Conference Material > Poster
Chiopris G, Hilbig A, Crucitti T, Lim CAE, Abdo Z
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/mHkaHKgJNw
Journal Article > ResearchFull Text
BMC Infect Dis. 2020 March 20; Volume 20 (Issue 1); DOI:10.1186/s12879-020-04968-x
Murray J, Whitehouse K, Ousley J, Bermudez E, Soe TT, et al.
BMC Infect Dis. 2020 March 20; Volume 20 (Issue 1); DOI:10.1186/s12879-020-04968-x
BACKGROUND:
Adolescents living with HIV/AIDS (ALHIV) are a particularly vulnerable but often overlooked group in the HIV response despite additional disease management challenges.
METHODS:
All ALHIV (10-19 years), on ART for ≥6 months, presenting to care at a Médecins Sans Frontières (MSF) clinic in Myanmar from January-April 2016 were eligible for the quantitative study component (clinical history, medical examination, laboratory investigation). A subset of these respondents were invited to participate in qualitative interviews. Interviews and focus groups were also conducted with other key informants (care givers, clinicians).
RESULTS:
Of 177 ALHIV, 56% (100) were aged 9-13 years and 77 (44%) were 14-19. 49% (86) had been orphaned by one parent, and 19% (33) by both. 59% (104) were severely underweight (BMI < 16). 47% presented with advanced HIV (WHO stage III/IV). 93% were virally supressed (< 250 copies/mL). 38 (21%) of ALHIV were on a second-line ART after first-line virological failure. Qualitative interviewing highlighted factors limiting adherence and the central role that HIV counsellors play for both ALHIV patients and caregivers.
CONCLUSIONS:
Our study shows good clinical, immunological, and virological outcomes for a cohort of Myanmar adolescents living with HIV, despite a majority being severely underweight, presenting with Stage III or IV illness, and the prevalence of comorbid infections (TB). Many treatment and adherence challenges were articulated in qualitative interviewing but emphasized the importance of actively engaging adolescents in their treatment. Comprehensive HIV care for this population must include routine viral load testing and social support programs.
Adolescents living with HIV/AIDS (ALHIV) are a particularly vulnerable but often overlooked group in the HIV response despite additional disease management challenges.
METHODS:
All ALHIV (10-19 years), on ART for ≥6 months, presenting to care at a Médecins Sans Frontières (MSF) clinic in Myanmar from January-April 2016 were eligible for the quantitative study component (clinical history, medical examination, laboratory investigation). A subset of these respondents were invited to participate in qualitative interviews. Interviews and focus groups were also conducted with other key informants (care givers, clinicians).
RESULTS:
Of 177 ALHIV, 56% (100) were aged 9-13 years and 77 (44%) were 14-19. 49% (86) had been orphaned by one parent, and 19% (33) by both. 59% (104) were severely underweight (BMI < 16). 47% presented with advanced HIV (WHO stage III/IV). 93% were virally supressed (< 250 copies/mL). 38 (21%) of ALHIV were on a second-line ART after first-line virological failure. Qualitative interviewing highlighted factors limiting adherence and the central role that HIV counsellors play for both ALHIV patients and caregivers.
CONCLUSIONS:
Our study shows good clinical, immunological, and virological outcomes for a cohort of Myanmar adolescents living with HIV, despite a majority being severely underweight, presenting with Stage III or IV illness, and the prevalence of comorbid infections (TB). Many treatment and adherence challenges were articulated in qualitative interviewing but emphasized the importance of actively engaging adolescents in their treatment. Comprehensive HIV care for this population must include routine viral load testing and social support programs.
Journal Article > ResearchFull Text
BMC Infect Dis. 2020 November 13; Volume 20; DOI:10.1186/s12879-020-05579-2
Murray J, Hilbig A, Soe TT, Ei WLSS, Soe KT, et al.
BMC Infect Dis. 2020 November 13; Volume 20; DOI:10.1186/s12879-020-05579-2
Background
Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost.
Methods
Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome.
Results
Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19).
Conclusions
Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost.
Methods
Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome.
Results
Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19).
Conclusions
Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
Conference Material > Poster
Adamu S, Hilbig A, Chopris G, Crucitti T, Lim CAE
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/9qTAvG3
Journal Article > ResearchFull Text
Open Forum Infect Dis. 2019 June 14
Ei WLSS, Soe KT, Hilbig A, Murray J, Heiden D
Open Forum Infect Dis. 2019 June 14
A retrospective review of diagnosis of cytomegalovirus retinitis (CMVR) before and after
introduction of routine immediate eye examination among AIDS patient in Myanmar with an
absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of
CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold.
Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.
introduction of routine immediate eye examination among AIDS patient in Myanmar with an
absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of
CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold.
Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.