Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients

Introduction

Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation.

Methods

Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm³ or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined.

Results

A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46–241) cells/mm³. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm³ in 2008 to a peak of 302 cells/mm³ after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27–0.59; p<0.001), sex (male vs. female; OR 1.51, 95% CI 1.18–1.93; p=0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24–2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77–5.21; p<0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19–3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31–3.43; p=0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18–7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1.−4.36; p=0.035).

Conclusions

Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.     

Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D

Quality of Life Research - To present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and...     

Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia

This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS?≥?.5) method. The MoCA was also scored according to the recommended cut-off of?≤?26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The?≤?26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.     

The presentation of depression symptoms in attention‐deficit/hyperactivity disorder: comparing child and parent reports

Background

Attention‐deficit/hyperactivity disorder (ADHD) frequently co‐occurs with depression, and outcomes are poor when both are present. Little is known about whether depression symptoms present differently in ADHD compared to the general population, or how reliable young people with ADHD are at reporting these symptoms. This study aimed to describe depression symptoms in a clinical ADHD sample compared to a population sample, and compare self‐reports of depression symptoms with parent‐reports.

Methods

Two hundred and forty‐nine children with ADHD and their parents completed follow‐up questionnaires around 5 years after taking part in a Cardiff University ADHD study. Child depression symptoms were measured using parent‐ and child‐reported Mood and Feelings Questionnaires (MFQ) and compared to a population sample with MFQ data (n = 1460). Within both samples, child‐ and parent‐reported depression symptoms were compared.

Results

Although the profile of depression symptoms was similar between young people with ADHD and those in the general population, depression symptoms were much more common in the ADHD sample (parent‐rated MFQ score = 24.52 vs. 9.39; child‐rated = 21.02 vs. 11.86). The most common symptoms in both samples included irritability, restlessness and concentration difficulties, with core depression symptoms such as feeling miserable/unhappy also prominent. Within the ADHD sample, but not the population sample, children reported depression symptoms less frequently than their parents.

Conclusions

Young people with ADHD are at high risk of experiencing symptoms of depression but may under‐report the severity of their symptoms. Obtaining parent reports of depression symptoms in this group may be important to avoid missing key indicators of risk.     

Raytracing Modelling of Infrared Light Management Using Molybdenum Disulfide (MoS2) as a Back-Reflector Layer in a Silicon Heterojunction Solar Cell (SHJ)

The silicon heterojunction solar cell (SHJ) is considered the dominant state-of-the-art silicon solar cell technology due to its excellent passivation quality and high efficiency. However, SHJ’s light management performance is limited by its narrow optical absorption in long-wave near-infrared (NIR) due to the front, and back tin-doped indium oxide (ITO) layer’s free carrier absorption and reflection losses. Despite the light-trapping efficiency (LTE) schemes adopted by SHJ in terms of back surface texturing, the previous investigations highlighted the ITO layer as a reason for an essential long-wavelength light loss mechanism in SHJ solar cells. In this study, we propose the use of Molybdenum disulfide (MoS₂) as a way of improving back-reflection in SHJ. The text presents simulations of the optical response in the backside of the SHJ applying the Monte-Carlo raytracing method with a web-based Sunsolve high-precision raytracing tool. The solar cells’ electrical parameters were also resolved using the standard electrical equivalent circuit model provided by Sunsolve. The proposed structure geometry slightly improved the SHJ cell optical current density by ~0.37% (rel.), and hence efficiency (η) by about 0.4% (rel.). The SHJ cell efficiency improved by 21.68% after applying thinner back ITO of about 30 nm overlayed on ~1 nm MoS₂. The efficiency improvement following the application of MoS₂ is tentatively attributed to the increased NIR absorption in the silicon bulk due to the light constructive interface with the backside components, namely silver (Ag) and ITO. Study outcomes showed that improved SHJ efficiency could be further optimized by addressing front cell components, mainly front ITO and MoS₂ contact engineering.