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Showing posts with label ARV. Show all posts
Showing posts with label ARV. Show all posts
Monday, December 28, 2015
Monday, July 27, 2015
Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
Below: Reasons for delaying antiretroviral therapy for clinically eligible patients
Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART.
Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.
Via: http://ht.ly/NfxV4 .@CDCgov
Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART.
Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.
Via: http://ht.ly/NfxV4 .@CDCgov
Outcomes of antiretroviral treatment in HIV-infected adults: a dynamic and observational cohort study in Shenzhen, China, 2003–2014
Below: CD4 cell count response after antiretroviral treatment (ART) initiation. (A) Median (IQR) CD4 cell count increase from ART initiation, stratified by immunological success and failure. (B) Median (IQR) CD4 cell count increase from ART initiation, stratified by baseline CD4 cell count.
In China, the number of people infected with HIV is 740 000 in estimation. Among these, a cumulative 436 817 people living with HIV/AIDS had been identified up to December 2013, including 173 825 people with AIDS. Since the China National Free Antiretroviral Treatment Program (NFATP) was established in 2003, the remarkable acceleration in treatment has been obvious. By December 2013, more than 278 000 people have received first-line highly active antiretroviral therapy (HAART). Along with the increasing treatment coverage, overall mortality rates have fallen from 39.3 deaths per 100 person-years in 2000 to 14.2 deaths per 100 person-years in 2009. All HIV-infected individuals who meet the national treatment criteria are eligible to receive treatment, and treatment has been implemented in all 31 provinces, autonomous regions and municipalities in China.
The limitations of previous studies reporting the effects of HAART in developing countries were the relatively small sample sizes or short durations of follow-up. Fortunately, our study reports the 10-year outcomes of virological and immunological treatment failure rates and their associated risk factors for all adult patients enrolled in the NFATP in Shenzhen.
Via: http://ht.ly/NvBMP MT @BMJ_Open
In China, the number of people infected with HIV is 740 000 in estimation. Among these, a cumulative 436 817 people living with HIV/AIDS had been identified up to December 2013, including 173 825 people with AIDS. Since the China National Free Antiretroviral Treatment Program (NFATP) was established in 2003, the remarkable acceleration in treatment has been obvious. By December 2013, more than 278 000 people have received first-line highly active antiretroviral therapy (HAART). Along with the increasing treatment coverage, overall mortality rates have fallen from 39.3 deaths per 100 person-years in 2000 to 14.2 deaths per 100 person-years in 2009. All HIV-infected individuals who meet the national treatment criteria are eligible to receive treatment, and treatment has been implemented in all 31 provinces, autonomous regions and municipalities in China.
The limitations of previous studies reporting the effects of HAART in developing countries were the relatively small sample sizes or short durations of follow-up. Fortunately, our study reports the 10-year outcomes of virological and immunological treatment failure rates and their associated risk factors for all adult patients enrolled in the NFATP in Shenzhen.
Via: http://ht.ly/NvBMP MT @BMJ_Open
Sunday, July 26, 2015
Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–2012
Via: http://ht.ly/Ph5GR HT @UPTuks
Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 – 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not.
The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
Below: Number of patients and the period incidence of LTFU with each year of taking ART, Tshepang Pharmacovigilance cohort, 2004–2012
Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 – 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not.
The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
Below: Number of patients and the period incidence of LTFU with each year of taking ART, Tshepang Pharmacovigilance cohort, 2004–2012
Undernutrition and Anaemia among HAART-Naïve HIV Infected Children in Lle-Lfe, Nigeria
More at ht.ly/Ppyi8 HT @PANAFRMEDJ
Results: The prevalence of stunting, underweight and wasting among the HIV infected subjects were 48. 6%,58. 6% and 31. 4% respectively which as significantly higher than 28. 1%, 7. 1% and 28. 1% among the HIV negative controls. 20. 1% of the HIV infected children were marasmic compared to 2. 3% of the controls . Triple anthropometric failure was found in 7. 1% of the subjects as compared to none among the controls. Anaemia is significantly more prevalent among the subjects than the controls (70. 0% vs 31. 4%; p<0. 001). The prevalence of anaemia was higher in the HIV infected subjects with undernutrition. Low socioeconomic status, hypoalbuminemia and severe immunosuppression are significantly associated with higher undernutrition prevalence.
Conclusion: Several years after availability of HAART, undernutrition and anaemia remain widely prevalent among newly presenting HAART naïve HIV infected Nigerian children . Nutritional supplementation and evaluation for anaemia still need close attention in the management of these children.
Below: Prevalence of mild-moderate and severe anaemia in the HIV infected subjects and HIV negative controls
Results: The prevalence of stunting, underweight and wasting among the HIV infected subjects were 48. 6%,58. 6% and 31. 4% respectively which as significantly higher than 28. 1%, 7. 1% and 28. 1% among the HIV negative controls. 20. 1% of the HIV infected children were marasmic compared to 2. 3% of the controls . Triple anthropometric failure was found in 7. 1% of the subjects as compared to none among the controls. Anaemia is significantly more prevalent among the subjects than the controls (70. 0% vs 31. 4%; p<0. 001). The prevalence of anaemia was higher in the HIV infected subjects with undernutrition. Low socioeconomic status, hypoalbuminemia and severe immunosuppression are significantly associated with higher undernutrition prevalence.
Conclusion: Several years after availability of HAART, undernutrition and anaemia remain widely prevalent among newly presenting HAART naïve HIV infected Nigerian children . Nutritional supplementation and evaluation for anaemia still need close attention in the management of these children.
Below: Prevalence of mild-moderate and severe anaemia in the HIV infected subjects and HIV negative controls
Translating PrEP Effectiveness into Public Health Impact: Key Considerations for Decision-Makers on Cost-Effectiveness, Price, Regulatory Issues, Distributive Justice and Advocacy for Access
Read at: http://ht.ly/Q6ptI HT @UvA_Amsterdam
Discussion
In considering the role that PrEP can play in combination prevention programmes, decision-makers must determine who can benefit most from PrEP, how PrEP can be provided safely and efficiently, and what kind of health system support will ensure successful implementation. To do this, they need contextualized information on disease burden by population, analyses of how PrEP services might best be delivered, and projections of the human resource and infrastructure requirements for each potential delivery model. There are cost considerations, varying cost-effectiveness results and regulatory challenges. The principles of ethics can inform thorny discussions about who should be prioritized for oral PrEP and how best to introduce it fairly. We describe the cost-effectiveness of PrEP in different populations at higher risk of HIV exposure, its price in low- and middle-income countries, and the current regulatory situation. We explore the principles of ethics that can inform resource allocation decision-making about PrEP anchored in distributive justice, at a time when universal access to antiretroviral treatment remains to be assured. We then highlight the role of advocacy in moving the PrEP agenda forward.
Conclusions
The time is ripe now for decisions about whether, how and for whom PrEP should be introduced into a country's HIV response. It has the potential to contribute significantly to high impact HIV prevention if it is tailored to those who can most benefit from it and if current regulatory and pricing barriers can be overcome. Advocacy at all levels can help inform decision-making and push the access agenda to avert HIV infections among those at highest risk of HIV exposure. The benefits will accrue beyond the individual level to slow HIV transmission at the population level.
Below: Regulatory approval in trial host countries for daily TFD/FTC
Saturday, March 29, 2014
HPV Type 26 Causing Invasive Squamous Cell Carcinomas of Fingernails - AIDS Patient on HAART
See more at ht.ly/usoBq
Below:
(a–c) Hyperkeratotic verrucous tumours of the fingertips originating from the nailbed. Following surgical removal and destruction of nail matrices, tumours recurred and eventually invaded into adjacent periungual skin. Histology revealed invasive squamous cell carcinomas. (d) Massive involvement of the perianal region with whitish-brown plaques (leucoplakias). Multiple biopsies revealed high-grade squamous intraepithelial neoplasias. Aggregates of hyperkeratotic condylomata acuminata are widely disseminated on the genitalia, perineum and buttocks.
Summary:
Squamous cell carcinoma (SCC) of the nail unit is a rare disorder. An association with high-risk genital human papillomavirus (HPV) infection has been reported. We report a 28-year-old human immunodeficiency virus (HIV)-infected bisexual man who had multiple invasive SCC of the fingers, infected with the rare type HPV 26. Classification of HPV 26 as high- or intermediate-risk type has been uncertain, due to its rare presence in cervical cancer. Despite successful treatment with highly active antiretroviral therapy (HAART), the patient developed extensive hyperkeratotic nailbed proliferations of all fingers. Tumours were refractory to treatment and invaded into adjacent tissues. X-rays of the hands demonstrated bone invasion, necessitating amputation of distal phalanges of several fingers. Histologically, highly differentiated preinvasive and invasive verrucous SCCs were identified. Molecular DNA typing identified HPV 26 in the SCCs and in some premalignant lesions. By in situ hybridization HPV 26 DNA was detected in numerous tumour cells, indicating productive infection with high-level amplification of the viral genome. In the remaining proliferations, high-risk HPV type 58, cutaneous HPVs and a putative new HPV type were identified. HPV 26 infection appears to be causally involved in the development of SCC of the nail unit in this immunosuppressed patient. Timely evaluation of chronic verrucous nailbed tumours is recommended, especially in immunocompromised patients. Identification of HPV 26, besides known high-risk HPV types, may identify patients at risk for developing SCC of the nailbed and possibly at other locations.
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