Journal Article > ResearchFull Text
J Am Heart Assoc. 2021 June 15; 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. 2021 June 15; 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
Ann Glob Health. 2015 March 12; Volume 81 (Issue 1); 207.; DOI:10.1016/j.aogh.2015.02.977
Kim JH, Hemphill LC, Boum Y II, Bangsberg DR, Siedner MJ
Ann Glob Health. 2015 March 12; Volume 81 (Issue 1); 207.; DOI:10.1016/j.aogh.2015.02.977
BACKGROUND
Non-communicable diseases (NCDs) account for the majority of adult deaths worldwide, and 80% of these deaths occur in
low and middle-income countries (LMICs). The burden of NCDs in LMICs is predicted to grow with improvements in sanitation and infectious disease control, and will be altered by local diet, smoking rates, and HIV co-infection. There is a critical need to identify and implement low-cost, well-validated diagnostic tests to elucidate the epidemiology of NCDs, and enable diagnostic monitoring and ther- apeutic interventions. Moreover, tests that enable non-healthcare professionals to lead care provision will augment the scalability of this strategy. We recently completed implementation and evaluation of a bundle of point-of-care, low-cost diagnostics for NCD measurement in rural Uganda.
METHODS
We performed a cross-sectional cohort study in rural, southwestern Uganda of HIV-infected persons on antiretroviral therapy at the Mbarara Regional Referral Hospital and a control group of HIV-uninfected persons from the clinic catchment area. Three non-healthcare professional Ugandan staff completed a two- week intensive course to perform a series of point-of-care cardiovas- cular assessments, including portable electrocardiogram (EKG), ankle-brachial index (ABI), hemoglobin A1c testing (HbA1c), auto- mated blood pressure, and anthropometric measurements. An American medical student was trained through the University of Wisconsin Atherosclerosis Imaging Research Program to perform measurement of carotid intima-media thickness (CIMT). We assessed the quality and feasibility of each measurement by: 1) proportion of valid hemoglobin A1c results; 2) proportion of interpretable carotid ultrasound images as graded by a board-certified vascular cardiologist using the University of Wisconsin CIMT image quality assessment scale; and 3) correlation between brachial blood pressure measure- ments and automated systolic blood pressure measurements. The study received ethics approval from the Mbarara University of Science & Technology and Partners Healthcare. All participants provided written informed consent.
FINDINGS
105 HIV-infected and 90 HIV-uninfected individuals were enrolled in the study. None of the HbA1c tests were invalid (0/ 195). Of the 96 CIMT images reviewed, 86 (90%) were found to be of adequate quality, and 10 (10.4%) were not suitable for measure- ment. The right and left brachial blood pressure measurements had coefficients of determination of 0.79 and 0.72, respectively, with the automated systolic blood pressure measurements. Based on an esti- mate patient volume of 1,000 patients per year and measurement for 3 years, the cost for this array of tests, including capital equipment, would be approximately $28 per patient.
INTERPRETATION
Low-cost, portable, and well-validated point-of-care tests can be implemented by non-medical professionals in LMICs. Implementation evaluations should be pursued to assess the large- scale feasibility, scalability, and impact of this strategy.
Non-communicable diseases (NCDs) account for the majority of adult deaths worldwide, and 80% of these deaths occur in
low and middle-income countries (LMICs). The burden of NCDs in LMICs is predicted to grow with improvements in sanitation and infectious disease control, and will be altered by local diet, smoking rates, and HIV co-infection. There is a critical need to identify and implement low-cost, well-validated diagnostic tests to elucidate the epidemiology of NCDs, and enable diagnostic monitoring and ther- apeutic interventions. Moreover, tests that enable non-healthcare professionals to lead care provision will augment the scalability of this strategy. We recently completed implementation and evaluation of a bundle of point-of-care, low-cost diagnostics for NCD measurement in rural Uganda.
METHODS
We performed a cross-sectional cohort study in rural, southwestern Uganda of HIV-infected persons on antiretroviral therapy at the Mbarara Regional Referral Hospital and a control group of HIV-uninfected persons from the clinic catchment area. Three non-healthcare professional Ugandan staff completed a two- week intensive course to perform a series of point-of-care cardiovas- cular assessments, including portable electrocardiogram (EKG), ankle-brachial index (ABI), hemoglobin A1c testing (HbA1c), auto- mated blood pressure, and anthropometric measurements. An American medical student was trained through the University of Wisconsin Atherosclerosis Imaging Research Program to perform measurement of carotid intima-media thickness (CIMT). We assessed the quality and feasibility of each measurement by: 1) proportion of valid hemoglobin A1c results; 2) proportion of interpretable carotid ultrasound images as graded by a board-certified vascular cardiologist using the University of Wisconsin CIMT image quality assessment scale; and 3) correlation between brachial blood pressure measure- ments and automated systolic blood pressure measurements. The study received ethics approval from the Mbarara University of Science & Technology and Partners Healthcare. All participants provided written informed consent.
FINDINGS
105 HIV-infected and 90 HIV-uninfected individuals were enrolled in the study. None of the HbA1c tests were invalid (0/ 195). Of the 96 CIMT images reviewed, 86 (90%) were found to be of adequate quality, and 10 (10.4%) were not suitable for measure- ment. The right and left brachial blood pressure measurements had coefficients of determination of 0.79 and 0.72, respectively, with the automated systolic blood pressure measurements. Based on an esti- mate patient volume of 1,000 patients per year and measurement for 3 years, the cost for this array of tests, including capital equipment, would be approximately $28 per patient.
INTERPRETATION
Low-cost, portable, and well-validated point-of-care tests can be implemented by non-medical professionals in LMICs. Implementation evaluations should be pursued to assess the large- scale feasibility, scalability, and impact of this strategy.
Journal Article > ReviewFull Text
E Clinical Medicine. 2023 May 1; Volume 59; 101965.; DOI:10.1016/j.eclinm.2023.101965
Shoham S, Batista C, Ben Amor Y, Ergonul O, Hassanain M, et al.
E Clinical Medicine. 2023 May 1; Volume 59; 101965.; DOI:10.1016/j.eclinm.2023.101965
The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients' immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in immunocompromised people are generally lacking and extrapolated from other populations. The large clinical trials leading to authorisation and approval of SARS-CoV-2 vaccines and therapeutics included very few immunocompromised participants. While experience is accumulating, studies focused on the special circumstances of immunocompromised patients are needed to inform prevention and treatment approaches.
Journal Article > ResearchFull Text
J Infect Dis. 2007 April 1; Volume 195 (Issue 7); DOI:10.1086/512241
Imwong M, Snounou G, Pukrittayakamee S, Tanomsing N, Kim JH, et al.
J Infect Dis. 2007 April 1; Volume 195 (Issue 7); DOI:10.1086/512241
BACKGROUND: Relapses originating from hypnozoites are characteristic of Plasmodium vivax infections. Thus, reappearance of parasitemia after treatment can result from relapse, recrudescence, or reinfection. It has been assumed that parasites causing relapse would be a subset of the parasites that caused the primary infection. METHODS: Paired samples were collected before initiation of antimalarial treatment and at recurrence of parasitemia from 149 patients with vivax malaria in Thailand (n=36), where reinfection could be excluded, and during field studies in Myanmar (n=75) and India (n=38). RESULTS: Combined genetic data from 2 genotyping approaches showed that novel P. vivax populations were present in the majority of patients with recurrent infection (107 [72%] of 149 patients overall [78% of patients in Thailand, 75% of patients in Myanmar {Burma}, and 63% of patients in India]). In 61% of the Thai and Burmese patients and in 55% of the Indian patients, the recurrent infections contained none of the parasite genotypes that caused the acute infection. CONCLUSIONS: The P. vivax populations emerging from hypnozoites commonly differ from the populations that caused the acute episode. Activation of heterologous hypnozoite populations is the most common cause of first relapse in patients with vivax malaria.
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 2018 April 11; Volume 78 (Issue 4); 458-464.; DOI:10.1097/QAI.0000000000001696
Muiru AN, Bibangambah P, Hemphill LC, Sentongo R, Kim JH, et al.
J Acquir Immune Defic Syndr. 2018 April 11; Volume 78 (Issue 4); 458-464.; DOI:10.1097/QAI.0000000000001696
BACKGROUND
The utility and validity of cardiovascular diseases (CVD) risk scores are not well studied in sub-Saharan Africa. We compared and correlated CVD risk scores with carotid intima media thickness (c-IMT) among HIV-infected and uninfected people in Uganda.
METHODS
We first calculated CVD risk using the (1) Framingham laboratory-based score; (2) Framingham nonlaboratory score (FRS-BMI); (3) Reynolds risk score; (4) American College of Cardiology and American Heart Association score; and (5) the Data collection on Adverse Effects of Anti-HIV Drugs score. We then compared absolute risk scores and risk categories across each score using Pearson correlation and kappa statistics, respectively. Finally, we fit linear regression models to estimate the strength of association between each risk score and c-IMT.
RESULTS
Of 205 participants, half were females and median age was 49 years [interquartile range (IQR) 46-53]. Median CD4 count was 430 cells/mm (IQR 334-546), with median 7 years of antiretroviral therapy exposure (IQR 6.4-7.5). HIV-uninfected participants had a higher median systolic blood pressure (121 vs. 110 mm Hg), prevalent current smokers (18% vs. 4%, P = 0.001), higher median CVD risk scores (P < 0.003), and greater c-IMT (0.68 vs. 0.63, P = 0.003). Overall, FRS-BMI was highly correlated with other risk scores (all rho >0.80). In linear regression models, we found significant correlations between increasing CVD risk and higher c-IMT (P < 0.01 in all models).
CONCLUSIONS
In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard risk scores and c-IMT. HIV-uninfected individuals had higher risk scores than HIV-infected individuals, and the difference seemed to be driven by modifiable factors.
The utility and validity of cardiovascular diseases (CVD) risk scores are not well studied in sub-Saharan Africa. We compared and correlated CVD risk scores with carotid intima media thickness (c-IMT) among HIV-infected and uninfected people in Uganda.
METHODS
We first calculated CVD risk using the (1) Framingham laboratory-based score; (2) Framingham nonlaboratory score (FRS-BMI); (3) Reynolds risk score; (4) American College of Cardiology and American Heart Association score; and (5) the Data collection on Adverse Effects of Anti-HIV Drugs score. We then compared absolute risk scores and risk categories across each score using Pearson correlation and kappa statistics, respectively. Finally, we fit linear regression models to estimate the strength of association between each risk score and c-IMT.
RESULTS
Of 205 participants, half were females and median age was 49 years [interquartile range (IQR) 46-53]. Median CD4 count was 430 cells/mm (IQR 334-546), with median 7 years of antiretroviral therapy exposure (IQR 6.4-7.5). HIV-uninfected participants had a higher median systolic blood pressure (121 vs. 110 mm Hg), prevalent current smokers (18% vs. 4%, P = 0.001), higher median CVD risk scores (P < 0.003), and greater c-IMT (0.68 vs. 0.63, P = 0.003). Overall, FRS-BMI was highly correlated with other risk scores (all rho >0.80). In linear regression models, we found significant correlations between increasing CVD risk and higher c-IMT (P < 0.01 in all models).
CONCLUSIONS
In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard risk scores and c-IMT. HIV-uninfected individuals had higher risk scores than HIV-infected individuals, and the difference seemed to be driven by modifiable factors.
Journal Article > CommentaryFull Text
Science. 2001 August 10; Volume 293 (Issue 5532); 1049-1051.; DOI:10.1126/science.1061861
Gupta RS, Kim JH, Espinal MA, Caudron JM, Pecoul B, et al.
Science. 2001 August 10; Volume 293 (Issue 5532); 1049-1051.; DOI:10.1126/science.1061861
Journal Article > CommentaryFull Text
E Clinical Medicine. 2021 June 1; Volume 36; 100925.; DOI:10.1016/j.eclinm.2021.100925
Naniche D, Hotez PJ, Bottazzi ME, Ergonul O, Figueroa J, et al.
E Clinical Medicine. 2021 June 1; Volume 36; 100925.; DOI:10.1016/j.eclinm.2021.100925
Journal Article > CommentaryFull Text
E Clinical Medicine. 2021 August 3; Volume 39; DOI:10.1016/j.eclinm.2021.101053
Hotez PJ, Batista C, Amor YB, Ergonul O, Figueroa J, et al.
E Clinical Medicine. 2021 August 3; Volume 39; DOI:10.1016/j.eclinm.2021.101053
A Lancet Commission for COVID-19 task force is shaping recommendations to achieve vaccine and therapeutics access, justice, and equity. This includes ensuring safety and effectiveness harmonized through robust systems of global pharmacovigilance and surveillance. Global production requires expanding support for development, manufacture, testing, and distribution of vaccines and therapeutics to low- and middle-income countries (LMICs). Global intellectual property rules must not stand in the way of research, production, technology transfer, or equitable access to essential health tools, and in context of pandemics to achieve increased manufacturing without discouraging innovation. Global governance around product quality requires channelling widely distributed vaccines through WHO prequalification (PQ)/emergency use listing (EUL) mechanisms and greater use of national regulatory authorities. A World Health Assembly (WHA) resolution would facilitate improvements and consistency in quality control and assurances. Global health systems require implementing steps to strengthen national systems for controlling COVID-19 and for influenza vaccinations for adults including pregnant and lactating women. A collaborative research network should strive to establish open access databases for bioinformatic analyses, together with programs directed at human capacity utilization and strengthening. Combating anti-science recognizes the urgency for countermeasures to address a global-wide disinformation movement dominating the internet and infiltrating parliaments and local governments.
Journal Article > CommentaryFull Text
PLOS Med. 2021 September 13; Volume 18 (Issue 9); e1003772.; DOI:10.1371/journal.pmed.1003772
Figueroa J, Hotez PJ, Batista C, Ergonul O, Gilbert S, et al.
PLOS Med. 2021 September 13; Volume 18 (Issue 9); e1003772.; DOI:10.1371/journal.pmed.1003772
Journal Article > CommentaryFull Text
E Clinical Medicine. 2022 January 1; Volume 43; 101230.; DOI:10.1016/j.eclinm.2021.101230
Batista C, Hotez PJ, Ben Amor Y, Kim JH, Kaslow D, et al.
E Clinical Medicine. 2022 January 1; Volume 43; 101230.; DOI:10.1016/j.eclinm.2021.101230