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Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study

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Infectious Disease Modelling 2019年第1期4卷 73-82页

作者： Dobromir Dimitrov Daniel Wood Angela Ulrich David A.Swan Blythe Adamson Javier R.Lama Jorge Sanchez Ann Duerr Vaccine and Infectious Diseases Division Fred Hutchinson Cancer Research CenterSeattleWAUSA Department of Global Health University of WashingtonSeattleWAUSA Comparative Health Outcomes Policy&Economics(CHOICE)InstituteUniversity of WashingtonSeattleWAUSA Asociacion Civil Impacta Salud y Educacion LimaPeru Centro de Investigaciones Tecnologicas Biomedicas y MedioambientalesUniversidad Mayor de San MarcosLimaPeru

Background:The Sabes study,a treatment as prevention intervention in Peru,tested the hypothesis that initiating antiretroviral therapy(ART)early in HIV infection when viral load is high,would markedly reduce onward HIV transmission among high-risk men who have sex with men(MSM)and transgender women(TW).We investigated the potential population-level benefits of detection of HIV early after acquisition and rapid initiation of ART.Methods:We designed a transmission dynamic model to simulate the HIV epidemic among MSM and TW in Peru,calibrated to data on HIV prevalence and ART coverage from 2004 to 2011.We assessed the impact of an intervention starting in 2018 in which up to 50%of the new infections were diagnosed within three months of acquisition and initiated on ART within 1 month of diagnosis.We estimated the impact of the intervention over 20 years using the cumulative prevented fraction of new HIV infections compared to scenarios without intervention.Findings:Our model suggests that only 19%of the infected MSM and TW are virally suppressed in 2018 and 35%e40%of the new HIV infections are transmitted from contacts with acutely-infected partners.An intervention reaching 10%of all acutely infected MSM and TW is projected to prevent 13.3%[Uncertainty interval:11.9%e14.3%]of the new infections over 20 years and reduce HIV incidence in 2038 by 24%.Reaching 50%of all acutely infected MSM and TWwill increase the prevalence of viral suppression in 2038 to 59%and prevent 41%of expected infections over 20 years.Reaching 50%of the high-risk MSM and TW in acute phase would reduce HIV incidence in 2038 by 60%and prevent 36%of new infections between 2018 and 2038.Conclusions:Early detection of HIV infections and rapid initiation of ART among MSM is desirable as it would increase the effectiveness of the HIV prevention program in Peru.Targeting high-risk MSM and TW will be highly efficient.

关键词： Mathematical model antiretroviral therapy HIV incidence HIV prevention

Recombinant HIV to kill latent reservoir cells: a hypothetical therapeutic strategy

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Medical Theory and Hypothesis 2022年第4期5卷 32-38页

作者： Umesh Chandra Hader Department of Zoology Raniganj Girls’CollegeSearsole-RajbariPaschim BardhamanRaniganj 713358West BengalIndia.

Latency is the pivotal factor that governs the long-term pathogenecity and persistence of HIV-1 infection.It is also the primary impediment to cure and successful treatment,resulting in patient death.Latency of HIV-1 infection promotes failure of the conventional antiretroviral therapy(ART).Cessation of ART immediately leads to viral reactivation and attainment of viral load in peripheral circulation.ART comes with severe side effects and is ineffective at treating latent infection.To eliminate latent infection,alternate therapeutic strategies such as Shock and Kill,Block and Lock,gene editing and vaccination have been proposed.Although these strategies have experimentally been proven successful,they possess major limitations.Hence,in this hypothesis,an alternate therapeutic strategy has been proposed to solve the threat of HIV-latency.The proposed model encompasses the generation and administration of recombinant HIV-1 particles whose genomes having pro-apoptotic gene,tBid,will activate apoptotic cell death pathways after infecting only the latent cells,thereby removing latent HIV host cells from patients’bodies.

关键词： HIV latency recombinant HIV tBid homologous recombination antiretroviral therapy lentiviral vectors

Very high baseline HIV viremia impairs efficacy of non-nucleoside reverse transcriptase inhibitor-based ART:a longterm observation in treatment-naïve patients

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Infectious Diseases of Poverty 2020年第3期9卷 144-145页

作者： Shuai Chen Yang Han Xiao-Jing Song Yan-ling Li Ting Zhu Hong-Zhou Lu Xiao-Ping Tang Tong Zhang Min Zhao Yun He Sheng-Hua He Min Wang Yong-Zhen Li Shao-Biao Huang Yong Li Jing Liu Wei Cao Tai-Sheng Li Department of Infectious Diseases Peking Union Medical College HospitalChinese Academy of Medical SciencesNo.1 ShuaifuyuanWangfujing StreetBeijing 100730China 不详

Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.Methods:A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009,and from May 2013 to December 2015.Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen.All patients had baseline HIV-RNA levels over 500 copies/ml,good adherence,and were followed for at least 24 weeks.Virological suppression was defined as the first HIV-RNA<50 copies/ml.Virological failure was defined as any of incomplete viral suppression(HIV-RNA≥200 copies/ml without virological suppression within 24 weeks of treatment)and viral rebound(confirmed HIV-RNA level≥50 copies/ml after virological suppression).Chi-square test,Kaplan–Meier analysis,Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.Results:A total of 758 treatment-naïve HIV patients in China were enlisted.Median follow-up time(IQR)was 144(108–276)weeks.By week 48,rates of virological suppression in three groups(<100000,100000–500000 and≥500000 copies/ml)were 94.1,85.0,and 63.8%,respectively(P<0.001).Very high baseline HIV viremia over 500000 copies/ml were found to be associated with delayed virological suppression(≥500000 vs<100000,adjusted relative hazard=0.455,95%CI:0.32–0.65;P<0.001)as well as incomplete viral suppression(≥500000 vs<100000,adjusted odds ratio[aOR]=6.084,95%CI:2.761–13.407;P<0.001)and viral rebound(≥50000 vs<100000,aOR=3.671,95%CI:1.009–13.355,P=0.048).Conclusions:Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure.More potent initial regimens should be considere

关键词： HIV Viral load Baseline RNA antiretroviral therapy Treatment outcome Virologic response

Immunological effect of aqueous extract of Vernonia amygdalina and a known immune booster called immunace and their admixtures on HIV/AIDS clients:a comparative study

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Asian Pacific Journal of Tropical Biomedicine 2012年第3期2卷 181-184页

作者： Momoh MA Muhamed U Agboke AA Akpabio EI Uduma Eke Osonwa Department of Pharmaceutics University of Nigeria Nsukka Department of Chemistry Ahmadu Bello University Zaria Department of Pharmaceutics and Pharmaceutical Technology University of Uyo

Objective:To investigate the immunological effect of Vernonia amygdalina(V.amygdalina) leaf extract and immunace on HIV infected patients taking highly active antiretrwiral therapy. Methods:Fresh V.amygdalina leaves were collected within Nsukka area in Enugu State.The leaves were rinsed with distilled water.Two handful of cleaned fresh leaves were soaked in 200 mL water and squeezed gently by hand to a mixture.Clients were divided into four groups and each group was given different combination.They took the medication for four weeks.The immune effect was tested against marketed immune booster in some retroviral clients.Results:The mean absolute CD4 count was increased in the client who took the extract or supplement.And the clients who took both the extract and supplement had a greater increase in the CD4 count.The increased CD4 was significant as compared with the control group(P<0.05).The skin rashes were also improved in the entire groups.Conclusions:It can be concluded that the aqueous extract of V.amygdalina and immunace or both have immunological effect on HIV infected patients. Therefore,we suggest that the V.amygdalina extract or immunace or both could be used as adjuvant in the management of HIV/AIDS clients.

关键词： CD4^(+) cell Immune Vernonia amygdalina HIV/AIDS antiretroviral therapy Immunological effect Immunace®

Current progress of China’s free ART program

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Cell Research 2005年第Z1期 877-882页

作者： Jennifer PAN Division of Treatment and Care National Center for STD/AIDS Prevention and Control Chinese Center for Disease Preven- tion and Control Beijing 100050 China

China’s Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little experience in HIV/AIDS treatment and care and resource limitations, China’s efforts to provide widespread access to free antiretroviral therapy has been a process fraught with difficulty. However, the Free ART Program is progressing from an emergency response to a standardized treatment and care system. The development of national guidelines, training programs, a laboratory sup- port network, a national patient database, programs for special populations such as children and patients living with co- infections, and operational research has improved the scope and quality of the free treatment program. As of June 30, 2005, a total of 19,456 patients in 28 provinces, autonomous regions, and special municipalities had received free ART. Challenges stemming from the nature of China’s health system and patient population persist, but with strong govern- ment support and a diverse set of resources, China has the capacity to overcome these challenges and to provide nationwide access to high quality treatment and care.

关键词： human immunodeficiency virus acquired immune deficiency syndrome China antiretroviral therapy free ART program treatment and care.

Chronic Carriage of Hepatitis B Virus at the University Teaching Hospital Yalgado Ouedraogo: Therapeutic Aspects and Outcome in a Cohort of HBeAg+ Outpatients

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Open Journal of Epidemiology 2021年第3期11卷 245-255页

作者： Eric Nagaonlé Somé Félicité W. Nana Bertrand I. Méda Moussa Son Drabo Maxime Séni Kouanda Roger Sombié Biomedical and Public Health Department Institut de Recherche en Sciences de la Santé (IRSS) Ouagadougou Burkina Faso Gastro-Enterology Department UFR des Sciences de la Santé Université Joseph Ki-Zerbo Ouagadougou Burkina Faso

Introduction: The HbsAg prevalence in Burkina Faso was 9.1%. We aimed at describing the therapeutic features and the clinical outcome for the patients taking antiretroviral treatment. Materials and Methods: We implemented a cross-sectional study from January 1st, 2004 to December 31st, 2015. Patients aged more than 15 years with positive hepatitis B surface antigen for over six months and positive hepatitis B e-antigen were included. Results: We analyzed the data of 148 participants for a sex ratio of 3;sixty-three patients including 49 men (77.8%) were on treatment. and 81.5% had inflammatory activity greater than one. Under tenofovir, the normalization of ALT was observed in 42 (84%) patients while HBV-DNA became undetectable in 24/33 patients. HBeAg negativation was observed in 16/25 (64%) patients after seven years of treatment. With lamivudine, 2/9 patients had a complete virologic response and six had a normalization of their ALT. Two and 9 patients lost HBeAg after 7 and 9 years of treatment, respectively. Overall 63% and 27% of the patients were in the high or low-adherence group, respectively. In the low-adherence group, all patients had normal or abnormal ALT, but detectable HBV DNA. Ten patients taking lamivudine developed resistance including primary resistance in three patients. No resistance has been observed with tenofovir. Conclusion: The management of the viral hepatitis B includes often a long follow up period without any medication. When antiviral is indicated, the adherence to the treatment is crucial to a long-term control of the virus. In our setting, the low purchase power of the patients may jeopardize their therapeutic future and there is a need to support this group of patients with free-of-charge medicines as it is provided for the HIV infected people.

关键词： Viral Hepatitis B HBe Antigen antiretroviral therapy Adherence Resistance

Non-adherence to Anti-retroviral therapy among HIV-Infected Individuals in Kyrgyzstan:Prevalence and Risk Factors,2014-2016

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Journal of Health Science 2020年第1期8卷 1-8页

作者： Aisuluu Kubatova Aizat Arunova UKKadyrbekov Simon Ajeilat National AIDS Center Ministry of HealthStreet Logvinenko 8Bishkek 720001Kyrgyz Republic Department of Disease Prevention and State Sanitary Epidemiologic Surveillance Ministry of HealthStreet Razzakova 63BishkekKyrgyz Republic Central Asia Field Epidemiology Training Program

Backgrounds:Currently in Kyrgyzstan,ART(antiretroviral therapy)is freely provided to HIV-infected individuals on clinical grounds.Strict adherence to ART is required,it improves HIV-infected individuals’survival and quality of life,prevents HIV transmission and drug resistance.Our study aims to identify the prevalence of non-adherence to ART therapy and factors associated with it so that strategies can be designed to help maintain adherence.Methods:In a retrospective cohort study,we enrolled randomly selected 432 individuals,≥18 years of age,from among all HIV-infected individuals in Kyrgyzstan(n=950)who started ART during Jan.2014-Sep.2016.All were followed up until Dec.2016.Non-adherents were:(1)individuals lost to follow-up;(2)individuals who missed≥4.5 days of treatment per 30 days during the study period-this was established by comparing the total tablets prescribed,dates of visits for treatment,and number of tablets consumed.We reviewed the country’s HIV surveillance data and medical facilities records.We collected information on the known non-adherent risk factors,HIV clinical presentation,and details of treatment-regimens.We used logistic regression to assess the risk factors and non-adherent associations.Results:The overall non-adherence rate was 50%(214/432).In sub-group analysis,the highest rate was:61%(50/82)among alcohol abusers,60%(65/109)in those who received≥2 tablets/dose,59%(44/75)in those receiving≥2 doses/day,57%(89/155)in drug users,and 53%(144/271)in individuals aged<40 years.In multivariate analysis,≥2 tablets/dose(OR=2.1,95%CI 1.0-4.1),age<40 years(OR=1.7,95%CI 1.1-2.6),and alcohol abuse(OR=1.6,95%CI 1-2.8)were associated with non-adherence.Conclusion:The observed non-adherence rate is unacceptably high.Adherence can be improved by introducing the one tablet/day treatment regimen,establishing regular contact with those under ART,and providing them with appropriate counseling,especially those<40 years of age or with substance abuse.

关键词： HIV non-adherence antiretroviral therapy Kyrgyzstan

Pattern of HIV-1 Drug Resistance among Adults on ART in Nigeria

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World Journal of AIDS 2013年第4期3卷 327-334页

作者： Georgina N.Odaibo Prosper Okonkwo Isaac F.Adewole David O.Olaleye Department of Virology College of MedicineUniversity of IbadanIbadanNigeria AIDS Prevention Initiative Nigeria Arab Contractor BuildingAbujaNigeria Department of Obstetrics and Gynecology College of MedicineUniversity of IbadanIbadanNigeria.

Background: The development of anitiretroviral drug resistance may limit the benefit of antiretroviral therapy. Therefore the need to closely monitor these mutations, especially the use of ART is increasing. This study was therefore designed to determine the ARV drug resistance pattern among ART na?ve and expose individuals attending a PEPFAR supported by antiretroviral clinic in Nigeria. Methodology: The study participants included patients attending the PEPFAR supported by University College Hospital (UCH), Ibadan ART clinic who have been on HIV treatment for at least one year with consecutive viral load of over 2000 copies/ml as well some ART Na?ve individuals with high (>50,000 copies/ml) baseline viral level attending the hospital for pre-ART assessment. Blood sample was collected from each individual for CD4 enumeration, viral load level determination and DNA sequencing for genotypic typing. antiretroviral drug resistance mutations (DRM) were determined by using the Viroseq software and drug mutations generated by using a combination of Viroseq and Stanford algorithm. DRM were classified as major or minor mutations based on the June 2013 Stanford DR database. Results: The most common major NRTI, NNRTI and PI mutation were D67N (33.3%), Y181C (16.7%) and M46L/I (55.6%) respectively. Lamivudine (3TC) and emtricitabine (FTC);nevirapine (NVP) and nelfinavir (NFV) were the most common NRTI, NNRTI, and PI drugs to which the virus in the infected individuals developed resistance. Isolates from 4 patients were resistant to triple drug class, including at least one NRTI, NNRTI and a PI. Only one (4.8%) of the isolates from drug Na?ve individuals had major DRM that conferred resistance to any drug. Conclusion: Demonstration of high rates of antiretroviral DRM among patients on 1st and 2nd line ART and the presence of DRM in drug Na?ve individuals in this study show the importance of surveillance for resistance to ARV in line with the magnitude of scaling up of treatment program in the country.

关键词： antiretroviral therapy Drug Resistance Mutation ART Na?ve 1st and 2nd Line ART

Estimation and Projection of HIV/AIDS Epidemic and Treatment Demand in Beijing and Hunan Province with Spectrum

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国际感染病学(电子版) 2013年第1期 13-24页

作者： Ning Ma Min Liu Min Zheng Xi Chen Hong-yan Lu Hong-guang Chen Jun Zheng Gui-ying Li Juan Wang Guo-wu Liu Ning Wang Department of Epidemiology & Biostatistics School of Public HealthPeking University Hunan Provincial Center of Disease Prevention and Control Beijing Center for Disease Control and Prevention Chinese Center for Disease Control and Prevention National Center for AIDS/STD Control and Prevention

Objective To estimate the HIV/AIDS epidemic and treatment demand and predict the situation in the next five years with Spectrum.Methods Using Spectrum(version:3.54)to estimate the number of new HIV infections,number of people living with HIV,need for ART in adults and children,need for PMTCT and cotrimoxazole in Beijing and Hunan Province.Data used in the model including high-risk populations monitoring data and demographic information,was collected from Beijing Center for Disease Control and Prevention,Hunan Center for Disease Control and Prevention and extracted from statistical yearbooks and published literatures.Results Few new HIV/AIDS were reported in Beijing prior to 1994,however,the number of HIV infections was increasing rapidly from 1995 to 2008,and decreased after that,increased rapidly again after 2012.The number of patients who need antiretroviral treatment was increasing among the group aged between 15-49 years with young patients aged 15-24 years peaked in 2010 and decreased rapidly after that.Few HIV-infected patients were reported before 1997 in Hunan Province,and the number of new infections was increasing rapidly since 1998.The number of patients who need antiretroviral treatment was increasing among the group aged between 15-49 years since 2000 with young patients aged 15-24 years in need of antiretroviral therapy increasing continuously.Conclusions After HIV infection was first founded in Beijing and Hunan Province,there was a slow growth and then a rapid growth of HIV epidemic.According to prediction of Spectrum,the demand for antiretroviral therapy in Beijing would begin to decline since 2011,meanwhile,the HIV epidemic in Hunan Province would enter a rapid growth period with the demand for antiviral therapy continuing to increase.In this study,Spectrum was applied to estimate the HIV epidemic situation and need for treatment in the next five years in Beijing and Hunan Province.It provides the basis for health resource allocation and policy formulation of HIV management.

关键词： Acquired immune deficiency syndrome Spectrum Epidemic estimation antiretroviral therapy