scholarly journals Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis

2019 ◽  
Vol 70 (8) ◽  
pp. 1652-1657 ◽  
Author(s):  
Godfather Dickson Kimaro ◽  
Lorna Guinness ◽  
Tinevimbo Shiri ◽  
Sokoine Kivuyo ◽  
Duncan Chanda ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Incremental Cost ◽  
Cd4 Count ◽  
Cryptococcal Antigen ◽  
Adherence Support ◽  
Short Period ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness. Methods HIV-infected adults with CD4 count <200 cells/μL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER. Results Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95% confidence interval [CI], $331–$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66–$88). The incremental cost was similar when analysis was restricted to persons with CD4 count <100 cells/μL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95% CI, $43–$211) for all participants with CD4 count up to 200 cells/μL and US$91 (95% CI, $49–$443) among those with CD4 counts <100 cells /μL. Cost-effectveness was most sensitive to mortality estimates. Conclusions Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings.

scholarly journals Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

2019 ◽  
Vol 71 (8) ◽  
pp. e308-e315
Author(s):  
McKaylee M Robertson ◽  
Sarah L Braunstein ◽  
Donald R Hoover ◽  
Sheng Li ◽  
Denis Nash
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Population Based ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

scholarly journals Myocardial Steatosis Among Antiretroviral Therapy–Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial

2020 ◽  
Vol 222 (Supplement_1) ◽  
pp. S63-S69
Author(s):  
Tomas G Neilan ◽  
Kim-Lien Nguyen ◽  
Vlad G Zaha ◽  
Kara W Chew ◽  
Leavitt Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
Resonance Spectroscopy ◽  
Vascular Events ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Myocardial Steatosis

Abstract Background People with human immunodeficiency virus (PWH) face increased risks for heart failure and adverse heart failure outcomes. Myocardial steatosis predisposes to diastolic dysfunction, a heart failure precursor. We aimed to characterize myocardial steatosis and associated potential risk factors among a subset of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) participants. Methods Eighty-two PWH without known heart failure successfully underwent cardiovascular magnetic resonance spectroscopy, yielding data on intramyocardial triglyceride (IMTG) content (a continuous marker for myocardial steatosis extent). Logistic regression models were applied to investigate associations between select clinical characteristics and odds of increased or markedly increased IMTG content. Results Median (Q1, Q3) IMTG content was 0.59% (0.28%, 1.15%). IMTG content was increased (> 0.5%) among 52% and markedly increased (> 1.5%) among 22% of participants. Parameters associated with increased IMTG content included age (P = .013), body mass index (BMI) ≥ 25 kg/m2 (P = .055), history of intravenous drug use (IVDU) (P = .033), and nadir CD4 count < 350 cells/mm³ (P = .055). Age and BMI ≥ 25 kg/m2 were additionally associated with increased odds of markedly increased IMTG content (P = .049 and P = .046, respectively). Conclusions A substantial proportion of antiretroviral therapy–treated PWH exhibited myocardial steatosis. Age, BMI ≥ 25 kg/m2, low nadir CD4 count, and history of IVDU emerged as possible risk factors for myocardial steatosis in this group. Clinical Trials Registration NCT02344290; NCT03238755.

scholarly journals Epidemiology and Outcomes in Critically Ill Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Shannon L. Turvey ◽  
Sean M. Bagshaw ◽  
Dean T. Eurich ◽  
Wendy I. Sligl
Keyword(s):  
Critical Illness ◽  
Antiretroviral Therapy ◽  
Cox Regression ◽  
Illness Severity ◽  
Cd4 Count ◽  
Apache Ii Score ◽  
Predictors Of Mortality ◽  
Immunodeficiency Virus ◽  
Artery Disease ◽  
The Impact

Purpose.The impact of critical illness on survival of HIV-infected patients in the era of antiretroviral therapy remains uncertain. We describe the epidemiology of critical illness in this population and identify predictors of mortality.Materials and Methods.Retrospective cohort of HIV-infected patients was admitted to intensive care from 2002 to 2014. Patient sociodemographics, comorbidities, case-mix, illness severity, and 30-day mortality were captured. Multivariable Cox regression analyses were performed to identify predictors of mortality.Results.Of 282 patients, mean age was 44 years (SD 10) and 169 (59%) were male. Median (IQR) CD4 count and plasma viral load (PVL) were 125 cells/mm3(30–300) and 28,000 copies/mL (110–270,000). Fifty-five (20%) patients died within 30 days. Factors independently associated with mortality included APACHE II score (adjusted hazard ratio [aHR] 1.12; 95% CI 1.08–1.16;p<0.001), cirrhosis (aHR 2.30; 95% CI 1.12–4.73;p=0.024), coronary artery disease (aHR 6.98; 95% CI 2.20–22.13;p=0.001), and duration of HIV infection (aHR 1.07 per year; 95% CI 1.02–1.13;p=0.01). CD4 count and PVL were not associated with mortality.Conclusions.Mortality from an episode of critical illness in HIV-infected patients remains high but appears to be driven by acute illness severity and HIV-unrelated comorbid disease rather than degree of immune suppression.

scholarly journals Analisis Efektivitas Biaya Penggunaan Obat Antiretroviral Atripla dan T/H/A pada Pasien HIV Rawat Inap RSUD Raden Mattaher Provinsi Jambi Tahun 2017-2018

2020 ◽  
Vol 17 (1) ◽  
pp. 216
Author(s):  
Jelly Permatasari ◽  
Disty Aldila Wicaksono ◽  
Medi Andriani
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Purposive Sampling ◽  
Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) telah manjadi masalah darurat global. HIV merupakan penyakit kronis yang membutuhkan pengobatan seumur hidup. Infeksi yang disebabkan oleh HIV ini dapat menurunkan sistem kekebalan tubuh sehingga menimbulkan infeksi oprtunistik pada penderita. Infeksi opurtunistik tersebut dapat memperpanjang lama rawatan pada penderita, sehingga menambah biaya pengobatan HIV. Penelitian ini  merupakan studi farmakoekonomi. Sampel diperoleh dari data rekam medis pasien HIV rawat inap tahun 2017-2018 yang memenuhui kriteria inklusi yang diambil secara  purposive sampling. Sampel yang memenuhi kriteria inklusi berjumlah 24 orang. Persentase kelompok usia pasien 17-25, 26-35, 36-45, dan 46-55 tahun masing-masing sebesar 33,33; 33,33; 29,17; dan 4,17%. Persentase jenis kelamin laki-laki dan perempuan masing-masing 54,17 dan 45,83%. Pekerjaan pasien meliputi wiraswasta (41,67%), IRT (41,67%), petani (8,33%), pegawai swasta (8,33%). Persentase lama rawatan <9 hari dan >9 hari masing-masing sebesar 83,33 dan 16,67%. Antiretroviral (ARV) yang digunakan adalah atripla (EFV 600 mg, AZT 300 mg, TDF 300 mg) dan T/H/A (kombinasi TDF 300 mg, hiviral/lamivudine 150 mg, dan aluvia (lopinavir/ritonavir 200 mg/50 mg)), yaitu sebesar 66,67 dan 33,33%. Rata-rata biaya medis langsung atripla sebesar Rp1.547.713,00, sedangkan pada T/H/A sejumlah Rp2.962.642,00. Persentase efektifitas atripla adalah 87,5%, sedangkan T/H/A sebesar 75%. Nilai incremental cost-effectiveness ratio (ICER) sebesar -113.194,32. Analisis efektifitas biaya penggunaan ARV pada pasien rawat inap di RSUD Raden Mattaher Provinsi Jambi pada tahun 2017-2018 menunjukkan bahwa atripla merupakan ARV yang paling efektif secara biaya dan outcome (lama rawat).

scholarly journals All-Cause Mortality and Serious Non-AIDS Events in Adults With Low-level Human Immunodeficiency Virus Viremia During Combination Antiretroviral Therapy: Results From a Swedish Nationwide Observational Study

2020 ◽  
Author(s):  
Olof Elvstam ◽  
Gaetano Marrone ◽  
Patrik Medstrand ◽  
Carl Johan Treutiger ◽  
Anders Sönnerborg ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Low Level ◽  
Immunodeficiency Virus ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The impact of low levels of human immunodeficiency virus (HIV) RNA (low-level viremia [LLV]) during combination antiretroviral therapy (cART) on clinical outcomes is unclear. We explored the associations between LLV and all-cause mortality, AIDS, and serious non-AIDS events (SNAEs). Methods We grouped individuals starting cART 1996–2017 (identified from the Swedish InfCare HIV register) as virologic suppression (VS; &lt;50 copies/mL), LLV (repeated viral load, 50–999 copies/mL), and nonsuppressed viremia (NSV; ≥1000 copies/mL). Separately, LLV was subdivided into 50–199 and 200–999 copies/mL (reflecting different definitions of virologic failure). Proportional-hazard models (including sex, age, pre-ART CD4 count and viral load, country of birth, injection drug use, treatment experience and interruptions, and an interaction term between viremia and time) were fitted for the study outcomes. Results A total of 6956 participants were followed for a median of 5.7 years. At the end of follow-up, 60% were categorized as VS, 9% as LLV, and 31% as NSV. Compared with VS, LLV was associated with increased mortality (adjusted hazard ratio [aHR], 2.2; 95% confidence interval [CI], 1.3–3.6). This association was also observed for LLV 50–199 copies/mL (aHR, 2.2; 95% CI, 1.3–3.8), but was not statistically significant for LLV 200–999 copies/mL (aHR, 2.1; 95% CI, .96–4.7). LLV 50–999 copies/mL was not linked to increased risk of AIDS or SNAEs, but in subanalysis, LLV 200–999 copies/mL was associated with SNAEs (aHR, 2.0; 95% CI, 1.2–3.6). Conclusions In this population-based cohort, LLV during cART was associated with adverse clinical outcomes.

scholarly journals Safety and Effectiveness of Isoniazid Preventive Therapy in Pregnant Women Living with Human Immunodeficiency Virus on Antiretroviral Therapy: An Observational Study Using Linked Population Data

2020 ◽  
Vol 71 (8) ◽  
pp. e351-e358 ◽  
Author(s):  
Emma Kalk ◽  
Alexa Heekes ◽  
Ushma Mehta ◽  
Renee de Waal ◽  
Nisha Jacob ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Absolute Risk ◽  
First Trimester ◽  
Preventive Therapy ◽  
Cd4 Count ◽  
Isoniazid Preventive Therapy ◽  
Immunodeficiency Virus

Abstract Background Isoniazid preventive therapy (IPT) is widely used to protect against tuberculosis (TB) in people living with human immunodeficiency virus (HIV). Data on the safety and efficacy of IPT in pregnant women living with HIV (PWLHIV) are mixed. We used an individual-level, population-wide health database to examine associations between antenatal IPT exposure and adverse pregnancy outcomes, maternal TB, all-cause mortality, and liver injury during pregnancy through 12 months postpartum. Methods We used linked routine electronic health data generated in the public sector of the Western Cape, South Africa, to define a cohort of PWLHIV on antiretroviral therapy. Pregnancy outcomes were assessed using logistic regression; for maternal outcomes we applied a proportional hazards model with time-updated IPT exposure. Results Of 43 971 PWLHIV, 16.6% received IPT. Women who received IPT were less likely to experience poor pregnancy outcomes (adjusted odds ratio [aOR], 0.83 [95% confidence interval {CI}, .78–.87]); this association strengthened with IPT started after the first trimester compared with none (aOR, 0.71 [95% CI, .65–.79]) or with first-trimester exposure (aOR, 0.64 [95% CI, .55–.75]). IPT reduced the risk of TB by approximately 30% (aHR, 0.71 [95% CI, .63–.81]; absolute risk difference, 1518/100 000 women). The effect was modified by CD4 cell count with protection conferred if CD4 count was ≤350 cells/μL (aHR, 0.51 [95% CI, .41–.63]) vs 0.93 [95% CI, .76–1.13] for CD4 count &gt;350 cells/µL). Conclusions This analysis of programmatic data is reassuring regarding the safety of antenatal IPT, with the greatest benefits against TB disease observed in women with CD4 count ≤350 cells/μL.

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