Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

To achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child’s treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR?=?0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR?=?5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR?=?12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child’s medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings.     

HIV／AIDS病人ART相关性高乳酸血症的预测因素分析

目的探讨艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人进行抗反转录病毒治疗（ART）中,发生高乳酸血症（LAHL）的预测因素分析。方法回顾性分析2005年1月-2012年5月,门诊进行ART的随访AIDS病人出现LAHL的临床资料,对相关性数据进行统计学分析。结果在191例门诊进行ART随访的AIDS病人中,有71例发生LAHL,其中女性34例（χ2=6.147,P〈0.01）,服用D4T的42例（χ2=7.784,P〈0.01）,服用核苷类反转录酶抑制剂（NRTIs）药物超过1年以上59例（χ2=18.100,P〈0.01）。发生LAHL病人相比未发生LAHL病人更容易出现丙氨酸转氨酶（ALT）、天冬氨酸转氨酶、乳酸脱氢酶（LDH）、γ-谷酰转肽酶（GGT）升高,差异有统计学意义（P〈0.01）。在多因素非条件Logistic回归分析中,女性[比值比（OR）10.923,95%可信区间（CI）：1.067～111.836]、ALT升高（OR1.09,95%CI：1.017～1.168）、LDH升高（OR1.025,95%CI：1.007～1.043）,均为发生LHAL的预测因素。在ART中CD4T淋巴细胞计数升高病人中LAHL发生率低（OR0.991,95%CI：0.983～0.999）。结论 AIDS病人服用NRTIs药物,尤其是服用D4T、女性、服药时间超过1年以上,是发生LAHL的预测因素。在ART过程中出现ALT、GGT、LDH升高,要高度警惕是否存在LAHL风险,避免进一步发展成致死性的乳酸酸中毒。     

Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic

ObjectiveTo evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment three years after initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen in an AIDS outpatient clinic in Brazil.MethodsRetrospective cohort of HIV-1 infected patients attending an outpatient HIV clinic in Vitoria, Brazil, between January/2010 and May/2011. Data, including blood pressure, dyslipidemia (high total cholesterol and low HDL-C), fasting glucose, and cardiovascular risk by Framingham Risk Score were abstracted from medical records from clinic visits six months prior and three years after starting ART. We assessed independent associated factors for dyslipidemia using multiple logistic regression.ResultsFour hundred and ninety-eight patients on ART were studied. Median age was 45 years (interquartile range (IQR): 37–52), and median time since HIV diagnosis was 7.7 years (IQR: 3.8–10.0). The proportion of patients with dyslipidemia was 22.3% (95% CI: 18.6–25.9%) 36 months after ART initiation. Triglycerides levels >150 mg/dL (55.2% vs. 25.4%, p = 0.021) and high fasting glucose (5.8% vs. 2.3%, p = 0.034) were diagnosed more frequently after ART use when compared to baseline values. Multiple logistic regression analysis has shown dyslipidemia to be associated with lopinavir/r use [OR = 1.74 (95% CI: 1.12–2.86)].ConclusionThese data show high chance of dyslipidemia after initiation of ART. Long-term follow-up will help identify the impact of ART on cardiovascular risk.     

运城市艾滋病免费抗病毒治疗病例生存分析

目的评估山西省运城市艾滋病免费抗病毒治疗的效果,分析影响治疗效果的主要因素。方法采用回顾性队列研究方法,选择2004年6月底至2009年12月底纳入国家免费抗病毒治疗系统的病例,收集资料,补充调查,采用SPSS 18.0统计分析。结果 602例抗病毒治疗病例中,存活490例(81.4%),死亡81例(13.5%),退出和转诊22例(3.7%),意外死亡9例(1.5%)。治疗后第3、6、12、24、36、48、60个月,累计生存率分别为0.93、0.91、0.89、0.87、0.86、0.85、0.84。CD4+T淋巴细胞计数治疗前平均值(123±98.6)个/μL,治疗后平均值(298±187.1)个/μL,治疗前后平均增加175个/μL(P=0.000)。病毒载量治疗前<最低检测限(LDL)占9.1%,治疗后相似文献   

凉山州成人HIV/AIDS病人退出抗病毒治疗的原因及影响因素

目的了解四川省凉山州成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)中,已接受抗病毒治疗(ART)的病人退出治疗的原因及影响因素,为今后更好地提高民族欠发达地区ART依从性提供依据和参考。方法选取凉山州HIV/AIDS病人退出治疗较严重的两个县作为研究现场,对符合纳入标准的研究对象采用自行设计的问卷进行调查,采用Logistic回归分析相关影响因素。结果 488名调查对象中,退出ART的病人占37.91%(185人),维持ART的病人占62.09%(303人)。能够维持ART的最主要原因是:认为接受ART后可以延长生命的占68.98%(209/303);退出治疗的主要原因是:外出务工领药不方便占30.27%(56/185),强制戒毒停药17.84%(33/185),药物不良反应12.43%(23/185)和由于农忙等原因未去领药11.35%(21/185)。多因素Logistic回归分析显示,服药后外出务工[比值比(OR)3.823,95%可信区间(CI):2.384~6.131]、男性(OR=1.839,95%CI:1.133~2.983)、服用过中药(OR=1.836,95%CI:1.097~3.071)、就医不便捷(OR=1.694,95%CI:1.002~2.866)是退出ART的危险因素;而病人在ART过程中得到家人支持(OR=0.250,95%CI:0.093~0.671)、接受过ART服药依从性教育(OR=0.107,95%CI:0.044~0.260)、ART知识(按得分≥5分计)(OR=0.203,95%CI:0.095~0.434)是HIV/AIDS病人退出ART的保护因素。结论针对HIV/AIDS病人退出ART的问题,可通过完善抗病毒治疗的异地转介机制、推进戒毒所内ART的开展、加强ART人群的依从性教育等措施来改善。     

Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines

Whether the definition of hypertension according to 2017 AHA/ACC guidelines and blood pressure (BP) changes was related to the increased risk of chronic kidney disease (CKD) remained debated. This prospective cohort study aimed to investigate the association of BP and long‐term BP change with CKD risk with different glucose metabolism according to the new hypertension guidelines. This study examined 12 951 participants and 11 183 participants derived from the older people cohort study, respectively. Participants were divided into three groups based on blood glucose and the risks were assessmented by the logistic regression model. During a 10 years of follow‐up period, 2727 individuals developed CKD (21.1%). Compared with those with BP < 130/80 mmHg, individuals with increased BP levels had significantly increased risk of incident CKD. Participants with BP of 130–139/80–89 or ≥140/90 mmHg had 1.51‐ and 1.89‐fold incident risk of CKD in patients with diabetes mellitus (DM). Compared with individuals with stable BP (−5 to 5 mmHg), the risk of CKD was reduced when BP decreased by 5 mmHg or more and increased when BP increased ≥5 mmHg among normoglycemia and prediabetes participants. Similar results were observed for rapid estimated glomerular filtration rate (eGFR) decline. In conclusion, the BP of 130–139/80–89 mmHg combined with prediabetes or DM had an increased risk of incident CKD and rapid eGFR decline in older people. Long‐term changes of BP by more than 5 mmHg among normoglycemia or prediabetes were associated with the risk of incident CKD and rapid eGFR decline.     

HIV/AIDS合并梅毒患者 临床特征及长期抗病毒治疗研究

[摘要]　目的　探讨HIV/AIDS合并梅毒患者临床特征及长期抗反转录病毒治疗（anti-retroviral therapy, ART）的病毒学、免疫学效果以及梅毒复发和/或再感染情况。方法?收集2017年1月1日—2019年12月31日在首都医科大学附属北京佑安医院进行初始ART的HIV/AIDS患者的基本信息和实验室检测数据，分析患者的临床特征及其ART后病毒学、免疫学效果以及梅毒复发及再感染情况。结果?共纳入728例HIV合并梅毒感染者，其中99.6%为男性，97.7%为同性性传播感染者，ART时间中位数为950（691，1217） d，从诊断到开始ART的中位时间为15.5（8.0，41.0） d，诊断至开始ART时间≥180 d以上的患者占14.7%（107/728）。经过治疗，患者CD4+ T淋巴细胞计数增加了242（130，369）个/μl，99.3%（723/728）的患者HIV载量控制在400拷贝ml以内。经足量、规律驱梅治疗6～12个月后，梅毒复发和/或再感染率为18.4%（134/728）。结论?HIV/AIDS合并梅毒患者经长期ART后病毒学、免疫学效果良好，梅毒的复发和/或再感染率较高，梅毒足量规则治疗的同时，加强性健康宣教和定期随访复查至关重要。     

鼾症患者日间嗜睡与血压及血糖的关系研究

目的探讨日间嗜睡是否为鼾症患者合并高血压,糖尿病的危险因素。方法对经多导睡眠图确诊的单纯鼾症患者及正常对照组以Epworth嗜睡量表（Epworth sleeps cale）进行问卷调查并判断嗜睡评分（EP）,分析日间嗜睡在高血压血糖变化中的影响。结果单纯鼾症组（50例）血压：（144．68±11．93／90．66±9．20）mmHg,高血压发生率66％,空腹血糖（6．17±1．48）mmol／L,正常对照组（20例）血压（132．75±9．39／81．5±7．63）mmHg,高血压发生率30％,空腹血糖（5．37±0．74）mmol／L。两组的嗜睡指数分别为：单纯鼾症组（14．98±4．76）,对照组（7．7±2．13）,其差异有统计学意义（P〈0．05）。嗜睡指数与微觉醒指数正相关（r=0．9049）（P〈0．05）,鼾症组嗜睡指数与血压呈正相关（r=0．4242）（P〈0．05）,且相关性随着年龄的增长而减小。单纯鼾症组较对照组空腹血糖也增高（P〈0．05）。结论鼾症及日间嗜睡是高血压,糖尿病的危险因素,对其机制的研究可能对控制OSAS的并发症有一定意义。     

云南省HIV／AIDS病人早期抗病毒治疗的有效性和安全性分析

目的评价云南省艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人（HIV／AIDs病人）早期抗反转录病毒治疗（ART）的有效性和安全性。方法对云南省2011年8月至2012年8月期间开始ART的病人,按照基线CD4淋巴细胞（CD4细胞）计数水平分A、B两组,A组为基线CD4细胞计数〉350／±的病人（早期治疗组）,B组为基线CD4细胞计数≤350／μL．的病人（延迟治疗组）。比较两组病人治疗满1年后的队列保持情况、治疗效果、治疗期间病人的不良反应和机会性感染发生等情况。结果两组9810例病人治疗满1年后,在队列保持方面,A组病人坚持治疗的比例（在治率）为88．0％（1712／1946）,高于B组的84．9％（6674／7864）;死亡率A组（1．2％）低于B组（5．7％）;在治疗效果方面,两组的HIV病毒载量抑制比例差异无统计学意义（P〉0．05）,两组病人中．HIV病毒载量〈C400拷贝／mL病人所占比例,分别为90．4％和91．2％;治疗6个月和12个月时,与基线CD4细胞计数相比,A组的增幅（4．32％）（治疗前后CD4细胞差值的比较）低于B组（10．27％）,P〈0．01,但A组病人仍然获得比B组较高的CD4细胞平均值;在机会性感染和不良反应方面,A组的发生比例（4．3％和20．9％）均低于B组（10．3％和24．3％）,P〈0．01。结论云南省HIV／AIDS病人早期治疗12个月能够获得良好的有效性和安全性,初步实现了减少HIV相关的发病率和死亡率、非艾滋病相关疾病的发病率和死亡率和改善生活质量的抗病毒治疗总体目标。     

Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV

Women with perinatally acquired HIV (PAH) face unique psychosocial challenges due to the presence of a lifelong chronic illness and often unstable living situations. With advances in HIV treatment, an increasing number of those with PAH are reaching childbearing age and becoming pregnant. Depression may be an important and common factor that complicates both treatment and pregnancy outcomes in this group. We conducted a retrospective cohort study in pregnant patients with PAH to determine if history of depression is associated with nonadherence to antiretroviral therapy (ART). We reviewed charts of women with PAH receiving prenatal care at a single institution from March 1995 to December 2012. ART nonadherence was measured by patient self-report of any missed doses in the third trimester. Demographic, obstetric, and HIV infection characteristics of patients with a history of depression (dPAH) were compared to patients without a history of depression. Nine pregnancies among 6 dPAH women and 14 pregnancies among 12 PAH women without a history of depression were identified. None of the dPAH women reported 100% adherence to ART in the third trimester while 57% of women without a history of depression reported strict adherence (p = 0.04). The mean HIV RNA level at delivery was higher among dPAH women (17,399 vs. 2966 copies/Ml; p = 0.03) and fewer reached an undetectable HIV RNA level (<400 copies/mL) at delivery (p = 0.03). We concluded that a history of depression may contribute to poor medication adherence and treatment outcomes among pregnant women with PAH. Focused attention on diagnosis and treatment of depression in the preconception period may lead to more optimal medication adherence.     

Low blood pressure and blood glucose levels in Alzheimer's disease Evidence for a hypometabolic disorder?

Abstract. Objective. To test possible differences between patients with Alzheimer's disease (AD) and patients with other forms of dementia and the healthy population concerning body composition, blood pressure, metabolic data and leukoaraiosis (LA). Design. Retrospective study on data collected according to a predefined protocol. Setting. A geriatric, neuropsychiatric diagnostic unit. Subjects. Seventy-one consecutive patients with dementia. Main outcome measures. Body mass index, blood pressure, metabolism and LA in AD compared to other dementia forms. Results. Mean blood pressure and fasting blood glucose levels were lower in patients with AD, 94 ± 12 mmHg and 4.3 ± 0.5 mmol l^?1, compared to patients with unspecified dementia (NUD), 100 ± 10 mmHg and 5.5 ± 2.5 mmol l^?1 (P < 0.05) and vascular dementia (VAD), 114 ± 12 mmHg and 5.6 ± 1.6 mmol l^?1 (P < 0.001) and the age-matched healthy population. Body mass index, serum cholesterol and Cortisol were similar in all groups of dementia patients whereas triglycerides were highest in the VAD group. No cases of diabetes or treatment for hypertension were found in the AD group while the prevalence was 21% and 36% for diabetes in the NUD and VAD groups and 8% in the population from the same region. There were 16% with antihypertensive treatment in dementia NUD, 50% in VAD, and 30% in the general population. Treated or newly detected hypothyreosis was present in 11 % of the AD patients, none in the other dementia groups and 2% in the general population. Smoking was least common in AD. Degree of LA correlated with blood pressure and blood glucose levels. Conclusions. AD was clearly different to other dementia patients. They had lower blood pressure, blood glucose and higher prevalence of hypothyreosis than the healthy, age-matched population. These findings may indicate that AD could be a hypometabolic disorder.     

182例HIV/AIDS实施高效抗反转录病毒治疗的疗效评价

目的分析182例HIV/AIDS实施高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)的效果及其影响因素,为进一步有效治疗提供依据。方法采用回顾性调查方法,对我院接受规范HAART的182例HIV/AIDS患者的CD4+T淋巴细胞绝对计数和病毒载量进行分析。结果 182例中,157例治疗后CD4+T淋巴细胞计数增加,且在治疗后前6个月内增加速度最快,随着治疗时间延长则较为缓慢。病毒载量在治疗后的6个月内下降最快,大部分降至血浆检测不到的水平,6个月后比较稳定;但随着治疗时间延长,部分患者的病毒载量出现反弹,可能与患者服药依从性差和病毒耐药性的出现有关。治疗前后CD4+T淋巴细胞计数差异有统计学意义(P0.05)。多因素logistic回归分析表明年龄和病毒载量是影响HAART疗效的危险因素,基线CD4+T淋巴细胞计数和按时服药是保护因素。结论 HAART能明显增加CD4+T淋巴细胞计数,降低病毒载量,有效控制机会感染,治疗效果显著。影响HAART疗效的因素是多方面的,在治疗过程中应综合考虑各种可能影响因素以提高疗效,对符合条件的患者应尽早进行规范的抗病毒治疗。     

Tuberculosis incidence among people living with HIV/AIDS with virological failure of antiretroviral therapy in Salvador,Bahia, Brazil

Antiretroviral therapy for HIV has led to increased survival of HIV-infected patients. However, tuberculosis remains the leading opportunistic infection and cause of death among people living with HIV/AIDS. Tuberculosis has been shown to be a good predictor of virological failure in this group. This study aimed to evaluate the incidence of tuberculosis and its consequences among individuals diagnosed with virological failure of HIV. This was a retrospective cohort study involving people living with HIV/AIDS being followed-up in an AIDS reference center in Salvador, Bahia, Brazil. Individuals older than 18 years with HIV infection on antiretroviral therapy for at least six months, diagnosed with virological failure (HIV-RNA greater than or equal to 1000 copies/mL), from January to December 2013 were included. Tuberculosis was diagnosed according to the criteria of the Brazilian Society of Pneumology. Fourteen out of 165 (8.5%) patients developed tuberculosis within two years of follow-up (incidence density = 4.1 patient-years). Death was directly related to tuberculosis in 6/14 (42.9%). A high incidence and tuberculosis-related mortality was observed among patients with virological failure. Diagnosis of and prophylaxis for tuberculosis in high-incidence countries such as Brazil is critical to decrease morbidity and mortality in people living with HIV/AIDS.     

Association between HIV infection and attenuated diurnal blood pressure rhythm in untreated hypertensive individuals*

Objective

Hypertensive cardiovascular complications are more closely associated with ambulatory blood pressure (ABP), particularly the attenuated diurnal blood pressure (BP) rhythm (i.e. a fall in systolic blood pressure <10% during the night compared with the day), than with casual BP. The aim of the study was to assess the ABP pattern in an HIV‐infected cohort in which hypertension was newly diagnosed.

Methods

ABP over 24 h was compared between 77 newly diagnosed, untreated hypertensive HIV‐positive individuals and 76 HIV‐uninfected untreated hypertensive controls.

Results

More HIV‐infected subjects had an attenuated ABP rhythm with a reduced nocturnal fall than HIV‐negative hypertensive control subjects (60 vs. 33%, respectively; P=0.001). The dipping pattern was observed despite newly diagnosed hypertension, a low prevalence of microalbuminuria, and the absence of signs of overt kidney disease. Furthermore, the prevalence of nondipping in the HIV‐infected subjects was independent of combination antiretroviral treatment. Multiple logistic regression analysis with dipping pattern as the dependent variable showed that HIV status was an independent predictor of nondipping BP [P=0.002; odds ratio (OR) 0.33; 95% confidence interval (CI) 0.17–0.66]; casual SBP (P=0.37; OR 1.001; 95% CI 0.99–1.04) and microalbuminuria (P=0.39; OR 1.56; 95% CI 0.57–4.28) were not associated with dipping pattern.

Conclusions

The prevalence of a nondipping BP pattern in HIV‐infected subjects with newly diagnosed hypertension who had not received antihypertensive treatment was high and significantly greater than in hypertensive control subjects.     

Risk indicators and effects of hypertension on HIV/AIDS disease progression among patients seen at Kenyatta hospital HIV care center

There is paucity of data on prevalence of hypertension and its effects on HIV/AIDS progression among patients at Kenyatta National Hospital (KNH), Kenya. This was a cross sectional study conducted between January and May 2015 at the KNH HIV Care Centre. Ethical approval was obtained from institutional ethics review board. HIV positive adult patients were recruited sequentially, and written informed consent obtained from each participant. Systematic sampling was used to select participants who were screened for blood pressure, body mass index (BMI) and lifestyle characteristics. Data on clinical parameters were extracted from patient records. A total of 297 participants (89 males and 208 females) were enrolled in the study. The participants were socially diverse in cultural beliefs, religious practices and lifestyles. Their ages ranged from 30 to 57 years, and the average age of males (M?=?44.56, SD?=?6.05) was higher than females (M?=?42.29, SD?=?6.16), p?p?p?. The risk factors include prolonged use of ART as well as increased body mass index. The effects of hypertension on HIV progression include low CD4+ T cell counts which complicate the underlying immunosuppression.     

Patterns and correlates of cannabis use among individuals with HIV/AIDS in Maritime Canada

BACKGROUND:

The prevalence of cannabis use in HIV-infected individuals is high and its long-term effects are unclear.

METHODS:

The prevalence, perceived benefits and consequences, and predictors of cannabis use were studied using a cross-sectional survey in two immunodeficiency clinics in Maritime Canada.

RESULTS:

Current cannabis use was identified in 38.5% (87 of 226) of participants. Almost all cannabis users (85 of 87 [97.7%]) acknowledged its use for recreational purposes, with 21.8% (19 of 87) reporting medicinal cannabis use. The majority of patients enrolled in the present study reported mild or no symptoms related to HIV (n=179). Overall, 80.5% (70 of 87) of the cannabis-using participants reported a symptom-relieving benefit, mostly for relief of stress, anorexia or pain. Participants consumed a mean (± SD) of 18.3±21.1 g of cannabis per month and spent an average of $105.15±109.87 on cannabis per month. Cannabis use was associated with rural residence, lower income level, driving under the influence of a substance, and consumption of ecstasy and tobacco. Income level, ecstasy use and tobacco use were retained as significant predictors in regression modelling. Cannabis use was not associated with adverse psychological outcomes.

DISCUSSION:

Prolonged previous cannabis consumption and the substantial overlap between recreational and medicinal cannabis use highlight the challenges in obtaining a tenable definition of medicinal cannabis therapy.     

Fears about antiretroviral therapy among users of the internet forum for people living with HIV/AIDS in Russia

The purpose of this research was to identify different types of fear related to starting and adhering to antiretroviral therapy (ART) among people living with HIV (PLHIV) in Russia. Data were collected from the Russian-language internet forum for PLHIV (hivlife.info). Qualitative data analysis focused on the sections of the forum where users discussed health-related issues in order to identify fears related to HIV treatment. The following types of fear were revealed: fear of the illness, fear to learn negative information about one’s health, fear of side effects, fear of therapy to be ineffective, fear that the appropriate medications will become unavailable, fear of lifestyle changes, and fear for the well-being of significant others. Efforts to increase the uptake of and adherence to ART should take into account the fears of PLHIV.