scholarly journals “Myocardial inflammatory changes before and after antiretroviral therapy initiation in people with advanced HIV disease”

2020 ◽  
Author(s):  
A Piñeirua-Menéndez ◽  
R Flores-Miranda ◽  
D Sánchez-Nava ◽  
R Ortega-Pérez ◽  
P F Belaunzaran-Zamudio ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Late Presentation ◽  
Hiv Disease ◽  
Cardiovascular Mri ◽  
Cd4 Cells ◽  
Combined Antiretroviral Therapy ◽  
Before And After ◽  
Advanced Hiv Disease ◽  
Inflammatory Changes ◽  
Advanced Immunosuppression

Abstract Because high frequency and late presentation of HIV disease in our population, we decided to explore the presence of myocarditis among people with HIV-infection and advanced immunosuppression (less than 200 CD4+ cells/μL), and to describe the inflammatory changes observed after combined antiretroviral therapy (cART) initiation in an observational, longitudinal, prospective cohort performing cardiovascular MRI (cMRI) and doppler trans-thoracic echocardiogram (TTE).

scholarly journals The Population Impact of Late Presentation With Advanced HIV Disease and Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin America

2019 ◽  
Vol 189 (6) ◽  
pp. 564-572 ◽  
Author(s):  
Pablo F Belaunzarán-Zamudio ◽  
Yanink N Caro-Vega ◽  
Bryan E Shepherd ◽  
Peter F Rebeiro ◽  
Brenda E Crabtree-Ramírez ◽  
...  
Keyword(s):  
Latin America ◽  
Antiretroviral Therapy ◽  
Population Attributable Fraction ◽  
Immune Deficiency Syndrome ◽  
Late Presentation ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Advanced Hiv Disease ◽  
The Impact

Abstract Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001–2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of <200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.

Antiretroviral Therapy in Advanced HIV Disease: Which is the Best Regimen?

Aids Reviews ◽  
2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Joaquim Burgos ◽  
Esteban Ribera ◽  
Vicenç Falcó
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Disease ◽  
Advanced Hiv Disease

scholarly journals Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259073
Author(s):  
Nadine Mayasi Ngongo ◽  
Gilles Darcis ◽  
Hippolyte Situakibanza Nanituna ◽  
Marcel Mbula Mambimbi ◽  
Nathalie Maes ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Early Detection ◽  
Hiv Infection ◽  
Median Time ◽  
Clinical Stage ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Time To Initiation ◽  
Advanced Hiv Disease

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

scholarly journals The Changing Natural History of HIV Disease: Before and After the Introduction of Generic Antiretroviral Therapy in Southern India

2005 ◽  
Vol 41 (10) ◽  
pp. 1525-1528 ◽  
Author(s):  
N. Kumarasamy ◽  
S. Solomon ◽  
S. K. Chaguturu ◽  
A. J. Cecelia ◽  
S. Vallabhaneni ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Natural History ◽  
Southern India ◽  
Hiv Disease ◽  
Before And After ◽  
History Of

scholarly journals Directrices para el tratamiento de la infección avanzada por el VIH y el inicio rápido del tratamiento antirretroviral

2018 ◽  
Keyword(s):  
Antiretroviral Therapy ◽  
World Health Organization ◽  
World Health ◽  
Hiv Disease ◽  
Sociedad Civil ◽  
Health Organization ◽  
Advanced Hiv Disease

En el 2016, la OMS publicó sus directrices unificadas sobre el uso de los antirretrovirales (ARV) en el tratamiento y la prevención de la infección por el VIH. Como parte de esta revisión, la OMS reconoce que, a medida que se amplíe la escala del tratamiento antirretroviral (TAR) y que los países adopten la política de “tratar a todos”, será necesario diferenciar los servicios de TAR para proporcionar conjuntos de intervenciones de atención de salud adaptados a las personas con infección por el VIH con necesidades clínicas diversas. Con este fin, se definen cuatro grupos de personas: 1) las que acuden por primera vez o regresan en busca de atención presentando una infección avanzada por el VIH; 2) las que acuden por primera vez o regresan en busca de atención encontrándose bien desde el punto de vista clínico; 3) las que se encuentran clínicamente estables mientras siguen el TAR; y 4) las que reciben un esquema de TAR que no está siendo eficaz...El público destinatario de estas directrices está constituido principalmente por directores de programas nacionales del VIH, que son los responsables de adaptar estas nuevas recomendaciones a nivel del país. Las directrices son también pertinentes para los médicos clínicos y otros interesados directos, como las personas con infección por el VIH, organizaciones nacionales de la sociedad civil, asociados para la implementación, organizaciones no gubernamentales y financiadores nacionales e internacionales de los programas del VIH. Versión oficial en español de la obra original en inglés: Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017. © World Health Organization 2017. ISBN 978-92-4-155006-2.

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