Journal Article > ResearchAbstract
J Acquir Immune Defic Syndr. 2019 August 15; 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. 2019 August 15; 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 > ReviewAbstract
J Acquir Immune Defic Syndr. 2019 January 25; Volume 80 (Issue 5); DOI:10.1097/QAI.0000000000001957
O'Brien DP, Ford NP, Djirmay AG, Calmy A, Victoria M, et al.
J Acquir Immune Defic Syndr. 2019 January 25; Volume 80 (Issue 5); DOI:10.1097/QAI.0000000000001957
Evidence suggests that there are important interactions between HIV and Female Genital Schistosomiasis (FGS) that may have significant effects on individual and population health. However, the exact way they interact and the health impacts of the interactions are not well understood. In this paper we discuss what is known about the interactions between FGS and HIV, and the potential impact of the interactions. This includes the likelihood that FGS is an important health problem for HIV positive women in schistosoma-endemic areas potentially associated with an increased risk of mortality, cancer and infertility. Additionally, it may be significantly impacting the HIV epidemic in sub-Saharan Africa by making young women more susceptible to HIV. We call for immediate action and argue that research is urgently required to address these knowledge gaps and propose a research agenda to achieve this.
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 2018 January 16; 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. 2018 January 16; 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 Acquir Immune Defic Syndr. 2011 June 1; Volume 57 (Issue 2); DOI:10.1097/QAI.0b013e3182199ee9
Lawn SD, Campbell L, Kaplan R, Boulle AM, Cornell M, et al.
J Acquir Immune Defic Syndr. 2011 June 1; Volume 57 (Issue 2); DOI:10.1097/QAI.0b013e3182199ee9
We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.
Journal Article > Meta-AnalysisFull Text
J Acquir Immune Defic Syndr. 2010 August 1; Volume 54 (Issue 5); DOI:10.1097/QAI.0b013e3181e0c4cf
Fenner L, Brinkhof MW, Keiser O, Weigel R, Cornell M, et al.
J Acquir Immune Defic Syndr. 2010 August 1; Volume 54 (Issue 5); DOI:10.1097/QAI.0b013e3181e0c4cf
BACKGROUND: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year. RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV). CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.
Journal Article > ResearchAbstract
J Acquir Immune Defic Syndr. 2013 January 22; Volume 63 (Issue 1); DOI:10.1097/QAI.0b013e318287c1fe
Hoffman CJ, Schomaker M, Fox MP, Mutevedzi, Giddy J, et al.
J Acquir Immune Defic Syndr. 2013 January 22; Volume 63 (Issue 1); DOI:10.1097/QAI.0b013e318287c1fe
In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information.
Journal Article > LetterAbstract
J Acquir Immune Defic Syndr. 2015 June 1; Volume 70 (Issue 1); DOI:10.1097/QAI.0000000000000706
Grimsrud A, Wilkinson LS, Cornell M
J Acquir Immune Defic Syndr. 2015 June 1; Volume 70 (Issue 1); DOI:10.1097/QAI.0000000000000706
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 2011 November 1; Volume 58 (Issue 3); 233-240.; DOI:10.1097/QAI.0b013e318228667f
Singh A, Sunpath H, Green TN, Padayachi N, Hiramen K, et al.
J Acquir Immune Defic Syndr. 2011 November 1; Volume 58 (Issue 3); 233-240.; DOI:10.1097/QAI.0b013e318228667f
BACKGROUND
Drug resistance poses a significant challenge for the successful application of highly active antiretroviral therapy (HAART) globally. Furthermore, emergence of HIV-1 isolates that preferentially use CXCR4 as a coreceptor for cell entry, either as a consequence of natural viral evolution or HAART use, may compromise the efficacy of CCR5 antagonists as alternative antiviral therapy.
METHODS
We sequenced the pol gene of viruses from 45 individuals failing at least 6 months of HAART in Durban, South Africa, to determine the prevalence and patterns of drug-resistance mutations. Coreceptor use profiles of these viruses and those from 45 HAART-naive individuals were analyzed using phenotypic and genotypic approaches.
RESULTS
Ninety-five percent of HAART-failing patients had at least one drug-resistant mutation. Thymidine analog mutations (TAMs) were present in 55% of patients with 9% of individuals possessing mutations indicative of the TAM1 pathway, 44% had TAM2, whereas 7% had mutations common to both pathways. Sixty percent of HAART-failing subjects had X4/dual//mixed-tropic viruses compared with 30% of HAART-naïve subjects (P < 0.02). Genetic coreceptor use prediction algorithms correlated with phenotypic results with 60% of samples from HAART-failing subjects predicted to possess CXCR4-using (X4/dual/mixed viruses) versus 15% of HAART-naïve patients.
CONCLUSIONS
The high proportion of TAMs and X4/dual/mixed HIV-1 viruses among patients failing therapy highlight the need for intensified monitoring of patients taking HAART and the problem of diminished drug options (including CCR5 antagonists) for patients failing therapy in resource-poor settings.
Drug resistance poses a significant challenge for the successful application of highly active antiretroviral therapy (HAART) globally. Furthermore, emergence of HIV-1 isolates that preferentially use CXCR4 as a coreceptor for cell entry, either as a consequence of natural viral evolution or HAART use, may compromise the efficacy of CCR5 antagonists as alternative antiviral therapy.
METHODS
We sequenced the pol gene of viruses from 45 individuals failing at least 6 months of HAART in Durban, South Africa, to determine the prevalence and patterns of drug-resistance mutations. Coreceptor use profiles of these viruses and those from 45 HAART-naive individuals were analyzed using phenotypic and genotypic approaches.
RESULTS
Ninety-five percent of HAART-failing patients had at least one drug-resistant mutation. Thymidine analog mutations (TAMs) were present in 55% of patients with 9% of individuals possessing mutations indicative of the TAM1 pathway, 44% had TAM2, whereas 7% had mutations common to both pathways. Sixty percent of HAART-failing subjects had X4/dual//mixed-tropic viruses compared with 30% of HAART-naïve subjects (P < 0.02). Genetic coreceptor use prediction algorithms correlated with phenotypic results with 60% of samples from HAART-failing subjects predicted to possess CXCR4-using (X4/dual/mixed viruses) versus 15% of HAART-naïve patients.
CONCLUSIONS
The high proportion of TAMs and X4/dual/mixed HIV-1 viruses among patients failing therapy highlight the need for intensified monitoring of patients taking HAART and the problem of diminished drug options (including CCR5 antagonists) for patients failing therapy in resource-poor settings.
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 2002 May 1
Tassie JM, Grabar S, Lancar R, Deloumeaux J, Bentata M, et al.
J Acquir Immune Defic Syndr. 2002 May 1
To estimate the change in AIDS incubation time during three periods characterized by different availability of antiretroviral treatments, data from the French Hospital Database on HIV of 4702 HIV-1-positive subjects with a documented date of infection were analyzed. Times from seroconversion to AIDS were compared in three periods: period 1 from January 1992 to June 1995 (monotherapy); period 2 from July 1995 to June 1996 (dual therapy); and period 3 from July 1996 to June 1999 (triple therapy). Nonparametric survival analyses were performed to account for staggered entries in the database and during each period. From periods 1 to 3, antiretroviral treatments were initiated earlier after infection, more subjects were treated, and the nature of regimens changed (25.6% of subjects were treated with monotherapy in period 1, 34.6% were treated with dual therapy in period 2, and 53.4% were treated with triple therapy in period 3). Compared with period 1, the relative hazard (RH) of AIDS was 0.31 in period 3 (95% confidence interval [CI]: 0.24-0.39). When comparing period 3 with period 2, the RH of AIDS was 0.36 (CI: 0.29-0.45). Assuming a log normal distribution, the median time to AIDS was estimated as 8.0 years in period 1 (CI: 6.0-10.6), 9.8 years in period 2 (CI: 8.5, 11.2), and 20.0 years in period 3 (CI: 17.1-23.3). This lengthening in time to AIDS from 1992 to 1999 was particularly marked in the period after the introduction of triple therapy, including protease inhibitors.
Journal Article > Meta-AnalysisAbstract
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac
Bonner K, Mezochow A, Roberts TR, Ford NP, Cohn J
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac