhagani, S.; Burns, F.; Byrne, P.; Carroll, A.; Cropley, I.; Cuthbertson, Z.; Drinkwater, T.; Fernandez, T.; Garusu, E.; Gonzales, A.; Grover, D.; Hutchinson, S.; Killingley, B.; Murphy, G.; Ivens, D.; Johnson, M.; Kinloch de Loes, S.; Lipman, M.; Madge, S.; Marshall, N.; Montgomery, H.; Shah, R.; Swaden, L.; Tyrer, M.; Youle, M.; Webster, D.; Wright, A.; Chaloner, C.; Miah, M.; Tsintas, R.; Burch, L.; Cambiano, V.; Lampe, F.; Nakagawa, F.; O'Connor, J.; Speakman, A.; Connell, M.; Clewley, G.; Martin, S.; Thomas, M.; Aagaard, B.; Aragon, E.; Arnaiz, J.; Borup, L.; Dragsted, U.; Fau, A.; Gey, D.; Grarup, J.; Hengge, U.; Herrero, P.; Jansson, P.; Jensen, B.; Jensen, K.; Juncher, H.; Lopez, P.; Matthews, C.; Mollerup, D.; Pearson, M.; Reilev, S.; Tillmann, K.; Varea, S.; Angus, B.; Babiker, A.; Cordwell, B.; Darbyshire, J.; Dodds, W.; Fleck, S.; Horton, J.; Hudson, F.; Moraes, Y.; Pacciarini, F.; Palfreeman, A.; Paton, N.; Smith, N.; van Hooff, F.; Bebchuk, J.; Collins, G.; Denning, E.; DuChene, A.; Fosdick, L.; Harrison, M.; Herman-Lamin, K.; Larson, G.; Nelson, R.; Quan, K.; Quan, S.; Schultz, T.; Wyman, N.; Carey, C.; Chan, F.; Courtney-Rodgers, D.; Drummond, F.; Emery, S.; Harrod, M.; Jacoby, S.; Kearney, L.; Lin, E.; Pett, S.; Robson, R.; Seneviratne, N.; Stewart, M.; Watts, E.; Finley, E.; Sánchez, A.; Standridge, B.; Vjecha, M.; Belloso, W.; Davey, R.; Duprez, D.; Lifson, A.; Pederson, C.; Price, R.; Prineas, R.; Rhame, F.; Worley, J.; Modlin, J.; Beral, V.; Chaisson, R.; Fleming, T.; Hill, C.; Kim, K.; Murray, B.; Pick, B.; Seligmann, M.; Weller, I.; Cahill, K.; Fox, L.; Luzar, M.; Martinez, A.; McNay, L.; Pierson, J.; Tierney, J.; Vogel, S.; Costas, V.; Eckstrand, J.; Brown, S.; Abusamra, L.; Angel, E.; Aquilia, S.; Benetucci, J.; Bittar, V.; Bogdanowicz, E.; Cahn, P.; Casiro, A.; Contarelli, J.; Corral, J.; Daciuk, L.; David, D.; Dobrzanski, W.; Duran, A.; Ebenrstejin, J.; Ferrari, I.; Fridman, D.; Galache, V.; Guaragna, G.; Ivalo, S.; Krolewiecki, A.; Lanusse, I.; Laplume, H.; Lasala, M.; Lattes, R.; Lazovski, J.; Lopardo, G.; Lourtau, L.; Lupo, S.; Maranzana, A.; Marson, C.; Massera, L.; Moscatello, G.; Olivia, S.; Otegui, I.; Palacios, L.; Parlante, A.; Salomon, H.; Sanchez, M.; Somenzini, C.; Suarez, C.; Tocci, M.; Toibaro, J.; Zala, C.; Agrawal, S.; Ambrose, P.; Anderson, C.; Anderson, J.; Beileiter, K.; Blavius, K.; Boyle, M.; Bradford, D.; Britton, P.; Brown, P.; Busic, T.; Cain, A.; Carrall, L.; Carson, S.; Chenoweth, I.; Clark, F.; Clemons, J.; Clezy, K.; Cortissos, P.; Cunningham, N.; Curry, M.; Daly, L.; D'Arcy-Evans, C.; del Rosario, R.; Dinning, S.; Dobson, P.; Donohue, W.; Doong, N.; Downs, C.; Edwards, E.; Egan, C.; Ferguson, W.; Finlayson, R.; Forsdyke, C.; Foy, L.; Frater, A.; French, M.; Gleeson, D.; Gold, J.; Habel, P.; Haig, K.; Hardy, S.; Holland, R.; Hudson, J.; Hutchison, R.; Hyland, N.; James, R.; Johnston, C.; Kelly, M.; King, M.; Kunkel, K.; Lau, H.; Leamy, J.; Lester, D.; Leung, J.; Lohmeyer, A.; Lowe, K.; MacRae, K.; Magness, C.; Martinez, O.; Maruszak, H.; Medland, N.; Miller, S.; Murray, J.; Negus, P.; Newman, R.; Nowlan, C.; Oddy, J.; Orford, N.; Orth, D.; Patching, J.; Plummer, M.; Price, S.; Primrose, R.; Prone, I.; Ree, H.; Remington, C.; Richardson, R.; Robinson, S.; Rogers, G.; Roney, J.; Russell, D.; Ryan, S.; Sarangapany, J.; Schmidt, T.; Schneider, K.; Shields, C.; Silberberg, C.; Shaw, D.; Smith, D.; Meng Soo, T.; Sowden, D.; Street, A.; Kiem tee, B.; Thomson, J. L.; Topaz, S.; Villella, C.; Walker, A.; Watson, A.; Wendt, N.; Williams, L.; Youds, D.; Aichelburg, A.; Cichon, P.; Gemeinhart, B.; Rieger, A.; Schmied, B.; Touzeau-Romer, V.; DeRoo, A.; O'Doherty, E.; de Salles Amorim, C.; Basso, C.; Flint, S.; Kallas, E.; Levi, G.; Lewi, D.; Pereira, L.; da Silva, M.; Souza, T.; Toscano, A.; Angel, J.; Arsenault, M.; Bast, M.; Beckthold, B.; Bouchard, P.; Chabot, I.; Clarke, R.; Cohen, J.; Coté, P.; Ellis, M.; Gagne, C.; Gill, J.; Houde, M.; Johnston, B.; Jubinville, N.; Kato, C.; Lamoureux, N.; Latendre- Paquette, J.; Lindemulder, A.; McNeil, A.; McFarland, N.; Montaner, J.; Morrisseau, C.; O'Neill, R.; Page, G.; Piche, A.; Pongracz, B.; Preziosi, H.; Puri, L.; Rachlis, A.; Ralph, E.; Raymond, I.; Rouleau, D.; Routy, J. P.; Sandre, R.; Seddon, T.; Shafran, S.; Sikora, C.; Smaill, F.; Stromberg, D.; Trottier, S.; Walmsley, S.; Weiss, K.; Williams, K.; Zarowny, D.; Baadegaard, B.; Bengaard Andersen, Á; Boedker, K.; Collins, P.; Jensen, L.; Moller, H.; Lehm Andersen, P.; Loftheim, I.; Mathiesen, L.; Nielsen, H.; Obel, N.; Petersen, D.; Pors Jensen, L.; Trunk Black, F.; Aboulker, J. P.; Aouba, A.; Bensalem, M.; Berthe, H.; Blanc, C.; Bornarel, D.; Bouchaud, O.; Boue, F.; Bouvet, E.; Brancon, C.; Breaud, S.; Brosseau, D.; Brunet, A.; Capitant, C.; Ceppi, C.; Chakvetadze, C.; Cheneau, C.; Chennebault, J. M.; de Truchis, P.; Delavalle, A. M.; Delfraissy, J. F.; Dumont, C.; Edeb, N.; Fabre, G.; Foltzer, A.; Foubert, V.; Gastaut, J. A.; Gerbe, J.; Girard, P. M.; Goujard, C.; Hoen, B.; Honore, P.; Hue, H.; Hynh, T.; Jung, C.; Kahi, S.; Lang, J. M.; Le Baut, V.; Lefebvre, B.; Leturque, N.; Lévy, Y.; Loison, J.; Maddi, G.; Maignan, A.; Majerholc, C.; de Boever, C.; Meynard, J. L.; Michelet, C.; Michon, C.; Mole, M.; Netzer, E.; Pialoux, G.; Poizot-Martin, I.; Raffi, F.; Ratajczak, M.; Ravaux, I.; Reynes, J.; Salmon-Ceron, D.; Sebire, M.; Simon, A.; Tegna, L.; Tisne-Dessus, D.; Tramoni, C.; Vidal, M.; Viet-Peaucelle, C.; Weiss, L.; Zeng, A.; Zucman, D.; Adam, A.; Arastéh, K.; Behrens, G.; Bergmann, F.; Bittner, D.; Bogner, J.; Brockmeyer, N.; Darrelmann, N.; Deja, M.; Doerler, M.; Esser, S.; Faetkenheuer, G.; Fenske, S.; Gajetzki, S.; Goebel, F.; Gorriahn, D.; Harrer, E.; Harrer, T.; Hartl, H.; Hartmann, M.; Heesch, S.; Jakob, W.; Jäger, H.; Klinker, H.; Kremer, G.; Ludwig, C.; Mantzsch, K.; Mauss, S.; Meurer, A.; Niedermeier, A.; Pittack, N.; Plettenberg, A.; Potthoff, A.; Probst, M.; Rittweger, M.; Ross, B.; Rotty, J.; Rund, E.; Ruzicka, T.; Schmidt, R. T.; Schmutz, G.; Schnaitmann, E.; Schuster, D.; Sehr, T.; Spaeth, B.; Stephan, C.; Stockey, T.; Stoehr, A.; Trein, A.; Vaeth, T.; Vogel, M.; Wasmuth, J.; Wengenroth, C.; Winzer, R.; Wolf, E.; Reidy, D. L.; Cohen, Y.; Drora, G.; Eliezer, I.; Godo, O.; Kedem, E.; Magen, E.; Mamorsky, M.; Sthoeger, Z.; Vered, H.; Aiuti, F.; Bechi, M.; Bergamasco, A.; Bertelli, D.; Bruno, R.; Butini, L.; Cagliuso, M.; Carosi, G.; Casari, S.; Chrysoula, V.; Cologni, G.; Conti, V.; Corpolongo, A.; D'Offizi, G.; Gaiottino, F.; Di Pietro, M.; Filice, G.; Francesco, M.; Gianelli, E.; Graziella, C.; Magenta, L.; Martellotta, F.; Maserati, R.; Murdaca, G.; Nardini, G.; Nozza, S.; Puppo, F.; Pogliaghi, M.; Ripamonti, D.; Ronchetti, C.; Rusconi, V.; Sacchi, P.; Silvia, N.; Suter, F.; Tambussi, G.; Uglietti, A.; Vechi, M.; Vergani, B.; Vichi, F.; Vitiello, P.; Iwamoto, A.; Kikuchi, Y.; Miyazaki, N.; Mori, M.; Nakamura, T.; Odawara, T.; Oka, S.; Shirasaka, T.; Tabata, M.; Takano, M.; Ueta, C.; Watanabe, D.; Yamamoto, Y.; Erradey, I.; Himmich, H.; Marhoum El Filali, K.; Blok, W.; van Boxtel, R.; Brinkman H Doevelaar, K.; Grijsen, M.; Juttmann, J.; Ligthart, S.; van der Meulen, P.; Lange, J.; Schrijnders-Gudde, L.; Septer-Bijleveld, E.; Sprenger, H.; Vermeulen, J.; Kvale, D.; Inglot, M.; Rymer, W.; Szymczak, A.; Aldir, M.; Baptista, C.; da Conceicao Vera, J.; dos Santos, C. Raquel A.; Valadas, E.; Vaz Pinto, I.; Chia, E.; Foo, E.; Karim, F.; Lim, P. 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L.; Clifford, D.; Climo, M.; Couey, P.; Cuervo, H.; Deeks, S.; Dennis, M.; Diaz-Linares, M.; Dickerson, D.; Diez, M.; Di Puppo, J.; Dodson, P.; Dupre, D.; Elion, R.; Elliott, K.; El-Sadr, W.; Estes, M.; Fabre, J.; Farrough, M.; Flamm, J.; Follansbee, S.; Foster, C.; Frank, C.; Franz, J.; Frechette, G.; Freidland, G.; Frische, J.; Fuentes, L.; Funk, C.; Geisler, C.; Genther, K.; Giles, M.; Goetz, M.; Gonzalez, M.; Graeber, C.; Graziano, F.; Grice, D.; Hahn, B.; Hamilton, C.; Hassler, S.; Henson, A.; Hopper, S.; John, M.; Johnson, L.; Johnson, R.; Jones, R.; Kahn, J.; Klimas, N.; Kolber, M.; Koletar, S.; Labriola, A.; Larsen, R.; Lasseter, F.; Lederman, M.; Ling, T.; Lusch, T.; MacArthur, R.; Machado, C.; Makohon, L.; Mandelke, J.; Mannheimer, S.; Martínez, M.; Martinez, N.; Mass, M.; Masur, H.; McGregor, D.; McIntyre, D.; McKee, J.; McMullen, D.; Mettinger, M.; Middleton, S.; Mieras, J.; Mildvan, D.; Miller, P.; Miller, T.; Mitchell, V.; Mitsuyasu, R.; Moanna, A.; Mogridge, C.; Moran, F.; Murphy, R.; Nahass, R.; Nixon, D.; O'Brien, S.; Ojeda, J.; Okhuysen, P.; Olson, M.; Osterberger, J.; Owen, W.; Pablovich, S.; Patel, S.; Pierone, G.; Poblete, R.; Potter, A.; Preston, E.; Rappoport, C.; Regevik, N.; Reyelt, M.; Riney, L.; Rodriguez-Barradas, M.; Rodriguez, M.; Rodriguez, J.; Roland, R.; Rosmarin-DeStefano, C.; Rossen, W.; Rouff, J.; Saag, M.; Santiago, S.; Sarria, J.; Wirtz, S.; Schmidt, U.; Scott, C.; Sheridan, A.; Shin, A.; Shrader, S.; Simon, G.; Slowinski, D.; Smith, K.; Spotkov, J.; Sprague, C.; States, D.; Suh, C.; Sullivan, J.; Summers, K.; Sweeton, B.; Tan, V.; Tanner, T.; Temesgen, Z.; Thomas, D.; Thompson, M.; Tobin, C.; Toro, N.; Towner, W.; Upton, K.; Uy, J.; Valenti, S.; van der Horst, C.; Vita, J.; Voell, J.; Walker, J.; Walton, T.; Wason, K.; Watson, V.; Wellons, A.; Weise, J.; White, M.; Whitman, T.; Williams, B.; Williams, N.; Windham, J.; Witt, M.; Workowski, K.; Wortmann, G.; Wright, T.; Zelasky, C.; Zwickl, B.; Dietz, D.; Chesson, C.; Schmetter, B.; Grue, L.; Willoughby, M.; Demers, A.; Dragsted, U. B.; Jensen, K. B.; Jansson, P. O.; Jensen, B. G.; Benfield, T. L.; Darbyshire, J. H.; Babiker, A. G.; Palfreeman, A. J.; Fleck, S. L.; Collaco-Moraes, Y.; Wyzydrag, L.; Cooper, D. A.; Drummond, F. M.; Connor, S. A.; Satchell, C. S.; Gunn, S.; Delfino, M. A.; Merlin, K.; McGinley, C.; Neaton, J. D.; George, M.; Grund, B.; Hogan, C.; Miller, C.; Neuhaus, J.; Roediger, M. P.; Thackeray, L.; Campbell, C.; Lahart, C.; Perlman, D.; Rein, M.; DerSimonian, R.; Brody, B. A.; Daar, E. S.; Dubler, N. N.; Fleming, T. R.; Freeman, D. J.; Kahn, J. P.; Kim, K. M.; Medoff, G.; Modlin, J. F.; Moellering, R.; Murray, B. E.; Robb, M. L.; Scharfstein, D. O.; Sugarman, J.; Tsiatis, A.; Tuazon, C.; Zoloth, L.; Klingman, K.; Lehrman, S.; Belloso, W. H.; Losso, M. H.; Benetucci, J. A.; Bogdanowicz, E. P.; Cahn, P. E.; Casiró, A. D.; Cassetti, I.; Contarelli, J. M.; Corral, J. A.; Crinejo, A.; David, D. O.; Ishida, M. T.; Laplume, H. E.; Lasala, M. B.; Lupo, S. H.; Masciottra, F.; Michaan, M.; Ruggieri, L.; Salazar, E.; Sánchez, M.; Hoy, J. F.; Rogers, G. D.; Allworth, A. M.; Anderson, J. S. C.; Armishaw, J.; Barnes, K.; Chiam, A.; Chuah, J. C. P.; Curry, M. C.; Dever, R. L.; Donohue, W. A.; Doong, N. C.; Dwyer, D. E.; Dyer, J.; Eu, B.; Ferguson, V. W.; French, M. A. H.; Garsia, R. J.; Hudson, J. H.; Jeganathan, S.; Konecny, P.; McCormack, C. L.; McMurchie, M.; Moore, R. J.; Moussa, M. B.; Piper, M.; Read, T.; Roney, J. J.; Shaw, D. R.; Silvers, J.; Smith, D. J.; Street, A. C.; Vale, R. J.; Wendt, N. A.; Wood, H.; Youds, D. W.; Zillman, J.; Tozeau, V.; DeWit, S.; de Roo, A.; Leonard, P.; Lynen, L.; Moutschen, M.; Pereira, L. C.; Souza, T. N. L.; Schechter, M.; Zajdenverg, R.; Almeida, M. M. T. B.; Araujo, F.; Bahia, F.; Brites, C.; Caseiro, M. M.; Casseb, J.; Etzel, A.; Falco, G. G.; Filho, E. C. J.; Flint, S. R.; Gonzales, C. R.; Madruga, J. V. R.; Passos, L. N.; Reuter, T.; Sidi, L. C.; Toscano, A. L. C.; Cherban, E.; Conway, B.; Dufour, C.; Foster, A.; Haase, D.; Haldane, H.; Klein, M.; Lessard, B.; Martel, A.; Martel, C.; Paradis, E.; Schlech, W.; Schmidt, S.; Thompson, B.; Vezina, S.; Wolff Reyes, M. J.; Northland, R.; Hergens, L.; Loftheim, I. R.; Raukas, M.; Justinen, J.; Landman, R.; Abel, S.; Abgrall, S.; Amat, K.; Auperin, L.; Barruet, R.; Benalycherif, A.; Benammar, N.; Bentata, M.; Besnier, J. M.; Blanc, M.; Cabié, A.; Chavannet, P.; Dargere, S.; de la Tribonniere, X.; Debord, T.; Decaux, N.; Delgado, J.; Frixon-Marin, V.; Genet, C.; Gérard, L.; Gilquin, J.; Jeantils, V.; Kouadio, H.; Leclercq, P.; Lelièvre, J.-D.; Levy, Y.; Michon, C. P.; Nau, P.; Pacanowski, J.; Piketty, C.; Salmon, D.; Schmit, J. L.; Serini, M. A.; Tassi, S.; Touam, F.; Verdon, R.; Weinbreck, P.; Yazdanpanah, Y.; Yeni, P.; Bitsch, S.; Bogner, J. R.; Goebel, F. D.; Lehmann, C.; Lennemann, T.; Potthof, A.; Wasmuth, J. C.; Wiedemeyer, K.; Hatzakis, A.; Touloumi, G.; Antoniadou, A.; Daikos, G. L.; Dimitrakaki, A.; Gargalianos-Kakolyris, P.; Giannaris, M.; Karafoulidou, A.; Katsambas, A.; Katsarou, O.; Kontos, A. N.; Kordossis, T.; Lazanas, M. K.; Panagopoulos, P.; Paparizos, V.; Papastamopoulos, V.; Petrikkos, G.; Skoutelis, A.; Tsogas, N.; Bergin, C. J.; Mooka, B.; Mamorksy, M. G.; Agmon-Levin, N.; Karplus, R.; Shahar, E.; Biglino, A.; de Gioanni, M.; Montroni, M.; Raise, E.; Honda, M.; Ishisaka, M.; Caplinskas, S.; Uzdaviniene, V.; Schmit, J. C.; Mills, G. D.; Blackmore, T.; Masters, J. A.; Morgan, J.; Pithie, A.; Brunn, J.; Ormasssen, V.; La Rosa, A.; Guerra, O.; Espichan, M.; Gutierrez, L.; Mendo, F.; Salazar, R.; Knytz, B.; Kwiatkowski, J.; Castro, R. S.; Horta, A.; Miranda, A. C.; Pinto, I. V.; Vera, J.; Vinogradova, E.; Yakovlev, A.; Wood, R.; Orrel, C.; Arnaiz, J. A.; Carrillo, R.; Dalmau, D.; Jordano, Q.; Knobel, H.; Larrousse, M.; Moreno, J. S.; Oretaga, E.; Pena, J. N.; Spycher, R.; Bottone, S.; Christen, A.; Franc, C.; Furrer, H. J.; Gayet-Ageron, A.; Genné, D.; Hochstrasser, S.; Moens, C.; Nüesch, R.; Ruxrungtham, K.; Pumpradit, W.; Dangthongdee, S.; Kiertiburanakul, S.; Klinbuayaem, V.; Mootsikapun, P.; Nonenoy, S.; Piyavong, B.; Prasithsirikul, W.; Raksakulkarn, P.; Gazzard, B. G.; Ainsworth, J. G.; Angus, B. J.; Barber, T. J.; Brook, M. G.; Care, C. D.; Chadwick, D. R.; Chikohora, M.; Churchill, D. R.; Cornforth, D.; Dockrell, D. H.; Easterbrook, P. J.; Fox, P. A.; Gomez, P. A.; Gompels, M. M.; Harris, G. M.; Herman, S.; Jackson, A. G. A.; Jebakumar, S. P. R.; Kinghorn, G. R.; Kuldanek, K. A.; Larbalestier, N.; Lumsden, M.; Maher, T.; Mantell, J.; Muromba, L.; Orkin, C. M.; Peters, B. S.; Peto, T. E. A.; Portsmouth, S. D.; Rajamanoharan, S.; Ronan, A.; Schwenk, A.; Slinn, M. A.; Stroud, C. J.; Thomas, R. C.; Wansbrough-Jones, M. H.; Whiles, H. J.; White, D. J.; Williams, E.; Williams, I. G.; Acosta, E. A.; Adamski, A.; Antoniskis, D.; Aragon, D. R.; Barnett, B. J.; Baroni, C.; Barron, M.; Baxter, J. D.; Beers, D.; Beilke, M.; Bemenderfer, D.; Bernard, A.; Besch, C. L.; Bessesen, M. T.; Bethel, J. T.; Blue, S.; Blum, J. D.; Boarden, S.; Bolan, R. K.; Borgman, J. B.; Brar, I.; Braxton, B. K.; Bredeek, U. F.; Brennan, R.; Britt, D. E.; Bulgin-Coleman, D.; Bullock, D. E.; Campbell, B.; Caras, S.; Carroll, J.; Casey, K. K.; Chiang, F.; Cindrich, R. B.; Clark, C.; Cohen, C.; Coley, J.; Condoluci, D. V.; Contreras, R.; Corser, J.; Cozzolino, J.; Daley, L.; Dandridge, D.; D'Antuono, V.; Darcourt Rizo, J. G.; DeHovitz, J. A.; Dejesus, E.; DesJardin, J.; Dietrich, C.; Dolce, E.; Erickson, D.; Faber, L. L.; Falbo, J.; Farrough, M. J.; Farthing, C. F.; Ferrell-Gonzalez, P.; Flynn, H.; Frank, M.; Freeman, K. F.; French, N.; Fujita, N.; Gahagan, L.; Gilson, I.; Goetz, M. B.; Goodwin, E.; Guity, C. K.; Gulick, P.; Gunderson, E. R.; Hale, C. M.; Hannah, K.; Henderson, H.; Hennessey, K.; Henry, W. K.; Higgins, D. T.; Hodder, S. L.; Horowitz, H. W.; Howe-Pittman, M.; Hubbard, J.; Hudson, R.; Hunter, H.; Hutelmyer, C.; Insignares, M. T.; Jackson, L.; Jenny, L.; Johnson, D. L.; Johnson, G.; Johnson, J.; Kaatz, J.; Kaczmarski, J.; Kagan, S.; Kantor, C.; Kempner, T.; Kieckhaus, K.; Kimmel, N.; Klaus, B. M.; Koeppe, J. R.; Koirala, J.; Kopka, J.; Kostman, J. R.; Kozal, M. J.; Kumar, A.; Lampiris, H.; Lamprecht, C.; Lattanzi, K. M.; Lee, J.; Leggett, J.; Long, C.; Loquere, A.; Loveless, K.; Lucasti, C. J.; MacVeigh, M.; Makohon, L. H.; Markowitz, N. P.; Marks, C.; Martorell, C.; McFeaters, E.; McGee, B.; McIntyre, D. M.; McManus, E.; Melecio, L. G.; Melton, D.; Mercado, S.; Merrifield, E.; Mieras, J. A.; Mogyoros, M.; Moran, F. M.; Murphy, K.; Mutic, S.; Nadeem, I.; Nadler, J. P.; Ognjan, A.; O'Hearn, M.; O'Keefe, K.; Okhuysen, P. C.; Oldfield, E.; Olson, D.; Orenstein, R.; Ortiz, R.; Parpart, F.; Pastore-Lange, V.; Paul, S.; Pavlatos, A.; Pearce, D. D.; Pelz, R.; Peterson, S.; Pitrak, D.; Powers, S. L.; Pujet, H. C.; Raaum, J. W.; Ravishankar, J.; Reeder, J.; Reilly, N. A.; Reyelt, C.; Riddell, J.; Rimland, D.; Robinson, M. L.; Rodriguez, A. E.; Rodriguez-Barradas, M. C.; Rodriguez Derouen, V.; Rosmarin, C.; Rossen, W. L.; Rouff, J. R.; Sampson, J. H.; Sands, M.; Savini, C.; Schrader, S.; Schulte, M. M.; Scott, R.; Seedhom, H.; Sension, M.; Sheble-Hall, A.; Shuter, J.; Slater, L. N.; Slotten, R.; Smith, M.; Snap, S.; States, D. M.; Stringer, G.; Summers, K. K.; Swanson, K.; Sweeton, I. B.; Szabo, S.; Tedaldi, E. M.; Telzak, E. E.; Thompson, M. A.; Thompson, S.; Ting Hong Bong, C.; Vaccaro, A.; Vasco, L. M.; Vecino, I.; Verlinghieri, G. K.; Visnegarwala, F.; Wade, B. H.; Weis, S. E.; Weise, J. A.; Weissman, S.; Wilkin, A. M.; Witter, J. H.; Wojtusic, L.; Wright, T. J.; Yeh, V.; Young, B.; Zeana, C.; Zeh, J.; Savio, E.; Vacarezza, M.

    2015-01-01

    Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a

  8. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    NARCIS (Netherlands)

    Mocroft, A.; Lundgren, J.D.; Ross, M.; Law, M.; Reiss, P.; Kirk, O.; Smith, C.; Wentworth, D.; Neuhaus, J.; Fux, C.A.; Moranne, O.; Morlat, P.; Johnson, M.A.; Ryom, L.; Burger, D.M.

    2015-01-01

    BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic

  9. Effects of CD4 Cell Counts and Viral Load Testing on Mortality Rates in Patients With HIV Infection Receiving Antiretroviral Treatment: An Observational Cohort Study in Rural Southwest China.

    Science.gov (United States)

    Shen, Zhiyong; Zhu, Qiuying; Tang, Zhenzhu; Pan, Stephen W; Zhang, Heng; Jiang, He; Chen, Yi; Lan, Guanghua; Xing, Hui; Liao, Lingjie; Feng, Yi; Ruan, Yuhua; Shao, Yiming

    2016-07-01

    Recent studies have suggested that CD4 cell count monitoring has little added value in patients who are virologically suppressed and immunologically stable if viral load (VL) testing is routinely available. These conclusions have not been directly assessed using mortality rate as a study end point in a real-world setting. This human immunodeficiency virus (HIV) treatment cohort study from 2008 to 2014 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between the frequency of CD4 cell counts and VL testing and death. Compared with monitoring CD4 cell counts ≥3 times during the first year of antiretroviral therapy (ART) initiation, as currently suggested by the Chinese National Free Antiretroviral Treatment Program, monitoring them less than twice during the first year of ART was significantly associated with death; however, monitoring them twice in that year did not significantly increase mortality rates. Compared with testing VL at least once during the first year of ART, as currently suggested by the National Free Antiretroviral Treatment Program, performing no VL tests in the first year after ART initiation was significantly associated with higher mortality rates. Routine CD4 cell count monitoring did not have an impact on mortality rates among HIV-infected patients with VLs <1000 copies/mL or CD4 cell counts ≥350/μL beyond 12 months after ART initiation. Our study suggests that CD4 cell counts can be reduced to twice during the first year of ART and be reduced or stopped for patients who have achieved virologic suppression or immunologic stability after 12 months of treatment. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  10. Acceptability of Outpatient Ready-To-Use Food-Based Protocols in HIV-Infected Senegalese Children and Adolescents Within the MAGGSEN Cohort Study.

    Science.gov (United States)

    Cames, Cecile; Varloteaux, Marie; Have, Ndeye Ngone; Diom, Alhadji Bassine; Msellati, Philippe; Mbaye, Ngagne; Mbodj, Helene; Sy Signate, Haby; Diack, Aminata

    2016-11-22

    To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children (P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. NCT01771562 (Current Controlled Trials). © The Author(s) 2016.

  11. Bonafide, type-specific human papillomavirus persistence among HIV-positive pregnant women: predictive value for cytological abnormalities, a longitudinal cohort study

    Directory of Open Access Journals (Sweden)

    Angela RI Meyrelles

    2016-02-01

    Full Text Available This study investigated the rate of human papillomavirus (HPV persistence, associated risk factors, and predictors of cytological alteration outcomes in a cohort of human immunodeficiency virus-infected pregnant women over an 18-month period. HPV was typed through L1 gene sequencing in cervical smears collected during gestation and at 12 months after delivery. Outcomes were defined as nonpersistence (clearance of the HPV in the 2nd sample, re-infection (detection of different types of HPV in the 2 samples, and type-specific HPV persistence (the same HPV type found in both samples. An unfavourable cytological outcome was considered when the second exam showed progression to squamous intraepithelial lesion or high squamous intraepithelial lesion. Ninety patients were studied. HPV DNA persistence occurred in 50% of the cases composed of type-specific persistence (30% or re-infection (20%. A low CD4+T-cell count at entry was a risk factor for type-specific, re-infection, or HPV DNA persistence. The odds ratio (OR was almost three times higher in the type-specific group when compared with the re-infection group (OR = 2.8; 95% confidence interval: 0.43-22.79. Our findings show that bonafide (type-specific HPV persistence is a stronger predictor for the development of cytological abnormalities, highlighting the need for HPV typing as opposed to HPV DNA testing in the clinical setting.

  12. a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    RP Lystad

    2015-09-01

    Full Text Available The objectives of this study were to estimate the incidence and describe the pattern and severity of training injuries in taekwondo, and to compare pattern and severity of training injuries with competition injuries. One hundred and fifty-two active Australian amateur taekwondo athletes, aged 12 years or over, completed an online survey comprising questions on training exposure and injury history over the preceding 12 months. The main outcome measures were: overall injury incidence rate per athlete-year; training injury incidence rate per athlete-year, per 1000 athlete-training-sessions, and per 1000 athlete-hours of training; injury severity; and injury proportions by anatomical region and by type of injury. Injury incidence rates were calculated with 95% confidence intervals using standard methods, while injury proportions were compared using Fisher’s exact test. The vast majority (81.5% of taekwondo injuries in an average athlete-year occurred during training. The training injury incidence rate was estimated to be 1.6 (95% CI: 1.4, 1.9 per athlete-year, 11.8 (95% CI: 10.4, 13.4 per 1000 athlete-training-sessions, and 7.0 (95% CI: 6.1, 7.9 per 1000 athlete-hours of training. Among athletes with five or fewer injuries, the severity and injury pattern of training injuries were, by and large, the same as for competition injuries. Approximately sixty percent (60.3% of training injuries required treatment by a health professional. Considering the burden of training injuries exceeds that of competition injuries, taekwondo governing bodies and stakeholders are encouraged to devote more efforts towards the identification of risk factors for, and prevention of, training injuries in the sport of taekwondo.

  13. A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro, Brazil.

    Science.gov (United States)

    David, Solange Gonçalves; Lovero, Kathryn L; Pombo March, Maria de Fátima B; Abreu, Thalita G; Ruffino Netto, Antonio; Kritski, Afranio L; Sant'Anna, Clemax C

    2017-06-01

    The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study. A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Frailty, HIV infection, and mortality in an aging cohort of injection drug users.

    Directory of Open Access Journals (Sweden)

    Damani A Piggott

    Full Text Available Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs.Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24-2.21 compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62-3.48 among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA. No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23-5.66, HIV infection alone (HR 3.29, 95% CI, 1.85-5.88, and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49-14.3.Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.

  15. Uncontrolled viral replication as a risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term antiretroviral therapy: APROCO/COPILOTE (ANRS CO8) cohort study.

    Science.gov (United States)

    Ferry, Tristan; Raffi, François; Collin-Filleul, Fidéline; Dupon, Michel; Dellamonica, Pierre; Waldner, Anne; Strady, Christophe; Chêne, Geneviève; Leport, Catherine; Moing, Vincent Le

    2009-08-01

    To determine risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term combination antiretroviral therapy (cART). A validation committee reviewed each severe clinical event that occurred in the APROCO/COPILOTE (ANRS CO8) cohort that enrolled 1281 patients in 1997-1999 at the initiation of cART containing protease inhibitor. Probability of the occurrence of a first non-AIDS, cART-related, and AIDS-defining event was estimated, and potential determinants were studied using Cox regression models. During a median follow-up of 7.3 years, the incidence of non-AIDS events was higher than that of cART-related and AIDS-defining events (10.5, 3.6, and 2.6 per 100 patient-years, respectively). Bacterial (mainly airway) infections were the most frequent non-AIDS events (23.4%) followed by non-AIDS-defining malignancies and cardiovascular events (both 9.5%). Factors independently associated with the occurrence of a first non-AIDS event were age >60 years [hazard ratio (HR) 2.1; 95% confidence interval (CI): 1.3 to 3.2] and CD4 4 log10 copies per milliliter at the time of the event (HR 1.9; 95% CI: 1.5 to 2.5). Optimization and permanent continuation of long-term antiretroviral therapy in HIV-infected patients is the best strategy to prevent or reduce the occurrence of non-AIDS severe morbidity.

  16. The risk of AIDS-defining events is decreasing over time in the German HIV-1 Seroconverter Cohort

    Directory of Open Access Journals (Sweden)

    Altmann Mathias

    2012-04-01

    Full Text Available Abstract Background With ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART needs to be monitored continuously at the population level. The German HIV-1 Seroconverter Cohort is a multi-centre, open, long-term observational cohort including patients with a known or reliably estimated date of HIV-infection i.e. last negative and first positive HIV antibody test within a maximum three-year interval or laboratory evidence of seroconversion. Our study aims to investigate survival improvements and changes in AIDS risk over calendar periods in the German HIV-1 Seroconverter Cohort. Methods Retrospective (for the pre-1997 period and prospective (since 1997 data from the German HIV-1 Seroconverter Cohort were used. Time from seroconversion to first AIDS-defining event over calendar periods was analysed by using Cox models adjusting for age at seroconversion, sex, transmission groups and short HIV test interval. Kaplan-Meier methods were used to determine expected survival (remaining AIDS-free by calendar period. Results 2162 seroconverters with 8976 person-years of observation were included in our analysis (up to 31.12.2010. A total of 196 first AIDSdefining events were reported. Two periods i.e. 19972000 and 2007-2010 were statistically associated with a reduction in the risk of AIDS, accounting for an overall reduction of 80%. Compared to1997-2000, hazard ratios were 2.6 (95%CI, 1.6-4.8; p=0.000 in pre-1997 and 0.5 (95%CI, 0.3-0.8; p=0.007 in 20072010. Independent risk factor for AIDS progression was age at seroconversion (HR, 1.3 per 10year-increase; p=0.001. Conclusion HAART effectiveness has improved in the German HIV-1-Seroconverter Cohort. The risk to develop AIDS decreased significantly in 19972000 and in 20072010. However, elderly may require particular monitoring in view of their faster

  17. No evidence of XMRV or related retroviruses in a London HIV-1-positive patient cohort.

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    Eleanor R Gray

    Full Text Available BACKGROUND: Several studies have implicated a recently discovered gammaretrovirus, XMRV (Xenotropic murine leukaemia virus-related virus, in chronic fatigue syndrome and prostate cancer, though whether as causative agent or opportunistic infection is unclear. It has also been suggested that the virus can be found circulating amongst the general population. The discovery has been controversial, with conflicting results from attempts to reproduce the original studies. METHODOLOGY/PRINCIPAL FINDINGS: We extracted peripheral blood DNA from a cohort of 540 HIV-1-positive patients (approximately 20% of whom have never been on anti-retroviral treatment and determined the presence of XMRV and related viruses using TaqMan PCR. While we were able to amplify as few as 5 copies of positive control DNA, we did not find any positive samples in the patient cohort. CONCLUSIONS/SIGNIFICANCE: In view of these negative findings in this highly susceptible group, we conclude that it is unlikely that XMRV or related viruses are circulating at a significant level, if at all, in HIV-1-positive patients in London or in the general population.

  18. No Evidence of XMRV or Related Retroviruses in a London HIV-1-Positive Patient Cohort

    Science.gov (United States)

    Gray, Eleanor R.; Garson, Jeremy A.; Breuer, Judith; Edwards, Simon; Kellam, Paul; Pillay, Deenan; Towers, Greg J.

    2011-01-01

    Background Several studies have implicated a recently discovered gammaretrovirus, XMRV (Xenotropic murine leukaemia virus-related virus), in chronic fatigue syndrome and prostate cancer, though whether as causative agent or opportunistic infection is unclear. It has also been suggested that the virus can be found circulating amongst the general population. The discovery has been controversial, with conflicting results from attempts to reproduce the original studies. Methodology/Principal Findings We extracted peripheral blood DNA from a cohort of 540 HIV-1-positive patients (approximately 20% of whom have never been on anti-retroviral treatment) and determined the presence of XMRV and related viruses using TaqMan PCR. While we were able to amplify as few as 5 copies of positive control DNA, we did not find any positive samples in the patient cohort. Conclusions/Significance In view of these negative findings in this highly susceptible group, we conclude that it is unlikely that XMRV or related viruses are circulating at a significant level, if at all, in HIV-1-positive patients in London or in the general population. PMID:21448291

  19. Prostate Cancer Biospecimen Cohort Study

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-15-2-0062 TITLE: Prostate Cancer Biospecimen Cohort Study PRINCIPAL INVESTIGATOR: Bettina F. Drake, MPH, PhD CONTRACTING...ADDRESS. 1. REPORT DATE October 2017 2. REPORT TYPE Annual 3. DATES COVERED 30 Sep 2016 - 29 Sep 2017 4. TITLE AND SUBTITLE Prostate Cancer Biospecimen...14. ABSTRACT The goal of the study is development of a Prostate Cancer Biorepository Network (PCBN) resource site with high quality and well

  20. Impact of viral hepatitis co-infection on response to antiretroviral therapy and HIV disease progression in the HIV-NAT cohort

    NARCIS (Netherlands)

    Law, W. Phillip; Duncombe, Chris J.; Mahanontharit, Apicha; Boyd, Mark A.; Ruxrungtham, Kiat; Lange, Joep M. A.; Phanuphak, Praphan; Cooper, David A.; Dore, Gregory J.

    2004-01-01

    OBJECTIVE: To examine the impact of viral hepatitis co-infection on HIV disease outcomes following commencement of combination antiretroviral therapy in a developing country setting. METHODS: HIV RNA suppression, CD4 cell count recovery, and HIV disease progression were examined within a cohort of

  1. Operational effectiveness of guidelines on complete breast-feeding cessation to reduce mother-to-child transmission of HIV: results from a prospective observational cohort study at routine prevention of mother-to-child transmission sites, South Africa.

    Science.gov (United States)

    Goga, Ameena E; Van Wyk, Brian; Doherty, Tanya; Colvin, Mark; Jackson, Debra J; Chopra, Mickey

    2009-04-15

    Until 2006, HIV-positive women who chose to exclusively breast-feed were advised to completely stop breast-feeding by 6 months. We investigated operational feasibility and predictors of complete breast-feeding cessation (CBC). A prospective observational cohort study at 3 routine prevention of mother-to-child transmission sites, South Africa. Data on "complete breast-feeding cessation at 24 weeks" and "not breast-feeding (NBF) for 4 days before the last follow-up visit at or before 24 weeks" were gathered during home visits (3, 5, 7, 9, 12, 16, 20, and 24 weeks). The main subgroup of interest for this analysis was women practicing exclusive breast-feeding/predominant breast-feeding at 3 weeks. Univariate analysis, logistic regression, Kaplan-Meier Survival analysis, and Cox regression were performed. Eighty-eight women (43.6%) reported CBC. "Health staff suggesting formula use: [OR(a) 4.39 (1.76-10.97)] and "infant hospitalization" [OR(a) 3.27 (1.37-7.79)] were the only significant predictors of CBC. The probability of NBF at 5, 7, 9, 12, 16, 20, and 24 weeks was 2.8% [95% confidence interval (CI) 1.8% to 3.8%], 4.3% (3.0% to 5.6%), 5.9% (4.4% to 7.4%, 9.8% (7.9% to 11.7%), 16.1 (13.8% to 18.4%), 23.1% (20.5% to 25.7%), and 37.6% (34.6% to 40.6%), respectively. Infant HIV status [hazard ratio 5.5 95% CI 2.4 to 12.5] was the only predictor of infant death. NBF was not protective against 9-month infant HIV or death in univariate and multivariable analysis. At programmatic level, CBC by 24 weeks is uncommon, and success seems unrelated to predetermined social, economic, and environmental (acceptable, feasible, affordable, sustainable, and safe AFASS) criteria. Thus at this level, activities that encourage CBC (amongst women meeting AFASS criteria) need to be identified and tested.

  2. Severe adverse events during second-line tuberculosis treatment in the context of high HIV Co-infection in South Africa: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Kathryn Schnippel

    2016-10-01

    Full Text Available Abstract Background According to the World Health Organization, South Africa ranks as one of the highest burden of TB, TB/HIV co-infection, and drug-resistant TB (DR-TB countries. DR-TB treatment is complicated to administer and relies on the use of multiple toxic drugs, with potential for severe adverse drug reactions. We report the occurrence of adverse events (AEs during a standardised DR-TB treatment regimen at two outpatient, decentralized, public-sector sites in Johannesburg, South Africa. Methods We reviewed medical records of the six-month intensive treatment phase for rifampicin-resistant (RR TB patients registered May 2012 - December 2014. Patients contributed follow-up time until death, loss from treatment, censoring (6 months or data extraction. A standardized regimen of kanamycin, moxifloxacin, ethionamide, terizidone, and pyrazinamide was used according to national guidelines. AEs were graded using the AIDS Clinical Trial Group scale. We present subhazard ratios from competing risk analysis for time to severe AE, accounting for mortality and loss from treatment. Results Across the two sites, 578 eligible patient files were reviewed. 36.7 % were categorized as low weight (≤50 kg at DR-TB initiation. 76.0 % had no history of TB treatment prior to the current episode of RR TB. 26.8 % were diagnosed with RR TB while hospitalized, indicating poor clinical condition. 82.5 % of patients were also HIV positive, of whom 43.8 % were on ART prior to RR TB treatment and 32.1 % initiated ART with or after RR TB treatment. Median CD4 count was 114.5 (IQR: 45-246.5. Overall, 578 reports of AEs were captured for 204 patients (35.3 % and 110 patients (19.0 % had at least one severe AE reported. Patients with at least one AE experienced a median of 3 (IQR: 2-4 AEs per patient. HIV-positive patients with CD4 counts ≤100 cells/mm3 and those newly initiating ART were more likely to experience a severe AE (sHR: 2.76, 95 % CI: 1.30–5

  3. Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

    Science.gov (United States)

    Spoerri, Adrian; Egger, Matthias; Kielkowski, Danuta; Crankshaw, Tamaryn; Cloete, Christie; Giddy, Janet; Bohlius, Julia

    2016-01-01

    The surveillance of HIV‐related cancers in South Africa is hampered by the lack of systematic collection of cancer diagnoses in HIV cohorts and the absence of HIV status in cancer registries. To improve cancer ascertainment and estimate cancer incidence, we linked records of adults (aged ≥ 16 years) on antiretroviral treatment (ART) enrolled at Sinikithemba HIV clinic, McCord Hospital in KwaZulu‐Natal (KZN) with the cancer records of public laboratories in KZN province using probabilistic record linkage (PRL) methods. We calculated incidence rates for all cancers, Kaposi sarcoma (KS), cervix, non‐Hodgkin's lymphoma and non‐AIDS defining cancers (NADCs) before and after inclusion of linkage‐identified cancers with 95% confidence intervals (CIs). A total of 8,721 records of HIV‐positive patients were linked with 35,536 cancer records. Between 2004 and 2010, we identified 448 cancers, 82% (n = 367) were recorded in the cancer registry only, 10% (n = 43) in the HIV cohort only and 8% (n = 38) both in the HIV cohort and the cancer registry. The overall cancer incidence rate in patients starting ART increased from 134 (95% CI 91–212) to 877 (95% CI 744–1,041) per 100,000 person‐years after inclusion of linkage‐identified cancers. Incidence rates were highest for KS (432, 95% CI 341–555), followed by cervix (259, 95% CI 179–390) and NADCs (294, 95% CI 223–395) per 100,000 person‐years. Ascertainment of cancer in HIV cohorts is incomplete, PRL is both feasible and essential for cancer ascertainment. PMID:27098265

  4. HIV incidence in an open national cohort of men who have sex with men attending sexually transmitted infection clinics in England.

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    Desai, S; Nardone, A; Hughes, G; Delpech, V; Burns, F; Hart, G; Gill, O N

    2017-10-01

    The aim of the study was to determine HIV incidence among men who have sex with men (MSM) who repeat test for HIV at sexually transmitted infection (STI) clinics in England, and identify associated factors. Annual HIV incidence and 95% confidence interval (CI) were calculated for a national cohort of MSM who tested HIV negative at any STI clinic in England in 2012 and had a follow-up test within 1 year using routinely collected data. Cox regression analyses were performed to identify predictors of HIV acquisition and population attributable risk for HIV infection was calculated for predictors. In 2012, 85 500 MSM not known to be HIV positive attended any STI clinic in England, and 31% tested for HIV at least twice within 1 year at the same clinic. HIV incidence was 2.0 per 100 person-years (PY; 95% CI 1.8-2.2) among repeat testers. Incidence was higher among MSM of black ethnicity (3.2 per 100 PY) and those with a bacterial STI diagnosis at the initial attendance (3.2 per 100 PY). MSM with a previous syphilis or gonorrhoea infection were at significantly greater risk of acquiring HIV in the subsequent year [adjusted hazard ratio 4.1 (95% CI 2.0-8.3) and 2.1 (95% CI 1.4-3.2), respectively]. The predictors accounted for 37% of HIV infections. Annual HIV incidence among MSM attending STI clinics in England is high. Previous STIs were predictors of HIV acquisition but only accounted for one in five infections. More discriminatory behavioural predictors of HIV acquisition could provide better triaging of HIV prevention services for MSM attending STI clinics. © 2017 British HIV Association.

  5. High prevalence of Mycobacterium tuberculosis bacteraemia among a cohort of HIV-infected patients with severe sepsis in Lusaka, Zambia.

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    Muchemwa, Levy; Shabir, Lakhi; Andrews, Ben; Bwalya, Mwango

    2017-05-01

    Tuberculosis is recognised as one of the leading causes of severe sepsis among HIV-infected patients. Most patients with Mycobacterium tuberculosis bacteraemia have advanced HIV disease with CD4 counts less than 100 cells/μl and its presentation is non-specific in most instances. This was a cross-sectional study which was done by analyzing data from 201 adult HIV-infected patients who met the inclusion criteria for severe sepsis. The prevalence of Mycobacterium tuberculosis bactraemia in the study population was 34.8%. Severe sepsis caused by other etiologies was observed in 33 (16.4%) of the participants. Concomitant infection of Mycobacterium tuberculosis bactraemia with other organisms is not uncommon in patients with severe sepsis. This cohort of HIV-infected patients had severe immunosuppression with a median CD4 count of 51 (20-136) cells/μl with moderate anaemia, mean haemoglobin 8.0 (3.0) g/dl, and were generally underweight with a mean mid upper arm circumference (MUAC) of 21.0 (3.4) cm. Mycobacterium tuberculosis bacteraemia is very common in HIV-infected patients with advanced HIV disease who present with severe sepsis. Mycobacterium tuberculosis bacteraemia co-infection with aerobic organisms is not uncommon. Factors that were independently associated with Mycobacterium tuberculosis bacteraemia in our study population were MUAC and sodium level.

  6. HIV prevalence and incidence are no longer falling in southwest Uganda: evidence from a rural population cohort 1989-2005.

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    Shafer, Leigh Anne; Biraro, Samuel; Nakiyingi-Miiro, Jessica; Kamali, Anatoli; Ssematimba, Duncan; Ouma, Joseph; Ojwiya, Amato; Hughes, Peter; Van der Paal, Lieve; Whitworth, Jimmy; Opio, Alex; Grosskurth, Heiner

    2008-08-20

    Throughout the 1990s, HIV-1 prevalence and incidence were falling in Uganda. Recently, some researchers have noticed that HIV-1 prevalence is levelling off. We examine prevalence, incidence, and sexual behaviour trends in a rural population cohort in Uganda over 16 years. We report prevalence by survey round and incidence by calendar year from a prospective general population cohort study. Using logistic regression Wald tests, we examined casual partners, condom use, and pregnancies. We examined age at sexual debut by means of life tables. HIV-1 prevalence declined from 8.5% in 1990/1991 to 6.2% in 1999/2000, and thereafter rose to 7.7% in 2004/2005. Incidence (per 1000 person-years at risk) fell from 7.5 in 1990 to 4.1 in 1998, and thereafter increased to 5.0 by 2004. The 2005 incidence estimate reached an all-time low of 2.5, but the preliminary 2006 estimate shows a rise again. Incidence trends varied by age and sex. Some sexual behaviour indicators showed more risky behaviour in recent years compared with the 1990s, whereas others indicated that the reduction in risky behaviour that began in the 1990s continues. HIV-1 prevalence is rising in this cohort. Incidence is stabilizing, and shows signs of increasing among some subgroups. The extent to which changing sexual behaviour has played a role in these epidemiological trends is unclear, but it is likely to have contributed. To solidify the success that Uganda had throughout the 1990s in controlling the HIV epidemic, the efforts in HIV prevention need to be re-strengthened, using all strategies known.

  7. Mapping abnormal subcortical brain morphometry in an elderly HIV+ cohort

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    Benjamin S.C. Wade

    2015-01-01

    Full Text Available Over 50% of HIV+ individuals exhibit neurocognitive impairment and subcortical atrophy, but the profile of brain abnormalities associated with HIV is still poorly understood. Using surface-based shape analyses, we mapped the 3D profile of subcortical morphometry in 63 elderly HIV+ participants and 31 uninfected controls. The thalamus, caudate, putamen, pallidum, hippocampus, amygdala, brainstem, accumbens, callosum and ventricles were segmented from high-resolution MRIs. To investigate shape-based morphometry, we analyzed the Jacobian determinant (JD and radial distances (RD defined on each region's surfaces. We also investigated effects of nadir CD4+ T-cell counts, viral load, time since diagnosis (TSD and cognition on subcortical morphology. Lastly, we explored whether HIV+ participants were distinguishable from unaffected controls in a machine learning context. All shape and volume features were included in a random forest (RF model. The model was validated with 2-fold cross-validation. Volumes of HIV+ participants' bilateral thalamus, left pallidum, left putamen and callosum were significantly reduced while ventricular spaces were enlarged. Significant shape variation was associated with HIV status, TSD and the Wechsler adult intelligence scale. HIV+ people had diffuse atrophy, particularly in the caudate, putamen, hippocampus and thalamus. Unexpectedly, extended TSD was associated with increased thickness of the anterior right pallidum. In the classification of HIV+ participants vs. controls, our RF model attained an area under the curve of 72%.

  8. Hospitalizations among HIV controllers and persons with medically controlled HIV in the U.S. Military HIV Natural History Study

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    Trevor A Crowell

    2016-03-01

    Full Text Available Introduction: HIV controllers (HICs experience relatively low-level viraemia and CD4 preservation without antiretroviral therapy (ART, but also immune activation that may predispose to adverse clinical events such as cardiovascular disease and hospitalization. The objective of this study was to characterize the rates and reasons for hospitalization among HICs and persons with medically controlled HIV. Methods: Subjects with consistently well-controlled HIV were identified in the U.S. Military HIV Natural History Study. ART prescription and HIV-1 RNA data were used to categorize subjects as HICs or medically controlled as defined by ≥3 HIV-1 RNA measurements ≤2000 or ≤400 copies/mL, respectively, representing the majority of measurements spanning ≥12 months. Hospitalizations were tallied and assigned diagnostic categories. All-cause hospitalization rates were compared between groups using negative binomial regression. Results and discussion: Of 3106 subjects followed from 2000 to 2013, 221 were HICs, including 33 elite (1.1% and 188 viraemic (6.0% controllers, who contributed 882 person-years (PY of observation time. An additional 870 subjects with medically controlled HIV contributed 4217 PY. Mean hospitalization rates were 9.4/100 PY among HICs and 8.8/100 PY among medically controlled subjects. Non-AIDS-defining infections were the most common reason for hospitalization (2.95/100 PY and 2.70/100 PY, respectively and rates of cardiovascular hospitalization were similar in both groups (0.45/100 PY and 0.76/100 PY. There was no difference in hospitalization rate for HICs compared with subjects with medically controlled HIV (adjusted incidence rate ratio 1.15 [95% confidence interval 0.80 to 1.65]. Conclusions: All-cause and cardiovascular hospitalization rates did not differ between HICs and persons with medically controlled HIV. Non-AIDS defining infections were common in this young, healthy, predominantly male cohort of military

  9. Pharmacist counseling in a cohort of women with HIV and women at risk for HIV

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    Cunningham CO

    2012-06-01

    Full Text Available Jennifer M Cocohoba,1 Keri N Althoff,2 Mardge Cohen,3 Haihong Hu,4 Chinazo O Cunningham,5 Anjali Sharma,6 Ruth M Greenblatt1,71University of California, San Francisco School of Pharmacy, San Francisco, CA; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Department of Medicine, Stroger Hospital and Rush Medical College, Chicago, IL; 4Department of Medicine, Georgetown University, Washington, DC; 5Albert Einstein College of Medicine, Bronx, NY; 6SUNY Downstate Medical Center, Brooklyn, NY; 7University of California, San Francisco School of Medicine, San Francisco, CA, USABackground and methods: Achieving high adherence to antiretroviral therapy for human immunodeficiency virus (HIV is challenging due to various system-related, medication-related, and patient-related factors. Community pharmacists can help patients resolve many medication-related issues that lead to poor adherence. The purpose of this cross-sectional survey nested within the Women’s Interagency HIV Study was to describe characteristics of women who had received pharmacist medication counseling within the previous 6 months. The secondary objective was to determine whether HIV-positive women who received pharmacist counseling had better treatment outcomes, including self-reported adherence, CD4+ cell counts, and HIV-1 viral loads.Results: Of the 783 eligible participants in the Women’s Interagency HIV Study who completed the survey, only 30% of participants reported receiving pharmacist counseling within the last 6 months. Factors independently associated with counseling included increased age (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.07–1.55, depression (OR 1.75; 95% CI 1.25–2.45, and use of multiple pharmacies (OR 1.65; 95% CI 1.15–2.37. Patients with higher educational attainment were less likely to report pharmacist counseling (OR 0.68; 95% CI 0.48–0.98, while HIV status did not play a statistically significant role. HIV

  10. Management of dyslipidaemia in an HIV-positive cohort

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    A Loy

    2012-11-01

    Full Text Available Background: Dyslipidaemia, secondary to both HIV and the use of antiretroviral therapy (ART is well recognised, with HIV replication and immune status also thought to contribute to the risk. Traditionally the HIV physician has looked after HIV with primary care physicians (GP managing non-HIV-related medical issues. However with the ageing population and the effectiveness of ART the HIV physician is diversifying to focus management strategies on preventative measures also. Method: 127 subjects were recruited. All subjects were HIV-positive males without any traditional cardiovascular disease symptoms or history. Details of patients demographics, family history, statin therapy, and primary care physician contact were collected. Baseline parameters were recorded and fasting bloods taken. Results: 127 asymptomatic HIV-positive males were recruited. 74/127 (58.3% met the EACS criteria for statin prescription. 33/74 (44.6% were on a statin. There was no significant difference between the class of antiretroviral prescribed, (NNRTI v PI and lipid abnormalities (p=0.628. Hypertension and increased waist:hip ratio significantly increased the chances of the patient being hyperlipidaemic. Patients were more likely to be prescribed a statin if they were older, had hypertension, an increased waist circumference, increased Framingham risk, increased brain natriuretic peptide (BNP, or were diagnosed HIV-positive for longer (p<0.05. Pravastatin (21/33 [63.6%], was most commonly prescribed statin. 24.2% received their statin prescription from their HIV physician, with 75.8% receiving their prescription from their GP. 5/21 (23.8% on pravastatin met the target verses 7/7 (100% on atorvastatin verses 2/2 (100% on simvastatin versus 1/3 (33.3% on rosuvastatin (p=0.02. Meeting lipid targets was less successful in the protease inhibitor group (1/9 11.1% versus 11/21 (52.4% in the NNRTI group (p=0.16. Conclusion: The majority met criteria for lipid management but less

  11. Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study.

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    Hussen, Sophia A; Chakraborty, Rana; Knezevic, Andrea; Camacho-Gonzalez, Andres; Huang, Eugene; Stephenson, Rob; Del Rio, Carlos

    2017-09-01

    The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p = 0.002). Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year

  12. Validation of an algorithm to identify antiretroviral-naïve status at time of entry into a large, observational cohort of HIV-infected patients.

    Science.gov (United States)

    Gandhi, Neel R; Tate, Janet P; Rodriguez-Barradas, Maria C; Rimland, David; Goetz, Matthew Bidwell; Gibert, Cynthia; Brown, Sheldon T; Mattocks, Kristin; Justice, Amy C

    2013-09-01

    Large, observational HIV cohorts play an important role in answering questions which are difficult to study in randomized trials; however, they often lack detailed information regarding previous antiretroviral treatment (ART). Knowledge of ART treatment history is important when ascertaining the long-term impact of medications, co-morbidities, or adverse reactions on HIV outcomes. We performed a retrospective study to validate a prediction algorithm for identifying ART-naïve patients using the Veterans Aging Cohort Study's Virtual Cohort-an observational cohort of 40 594 HIV-infected veterans nationwide. Medical records for 3070 HIV-infected patients were reviewed to determine history of combination ART treatment. An algorithm using Virtual Cohort laboratory data was used to predict ART treatment status and compared to medical record review. Among 3070 patients' medical records reviewed, 1223 were eligible for analysis. Of these, 990 (81%) were ART naïve at cohort entry based on medical record review. The prediction algorithm's sensitivity was 86%, specificity 47%, positive predictive value (PPV) 87%, and negative predictive value 45%, using a viral load threshold of limit analyses to ART-naïve patients when studying the contribution of ART to outcomes and adverse events. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Spatial distribution of HIV, HCV, and co-infections among drug users in the southwestern border areas of China (2004-2014): a cohort study of a national methadone maintenance treatment program.

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    Li, Mingli; Li, Rongjian; Shen, Zhiyong; Li, Chunying; Liang, Nengxiu; Peng, Zhenren; Huang, Wenbo; He, Chongwei; Zhong, Feng; Tang, Xianyan; Lan, Guanghua

    2017-09-30

    A methadone maintenance treatment (MMT) program to curb the dual epidemics of HIV/AIDS and drug use has been administered by China since 2004. Little is known regarding the geographic heterogeneity of HIV and hepatitis C virus (HCV) infections among MMT clients in the resource-constrained context of Chinese provinces, such as Guangxi. This study aimed to characterize the geographic distribution patterns and co-clustered epidemic factors of HIV, HCV and co-infections at the county level among drug users receiving MMT in Guangxi Zhuang Autonomous Region, located in the southwestern border area of China. Baseline data on drug users' demographic, behavioral and biological characteristics in the MMT clinics of Guangxi Zhuang Autonomous Region during the period of March 2004 to December 2014 were obtained from national HIV databases. Residential addresses were entered into a geographical information system (GIS) program and analyzed for spatial clustering of HIV, HCV and co-infections among MMT clients at the county level using geographic autocorrelation analysis and geographic scan statistics. A total of 31,015 MMT clients were analyzed, and the prevalence of HIV, HCV and co-infections were 13.05%, 72.51% and 11.96% respectively. Both the geographic autocorrelation analysis and geographic scan statistics showed that HIV, HCV and co-infections in Guangxi Zhuang Autonomous Region exhibited significant geographic clustering at the county level, and the Moran's I values were 0.33, 0.41 and 0.30, respectively (P areas surrounding P county. HIV, HCV and co-infections among MMT clients in Guangxi Zhuang Autonomous Region all presented substantial geographic heterogeneity at the county level with a number of overlapping significant clusters. The areas surrounding P county were effective in enrolling high-risk clients in their MMT programs which, in turn, might enable people who inject drugs to inject less, share fewer syringes, and receive referrals for HIV or HCV treatment in

  14. Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa.

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    Fatti, G; Shaikh, N; Eley, B; Jackson, D; Grimwood, A

    2014-12-01

    South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories. A cohort of HIV-positive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as 24 years old and adolescents as 19 years. The effect of younger maternal age categories on MTCT and maternal and child health outcomes was assessed using log-binomial and Cox regression controlling for confounding, using women aged > 24 years as the comparison group. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (CI) 1.21 - 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 - 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 - 0.94), and increased MTCT (aRR 3.07; 95% CI 1.18 - 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 - 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 - 426) and stillbirth (aRR 3.33; 95% CI 1.53 - 7.25). An increasing proportion of pregnant HIV-positive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal

  15. CD8+ T-Cells Count in Acute Myocardial Infarction in HIV Disease in a Predominantly Male Cohort

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    Oluwatosin A. Badejo

    2015-01-01

    Full Text Available Human Immunodeficiency Virus- (HIV- infected persons have a higher risk for acute myocardial infarction (AMI than HIV-uninfected persons. Earlier studies suggest that HIV viral load, CD4+ T-cell count, and antiretroviral therapy are associated with cardiovascular disease (CVD risk. Whether CD8+ T-cell count is associated with CVD risk is not clear. We investigated the association between CD8+ T-cell count and incident AMI in a cohort of 73,398 people (of which 97.3% were men enrolled in the U.S. Veterans Aging Cohort Study-Virtual Cohort (VACS-VC. Compared to uninfected people, HIV-infected people with high baseline CD8+ T-cell counts (>1065 cells/mm3 had increased AMI risk (adjusted HR=1.82, P<0.001, 95% CI: 1.46 to 2.28. There was evidence that the effect of CD8+ T-cell tertiles on AMI risk differed by CD4+ T-cell level: compared to uninfected people, HIV-infected people with CD4+ T-cell counts ≥200 cells/mm3 had increased AMI risk with high CD8+ T-cell count, while those with CD4+ T-cell counts <200 cells/mm3 had increased AMI risk with low CD8+ T-cell count. CD8+ T-cell counts may add additional AMI risk stratification information beyond that provided by CD4+ T-cell counts alone.

  16. Treatment and disease progression in a birth cohort of vertically HIV-1 infected children in Ukraine

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    Pilipenko Tatyana

    2010-11-01

    Full Text Available Abstract Background Ukraine has the highest HIV prevalence (1.6% and is facing the fastest growing epidemic in Europe. Our objective was to describe the clinical, immunological and virological characteristics, treatment and response in vertically HIV-infected children living in Ukraine and followed from birth. Methods The European Collaborative Study (ECS is an ongoing cohort study, in which HIV-1 infected pregnant women are enrolled and followed in pregnancy, and their children prospectively followed from birth. ECS enrolment in Ukraine started in 2000 initially with three sites, increasing to seven sites by 2009. Results A total of 245 infected children were included in the cohort by April 2009, with a median age of 23 months at most recent follow-up; 33% (n = 77 had injecting drug using mothers and 85% (n = 209 were infected despite some use of antiretroviral prophylaxis for prevention of mother-to-child transmission. Fifty-five (22% children had developed AIDS, at a median age of 10 months (IQR = 6-19. The most prevalent AIDS indicator disease was Pneumocystis jiroveci pneumonia (PCP. Twenty-seven (11% children had died (median age, 6.2 months. Overall, 108 (44% children had started highly active antiretroviral treatment (HAART, at a median 18 months of age; median HAART duration was 6.6 months to date. No child discontinued HAART and 92% (100/108 remained on their first-line HAART regimen to date. Among children with moderate/severe immunosuppression, 36% had not yet started HAART. Among children on HAART, 71% (69/97 had no evidence of immunosuppression at their most recent visit; the median reduction in HIV RNA was 4.69 log10 copies/mL over a median of 10 months treatment. From survival analysis, an estimated 94%, 84% and 81% of children will be alive and AIDS-free at 6, 12 and 18 months of age, respectively. However, survival increased significantly over time: estimated survival rates to 12 months of age were 87% for children born in 2000

  17. Long-Term Changes of Subcutaneous Fat Mass in HIV-Infected Children on Antiretroviral Therapy: A Retrospective Analysis of Longitudinal Data from Two Pediatric HIV-Cohorts.

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    Sophie Cohen

    Full Text Available Longitudinal studies objectively evaluating changes in regional fat distribution of HIV-infected children assessed by whole body dual energy X-ray absorptiometry (DEXA are scarce, whilst this long-term effect of HIV and antiretroviral therapy (cART is an important issue in infected children in need for lifelong treatment.We assessed regional fat distribution over time, measured with sequential DEXA-scans in HIV-infected children on cART in cohorts from South Africa (SA and the Netherlands (NL, and in healthy controls (SA. Limb and trunk fat Z-scores were calculated with the lambda-mu-sigma (LMS method. Multivariable linear regression models with mixed effects were used to investigate the effect of cART compounds on body fat distribution over time.In total, 218 children underwent 445 DEXA assessments with a median follow-up of 3.5 years. Fat mass in all limbs was decreased in HIV-infected children compared to controls (arm fat Z-score: coefficient -0.4813; P = 0.006, leg fat Z-score: coefficient -0.4345; P = 0.013. In the HIV-infected group, stavudine treatment was associated with lower subcutaneous fat mass (arm fat Z-score: coefficient -0.5838; P = 0.001, with an additional cumulative exposure effect (arm fat Z-score: coefficient -0.0867; P = 0.003.Our study shows that subcutaneous fat loss is still prevalent in HIV-infected children on cART, and is strongly associated with cumulative stavudine exposure. These results underline the need for early detection of subcutaneous fat loss and alternative treatment options for HIV-infected children globally.

  18. HIV Care in the Swedish-Danish HIV Cohort 1995-2010

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    Helleberg, Marie; Häggblom, Amanda; Sönnerborg, Anders

    2013-01-01

    Successful treatment reduces morbidity, mortality and transmission of HIV. We evaluated trends in the treatment status of HIV infected individuals enrolled in care in Sweden and Denmark during the years 1995-2010. Our aim was to assess the proportion of HIV-infected individuals who received...

  19. Incidence of and temporal relationships between HIV, herpes simplex II virus, and syphilis among men who have sex with men in Bangkok, Thailand: an observational cohort.

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    Thienkrua, Warunee; Todd, Catherine S; Chonwattana, Wannee; Wimonsate, Wipas; Chaikummao, Supaporn; Varangrat, Anchalee; Chitwarakorn, Anupong; van Griensven, Frits; Holtz, Timothy H

    2016-07-22

    High HIV incidence has been detected among men who have sex with men (MSM) in Thailand, but the relationship and timing of HIV, herpes simplex virus 2 (HSV-2), and syphilis is unknown. This analysis measures incidence, temporal relationships, and risk factors for HIV, HSV-2, and syphilis among at-risk MSM in the Bangkok MSM Cohort Study. Between April 2006 and December 2010, 960 men negative for HIV, HSV-2, and syphilis at entry enrolled and contributed 12-60 months of follow-up data. Behavioral questionnaires were administered at each visit; testing for HIV antibody was performed at each visit, while testing for syphilis and HSV-2 were performed at 12 month intervals. We calculated HIV, HSV-2, and syphilis incidence, assessed risk factors with complementary log-log regression, and among co-infected men, measured temporal relationships between infections with Kaplan-Meier survival analysis and paired t-test. The total number of infections and incidence density for HIV, HSV-2, and syphilis were 159 infections and 4.7 cases/100 PY (95 % Confidence Interval (CI): 4.0-5.4), 128 infections and 4.5/100 PY (95 % CI: 3.9-5.5), and 65 infections and 1.9/100 PY (95 % CI: 1.5-2.5), respectively. Among men acquiring >1 infection during the cohort period, mean time to HIV and HSV-2 infection was similar (2.5 vs. 2.9 years; p = 0.24), while syphilis occurred significantly later following HIV (4.0 vs. 2.8 years, p syphilis (Adjusted Hazards Ratio (AHR) = 3.49, 95 % CI: 1.89-6.42) or HIV (AHR = 2.26, 95 % CI: 1.47-3.48) acquisition during the cohort was significantly higher among men with incident HSV-2 infection. No single independent behavioral factor was common to HIV, HSV-2, and syphilis acquisition. HIV and HSV-2 incidence was high among this Thai MSM cohort. However, acquisition of HIV and co-infection with either HSV-2 or syphilis was low during the time frame men were in the cohort. Evaluation of behavioral risk factors for these infections suggests

  20. Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort

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    Gregson, Simon; Mugurungi, Owen; Eaton, Jeffrey; Takaruza, Albert; Rhead, Rebecca; Maswera, Rufurwokuda; Mutsvangwa, Junior; Mayini, Justin; Skovdal, Morten; Schaefer, Robin; Hallett, Timothy; Sherr, Lorraine; Munyati, Shungu; Mason, Peter; Campbell, Catherine; Garnett, Geoffrey P; Nyamukapa, Constance Anesu

    2017-01-01

    Purpose The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART). Participants General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15–44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years). Findings to date HIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART. Future plans We plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome. PMID

  1. Incidence of Co-Infections of HIV, Herpes Simplex Virus Type 2 and Syphilis in a Large Cohort of Men Who Have Sex with Men in Beijing, China

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    Zhang, Zheng; Wang, Zixin; Qi, Xiao; Ruan, Yuhua; Zhou, Yunhua; Li, Chunrong; Luo, Fengji; Lau, Joseph T. F.

    2016-01-01

    Background The HIV-epidemic among MSM in China has worsened. In this key population, prevalence of HSV-2 and syphilis infection and co-infection with HIV is high. Methods A longitudinal study was conducted (n = 962) in Beijing, China, with three overlapping cohorts (n = 857, 757 and 760) consisting of MSM that were free from pairs of infections of concern (i.e. HIV-HSV-2, HIV-syphilis, HSV-2-syphilis) at baseline to estimate incidence of HIV, HSV-2, syphilis, and those of co-infection. Results The incidence of HIV, HSV-2 and syphilis in the overall cohort was 3.90 (95% CI = 2.37, 5.43), 7.87 (95% CI = 5.74, 10.00) and 6.06 (95% CI = 4.18, 7.94) cases per 100 person-years (PYs), respectively. The incidence of HIV-HSV-2, HIV-Syphilis and HSV-2-Syphilis co-infections was 0.30 (95% CI = 0.29, 0.88), 1.02 (95% CI = 0.13, 2.17) and 1.41 (95% CI: 0.04, 2.78) cases per 100 PYs, respectively, in the three sub-cohorts constructed for this study. Conclusions The incidence of HIV, HSV-2 and syphilis was very high and those of their co-infections were relatively high. Such co-infections have negative impacts on the HIV/STI epidemics. Prevention practices need to take such co-infections into account. PMID:26820145

  2. Partial protective effect of CCR5-Delta 32 heterozygosity in a cohort of heterosexual Italian HIV-1 exposed uninfected individuals

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    Cauda Roberto

    2006-09-01

    Full Text Available Abstract Despite multiple sexual exposure to HIV-1 virus, some individuals remain HIV-1 seronegative (exposed seronegative, ESN. The mechanisms underlying this resistance remain still unclear, although a multifactorial pathogenesis can be hypothesised. Although several genetic factors have been related to HIV-1 resistance, the homozigosity for a mutation in CCR5 gene (the 32 bp deletion, i.e. CCR5-Delta32 allele is presently considered the most relevant one. In the present study we analysed the genotype at CCR5 locus of 30 Italian ESN individuals (case group who referred multiple unprotected heterosexual intercourse with HIV-1 seropositive partner(s, for at least two years. One hundred and twenty HIV-1 infected patients and 120 individuals representative of the general population were included as control groups. Twenty percent of ESN individuals had heterozygous CCR5-Delta 32 genotype, compared to 7.5% of HIV-1 seropositive and 10% of individuals from the general population, respectively. None of the analysed individuals had CCR5-Delta 32 homozygous genotype. Sequence analysis of the entire open reading frame of CCR5 was performed in all ESN subjects and no polymorphisms or mutations were identified. Moreover, we determined the distribution of C77G variant in CD45 gene, which has been previously related to HIV-1 infection susceptibility. The frequency of the C77G variant showed no significant difference between ESN subjects and the two control groups. In conclusion, our data show a significantly higher frequency of CCR5-Delta 32 heterozygous genotype (p = 0.04 among the Italian heterosexual ESN individuals compared to HIV-1 seropositive patients, suggesting a partial protective role of CCR5-Delta 32 heterozygosity in this cohort.

  3. Internet-based cohort study of HIV testing over 1 year among men who have sex with men living in England and exposed to a social marketing intervention promoting testing.

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    Hickson, Ford; Tomlin, Keith; Hargreaves, James; Bonell, Chris; Reid, David; Weatherburn, Peter

    2015-02-01

    Increasing HIV testing among men who have sex with men (MSM) is a major policy goal in the UK. Social marketing is a common intervention to increase testing uptake. We used an online panel of MSM to examine rates of HIV testing behaviour and the impact of a social marketing intervention on them. MSM in England were recruited to a longitudinal internet panel through community websites and a previous survey. Following an enrolment survey, respondents were invited to self-complete 13 surveys at monthly intervals throughout 2011. A unique alphanumeric code linked surveys for individuals. Rates of HIV testing were compared relative to prompted recognition of a multi-part media campaign aiming to normalise HIV testing. Of 3386 unique enrolments, 2047 respondents were included in the analysis, between them submitting 15,353 monthly surveys (equivalent to 1279 years of follow-up), and recording 1517 HIV tests taken, giving an annual rate of tests per participant of 1.19 (95% CI 1.13 to 1.25). Tests were highly clustered in individuals (61% reported no test during the study). Testing rates were higher in London, single men and those aged 25-34 years. Only 7.6% recognised the intervention when prompted. After controlling for sociodemographic characteristics and exposure to other health promotion campaigns, intervention recognition was not associated with increased likelihood of testing. Higher rates of testing were strongly associated with higher number of casual sexual partners and how recently men had HIV tested before study enrolment. This social marketing intervention was not associated with increased rates of HIV testing. More effective promotion of HIV testing is needed among MSM in England to reduce the average duration of undiagnosed infection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Interactive Data Visualization for HIV Cohorts: Leveraging Data Exchange Standards to Share and Reuse Research Tools.

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    Meridith Blevins

    Full Text Available To develop and disseminate tools for interactive visualization of HIV cohort data.If a picture is worth a thousand words, then an interactive video, composed of a long string of pictures, can produce an even richer presentation of HIV population dynamics. We developed an HIV cohort data visualization tool using open-source software (R statistical language. The tool requires that the data structure conform to the HIV Cohort Data Exchange Protocol (HICDEP, and our implementation utilized Caribbean, Central and South America network (CCASAnet data.This tool currently presents patient-level data in three classes of plots: (1 Longitudinal plots showing changes in measurements viewed alongside event probability curves allowing for simultaneous inspection of outcomes by relevant patient classes. (2 Bubble plots showing changes in indicators over time allowing for observation of group level dynamics. (3 Heat maps of levels of indicators changing over time allowing for observation of spatial-temporal dynamics. Examples of each class of plot are given using CCASAnet data investigating trends in CD4 count and AIDS at antiretroviral therapy (ART initiation, CD4 trajectories after ART initiation, and mortality.We invite researchers interested in this data visualization effort to use these tools and to suggest new classes of data visualization. We aim to contribute additional shareable tools in the spirit of open scientific collaboration and hope that these tools further the participation in open data standards like HICDEP by the HIV research community.

  5. cholangiopathy in a co-hort of hiv positive kenyan patients

    African Journals Online (AJOL)

    2013-12-01

    Dec 1, 2013 ... East African Medical Journal Vol. 90 No. 12 (Supplement) December 2013. CHOLANGIOPATHY IN A CO-HORT OF HIV POSITIVE KENYAN PATIENTS. A. E. O. Otedo, MBChB, MMed (Int. Med), Cert. Gastroenterology, DDMS/Senior Medical Specialist, Consultant. Physician and Gastroenterologist, J. O. ...

  6. The effect of antiretroviral therapy on the prevalence of HIV-associated oral candidiasis in a Spanish cohort.

    Science.gov (United States)

    Ceballos-Salobreña, Alejandro; Gaitaín-Cepeda, Luis; Ceballos-García, Laura; Samaranayake, Lakshman P

    2004-03-01

    To investigate the temporal changes in the prevalence of oral candidiasis in a cohort of Spanish human immunodeficiency virus (HIV)-infected individuals, before and after the introduction of highly active antiretroviral therapy (HAART). Retrospective analysis of a clinical database from "Carlos Haya" Hospital, Málaga, Spain, from 1995 to 2000. The prevalence of oral candidiasis was assessed in 807 HIV/AIDS patients and the temporal progression of its major variants evaluated using a linear regression model. Overall oral candidiasis was prevalent in 30.0% to 48.3% of the cohort throughout and no significant variation in its incidence was noted during the study period. Prevalence of erythematous candidiasis increased from 24.5% (1995) to 45.0% (2000) and pseudomembranous candidiasis decreased from 22.4% (1995) to 5.2% (2000) (PHyperplastic candidiasis was not detected in the cohort after the introduction of HAART therapy. Although oral candidiasis in HIV-infected Spanish individuals has not decreased significantly after the introduction of HAART, there appears to be a significant reduction in hyperplastic and pseudomembranous variants of the disease with a compensatory increase in erythematous candidiasis.

  7. Impaired lipid profile and insulin resistance in a cohort of Austrian HIV patients.

    Science.gov (United States)

    Schulte-Hermann, Kathrin; Schalk, Horst; Haider, Bernhard; Hutterer, Judith; Gmeinhart, Bernd; Pichler, Karlheinz; Brath, Helmut; Dorner, Thomas E

    2016-04-01

    Traditional risk factors for cardiovascular diseases have been shown to have an even higher impact in the HIV infected population. Cardiovascular risk factors amongst people living with HIV treated in doctor's offices in Austria have not been documented before. Our study aimed to close this gap, focusing on dyslipidemia, diabetes mellitus and diabetes risk. After ethics approval, consecutive patients who visited their treating physicians for routine checks were enrolled. The lipid profile was assessed by measuring total cholesterol, triglycerides, HDL and apolipoprotein B and calculating LDL and non-HDL-cholesterol. The diabetes risk was calculated by measuring insulin and blood glucose levels and assessing insulin resistance and beta cell function using the HOMA-IR model. 522 patients were included in the analysis. 90.2% of the participants were on antiretroviral therapy. Two third had an impaired lipid profile, but dyslipidemia had been diagnosed only in 46.3% of the patients. There was a clear correlation between protease inhibitor use and pathologic blood lipids. Of the persons with dyslipidemia, 18.4% received lipid lowering drugs. 8 persons (1.6%) fulfilled the criteria for diabetes mellitus. Of those, 4 patients already had a diagnosed diabetes mellitus. 50.1% of the study participants showed an increased insulin resistance. Patients on nucleoside reverse transcriptase inhibitors had significantly higher markers for impaired glucose metabolism. We found a high percentage of increased insulin resistance, of impaired lipid profile and in contrast to this a low treatment rate with lipid lowering drugs in this cohort of people living with HIV. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  8. HIV-Associated Oral Mucosal Melanin Hyperpigmentation: A Clinical Study in a South African Population Sample

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    R. Chandran

    2016-01-01

    Full Text Available Objective. The aim of the study was to determine the prevalence of HIV-associated oral mucosal melanin hyperpigmentation (HIV-OMH in a specific population of HIV-seropositive South Africans and to analyse the associations between HIV-OMH clinical features and the demographic and immunological characteristics of the study cohort. Material and Methods. This cross-sectional study included 200 HIV-seropositive Black subjects. The collected data comprised age, gender, CD4+ T cell count, viral load, systemic disease, medications, oral site affected by HIV-OMH, extent (localized or generalized, intensity of the pigmentation (dark or light, and smoking and snuff use. Results. Overall, 18.5% of the study cohort had HIV-OMH. Twenty-two and a half percent had OMH that could not with confidence be attributed to HIV infection, and 59% did not have any OMH. There was a significant but weak association between smoking and the presence of HIV-OMH. Conclusions. The prevalence of HIV-OMH in the study population was 18.5%, the gingiva being the most commonly affected site. It appears that the CD4+ T cell count does not play any role in the biopathology of HIV-OMH.

  9. Citizenship status and engagement in HIV care: an observational cohort study to assess the association between reporting a national ID number and retention in public-sector HIV care in Johannesburg, South Africa.

    Science.gov (United States)

    Shearer, Kate; Clouse, Kate; Meyer-Rath, Gesine; MacLeod, William; Maskew, Mhairi; Sanne, Ian; Long, Lawrence; Fox, Matthew P

    2017-01-24

    In many resource-limited settings, people from rural areas migrate to urban hubs in search of work. Thus, urban public-sector HIV clinics in South Africa (SA) often cater to both local residents and patients from other provinces and/or countries. The objective of this analysis was to compare programmatic treatment outcomes by citizenship status in an urban clinic in SA. An urban public-sector HIV treatment facility in Johannesburg, SA. We included all antiretroviral therapy (ART)-naïve, non-pregnant patients who initiated standard first-line treatment from January 2008 to December 2013. 12 219 patients were included and 59.5% were women. Patients were followed from ART initiation until death, transfer, loss to follow-up (LTF), or data set closure. We describe attrition (mortality and LTF) stratified by SA citizenship status (confirmed SA citizens (with national ID number), unconfirmed SA citizens (no ID), and foreign nationals) and model the risk of attrition using Cox proportional hazards regression. 70% of included patients were confirmed SA citizens, 19% were unconfirmed SA citizens, and 11% were foreign nationals. Unconfirmed SA citizens were far more likely to die or become LTF than