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Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort
Vicente Estrada, Paloma Geijo, Manuel Fuentes-Ferrer, María Alcalde, María Rodrigo, María Galindo, Agustín Mu?oz, Pere Domingo, Esteve Ribera, Jaime Cosín, Pompeyo Viciana, Fernando Lozano, Alberto Terrón, Antonio Vergara, Ramón Teira, Josefa Mu?oz-Sánchez, Bernardino Roca, Trinitario Sánchez, José López-Aldeguer, Elisabeth Deig, Francisco Vidal, Enric Pedrol, Manuel Casta?o-Carracedo, Teresa Puig, Myriam Garrido, Ignacio Suárez-Lozano
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-36
Abstract: Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included.Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio.In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.The increase in cardiovascular risk (CVR) observed in HIV-infected patients is a cause for concern. Most clinical studies have detected a relationship between cardiovascular disease and traditional risk factors, among which age, male gender, smoking, hypertension and diabetes are the most important. There is far less information concerning CVR in HIV-infected female patients. For years, some inequalities in female participation in clinical studies have been observed. In HIV infection, women have been under-represented as participants as t
Adult HIV care resources, management practices and patient characteristics in the Phase 1 IeDEA Central Africa cohort
Kimon Divaris,Jamie Newman,Jennifer Hemingway-Foday,Wilfred Akam
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.2.17422
Abstract: Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site). Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%). Conclusions: Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort's site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa.
Tuberculosis treatment survival of HIV positive TB patients on directly observed treatment short-course in Southern Ethiopia: A retrospective cohort study
Debebe Shaweno, Alemayehu Worku
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-682
Abstract: Findings: A retrospective cohort study was employed to compare the survival between HIV positive and HIV negative TB patients (370 each) during an eight month directly observed treatment short-course (DOTS) period. TB patient's HIV status was considered as an exposure and follow up time until death was taken as an outcome. All patients with TB treatment outcomes other than death were censored, and death was considered as failure. Cox proportional hazard regression model was used to determine the hazard ratio (HR) of death for each main baseline predictor.TB/HIV co-infected patients were more likely to die; adjusted Hazard Rate (AHR) =1.6, 95%CI (1.01, 2.6) during the DOTS period. This risk was statistically higher among HIV patients during the continuation phase (p=0.0003), as a result HIV positive TB patients had shorter survival (Log rank test= 6.90, df= 2, p= 0.008). The adjusted survival probability was lower in HIV positive TB patients (<15%) than HIV negative TB patients (>85%) at the end of the DOTS period (8th month).TB treatment survival was substantially lower in HIV infected TB patients, especially during the continuation phase. Targeted and comprehensive management of TB/HIV with a strict follow up should be considered through the entire TB treatment period.
Reproductive Healthcare Needs and Desires in a Cohort of HIV-Positive Women  [PDF]
Martina L. Badell,Eva Lathrop,Lisa B. Haddad,Peggy Goedken,Minh Ly. Nguyen,Carrie A. Cwiak
Infectious Diseases in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/107878
Abstract: Background. The aim of this study was to determine current contraceptive use, contraceptive desires and knowledge, future fertility desires, and sterilization regret in a cohort of HIV-positive women. Study Design. 127 HIV-positive women receiving care at an urban infectious disease clinic completed a survey addressing their contraceptive and reproductive histories as well as their future contraceptive and fertility desires. Results. The most common forms of contraception used were sterilization (44.4%) and condoms (41.3%). Less than 1% used a long-term reversible method of contraception (LARC) despite these being the methods that best fit their desired attributes of a contraceptive method. Overall, 29.4% desired future fertility. Only 50.6% of those sexually active had spoken with a provider within the last year regarding their contraceptive plans. There was a high degree of sterilization regret (36.4%), and 18.2% of sterilized women desired future fertility. Multivariate analysis found women in a monogamous relationship had a statistically increased rate of regret compared to women who were not sexually active (OR 13.8, 95% CI 1.6–119, ). Conclusion. Given the diversity in contraceptive and fertility desires, coupled with a higher rate of sterilization regret than is seen in the general population, integration of comprehensive family planning services into HIV care via increased contraceptive education and access is imperative. 1. Introduction Since the mean desired fertility rate in the United States is 2 [1], American women spend most of their reproductive lives attempting to space or prevent pregnancies; however, nearly half of all pregnancies in the USA are unintended (unwanted or mistimed) [2]. Women at highest risk for unintended pregnancies are also at highest risk for HIV and sexually transmitted infection acquisition, including women of minority race, lower education level, and lower socioeconomic status [3]. Approximately 100,000 women of reproductive age in the USA are infected with HIV, and women of color disproportionately account for 80% of HIV-infected women [4]. The prognosis for people living with HIV has greatly improved and therefore the healthcare community is able to focus on quality-of-life issues rather than only length of life issues [5]. For example, the availability and use of highly active antiretroviral therapy (HAART) has dramatically reduced mother-to-child transmission and allowed HIV-positive women to live longer, healthier lives which in turn has affected their fertility desires [6, 7]. Cohort studies of HIV-positive
Insulin resistance and adipokines serum levels in a caucasian cohort of hiv-positive patients undergoing antiretroviral therapy: a cross sectional study  [cached]
Arama Victoria,Tiliscan Catalin,Streinu-Cercel Adrian,Ion Daniela
BMC Endocrine Disorders , 2013, DOI: 10.1186/1472-6823-13-4
Abstract: Background Insulin resistance is frequent in human immunodeficiency virus (HIV) infection and may be related to antiretroviral therapy. Cytokines secreted by adipose tissue (adipokines) are linked to insulin sensitivity. The present study is aimed to assess the prevalence of insulin resistance (IR) and its association with several adipokines, in a non-diabetic Romanian cohort of men and women with HIV-1 infection, undergoing combination antiretroviral therapy (cART). Methods A cross-sectional study was conducted in an unselected sample of 89 HIV-1-positive, non-diabetic patients undergoing stable cART for at least 6 months. Metabolic parameters were measured, including fasting plasma insulin, and circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) levels. Insulin resistance was estimated by measuring the Quantitative Insulin Sensitivity Check Index (QUICKI), using a cut-off value of 0.33. A linear regression model was fitted to QUICKI to test the association of IR and adipokines levels. Results A total of 89 patients (aged 18–65, median: 28 years) including 51 men (57.3%) and 38 women (42.7%) were included in the study. Fifty nine patients (66.3%) were diagnosed with IR based on QUICKI values lower than the cut-off point. IR prevalence was 72.5% in men and 57.6% in women. The presence of the IR was not influenced by either the time of the HIV diagnosis or by the duration of cART. Decreased adiponectin and increased serum triglycerides were associated with increased IR in men (R=0.43, p=0.007). Hyperleptinemia in women was demonstrated to be associated with the presence of IR (R=0.33, p=0.03). Conclusions Given the significant prevalence of the IR in our young non-diabetic cohort with HIV infection undergoing antiretroviral therapy reported in our study and the consecutive risk of diabetes and cardiovascular events, we suggest that the IR management should be a central component of HIV-infection therapeutic strategy. As adipokines play major roles in regulating glucose homeostasis with levels varying according to the sex, we suggest that further studies investigating adipokines should base their analyses on gender differences.
Cervical Screening within HIV Care: Findings from an HIV-Positive Cohort in Ukraine  [PDF]
Heather Bailey, Claire Thorne, Igor Semenenko, Ruslan Malyuta, Rostislav Tereschenko, Irina Adeyanova, Elena Kulakovskaya, Lyudmila Ostrovskaya, Liliana Kvasha, Mario Cortina-Borja, Claire L. Townsend
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034706
Abstract: Introduction HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe. Methods Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored. Results Overall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51–0.75 p<0.01 for 1st/2nd trimester diagnosis and APR 0.42, 95% CI 0.28–0.63 p<0.01 for 3rd trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07–3.11 and APR 3.49 95% CI 2.11–5.76 respectively). Conclusions In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.
Adequacy of pain management in HIV-positive patients
C Narasimooloo, SS Naidoo, BM Gaede
South African Family Practice , 2011,
Abstract: Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence, severity, recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive, consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain, pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83% experiencing significant pain, in other words a “worst pain” rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients’ daily functioning. Pain was documented on 71% of the patients’ medical charts that were reviewed; however, only 34% were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients’ medical records, the management of pain was considered to be inadequate in a third of those experiencing pain.
Hepatitis B Virus Infection in HIV-Positive Individuals in the UK Collaborative HIV Cohort (UK CHIC) Study  [PDF]
Huw Price,Loveleen Bansi,Caroline A. Sabin,Sanjay Bhagani,Andrew Burroughs,David Chadwick,David Dunn,Martin Fisher,Janice Main,Mark Nelson,Deenan Pillay,Alison Rodger,Chris Taylor,Richard Gilson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049314
Abstract: Hepatitis B virus (HBV) infection is an increasingly important cause of morbidity and mortality in HIV-infected adults. This study aimed to determine the prevalence and incidence of HBV in the UK CHIC Study, a multicentre observational cohort.
Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda  [PDF]
Angela Kaida, Lynn T. Matthews, Steve Kanters, Jerome Kabakyenga, Conrad Muzoora, A. Rain Mocello, Jeffrey N. Martin, Peter Hunt, Jessica Haberer, Robert S. Hogg, David R. Bangsberg
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0063411
Abstract: Objective Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility. Methods Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18–49 years) who enrolled between 2005–2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation. Results At baseline (pre-ART initiation), median age was 33 years [IQR: 27–37] and median prior livebirths was four [IQR: 2–6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81–207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86–0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29–4.63). Conclusions Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.
Gender Differences in Clinical Outcomes among HIV-Positive Individuals on Antiretroviral Therapy in Canada: A Multisite Cohort Study  [PDF]
Angela Cescon, Sophie Patterson, Keith Chan, Alexis K. Palmer, Shari Margolese, Ann N. Burchell, Curtis Cooper, Marina B. Klein, Nima Machouf, Julio S. G. Montaner, Chris Tsoukas, Robert S. Hogg, Janet M. Raboud, Mona R. Loutfy, CANOC Collaboration
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083649
Abstract: Background Cohort data examining differences by gender in clinical responses to combination antiretroviral therapy (ART) remain inconsistent and have yet to be explored in a multi-province Canadian setting. This study investigates gender differences by injection drug use (IDU) history in virologic responses to ART and mortality. Methods Data from the Canadian Observational Cohort (CANOC) collaboration, a multisite cohort study of HIV-positive individuals initiating ART after January 1, 2000, were included. This analysis was restricted to participants with a follow-up HIV-RNA plasma viral load measure and known IDU history. Weibull hazard regression evaluated time to virologic suppression (2 consecutive measures <50 copies/mL), rebound (>1000 copies/mL after suppression), and all-cause mortality. Sensitivity analyses explored the impact of presumed ART use in pregnancy on virologic outcomes. Results At baseline, women (1120 of 5442 participants) were younger (median 36 vs. 41 years) and more frequently reported IDU history (43.5% vs. 28.8%) (both p<0.001). Irrespective of IDU history, in adjusted multivariable analyses women were significantly less likely to virologically suppress after ART initiation and were at increased risk of viral load rebound. In adjusted time to death analysis, no differences by gender were noted. After adjusting for presumed ART use in pregnancy, observed gender differences in time to virologic suppression for non-IDU, and time to virologic rebound for IDU, became insignificant. Conclusions HIV-positive women in CANOC are at heightened risk for poor clinical outcomes. Further understanding of the intersections between gender and other factors augmenting risk is needed to maximize the benefits of ART.
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