Journal Article > CommentaryFull Text
N Engl J Med. 2 February 2023; Volume 388 (Issue 5); 387-390.; DOI:10.1056/NEJMp2213809
Haberer JE, Boum Y
N Engl J Med. 2 February 2023; Volume 388 (Issue 5); 387-390.; DOI:10.1056/NEJMp2213809
Journal Article > ResearchAbstract Only
AIDS Behav. 2 June 2016; Volume 21 (Issue 6); 1735-1740.; DOI:10.1007/s10461-016-1447-1
Musinguzi N, Mocello AR, Boum Y II, Hunt PW, Martin JN, et al.
AIDS Behav. 2 June 2016; Volume 21 (Issue 6); 1735-1740.; DOI:10.1007/s10461-016-1447-1
Little is known about associations between viral suppression, adherence, and duration of prior viral suppression in sub-Saharan Africa. Study participants were from the UARTO study in Mbarara, Uganda. We fit regression models to characterize relationships between average adherence, treatment interruptions, and rebound viremia (>400 copies/mL) following a previously undetectable result. Our goal was to understand the impact of prior viral suppression on these relationships. 396 participants contributed 2864 quarterly visits. Restricted to periods with average adherence <50%, each 10% increase in adherence reduced the odds of rebound viremia by 74% [adjusted odds ratio (AOR) = 0.26, P = 0.002] and 29 % (AOR = 0.71, P = 0.057) during the first 12 months of suppression and beyond 12 months respectively, interaction term P = 0.018. Among periods with adherence ≥50%, the risk of rebound viremia decreased with increasing adherence during the first 12 months of viral suppression (AOR = 0.73 for each 10 % increase, P = 0.001), but not thereafter (AOR = 1.09, P = 0.67), interaction term P = 0.027. In contrast, 72-h interruptions, were associated with increased rebound viremia during the first 12 months (AOR = 1.30, P = 0.009) and after (AOR = 1.39, P = 0.005), interaction term P = 0.69. Completing 12 months of viral suppression decreases the impact of average adherence, but not prolonged treatment interruptions, on risk of rebound viremia.
Journal Article > ResearchAbstract
J Acquir Immune Defic Syndr. 15 August 2019; Volume 81 (Issue 5); DOI:10.1097/QAI.0000000000002053
Kaida A, Kabakyenga JK, Bwana M, Bajunirwe F, Muyindike WR, et al.
J Acquir Immune Defic Syndr. 15 August 2019; Volume 81 (Issue 5); DOI:10.1097/QAI.0000000000002053
Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy (ART) in Uganda. Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men's sexual and reproductive health annually and repeated at time of reported pregnancy (2011-2015). We measured partner pregnancy incidence overall, by pregnancy intention, and by reported partner HIV-serostatus. We assessed viral suppression (≤400 copies/mL) during the peri-conception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy. Among 189 men, baseline median age was 39.9 years [IQR:34.7,47.0], years on ART was 3.9 [IQR:0.0,5.1], and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence=16.0/100 person-years); 45% with HIV-serodifferent partners. By three years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV-serostatus (p=0.75). 69% of pregnancies were intended, 18% wanted but mis-timed, and 8% unwanted. 78% of men were virally suppressed prior to pregnancy report. Men who were younger (aHR:0.94/year;95%CI:0.89-0.99), had incomplete primary education (aHR:2.95;95%CI:1.36-6.40), and reported fertility desires (aHR:2.25;95%CI:1.04-4.85) had higher probability of partner pregnancy. A high incidence of intended partner pregnancy highlights the need to address men's reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV and one-quarter of men were not virally suppressed during peri-conception. Safer conception care provides opportunity to support men's health and reproductive goals, while preventing HIV transmission to women and infants.
Journal Article > ResearchFull Text
BMJ Glob Health. 18 October 2019; Volume 4 (Issue 5); e001855.; DOI:10.1136/bmjgh-2019-001855
Mbaye R, Gebeyehu R, Hossmann S, Mbarga NF, Bih-Neh E, et al.
BMJ Glob Health. 18 October 2019; Volume 4 (Issue 5); e001855.; DOI:10.1136/bmjgh-2019-001855
INTRODUCTION
Africa contributes little to the biomedical literature despite its high burden of infectious diseases. Global health research partnerships aimed at addressing Africa-endemic disease may be polarised. Therefore, we assessed the contribution of researchers in Africa to research on six infectious diseases.
METHODS
We reviewed publications on HIV and malaria (2013-2016), tuberculosis (2014-2016), salmonellosis, Ebola haemorrhagic fever and Buruli ulcer disease (1980-2016) conducted in Africa and indexed in the PubMed database using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Papers reporting original research done in Africa with at least one laboratory test performed on biological samples were included. We studied African author proportion and placement per study type, disease, funding, study country and lingua franca.
RESULTS
We included 1182 of 2871 retrieved articles that met the inclusion criteria. Of these, 1109 (93.2%) had at least one Africa-based author, 552 (49.8%) had an African first author and 41.3% (n=458) an African last author. Papers on salmonellosis and tuberculosis had a higher proportion of African last authors (p<0.001) compared with the other diseases. Most of African first and last authors had an affiliation from an Anglophone country. HIV, malaria, tuberculosis and Ebola had the most extramurally funded studies (≥70%), but less than 10% of the acknowledged funding was from an African funder.
CONCLUSION
African researchers are under-represented in first and last authorship positions in papers published from research done in Africa. This calls for greater investment in capacity building and equitable research partnerships at every level of the global health community.
Africa contributes little to the biomedical literature despite its high burden of infectious diseases. Global health research partnerships aimed at addressing Africa-endemic disease may be polarised. Therefore, we assessed the contribution of researchers in Africa to research on six infectious diseases.
METHODS
We reviewed publications on HIV and malaria (2013-2016), tuberculosis (2014-2016), salmonellosis, Ebola haemorrhagic fever and Buruli ulcer disease (1980-2016) conducted in Africa and indexed in the PubMed database using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Papers reporting original research done in Africa with at least one laboratory test performed on biological samples were included. We studied African author proportion and placement per study type, disease, funding, study country and lingua franca.
RESULTS
We included 1182 of 2871 retrieved articles that met the inclusion criteria. Of these, 1109 (93.2%) had at least one Africa-based author, 552 (49.8%) had an African first author and 41.3% (n=458) an African last author. Papers on salmonellosis and tuberculosis had a higher proportion of African last authors (p<0.001) compared with the other diseases. Most of African first and last authors had an affiliation from an Anglophone country. HIV, malaria, tuberculosis and Ebola had the most extramurally funded studies (≥70%), but less than 10% of the acknowledged funding was from an African funder.
CONCLUSION
African researchers are under-represented in first and last authorship positions in papers published from research done in Africa. This calls for greater investment in capacity building and equitable research partnerships at every level of the global health community.
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 16 January 2018; Volume 77 (Issue 5); DOI:10.1097/QAI.0000000000001629
Castillo-Mancilla JR, Morrow M, Boum Y II, Byakwaga H, Haberer JE, et al.
J Acquir Immune Defic Syndr. 16 January 2018; Volume 77 (Issue 5); DOI:10.1097/QAI.0000000000001629
Residual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays.
Journal Article > ResearchFull Text
J Am Heart Assoc. 15 June 2021; Volume 10 (Issue 12); e019994.; DOI:10.1161/JAHA.120.019994
Siender M, Bibangambah P, Kim JH, Lankowski A, Chang JL, et al.
J Am Heart Assoc. 15 June 2021; Volume 10 (Issue 12); e019994.; DOI:10.1161/JAHA.120.019994
BACKGROUND
Although ≈70% of the world's population of people living with HIV resides in sub-Saharan Africa, there are minimal prospective data on the contributions of HIV infection to atherosclerosis in the region.
METHODS AND RESULTS
We conducted a prospective observational cohort study of people living with HIV on antiretroviral therapy >40 years of age in rural Uganda, along with population-based comparators not infected with HIV. We collected data on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models, adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3-4, range 1-5). Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non-high-density lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001-0.007 mm], 0.006 mm/year for people living with HIV [95% CI, 0.003-0.008 mm], HIV×time interaction P=0.25).
CONCLUSIONS
In rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub-Saharan Africa.
REGISTRATION
https://www.ClinicalTrials.gov; Unique identifier: NCT02445079.
Although ≈70% of the world's population of people living with HIV resides in sub-Saharan Africa, there are minimal prospective data on the contributions of HIV infection to atherosclerosis in the region.
METHODS AND RESULTS
We conducted a prospective observational cohort study of people living with HIV on antiretroviral therapy >40 years of age in rural Uganda, along with population-based comparators not infected with HIV. We collected data on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models, adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3-4, range 1-5). Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non-high-density lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001-0.007 mm], 0.006 mm/year for people living with HIV [95% CI, 0.003-0.008 mm], HIV×time interaction P=0.25).
CONCLUSIONS
In rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub-Saharan Africa.
REGISTRATION
https://www.ClinicalTrials.gov; Unique identifier: NCT02445079.
Journal Article > ResearchFull Text
SSM Ment Health. 1 December 2021; Volume 1; 100034.; DOI:10.1016/j.ssmmh.2021.100034
Bebell LM, Kembabazi A, Musinguzi N, Martin JN, Hunt PW, et al.
SSM Ment Health. 1 December 2021; Volume 1; 100034.; DOI:10.1016/j.ssmmh.2021.100034
Depression affects over 40% of people with HIV (PHIV) in low- and middle-income countries, and over half of PHIV report HIV-related internalized stigma. However, few longitudinal studies of PHIV have examined the relationship between HIV-related stigma and depression. Data were analyzed from the 2007-15 Uganda AIDS Rural Treatment Outcomes (UARTO) Study, a cohort of 454 antiretroviral therapy (ART)-naïve PHIV (68% women) starting ART. Our primary outcome was depression symptom severity over the first two years of ART, measured using a locally adapted version of the Hopkins Symptom Checklist; our primary exposure was the 6-item Internalized AIDS-Related Stigma Scale. Both scores were measured at enrollment and at quarterly follow-up visits. We fit linear generalized estimating equations (GEE) regression models to estimate the association between stigma and depression symptom severity, adjusting for potential confounders. We included a stigma×time product term to assess the modifying effect of ART on the association between internalized stigma and depression symptom severity. UARTO participants had a median age of 32 years and median enrollment CD4 count of 217 cells/mm3. Both depression symptom severity and internalized stigma declined on ART, particularly during the first treatment year. In multivariable regression models, depression symptom severity was positively associated with internalized stigma (b=0.03; 95% confidence interval [CI], 0.02 to 0.04) and negatively associated with ART duration >6 months (b =- 0.16; 95% CI,- 0.19 to -0.13). The estimated product term coefficient was negative and statistically significant (P = 0.004), suggesting that the association between internalized stigma and depression symptom severity weakened over time on ART. Thus, in this large cohort of PHIV initiating ART in rural Uganda, depression symptom severity was associated with internalized stigma but the association declined with time on ART. These findings underscore the potential value of ART as a stigma reduction intervention for PHIV, particularly during early treatment.
Journal Article > ResearchFull Text
AIDS. 8 January 2014; Volume 28 (Issue 8); 1221-6.; DOI:10.1097/QAD.0000000000000188
Venkataramani AS, Thirumurthy H, Haberer JE, Boum Y II, Siedner MJ, et al.
AIDS. 8 January 2014; Volume 28 (Issue 8); 1221-6.; DOI:10.1097/QAD.0000000000000188
OBJECTIVE
To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes.
DESIGN
Prospective cohort study of HIV-positive patients on ART in rural Uganda.
METHODS
Patients initiating ART at a regional referral clinic in Uganda were enrolled in the Uganda AIDS Rural Treatment Outcomes study starting in 2005. Data on labor force participation and asset ownership were collected on a yearly basis, and CD4 cell counts were collected at pre-ART baseline. We fitted multivariable regression models to assess whether economic outcomes at baseline and in the 6 years following ART initiation varied by baseline CD4 cell count.
RESULTS
Five hundred and five individuals, followed up to 6 years, formed the estimation sample. Participants initiating ART at CD4 cell count at least 200 cells/μl were 13 percentage points more likely to be working at baseline (P < 0.01, 95% confidence interval 0.06-0.21) than those initiating below this threshold. Those in the latter group achieved similar labor force participation rates within 1 year of initiating ART (P < 0.01 on the time indicators). Both groups had similar asset scores at baseline and demonstrated similar increases in asset scores over the 6 years of follow-up.
CONCLUSION
ART helps participants initiating therapy at CD4 cell count below 200 cells/μl rejoin the labor force, though the findings for participants initiating with higher CD4 cell counts suggests that pretreatment declines in labor supply may be prevented altogether with earlier therapy. Baseline similarities in asset scores for those with early and advanced disease suggest that mechanisms other than morbidity may help drive the relationship between HIV infection and economic outcomes.
To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes.
DESIGN
Prospective cohort study of HIV-positive patients on ART in rural Uganda.
METHODS
Patients initiating ART at a regional referral clinic in Uganda were enrolled in the Uganda AIDS Rural Treatment Outcomes study starting in 2005. Data on labor force participation and asset ownership were collected on a yearly basis, and CD4 cell counts were collected at pre-ART baseline. We fitted multivariable regression models to assess whether economic outcomes at baseline and in the 6 years following ART initiation varied by baseline CD4 cell count.
RESULTS
Five hundred and five individuals, followed up to 6 years, formed the estimation sample. Participants initiating ART at CD4 cell count at least 200 cells/μl were 13 percentage points more likely to be working at baseline (P < 0.01, 95% confidence interval 0.06-0.21) than those initiating below this threshold. Those in the latter group achieved similar labor force participation rates within 1 year of initiating ART (P < 0.01 on the time indicators). Both groups had similar asset scores at baseline and demonstrated similar increases in asset scores over the 6 years of follow-up.
CONCLUSION
ART helps participants initiating therapy at CD4 cell count below 200 cells/μl rejoin the labor force, though the findings for participants initiating with higher CD4 cell counts suggests that pretreatment declines in labor supply may be prevented altogether with earlier therapy. Baseline similarities in asset scores for those with early and advanced disease suggest that mechanisms other than morbidity may help drive the relationship between HIV infection and economic outcomes.
Journal Article > ResearchFull Text
PLOS One. 12 May 2021; Volume 16 (Issue 5); e0251504.; DOI:10.1371/journal.pone.0251504
Mbarga NF, Epee E, Mbarga M, Ouamba P, Nanda H, et al.
PLOS One. 12 May 2021; Volume 16 (Issue 5); e0251504.; DOI:10.1371/journal.pone.0251504
BACKGROUND
A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon.
MATERIALS AND METHODS
In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk.
FINDINGS
A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity.
CONCLUSIONS
Most COVID-19 cases in this study were benign with low fatality. Age (40–70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making.
A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon.
MATERIALS AND METHODS
In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk.
FINDINGS
A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity.
CONCLUSIONS
Most COVID-19 cases in this study were benign with low fatality. Age (40–70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making.
Journal Article > ResearchFull Text
J Infect Dis. 28 February 2014 (Issue 3); DOI:1;210(3):383-91
Byakwaga H, Boum Y II, Huang Y, Muzoora C, Kembabazi A, et al.
J Infect Dis. 28 February 2014 (Issue 3); DOI:1;210(3):383-91
Human immunodeficiency virus (HIV) infection-induced indoleamine 2,3-dioxygenase-1 (IDO) expression in activated monocytes and dendritic cells catabolizes tryptophan to kynurenine and other downstream catabolites that inhibit T-cell proliferation and interleukin 17 (IL-17) production. The prognostic significance of this pathway in treated HIV disease is unknown.