Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Correlation of human immunodeficiency virus and antiretroviral therapy with cardiac disorders

The occurrence of cardiovascular illness in the human immunodeficiency virus(HIV)community is increasing,with a particular focus on coronary heart disease.Patients infected with HIV have a higher risk of myocardial infarction compared to the general population in modern countries due to the development of effective antiretroviral medications and increased life expectancy.Those not receiving highly active antiretroviral therapy(ART)may experience common cardiac consequences,including myocarditis,dilated cardiomyopathy,endocarditis,pulmonary hypertension,pericardial effusion,and cardiotoxicity associated with non-antiretroviral drugs.After the use of highly active ART,continuing immune activation and systemic inflammation seem to play a central role in this process.Recent studies suggest that protease inhibitors might negatively impact the progression of HIV-related heart failure(HF),which complicates the determination of the best therapy strategy for HIVassociated cardiomyopathy.The objective of this review is to examine the pathophysiology and correlation of various antiretroviral drugs leading to HIV-associated HF.Additionally,we explore the causes of HIV-associated atherosclerotic cardiovascular disease,including the high frequency of classic cardiovascular risk factors in HIVinfected patients,as well as HIV-related factors like the use of ART and chronic inflammation despite successful treatment of HIV infection.Numerous studies have revealed that individuals living with HIV/acquired immune deficiency syndrome frequently experience HF.In conclusion,despite advancements in HIV care,HIV-infected individuals continue to face an increased risk of HIV-associated cardiomyopathy and atherosclerosis.Further research is necessary to comprehend the underlying causes and develop effective treatments for cardiovascular disease in this population.We also discuss the currently available therapeutic options and ongoing research to mitigate the risk of cardiovascular disease and inflammation in HIV-infected individuals.

HIV-1 Subtype Diversity and Factors Affecting Drug Resistance among Patients with Virologic Failure in Antiretroviral Therapy in Hainan Province,China,2014–2020

Objective This study aimed to determine the HIV-1 subtype distribution and HIV drug resistance(HIVDR)in patients with ART failure from 2014 to 2020 in Hainan,China.Methods A 7-year cross-sectional study was conducted among HIV/AIDS patients with ART failure in Hainan.We used online subtyping tools and the maximum likelihood phylogenetic tree to confirm the HIV subtypes with pol sequences.Drug resistance mutations(DRMs)were analyzed using the Stanford University HIV Drug Resistance Database.Results A total of 307 HIV-infected patients with ART failure were included,and 241 available pol sequences were obtained.Among 241 patients,CRF01_AE accounted for 68.88%,followed by CRF07_BC(17.00%)and eight other subtypes(14.12%).The overall prevalence of HIVDR was 61.41%,and the HIVDR against non-nucleoside reverse transcriptase inhibitors(NNRTIs),nucleotide reverse transcriptase inhibitors(NRTIs),and protease inhibitors(PIs)were 59.75%,45.64%,and 2.49%,respectively.Unemployed patients,hypoimmunity or opportunistic infections in individuals,and samples from 2017 to 2020 increased the odd ratios of HIVDR.Also,HIVDR was less likely to affect female patients.The common DRMs to NNRTIs were K103N(21.99%)and Y181C(20.33%),and M184V(28.21%)and K65R(19.09%)were the main DRMs against NRTIs.Conclusion The present study highlights the HIV-1 subtype diversity in Hainan and the importance of HIVDR surveillance over a long period.

Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

To explore patients’ perceptions about motivators and barriers of adherence to highly active antiretroviral therapy among people living with HIV: A qualitative study

Objective:For people living with HIV(PLHIV),strict adherence to highly active antiretroviral therapy(HAART)is the key to effective treatment and retention in human immunodeficiency virus(HIV)care.There are many factors which promote or halt the antiretroviral therapy(ART)adherence practices.Therefore,the present study aimed to examine the HAART adherence levels and to explore patients’views about barriers and facilitators to HIV treatment adherence.Methods:Semi-structured interviews were conducted among 15 PLHIV at the ART clinic of Dr.Ram Manohar Lohia Hospital,New Delhi.Interviews were audio-recorded in the local Hindi language,and bilingual experts(English and Hindi)transcribed verbatim.Qualitative data were coded for themes and subthemes and analyzed using a phenomenological approach as per thematic content analysis.Results:Feeling of hopelessness,delayed ART initiation,difficult initial phase of ART,forget to take ART on time,fear of disclosure of HIV diagnosis,lack of privacy and negative social support,and impact of lockdown due to COVID-19 were revealed as significant barriers to ART adherence.At the same time,commitment to raise and educate children,ART to increase life span,maintain oneself to be physically fit and healthy,only a single pill per day,very supportive counselors and health-care professionals,and hope to give birth to a healthy child were identified as facilitators of HIV retention.Conclusion:Understanding patient’s perception about ART adherence,its motivational and barrier factors which are directly affecting ART adherence and retention of PLHIV in HIV treatment and follow-ups are of utmost importance to improve ART adherence during HIV patient care services.

Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs

For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.

Vitamin D and Secondary Hyperparathyroidism in HIV Infected Patients Taking Antiretroviral Therapy

Objective: Due to the lack of studies assessing hypovitaminosis D and secondary hyperparathyroidism in Brazilian HIV-infected population, especially in the northeastern population, this study aimed to determine the profile of these conditions in patients infected with HIV and its correlation with immuno-virological, sociodemographic data and associated comorbidities. Methods: Comparison studies were obtained from routine clinical samples of HIV infected patients submitted for 25-OH Vitamin D, PTH and alkaline phosphatase determination. Results: A total of 78 patients were included, 42 (53.8%) males, mean age 45.7 years. Antiretroviral regimens most used in this study were Zidovudine/Lamivudine/Efavirenz 17.9%, Tenofovir/Lamivudine/Efavirenz 17.9%,Tenofovir/Lamivudine/Atazanavir-r 15.4%. The mean value CD4 count was 592.1 ± 247.2 cells/mm3, CD8 cell count was 1026.5 ± 467.3 cells/mm3, mean detectable viral load was 2220 ± 15703 copies and CD4/CD8 ratio was 0.63 ± 0.33. A total of 34 vitamin D dosages were collected with 41.2% representing sufficient amount and 58.8% insufficient. Alkaline Phosphatase (ALP) dosage was elevated in 49.3% (N=35) of the patients. Parathormone (PTH) was elevated in 18% (N = 11). Among patients with elevated PTH levels, 81.9% had elevated levels of ALP (p = 0.01). In the group of patients with high levels of ALP, 45.7% had a CD4 count 3 (p = 0.02). There was no significant difference in vitamin D related to gender (p = 0.21), age (p = 0.23), CD4 count (p = 0.26), suppressed viral load (p = 0.44) or blood glucose (p = 0.45). Conclusions: This study evidenced a high prevalence of Vitamin D insufficiency in Northeast Brazil, which suggests HIV infection correlation. A high prevalence of Hyperparathyroidism was detected and related with inflammatory condition persistence and low CD4 count. We suggest improve vitamin D follow up and measurements in this population with better CD4 count control to avoid future osteoarticular complications of HIV treatment.

Effects of viremia and CD4 recovery on gut“microbiome-immunity”axis in treatment-na?ve HIV-1-infected patients undergoing antiretroviral therapy

BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio<1(immunological non-responders[INRs])and CD4/CD8>1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and butyric acids.Contemporarily,a reduction of serum IP-10 and an increase of IL-8 levels were detected in the viral suppression condition.In addition,the same components were compared between IRs and INRs.Concerning the microflora population,we detected a reduction of Faecalibacterium and an increase of Alistipes in INRs.Simultaneously,fecal isobutyric,isovaleric,and 2-methylbutyric acids were also increased in INRs.CONCLUSION Our results provided an additional perspective about the impact of HIV infection,ART,and immune recovery on the"microbiome-immunity axis"at the metabolism level.These factors can act as indicators of the active processes occurring in the gastrointestinal tract.Individuals with HIV-1 infection,before ART and after reaching virological suppression with 24 wk of ART,displayed a microbiota with unchanged overall bacterial diversity;moreover,their systemic inflammatory status seems not to be completely restored.In addition,we confirmed the role of the GM metabolites in immune reconstitution.

Interleukin-15 is a significant predictor of sarcopenia in human immunodeficiency virus infected patients on antiretroviral therapy:A cross-sectional study

Objective:To identify the relationship between interleukin(IL)-15 levels and sarcopenia in human immunodeficiency virus(HIV)-infected patients who have received antiretroviral therapy.Methods:This study was a cross-sectional design with 70 participants conducted from January to March 2021.All the participants were assessed for sarcopenia and the IL-15 levels.Sarcopenia was established based on the the Asian Working Group for Sarcopenia(AWGS)2019 criteria.Plasma IL-15 was determined.This analysis was carried out by means of 2×2 tabulation and the statistical test used is Chi-square.Results:Seventy patients received antiretroviral therapy>6 months and showed a good clinical response.Among them,36(51.4%)took zidovudine-based antiretroviral therapy with a median duration of illness of 5 years.The proportion of sarcopenia in patients with HIV infection was 32.9%.The median CD4 cell count was 395.5 cells/L(range:203-937 cells/L).Logistic regression analysis revealed that age>50 years(aOR 8.3,95%CI 1.6-44.5),underweight(aOR 7.7,95%CI 1.5-40.5),IL-15≥150.5 ng/L(aOR 4.9,95%CI 1.3-19.0)and female(aOR 4.8,95%CI 1.2-18.3 were significant and independent adverse predictors of sarcopenia in subjects with HIV infection.Conclusions:There is an association between high levels of IL-15 and sarcopenia in HIV-infected patients on antiretroviral therapy for more than 6 months with good clinical response.

Effects of Hepatitis B Virus Co-Infection and Antiretroviral Therapy on Disease Progression among HIV Patients Treated at the Buea Regional Hospital, Southwest Region, Cameroon: A Case-Control Study

In the era of “test and treat”, when AIDS-defining events have been drastically reduced, chronic liver disease associated with viral hepatitis and antiretroviral therapy (ART) remains an important cause of non-AIDS morbidity and mortality among HIV-infected patients. Compared to the general population, HIV-infected patients are about 10-times at risk of hepatitis B virus infection. Additionally, several antiretroviral regimens are hepatotoxic. Therefore, effective monitoring and management of ART and HBV co-infection are essential to ending the AIDS epidemic and eliminating viral hepatitis by 2030. This was a hospital-based, matched (age and sex) case-control study. HIV patients (case patients) on ART for at least six months and “healthy” controls aged 18 years and older were enrolled. Blood samples were collected for immuno-hematologic indices and transaminases measurements. Data were presented as counts, percentages, median (IQR) and means (SD), and a p-value 1.5) and mild (0.6 - 1.5) liver fibrosis based on the APRI score was 0.5% and 8%, respectively. Significant fibrosis (>3.25) was 0.9%, while 18.4% had inconclusive fibrosis (1.45 - 3.25) based on the FIB-4 score. HIV/HBV co-infected patients had a higher occurrence of liver fibrosis (APRI: 0.5% vs FIB-4: 0.9%). Co-infections with HBV increase the risk of liver-related morbidity in HIV patients. Therefore, screening for serological markers of chronic HBV infection and hepatic transaminase levels in HIV patients remains crucial in the continuum of care.

Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study

Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus(HIV)patients in whom antiretroviral therapy(ART)was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1(treatment time≤3 years,n1=5,218)and Group 2(treatment time>3 years,n2=4,200).Patient follow-up data,including age,cluster of differentiation 4(CD4)count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl(interquartile range,77.0–282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2(P<0.05).A significant interaction between group and time effects was observed(P<0.05)in total cholesterol(TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time(P=0.001).The initial CD4 count(odds ratio[OR]=0.756),female sex(OR=0.713),Zerit(d4T)(OR=1.443),TC(OR=1.285),and aspartate aminotransferase level(OR=1.002)were significantly associated with the survival time of dead patients with HIV(P<0.05).Additionally,the initial CD4 count(OR=1.456),age(OR=1.022),time interval(OR=0.903),patient’s living status(OR=0.597),d4T(OR=2.256),and triglyceride(OR=0.930)and hemoglobin levels(OR=0.997)were significantly associated with the treatment time of HIV patients with drug withdrawal(P<0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.

Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy

Cardiovascular disease(CVD)has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus(HIV)(PLWH)on antiretroviral therapy(ART).Nearly 50%of PLWH are likely to have an increased risk of developing CVD,including coronary heart disease,cerebrovascular disease,peripheral artery disease and aortic atherosclerosis.Aside from the common risk factors,HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity.Potential non-pharmacological therapies are currently being tested worldwide for this purpose,including eating patterns such as Intermittent fasting(IF).IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins,blood pressure(BP),platelet-derived growth factor AB,systemic inflammation,and carotid artery intima-media thickness among others cardiovascular benefits.This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction,lipid peroxidation and aging.Intermittent fasting regimens need to be tested in clinical trials as an important,cost-effective,and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.

Viral Monitoring and Prevalence of Viral Failure in HIV-1 Infected Children under First Line Antiretroviral Therapy during the First 60 Months of Treatment in Yaoundé, Cameroon: A Serial Cross Sectional Analysis

Objective: The objective was to measure the prevalence of viral failure (VF) in HIV-1-infected children on first-line antiretroviral therapy (ART) in routine practice. Methods: Serial cross sectional analysis of viral load (VL) in HIV-1 infected children on first-line ART for ≥24 weeks was done. VL was measured by Real-Time-Polymerase chain reaction (biocentrics). Samples were collected at 6, 12, 24, 36, 48, 60 months of treatment. Main measurement: Virological failure (VF) defined by a one-off VL > 1000 copies/ml. Results: 375 children aged ≤16 years on first-line-ART were included. Median age at ART start was 4.2 years and ≥50% have started ART ≤3rd birthday. A total of 717 measurements of VL were collected. VF was rated between 18% and 26% from 6 - 60 months (mean 20.2%), 95% IC [13.1 - 27.3] at the threshold of 1000 copies/ml, not too different at the threshold of 400 copies/ml, 21% - 30% (mean 23.9%), 95% IC [16.3 - 31.5], p = 0.9. Conclusion: In Yaounde, almost 20% of children on first-line of adherent-ART can experiment VF while improving immune status urging improvement of adherence.

Optimal Timing of Antiretroviral Therapy Initiation in Acquired Immunodeficiency Syndrome-Associated Toxoplasmic Encephalitis:A Prospective Observational Multicenter Study in China

Background:Toxoplasmic encephalitis(TE)is the most frequent cause of expansive brain lesions among patients with acquired immunodeficiency syndrome(AIDS).However,the optimal timing of antiretroviral therapy(ART)initiation in these patients remains controversial.This study aims to investigate the differences in outcomes of ART initiation at different times,in order to help clarify the treatment timing of AIDS-associated TE.Methods:This multicenter prospective observational study included 87 patients recruited from 11 research centers in China(from March 2019 to December 2022).Of the patients,38 were assigned to the early ART group(initiating ART within 2 weeks after anti-Toxoplasma treatment initiation),and the remaining 49 patients received deferred ART(initiating ART at least 2 weeks after anti-Toxoplasma treatment initiation).The main outcomes includedmortality and emergence of immune reconstitution inflammatory syndrome(IRIS).Human immunodeficiency virus(HIV)-1 viral load and CD4^(+)T-cell counts at weeks 24 and 48 were observed.Results:The number of deaths(1 vs.5,P=0.225)and incidence of IRIS(2.6%vs.0,P=0.437)were not significantly different between the early and deferred ART groups at week 48.Early ART initiation did not contribute significantly to HIV-1 viral load control(<50 copies/mL,n=8 vs.n=3 at week 24,P=0.142;n=7 vs.n=7 atweek 48,P=1.000).The median CD4^(+)T-cell counts between the two groups were not significantly different,either at week 24(155 vs.91 cells/mm^(3),P=0.837)or atweek 48(181 vs.146 cells/mm^(3),P=0.219).Conclusion:In patients with AIDS-associated TE,early ART initiation was not significantly different from deferred ART initiation in terms of incidence of mortality,IRIS,and HIV virological and immunological outcomes.Trial registration:This study was registered(registration number:ChiCTR1900021195)as one of 12 clinical trials under the title of a general project at the Chinese Clinical Trial Registry(chictr.gov)on February 1,2019.Enrollment for this study began inMarch 2019.

Factors Associated with Antiretroviral Therapy Defaulting among Adult Patients Receiving Care at Chikankata Mission Hospital, Chikankata District, Zambia

Background: Defaulting on antiretroviral therapy has been identified as the most important factor contributing to the antiretroviral therapy failure rate. This study aimed to investigate factors associated with defaulting on antiretroviral therapy among adult patients receiving care at Chikankata Mission Hospital antiretroviral therapy clinic. Method: Cross-sectional analytical study on 385 participants selected by a computer generated random numbers technique of simple random sampling from among the patients receiving antiretroviral therapy at Chikankata Mission Hospital. Data collected were processed and analysed using Statistical Package for Social Science version 27. Univariate and backward multivariable logistic regression analysis was performed to identify factors associated with antiretroviral therapy defaulting. The level of significance was set at 5% with a confidence level of 95%. Results: Over half (58.4%) of the study participants defaulted on antiretroviral therapy. About 65.8% of study participants indicated improved health as the reason they defaulted on antiretroviral therapy. Most participants indicated that it was important to always go for antiretroviral therapy services (Adjusted Odds Ratio 1.95;95% Confidence Interval: [1.14 - 3.33], p = 0.015). Very few participants indicated poor family support for antiretroviral therapy services (Adjusted Odds Ratio 4.08;95% Confidence Interval: [2.02 - 8.23], p Conclusion: Defaulting on antiretroviral therapy continues to be a significant problem and needs to be addressed as a matter of priority. More counselling and awareness-raising programmes are required to improve knowledge and understanding on the importance of attending scheduled antiretroviral therapy clinics and services as well as the consequences of defaulting on antiretroviral therapy.

Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy

OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.

Pretreatment HIV drug resistance in adults initiating antiretroviral therapy in China,2017

Background:After the scale-up of antiretroviral therapy(ART)for HIV infected people,increasing numbers of patients have pretreatment drug resistance(PDR).In this study,the prevalence of PDR was evaluated in adults initiating antiretroviral therapy in China.Methods:Blood samples were obtained from 1943 patients who initiated antiretroviral therapy(ART)in 2017 from 13 provinces or cities in China.Pol sequences were used to analyze drug resistance and construct transmission networks.Logistic regression model was used to estimate the potential factors associated with PDR.Results:In total,1711 eligible patients(76.0%male;87.8%aged≥25 years)were included,of which 117(6.8%)had PDR.The highest rates of PDR were 12.2%in Liangshan Prefecture of Sichuan and 9.3 and 8.9%in Dehong and Lincang Prefecture of Yunnan.A multivariate logistic regression analysis revealed that PDR was significantly higher among intravenous drug users(adjusted Odds Ratio(aOR)=2.64,95%CI:1.57–4.44)and individuals from Liangshan,Dehong,and Lincang(aOR=2.04,95%CI:1.26–3.30).In total,754 sequences were used to generate 164 transmission networks.Five transmission networks had two or three sequences containing the same mutations,two networks contained subjects from Liangshan,and one network contained subjects from Dehong.Conclusions:Overall,the PDR prevalence was moderate,with a particularly high prevalence in areas with severe HIV epidemics.These results indicate the importance of continuous PDR monitoring in patients initiating antiretroviral therapy.

Immuno-haematologic and virologic responses and predictors of virologic failure in HIV-1 infected adults on first-line antiretroviral therapy in Cameroon

Background:Contemporary data on the immunologic,haematologic and virologic responses and predictors of virologic failure after initiation of free antiretroviral treatment in Cameroon are needed to evaluate the current treatment-monitoring algorithm and to complement efforts to scale-up and improve on the management of HIV infections.Methods:This was a cross-sectional study conducted between October 2010 and June 2012.A total of 951 participants aged 18-74 years were recruited from selected approved HIV treatment centres of the Northwest and Southwest regions.This comprised 247 males and 704 females.Demographic,self-reported risk behaviours and socioeconomic data were obtained using a structured questionnaire.Full blood and CD4+T-cell counts were done using standard automated techniques.Determination of viral load(VL)was done using Abbott RealTime HIV-1 m2000™system.Data was analysed using SPSS version 17.The statistical significance level was P<0.05.Results:The median duration of antiretroviral therapy(ART)was 24 months.The population mean CD4+T-cell count was 255.3 cells/μL[95%CI,236.8-273.9].Overall,45.9%,43.8%and 10.2%of the participants had CD4+T-cell counts of<200 cells/μL,200-499 cells/μL and>500 cells/μL respectively.Anaemia was present in 26.2%of the participants with 62.3%,25.7%and 12%described as mild,moderate and severe anaemia respectively.Virologic failure occurred in 23.2%of the participants with 12.3%having VL>10,000 RNA copies/mL.Meanwhile 76.8%of patients attained adequate viral suppression with 40.8%having undetectable viral load.The age group 18-29 years(p=0.024),co-infection with tuberculosis(p=0.014),anaemia(p=0.028)and distance from the treatment centre(p=0.011)independently predicted virologic failure.Conclusion:The majority of the participants achieved adequate viral suppression after≥6 months of ART.Despite these favourable immuno-haematologic and virologic outcomes,the National AIDS Control Program should step-up efforts to improve on antiretroviral drug distribution,as well as proper assessment and management of anaemia,foster early diagnosis and treatment of tuberculosis and enhance treatment adherence counselling especially in younger patients.

Efficacy and safety of Mianyi granules(免疫Ⅱ颗粒) for reversal of immune nonresponse following antiretroviral therapy of human immunodeficiency virus-1:a randomized,double-blind,multi-center,placebo-controlled trial

OBJECTIVE:To investigate whether Mianyi granules(免疫Ⅱ颗粒)are effective and safe in reversing immune nonresponse following antiretroviral therapy(ART)in individuals with human immunodeficiency virus(HIV)infection.METHODS:Randomized,double-blind,multi-center,placebo-controlled trial(factorial design)of daily oral Mianyi granules versus placebo for 72 weeks.A total of 361 HIV-positive individuals receiving ART at five ClassⅢGradeⅠhospitals in China between September 2013 and January 2016 completed the study.The primary endpoints were frequencies of CD3+,CD4+,CD8+,and CD45 RA+cells at seven timepoints over the 72 weeks.Secondary endpoints included viral loads,clinical symptoms,and quality of life at 72 weeks.RESULTS:A total of 400 participants were enrolled in the study and randomized,of whom 361 completed the study:189 individuals(140 men and 49 women)in the Mianyi granule group and 172 individuals(135 men and 37 women)in the placebo group.In the intent-to-treat population,CD4+T cell counts increased from(193±71)cells/mm^(3)at baseline to(288±131)cells/mm^(3)posttreatment in the Mianyi granule group and from(200±75)cells/mm^(3)at baseline to(264±124)cells/mm^(3)posttreatment in the placebo group.Patients treated with Mianyi granule had higher increases in CD4+T cell counts than those treated with placebo(P=0.045).Reversal of immune nonresponse was defined as a CD4+T cell increase of more than 100 cells/mm^(3).After treatment for 72 weeks,Mianyi granule was effective in reversing immune nonresponse in a higher proportion of individuals(20.2%)compared with placebo(9.7%).CD45 RA+cell counts increased from(34±32)cell/mm^(3)at baseline to(51±61)cells/mm^(3)post-treatment in the Mianyi granule group and from(37±33)cells/mm^(3)at baseline to(48±37)cells/mm^(3)post-treatment in the placebo group.Mianyi granules were more effective than placebo in increasing CD45 RA+cell counts.CONCLUSIONS:In ART-treated HIV-positive adults with immune nonresponse,treatment with Mianyi granules for 72 weeks was safe and significantly increased CD4+and CD45 RA+cell counts,thereby promoting immune reconstitution.

Impact of body fat changes in mediating the effects of antiretroviral therapy on blood pressure in HIV-infected persons in a sub-Saharan African setting

Background:Previous studies of HIV-infected patients have shown significant associations between highly active antiretroviral therapy(HAART)and increased blood pressure;however,the mechanisms involved are less clear.Therefore,we sought to investigate the potential impact of body fat changes in mediating the effects of HAART on blood pressure changes among people living with HIV.Methods:Four hundred six consenting patients(≥18 years of age)attending a tertiary HIV clinic in semi-urban Nigeria were recruited between August and November 2014 as part of a cross-sectional study.We performed bias-corrected bootstrap tests of mediation using 95%confidence intervals(CI)to determine the mediating effects of body mass index and waist circumference(mediators)on the total effects of HAART exposure(primary predictor)on blood pressure(outcome),while controlling for age,sex and other potential confounders.Results:Waist circumference remained a significant partial mediator of the total effects of HAART exposure on increasing systolic blood pressure(coefficient:1.01,95%CI:0.33 to 2.52,11%mediated)and diastolic blood pressure(coefficient:0.68,95%CI:0.26 to 1.89,9%mediated)after adjusting for age,sex,smoking status,CD4 count and duration of HIV infection.No significant mediating effect was observed with body mass index alone or in combination with waist circumference after adjusting for all potential confounders.Conclusion:Waist circumference significantly mediates the effects of HAART on blood pressure in persons living with HIV,independent of the role of traditional risk factors.The use of waist circumference as a complementary body fat measure to body mass index may improve the clinical prediction of hypertension in HIV-infected patients on antiretroviral therapy.