scholarly journals Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study

2020 ◽  
Vol 75 (10) ◽  
pp. 3004-3014
Author(s):  
Belén Alejos ◽  
Inés Suárez-García ◽  
Marta Rava ◽  
Azucena Bautista-Hernández ◽  
Félix Gutierrez ◽  
...  
Keyword(s):  
Immunological Response ◽  
Hiv Treatment ◽  
Research Network ◽  
First Line ◽  
Cd4 Cell Count ◽  
Initial Regimen ◽  
Treatment Naïve ◽  
Cd4 Percentage ◽  
Cd4 Cell ◽  
The Impact

Abstract Objectives We compared 48 week effectiveness and safety of first-line antiretroviral regimens. Methods We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load <50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization (>0.4 and >1); (iv) CD4 percentage normalization (>29%); (v) multiple T-cell marker recovery (MTMR: CD4 > 500 cells/mm3 plus CD4 percentage >29% plus CD4/CD8 > 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). Results Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. Conclusions The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.

scholarly journals Using record linkage to assess the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa.

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Chodziwadziwa Whiteson Kabudula ◽  
Georges Reniers ◽  
Francesc Xavier Gómez-Olivé ◽  
Kathleen Kahn ◽  
Stephen Tollman
Keyword(s):  
South Africa ◽  
Cell Count ◽  
Late Presentation ◽  
Short Term ◽  
Cd4 Cell Count ◽  
Short Term Mortality ◽  
Care And Treatment ◽  
Cd4 Cell ◽  
The Impact ◽  
Rural South Africa

ABSTRACT ObjectivesTo assess the impact of late presentation (CD4 cell count <200 cells/μl at presentation) for care and treatment on short-term mortality (death within a year of presentation) among HIV-infected adults in rural South Africa. ApproachWe applied deterministic and probabilistic record linkage approaches to link adult patients seeking care and treatment for HIV from a health facility between 2007 and 2013 to population under continuous surveillance by the Agincourt Health and Demographic Surveillance System (HDSS) in rural northeast South Africa. The resulting record-linked dataset was thereafter analysed to estimate short-term mortality (death within a year of presentation) differences in late presenters (initial presentation at health facility with CD4 cell count less than 200 cells/μl) and early presenters (presentation with CD4 cell count of 200 or more cells/μl). In the linked dataset, CD4 cell count was extracted from the health facility database where as date of death came from the HDSS database. ResultsA total of 3,553 patients who sought care and treatment for HIV at Bhubhezi clinic between 2007 and 2013 were linked to the Agincourt HDSS surveillance population. Proportion of patients classified as late presenters was 60.9%. Short-term mortality was 8.9% (317/3,553): 11.1% among those who presented late and 5.5 % among those who presented early (P<0.001). ConclusionRecord linkage facilitated the assessment of the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa. In the population studied, late presentation is high and is contributing to high mortality among people living with HIV. Strategies that would facilitate early presentation are needed in order to reduce mortality among people living with HIV.

scholarly journals Patterns of Use and Outcomes in Patients Treated with Etravirine in the HIV Research Network

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Kelly Gebo ◽  
Cindy Voss ◽  
Joseph Mrus ◽  
HIV Research Network
Keyword(s):  
Clinical Care ◽  
Primary Objective ◽  
Research Network ◽  
Virologic Suppression ◽  
Cd4 Cell Count ◽  
Patterns Of Use ◽  
Regimen Change ◽  
Hiv Research ◽  
Cd4 Cell ◽  
Hiv 1

This observational analysis examined the clinical outcomes of patients receiving etravirine-(ETR-) based therapy, particularly with protease inhibitors (PIs) other than darunavir (DRV) and with raltegravir (RAL). Data included treatment-experienced adults in the HIV Research Network who began ETR-containing antiretroviral regimens in 2008–2010. The primary objective was to assess 6-month outcomes (durability, i.e., still on an ETR-containing regimen; change in CD4+ cell count and HIV-1 RNA <400 copies/mL). The cohort included 587 patients receiving ETR; 42% of ETR use was in patients not on DRV/ritonavir (r). Patients receiving ETR plus DRV/r had longer durability versus those on ETR plus a PI other than DRV/r at months 6 (91.2% versus 85.5%) and 12 (77.4% versus 65.2%), respectively. Patients on regimens with a PI other than DRV/r were the least likely to be receiving ETR at month 6 (85.5%) versus patients on other ETR-based regimens. Patients on regimens without a PI and without RAL had lower virologic suppression (month 6, 54.2%; month 12, 63.2%) versus patients on other ETR-based regimens. In a clinical care, nontrial setting, ETR was used in regimens without DRV/r. In this population, the 6-month response rates were similar and durable across all regimens, except when ETR was used without RAL and without a PI.

scholarly journals Retention in Care among Patients with Early HIV Disease in Haiti

2017 ◽  
Vol 16 (6) ◽  
pp. 523-526 ◽  
Author(s):  
Kelly A. Hennessey ◽  
Taina Dadaille Leger ◽  
Vanessa R. Rivera ◽  
Adias Marcelin ◽  
Margaret L. McNairy ◽  
...  
Keyword(s):  
Cell Count ◽  
Retention In Care ◽  
Hiv Treatment ◽  
World Health ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Hiv Test ◽  
Lost To Follow Up ◽  
Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

scholarly journals HIV virological failure and drug resistance among injecting drug users receiving first-line ART in China

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e005886 ◽  
Author(s):  
Xuebing Leng ◽  
Shujia Liang ◽  
Yanling Ma ◽  
Yonghui Dong ◽  
Wei Kan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Virological Failure ◽  
Nucleoside Reverse Transcriptase Inhibitor ◽  
Drug Users ◽  
Monitoring Network ◽  
Transcriptase Inhibitor ◽  
First Line ◽  
Cd4 Cell Count ◽  
Reverse Transcriptase Inhibitor ◽  
Cd4 Cell

ObjectiveTo explore HIV virological failure and drug resistance among injecting drug users (IDUs) receiving first-line antiretroviral treatment (ART) in China.DesignA series of cross-sectional surveys from 2003 to 2012 from the Chinese National HIV Drug Resistance (HIVDR) Surveillance and Monitoring Network.SettingChina.ParticipantsData were analysed by the Chinese National (HIVDR) Surveillance and Monitoring Network from 2003 to 2012. Demographic, ART and laboratory data (CD4+ cell count, viral load and drug resistance) were included. Factors associated with virological failure were identified by logistic regression analysis.Results929 of the 8556 individuals in the Chinese HIVDR database were IDUs receiving first-line ART. For these 929 IDUs, the median duration of treatment was 14 months (IQR 6.0–17.8). 193 of the 929 IDUs (20.8%) experienced virological failure (HIV viral load ≥1000 copies/mL). The prevalence of HIVDR among patients with virological failure was 38.9% (68/175). The proportion of patients with drug resistance to non-nucleoside reverse transcriptase inhibitor (NNRTIs), nucleoside reverse transcriptase inhibitor (NRTIs) and protease inhibitors (PIs) was 52.9%, 76.5% and 4.4%, respectively. Factors independently associated with virological failure include: ethnic minorities, junior high school education or less, farmers, self-reported missing doses in the past month, CD4 cell count at survey from 200 to 349 cells/mm3 or from 0 to 199 cells/mm3, and residence of Guangxi and Yunnan provinces.ConclusionsThe proportion of virological failure was high among IDUs receiving first-line ART in China. However, better treatment outcomes were observed in Guangxi and Yunnan, which indicates the importance of ART education and adherence to intervention, especially for patients who are farmers, minorities or have a poor educational background.

scholarly journals The Potential of Vaccines for the Control of AIDS

1994 ◽  
Vol 5 (suppl a) ◽  
pp. 36A-41A
Author(s):  
Margaret I Johnston ◽  
Patricia E Fast ◽  
Mary Clare Walker ◽  
Daniel Hoth
Keyword(s):  
Vaccine Development ◽  
Cytotoxic T Lymphocyte ◽  
Phase 1 ◽  
Cd4 Cell Count ◽  
Naked Dna ◽  
The Status ◽  
Subsequent Exposure ◽  
The Individual ◽  
Cd4 Cell ◽  
The Impact

The goal of a prophylactic human immunodeficiency (HIV) vaccine is to elicit immune response(s) that will, upon subsequent exposure to HIV. prevent lnfection and/or disease. On the other hand. therapeutic administration of a vaccine to an individual in whom infection is already established might benefit the individual by augmenting existing functional immune responses or inducing new ones. Development of vaccines for the prevention of AIDS offers unique challenges. Concerns regarding the safely of attenuated and whole-killed products have led to the pursuit of alternativc designs. including recombinant proteins, vectors and particles, synthetic peptides and naked DNA. Seven recombinant envelope. two recombinant vector and four other candidate vaccines that have entered into phase 1 trials in noninfected individuals have proven safe to date, and have differed In their ability lo induce functional antibody and Cytotoxic T lymphocytes. Two recombinant envelope products have recently progressed to phase 2 testing, Five envelope-based and six other products have entered trial in HIV-infected and individuals and have appeared to be safe, Evidence of new antibody, increased T cell proliferation and lncreased cytotoxic T lymphocyte activity have been reported. Additional placebo controlled trials will be required to evaluate the impact of therapeutic vaccination on CD4 cell count. viral burdrn and clinical end-points. The status of HIV/AIDS vaccine development is reviewed. with emphasis on the challenging task of finding an effieacious, safe, prophylactic vaccine.

Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia

2020 ◽  
Vol 31 (5) ◽  
pp. 410-419
Author(s):  
Cielo Yaneth Ríos-Hincapié ◽  
Marcela Rojas ◽  
Martha López ◽  
Alexandra Porras ◽  
Ricardo Luque ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Rapid Test ◽  
Hiv Treatment ◽  
Sputum Smear ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Factors Associated ◽  
Previously Treated ◽  
Tuberculosis Diagnosis ◽  
Cd4 Cell

We investigated the delays in the diagnosis of tuberculosis and/or HIV, their treatment initiation, and factors associated with each delay. All drug-susceptible tuberculosis cases diagnosed in 2014 and 2015 in Colombia, with a confirmed diagnosis of HIV were included. A total of 1909 patients were registered with tuberculosis/HIV co-infection. Seventy-nine percent of patients were men, 50% had sputum smear-negative tuberculosis, culture was done in 50% of cases, 68.5% had <200 CD4 cell count at diagnosis, and 35% had concurrent tuberculosis/HIV diagnosis. Delays in the tuberculosis diagnosis were identified in 54.8% of the patients, and delays in tuberculosis and HIV treatment initiation in 41.8% and 27.4%, respectively. The risk factors associated with delay in tuberculosis diagnosis were age between 15–34 and ≥45 years, and those patients who received tuberculin skin test. The risk factor associated with antiretroviral therapy initiation delay was previously-treated tuberculosis patients after failure. It is necessary to implement strategies for early detection and treatment initiation of HIV and to use rapid test for tuberculosis diagnosis in this population.

The effect of baseline CD4 cell count and HIV-1 viral load on the efficacy and safety of nevirapine or efavirenz-based first-line HAART

AIDS ◽  
2005 ◽  
Vol 19 (5) ◽  
pp. 463-471 ◽  
Author(s):  
F van Leth ◽  
S Andrews ◽  
B Grinsztejn ◽  
E Wilkins ◽  
MK Lazanas ◽  
...  
Keyword(s):  
Viral Load ◽  
Cell Count ◽  
Efficacy And Safety ◽  
First Line ◽  
Cd4 Cell Count ◽  
Cd4 Cell ◽  
Hiv 1

The Impact of Episodic CD4 Cell Count-Guided Antiretroviral Therapy on Quality of Life

2008 ◽  
Vol 47 (2) ◽  
pp. 185-193 ◽  
Author(s):  
William J Burman ◽  
Birgit Grund ◽  
Mollie P Roediger ◽  
Gerald Friedland ◽  
Janet Darbyshire ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Cd4 Cell Count ◽  
Cd4 Cell ◽  
The Impact
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