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Factors Associated with antiretroviral therapy Defaulting among Adult Patients Receiving Care at Chikankata Mission Hospital, Chikankata District, Zambia

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Journal of Biosciences and Medicines 2024年第5期12卷 340-365页

作者： Fred Paundi Emmanuel Musenge Namayipo Nankamba Department of Clinical Nursing Sciences School of Nursing Sciences University of Zambia Lusaka Zambia

Background: Defaulting on antiretroviral therapy has been identified as the most important factor contributing to the antiretroviral therapy failure rate. This study aimed to investigate factors associated with defaulting on antiretroviral therapy among adult patients receiving care at Chikankata Mission Hospital antiretroviral therapy clinic. Method: Cross-sectional analytical study on 385 participants selected by a computer generated random numbers technique of simple random sampling from among the patients receiving antiretroviral therapy at Chikankata Mission Hospital. Data collected were processed and analysed using Statistical Package for Social Science version 27. Univariate and backward multivariable logistic regression analysis was performed to identify factors associated with antiretroviral therapy defaulting. The level of significance was set at 5% with a confidence level of 95%. Results: Over half (58.4%) of the study participants defaulted on antiretroviral therapy. About 65.8% of study participants indicated improved health as the reason they defaulted on antiretroviral therapy. Most participants indicated that it was important to always go for antiretroviral therapy services (Adjusted Odds Ratio 1.95;95% Confidence Interval: [1.14 - 3.33], p = 0.015). Very few participants indicated poor family support for antiretroviral therapy services (Adjusted Odds Ratio 4.08;95% Confidence Interval: [2.02 - 8.23], p Conclusion: Defaulting on antiretroviral therapy continues to be a significant problem and needs to be addressed as a matter of priority. More counselling and awareness-raising programmes are required to improve knowledge and understanding on the importance of attending scheduled antiretroviral therapy clinics and services as well as the consequences of defaulting on antiretroviral therapy.

关键词： Defaulting antiretroviral therapy Human Immunodeficiency Virus Acquired Immune Deficiency Syndrome

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Factors of Adherence to Concurrent Tuberculosis Treatment and antiretroviral therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

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Health 2024年第2期16卷 131-147页

作者： François Anicet Onana Akoa Ulrich Dama Jean Ndibi Abanda Alphonse Tedonge Asobochia Melkior Fobasso Dzeuta Pearl Nsom Mbu Yokyu Zachary Pangwoh Pierre Yassa Yoniene Faculty of Health Sciences University of Lisala (CIREP-UNILIS) Lisala Democratic Republic of the Congo Faculty of Health Sciences Catholic University of Central Africa Yaoundé Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon Faculty of Public Health Texila American University Guyana South America Faculty of Medicine University Simon Kimbangu Kinshasa Democratic Republic of the Congo

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

关键词： Factors of Adherence Tuberculosis Treatment antiretroviral therapy HIV-TB Co-Infection East Region Cameroon

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Development of a droplet digital polymerase chain reaction assay for the sensitive detection of total and integrated HIV-1 DNA

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Chinese Medical Journal 2024年第6期137卷 729-736页

作者： Lin Yuan Zhiying Liu Xin Zhang Feili Wei Shan Guo Na Guo Lifeng Liu Zhenglai Ma Yunxia Ji Rui Wang Xiaofan Lu Zhen Li Wei Xia Hao Wu Tong Zhang Bin Su Beijing Key Laboratory for HIV/AIDS Research Clinical and Research Center for Infectious DiseasesBeijing Youan HospitalCapital Medical UniversityBeijing 100069China Beijing Institute of Hepatology Beijing Youan HospitalCapital Medical UniversityBeijing 100069China

Background:Total human immunodeficiency virus(HIV)DNA and integrated HIV DNA are widely used markers of HIV persistence.Droplet digital polymerase chain reaction(ddPCR)can be used for absolute quantification without needing a standard curve.Here,we developed duplex ddPCR assays to detect and quantify total HIV DNA and integrated HIV DNA.Methods:The limit of detection,dynamic ranges,sensitivity,and reproducibility were evaluated by plasmid constructs containing both the HIV long terminal repeat(LTR)and human CD3 gene(for total HIV DNA)and ACH-2 cells(for integrated HIV DNA).Forty-two cases on stable suppressive antiretroviral therapy(ART)were assayed in total HIV DNA and integrated HIV DNA.Correlation coefficient analysis was performed on the data related to DNA copies and cluster of differentiation 4 positive(CD4^(+))T-cell counts,CD8^(+)T-cell counts and CD4/CD8 T-cell ratio,respectively.The assay linear dynamic range and lower limit of detection(LLOD)were also assessed.Results:The assay could detect the presence of HIV-1 copies 100%at concentrations of 6.3 copies/reaction,and the estimated LLOD of the ddPCR assay was 4.4 HIV DNA copies/reaction(95%confidence intervals[CI]:3.6-6.5 copies/reaction)with linearity over a 5-log_(10)-unit range in total HIV DNA assay.For the integrated HIV DNA assay,the LLOD was 8.0 copies/reaction(95%CI:5.8-16.6 copies/reaction)with linearity over a 3-log 10-unit range.Total HIV DNA in CD4^(+)T cells was positively associated with integrated HIV DNA(r=0.76,P<0.0001).Meanwhile,both total HIV DNA and integrated HIV DNA in CD4^(+)T cells were inversely correlated with the ratio of CD4/CD8 but positively correlated with the CD8^(+)T-cell counts.Conclusions:This ddPCR assay can quantify total HIV DNA and integrated HIV DNA efficiently with robustness and sensitivity.It can be readily adapted for measuring HIV DNA with non-B clades,and it could be beneficial for testing in clinical trials.

关键词： Human immunodeficiency virus HIV Integrated HIV-1 DNA Total HIV DNA Droplet digital polymerase chain reaction HIV reservoir antiretroviral therapy

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HIV-1 Subtype Diversity and Factors Affecting Drug Resistance among Patients with Virologic Failure in antiretroviral therapy in Hainan Province,China,2014–2020

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生物医学与环境科学:英文版 2023年第9期36卷 800-813页

作者： YU De E XU Yu Jun LI Mu YANG Yuan LIANG Hua Yue ZHONG Shan Mei QIN Cai LAN Ya Nan LI Da Wei YU Ji Peng PANG Yuan QIN Xue Qiu LIANG Hao ZHU Kao Kao YE Li LIANG Bing Yu Guangxi Key Laboratory of AIDS Prevention and Treatment School of Public HealthGuangxi Medical UniversityNanning 530021GuangxiChina International School of Public Health and One Health Hainan Medical UniversityHaikou 571199HainanChina Prevention and Treatment Department the Fifth People's Hospital of Hainan Province&Affiliated Dermatology Hospital of Hainan Medical UniversityHaikou 570102HainanChina Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry Life Sciences InstituteGuangxi Medical UniversityNanning 530021GuangxiChina Oncology Medical College Guangxi Medical UniversityNanning 530021GuangxiChina The First Clinical Medical College Guangxi Medical UniversityNanning 530021GuangxiChinaGuangxi Key Laboratory of AIDS Prevention and TreatmentSchool of Public HealthGuangxi Medical UniversityNanning 530021GuangxiChina

Objective This study aimed to determine the HIV-1 subtype distribution and HIV drug resistance(HIVDR)in patients with ART failure from 2014 to 2020 in Hainan,China.Methods A 7-year cross-sectional study was conducted among HIV/AIDS patients with ART failure in Hainan.We used online subtyping tools and the maximum likelihood phylogenetic tree to confirm the HIV subtypes with pol sequences.Drug resistance mutations(DRMs)were analyzed using the Stanford University HIV Drug Resistance Database.Results A total of 307 HIV-infected patients with ART failure were included,and 241 available pol sequences were obtained.Among 241 patients,CRF01_AE accounted for 68.88%,followed by CRF07_BC(17.00%)and eight other subtypes(14.12%).The overall prevalence of HIVDR was 61.41%,and the HIVDR against non-nucleoside reverse transcriptase inhibitors(NNRTIs),nucleotide reverse transcriptase inhibitors(NRTIs),and protease inhibitors(PIs)were 59.75%,45.64%,and 2.49%,respectively.Unemployed patients,hypoimmunity or opportunistic infections in individuals,and samples from 2017 to 2020 increased the odd ratios of HIVDR.Also,HIVDR was less likely to affect female patients.The common DRMs to NNRTIs were K103N(21.99%)and Y181C(20.33%),and M184V(28.21%)and K65R(19.09%)were the main DRMs against NRTIs.Conclusion The present study highlights the HIV-1 subtype diversity in Hainan and the importance of HIVDR surveillance over a long period.

关键词： HIV-1 subtypes antiretroviral therapy Virological failure Drug resistance

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Effects of viremia and CD4 recovery on gut“microbiome-immunity”axis in treatment-na?ve HIV-1-infected patients undergoing antiretroviral therapy

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World Journal of Gastroenterology 2022年第6期28卷 635-652页

作者： Edda Russo Giulia Nannini Gaetana Sterrantino Seble Tekle Kiros Vincenzo Di Pilato Marco Coppi Simone Baldi Elena Niccolai Federica Ricci Matteo Ramazzotti Marco Pallecchi Filippo Lagi Gian Maria Rossolini Alessandro Bartoloni Gianluca Bartolucci Amedeo Amedei Department of Clinical and Experimental Medicine University of FlorenceFlorence 50134Italy Department of Surgical Sciences and Integrated Diagnostics University of GenoaGenoa 16126Italy Department of Biomedical Experimental and Clinical"Mario Serio"University of FlorenceFlorence 50134Italy Microbiology and Virology Unit Florence Careggi University HospitalUniversity of FlorenceFlorence 50134Italy Department of Neurosciences PsychologyDrug Research and Child HealthUniversity of FlorenceFlorence 50019Italy

BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and buty

关键词： HIV antiretroviral therapy Microbiome-immunity axis Microbiota Cytokines Short chain fatty acid Inflammation Immunological responders Viremia

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Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

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World Journal of Diabetes 2023年第3期14卷 299-312页

作者： Da-Feng Liu Xin-Yi Zhang Rui-Feng Zhou Lin Cai Dong-Mei Yan Li-Juan Lan Sheng-Hua He Hong Tang Department of Internal Medicine Public Health and Clinical Center of ChengduChengdu 610061Sichuan ProvinceChina Department of Endocrinology and Metabolism Sichuan University West China HoapitalChengdu 610041Sichuan ProvinceChina Department of Infectious Disease Public Health and Clinical Center of ChengduChengdu 610061Sichuan ProvinceChina Center of Infectious Disease Sichuan University West China HoapitalChengdu 610041Sichuan ProvinceChina

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

关键词： Human immunodeficiency virus antiretroviral therapy Fasting plasma glucose Dynamic change Long-term

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Interleukin-15 is a significant predictor of sarcopenia in human immunodeficiency virus infected patients on antiretroviral therapy:A cross-sectional study

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Asian Pacific Journal of Tropical Medicine 2022年第8期15卷 361-366页

作者： Aprianta Agus Somia Agus Aryana Suka Internal Medicine Education Program Faculty of MedicineUdayana UniversityDenpasarBaliIndonesia Tropical Infectious Disease Division Department of Internal MedicineSanglah General HospitalDenpasarBaliIndonesia Geriatric Division Department of Internal MedicineSanglah General HospitalDenpasarBaliIndonesia

Objective:To identify the relationship between interleukin(IL)-15 levels and sarcopenia in human immunodeficiency virus(HIV)-infected patients who have received antiretroviral therapy.Methods:This study was a cross-sectional design with 70 participants conducted from January to March 2021.All the participants were assessed for sarcopenia and the IL-15 levels.Sarcopenia was established based on the the Asian Working Group for Sarcopenia(AWGS)2019 criteria.Plasma IL-15 was determined.This analysis was carried out by means of 2×2 tabulation and the statistical test used is Chi-square.Results:Seventy patients received antiretroviral therapy>6 months and showed a good clinical response.Among them,36(51.4%)took zidovudine-based antiretroviral therapy with a median duration of illness of 5 years.The proportion of sarcopenia in patients with HIV infection was 32.9%.The median CD4 cell count was 395.5 cells/L(range:203-937 cells/L).Logistic regression analysis revealed that age>50 years(aOR 8.3,95%CI 1.6-44.5),underweight(aOR 7.7,95%CI 1.5-40.5),IL-15≥150.5 ng/L(aOR 4.9,95%CI 1.3-19.0)and female(aOR 4.8,95%CI 1.2-18.3 were significant and independent adverse predictors of sarcopenia in subjects with HIV infection.Conclusions:There is an association between high levels of IL-15 and sarcopenia in HIV-infected patients on antiretroviral therapy for more than 6 months with good clinical response.

关键词： antiretroviral therapy HIV IL-15 Inflammatory Sarcopenia Underweight

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antiretroviral therapy related adverse effects:Can sub-Saharan Africa cope with the new“test and treat”policy of the World Health Organization?

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Infectious Diseases of Poverty 2017年第1期6卷 212-216页

作者： Jobert Richie N.Nansseu Jean Joel R.Bigna Department of Public Health Faculty of Medicine and Biomedical Sciences of the University of YaoundeIPO Box 1364YaoundeCameroon Sickle Cell Disease Unit Mother and Child Centre of the Chantal Biya FoundationYaoundeCameroon Department of Epidemiology and Public Health Centre Pasteur of CameroonYaoundeCameroon Faculty of Medicine University of Paris Sud XILe Kremlin BicêtreParisFrance

Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Organization(WHO).Implementation of this policy will lead to an increased incidence of ART-related adverse effects,especially in sub-Saharan Africa(SSA).Is the region yet ready to cope with such a challenging issue?Main body:The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS,but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities,and the situation will get worse in the near future.Indeed,ART is associated with an increased risk of developing cardiovascular disease,lipodystrophy,prediabetes and overt diabetes,insulin resistance and hyperlactatemia/lactic acidosis.The prevalence of these disorders is already high in SSA,and the situation will be exacerbated by the implementation of the new WHO recommendations.Most SSA countries are characterized by(extreme)poverty,very weak health systems,inadequate and low quality of health services,inaccessibility to existing health facilities,lack of(qualified)health personnel,lack of adequate equipment,inaccessibility and unaffordability of medicines,and heavy workload in a context of a double burden of disease.Additionally,there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA,to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.These are required if we are to anticipate and effectively prevent this upcoming burden.Conclusion:While SSA would be the first region to experience the huge benefits of implementing the“test and treat”policy of the WHO,the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications.Urgent measures should

关键词： HIV/AIDS Test and treat 90-90-90 antiretroviral therapy Sub-Saharan Africa

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Correlation of human immunodeficiency virus and antiretroviral therapy with cardiac disorders

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Global Health Journal 2023年第3期7卷 130-136页

作者： Riya Sharma Mandeep kaur Department of Pharmacy Practice ISF College of PharmacyMogaPunjab 142001India

The occurrence of cardiovascular illness in the human immunodeficiency virus(HIV)community is increasing,with a particular focus on coronary heart disease.Patients infected with HIV have a higher risk of myocardial infarction compared to the general population in modern countries due to the development of effective antiretroviral medications and increased life expectancy.Those not receiving highly active antiretroviral therapy(ART)may experience common cardiac consequences,including myocarditis,dilated cardiomyopathy,endocarditis,pulmonary hypertension,pericardial effusion,and cardiotoxicity associated with non-antiretroviral drugs.After the use of highly active ART,continuing immune activation and systemic inflammation seem to play a central role in this process.Recent studies suggest that protease inhibitors might negatively impact the progression of HIV-related heart failure(HF),which complicates the determination of the best therapy strategy for HIVassociated cardiomyopathy.The objective of this review is to examine the pathophysiology and correlation of various antiretroviral drugs leading to HIV-associated HF.Additionally,we explore the causes of HIV-associated atherosclerotic cardiovascular disease,including the high frequency of classic cardiovascular risk factors in HIVinfected patients,as well as HIV-related factors like the use of ART and chronic inflammation despite successful treatment of HIV infection.Numerous studies have revealed that individuals living with HIV/acquired immune deficiency syndrome frequently experience HF.In conclusion,despite advancements in HIV care,HIV-infected individuals continue to face an increased risk of HIV-associated cardiomyopathy and atherosclerosis.Further research is necessary to comprehend the underlying causes and develop effective treatments for cardiovascular disease in this population.We also discuss the currently available therapeutic options and ongoing research to mitigate the risk of cardiovascular disease and inflammation in HIV-infected individuals.

关键词： antiretroviral therapy Cardiac disorders Myocardial infarction cardiomyopathy Heart failure HIV/AIDS Myocardial infarction

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Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy

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Journal of Traditional Chinese Medicine 2016年第4期36卷 411-417页

作者： Guo Huijun Wang Jian Li Zhengwei Jiang Ziqiang Xu Qianlei Xu Liran Department of Acquired Immune Deficiency Syndrome AIDS Treatment and Research Center the First Affiliated Hospital of Henan University of Traditional Chinese Medicine Traditional Chinese Medicine Center for Acquired Immune Deficiency Syndrome Prevention and Treatment China Academy of Traditional Chinese Medicine

OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.

关键词： Acquired immunodeficiency syndrome antiretroviral therapy highly active Mortality Medicine Chinese traditional Retrospective cohort study

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